heroin and Substance-Related-Disorders

Illicit drug use/misuse among older adults is understudied, although current trends point to older adults being the fastest-growing segment in the United States and other developed countries. There is a need for further insight into drug use patterns in older adults, who face their own set of socioeconomic, medical, and psychiatric problems. We reviewed the literature for data related to use/misuse of heroin and stimulants (cocaine, amphetamines, and methamphetamines) among people over the age of 40 years. We focused on prevalence rates of use/misuse of these substances, comorbidities, diagnostic challenges, screening tools, and treatment recommendations specific to the geriatric population.

Topics: Aged; Heroin; Humans; Illicit Drugs; Prevalence; Substance-Related Disorders; United States

A mounting body of evidence suggests that polysubstance use (PSU) is common among people who use opioids (PWUO). Measuring PSU, however, is statistically and methodologically challenging. Person-centered analytical approaches (e.g., latent class analysis) provide a holistic understanding of individuals' substance use patterns and help understand PSU heterogeneities among PWUO and their specific needs in an inductive manner. We reviewed person-centered studies that characterized latent patterns of PSU among PWUO.. We searched MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar from inception, through to June 15, 2020, for empirical peer-reviewed studies or gray literature that reported on latent classes of PSU among PWUO. Two independent reviewers completed the title, abstract, full-text screening, and data extraction. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale, and quality of reporting was evaluated using the Guidelines for Reporting on Latent Trajectory Studies checklist. Studies' findings were summarized and presented in a narrative fashion.. Out of the 3372 initial unique studies identified, 30 were included. PSU operationalization varied substantially among the studies. We identified five distinct PSU latent classes frequently observed across the studies: Infrequent/low PSU, PSU primarily involving heroin use, PSU primarily involving heroin and stimulant use, PSU primarily involving stimulant use, and frequent PSU. Belonging to higher frequency or severity PSU classes were associated with frequent injection drug use, sharing needles and paraphernalia, high-risk sexual behaviours, as well as experiences of adversities, such as homelessness, incarceration, and poor mental health.. PSU patterns vary significantly across different subgroups of PWUO. The substantial heterogeneities among PWUO need to be acknowledged in substance use clinical practices and policy developments. Findings call for comprehensive interventions that recognize these within-group diversities and address the varying needs of PWUO.

Topics: Analgesics, Opioid; Central Nervous System Stimulants; Heroin; Humans; Substance-Related Disorders

Dihydrocodeine (DHC) is considered a 'weak' opioid, but there is evidence of its increasing misuse in overdose deaths. This research aims to analyse trends in DHC-related deaths in England relevant to source and dose of DHC, and decedent demographics.. Cases from England reported to the National Programme on Substance Abuse Deaths (NPSAD) where DHC was identified at post-mortem and/or implicated in death between 2001 and 2020 were extracted for analysis.. 2071 DHC-related deaths were identified. The greatest number of deaths involved illicitly obtained DHC and a significant increase in these deaths was recorded over time (r = 0.5, p = 0.03). However, there was a concurrent decline in the implication rate of DHC in causing death (r = -0.6, p < 0.01). Fatalities were primarily due to accidental overdose (64.8%) and misuse was highly prevalent in combination with additional central nervous system depressants (95.3%), namely illicit heroin/morphine and diazepam. In contrast, when DHC was obtained over-the-counter (OTC) suicide mortality accounted for almost half of the deaths (42.5%). Differences in polysubstance use were also identified, with less heroin/morphine and benzodiazepine co-detection, but increased OTC codeine co-detection.. DHC misuse in England is increasing. The pharmacological consideration of DHC as a 'weak' opioid may be misinterpreted by users, leading to accidental overdosing. There is an urgent need to understand increasing polypharmacy in overdose deaths. Additionally, suicides involving DHC is a potential cause for concern and a review of OTC opioid-paracetamol preparations is necessary to determine whether the benefits of these medications continue to outweigh the risks of intentional overdose.

Topics: Analgesics, Opioid; Codeine; Drug Overdose; England; Heroin; Humans; Morphine; Substance-Related Disorders; Suicide

Drug addiction is a chronic relapsing disorder, as more than 80% of former drug users relapse within a year after quit attempts have ended. This review examines incubated craving that develops over long periods of weeks to months after addictive drug use ends, when rats are given a small priming exposure to the formerly used drug, and a large amount of drug seeking occurs, reflecting large increases in craving over time. Expanded craving occurs when not only the recently-used drug, but other related or unrelated drugs of abuse elicit drug seeking that leads to relapse behavior, including common drugs like caffeine or nicotine, Thus, expanded craving is an increase in the conditions that elicit relapse, such as, a variety of drugs, and it persists weeks after drug use ends. Incubated and expanded craving occur with several drugs of abuse, and these forms of craving, can last for weeks to months and end in relapse. Voluntary physical exercise, blocked incubated cocaine craving, and expanded heroin craving elicited by multiple conditions was reduced in female and male rats. This review examines voluntary physical exercise as a long-term, self-initiated, and self-sustainable treatment that reduces long-term drug craving leading to relapse.

Topics: Animals; Behavior, Addictive; Cocaine; Craving; Drug-Seeking Behavior; Exercise Therapy; Female; Heroin; Humans; Male; Methamphetamine; Models, Animal; Physical Conditioning, Animal; Rats; Recurrence; Self Administration; Substance-Related Disorders

To summarize evidence on the frequency and predictors of health-care utilization among people who use illicit drugs.. Systematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting health-care utilization published between 1 January 2000 and 3 December 2018. We conducted narrative synthesis and meta-analysis following a registered protocol (identifier: CRD42017076525).. People who use heroin, powder cocaine, crack cocaine, methamphetamine, amphetamine, ecstasy/3,4-methyl​enedioxy​methamphetamine (MDMA), cannabis, hallucinogens or novel psychoactive substances; have a diagnosis of 'substance use disorder'; or use drug treatment services.. Primary outcomes were the cumulative incidence (risk) and rate of care episodes in three settings: primary care, hospital admissions (in-patient) and emergency department (ED).. Ninety-two studies were included, 84% from North America and Australia. Most studies focused on people using heroin, methamphetamine or crack cocaine, or who had a diagnosis of drug dependence. We were able to conduct a meta-analysis of rates across 25 studies reporting ED episodes and 25 reporting hospital admissions, finding pooled rates of 151 [95% confidence interval (CI) = 114-201] and 41 (95% CI = 30-57) per 100 person-years, respectively; on average 4.8 and 7.1 times more often than the general population. Heterogeneity was very high and was not explained by drugs used, country of study, recruitment setting or demographic characteristics. Predictors of health-care utilization were consistent across studies and included unstable housing, drug injection and mental health problems. Opioid substitution therapy was consistently associated with reduced ED presentation and hospital admission. There was minimal research on health-care utilization by people using ecstasy/MDMA, powder cocaine, hallucinogens or novel psychoactive substances.. People who use illicit drugs are admitted to emergency department or hospital several times more often than the general population.

Topics: Adult; Amphetamines; Australia; Crack Cocaine; Drug Users; Emergency Service, Hospital; Female; Heroin; Hospitalization; Humans; Illicit Drugs; Male; North America; Patient Acceptance of Health Care; Substance-Related Disorders

The prevalence of drug use during pregnancy continues to increase despite the associated serious adverse obstetrical outcomes, including increased risk of miscarriage, fetal growth restriction, brain development impairment, neonatal abstinence syndrome, preterm delivery, and stillbirths. Monitoring drug use during pregnancy is crucial to limit prenatal exposure and provide suitable obstetrical health care. The authors reviewed published literature reporting the concentrations of common drugs of abuse and new psychoactive substances (NPS), such as synthetic cathinones and synthetic opioids, NPS, and their metabolites using unconventional matrices to identify drug use during pregnancy and improve data interpretation.. A literature search was performed from 2010 to July 2019 using PubMed, Scopus, Web of Science scientific databases, and reports from international institutions to review recently published articles on heroin, cocaine, amphetamine, methamphetamine, synthetic cathinone, and synthetic opioid monitoring during pregnancy.. Meconium has been tested for decades to document prenatal exposure to drugs, but data regarding drug concentrations in amniotic fluid, the placenta, the umbilical cord, and neonatal hair are still lacking. Data on prenatal exposure to NPS are limited.. Maternal hair testing is the most sensitive alternative matrix for identifying drug use during pregnancy, while drug concentrations in the meconium, placenta, and umbilical cord offer the identification of prenatal drug exposure at birth. Adverse developmental outcomes for the infant make it critical to promptly identify maternal drug use to limit fetal exposure or, if determined at birth, to provide resources to the exposed child and family. Alternative matrices offer choices for monitoring and challenge laboratories to deliver highly sensitive and specific analytical methods for detection.

Topics: Alkaloids; Amphetamines; Analgesics, Opioid; Cocaine; Drug Monitoring; Female; Hair; Heroin; Humans; Meconium; Placenta; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Substance-Related Disorders; Umbilical Cord

Sharp increases in opioid prescriptions, and associated increases in overdose deaths in the 2000s, evoked widespread calls to change perceptions of opioid analgesics. Medical literature discussions of opioid analgesics began emphasizing patient and public health hazards. Repetitive exposure to this information may influence physician assumptions. While highly consequential to patients with pain whose function and quality of life may benefit from opioid analgesics, current assumptions about prescription opioid analgesics, including their role in the ongoing opioid overdose epidemic, have not been scrutinized.. Information was obtained by searching PubMed, governmental agency websites, and conference proceedings.. Opioid analgesic prescribing and associated overdose deaths both peaked around 2011 and are in long-term decline; the sharp overdose increase recorded in 2014 was driven by illicit fentanyl and heroin. Nonmethadone prescription opioid analgesic deaths, in the absence of co-ingested benzodiazepines, alcohol, or other central nervous system/respiratory depressants, are infrequent. Within five years of initial prescription opioid misuse, 3.6% initiate heroin use. The United States consumes 80% of the world opioid supply, but opioid access is nonexistent for 80% and severely restricted for 4.1% of the global population.. Many current assumptions about opioid analgesics are ill-founded. Illicit fentanyl and heroin, not opioid prescribing, now fuel the current opioid overdose epidemic. National discussion has often neglected the potentially devastating effects of uncontrolled chronic pain. Opioid analgesic prescribing and related overdoses are in decline, at great cost to patients with pain who have benefited or may benefit from, but cannot access, opioid analgesic therapy.

Topics: Analgesics, Opioid; Drug Overdose; Fentanyl; Heroin; Humans; Opioid-Related Disorders; Prescription Drugs; Substance-Related Disorders

Since the 1990s, there have been seven clinical trials, and considerable clinical experience, in supervised injectable opioid treatment (SIOT) for individuals who, despite previous treatments, continue to inject illicit heroin and experience harmful health and social consequences. Most studies prescribed pharmaceutical heroin (diacetyl morphine, or DAM). This paper critically reviews randomised trials, long-term follow-up studies and qualitative reports of SIOT, and briefly reviews evidence regarding other medications used in injectable treatment as an alternative to DAM. It seeks to identify critical, unresolved issues regarding this treatment. Randomised trials comparing DAM with oral methadone (OM) report that while in treatment, participants randomised to DAM used less street heroin; reported spending less money on drugs, committed fewer crimes, and experienced improved health. Similar findings pertain to SIOT with hydromorphone. Because of the risks of overdose, diversion, and misuse, all recent trials of injected DAM involved supervised administration. This contributes to treatment being expensive to deliver. There is conflicting evidence regarding societal cost effectiveness, with some studies estimating that the reduction in crime more than compensates for the expense of the treatment. The critical, unresolved issues concerning this modality of treatment relate to the way in which it is approached-either as a medium-term, intensive intervention where other treatment has failed, designed to bring people into conventional opioid agonist treatment (OAT); or an indefinite support aimed at reducing social and personal harm. The former seems in line with the available findings on long-term effectiveness of SIOT and might be more acceptable given its rather moderate cost.

Topics: Analgesics, Opioid; Drug Overdose; Follow-Up Studies; Heroin; Humans; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders; Randomized Controlled Trials as Topic; Substance-Related Disorders; Treatment Outcome

A review of the evidence was conducted regarding asthma associated with the use of cocaine, heroin, and marijuana.. A search of the English literature was performed via PubMed/Medline and EMBASE using the search terms asthma AND cocaine, heroin, and marijuana. When pertinent articles were found, salient references in those articles were assessed.. Due to the relatively small number of studies, we included all studies and cases.. For several decades, case reports, retrospective studies, and laboratory investigations have demonstrated that inhalation of cocaine or heroin is associated with increased asthma symptoms and reduced pulmonary function. Smoking crack cocaine, nasal insufflation of cocaine or heroin, and smoking heroin increases the risk of emergency department visits and hospitalizations for asthma. Although frequent smoking of marijuana may cause symptoms of cough, sputum production, and wheezing in the general population, more studies are needed specifically in patients with asthma. Smoking marijuana with concomitant tobacco use is common and further worsens the respiratory symptoms.. Use of cocaine and heroin in patients with asthma should be avoided. Pending further studies, it would be prudent for patients with asthma to avoid smoking marijuana. Clinicians need to be vigilant regarding use of these drugs in their patients with hyperreactive airway disease.

Topics: Administration, Inhalation; Asthma; Cannabis; Cocaine-Related Disorders; Crack Cocaine; Heroin; Heroin Dependence; Humans; Marijuana Abuse; Marijuana Smoking; Respiratory Function Tests; Respiratory Sounds; Retrospective Studies; Substance-Related Disorders

The recreational use of illicit drugs remains an enormous and growing problem throughout the United States of America and around the world. Cocaine is most frequently thought of when considering the cardiovascular toxicity of illicit drugs. The association of cocaine use with sudden death due to myocardial ischaemia and infarction is well recognised, and this risk appears to be amplified by concomitant cigarette smoking and alcohol consumption. Like cocaine, amphetamine and its derivatives lead to indirect stimulation of the autonomic nervous system through the release of norepinephrine, dopamine, and serotonin in nerve terminals of the central and autonomic nervous systems. However, amphetamine lacks the ion channel-blocking properties of cocaine. Also similar to cocaine, coronary artery spasm may be induced in individuals with or without atherosclerotic disease and may lead to myocardial infarction. With the movement across the United States of America to legalise marijuana, or cannabis, for medicinal and recreational purposes, it is important to consider its potential deleterious effects. Marijuana has long been thought to have very few adverse effects with the exception of long-term dependence. There are, however, scattered reports of acute adverse events up to and including sudden death. These appear to be due to myocardial infarction. In conclusion, the incidence of sudden death associated with the use of these drugs varies from rare in the case of marijuana use to not infrequent with some drugs such as cocaine. It is important for care providers to recognise the potential for drug abuse when caring for a sudden cardiac arrest survivor.

Topics: Adolescent; Alcohol Drinking; Amphetamines; Cannabis; Cocaine; Death, Sudden, Cardiac; Heroin; Humans; Illicit Drugs; Myocardial Infarction; Smoking; Substance-Related Disorders

Opioid abuse in humans is characterized by discontinuous periods of drug use and abstinence. With time, the probability of falling into renewed drug consumption becomes particularly high and constitutes a considerable problem in the management of heroin addicts. The major problem in the treatment of opioid dependence still remains the occurrence of relapse, to which stressful life events, renewed use of heroin, and exposure to drug-associated environmental cues are all positively correlated. To study the neurobiology of relapse, many research groups currently use the reinstatement animal model, which greatly contributed to disentangle the mechanisms underlying relapse to drug-seeking in laboratory animals. The use of this model is becoming increasingly popular worldwide, and new versions have been recently developed to better appreciate the differential contribution of each opioid receptor subtype to the relapse phenomenon. In this chapter we review the state of the art of our knowledge on the specific role of the opioid receptors as unrevealed by the reinstatement animal model of opioid-seeking behavior.

Topics: Analgesics, Opioid; Animals; Behavior, Addictive; Disease Models, Animal; Heroin; Humans; Opioid-Related Disorders; Receptors, Opioid; Substance-Related Disorders

The review represents one in a family of four reviews focusing on a range of different interventions for drug-using offenders. This specific review considers pharmacological interventions aimed at reducing drug use or criminal activity, or both, for illicit drug-using offenders.. To assess the effectiveness of pharmacological interventions for drug-using offenders in reducing criminal activity or drug use, or both.. We searched Fourteen electronic bibliographic databases up to May 2014 and five additional Web resources (between 2004 and November 2011). We contacted experts in the field for further information.. We included randomised controlled trials assessing the efficacy of any pharmacological intervention a component of which is designed to reduce, eliminate or prevent relapse of drug use or criminal activity, or both, in drug-using offenders. We also report data on the cost and cost-effectiveness of interventions.. We used standard methodological procedures as expected by Cochrane.. Fourteen trials with 2647 participants met the inclusion criteria. The interventions included in this review report on agonistic pharmacological interventions (buprenorphine, methadone and naltrexone) compared to no intervention, other non-pharmacological treatments (e.g. counselling) and other pharmacological drugs. The methodological trial quality was poorly described, and most studies were rated as 'unclear' by the reviewers. The biggest threats to risk of bias were generated through blinding (performance and detection bias) and incomplete outcome data (attrition bias). Studies could not be combined all together because the comparisons were too different. Only subgroup analysis for type of pharmacological treatment were done. When compared to non-pharmacological, we found low quality evidence that agonist treatments are not effective in reducing drug use or criminal activity, objective results (biological) (two studies, 237 participants (RR 0.72 (95% CI 0.51 to 1.00); subjective (self-report), (three studies, 317 participants (RR 0.61 95% CI 0.31 to 1.18); self-report drug use (three studies, 510 participants (SMD: -0.62 (95% CI -0.85 to -0.39). We found low quality of evidence that antagonist treatment was not effective in reducing drug use (one study, 63 participants (RR 0.69, 95% CI 0.28 to 1.70) but we found moderate quality of evidence that they significantly reduced criminal activity (two studies, 114 participants, (RR 0.40, 95% CI 0.21 to 0.74).Findings on the effects of individual pharmacological interventions on drug use and criminal activity showed mixed results. In the comparison of methadone to buprenorphine, diamorphine and naltrexone, no significant differences were displayed for either treatment for self report dichotomous drug use (two studies, 370 participants (RR 1.04, 95% CI 0.69 to 1.55), continuous measures of drug use (one study, 81 participants, (mean difference (MD) 0.70, 95% CI -5.33 to 6.73); or criminal activity (one study, 116 participants, (RR 1.25, 95% CI 0.83 to 1.88) between methadone and buprenorphine. Similar results were found for comparisons with diamorphine with no significant differences between the drugs for self report dichotomous drug use for arrest (one study, 825 participants, (RR 1.25, 95% CI 1.03 to 1.51) or naltrexone for dichotomous measures of reincarceration (one study, 44 participants, (RR 1.10, 95% CI 0.37 to 3.26), and continuous outcome measure of crime, (MD -0.50, 95% CI -8.04 to 7.04) or self repor. When compared to non-pharmacological treatment, agonist treatments did not seem effective in reducing drug use or criminal activity. Antagonist treatments were not effective in reducing drug use but significantly reduced criminal activity. When comparing the drugs to one another we found no significant differences between the drug comparisons (methadone versus buprenorphine, diamorphine and naltrexone) on any of the outcome measures. Caution should be taken when interpreting these findings, as the conclusions are based on a small number of trials, and generalisation of these study findings should be limited mainly to male adult offenders. Additionally, many studies were rated at high risk of bias.

Topics: Adult; Buprenorphine; Crime; Criminals; Female; Heroin; Humans; Male; Methadone; Naltrexone; Narcotics; Opiate Substitution Treatment; Randomized Controlled Trials as Topic; Substance-Related Disorders

Immunotherapy has a great potential of becoming a new therapeutic strategy in the treatment of addiction to psychoactive drugs. It may be used to treat addiction but also to prevent neurotoxic complications of drug overdose. In preclinical studies two immunological methods have been tested; active immunization, which relies on the administration of vaccines and passive immunization, which relies on the administration of monoclonal antibodies. Until now researchers have succeeded in developing vaccines and/or antibodies against addiction to heroin, cocaine, methamphetamine, nicotine and phencyclidine. Their effectiveness has been confirmed in preclinical studies. At present, clinical studies are being conducted for vaccines against nicotine and cocaine and also anti-methamphetamine monoclonal antibody. These preclinical and clinical studies suggest that immunotherapy may be useful in the treatment of addiction and drug overdose. However, there are a few problems to be solved. One of them is controlling the level of antibodies due to variability between subjects. But even obtaining a suitable antibody titer does not guarantee the effectiveness of the vaccine. Additionally, there is a risk of intentional or unintentional overdose. As vaccines prevent passing of drugs through the blood/brain barrier and thereby prevent their positive reinforcement, some addicted patients may erroneously seek higher doses of psychoactive substances to get "high". Consequently, vaccination should be targeted at persons who have a strong motivation to free themselves from drug dependency. It seems that immunotherapy may be an opportunity for effective treatment of drug addiction if directed to adequate candidates for treatment. For other addicts, immunotherapy may be a very important element supporting psycho- and pharmacotherapy.

Topics: Antibodies, Monoclonal; Clinical Trials as Topic; Cocaine; Female; Heroin; Humans; Immunization, Passive; Immunotherapy; Male; Nicotine; Substance-Related Disorders; Treatment Outcome; Vaccination

A majority of studies have shown a link between the common functional rs6265 polymorphism of the BDNF gene and susceptibility to drug dependence. However, the pattern of results is inconsistent. To precisely evaluate this association, a systematic review and meta-analysis of previous case-control reports was conducted. Data from 20 studies containing 9419 participants (4665 cases and 4754 controls) conducted between 2004 and 2013 restricted to alcohol, nicotine, heroin, substance and methamphetamine dependency were meta-analyzed. Following quality control of the results, a significant association between C allele and methamphetamine dependence remained in south Asian subjects (p = 0.004). Similar results were detected in south Asian subjects for methamphetamine dependence and in Chinese subjects for heroin dependence under an autosomal codominant genotype model (TT vs CC, p = 0.005 and p = 0.0004, respectively). In conclusion, the rs6265 polymorphism may be a risk factor for methamphetamine dependence in south Asian subjects or for heroin dependence in Chinese subjects.

Topics: Alcohols; Asian People; Brain-Derived Neurotrophic Factor; Genetic Predisposition to Disease; Genotype; Heroin; Heroin Dependence; Humans; Methamphetamine; Polymorphism, Genetic; Substance-Related Disorders

The review represents one in a family of four reviews focusing on a range of different interventions for drug-using offenders. This specific review considers pharmacological interventions aimed at reducing drug use and/or criminal activity for illicit drug-using offenders.. To assess the effectiveness of pharmacological interventions for drug-using offenders in reducing criminal activity and/or drug use.. Fourteen electronic bibliographic databases (searched between 2004 and 21 March 2013) and five additional Web resources (searched between 2004 and 11 November 2011) were searched. Experts in the field were contacted for further information.. Randomised controlled trials assessing the efficacy of any pharmacological interventions for reducing, eliminating or preventing relapse in drug-using offenders were included. Data on the cost and cost-effectiveness of interventions were reported.. We used standard methodological procedures as expected by The Cochrane Collaboration.. A total of 76 trials across the four reviews were identified. After a process of prescreening had been completed, 17 trials were judged to meet the inclusion criteria for this specific review (six of the 17 trials are awaiting classification for the review). The remaining 11 trials contained a total of 2,678 participants. Nine of the eleven studies used samples with a majority of men. The interventions (buprenorphine, methadone and naltrexone) were compared to non pharmacological treatments (e.g., counselling) and other pharmacological drugs. The methodological trial quality was poorly described, and most studies were rated as 'unclear' by the reviewers. The biggest threats to risk of bias were generated through blinding (performance and detection bias) and incomplete outcome data (attrition bias). When combined, the results suggest that pharmacological interventions do significantly reduce subsequent drug use using biological measures, (three studies, 300 participants, RR 0.71 (95% CI 0.52 to 0.97)), self report dichotomous data (three studies, 317 participants, RR 0.42, (95% CI 0.22 to 0.81)) and continuous measures (one study, MD -59.66 (95% CI -120.60 to 1.28)) . In the subgroups analysis for community setting, (two studies, 99 participants: RR 0.62 (95% CI 0.35 to 1.09)) and for secure establishment setting, (one study, 201 participants: RR 0.76 (95% CI 0.52 to 1.10)), the results are no longer statistically significant. Criminal activity was significantly reduced favouring the dichotomous measures of re arrest, (one study, 62 participants, RR 0.60 (95% CI 0.32 to 1.14)), re-incarceration, (three studies, 142 participants, RR 0.33 (95% CI 0.19 to 0.56)) and continuous measures (one study, 51 participants, MD -74.21 (95% CI -133.53 to -14.89)). Findings on the effects of individual pharmacological interventions on drug use and criminal activity show mixed results. Buprenorphine in comparison to a non pharmacological treatment seemed to favour buprenorphine but not significantly with self report drug use, (one study, 36 participants, RR 0.58 (95% CI 0.25 to 1.35)). Methadone and cognitive behavioural skills in comparison to standard psychiatric services, did show a significant reduction for self report dichotomous drug use (one study, 253 participants, RR 0.43 (95% CI 0.33 to 0.56)) but not for self report continuous data (one study 51 participants) MD -0.52 (95% CI -1.09 to 0.05)), or re incarceration RR 1.23 (95% CI 0.53 to 2.87)). Naltrexone was fav. Pharmacological interventions for drug-using offenders do appear to reduce overall subsequent drug use and criminal activity (but to a lesser extent). No statistically significant differences were displayed by treatment setting. Individual differences are displayed between the three pharmacological interventions (buprenorphine, methadone and naltrexone) when compared to a non pharmacological intervention, but not when compared to each other. Caution should be taken when interpreting these findings, as the conclusions are based on a small number of trials, and generalisation of these study findings should be limited mainly to male adult offenders. Additionally, many studies were rated at high risk of bias because trial information was inadequately described.

Topics: Adult; Buprenorphine; Criminals; Female; Heroin; Humans; Male; Methadone; Naltrexone; Narcotics; Randomized Controlled Trials as Topic; Substance-Related Disorders

Recognition that use and abuse of substances by pregnant patients perpetuates, despite ongoing efforts to educate the public, necessitates clinicians to integrate understanding of potential effects on antepartum and intrapartum fetal testing into their interpretation and implementation of clinical findings. This includes acknowledging some anticipated alterations in results and selecting the appropriate type and frequency of testing methods and interventions. Certain substances are well documented in terms of expected variations in test results; others are not as clearly defined. An overview of information that may be helpful to the clinician is presented to promote understanding of fetal evaluation performed through common tests such as contraction stress test, the nonstress test, the biophysical profile, the modified biophysical profile, fetal movement counting, and Doppler velocimetry. What evidence is available should be used to assist in defining the actual status of the fetus as best as possible, even when the effects of substances may be unknown or have obscure results.

Topics: Alcohol Drinking; Biophysical Phenomena; Blood Flow Velocity; Cocaine; Female; Fetal Movement; Heart Rate, Fetal; Heroin; Humans; Methadone; Narcotics; Pregnancy; Pregnancy Complications; Smoking; Substance-Related Disorders; Umbilical Arteries

Breastfeeding is the recommended feeding method for infants. The decision to allow women to breastfeed while consuming alcohol and other drugs postpartum presents a problem for the health care provider. This article discusses the biochemical properties of various drugs as they relate to breastfeeding. Women in a methadone treatment program should be allowed to breast feed; however, more research is needed to determine the efficacy of breastfeeding when women are receiving buprenorphine. Breastfeeding should not be recommended in women who abuse heroin recreationally until more information is known about the actual amount of morphine present in the breast milk.

Topics: Breast Feeding; Buprenorphine; Cocaine; Contraindications; Dronabinol; Ethanol; Female; Heroin; Humans; Infant; Lactation; Methadone; Milk, Human; Substance-Related Disorders

Drug addiction continues to be a serious medical and social problem. Vulnerability to develop an addiction to drugs is dependent on genetic, environmental, social and biological factors. In particular, the interactions of environmental and genetic factors indicate the significance of epigenetic mechanisms, which have been found to occur in response to illicit drug use or as underlying factors in chronic substance abuse and relapse. Epigenetics is defined as the heritable and possibly reversible modifications in gene expression that do not involve alterations in the DNA sequence. This review discusses the various types of epigenetic modifications and their relevance to drug addiction to elucidate whether epigenetics is a predisposing factor, or a response to, developing an addiction to drugs of abuse.

Topics: Behavior, Addictive; Chromatin Assembly and Disassembly; Cocaine; DNA Methylation; Epigenesis, Genetic; Genetic Predisposition to Disease; Heroin; Humans; Receptors, Opioid, mu; Serotonin Plasma Membrane Transport Proteins; Substance-Related Disorders

This manuscript provides an overview of the current scientific literature on the impact of maternal drug use, specifically opioids and cocaine, during pregnancy on the acute and long-term outcomes of infants and toddlers from birth through age 3 years. Emphasis with regard to opioids is placed on heroin and opioid substitutes used to treat opioid addiction, including methadone, which has long been regarded as the standard of care in pregnancy, and buprenorphine, which is increasingly being investigated and prescribed as an alternative to methadone. Controlled studies comparing methadone at high and low doses, as well as those comparing methadone with buprenorphine, are highlighted and the diagnosis and management of neonatal abstinence syndrome is discussed. Over the past two decades, attention of the scientific and lay communities has also been focused on the potential adverse effects of cocaine and crack cocaine, especially during the height of the cocaine epidemic in the United States. Herein, the findings are summarized from prospective studies comparing cocaine-exposed with non-cocaine-exposed infants and toddlers with respect to anthropometric growth, infant neurobehavior, visual and auditory function, and cognitive, motor, and language development. The potentially stigmatizing label of the so-called "crack baby" preceded the evidence now accumulating from well-designed prospective investigations that have revealed less severe sequelae in the majority of prenatally exposed infants than originally anticipated. In contrast to opioids, which may produce neonatal abstinence syndrome and infant neurobehavioral deficits, prenatal cocaine exposure appears to be associated with what has been described as statistically significant but subtle decrements in neurobehavioral, cognitive, and language function, especially when viewed in the context of other exposures and the caregiving environment which may mediate or moderate the effects. Whether these early findings may herald more significant learning and behavioral problems during school-age and adolescence when the child is inevitably confronted with increasing social and academic challenges is the subject of ongoing longitudinal research.

Topics: Buprenorphine; Child Development; Child, Preschool; Cocaine; Cocaine-Related Disorders; Female; Heroin; Humans; Infant; Infant, Newborn; Male; Methadone; Neonatal Abstinence Syndrome; Pregnancy; Prenatal Exposure Delayed Effects; Substance-Related Disorders

The transition from prison back into the community is particularly hazardous for drug-using offenders whose tolerance for heroin has been reduced by imprisonment. Studies have indicated an increased risk of drug-related death soon after release from prison, particularly in the first 2 weeks. For precise, up-to-date understanding of these risks, a meta-analysis was conducted on the risk of drug-related death in weeks 1 + 2 and 3 + 4 compared with later 2-week periods in the first 12 weeks after release from prison.. English-language studies were identified that followed up adult prisoners for mortality from time of index release for at least 12 weeks. Six studies from six prison systems met the inclusion criteria and relevant data were extracted independently.. These studies contributed a total of 69 093 person-years and 1033 deaths in the first 12 weeks after release, of which 612 were drug-related. A three- to eightfold increased risk of drug-related death was found when comparing weeks 1 + 2 with weeks 3-12, with notable heterogeneity between countries: United Kingdom, 7.5 (95% CI: 5.7-9.9); Australia, 4.0 (95% CI: 3.4-4.8); Washington State, USA, 8.4 (95% CI: 5.0-14.2) and New Mexico State, USA, 3.1 (95% CI: 1.3-7.1). Comparing weeks 3 + 4 with weeks 5-12, the pooled relative risk was: 1.7 (95% CI: 1.3-2.2).. These findings confirm that there is an increased risk of drug-related death during the first 2 weeks after release from prison and that the risk remains elevated up to at least the fourth week.

Topics: Adolescent; Adult; Analgesics, Opioid; Australia; Cross-Cultural Comparison; Databases, Bibliographic; Deinstitutionalization; Drug Overdose; Female; Heroin; Humans; Male; Prisoners; Prisons; Records; Risk; Substance-Related Disorders; Time Factors; United Kingdom; United States

The importance of glutamate in the reinstatement of cocaine-seeking behavior has been established. New molecular and neurochemical adaptations in the glutamatergic system which drive cocaine relapse have been identified, such as the ability of CB1 receptor stimulation to reduce basal glutamate levels and the involvement of the GluR1 receptor subunit in reinstatement. Furthermore, it is apparent that similar glutamatergic neuroadaptations arise after self-administration of cocaine, heroin, nicotine, and alcohol. For example, reinstatement to cocaine, nicotine, and alcohol can be prevented both by the stimulation of group II mGluR receptors and by the blockade of group I mGluR receptors. The similarities in the neurochemistry behind relapse to these varied drug classes indicate that drugs that target the glutamate system could be effective at treating relapse to multiple types of drugs.

Topics: Animals; Behavior, Addictive; Brain; Cocaine; Ethanol; Glutamic Acid; Heroin; Humans; Nicotine; Receptors, Glutamate; Recurrence; Substance-Related Disorders; Synaptic Transmission

In humans, exposure to environmental contexts previously associated with drug intake often provokes relapse to drug use, but the mechanisms mediating this relapse are unknown. Based on early studies by Bouton & Bolles on context-induced 'renewal' of learned behaviours, we developed a procedure to study context-induced relapse to drug seeking. In this procedure, rats are first trained to self-administer drug in one context. Next, drug-reinforced lever responding is extinguished in a different (non-drug) context. Subsequently, context-induced reinstatement of drug seeking is assessed by re-exposing rats to the drug-associated context. Using variations of this procedure, we and others reported reliable context-induced reinstatement in rats with a history of heroin, cocaine, heroin-cocaine combination, alcohol and nicotine self-administration. Here, we first discuss potential psychological mechanisms of context-induced reinstatement, including excitatory and inhibitory Pavlovian conditioning, and occasion setting. We then summarize results from pharmacological and neuroanatomical studies on the role of several neurotransmitter systems (dopamine, glutamate, serotonin and opioids) and brain areas (ventral tegmental area, accumbens shell, dorsal striatum, basolateral amygdala, prefrontal cortex, dorsal hippocampus and lateral hypothalamus) in context-induced reinstatement. We conclude by discussing the clinical implications of rat studies on context-induced reinstatement of drug seeking.

Topics: Animals; Behavior, Addictive; Brain; Cocaine; Conditioning, Psychological; Ethanol; Extinction, Psychological; Heroin; Humans; Neurotransmitter Agents; Nicotine; Rats; Recurrence; Self Administration; Substance-Related Disorders

Topics: Cocaine; Heroin; Humans; Hypnotics and Sedatives; Methamphetamine; Skin Diseases; Skin Diseases, Infectious; Soft Tissue Infections; Substance Abuse Detection; Substance-Related Disorders

Screening for drug abuse should be a part of adolescent health maintenance visits. Good interviewing skills using open-ended, nonjudgmental questions in a private setting may elicit a history of drug abuse. A detailed and comprehensive history is important to recognize family dynamics, early behavioral changes (Table 5, see page 198), comorbid psychiatric conditions, and the adolescent's attitude toward substances of abuse. A good physical exam may reveal clinical sequelae of drug abuse. Testing for drug abuse should be done with the patient's consent except in cases where judgment is impaired. Periodic screening for drugs is a part of drug treatment and rehabilitation. The typical pediatrician is not equipped to provide drug counseling and treatment to the abusing adolescent. Specialized referral centers would be ideal, and clinicians need to be aware of local resources in their communities. Anticipatory guidance explaining the ill effects of drugs is mandatory. Prevention should be aimed at increasing public awareness of the consequences of drug abuse, improving parenting techniques, and introducing school-based drug prevention programs. The fight against substance abuse needs to be a community effort in which the individual, the family and the primary care physician play important roles.

Topics: Adolescent; Anabolic Agents; Cannabinoids; Central Nervous System Agents; Ethanol; Heroin; Humans; Illicit Drugs; Inhalation Exposure; Risk Factors; Smoking; Substance-Related Disorders; United States

This review summarizes the major metabolic pathways of the drugs of abuse, tetrahydrocannabinol, cocaine, heroin, morphine, and codeine, in humans including the involvement of isoenzymes. This knowledge may be important for predicting their possible interactions with other xenobiotics, understanding pharmaco-/toxicokinetic and pharmacogenetic variations, toxicological risk assessment, developing suitable toxicological analysis procedures, and finally for understanding certain pitfalls in drug testing. The detection times of these drugs and/or their metabolites in biological samples are summarized and the implications of the presented data on the possible interactions of drugs of abuse with other xenobiotics, ie, inhibition or induction of individual polymorphic and nonpolymorphic isoenzymes, discussed.

Topics: Cocaine; Codeine; Dronabinol; Heroin; Humans; Illicit Drugs; Isoenzymes; Morphine; Narcotics; Psychotropic Drugs; Substance-Related Disorders

Drug addiction is a chronic relapsing disorder characterized by compulsive drug intake, loss of control over intake, and impairment in social and occupational function. Animal models have been developed for various stages of the addiction cycle with a focus in our work on the motivational effects of drug dependence. A conceptual framework focused on allostatic changes in reward function that lead to excessive drug intake provides a heuristic framework with which to identify the neurobiologic mechanisms involved in the development of drug addiction. Neuropharmacologic studies in animal models have provided evidence for the dysregulation of specific neurochemical mechanisms in specific brain reward and stress circuits that provide the negative motivational state that drives addiction. The allostatic model integrates molecular, cellular and circuitry neuroadaptations in brain motivational systems produced by chronic drug ingestion with genetic vulnerability, and provides a new opportunity to translate advances in animal studies to the human condition.

Topics: Adaptation, Physiological; Animals; Behavior, Addictive; Brain; Cocaine; Dose-Response Relationship, Drug; Heroin; Narcotics; Neuroanatomy; Neuropharmacology; Reinforcement, Psychology; Substance-Related Disorders

Conducting toxicology on post-mortem specimens provides a number of very significant challenges to the scientist. The range of additional specimens include tissues such as decomposing blood and other tissues, hair, muscle, fat, lung, and even larvae feeding on the host require special techniques to isolate a foreign substance and allow detection without interference from the matrix. A number of drugs of abuse are unstable in the post-mortem environment that requires careful consideration when trying to interpret their significance. Heroin, morphine glucuronides, cocaine and the benzodiazepines are particularly prone to degradation. Moreover, redistributive process can significantly alter the concentration of drugs, particularly those with a higher tissue concentration than the surrounding blood. The designer amphetamines, methadone and other potent opioids will increase their concentration in blood post-mortem. These processes together with the development of tolerance means that no concentration of a drug of abuse can be interpreted in isolation without a thorough examination of the relevant circumstances and after the conduct of a post-mortem to eliminate or corroborate relevant factors that could impact on the drug concentration and the possible effect of a substance on the body. This article reviews particular toxicological issues associated with the more common drugs of abuse such as the amphetamines, cannabinoids, cocaine, opioids and the benzodiazepines.

Topics: Amphetamines; Analgesics, Opioid; Benzodiazepines; Cannabis; Cocaine; Dopamine Uptake Inhibitors; Forensic Medicine; Heroin; Humans; Postmortem Changes; Specimen Handling; Substance Abuse Detection; Substance-Related Disorders

Addiction is a relapsing brain disease with a tendency towards chronicity. Biological, psychological and socio-cultural factors play a role in the onset and course of this disease. The Health Council of the Netherlands has issued a report on pharmacotherapeutic interventions. The treatment of addiction should be regarded as a medical intervention. A growing number of effective pharmacotherapies are becoming available for the treatment of heroin addiction, although not all of those are available in the Netherlands. Currently, no effective pharmacotherapies are available for the treatment of cocaine addiction. In polydrug addicts, pharmacotherapeutic interventions should be directed at the various separate addictions. In the majority of cases pharmacotherapy is part of an integrated treatment approach in which supportive psychosocial interventions are also important. The long-term continuation of treatment is usually indicated. The Health Council recommends that addiction physicians be put in charge of the multidisciplinary treatment. Medical schools should pay attention to the practical aspects of the treatment and management of addicts. The organisation and workforce of addiction treatment services should comply with the demands that are placed upon healthcare services. Public information campaigns about addiction and the treatment options for addicts can contribute to the destigmatisation of this patient category.

Topics: Cocaine; Heroin; Humans; Netherlands; Practice Guidelines as Topic; Substance-Related Disorders

In certain populations around the world, the HIV pandemic is being driven by drug-abusing populations. Mounting evidence suggests that these patient populations have accelerated and more severe neurocognitive dysfunction compared with non-drug-abusing HIV-infected populations. Because most drugs of abuse are central nervous system stimulants, it stands to reason that these drugs may synergize with neurotoxic substances released during the course of HIV infection. Clinical and laboratory evidence suggests that the dopaminergic systems are most vulnerable to such combined neurotoxicity. Identifying common mechanisms of neuronal injury is critical to developing therapeutic strategies for drug-abusing HIV-infected populations. This article reviews 1) the current evidence for neurodegeneration in the setting of combined HIV infection and use of methamphetamine, cocaine, heroin or alcohol; 2) the proposed underlying mechanisms involved in this combined neurotoxicity; and 3) future directions for research. This article also suggests therapeutic approaches based on our current understanding of the neuropathogenesis of dementia due to HIV infection and drugs of abuse.

Topics: AIDS Dementia Complex; Animals; Dopamine; Dopamine Uptake Inhibitors; Gene Products, tat; Heroin; HIV Envelope Protein gp120; HIV-1; Humans; Narcotics; Neurons; Rats; Substance-Related Disorders; tat Gene Products, Human Immunodeficiency Virus

The article describes the development of drug-related problems in the context of the rapid sociopolitical and economic changes in the Czech Republic and the Slovak Republic. The period of the last decade is marked by an increase in drug use in both countries; 17% of adults in the Czech Republic and 12% of the Slovaks report lifetime drug use. The respective figures are even higher for the population of adolescents. According to the data from the ESPAD survey carried out in 1999, 35% of young Czechs and 19% of young Slovaks used marijuana. Metamphetamine is the most misused substance among problem drug users in the Czech Republic, and heroin dominates in Slovakia. The response of the society to social and health problems caused by drugs is discussed in the following areas: institutional differentiation, political coordination and legislative development. The need for further social research is stressed.

Topics: Adolescent; Crime; Czech Republic; Heroin; Hospitalization; Humans; Methamphetamine; Politics; Slovakia; Social Change; Socioeconomic Factors; Substance-Related Disorders

The most important task of clinical and experimental nephrology is to identify risk factors for progression of renal failure with the ultimate goal to counteract the dramatic increase of patients reaching end-stage renal disease. Recently, cigarette smoking has been recognized to be one of the most important remediable renal risk factors. The adverse renal effects of smoking seem to be independent of the underlying renal disease and the current evidence suggests a near doubling of the rate of progression in smokers vs. non-smokers. Cessation of smoking slows the rate of progression. Besides smoking, alcohol abuse has also been implicated as a renal risk factor. The present article reviews the current knowledge about the adverse renal effects of these legal drugs. Furthermore, the acute and chronic renal complications due to illegal recreational drugs is discussed. The impact of these drugs on the risk to reach end-stage renal failure is difficult to assess, which is mainly due to the fact that it is difficult to perform controlled prospective studies in substance abusers. According to estimates, 5-6% of new patients starting end-stage renal disease therapy may have opiate-use-related renal diseases in the USA--a figure which documents the magnitude of the problem. Thus, in any case of unexplained renal functional impairment substance abuse should be considered by the physician.

Topics: Acute Kidney Injury; Adolescent; Adult; Alcoholism; Amphetamines; Anti-Anxiety Agents; Benzodiazepines; Cocaine; Drug-Related Side Effects and Adverse Reactions; Hallucinogens; Heroin; Humans; Illicit Drugs; Kidney; Kidney Diseases; Kidney Failure, Chronic; Male; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Nephrotic Syndrome; Odds Ratio; Risk Factors; Smoking; Smoking Cessation; Substance-Related Disorders; Temazepam

Topics: Amphetamine; Cocaine; Diagnosis, Differential; Heroin; Humans; Methamphetamine; Prognosis; Rhabdomyolysis; Solvents; Substance-Related Disorders

Topics: Adolescent; Adult; Amphetamines; Cannabis; Cardiovascular Diseases; Child; Cocaine; Drug Overdose; Female; Hallucinogens; Heroin; Humans; Lysergic Acid Diethylamide; Male; Morphine; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Psilocybin; Substance-Related Disorders

Nociceptin/orphanin FQ (NC) binds with high affinity to the opioid receptor-like1 (ORL1) receptor. NC has been reported to block opioid-induced supraspinal analgesia, and it has been proposed that it may represent a functional antiopioid peptide in the control of brain nociceptive processes. The wide distribution of NC and of its receptors in the central nervous system suggests, however, that it may be involved in the control of a variety of biologic functions. Increasing evidence indicates that it may influence the rewarding and reinforcing properties of drugs of abuse. NC has been shown to abolish the rewarding properties of ethanol and morphine in the place conditioning paradigm, to reduce ethanol consumption in alcohol-preferring rats and to inhibit stress-induced alcohol-seeking behavior. These findings suggest that drugs directed at central NC receptors may represent an interesting approach to the treatment of ethanol and opiate abuse.

Topics: Alcohol Drinking; Analgesics, Opioid; Animals; Behavior; Brain; Dopamine; gamma-Aminobutyric Acid; Glutamic Acid; Heroin; Models, Biological; Morphine; Narcotic Antagonists; Narcotics; Neurotransmitter Agents; Nociceptin; Nociceptin Receptor; Opioid Peptides; Rats; Rats, Mutant Strains; Receptors, Opioid; Serotonin; Substance-Related Disorders; Time Factors; Vasodilator Agents

Topics: Adrenergic Uptake Inhibitors; Amphetamine; Cocaine; Diagnosis, Differential; Emergency Treatment; Germany; Heroin; Humans; Illicit Drugs; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Substance-Related Disorders

Topics: Amphetamines; Analgesics, Opioid; Anesthetics, Intravenous; Cocaine; Drug Overdose; Emergency Treatment; Heroin; Humans; Narcotics; Poisoning; Sodium Oxybate; Substance-Related Disorders

This article includes a summary and critique of methodological limitations of the peer-reviewed studies of developmental outcome during the first 2 years in children prenatally exposed to the most commonly used drugs of abuse: tobacco, alcohol, marijuana, heroin/methadone, and cocaine. Reported effects vary by specific drug or drug combinations and amount and timing of exposure; however, few thresholds have been established. Drug effects also appear to be exacerbated in children with multiple risks, including poverty, and nonoptimal caregiving environments. Although prenatal exposure to any one drug cannot reliably predict the outcome of an individual child, it may be a marker for an array of variables that can impact development. Appropriate intervention strategies require future research that determines which factors place exposed children at risk and which are protective for optimal development.

Topics: Alcoholism; Child Abuse; Child Development; Child, Preschool; Cocaine; Cocaine-Related Disorders; Ethanol; Female; Heroin; Heroin Dependence; Humans; Infant; Infant, Newborn; Marijuana Abuse; Methadone; Nicotine; Poverty; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Risk Factors; Smoking; Substance-Related Disorders

Levels of hardcore drug use have been especially difficult to estimate because of the relative rarity of the behavior, the difficulty of locating hardcore drug users, and the tendency to underreport stigmatized behavior. This chapter presents a new application of ratio estimation, combining sample data from the National Household Survey on Drug Abuse (NHSDA) together with population counts of the number of persons arrested in the past year from the Uniform Crime Report (UCR) and the number of persons in drug treatment programs in the past year from the National Drug and Alcoholism Treatment Unit Survey (NDATUS). The population counts serve as a benchmark accounting for undercoverage and underreporting of hard drug users.

Topics: Cocaine; Crime; Data Interpretation, Statistical; Health Surveys; Heroin; Humans; Odds Ratio; Substance-Related Disorders; United States

Topics: Adult; Amphetamines; Heroin; Humans; Kidney Diseases; Male; Narcotics; Psychotropic Drugs; Substance-Related Disorders

The increasing substance abuse causes serious medical problems in many countries. The perinatal effects of these substances are of obstetricians' interest. The frequency of drug usage during pregnancy ranges from 0.4% to 27% depending on the population. In Poland there is no data concerning drug usage. The aim of this review is to show the risk which results from drug usage during pregnancy, especially cocaine, heroine and marijuana.

Topics: Adult; Cannabis; Cocaine; Female; Heroin; Humans; Maternal-Fetal Exchange; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Risk Assessment; Substance-Related Disorders

There is currently a resurgence of interest in estimating numbers of illicit drug users in Australia. Defining why numbers are needed, who is to be counted and how estimates should be derived are vital steps in the production of useful, valid estimates. We present a range of estimates of heroin users in the Australian Capital Territory which were developed as part of an investigation of the feasibility of prescribing heroin to dependent users. These produced estimates ranging from 433 to 1251 users. We conclude that household surveys, capture-recapture, and multipliers derived from nomination techniques have serious and often unrecognised limitations. Capture-recapture estimates, in particular, are unlikely to be useful, except at a local level. The best way forward for the derivation of national estimates for the National Drug Strategy is a three-pronged approach; national surveys, validated multipliers and monitoring of key indicators by drug-related services and agencies.

Topics: Australia; Data Collection; Epidemiologic Methods; Heroin; Humans; Illicit Drugs; Models, Statistical; Reproducibility of Results; Substance-Related Disorders

Topics: Cannabis; Heroin; Humans; Substance-Related Disorders; United States; Veterans

Although substance use has been a worldwide problem at all levels of society since ancient times, recent attention has been focused on the use of legal and illegal substances by the pregnant woman. Almost all drugs taken by the pregnant woman are known to cross the placenta and have some effect on the fetus. This article reviews the effects of the drugs most frequently used by pregnant women in the United States--nicotine, alcohol, marijuana, opiates, and cocaine--on the fetus and neonate; when possible, information regarding long-term medical problems is included.

Topics: Cannabis; Child; Child, Preschool; Congenital Abnormalities; Developmental Disabilities; Female; Health Promotion; Heroin; Humans; Infant; Infant, Newborn; Male; Methadone; Pregnancy; Pregnancy Outcome; Prenatal Exposure Delayed Effects; Substance-Related Disorders; United States

Between 1972 and 1974, the outcomes of army enlisted men who had served in Vietnam during 1970-71 were evaluated and compared with that of a matched group. This paper reports the major findings of that study with respect to frequency of narcotic addiction in and after Vietnam, and the major risk factors for Vietnam addiction and later relapse. Extraordinary access to records facilitated drawing the sample, locating it, and verifying interview responses. The surprisingly low levels of readdiction and the rarity of addiction to narcotics alone as compared with poly-substance dependence are findings still not entirely incorporated into public and scientific views of heroin addiction. Some defenses against that incorporation are examined.

Topics: Adult; Behavior, Addictive; Heroin; Humans; Male; Middle Aged; Recurrence; Substance-Related Disorders; United States; Veterans; Vietnam; Warfare

Topics: Amphetamines; Cannabis; Cocaine; Europe; Heroin; Humans; Psychotropic Drugs; Spain; Substance-Related Disorders

Data on lifetime alcohol and heroin use by 443 White and Chicano addicts of both genders were obtained from a sample of admissions to several Southern California methadone maintenance programs. Patterns of alcohol and heroin use were examined with respect to gender and ethnic differences. Repeated-measures MANOVA established an inverse pattern of alcohol and heroin use for all four groups, confirming and extending the findings of a previous study by the authors. With this additional evidence, the authors propose a compensatory model that explains the obtained inverse pattern of alcohol and heroin use and that may be suitable in examining concurrent or sequential use of other psychoactive substances in addition to alcohol. Significantly higher levels of heavy alcohol use were reported by Chicano than by White addicts. Overall findings indicate that after heroin addiction occurs, there is a convergence in patterns of substance use by both genders, although variations related to ethnicity persist, particularly for alcohol use.

Topics: Adolescent; Adult; Alcoholism; Behavior, Addictive; Ethnicity; Female; Heroin; Hispanic or Latino; Humans; Longitudinal Studies; Male; Retrospective Studies; Sex Factors; Substance-Related Disorders; White People

Topics: Child; Child, Preschool; Cocaine; Developmental Disabilities; Ethanol; Female; Heroin; Humans; Infant; Infant, Newborn; Male; Maternal-Fetal Exchange; Pregnancy; Substance-Related Disorders

Urinalysis can be used as an objective criterion for monitoring the outcome of a treatment program or a clinical trial. Important factors to consider when implementing a drug testing program include standardization of assay technology and cutoffs between participating centers and selection of identical testing schedules. Also, it is vitally important to minimize the amount of safe time (time that drug use can go undetected) occurring in a testing schedule. The detection times for cocaine and heroin have been shown to vary with selection of cutoff and with the drug dose. Obviously, the selection of cutoffs is under program control, whereas the amount of illicit drug use is under subject control. Fortunately, changes in the illicit drug dose by the subject demonstrate a log-linear relationship to detection time. Hence, a higher drug dose by the subject only extends the detection time slightly (and improves the probability of detection) without greatly increasing the risks of drug carryover from one urine test to another. The most efficient testing schedule for judging the outcome of clinical trials for cocaine and heroin appears to be a 3-days-a-week schedule (Monday, Wednesday, Friday or Tuesday, Thursday, Saturday). When different schedules were challenged by simulating random times at which cocaine use might occur during the week, the 3-days-per-week schedule was the most efficient without the risk of carryover. The 3-days-per-week schedule also performed better than 1-day-per-week when multiple random drug use was simulated. Overall, the 3-days-per-week testing schedule with specified assay technology and cutoffs was the best compromise for maximizing detection of drug use, minimizing carryover, and providing a standardized methodology for outcome comparison between programs.

Topics: Clinical Trials as Topic; Cocaine; Data Interpretation, Statistical; Heroin; Heroin Dependence; Humans; Substance Abuse Detection; Substance-Related Disorders

Topics: Amphetamine; Animals; Cocaine; Heroin; Morphine; Neurotoxins; Prosencephalon; Self Administration; Substance-Related Disorders

Topics: Drug Overdose; Germany; Heroin; Humans; Inactivation, Metabolic; Legislation, Drug; Substance-Related Disorders

Topics: Antigens, CD; CD4-CD8 Ratio; Cocaine; Drug Interactions; Ethanol; Gene Expression Regulation; Heroin; Heroin Dependence; Humans; Immune System; Morphine; Rosette Formation; Substance-Related Disorders; T-Lymphocyte Subsets

Although emergency physicians treat many patients who use illegal drugs, little is known about the relative toxicities of the abused drug versus those that result from drug impurities and additives. Although case reports suggest significant contribution of contaminants to the morbidity and mortality of street drugs, most physicians' clinical experience and a comprehensive review of the clinical and forensic science literature demonstrate that impurities and additives play only a minor role in the majority of drug-related emergency department presentations. The strengths and weaknesses of several of the currently available drug abuse information data bases are reviewed, and qualitative information concerning the scope of contaminants that have been reported in preparations of cocaine, heroin, and phencyclidine is presented. More research is needed in this area, and a closer liaison between law enforcement, forensic scientists, and emergency physicians should be developed.

Topics: Cocaine; Databases, Bibliographic; Drug Contamination; Drug Information Services; Drug Overdose; Heroin; Humans; Illicit Drugs; Phencyclidine; Substance-Related Disorders

Use of addictive drugs, such as cocaine, marijuana, and nicotine, affects food and liquid intake behavior, taste preference, and body weight. Changes in specific nutrient status and metabolism can also develop; heroin addiction can cause hyperkalemia and morphine use can result in calcium inhibition. Nutrition-related physiological aspects, such as impaired gastrin release, hypercholesterolemia, hypothermia, and hyperthermia, are also seen with morphine use. Nutrition-related conditions can affect sensitivity to and dependence on drugs and their effects. Diabetes decreases sensitivity to and dependence on morphine, protein deprivation produces preferential fat utilization with low cocaine use, and vitamin D deficiency decelerates morphine dependency. During use and/or withdrawal from nicotine, heroin, marijuana, and cocaine, major changes in food selection and intake occur, which result in weight gain or loss. Detailed human studies are needed to investigate the effects of drug use on the broad spectrum of nutrients and to determine the role of nutrition during drug withdrawal.

Topics: Animals; Cannabis; Cocaine; Deficiency Diseases; Diet; Feeding Behavior; Heroin; Humans; Nicotine; Nutritional Status; Substance-Related Disorders

Topics: Animals; Cocaine; Heroin; Humans; Morphine; Narcotics; Nutrition Disorders; Nutritional Physiological Phenomena; Substance-Related Disorders

A review of the clinical characteristics of heroin addiction and parameters surrounding outpatient and inpatient care of patients afflicted with heroin dependency is presented. A case report demonstrating the difficulties encountered when one elects to treat the heroin addict is included.

Topics: Adult; Dental Care for Disabled; Hepatitis; Heroin; HIV Seropositivity; Humans; Injections, Intravenous; Male; Mouth; Sepsis; Substance-Related Disorders

Topics: Adult; Amphetamine; Cardiomyopathies; Cocaine; Drug Synergism; Electrocardiography; Female; Heroin; Humans; Male; Methylphenidate; Middle Aged; Substance-Related Disorders; Time Factors

Topics: Amphetamines; Barbiturates; Cannabis; Chromatography; Cocaine; Heroin; Humans; Lysergic Acid Diethylamide; Phencyclidine; Substance-Related Disorders

Topics: Abnormalities, Drug-Induced; Female; Fetal Alcohol Spectrum Disorders; Fetal Growth Retardation; Heroin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Methadone; Nasopharynx; Phencyclidine; Pregnancy; Pregnancy Complications; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Amphetamines; Barbiturates; Cannabis; Chromatography, Gas; Chromatography, High Pressure Liquid; Chromatography, Thin Layer; Cocaine; Heroin; Humans; Lysergic Acid Diethylamide; Pharmaceutical Preparations; Phencyclidine; Substance-Related Disorders

Topics: Adaptation, Physiological; Animals; Behavior, Animal; Drug Tolerance; Ethanol; Heroin; Humans; Morphine; Pituitary Hormones, Posterior; Self Administration; Substance-Related Disorders

Topics: Amphetamines; Analgesics, Opioid; Anti-Anxiety Agents; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Benzodiazepines; Chromatography, Gas; Chromatography, Liquid; Chromatography, Thin Layer; Cocaine; Codeine; Costs and Cost Analysis; Hallucinogens; Heroin; Humans; Hypnotics and Sedatives; Immunoassay; Mass Spectrometry; Narcotic Antagonists; Narcotics; Phenothiazines; Procaine; Quinine; Spectrometry, Fluorescence; Substance-Related Disorders; Terminology as Topic; Urine

Topics: Alcoholism; Ambulatory Care; Amphetamines; Aversive Therapy; Barbiturates; Cannabis; Follow-Up Studies; Hallucinogens; Heroin; Heroin Dependence; Humans; Legislation, Drug; Methadone; Smoking; Substance-Related Disorders; United Kingdom

Topics: Abnormalities, Drug-Induced; Animals; Cannabis; Chromosome Aberrations; Chromosome Disorders; Cytogenetics; Heroin; Humans; Lysergic Acid Diethylamide; Mutagens; Substance-Related Disorders

Topics: Abscess; Adult; Animals; Autopsy; Blindness; Brain Diseases; Cerebrovascular Disorders; Endocarditis; Haplorhini; Hepatitis A; Heroin; Heroin Dependence; Humans; Male; Muscular Diseases; Myelitis, Transverse; Nervous System Diseases; New York City; Peripheral Nervous System Diseases; Quinine; Substance-Related Disorders; Tetanus

Topics: Crime; Drug and Narcotic Control; Ethics, Medical; Government Agencies; Heroin; Heroin Dependence; Humans; Legislation, Drug; Politics; Public Opinion; Research; Substance Withdrawal Syndrome; Substance-Related Disorders; United Kingdom; United States

Topics: Adolescent; Adult; Antisocial Personality Disorder; Child; Child Development; Family; Father-Child Relations; Female; Group Processes; Heroin; Humans; Interpersonal Relations; Male; Marriage; Minority Groups; Morphine Dependence; Mother-Child Relations; Motivation; Personality Development; Psychological Theory; Social Behavior; Substance-Related Disorders; Urban Population

Topics: Altitude; Animals; Capillary Resistance; Cell Membrane Permeability; Dogs; Extracellular Space; Heroin; Humans; Infant; Lung; Lymphatic System; Mechanoreceptors; Microcirculation; Microscopy, Electron; Pulmonary Alveoli; Pulmonary Edema; Pulmonary Surfactants; Shock; Substance-Related Disorders; Water-Electrolyte Balance

Topics: Alcoholism; Amphetamine; Aversive Therapy; Barbiturates; Heroin; Humans; Lysergic Acid Diethylamide; Methadone; Morphine Dependence; Psychodrama; Psychotherapy; Psychotherapy, Group; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adolescent; Adult; Black or African American; Cannabis; Female; Heroin; Humans; Hypnotics and Sedatives; Lysergic Acid Diethylamide; Male; Middle Aged; Narcotics; Pentazocine; Sex Factors; Substance Withdrawal Syndrome; Substance-Related Disorders; Tranquilizing Agents; United States

Topics: Alkaloids; Analgesics; Animals; Drug Tolerance; Heroin; Humans; Models, Chemical; Morphinans; Narcotic Antagonists; Piperidines; Pyrrolidines; Structure-Activity Relationship; Substance-Related Disorders

Topics: Antidepressive Agents; Barbiturates; Brain Chemistry; Dreams; Heroin; Humans; Neurons; Protein Biosynthesis; Sleep, REM; Substance-Related Disorders; Time

Topics: Female; Halfway Houses; Heroin; Humans; Male; Methadone; Narcotic Antagonists; Psychotherapy, Group; Religion; Substance-Related Disorders

Topics: Adult; Aged; Blood Pressure; Body Temperature; Body Weight; Cardiovascular Diseases; Female; Gastrointestinal Diseases; Heroin; Humans; Liver Diseases; Lung Diseases; Lymphatic Diseases; Male; Middle Aged; Morphine Dependence; Pulse; Skin Diseases; Splenic Diseases; Substance-Related Disorders; Urologic Diseases

Topics: Adolescent; Adult; Endocarditis; Female; Hepatitis; Heroin; Humans; Lung Diseases; Male; Middle Aged; Substance-Related Disorders; Tetanus

Topics: Adolescent; Amphetamine; Amphetamines; Barbiturates; Cannabis; Codeine; Heroin; Humans; Hydromorphone; Jurisprudence; Meperidine; Mescaline; Methadone; Morphine Dependence; Nalorphine; Narcotic Antagonists; Psychotherapy; Statistics as Topic; Substance-Related Disorders

Topics: Analgesics; Analgesics, Non-Narcotic; Antipyretics; Biomedical Research; Codeine; Cyclazocine; Dextromoramide; Dextropropoxyphene; Heroin; Humans; Hydromorphone; Isonipecotic Acids; Meperidine; Methadone; Methotrimeprazine; Morphine; Nalorphine; Narcotic Antagonists; Oxymorphone; Pentazocine; Phenazocine; Substance-Related Disorders; Toxicology

Topics: Adolescent; Alcoholism; Amphetamine; Amphetamines; Barbiturates; Cannabis; Child; Epidemiology; Hallucinogens; Heroin; Humans; Inhalant Abuse; Personality; Smoking; Social Conditions; Substance-Related Disorders; Toxicology; United States

Illness models, including illness recognition, perceived severity, and perceived nature can affect treatment-seeking behaviors. Vignettes are a leading approach to examine models of illness but are understudied for substance use disorders (SUDs). We created vignettes for multiple common DSM-5 SUDs and assessed SUD illness models among college students.. Seven vignettes in which the protagonist meets DSM-5 diagnostic criteria for SUDs involving tobacco, alcohol, cannabis, Adderall, cocaine, Vicodin, and heroin were pilot tested and randomly assigned to 216 college students who completed measures related to illness recognition, perceived severity, and perceived nature. MANOVAs with Scheffe post-hoc tests were conducted to examine vignette group differences on models of illness.. Vignettes met acceptable levels of clarity and plausibility. Participants characterized the protagonist's substance use as a problem, a SUD, or an addiction most frequently with Vicodin, heroin, and cocaine and least frequently with tobacco and cannabis. Participants assigned to the Vicodin, heroin, and cocaine vignettes were the most likely to view the protagonist's situation as serious and life-threatening, whereas those assigned to the cannabis vignette were the least likely. Numerically more participants characterized the pattern of substance use as a problem (91%) or an addiction (90%) than a SUD (76%), while only 15% characterized it as a chronic medical condition.. Illness recognition and perceived severity varied across substances and were lowest for cannabis. Few participants conceptualized SUDs as chronic medical conditions. College students may benefit from psychoeducation regarding cannabis use disorder and the chronic medical condition model of SUDs.

Topics: Cannabis; Cocaine; Diagnostic and Statistical Manual of Mental Disorders; Heroin; Humans; Students; Substance-Related Disorders

We assessed the efficacy of pexacerfont, a CRF1 antagonist, for the treatment of withdrawal symptoms. In this randomized, double-blind, placebo-controlled clinical trial, male patients with amphetamine or opioid dependence, on the basis of the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV-TR), in the age range 18-55 years, received either pexacerfont or placebo (300, 200, and 100 mg/day in the first, second, and third week, respectively). No antidepressants, behavioral interventions, or substitution therapy were administered. Candidates were excluded if they had DSM-IV-TR axis I or II disorders (other than depressive/anxiety disorders). The primary outcomes were difference in the distribution of positive urine test results for heroin and methamphetamine at the end of the trial, and the mean difference in the change in the Visual Analog Scale (VAS) score for craving from the baseline to the endpoint between the two groups. No significant difference was detected for urine test results, but a significant difference was observed for craving scores. Also, significant time×treatment interactions were found for all the scales including VAS craving, VAS temptation severity, frequency of temptation, Clinical Opiate Withdrawal Scale, Amphetamine Withdrawal Questionnaire, Beck Anxiety Inventory, and Beck Depression Inventory II. Our findings favor pexacerfont as a potential treatment for withdrawal from drug dependence; however, further comprehensive studies are warranted.

Topics: Adult; Central Nervous System Stimulants; Diagnostic and Statistical Manual of Mental Disorders; Double-Blind Method; Drug Monitoring; Heroin; Humans; Male; Methamphetamine; Middle Aged; Psychiatric Status Rating Scales; Pyrazoles; Receptors, Corticotropin-Releasing Hormone; Severity of Illness Index; Substance Abuse Detection; Substance Withdrawal Syndrome; Substance-Related Disorders; Treatment Outcome; Triazines; Visual Analog Scale

For patients hospitalized on inpatient detoxification units, reducing negative symptoms such as withdrawal and craving is a key treatment area. Although lyric analysis is a commonly utilized music therapy intervention for clients in substance abuse rehabilitation, there is a lack of randomized controlled music therapy studies systematically investigating how lyric analysis interventions can affect patients on a detoxification unit.. The purpose of this cluster-randomized effectiveness study was to measure the effects of single-session group lyric analysis interventions on withdrawal and craving with patients on a detoxification unit. A secondary purpose of this study was to determine if relationships existed between treatment effects and participants' familiarity with the song.. Participants (N = 144) were cluster-randomized to experimental (posttest only) or wait-list control (pretest only) conditions to provide treatment to all participants in an inclusive single-session design.. Although participants in the experimental condition had lower withdrawal and craving means than participants in the control condition, these differences were not significant. Familiarity of the song in the lyric analysis was not related to withdrawal or craving.. Group-based lyric analysis interventions may be effective for temporarily relieving withdrawal and craving in patients on a detoxification unit. Familiarity of the song did not affect results. Implications for clinical practice, suggestions for future research, and limitations are provided.

Topics: Adult; Alcoholism; Central Nervous System Depressants; Cocaine; Cocaine-Related Disorders; Craving; Dopamine Uptake Inhibitors; Ethanol; Female; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Music Therapy; Narcotics; Psychotherapy, Group; Substance Withdrawal Syndrome; Substance-Related Disorders; Treatment Outcome; Young Adult

Opioid detoxification is not an effective stand-alone treatment for heroin dependence but is nevertheless an essential step in the path to recovery. There has been relatively little previous controlled research on the impact of treatment setting on the likelihood of successful completion of detoxification. In this study, 68 opioid-dependent patients receiving community treatment (predominantly with methadone) and requesting detoxification were randomly assigned to an inpatient versus outpatient setting. Both groups received the same medication (lofexidine), and the primary outcome measure was being opioid-free at detoxification completion. More inpatients (n = 18, 51.4%) than outpatients (n = 12, 36.4%) completed detoxification, but this difference was not statistically significant (χ(2) = 1.56, p = .21). However, the outpatient group received a significantly longer period of medication, and when the length of detoxification was controlled for, the results favored the inpatient setting (Exp(B) = 13.9, 95% confidence interval = 2.6-75.5, p = .002). Only 11 (16%) participants were opioid-free at the 1-month follow-up and 8 at the 6-month follow-up, with no between-group difference. Inpatient and outpatient opioid detoxification settings were not significantly different in completion or follow-up abstinence rates, but aspects of the study design may have favored the outpatient setting. Future studies should test patient characteristics that predict better outcomes in each setting.

Topics: Analgesics, Opioid; Clonidine; Female; Heroin; Heroin Dependence; Humans; Inpatients; Male; Methadone; Narcotics; Opioid-Related Disorders; Outcome Assessment, Health Care; Outpatients; Substance Withdrawal Syndrome; Substance-Related Disorders; Treatment Outcome

Methadone maintenance therapy (MMT) has been found effective in treating heroin addiction. Serious consideration should be given to the modality of methadone distribution, as it influences not only treatment outcome but the attitudes of policy makers and the community, too. On one hand, the choice of take-home methadone removes the need for daily attendance at a methadone clinic, which seems to improve patients' quality of life. On the other, this method, because of its lack of supervision and the absence of strict consumption monitoring, runs the risk of methadone misuse and diversion. In this study, we compared A) supervised daily consumption, B) contingent take-home incentives and C) non-contingent take-home in methadone maintenance in three groups of heroin-addicted patients attending three different MMT programmes. Retention rates at 12 months were significantly higher in contingent take-home patients (group B) than in those with supervised daily consumption (group A) and the non-contingent take-home (group C). Retention rates were higher in group A than in group C patients. Compared to patients in groups A and B, those in group C showed fewer negative urinalyses and higher rates of self-reported diversion and episodes of crime or violence. Results indicate a more positive outcomes following take-home methadone associated with behavioural incentives and other measures that aim to facilitate treatment compliance than those following daily supervised consumption. By contrast, non-contingent take-home methadone given to non-stabilized patients is associated with a high rate of diversion, along with more crime episodes and maladaptive behaviours.

Topics: Analgesics, Opioid; Comorbidity; Crime; Drug Administration Schedule; Female; Heroin; Heroin Dependence; Humans; Interview, Psychological; Male; Mental Disorders; Methadone; Motivation; Opiate Substitution Treatment; Opioid-Related Disorders; Patient Compliance; Self Report; Substance Abuse Detection; Substance-Related Disorders; Treatment Outcome; Violence

Benzodiazepine (BZD) use has been found to be associated with poorer psychosocial adjustment, higher levels of polydrug use and more risk-taking behaviors among opioid dependent patients. The aim of this paper is to analyze the correlation between BZD use, BZD prescription and treatment outcome among participants in the German trial on heroin-assisted treatment. 1015 patients who participated in the study comparing heroin-assisted and methadone maintenance treatment (HAT & MMT) for 12 months were included in the analysis. Analyses were carried out to assess the association of treatment outcome with baseline BZD use, with ongoing BZD use and with different patterns of BZD prescription. Baseline BZD use correlated with lower retention rates but not with poorer outcome. Ongoing BZD use correlated with poorer outcomes. Significantly better outcomes were found in the course of phobic anxiety symptomatology for those with regular prescription of BZD. The percentage of BZD positive urine tests decreased more in HAT than in MMT. Poorer outcome for benzodiazepine users may be mediated by a higher severity of addiction. Cautious prescribing of benzodiazepines may be beneficial due to the reduction of overall illicit use.

Topics: Anti-Anxiety Agents; Benzodiazepines; Drug Prescriptions; Female; Germany; Heroin; Heroin Dependence; Humans; Male; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders; Prescriptions; Psychiatric Status Rating Scales; Risk-Taking; Substance-Related Disorders; Treatment Outcome

The key component of the PharmChek sweat patch, the membrane, has been tested for the passage of externally applied materials. Drugs in the uncharged state rapidly penetrated the membrane but charged species were greatly slowed. In basic media, detectable concentrations of cocaine, methamphetamine, and heroin were observed at the earliest collection time (ca. 30 s), after drugs were placed on the outside of the membrane. Drug concentrations increased over the 2 h time course, when amounts detected (1710 ng cocaine, 1060 ng methamphetamine, 550 ng heroin per pad at 2 h) represented 5-17% of the drug deposited on the surface of the sweat patch. Drugs externally applied to human skin were shown to bind readily. Drugs deposited on the skin of drug-free volunteers several days prior to application of the sweat patch were not completely removed by normal hygiene or the cleaning procedures recommended before application of the sweat patch. Even 6 days of normal hygiene did not remove all drugs from externally contaminated skin and positive sweat patches resulted. A mechanism for passage of drugs through the sweat patch membrane, a mechanism for retention of drugs on skin, and a redesign of the sweat patch and modification of its use to reduce external contamination are proposed. Appropriate care should be taken in the interpretation of positive results from a sweat patch test until more research is conducted.

Topics: Bandages; Bias; Cocaine; Diffusion; Drug Contamination; Environmental Pollution; Equipment Contamination; Heroin; Humans; Hygiene; Methamphetamine; Skin Care; Substance Abuse Detection; Substance-Related Disorders; Sweat; Time Factors

A sample of 15 patients participating in an injectable methadone trial and of 15 patients in an oral methadone maintenance treatment, who admitted injecting part or all of their methadone take-home doses, were compared to 20 patients in maintenance treatment who use methadone exclusively by mouth. The present study confirms the poorer general health, the higher levels of emotional, psychological or psychiatric problems, the higher use of illicit drugs, and the higher number of problems related to employment and support associated with the use of the intravenous mode of administration of methadone. As expected, due to the shunt of metabolism in the gut wall and of the liver first-pass effect, higher concentration to dose ratios of (R)-methadone, which is the active enantiomer, were measured in the intravenous group (23% increase). This difference reached an almost statistically significant value (P = 0.054). This raises the question whether the effect of a higher methadone dose could be unconsciously sought by some of the intravenous methadone users.

Topics: Administration, Oral; Adult; Brief Psychiatric Rating Scale; Depressive Disorder; Dose-Response Relationship, Drug; Employment; Female; Health Status; Heroin; Humans; Injections, Intravenous; Male; Methadone; Schizophrenia; Self Administration; Severity of Illness Index; Substance Withdrawal Syndrome; Substance-Related Disorders

To compare the clinical efficacy of different doses of levomethadyl acetate hydrochloride (known as LAAM) in the treatment of opioid dependence.. A randomized controlled, double-blind, parallel group, 17-week study.. Outpatient facilities at Johns Hopkins University Bayview Medical Center, Baltimore, Md.. Opioid-dependent volunteers (N=180) applying to a treatment-research clinic.. Thrice-weekly (Monday/Wednesday/Friday) oral LAAM dose conditions of 25/25/35 mg, 50/50/70 mg, and 100/100/140 mg and nonmandatory counseling.. Retention in treatment, self-reported heroin use, and opioid-positive urine specimens.. Retention was independent of subjects' sex and dose. Self-reported heroin use decreased in a dose-related manner. At final assessment, patients in the high-dose condition reported using heroin 2.5 of 30 days as compared with 4.1 or 6.3 days for patients in the medium-dose and low-dose conditions, respectively (high dose vs low dose, P<.05); urinalysis results were similarly dose related. Overall, 20 (34%) of 59 patients in the high-dose condition remained opioid-abstinent for 4 consecutive weeks, as compared with 8 (14%) of 59 in the medium-dose and 7 (11%) of 62 in the low-dose conditions (P<.01). Self-report and urinalysis data are consistent with a greater than 90% reduction in illicit opioid use by the high-dose group relative to pretreatment levels.. Opioid substitution treatment with LAAM substantially reduces illicit opioid use. The clinical efficacy of LAAM is positively related to dose.

Topics: Adult; Analysis of Variance; Cocaine; Dose-Response Relationship, Drug; Double-Blind Method; Female; Heroin; Heroin Dependence; Humans; Male; Methadyl Acetate; Middle Aged; Narcotics; Substance-Related Disorders; Treatment Outcome

Studies conducted in the 1970s and early 1980s concluded that people will provide valid information about their illicit drug use when research interviews are conducted under appropriate conditions. Recent studies of treated and untreated populations using improved urinalysis techniques as well as hair analysis techniques indicate that the validity of respondents' self-reports of recent drug use may be considerably less than previously reported and may differ according to a number of factors. Results are presented from a study of clients participating in the Washington, DC, Treatment Initiative study who were assessed for drug use by interview, urinalysis, and hair analysis. At intake, almost all clients who tested positive had reported their use of heroin but fewer clients had reported their cocaine use. At posttreatment followup, clients underreported both heroin and cocaine use. Findings from treatment outcome studies that fail to validate and adjust their estimates of self-reported recent drug use should be interpreted with considerable caution.

Topics: Adult; Biological Assay; Cocaine; District of Columbia; Follow-Up Studies; Hair; Heroin; Humans; Interviews as Topic; Male; Reproducibility of Results; Substance-Related Disorders

The degree of non-compliance with a methadone programme is such that a zero is often recorded as the response variable. Such outcome variables cannot be transformed to normality in order to investigate a regression relationship between the response variable and various risk or treatment variables. The presence of a random effect as well in this regression causes added difficulty in the analysis. We show here that use of threshold models can provide a satisfactory solution to both these problems.

Topics: Australia; Benzodiazepines; Cocaine; Heroin; HIV Infections; Humans; Methadone; Models, Statistical; Patient Compliance; Preventive Health Services; Program Evaluation; Randomized Controlled Trials as Topic; Regression Analysis; Risk Factors; Substance-Related Disorders

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

1. Intravenous heroin was administered to volunteers, in doses of 2.5 and 5 mg to non-dependent subjects and does of 1/6, 1/3 and 1/2 of their prescribed daily does of opiates to dependent subjects, and pupillary responses measured before and three times during the 2 h after injection. 2. Tolerance to the miotic effects of heroin in the dependent subjects was demonstrated--larger doses of heroin were needed to produce the same pupil response in dependent subjects than in non-dependent subjects and the duration of action was shorter in the former group. 3. The effect of concurrent oral methadone medication on pupil response to heroin was demonstrated. Subjects prescribed both methadone and heroin showed smaller control pupil diameters and a reduced dose effect to heroin than did subjects prescribed heroin alone.

Topics: Dose-Response Relationship, Drug; Drug Interactions; Heroin; Humans; Methadone; Placebos; Pupil; Substance-Related Disorders

Among the increasing number of recent reports of the use of beta-adrenergic blocking drugs for a variety of psychiatric disorders is a series concluding that propranolol hydrochloride is efficacious in the treatment of opiate dependence. These reports were based on clinical observations of outpatient addicts in an uncontrolled situation. In order to validate these findings, we carried out a series of controlled, double-blind studies with hospitalized volunteers. The results of our studies do not confirm the previous reports. Propranolol neither relieved nor precipitated opiate withdrawal in subjects dependent either on dihydromorphinone hydrochloride or on heroin. It did not effectively block heroin-induced euphoria in dependent or nondependent subjects. In addition, there was no effect on the pattern of self-administration in opiate-dependent subjects, whether they were maintained on propranolol or placebo.

Topics: Adult; Clinical Trials as Topic; Heroin; Heroin Dependence; Humans; Hydromorphone; Male; Propranolol; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Administration, Oral; Adult; Aged; Clinical Trials as Topic; Dose-Response Relationship, Drug; Drug Tolerance; Female; Heroin; Humans; Infusions, Parenteral; Male; Middle Aged; Morphinans; Neoplasms; Pain; Substance-Related Disorders; Terminal Care; Time Factors

Topics: Adult; Clinical Trials as Topic; Heroin; Heroin Dependence; Humans; Placebos; Propranolol; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors

Topics: Acute Disease; Administration, Oral; Adolescent; Adult; Clinical Trials as Topic; Female; Heroin; Humans; Methadone; Nausea; Placebos; Propranolol; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors; Vomiting

Topics: Acetates; Administration, Oral; Adult; Amino Alcohols; Analysis of Variance; Benzene Derivatives; Clinical Trials as Topic; Codeine; Heroin; Humans; Illinois; Male; Methadone; Methylamines; Middle Aged; Placebos; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors; Work

Topics: Adult; Alcohols; Amphetamine; Barbiturates; Benzene Derivatives; Heroin; Humans; Injections, Intravenous; Male; Methadone; Methylamines; Morphine; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Administration, Oral; Clinical Trials as Topic; Codeine; Heroin; Humans; Methadone; Morphine Dependence; Pentazocine; Placebos; Self Medication; Substance-Related Disorders

Topics: 17-Hydroxycorticosteroids; Adult; Clinical Trials as Topic; Corticotropin-Releasing Hormone; Feedback; Glucocorticoids; Heroin; Humans; Hypoglycemia; Hypothalamo-Hypophyseal System; Insulin; Male; Methadone; Metyrapone; Middle Aged; Periodicity; Pituitary-Adrenal System; Stress, Physiological; Substance-Related Disorders

Topics: Adult; Clinical Trials as Topic; Drug Tolerance; Female; Heroin; Humans; Male; Methadone; Motivation; Reaction Time; Substance-Related Disorders

Topics: Animals; Clinical Trials as Topic; Conditioning, Psychological; Cyclazocine; Extinction, Psychological; Heroin; Humans; Morphinans; Narcotic Antagonists; New York City; Substance-Related Disorders

Topics: Chlorpromazine; Female; Heroin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Phenobarbital; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adolescent; Adult; Cocaine; Female; Heroin; Humans; Male; Methadone; Methamphetamine; Substance-Related Disorders; United Kingdom

Topics: Adolescent; Adult; Aged; Analgesics; Azocines; Clinical Trials as Topic; Cyclazocine; Electroencephalography; Heroin; Humans; Injections, Intravenous; Interpersonal Relations; Male; Middle Aged; Narcotic Antagonists; Sexual Behavior; Substance-Related Disorders

Topics: Behavior; Clinical Trials as Topic; Heroin; Humans; Injections, Intravenous; Male; Methods; Morphine; Morphine Dependence; Placebos; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors

Cannabis has consistently been the third most commonly abused drug among drug arrestees in Singapore over the past few years. Accordingly, this study aimed to understand the profile of cannabis users in Singapore and explore the effects of cannabis use on drug progression.. A total of 450 participants who had used cannabis at least once in their lifetime were recruited from the National Addictions Management Service, prisons, the Community Rehabilitation Centre and halfway houses from August 2017 to May 2018. A face-to-face questionnaire was administered and descriptive analyses were conducted.. The mean participant age was 40.9 ± 14.51 years, and 93.1% of them were male. The participants generally initiated cannabis use during adolescence, at a mean onset age of 16.5 ± 4.46 years. Most (89.6%) were introduced to cannabis by peers. Approximately half of them (46.9%) had used cannabis before other illicit drugs and 42.1% of them had used heroin as the succeeding drug.. In Singapore, cannabis use is often initiated during adolescence, largely under peer influence. Cannabis users may progress to other illicit drugs, particularly heroin, later in life.

Topics: Adolescent; Adult; Cannabis; Child; Female; Heroin; Humans; Illicit Drugs; Male; Middle Aged; Singapore; Substance-Related Disorders; Young Adult

Prior research indicates rising methamphetamine use and harms in the U.S., potentially related to increases in methamphetamine injection. To date, research on trends and correlates of methamphetamine injection is limited.. Analysis of trends and correlates of methamphetamine injection among treatment admissions among persons aged ≥ 12 whose primary substance of use at admission is methamphetamine. Data are from the Treatment Episode Data Set. Analyses includes descriptive statistics, trend analyses, and multilevel multivariable logistic regression.. Primary methamphetamine treatment admissions increased from 138,379 in 2010 to 201,021 in 2019. Among primary methamphetamine admissions, injection as the usual route of use increased from 24,821 (18.0 % of admissions) in 2010 to 55,951 (28.2 % of admissions) in 2019. Characteristics associated with increased adjusted odds of reporting methamphetamine injection included: males (aOR = 1.13, 95 % CI = 1.10-1.15); admission age 25-34 years (aOR = 1.23, 95 % CI = 1.19-1.28) and 35-44 years (aOR = 1.12, 95 % CI = 1.08-1.17) compared to age 18-24; dependent living (aOR = 1.33, 95 % CI = 1.29-1.37) and homelessness (aOR = 1.58, 95 % CI = 1.54-1.63) compared to independent living; part-time employment (aOR = 1.08, 95 % CI = 1.02-1.14), unemployment (aOR = 1.39, 95 % CI = 1.34-1.44) and not in labor force (aOR = 1.43, 95 % CI = 1.37-1.49) compared to full-time employment; one to ≥ four prior treatment admissions (aORs ranging from 1.19 to 1.94) compared to no prior admissions; also reporting use of cocaine (aOR = 1.10, 95 % CI = 1.05-1.16), heroin (aOR = 3.52, 95 % CI = 3.40-3.66), prescription opioids (aOR = 1.61, 95 % CI = 1.54-1.67), or benzodiazepines (aOR = 1.42, 95 % CI = 1.32-1.52) at treatment admission.. Findings lend further evidence to a resurgence of methamphetamine use that is intertwined with the ongoing opioid crisis in the U.S. Efforts to expand evidence-based prevention, treatment, and response efforts, particularly to populations at highest risk, are urgently needed.

Topics: Analgesics, Opioid; Benzodiazepines; Cocaine; Heroin; Humans; Male; Methamphetamine; Substance-Related Disorders

Kratom (Mitragyna speciosa) use is associated with polysubstance use (PSU) and use disorders. However, additional research on PSU heterogeneity in populations using this novel psychoactive substance is necessary. The authors investigated patterns of past 12-month PSU among US adults reporting past 12-month use of kratom and at least one additional substance.. Latent class models were fit using 2019 National Survey on Drug Use and Health (NSDUH) data which was collected from 412 US adults reporting past 12-month use of kratom and at least one of 11 additional substances.. Three distinct profiles were identified: "marijuana/alcohol/tobacco" (63.3%), "marijuana/alcohol/tobacco + psychedelics" (19.3%), and "marijuana/alcohol/tobacco + psychedelics/heroin/prescriptions" (17.4%).. This is the first epidemiological study in which a latent class analysis was used to identify unique PSU profiles among US adults using kratom and other substances. Understanding the profiles of people using kratom in relation to the use of other drugs might help guide screening interventions, treatment needs, and policy.

Topics: Adult; Hallucinogens; Heroin; Humans; Latent Class Analysis; Mitragyna; Substance-Related Disorders

(1) Background: Attention deficit hyperactivity disorder (ADHD) is a common comorbid condition in opioid use disorder (OUD) and is associated with a more severe course of substance use. Patients with severe OUD who have not responded to oral opioid maintenance treatment can be treated with intravenous diamorphine up to three times per day. Here, we investigated the prevalence of ADHD among patients undergoing either daily diamorphine maintenance treatment or daily oral opioid maintenance treatment. (2) Methods: We assessed all participants with the WURS-k and the ADHD-SR. The Diagnostic Interview for ADHD in Adults (DIVA) was performed with all participants who met the cut-off in the WURS-k and/or ADHD-SR. (3) Results: The overall prevalence of ADHD was 17.9%. Prevalence of ADHD among patients undergoing daily diamorphine maintenance treatment was 14.3%. Prevalence of ADHD among patients undergoing daily oral opioid maintenance treatment was 20.3%. The combined presentation of ADHD was the most prevalent condition. In urine samples of participants with comorbid ADHD, heroin was detected the most and cocaine the least frequently. (4) Conclusions: Almost one out of five patients with OUD suffered from comorbid ADHD. In 83.3%, ADHD had not been diagnosed prior to participation in this study. Thus, patients with SUD could benefit from being routinely screened for ADHD.

Topics: Adult; Attention Deficit Disorder with Hyperactivity; Comorbidity; Heroin; Humans; Opiate Substitution Treatment; Opioid-Related Disorders; Outpatients; Prevalence; Substance-Related Disorders

Psychedelics are being explored for their potential therapeutic benefits across a wide range of psychiatric diagnoses and may usher in a new age in psychiatric treatment. There is stigma associated with these currently illegal substances, and use varies by race and age. We hypothesized that minoritized racial and ethnic populations, relative to White respondents, would perceive psychedelic use as riskier.. Using 2019 cross-sectional data from the National Survey of Drug Use and Health, we conducted a secondary analysis of 41,679 respondents. Perceived risk of heroin was used as a surrogate for overall risk of illegal substance use; heroin and lysergic acid diethylamide were the only substances queried this way in the sample.. A majority regarded lysergic acid diethylamide (66.7%) and heroin (87.3%) as a great risk if used once or twice. There were clear differences by race, with White respondents and those indicating more than one race having significantly lower perceived risk of lysergic acid diethylamide than respondents from other groups. Perceived risk of use also significantly increased with age.. Perceived risk of lysergic acid diethylamide is unevenly distributed across the population. Stigma and racial disparities in drug-related crimes likely contribute to this. As research into potential therapeutic indications for psychedelics continues, perceived risk of use may change.

Topics: Cross-Sectional Studies; Hallucinogens; Heroin; Humans; Lysergic Acid Diethylamide; Substance-Related Disorders; United States

Drug use is prevalent among people who attend electronic dance music (EDM) parties at nightclubs or festivals. This population can serve as a sentinel population to monitor trends in use of party drugs and new psychoactive substances (NPS) that may diffuse through larger segments of the population.. We surveyed adults entering randomly selected EDM parties at nightclubs and dance festivals in New York City about their drug use in 2017 (n=954), 2018 (n=1,029), 2019 (n=606), 2021 (n=229), and 2022 (n=419). We estimated trends in past-year and past-month use of 22 drugs or drug classes based on self-report from 2017-2022 and examined whether there were shifts pre- vs. post-COVID (2017-2019 vs. 2021-2022).. Between 2017 and 2022, there were increases in past-year and past-month use of shrooms (psilocybin), ketamine, poppers (amyl/butyl nitrites), synthetic cathinones ("bath salts"), and novel psychedelics (lysergamides and DOx series), increases in past-year cannabis use, and increases in past-month use of 2C series drugs. Between 2017 and 2022, there were decreases in past-year heroin use and decreases in past-month cocaine use, novel stimulant use, and nonmedical benzodiazepine use. The odds of use of shrooms, poppers, and 2C series drugs significantly increased after COVID, and the odds of use of cocaine, ecstasy, heroin, methamphetamine, novel stimulants, and prescription opioids (nonmedical use) decreased post-COVID.. We estimate shifts in prevalence of various drugs among this sentinel population, which can inform ongoing surveillance efforts and public health response in this and the general populations.

Topics: Adult; Cocaine; COVID-19; Dancing; Hallucinogens; Heroin; Holidays; Humans; Illicit Drugs; Music; New York City; Substance-Related Disorders

Topics: Chorioretinitis; Heroin; Humans; Substance-Related Disorders

Question-order changes in repeated surveys can distort comparisons. We want to describe the evolution of drug risk perceptions among Spanish adolescents and assessing whether the 2006 peaks in perceived risk of occasional drug use can be explained by question-order changes.. The subjects were secondary students from a biennial national survey during 2000-2012. A one-off intervention was applied in 2006, replacing the two-adjacent items on perceived risk of occasional and regular use of each drug by non-adjacent items. Annual prevalence of high-risk perception were obtained for occasional and regular use of cannabis, heroin, cocaine and ecstasy. Subsequently, the 2006 percent level change (PC) in such were estimated prevalence using segmented Poisson regression, adjusting for various student and parent covariates.. The 2006 PC in prevalence of high-risk perception of occasional drug use ranged from +63% (heroin) to +83% (ecstasy). These PCs were very high in all considered subgroups. However, the 2006 PC in prevalence of high-risk perception of regular drug use ranged from 1% (heroin) to 12% (cannabis). The evolution of preventive interventions does not suggest alternative causal hypotheses for 2006 peaks other than question-order changes.. Within the cognitive heuristics framework, the 2006 spikes in perceived risk of occasional drug use were most likely due to a release of the anchor exerted by perceived risk of regular drug use over that of occasional use triggered by 2006 question-order changes. In repeated surveys it is inexcusable to pre-test the effect of any change in questionnaire format.

Topics: Adolescent; Affect; Cannabis; Cocaine; Heroin; Humans; N-Methyl-3,4-methylenedioxyamphetamine; Substance-Related Disorders

The National Programme on Substance Abuse Deaths (NPSAD) receives reports on drug-related deaths from coroners In England, Wales and Northern Ireland on a voluntary basis. The NPSAD was searched for cases with xylazine detections in cases received by December 31, 2022.. One drug-related death associated with xylazine use was reported to NPSAD by December 31, 2022. The deceased was a 43-year-old male who was found dead at home with drug paraphernalia located at the property in May 2022. The post-mortem examination identified recent puncture wounds to the groin. Coronial documentation reports that the deceased had a history of illicit drug use. A number of drugs were detected by post-mortem toxicology and xylazine was implicated in death alongside heroin, fentanyl and cocaine.. To the best of our knowledge, this is the first death associated with xylazine use reported in the UK, and even Europe, and indicates the entry of xylazine into the UK drug supply. This report highlights the importance of monitoring changes in illicit drug markets and the emergence of new drugs.

Topics: Adult; Analgesics, Opioid; Drug Overdose; Europe; Fentanyl; Heroin; Humans; Illicit Drugs; Male; Pharmaceutical Preparations; Substance-Related Disorders; United Kingdom; United States; Xylazine

The presence of pharmaceuticals (PHA) and narcotics (NAR) in wastewater (WW) has attracting growing interest due to concern for aquatic environment and the possibility to exploit their presence to estimate drug consumption by population. This work aims to (i) quantify PHA and NAR in the WW of the Brno metropolitan area, (ii) determine the effectiveness of the current conventional wastewater treatment plant (WWTP), and (iii) estimate the illicit drug (ID) consumption. 23 PHA and 9 NAR were frequently detected in the untreated WW and studied for their removal. One year monitoring was carried out to highlight a possible seasonal pattern with PHA and NAR load in WW, WWTP effectiveness, and illicit consumption. Results highlighted that the most abundant PHA and NAR were caffeine (73.9 ± 6.9 μg L

Topics: Amphetamine; Caffeine; Cocaine; Environmental Monitoring; Heroin; Humans; Illicit Drugs; Methadone; Methamphetamine; Narcotics; Seasons; Substance Abuse Detection; Substance-Related Disorders; Wastewater; Wastewater-Based Epidemiological Monitoring; Water Pollutants, Chemical

The consumption patterns of five categories of psychoactive substances (PS), including "conventional" illicit drugs, new psychoactive substances (NPS), therapeutic opioids, alcohol and nicotine, were studied in the city of Split, Croatia, using wastewater-based epidemiology (WBE), with an emphasis on the impact of a large electronic music festival. The study involved the analysis of 57 urinary biomarkers of PS in raw municipal wastewater samples collected in three characteristic periods, including the festival week in the peak-tourist season (July) and reference weeks in the peak-tourist season (August) and the off-tourist season (November). Such a large number of biomarkers allowed the recognition of distinct patterns of PS use associated with the festival, but also revealed some subtle differences between summer and autumn seasons. The festival week was characterized by markedly increased use of illicit stimulants (MDMA: 30-fold increase; cocaine and amphetamine: 1.7-fold increase) and alcohol (1.7-fold increase), while consumption of other common illicit drugs (cannabis and heroin), major therapeutic opioids (morphine, codeine and tramadol) and nicotine remained rather constant. Interestingly, NPS and methamphetamine clearly contributed to the festival PS signature in wastewater, but their prevalence was rather low compared to that of common illicit drugs. Estimates of cocaine and cannabis use were largely consistent with prevalence data from national surveys, whereas differences were found for typical amphetamine-type recreational drugs, particularly MDMA, and for heroin. The WBE data suggest that the largest proportion of morphine came from heroin consumption and that the percentage of heroin users seeking treatment in Split is probably rather low. The prevalence of smoking calculated in this study (30.6 %) was consistent with national survey data for 2015 (27.5-31.5 %), while the average alcohol consumption per capita >15 years (5.2 L) was lower than sales statistics suggest (8.9 L).

Topics: Amphetamine; Analgesics, Opioid; Cocaine; Ethanol; Heroin; Holidays; Humans; Illicit Drugs; Music; N-Methyl-3,4-methylenedioxyamphetamine; Nicotine; Substance Abuse Detection; Substance-Related Disorders; Wastewater; Water Pollutants, Chemical

Understanding drug use and behavior within the PWUD population is crucial to adapt harm reduction and prevention strategies, and provide improved addiction and medical treatment. However, in most countries such as France, the knowledge of drug use behaviors is likely biased as it originates from addiction centers which are attended by only an unknown proportion of PWUD. The objectives of this study were to describe drug use behavior in a population of active PWUD in the urban area of Montpellier, South of France.. We implemented a community-based respondent-driven sampling survey (RDSS), a validated strategy to obtain a representative sample of a population, to recruit PWUD in the city. Adult individuals reporting frequent psychoactive drug use other than cannabis, with confirmation by urine test, were eligible. Beside HCV and HIV testing, trained peers interviewed participants on their drug consumption and behavior using standardized questionnaires. Fifteen seeds launched the RDSS.. During the 11 weeks of the RDSS, 554 actives PWUD were consecutively included. They were mostly men (78.8%), had a median age of 39 years, and only 25.6% had a stable living place. On average, participants consumed 4.7 (± 3.1) different drugs, and 42.6% smoked free-base cocaine. Unexpectedly, heroin and methamphetamine were consumed by 46.8% and 21.5% of participants, respectively. Among the 194 participants injecting drugs, 33% declared sharing their equipment.. This RDSS highlighted a high consumption of heroin, crack and methamphetamine in this PWUD population. These unexpected results can be explained by low attendance to addiction centers, the source of drug use reports. Despite free care and risk reduction equipment in the city, sharing was very frequent among injectors, challenging the current program of harm reduction.

Topics: Adult; Behavior, Addictive; Cannabis; Female; Harm Reduction; Heroin; Humans; Male; Substance-Related Disorders

The market for illicit drugs and new psychoactive substances (NPS) has grown significantly and people attending festivals have been identified as being at high risk (high extent and frequency of substance use). Traditional public health surveillance data sources have limitations (high costs, long implementation times, and ethical issues) and wastewater-based epidemiology (WBE) can cost-effectively support surveillance efforts. Influent wastewater samples were analyzed for NPS and illicit drug consumption collected during New Year period (from 29-Dec-2021 to 4-Jan-2022) and a summer Festival (from 29-June-2022 to 12-July-2022) in a large city in Spain. Samples were analyzed for phenethylamines, cathinones, opioids, benzodiazepines, plant-based NPS, dissociatives, and the illicit drugs methamphetamine, MDA, MDMA, ketamine, heroin, cocaine, and pseudoephedrine by liquid chromatography mass spectrometry. High consumption rates of specific NPS and established illicit drugs were identified at the peak of each event. Furthermore, a dynamic change in NPS use (presence and absence of substances) was detected over a period of six months. Eleven NPS, including synthetic cathinones, benzodiazepines, plant-based NPS and dissociatives, and seven illicit drugs were found across both the New Year and summer Festival. Statistically significant differences (p < 0.05) were seen for 3-MMC (New Year vs summer Festival), eutylone (New Year vs summer Festival), cocaine (summer Festival vs normal week and summer Festival vs New Year), MDMA (New Year vs normal week and summer Festival vs normal week), heroin (summer Festival vs New Year) and pseudoephedrine (summer Festival vs New Year). This WBE study assessed the prevalence of NPS and illicit drugs at festivals following the reduction of the COVID-19 pandemic restrictions highlighting the high use of specific substances at the peak of each event. This approach identified in a cost-effective and timely manner without any ethical issues the most used drugs and changes in use patterns and, thus, can complement public health information.

Topics: Cocaine; COVID-19; Heroin; Holidays; Humans; Illicit Drugs; N-Methyl-3,4-methylenedioxyamphetamine; Pandemics; Prevalence; Pseudoephedrine; Psychotropic Drugs; Substance-Related Disorders

A record number of Opioid-related deaths occurred in Northern Ireland in 2021 and it is acknowledged that the Covid-19 pandemic compounded drugs related deaths crisis. This co-production study set out to refine the design of a wearable device for Opioid users to detect and subsequently prevent a potential overdose situation.. Purposive sampling was used to recruit people who had substance use disorders and were living in a hostel and prison during the Covid-19 pandemic. Principles of co-production influenced the study, which encompassed a focus group phase and a wearable phase. The initial phase included three focus groups with participants who inject Opioids and one focus group with workers from a street injector support service. During the wearable phase, the participant group tested the feasibility of the wearable technology in a controlled environment. This included testing the transferability of data from the device to a backend server on the cloud.. All focus group participants expressed an interest in the wearable technology when it was presented to them and agreed, that in principle, such a device would be extremely beneficial to help reduce the risk of overdose within the active drug using community. Participants outlined factors which would help or hinder the design of this proposed device and their decision to wear it, if it were readily available to them. Findings from wearable phase indicated that it was feasible to use a wearable device for monitoring Opioid users' biomarkers remotely. The provision of information regarding the specific functionality of the device was considered key and could be disseminated via front line services. The data acquisition and transfer process would not be a barrier for future research.. Understanding the benefit and disadvantages of technologies such as a wearable device to prevent Opioid-related deaths will be critical for mitigating the risk of overdose for people who use Heroin. It was also clear that this would be particularly relevant during Covid-19 lock-down periods, when the effects of the pandemic further exacerbated the isolation and solitude experienced by people who use Heroin.

Topics: Analgesics, Opioid; Communicable Disease Control; COVID-19; Drug Overdose; Heroin; Humans; Pandemics; Prisons; Substance-Related Disorders

Concomitant drug use is common among opioid-dependent patients in maintenance therapy. Attention deficit hyperactivity disorder (ADHD), a common comorbidity among opioid users, is associated with a higher risk of concomitant drug use. Earlier studies showed that methylphenidate (MPH) can reduce cocaine consumption among patients with ADHD. The use of MPH as an agonist-replacement or maintenance therapy in cocaine-dependent patients without ADHD is also common in Switzerland, despite a lack of supporting evidence. The aim of this study was to assess concomitant cocaine, amphetamine, MDMA, MPH, and heroin use among patients in opioid maintenance therapy either with or without comorbid ADHD. We expected stimulant consumption to be higher in patients with cocaine dependence and comorbid ADHD and that use of MPH would not lead to a reduction in cocaine consumption in patients without ADHD. We therefore evaluated correlations between use of MPH and cocaine consumption and between MPH consumption and cocaine craving within the two groups.. This cross-sectional study included 94 opioid-dependent patients in maintenance therapy in an outpatient department of the Psychiatric Hospital of Zurich. The patients were divided into two groups based on comorbid ADHD; a group with ADHD (N = 27) and a group without ADHD (N = 67). Drug use was assessed using 3-month hair analysis.. We did not find significant differences in the number of patients using cocaine, amphetamine, MDMA, or heroin between groups with or without ADHD. With respect to cocaine use, 85.2 percent of patients in the ADHD group and 73.1 percent in the non-ADHD group were users. The non-ADHD group showed a significant positive correlation between the concentration of MPH and cocaine in hair samples (p < 0.05), and a positive correlation between cocaine craving and the concentration of MPH in hair samples (p = 0.065). These two trends were not evident in the ADHD group.. Among patients without ADHD, use of MPH correlates with higher cocaine consumption and craving. Conversely, no significant correlation was found between MPH and cocaine use in patients with ADHD. Our study adds to the evidence that MPH confers negative effects in cocaine users without ADHD and should thus have no place in the treatment of these patients.

Topics: Amphetamine; Analgesics, Opioid; Attention Deficit Disorder with Hyperactivity; Central Nervous System Stimulants; Cocaine; Cocaine-Related Disorders; Cross-Sectional Studies; Heroin; Humans; Methylphenidate; N-Methyl-3,4-methylenedioxyamphetamine; Substance-Related Disorders; Treatment Outcome

People with substance use disorder (SUD) may be at increased risk of COVID-19 infection. However, there is little evidence regarding the incidence of and determinants associated with infection in this group. The aims of the study were to determine the cumulative incidence of COVID-19 among people who sought treatment for heroin, cocaine, cannabis, and alcohol use disorder in Catalonia; to identify sociodemographic, substance, and clinical determinants associated with COVID-19 infection among SUD patients; and to compare the cumulative incidence of COVID-19 infection in the population with SUD with that of the general population.. A patient-based retrospective observational study was conducted. The study population comprised people who sought treatment for heroin, cocaine, cannabis, or alcohol use disorder in Catalonia in 2018 and 2019. We analysed cumulative incidence of COVID-19 (confirmed by PCR test) from 25 February to 31 December 2020. Additionally, we used a log-link binomial generalized linear model for COVID-19 infection, using the substance as the exposition, adjusting for sociodemographic and clinical variables.. Of the 23,092 individuals who sought treatment for SUD, 38.15% were considered suspected cases of COVID-19, and 2.60% (95% CI = 2.41-2.82) were confirmed positive for COVID-19 by PCR test during the study period. Those who sought treatment for alcohol use (cumulative incidence of COVID-19 of 3% [95% CI = 2.70-3.34]) had a higher risk ratio than, those who sought treatment for heroin use (cumulative incidence of 1.94% [95% CI = 1.47-2.56]). Being born outside of Spain, living in an institutionalized residence, having HIV, and being in a high morbidity group were associated with higher risk of COVID-19 infection. Meanwhile, the cumulative incidence of COVID-19 in the general population, according to public COVID-19 test data, was 3.86% (95% CI = 3.85-3.87).. This study did not find higher cumulative incidence of COVID-19 infection among people with SUD in Catalonia in 2020, despite the clinical vulnerability of this population and their social disadvantage. However, differences were seen in the cumulative incidence of COVID-19 according to the substance for which treatment was sought. For example, those with alcohol dependence had a higher rate than those dependent on heroin. Further studies are needed to determine the factors contributing to these differences.

Topics: Alcoholism; Cocaine; COVID-19; Heroin; Humans; Incidence; Substance-Related Disorders

Sexual and gender minorities (SGMs) often deal with discrimination which can result in maladaptive coping like substance misuse, yet few studies have examined the association between everyday discrimination and various types of substance misuse among SGMs or whether there is heterogeneity in substance misuse or this relationship by SGM identity.. Data from 1316 adult SGMs in the United States were recruited from Reddit between February and March 2022. SGM identities (sexual minorities assigned male at birth (AMAB), sexual minorities assigned female at birth (AFAB), gender minorities AMAB, gender minorities AFAB), everyday discrimination, depressive symptoms, marijuana and alcohol misuse, over-the-counter drug misuse, prescription drug misuse, and heroin use were measured, along with demographics. Multivariable logistic regressions examined relationships between everyday discrimination and each substance misuse outcome, adjusting for SGM identity, race/ethnicity, age, income, and depressive symptoms. Interaction terms between everyday discrimination and SGM identities were added to each model to test for moderation.. In fully adjusted models, with each additional unit of everyday discrimination score, there were significantly increased odds of substance misuse for all outcomes. SGM by everyday discrimination interactions was significant for alcohol misuse, over-the-counter drug misuse, and heroin use, with the association between everyday discrimination and substance misuse stronger among gender minorities.. Substance misuse varied by SGM identity. Everyday discrimination was associated with substance misuse, but there was heterogeneity in this relationship between SGM identity and substance. Substance use disorder treatment and prevention among SGMs should consider heterogeneity by SGM identity and substance.

Topics: Adaptation, Psychological; Adult; Female; Gender Identity; Heroin; Humans; Infant, Newborn; Male; Sexual and Gender Minorities; Sexual Behavior; Substance-Related Disorders; United States

The present study explores Australian public support for more lenient treatment of persons found in possession of small amounts of illegal drugs for personal use.. Data for the study are drawn from the 2013, 2016 and 2019 National Drug Strategy Household Surveys. Bivariate associations were tested using χ. Support for legalising personal use of three drugs (cannabis, ecstasy and cocaine) has risen significantly since 2013 but remained stable (and low) for two (heroin and methamphetamine). Support for no action, a caution or a warning has grown for those found in possession of cannabis, ecstasy and heroin for personal use but not for those found in possession of methamphetamine. There is, however, more support for responding to this group with treatment, education or a small fine than there is for imprisonment.. There is strong support for legalising use of cannabis. There is little support for legalising use of ecstasy and cocaine but growing public support for a less punitive approach to those who use these drugs. There is little public support for a change in the current approach to heroin and methamphetamine.

Topics: Australia; Cannabis; Cocaine; Hallucinogens; Heroin; Humans; Illicit Drugs; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; Substance-Related Disorders

Increases in U.S. older adults' nonprescription opioid and psychostimulant use call for examining their treatment admissions for these substances.. Using admissions age 55 + involving heroin (N = 299,073) from the 2012-2019 Treatment Episode Data Set-Admissions, we examined trends and sociodemographic and clinical characteristics of three groups: (1) heroin-only admissions (i.e., not involving cocaine or methamphetamine), (2) heroin-cocaine admissions, and (3) heroin-methamphetamine admissions. Bivariable and multivariable logistic regression analyses were conducted to examine the research questions.. Between 2012 and 2019, the numbers of both heroin-only and heroin-cocaine admissions increased 2.3-fold and heroin-methamphetamine admissions increased seven-fold. First time heroin-methamphetamine admissions increased 18-fold. Heroin-methamphetamine admissions were concentrated in the Western region and heroin-cocaine admissions in the Northeastern region. Multivariable analyses showed a nearly 6 times higher relative risk ratio (RRR; 95% CI=5.24-6.74) for heroin-methamphetamine vs. heroin-only admissions in 2019 compared to 2012. Being non-Hispanic Black, compared to non-Hispanic White, was associated with a RRR of 2.4 (95% CI=2.34-2.46) for heroin-cocaine admissions and a RRR of 0.14 (95% CI=0.12-0.15) for heroin-methamphetamine admissions. Late-onset heroin use, experience of homelessness and other psychiatric problems, and past 30-day arrest episodes were associated with a higher likelihood of heroin-cocaine and heroin-methamphetamine admissions, while injection drug use (IDU) was associated with a higher likelihood of heroin-methamphetamine admissions only.. Healthcare providers should assess and monitor psychostimulant, methamphetamine in particular, use among older adults. Those who use heroin and psychostimulants should receive substance use treatment and help to secure stable housing and meet other living needs.

Topics: Aged; Central Nervous System Stimulants; Cocaine; Heroin; Humans; Methamphetamine; Middle Aged; Substance-Related Disorders

The drug toxicity crisis continues to be a significant cause of death. Over 24,600 people died from opioid toxicity in Canada over the last 5 years. Safe supply programs are required now more than ever to address the high rate of drug toxicity overdose deaths caused by illicit fentanyl and its analogues. This study aims to identify opioid preferences and associated variables to inform further phases of safe supply program implementation.. The Harm Reduction Client Survey, an annual cross-sectional survey of people who use drugs (PWUD), was administered at harm reduction supply distribution sites in BC in October-December 2019. The survey collects information on substance use patterns, associated harms, stigma, and utilization of harm reduction services. Eligibility criteria for survey participation included aged 19 years or older; self-reported substance use of any illicit substance in the past six months, and ability to provide verbal informed consent. We conducted multivariate logistic regression to investigate associations with opioid preference. We used the dichotomized preference for either heroin or fentanyl as an outcome variable. Explanatory variables of interest included: geographic region, urbanicity, gender, age category, Indigenous identity, housing, employment, witnessing or experiencing an overdose, using drugs alone, using drugs at an observed consumption site, injection as preferred mode of use, injecting any drug, frequency of use, and drugs used in last 3 days.. Of the 621 survey participants, 405 reported a preferred opioid; of these 57.8% preferred heroin, 32.8% preferred fentanyl and 9.4% preferred prescription opioids. The proportion of participants who preferred heroin over fentanyl significantly increased with age. The adjusted odds of a participant 50 or older preferring heroin was 6.76 (95% CI: 2.78-16.41, p-value: < 0.01) times the odds of an individual 29 or under. The adjusted odds of an Indigenous participant reporting a preference for heroin compared to fentanyl was 1.75 (95% CI: 1.03-2.98, p-value: 0.04) the odds of a non-Indigenous participant reporting the same. Adjusted odds of heroin preference also differed between geographic regions within British Columbia, Canada.. Opioid preference differs by age, geographic area, and Indigenous identity. To create effective safe supply programs, we need to engage PWUD about their drugs of choice.

Topics: Adult; Analgesics, Opioid; British Columbia; Cross-Sectional Studies; Drug Overdose; Drug-Related Side Effects and Adverse Reactions; Fentanyl; Heroin; Humans; Illicit Drugs; Substance-Related Disorders; Young Adult

Topics: Adult; Buprenorphine; Contraception; Drug Overdose; Female; Harm Reduction; Heroin; Humans; Male; Methadone; Methamphetamine; Naloxone; Opioid-Related Disorders; Pregnancy; Quality of Life; Referral and Consultation; Substance-Related Disorders

We aimed to examine trends and characteristics of substance use (opioid, cocaine, marijuana, and heroin) among hospitalized homeless patients in comparison with other hospitalized patients in 3 states.This was a cross-sectional study, based on the 2007 to 2015 State Inpatient Data of Arizona, Florida, and Washington (n = 32,162,939). Use of opioid, cocaine, marijuana, heroin, respectively, was identified by the International Classification of Diseases, 9th Revision. Multi-level multivariable regressions were performed to estimate relative risk (RR) and 95% confidence intervals (CI). Dependent variables were the use of substances (opioid, cocaine, marijuana, and heroin), respectively. The main independent variable was homeless status. The subgroup analysis by age group was also conducted.Homeless patients were associated with more use of opioid (RR [CI]), 1.23 [1.20-1.26], cocaine 2.55 [2.50-2.60], marijuana 1.43 [1.40-1.46], and heroin 1.57 [1.29-1.91] compared to other hospitalized patients. All hospitalized patients including those who were homeless increased substance use except the use of cocaine (RR [CI]), 0.57 [0.55-0.58] for other patients and 0.60 [0.50-0.74] for homeless patients. In all age subgroups, homeless patients 60 years old or older were more likely to be hospitalized with all 4 types of substance use, especially, cocaine (RR [CI]), 6.33 [5.81-6.90] and heroin 5.86 [2.08-16.52] in comparison with other hospitalized patients.Homeless status is associated with high risks of substance use among hospitalized patients. Homeless elderly are particularly vulnerable to use of hard drugs including cocaine and heroin during the opioid epidemics.

Topics: Aged; Analgesics, Opioid; Arizona; Cannabis; Cocaine; Cross-Sectional Studies; Female; Heroin; Hospitalization; Humans; Ill-Housed Persons; Male; Middle Aged; Substance-Related Disorders

Heroin-assisted treatment has proven effective in reducing criminal offenses in opioid dependent individuals. Few studies attempted to explain the observed crime reduction and the reasons why these patients keep offending and getting incarcerated have to date not been explored.. Patients with a history of incarcerations during the time of participating in heroin-assisted treatment (n = 22) were invited to a semi-structured, narrative interview. Findings were evaluated with Mayring's qualitative content analysis framework. Additionally, the Montreal Cognitive Assessment test and the multiple-choice vocabulary intelligence test used to assess cognitive impairment and premorbid intelligence levels.. Three main categories emerged in patients' narratives on their incarcerations: cocaine use, impaired functioning, and financial constraints. Lifetime prevalence of cocaine use disorder was 95.5% and their cocaine use often led to patients getting incarcerated. Impaired functioning mainly constituted the inability to receive and open mail. Financial constraints led to incarcerations in lieu of payment in 16 participants (72.7%). Categories overlapped notably and often occurred in close temporal proximity. A fourth category on the likelihood of getting incarcerated again in the future was inhomogeneous and ranged from the strong conviction to complete rejection of the scenario. Average premorbid intelligence levels were found, whereas the cognitive assessment suggested severe cognitive impairment in our sample.. Participants mainly reported to have committed minor offenses and not being able to pay for resulting fines. The resulting prison sentences are an unconvincing practice from a medical and economic perspective alike. Public expenditure and the interruptions of the continuum of care could be reduced by legislatively protecting these marginalised patients.

Topics: Cocaine; Crime; Heroin; Humans; Prisoners; Substance-Related Disorders

Mood disorder, impulsivity and aggression are common in drug users compared to healthy controls. However, no study has focused on the difference in various types of drug users. Therefore, the objective of this study was to explore the differences in depression, anxiety, impulsivity, and aggression among methamphetamine, heroin and polysubstance users and to further explore the risk factors for severe depression in the three groups.. Drug users over 18 years old who met the DSM-V diagnostic criteria for substance -related disorders were included in the study. All participants completed a general questionnaire, the Zung Self-Rating Depression Scale (SDS), the Zung Self-Rating Anxiety Scale (SAS), Barratt impulsiveness Scale Version 11 (BIS-11), and the Buss-Perry Aggression Questionnaire (BPAQ). One-way ANOVAs or Chi-square tests were used to test the differences among the groups, correlation analysis was used to test the relationship between drug use and other parameters, and multiple logistic regression was conducted to assess the risk factors for severe depression.. A total of 1,486 participants were included, comprising 86.3% males with a mean age of 38.97 years. There was a significant difference in the percentage of severe depression and SDS scores among the three groups, but no significant difference was found in SAS, BIS-11 and BPAQ scores. Using methamphetamines, hostility and anxiety were risk factors for developing severe depression in all the participants and anxiety remained constant in the other three groups. Moreover, methamphetamine use was 2.16 and 3.35 times more likely to cause severe depression than heroin and polysubstance use, respectively. The initial age of substance use was negatively correlated with BPAQ, SAS, and SDS scores, whereas the drug use duration and addiction duration were positively correlated.. In this study, we found that the highest prevalence of severe depression was in participants using methamphetamines and that using methamphetamines, hostility, and anxiety were risk factors for developing severe depression. This result addressed an important gap in our knowledge of the different characteristics of depression, anxiety, impulsivity and aggression in various types of substance users and provides clinicians and policy-makers with directions for intervention and preventing relapse.

Topics: Adolescent; Adult; Aggression; Anxiety; Cross-Sectional Studies; Depression; Depressive Disorder, Major; Drug Users; Female; Heroin; Humans; Impulsive Behavior; Male; Methamphetamine; Substance-Related Disorders

Empirical data regarding dynamic alterations in illicit drug supply markets in response to the COVID-19 pandemic, including the potential for introduction of novel drug substances and/or increased poly-drug combination use at the "street" level, that is, directly proximal to the point of consumption, are currently lacking. Here, a high-throughput strategy employing ambient ionization-mass spectrometry is described for the trace residue identification, characterization, and longitudinal monitoring of illicit drug substances found within >6,600 discarded drug paraphernalia (DDP) samples collected during a pilot study of an early warning system for illicit drug use in Melbourne, Australia from August 2020 to February 2021, while significant COVID-19 lockdown conditions were imposed. The utility of this approach is demonstrated for the de novo identification and structural characterization of β-U10, a previously unreported naphthamide analog within the "U-series" of synthetic opioid drugs, including differentiation from its α-U10 isomer without need for sample preparation or chromatographic separation prior to analysis. Notably, β-U10 was observed with 23 other drug substances, most commonly in temporally distinct clusters with heroin, etizolam, and diphenhydramine, and in a total of 182 different poly-drug combinations. Longitudinal monitoring of the number and weekly "average signal intensity" (ASI) values of identified substances, developed here as a semi-quantitative proxy indicator of changes in availability, relative purity and compositions of street level drug samples, revealed that increases in the number of identifications and ASI for β-U10 and etizolam coincided with a 50% decrease in the number of positive detections and an order of magnitude decrease in the ASI for heroin.

Topics: Analgesics, Opioid; Communicable Disease Control; COVID-19; Heroin; Humans; Illicit Drugs; Pandemics; Pilot Projects; Substance-Related Disorders

We aimed to evaluate the prevalence and trend of identifying as a sexual minority among the American adolescent population. Additionally, we aimed to evaluate the prevalence and odds of substance abuse, hopelessness, and suicidality among the sexual minority adolescents compared to their heterosexual peers.. We performed a retrospective cross-sectional study using Youth Risk Behavior Surveillance System (YRBSS) data from 2015 to 2019. YRBSS divides "Sexual identity" into three groups: heterosexuals, sexual minorities (gay or lesbian or bisexual), and unsure. We identified "hopelessness and suicidality" using the survey questions exploring if participants felt sad or hopeless for >2 weeks, considered suicide, made a suicide plan, and attempted suicide requiring medical care. Univariate and multivariable survey logistic regression analyses were performed to establish an association between hopelessness, suicidality, substance abuse, and identifying as a sexual minority.. Out of 41,377 adolescents, 4055 (9.8%) identified as a sexual minority. An increasing percentage of adolescents identified themselves as a sexual minority between 2015 to 2019 (8% to 11.2%) (pTrend<0.0001). The sexual minority had a higher prevalence of feeling sad and hopeless (63.4 vs. 28.6%), considering suicide (46 vs. 14.2%), planning suicide (38.9 vs. 11.5%), attempting suicide, and having injurious suicide attempts compared to heterosexuals. (p<0.0001) Amongst sexual minorities, the prevalence of substance abuse was higher compared to their heterosexual peers, which includes cigarettes (15 vs 7.8%), e-cigarette (27.2 vs 23.2%), inhalants (14.1 vs 5.3%), cocaine (8.4 vs 3.9%), marijuana (31.2 vs 20.2%), alcohol (36.9 vs 30.3%), steroids (6.4 vs 2.2%), heroin (4.4 vs 1.2%), and injectable drugs (4.0 vs 1.1%) (p<0.0001). In regression analysis, the sexual minority had higher odds of substance abuse, feeling sad and hopeless (aOR:4.6; 95%CI:4.0-5.2; p<0.0001), considering suicide (3.2; 2.8-3.7; p<0.0001), planning suicide (2.0; 1.7-2.3; p<0.0001) compared to heterosexual.. Sexual minorities not only have higher prevalence and odds of hopelessness and suicidality but also have higher prevalence and odds of substance abuse like cigarettes, marijuana, cocaine, heroin, inhalants, and steroids. Hence, early identification, risk stratification, and interventions to reduce mental health disparities are needed.

Topics: Adolescent; Centers for Disease Control and Prevention, U.S.; Cocaine; Cross-Sectional Studies; Electronic Nicotine Delivery Systems; Female; Heroin; Humans; Mental Health; Retrospective Studies; Risk-Taking; Sexual and Gender Minorities; Substance-Related Disorders; United States

Drug-related overdose deaths topped 100,000 between 2020 and 2021. Opioids and stimulants are implicated as the primary drivers of this public health crisis. Stigma remains one of the primary barriers to treatment and recovery from substance use disorders. However, little is known about how stigma varies across different substance types, whether individuals are actively using or in recovery, and medical versus recreational onset. We examined these questions using data from the 2021 Shatterproof Addiction Stigma Index, the only nationally representative data available on this topic. Respondents (N = 7051) completed a vignette-based survey experiment to assess public stigma (social distance, prejudice, competence, and causal attributions) toward people with alcohol, opioid (following a prescription pain or recreational use onset), heroin, or methamphetamine dependencies. Vignette characters were described as active users or in recovery. Adjusting for covariates (e.g., race, age, gender), prejudice and desire for social distance were highest toward heroin and methamphetamine, and lowest toward alcohol dependence. The perceived onset of the dependency affected stigma. Specifically, prescription opioids with a recreational onset were more stigmatized than those with a medical onset. Moreover, individuals depicted as being in recovery were less stigmatized than those depicted as active users. Recovery status had the largest impact on prejudice and social distance toward methamphetamine, relative to other conditions. The nature and magnitude of substance dependency stigma differs across substance types and onset and offset conditions. Reducing stigma will require tailored strategies that consider the multidimensional nature of stigma toward people with addiction.

Topics: Analgesics, Opioid; Heroin; Humans; Methamphetamine; Social Stigma; Substance-Related Disorders

To investigate attitude of community pharmacists toward patients with a substance-related disorder (heroin, alcohol and tobacco).. The attitudes were assessed thanks to the Attitude to Mental Illness Questionnaire (AMIQ) for heroin, alcohol and tobacco-related disorders in three independent groups of pharmacists. Estimation of substance-related harmfulness, knowledge of substance-related disorders and activities/needs for continuing education on substance-related disorders were also recorded.. Thirty-five pharmacists were included (heroin: 11, alcohol: 10 and tobacco: 14). AMIQ scores for heroin-related disorder were negative and lower than for alcohol (P<0.01) and tobacco (P<0.001). AMIQ scores for alcohol-related disorder were lower than for tobacco (P<0.05). The estimation of heroin-related harmfulness was higher than for alcohol and tobacco (P<0.001). The estimations of knowledge of substance-related disorders were lower for opioid and alcohol than for tobacco (P<0.001). AMIQ scores and the needs for continuing education on each associated addiction showed a positive relation (P<0.01).. Pharmacists had a negative attitude toward heroin and alcohol-related disorders. A positive attitude toward patients with a substance-related disorder was associated with a need for continuing education. Efforts should be made to change attitudes and to promote continuing education on heroin and alcohol-related disorders.

Topics: Alcohol-Related Disorders; Analgesics, Opioid; Attitude; Attitude of Health Personnel; Cross-Sectional Studies; Education, Continuing; Ethanol; Heroin; Humans; Nicotiana; Pharmacists; Substance-Related Disorders

Topics: Buprenorphine; Chromatography, Liquid; Glucuronosyltransferase; Heroin; Humans; Naloxone; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Substance-Related Disorders; Tandem Mass Spectrometry

Estimation of consumption of illicit drugs by wastewater-based epidemiology provides estimates of community drug-use patterns. This study describes monitoring data of three illicit drugs in New Zealand using wastewater-based epidemiology. Wastewater samples were collected at monthly intervals for larger (population ~ 50,000+) cities or in smaller towns where more data was required by authorities. In other smaller towns, samples were collected every 2 months. Samples were extracted and analysed for parent compounds and metabolites of methamphetamine, MDMA, cocaine, heroin and fentanyl consumption using solid-phase extraction followed by liquid chromatography coupled with tandem-mass spectrometry (LC-MS/MS) detection. Back calculations were performed to estimate the consumption of each drug in each catchment area. Methamphetamine was the drug measured with the highest estimated mean consumption rates (724 mg/1000 people per day) in New Zealand. North Island small urban settlements had the highest estimated mean methamphetamine consumption rates (1259 mg/1000 people/day). Cocaine had the lowest estimated consumption rates (9.4 mg/1000 people/day). The highest estimated mean cocaine consumption rate was in North Island major urban settlements (24.4 mg/1000 people/day). Major urban settlements had the highest estimated mean MDMA (420 mg/1000 people/day) and cocaine consumption rates (18.8 mg/1000 people/day). South Island medium urban settlements had unexpectedly high estimated mean consumption rates of MDMA (533 mg/1000 people/day) and cocaine (17.0 mg/1000 people/day). The higher-than-expected estimated cocaine consumption was from one medium urban settlement that is also a popular tourist destination in the South Island. Heroin biomarkers were not detected at any locations, and fentanyl was detected around or below the limit of reporting. This research provides information for appropriate responses for improved social and health investment to support social services associated with illicit drug consumption.

Topics: Chromatography, Liquid; Cocaine; Fentanyl; Heroin; Humans; Illicit Drugs; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; New Zealand; Substance Abuse Detection; Substance-Related Disorders; Tandem Mass Spectrometry; Wastewater; Water Pollutants, Chemical

Quantitative results from toxicological analyses of autopsy material are widely compared to ranges in reference works to determine if drug concentrations are in relevant levels for establishing intoxication. This study compares concentrations of commonly used opioids and stimulants from drug addict autopsies and driving under the influence of drugs (DUID) cases to supplement current knowledge of the possible span and overlaps of measured concentrations. The study included whole-blood results from forensic autopsies of drug addicts performed from 2015 to 2020 (n = 220) and DUID cases from 2015 to 2019 (n = 7088). The focus was on heroin/morphine, methadone, cocaine, amphetamine and MDMA concentrations because these drugs are commonly encountered in both fatal intoxications and DUID cases and the potential for abuse is well known. In the DUID group, the opioids heroin/morphine and methadone and the stimulants amphetamine and MDMA were often seen in concentrations above the reported lower comatose-fatal level whereas cocaine was almost always below. Thus, based on our data, the potential for false assessment of intoxication cases when comparing to reported comatose-fatal limits appears greatest on lower end concentrations of heroin/morphine, methadone, amphetamine and MDMA, whereas false assessment of cocaine appears less likely because most control cases are below reported comatose-fatal levels.

Topics: Amphetamine; Analgesics, Opioid; Autopsy; Central Nervous System Stimulants; Cocaine; Coma; Heroin; Humans; Methadone; Morphine; N-Methyl-3,4-methylenedioxyamphetamine; Substance Abuse Detection; Substance-Related Disorders

Polysubstance use among people who misuse opioids (PWMO) is highly prevalent, but understudied. We defined, estimated, and analyzed national polysubstance use patterns among PWMO using National Household Survey on Drug Use and Health data (2017-2019).. We obtained estimates of past-month patterns of polydrug use using cluster analysis and latent class/profile analysis. We considered misuse of prescription opioids and use of heroin, cocaine (including crack), marijuana, alcohol, and "other" substances.. We identified a five-cluster solution for binary indicators of past-month use and a six-cluster solution for frequency of use. The largest binary cluster (37%) included misuse of prescription opioids and use of alcohol. The second-largest cluster (15%) included misuse of prescription opioids, alcohol, marijuana, and "other" substances. Among those who used heroin, 36% used methamphetamine. In terms of frequency of use, the largest cluster among people who misuse opioid who used multiple substances (almost 40%) misused prescription pain relievers, alcohol, and marijuana infrequently. The second-largest cluster (23%) used marijuana almost daily and misused prescription pain relievers an average of 6.6 days. PWMO in a cluster of almost daily heroin use indicated use of methamphetamine, marijuana, and prescription opioids. Those who used methamphetamine, were using it more than 15 days a month.. We have developed reference measures of polydrug patterns among US household population and estimated their demographic characteristics. We identified clusters of high-risk polydrug use. These findings have implications for the development of prevention and treatment solutions in the United States.

Topics: Analgesics, Opioid; Heroin; Humans; Methamphetamine; Opioid-Related Disorders; Pain; Prescription Drug Misuse; Prescriptions; Substance-Related Disorders; United States

During the last decade, opioid prescription policies in Norway have been liberalised and pharmaceutical opioid (PO) dispensing has increased. Against this backdrop, we examined the trends in and the correlates of accidental overdose deaths attributable to PO in the period 2010-2018 in comparison with traditional heroin overdose deaths.. Accidental overdose deaths attributable to PO or heroin were identified through the Norwegian Cause of Death Registry (n = 1267) and cross-linked with population and patient registries. Overdose death correlates were examined using multivariable logistic regression.. The trend in accidental overdose deaths attributable to PO increased significantly from 2010 to 2018. Females, people aged 50 years or older, disability pension recipients and/or those with the highest net wealth had a greater risk of a PO vs. heroin overdose death, while those dying in public spaces, living in urban areas, having recent specialized drug treatment encounters, and/or criminal charge(s) had a lower risk. Among those with primary health care encounters, those with back problems and accidents and injuries had a greater risk of a PO vs. heroin overdose death, while those with a substance use disorder had a lower risk.. The increase in accidental overdose deaths attributable to PO coincides with the period of opioid prescription policy liberalization and an increase in PO consumption in Norway. The PO and heroin overdose deaths differed in terms of the associated sociodemographic characteristics, primary and secondary health care encounters, diagnoses, and criminal charges, indicating a need for additional interventions aimed at preventing PO overdose deaths specifically.

Topics: Analgesics, Opioid; Drug Overdose; Female; Heroin; Humans; Opiate Overdose; Pharmaceutical Preparations; Policy; Prescriptions; Substance-Related Disorders

At age 16, I injected morphine for the first time, and then started injecting heroin. By most standards, I was highly functioning, although I eventually became addicted. I was and remain socioeconomically privileged, but my relationship to heroin resulted in behaviors and consequences that I never could have conceived of, and which I sometimes strain to remember occurred. My life now is stable and conventional. Some aspects of my past addiction are unerasable, but the most salient of those are the social and legal consequences of having a criminal record-not any hallmarks of a chronic brain disease or disorder. I do not consider myself "in recovery." Rather, I am recovered, by standards both my own and derived from clinical nosology. I have been in sustained remission for over a decade. Yet feelings are not facts, as is often said. I still use alcohol, and occasionally (though not recently) I have used other drugs, so there remains the possibility that my brain is indeed "diseased" and I am not objectively recovered, my self-assessment notwithstanding. My aim in writing about my lived experience of drug use, addiction, and recovery is to highlight the heterogeneity of people's experiences and the insight that personal narratives can provide. Debates about the brain disease model of addiction are often confined to academia, with the real-world, unintended consequences of the "disease" label seldom considered. Stigmatization of people with addiction comes from moralizing about drug use but may also originate from well-intended labels. I posit that we should not need labels to care about addicted people and make scientifically informed treatment accessible. Addicted people deserve help because they either need or want it, regardless of labels that presume to describe the etiology or likely trajectory of their problems. I conclude that some labels, even those needed for clinical classification of human behavior, may be pernicious. Clinicians and researchers have an obligation to reflect more deeply on the implications of the disease conceptualization of complex human behaviors such as addiction.

Topics: Adolescent; Behavior, Addictive; Brain Diseases; Heroin; Humans; Substance-Related Disorders

Lower perceived risk is a well-established risk factor for initiating substance use behaviors and an integral component of many health behavior theories. Established literature has shown that many substance use behaviors are more prevalent among individuals who identify as lesbian, gay, or bisexual than among those who identify as heterosexual. However, potential differences in perceived risk by sexual identity among individuals with no lifetime use have not been well characterized to date.. Data on 111,785 adults aged 18-34 years (including 11,377 lesbian, gay, and bisexual adults) were from the 2015-2019 National Survey on Drug Use and Health. Perceived risks (classified as great risk versus less than great risk) were assessed with 11 National Survey on Drug Use and Health survey items regarding 6 different substances (alcohol, cigarettes, marijuana, cocaine, lysergic acid diethylamide, and heroin). Survey-weighted and sex-stratified logistic regression models were used to estimate sexual identity differences regarding perceived great risk among those reporting no lifetime use. Analyses were conducted in 2021-2022.. Gay men, bisexual men, lesbian/gay women, and bisexual women were all significantly less likely than heterosexual peers to perceive great risk associated with specific marijuana, cocaine, lysergic acid diethylamide, and heroin use behaviors. Bisexual men and women were also significantly less likely than heterosexual peers to perceive great risk associated with binge drinking behaviors and smoking ≥1 packs of cigarettes daily.. This novel investigation among never users provides evidence that lesbian, gay, and bisexual adults perceive significantly lower risks associated with multiple substance use behaviors than heterosexual adults, which may indicate important sexual identity differences in susceptibility to substance use initiation.

Topics: Bisexuality; Cocaine; Female; Heroin; Heterosexuality; Humans; Lysergic Acid Diethylamide; Male; Sexual and Gender Minorities; Sexual Behavior; Substance-Related Disorders; Young Adult

Cardiovascular disease (CVD) and heart failure (HF) are major causes of mortality in low-income populations and differ by sex. Risk assessment that incorporates cardiac biomarkers is common. However, research evaluating the utility of biomarkers rarely includes controlled substances, which may influence biomarker levels and thus influence CVD risk assessment.. We identified the effects of multiple substances on soluble "suppression of tumorigenicity 2" (sST2), a biomarker of adverse cardiac remodelling, in 245 low-income women. Adjusting for CVD risk factors, we examined associations between substance use and sST2 over six monthly visits.. Median age was 53 years and 74% of participants were ethnic minority women. An sST2 level > 35 ng/mL (suggesting cardiac remodelling) during ≥1 study visit was observed in 44% of participants. In adjusted analysis, higher sST2 levels were significantly and positively associated with the presence of cocaine (Adjusted Linear Effect [ALE]:1.10; 95% CI:1.03-1.19), alcohol (ALE:1.10; 95% CI:1.04-1.17), heroin (ALE:1.25; 95% CI:1.10-1.43), and the interaction between heroin and fentanyl use.. Results suggest that the use of multiple substances influences the level of sST2, a biomarker often used to evaluate cardiovascular risk. Incorporating substance use alongside cardiac biomarkers may improve CVD risk assessment in vulnerable women.

Topics: Biomarkers; Cardiovascular Diseases; Ethnicity; Female; Heart Failure; Heroin; Humans; Interleukin-1 Receptor-Like 1 Protein; Middle Aged; Minority Groups; Prognosis; Substance-Related Disorders; Ventricular Remodeling

Women comprise around 15% of admissions to provincial correctional institutions in Canada. Women in custody are known to have a high prevalence of mental health concerns, but little is known about how those referred to mental health services compare with referred men at a similar stage of imprisonment.. Our aim was to describe and compare clinical, social and demographic characteristics of a complete cohort of custodially remanded men and women who were referred to mental health services while under custodial remand in two correctional institutions.. We carried out retrospective analysis of data obtained from 4040 men and 1734 provincially detained women referred to mental health services in two correctional centres holding mainly pre-trial prisoners and serving a large mixed urban-rural catchment area in Toronto, Canada over a nearly five-year period. Men and women were first screened using the Brief Jail Mental Health Screen. Those who screened positive were assessed using the Jail Screening Assessment Tool the Brief Psychopathology Rating Scale-Expanded (BPRS-E) and the Clinical Global Impression-Corrections (CGI-C).. There were many similarities between men and women, but also some important differences. Women were more socioeconomically disadvantaged than men. More women than men reported having children, yet fewer reported having any form of employment or social supports, although men were more likely to report unstable housing. In addition, women were significantly more likely to have mood and anxiety problems and to be self-harming, but did not differ from men in current psychotic symptoms. We also found differences in patterns of substance use, with a higher proportion of women using heroin and methamphetamines but fewer women having accessed addiction services.. Our findings have implications for clinicians and service planners. They underscore the value of systematic screening for identifying need. More specifically, they suggest need for increased availability of addiction services for women as well as ensuring support for those women who have dependent-age children. Improvement in supports for entry into employment is particularly needed for women, while men are particularly likely to need access to stable housing.

Topics: Child; Female; Heroin; Humans; Male; Mental Disorders; Mental Health Services; Ontario; Prisoners; Prisons; Retrospective Studies; Substance-Related Disorders

Depression is a mental health problem and substance use concerns are socially unacceptable behaviors. While depression and substance use may individually impact self-concept and social relationships, their co-occurrence can increase the risk of self-stigmatization. However, there is no evidence regarding how depression and self-stigma may influence each other over time. The aim of the current study was to evaluate the cross-sectional and longitudinal relationships between features of depression and self-stigma in people with substance use disorders.. Overall, 319 individuals with substance use disorders (273 males) with a mean (± SD) age of 42.2 (± 8.9) years were recruited from a psychiatric center in Taiwan by convenience sampling. They were assessed for features of depression and self-stigma at four times over a period of nine months using the depression subscale of the Depression Anxiety Stress Scales (DASS-21) and Self-Stigma Scale-Short S (SSS-S), respectively. Repeated-measures analyses of variance, Pearson correlations and cross-lagged models using structural equation modeling examined cross-sectional and temporal associations between depression and self-stigma.. Positive cross-sectional associations were found between depressive features and all assessed forms of self-stigma over time (0.13 < r < 0.92). Three models of cross-lagged associations between different forms of self-stigma and depressive features indicated good fit indices (comparative fit index > 0.98). The direction of associations between depressive features towards self-stigma was stronger than the opposite direction.. Positive associations between depressive features and self-stigma were found in people with substance use disorders. Although these associations may be bidirectional longitudinally, the directions from depressive features to self-stigma may be stronger than the reverse directions, suggesting treatment of depression in earlier stages may prevent self-stigmatization and subsequent poor outcomes in people with substance use disorders.

Topics: Adult; Amphetamine; Cross-Sectional Studies; Depression; Heroin; Humans; Male; Middle Aged; Social Stigma; Substance-Related Disorders

Heroin, a mu agonist, acts through the mu opioid receptor. The mu opioid receptor gene, OPRM1, undergoes extensive alternative splicing, creating an array of splice variants that are conserved from rodent to humans. Increasing evidence suggests that these OPRM1 splice variants are pharmacologically important in mediating various actions of mu opioids, including analgesia, tolerance, physical dependence, rewarding behavior, as well as addiction. In the present study, we examine expression of the OPRM1 splice variant mRNAs in the medial prefrontal cortex (mPFC), one of the major brain regions involved in decision-making and drug-seeking behaviors, of male human heroin abusers and male rats that developed stable heroin-seeking behavior using an intravenous heroin self-administration (SA) model. The results show similar expression profiles among multiple OPRM1 splice variants in both human control subjects and saline control rats, illustrating conservation of OPRM1 alternative splicing from rodent to humans. Moreover, the expressions of several OPRM1 splice variant mRNAs were dysregulated in the postmortem mPFCs from heroin abusers compared to the control subjects. Similar patterns were observed in the rat heroin SA model. These findings suggest potential roles of the OPRM1 splice variants in heroin addiction that could be mechanistically explored using the rat heroin SA model.

Topics: Alternative Splicing; Animals; Heroin; Humans; Male; Prefrontal Cortex; Rats; Receptors, Opioid, mu; RNA, Messenger; Substance-Related Disorders

Substance use in young adulthood and polysubstance users (PSU), in particular, pose unique risks for adverse consequences. Prior research on young adult PSU has identified multiple classes of users, but most work has focused on college students. We examined PSU patterns by age and college attendance during young adulthood in two nationally representative samples. Using National Epidemiological Survey on Alcohol and Related Conditions (NESARC) Wave 1 and NESARC-III data sets, multigroup latent class analysis (MG-LCA) was employed to examine PSU patterns based on age (18-24 vs. 25-34) and determine whether solutions were similar (i.e., statistically invariant) by college attendance/graduation. Classes were estimated by binary past-year use of sedatives, tranquilizers, opioids/painkillers, heroin, amphetamines/stimulants, cocaine, hallucinogens, club drugs, and inhalants, and past-year frequency of alcohol, cigarette, and cannabis use. PSU patterns are largely replicated across waves. Model fit supported 3-class solutions in each MG-LCA: Low frequency-limited-range PSU (alcohol, cigarettes, and cannabis only), medium-to-high frequency limited-range PSU (alcohol, cigarettes, and cannabis only), and extended-range PSU (ER PSU; all substances). Apart from one model, MG-LCA solutions were not invariant by college attendance/graduation, suggesting important differences between these groups. Except for alcohol, cannabis, and cigarette use frequency, results showed that probabilities of illicit and prescription drug use declined in the older age group. Findings also supported examining college and noncollege youth separately when studying PSU. ER PSU may be uniquely vulnerable to coingesting substances, particularly for nongraduates, warranting future research to classify patterns of simultaneous PSU and identify predictors and consequences of high-risk combinations (e.g., alcohol and opioids). (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Topics: Adolescent; Adult; Aged; Amphetamines; Analgesics, Opioid; Cannabis; Cocaine; Hallucinogens; Heroin; Humans; Hypnotics and Sedatives; Illicit Drugs; Prescription Drugs; Substance-Related Disorders; Young Adult

This article examines injectable Opioid Agonist Treatment (iOAT), in which patients suffering from long-term, treatment refractory opioid use disorder (OUD) are prescribed injectable diacetylmorphine, the active ingredient of heroin. While iOAT is part of the continuum of care for OUD in some European countries and in some parts of Canada, it is not an available treatment in the United States. We suggest that one reason for this situation is the belief that a genuine treatment for substance use disorder cannot prescribe the same substance as that used. We examine possible rationales for this belief by considering four combinations of views on the constitutive causal basis of substance use disorders and the definition of effective treatment. We show that all but one combination counts iOAT as a genuine treatment and that there are good reasons to reject the one that does not. Specifically, we claim that medical interventions, such as iOAT, that significantly reduce the severity of a disorder deserve to be categorized as effective treatments and regarded as such in practice.

Topics: Analgesics, Opioid; Canada; Ethics, Clinical; Europe; Heroin; Humans; Narcotics; Opiate Substitution Treatment; Opioid-Related Disorders; Substance-Related Disorders; United States

Here we present a case of acute renal failure needing dialysis in a heroin addict patient chronically treated with Metadone. This give us the opportunity to review the renal effects of the main drugs of abuse, highlighting the shift occured from the four "old sisters" (Marijuana, Cocaine, Heroin and Amphetamine) to the news synthetic drugs (chiefly Synthetic Cathinones and Cannabinoids), that poses problems due to large diffusion, easy procurement, legal non-regulation and difficult analytical identification, raising medical and forensic questions. From a Nephrological point of view is essential to take great care over the need to diagnose this kind of pathology and to widen the search trying anyway to recognize the substances potentially involved.

Topics: Acute Kidney Injury; Cocaine; Heroin; Humans; Renal Dialysis; Substance-Related Disorders

The conjunction of the coronavirus disease lockdown and the use of illicit drugs suggests the potential increase in drug usage and opioid deaths. Because of other studies, we felt the need to examine if the lockdown has caused a change in the drug intake of our population of substance abuse and pain management patients.. Urine drug testing is a strategy to reduce harm to patients in pain management and substance abuse treatment programs. We analyzed trends in the clinical drug testing patterns of urine specimens sent by substance abuse and pain clinics to monitor their patients. These specimens were tested by a national clinical laboratory using LC-MS/MS definitive methods. The time frame of these comparative observations was the past five years, including the time of the pandemic.. The only decrease was a 30% reduction in test requests during the second quarter of 2020. Among the patients tested, positivity decreased greatly for the illicit drugs heroin and cocaine but increased for methamphetamine and fentanyl. Use of the antidepressant and anxiolytic drugs remained consistent or declined for some drugs, relative to pre-pandemic patterns. The percent of patients prescribed the opiates morphine and oxycodone decreased, while the use of hydrocodone increased. Positivity for the drug gabapentin increased greatly. The use of alcohol did not increase significantly during the lockdown period.. In summary, these findings demonstrate relatively consistent drug use, with decreased positivity for high-risk drugs and dangerous drug combinations. We speculate that monitoring of these patients mitigates the possibility of drug misuse and potential overdose and is in concordance with the goals of these monitoring programs.

Topics: Alcohol Drinking; Analgesics; Antidepressive Agents; California; Cocaine; COVID-19; Fentanyl; Heroin; Humans; Illicit Drugs; Methamphetamine; Pain Management; Secologanin Tryptamine Alkaloids; Social Isolation; Substance Abuse Detection; Substance-Related Disorders

The inability to maintain drug abstinence is often referred to as relapse and consists of a process by which an abstaining individual slips back into old behavioral patterns and substance use. Animal models of relapse have been developed over the last decades and significantly contributed to shed light on the neurobiological mechanisms underlying vulnerability to relapse. The most common procedure to study drug-seeking and relapse-like behavior in animals is the "extinction-reinstatement model." Originally elaborated by Pavlov and Skinner, the concepts of reinforced operant responding were applied to addiction research not before 1971 (Stretch et al., Can J Physiol Pharmacol 49:581-589, 1971), and the first report of a reinstatement animal model as it is now used worldwide was published only 10 years later (De Wit and Stewart, Psychopharmacology 75:134-143, 1981). According to the proposed model, opioids are typically self-administered intravenously, as humans do, and although rodents are most often employed in these studies, a variety of species including nonhuman primates, dogs, cats, and pigeons can be used. Several operant responses are available, depending on the species studied. For example, a lever press or a nose poke response typically is used for rodents, whereas a panel press response typically is used for nonhuman primates. In this chapter we describe a simple and easily reproducible protocol of heroin-seeking reinstatement in rats, which proved useful to study the neurobiological mechanisms underlying relapse to heroin and vulnerability factors enhancing the resumption of heroin-seeking behavior.

Topics: Administration, Intravenous; Analgesics, Opioid; Animals; Behavior Control; Behavior, Addictive; Conditioning, Operant; Cues; Disease Models, Animal; Drug-Seeking Behavior; Heroin; Infusions, Intravenous; Male; Opioid-Related Disorders; Rats; Rats, Sprague-Dawley; Rats, Wistar; Reinforcement, Psychology; Reward; Self Administration; Substance-Related Disorders

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

Topics: Aged; Heroin; Humans; Opioid-Related Disorders; Substance-Related Disorders; Surveys and Questionnaires

Behavioral economics provides a framework in which to understand choice and motivation in the field of substance use disorders. Hypothetical purchase tasks (HPT), which indicate the amount or probability of purchasing substances at different prices, have been suggested as a clinical tool that can help predict future substance use and identify targets for intervention.. Hypothetical demand for heroin, cocaine, and benzodiazepines was assessed at baseline and after six-months in 52 opioid-agonist treatment patients. The results were analyzed using a novel exponential demand equation (normalized zero-bounded exponential model [ZBEn]) that uses a log-like transform that accommodates zero consumption values.. Demand for these drugs was well described by the ZBEn model. After six months, demand intensity for heroin was decreased and demand metrics for cocaine and benzodiazepines increased. Multiple demand curve indices at baseline predicted the percentage of drug-positive urinalysis results at follow-up, even after controlling for covariates. Additionally, participants were divided into High and Low baseline demand groups for each drug based on demand indices. Participants with High demand at baseline for 8 out of 9 groups had significantly more drug-positive urine samples in the subsequent 6-month period.. This report provides evidence that demand assessment is predictive of future substance use and could help guide treatment planning at intake. These results also demonstrated that the ZBEn model provides good fits to consumption data and allows for sensitive statistical analyses.

Topics: Adult; Analgesics, Opioid; Benzodiazepines; Cocaine; Consumer Behavior; Economics, Behavioral; Female; Heroin; Humans; Male; Motivation; Substance-Related Disorders

Understanding whether International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes can be used to accurately detect substance use can inform their use in future surveillance and research efforts.. Using 2015-2018 data from a retrospective cohort study of 602 safety-net patients prescribed opioids for chronic non-cancer pain, we calculated the sensitivity and specificity of using ICD-10-CM codes to detect illicit substance use compared to retrospective self-report by substance (methamphetamine, cocaine, opioids [heroin or non-prescribed opioid analgesics]), self-reported use frequency, and type of healthcare encounter.. Sensitivity of ICD-10-CM codes for detecting self-reported substance use was highest for methamphetamine (49.5 % [95 % confidence interval: 39.6-59.5 %]), followed by cocaine (44.4 % [35.8-53.2 %]) and opioids (36.3 % [28.8-44.2 %]); higher for participants who reported more frequent methamphetamine (intermittent use: 27.7 % [14.6-42.6 %]; ≥weekly use: 67.2 % [53.7-79.0 %]) and opioid use (intermittent use: 21.4 % [13.2-31.7 %]; ≥weekly use: 52.6 % [40.8-64.2 %]); highest for outpatient visits (methamphetamine: 43.8 % [34.1-53.8 %]; cocaine: 36.8 % [28.6-45.6 %]; opioids: 33.1 % [25.9-41.0 %]) and lowest for emergency department visits (methamphetamine: 8.6 % [4.0-15.6 %]; cocaine: 5.3 % [2.1-10.5 %]; opioids: 6.3 % [3.0-11.2 %]). Specificity was highest for methamphetamine (96.4 % [94.3-97.8 %]), followed by cocaine (94.0 % [91.5-96.0 %]) and opioids (85.0 % [81.3-88.2 %]).. ICD-10-CM codes had high specificity and low sensitivity for detecting self-reported substance use but were substantially more sensitive in detecting frequent use. ICD-10-CM codes to detect substance use, particularly those from emergency department visits, should be used with caution, but may be useful as a lower-bound population measure of substance use or for capturing frequent use among certain patient populations.

Topics: Adult; Analgesics, Opioid; Chronic Pain; Cocaine; Emergency Service, Hospital; Female; Heroin; Humans; Illicit Drugs; International Classification of Diseases; Male; Methamphetamine; Middle Aged; Opioid-Related Disorders; Retrospective Studies; Self Report; Sensitivity and Specificity; Substance-Related Disorders

Globally, heroin and other opioids account for more than half of deaths and years-of-life-lost due to drug use and comprise one of the four major markets for illegal drugs. Having sound estimates of the number of problematic heroin users is fundamental to formulating sound health and criminal justice policies. Researchers and policymakers rely heavily upon general population surveys (GPS), such as the US National Survey on Drug Use and Health (NSDUH), to estimate heroin use, without confronting their limitations. GPS-based estimates are also ubiquitous for cocaine and methamphetamine, so insights pertaining to GPS for estimating heroin use are also relevant for those drug markets.. Four sources of potential errors in NSDUH are assessed: selective non-response, small sample size, sampling frame omissions and under-reporting. An alternative estimate drawing on a variety of sources including a survey of adult male arrestees is presented and explained. Other approaches to prevalence estimation are discussed.. Under-reporting and selective non-response in NSDUH are likely to lead to substantial underestimation. Small sample size leads to imprecise estimates and erratic year-to-year fluctuations. The alternative estimate provides credible evidence that NSDUH underestimates the number of frequent heroin users by at least three-quarters and perhaps much more.. GPS, even those as strong as NSDUH, are doomed by their nature to estimate poorly a rare and stigmatized behavior concentrated in a hard-to-track population. Although many European nations avoid reliance upon these surveys, many others follow the US model. Better estimation requires models that draw upon a variety of data sources, including GPS, to provide credible estimates. Recent methodological developments in selected countries can provide guidance. Journals should require researchers to critically assess the soundness of GPS estimates for any stigmatized drug-related behaviors with low prevalence rates.

Topics: Adult; Cocaine; Health Surveys; Heroin; Humans; Illicit Drugs; Male; Substance-Related Disorders

The misuse of illicit substances is associated with increased morbidity and mortality; thus, substance abuse is a global health concern. The Arabian Gulf region is considered a crossing point and a consumer of illicit drugs. However, a lack of laboratory-based research has limited the scientific assessment of drug misuse in the Arabian Gulf region. Thus, an up-to-date analytical representation of the drug situation is warranted.. We investigated the type and quantity of detained narcotic drugs and psychotropic substances from 2015 to 2018, representing a population of approximately 4 million people, in addition to the number of abusers and mortality among abusers. In total, 6220 cases from the Narcotic and Psychotropic Laboratory and 17,755 cases from the Forensic Toxicology Laboratory were reviewed and analyzed. Substances were identified and documented using gas chromatography-mass spectrometry and liquid chromatography-mass spectrometry.. Cannabis, including marijuana, was the most seized substance, followed by heroin, opium, and cocaine. Amphetamines, including methamphetamine, in the form of powder or pills, were seized in larger quantities than other psychoactive substances. The most consumed substances were, in order, amphetamines (including methamphetamine), benzodiazepines, cannabis, and heroin. We identify the common drugs in postmortem specimens, according to sex, from suspected drug-related deaths. The most common single drug identified were heroin, benzodiazepines, and methamphetamine. Similarly, the multiple-drug cocktail of heroin-benzodiazepines, cannabis-benzodiazepines, and cannabis-amphetamines, were detected frequently.. The data shows that cannabis is the leading type of illicit substance seized. Deaths resulting from benzodiazepines and heroin abuse were the highest in the single drug category, while heroin-benzodiazepines combination deaths were the highest in the multiple-drug category. Methamphetamine was the most abused illicit drug in Kuwait. These findings revealed the illicit drug abuse situation in the State of Kuwait, in a region that suffers from the scarcity of information regarding illicit substances. Thus, providing valuable information for drug enforcement, forensic analyst, health workers on national and international levels.

Topics: Heroin; Humans; Illicit Drugs; Kuwait; Narcotics; Psychotropic Drugs; Substance-Related Disorders

Methamphetamine use is a growing public health concern in the United States. Prior analyses with nationally representative data from 2015 to 2017 suggested that increases in methamphetamine use appeared largely selective to people using heroin. This analysis updated prior estimates to determine if trends are selectively persistent and how they compare to historical trends. We also evaluate sociodemographic risk factors associated with methamphetamine use among people using heroin.. Data from the 2015-2019 National Surveys on Drug Use and Health (NSDUH) were analyzed. Data from the 2006-2014 NSDUH were summarized for historical trends. Past month and past year methamphetamine use prevalence was determined within populations using heroin as well as those using other drugs (e.g., cocaine, cannabis). Multivariable logistic models accounting for complex survey design evaluated predictors of methamphetamine use among people using heroin.. From 2015 to 2019, past month methamphetamine use increased from 9.0% to 44.0% within the population of people reporting past month heroin use. Similarly, past year methamphetamine use increased from 22.5% to 46.7% among those reporting past year heroin use. Risk factors for methamphetamine use among people using heroin included rurality, past year injection drug use, and serious mental illness.. A rapid, selective, and sustained increase in methamphetamine use is evident among people using heroin. These findings combined with similar findings in treatment admission and overdose data emphasize the need for increased attention to a specific type of high-risk use pattern in the United States, an issue that appears increasingly unlikely to naturally resolve.

Topics: Cocaine; Heroin; Humans; Methamphetamine; Substance Abuse, Intravenous; Substance-Related Disorders; United States

Novel synthetic opioids are fueling the overdose deaths epidemic in North America.Recently, non-fentanyl novel synthetic opioids have emerged in forensic toxicological results. Cryptomarkets have become important platforms of distribution for illicit substances. This article presents the data concerning the availability trends of novel non-fentanyl synthetic opioids listed on one cryptomarket.. Listings from the EmpireMarket cryptomarket "Opiates" section were collected between June 2020 and August 2020. Collected data were processed using eDarkTrends Named Entity Recognition algorithm to identify novel synthetic opioids, and to analyze their availability trends in terms of frequency of listings, available average weights, average prices, quantity sold, and geographic indicators of shipment origin and destination information.. 35,196 opioid-related listings were collected through 12 crawling sessions. 17 nonfentanyl novel synthetic opioids were identified in 2.9 % of the collected listings for an average of 9.2 kg of substance available at each data point. 587 items advertised as non-fentanyl novel synthetic opioids were sold on EmpireMarket for a total weight of between 858 g and 2.7 kg during the study period. 45.5 % of these listings were advertised as shipped from China.. Fourteen of the 17 non-fentanyl novel synthetic opioids were identified for the first time on one large cryptomarket suggesting a shift in terms of novel non-fentanyl synthetic opioids availability. This increased heterogeneity of available novel synthetic opioids could reduce the efficiency of existing overdose prevention strategies. Identification of new opioids underpins the value of cryptomarket data for early warning systems of emerging substance use trends.

Topics: Analgesics, Opioid; Drug Overdose; Fentanyl; Heroin; Humans; Substance-Related Disorders

Previous studies showed the association between substance use disorders (SUDs) and borderline and antisocial personality disorders. Substance abusers may have emotional, somatic and interpersonal distresses. This study aimed to investigate the associations between substance, personality and psychosocial distresses.. This cross-sectional, questionnaire-based study recruited 39 individuals with heroin use disorder (HUD), 111 with methamphetamine use disorder (MUD) and 101 as the control group in a rural area of Taiwan. The Tridimensional Personality Questionnaire (TPQ) and Opiate Treatment Index were used to assess the association between personality and psychosocial conditions. Deviations of the three personality dimensions of TPQ (novelty seeking, harm avoidance, and reward dependence) could reflect eight personality patterns.. We found SUD was associated with high novelty seeking and harm avoidance traits and explosive (borderline) personality pattern, whereas HUD was also linked with sensitive (narcissistic) pattern. Subjects with HUD tended to have more deviant personality traits than subjects with MUD. For subjects with SUDs, all three personality dimensions and sensitive (narcissistic) personality patterns were associated with emotional and somatic distresses, and those with explosive (borderline) and sensitive (narcissistic) patterns had poor social functioning.. Our results indicate substance abusers with high novelty seeking and harm avoidance, corresponding to explosive (borderline) or sensitive (narcissistic) patterns, to have a higher tendency to suffer from somatic and psychosocial distresses.

Topics: Adult; Cross-Sectional Studies; Female; Heroin; Humans; Male; Methamphetamine; Personality; Personality Disorders; Personality Inventory; Psychometrics; Stress, Psychological; Substance-Related Disorders; Surveys and Questionnaires; Taiwan

Nationally, it was estimated that 11.4 million people misused opioids in 2017 with more than 47,000 opioid-related deaths. Although medication-assisted treatment (MAT) has been effective in enhancing treatment retention and decreasing frequency of opioid use, relapse rates for opioids and other substances remain high, emphasizing the importance of investigating novel interventions to augment MAT. One potential treatment approach is repetitive transcranial magnetic stimulation (rTMS)-a noninvasive, electrophysiological method of neuromodulation. Recently published studies of rTMS in individuals with alcohol, nicotine, and cocaine use disorder have suggested that this treatment shows promise in reducing cravings and substance use. The literature specific to rTMS and opioid use disorder (OUD) is limited to a single published study in heroin users, which showed that a single session of rTMS to the left dorsolateral prefrontal cortex (DLPFC) reduced cue-induced craving, with a further reduction following 5 consecutive days of rTMS. The following case report involved a 25-year-old Caucasian male diagnosed with OUD and cocaine use disorder. This subject continued to demonstrate ongoing substance use despite participating in comprehensive MAT with buprenorphine/naloxone in combination with psychosocial interventions. He was administered 7 separate sessions of rTMS targeting the left DLPFC. Substance-related cues were presented prior to, during, and following these rTMS administration sessions and the subject rated his substance cravings via a 100-point Visual Analog Scale. When compared with his cue-induced craving ratings, there was a mean reduction in craving for heroin and cocaine by ∼60% to 82% following the 7 administration sessions. Although this is a single case, further investigation of rTMS as an augmentation strategy for OUD and polysubstance use is warranted. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Topics: Adult; Cocaine; Cocaine-Related Disorders; Craving; Cues; Heroin; Heroin Dependence; Humans; Male; Prefrontal Cortex; Substance-Related Disorders; Transcranial Magnetic Stimulation

Illicit drug use contributes to substantial morbidity and mortality. Drug scheduling, a legal measure in drug enforcement, is often structured as a hierarchy based on addiction tendency, abuse trends, and harm, but may lack data-driven evidence when classifying substances. Our study aims to measure addiction tendency and use trends based on real-world data. We used the open access database of National Police Agency, Ministry of the Interior in Taiwan and analyzed all daily criminal cases of illicit drugs from 2013 to 2017 and monthly illicit drug enforcement data from the same database from 2002 to 2017. We hypothesized that repeat and frequent use despite legal consequence may be a reflection of addictive behavior, and empirical mode decomposition was applied in analysis to calculate addiction tendency indices and intrinsic 15-year use trends. Our analysis showed heroin has the highest addiction index, followed by methamphetamine. 3,4-Methyl enedioxy methamphetamine, marijuana, and ketamine had lower addictive propensities. This result is consistent with most drug scheduling hierarchies. 15-year use trends of substances were consistent with previous epidemiological studies.

Topics: Amphetamine-Related Disorders; Anesthetics, Dissociative; Cannabis; Central Nervous System Stimulants; Crime; Databases, Factual; Hallucinogens; Heroin; Humans; Illicit Drugs; Ketamine; Marijuana Abuse; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Opioid-Related Disorders; Psychiatric Status Rating Scales; Substance-Related Disorders; Taiwan

Studies on the mortalities of drug abusers in China are scarce. This study explores the deaths of methamphetamine, opioid, and ketamine abusers in Shanghai (2004-2017) and Wuhan (2005-2017). Chi-square/Fisher's exact tests were used to compare the differences in terms of region, gender, age, cause of death, and the method used in the last drug abuse. Poisson regression models were used to estimate the rate ratios ("RRs") and annual percentage changes ("APCs"). 314 heroin, 43 methamphetamine, and 4 ketamine abusers were included. Furthermore, simultaneously, 6 abusers used heroin and methamphetamine, and 7 abusers used methamphetamine and ketamine. Heroin-related deaths have declined in Shanghai (APC, -16.1; 95 % CI, -18.4 to -11.3) and Wuhan (APC, -16.0; 95 % CI, -18.9 to -10.6), whereas methamphetamine-related deaths have increased in Wuhan (APC, 12.8; 95 % CI, 0.0 to 29.2). On the whole, in the two cities, males were more frequently observed than females in heroin-related deaths (4.4, 230/52). However, the gender ratios for methamphetamine- (1.8, 34/19) and ketamine-related deaths (1.2, 6/5) were close to one. In view of the mortality rates of the drug abusers in most Chinese cities were still unclear, it is thus important to improve mortality surveillance of the drug abusers at the national level.

Topics: Adolescent; Adult; Age Distribution; Analgesics, Opioid; Carbon Monoxide Poisoning; China; Female; Heroin; Humans; Illicit Drugs; Ketamine; Male; Methamphetamine; Middle Aged; Sex Distribution; Substance-Related Disorders; Suicide; Young Adult

The differential utility of neurocognitive impulsivity and externalizing/ internalizing traits as putative endophenotypes for dependence on heroin vs. amphetamine is unclear.. This exploratory study aims to determine: (1) whether neurocognitive impulsivity dimensions and externalizing/internalizing traits are correlated between siblings discordant for heroin and amphetamine dependence; and (2) which of these associations are common across substances and which are substance- specific.. Pearson correlations between individuals with 'pure' heroin and amphetamine dependence and their unaffected biological siblings (n = 37 heroin sibling pairs; n = 30 amphetamine sibling pairs) were run on 10 neurocognitive measures, 6 externalizing measures, and 5 internalizing measures. Sibling pair effects were further examined using regression.. Siblings discordant for heroin dependence were significantly correlated on delay aversion on the Cambridge Gambling Task, risk-taking on the Balloon Analogue Risk Task, sensation seeking, and hopelessness. Siblings discordant for amphetamine dependence were significantly correlated on the quality of decision-making on the Cambridge Gambling Task, discriminability on the Immediate Memory Task, commission errors on the Go/No Go Task, trait impulsivity, ADHD and anxiety sensitivity.. Dimensions of impulsivity and externalizing/internalizing traits appear to aggregate among siblings discordant for substance dependence. Risk-taking propensity, sensation seeking and hopelessness were specific for heroin sibling pairs. Motor/action impulsivity, trait impulsivity, and anxiety sensitivity were specific to amphetamine sibling pairs. Decisional/choice impulsivity was common across both heroin and amphetamine sibling pairs. These findings provide preliminary evidence for the utility of neurocognitive impulsivity and externalizing/ internalizing traits as candidate endophenotypes for substance dependence in general and for substance-specific dependencies.

Topics: Adult; Amphetamine; Analysis of Variance; Behavior, Addictive; Cognition; Decision Making; Endophenotypes; Female; Heroin; Humans; Impulsive Behavior; Mental Status and Dementia Tests; Personality Inventory; Risk Assessment; Siblings; Substance-Related Disorders

Topics: Adolescent; Adult; Child; Female; Heroin; Hospitalization; Humans; Injections; Male; Methamphetamine; Middle Aged; Substance-Related Disorders; United States

It is difficult to translate results from animal research on addiction to an understanding of the behavior of human drug users. Despite decades of basic research on neurobiological mechanisms of drug addiction, treatment options remain largely unchanged. A potential reason for this is that mechanistic studies using rodent models do not incorporate a critical facet of human addiction: volitional choices between drug use and non-drug social rewards (e.g., employment and family). Recently, we developed an operant model in which rats press a lever for rewarding social interaction with a peer and then choose between an addictive drug (heroin or methamphetamine) and social interaction. Using this model, we showed that rewarding social interaction suppresses drug self-administration, relapse to drug seeking, and brain responses to drug-associated cues. Here, we describe a protocol for operant social interaction using a discrete-trial choice between drugs and social interaction that causes voluntary abstinence from the drug and tests for incubation of drug craving (the time-dependent increase in drug seeking during abstinence). This protocol is flexible but generally requires 8-9 weeks for completion. We also provide a detailed description of the technical requirements and procedures for building the social self-administration and choice apparatus. Our protocol provides a reliable way to study the role of operant social reward in addiction and addiction vulnerability in the context of choices. We propose that this protocol can be used to study brain mechanisms of operant social reward and potentially impairments in social reward in animal models of psychiatric disorders and pain.

Topics: Animals; Choice Behavior; Conditioning, Operant; Disease Models, Animal; Drug-Seeking Behavior; Female; Heroin; Male; Methamphetamine; Models, Psychological; Rats; Rats, Long-Evans; Rats, Sprague-Dawley; Remifentanil; Self Administration; Social Behavior; Substance-Related Disorders

The increased availability of prescription opioids (PO) and non-medical prescription opioids (NMPO) has fundamentally altered drug markets and typical trajectories from initiation to high-risk use among people who use opioids (PWUO). This multi-site study explores trends in opioid initiation in three US cities and associations with sociodemographic factors, current drug use and overdose risk.. We analysed survey data from a cross-sectional study of PWUO in Baltimore, Maryland (n = 173), Boston, Massachusetts (n = 80) and Providence, Rhode Island (n = 75). Age of first exposure to PO, NMPO and heroin was used to calculate opioid of initiation, and multinomial regression was employed to explore correlates of initiating with each.. Thirty-three percent of PWUO initiated with heroin, 24% with PO, 18% with NMPO and 24% with multiple opioids in their first year of use. We observed a reduction in heroin initiation and gradual replacement with PO/NMPO over time. Women were more likely to initiate with NMPO [relative risk ratio (RRR) 2.4; 95% confidence interval (CI) 1.1, 5.0], PO (RRR 2.2, 95% CI 1.1, 4.4) or multiple opioids (RRR 2.1, 95% CI 1.1, 4.2), than heroin. PWUO initiating with NMPO had significantly higher current benzodiazepine use, relative to those initiating with heroin (RRR 3.2, 95% CI 1.4, 7.4), and a high prevalence of current fentanyl use (30%).. Our study highlights women and PWUO initiating with NMPO as key risk groups amid the changing landscape of opioid use and overdose, and discusses implications for targeted prevention and treatment.

Topics: Adult; Analgesics, Opioid; Baltimore; Boston; Cities; Cross-Sectional Studies; Female; Heroin; Humans; Male; Middle Aged; Opioid-Related Disorders; Rhode Island; Sex Distribution; Substance-Related Disorders

The purposes of the study include (i) demonstrating the US national level historical trends of the number of admitted patients due to substance abuse and those reported the selected substances at the time of admission, and more importantly, (ii) identifying the significant covariates in the association of using each of the substances along with the dynamics of likelihood over the different levels of the covariates. The trend of total admitted patients shows an increasing pattern from 1992 to 2008 and later exhibits a decreasing pattern before experiencing a significant upturn again in the last two consecutive years. During the study period, the highest growth rate of around 1088% is evident for methamphetamine followed by heroin (192%) and marijuana or hashish (45%), while both cocaine or crack (-33%) and alcohol (-29%) show negative growth rates. The estimated logistic regression models show that every covariate, including age, education, employment, gender, living status, race, and ethnicity, has a significant effect on the status of using each of the five selected substances. In parallel, the dynamics of likelihood over the levels of each covariate on every substance unearth even more information. In conclusion, the findings on trend analysis suggest the immediate attention to the growth in admissions for substance abuse treatment, and in response to taking appropriate policy measures, the likelihood dynamics revealed for every substance would undoubtedly play a vital role in identifying the target group as per priority.

Topics: Cannabis; Heroin; Hospitalization; Humans; Methamphetamine; Substance-Related Disorders

People who use drugs problematically are consistently left out of consultations and deliberation on drug policy. This article explores how people who formerly used drugs problematically and service providers view Ireland's current drug policy and if alternative policies could be successful in an Irish context.. Semi-structured interviews were conducted with eight people who used drugs problematically and six practitioners working with people who use drugs in Cork city, Ireland. All people who used drugs problematically had at least one year of abstinence and had been criminalised because of their drug use, all but one had served at least one custodial sentence. Participants were asked their opinions on safe injecting facilities, heroin assisted treatment, decriminalisation of drugs for personal use, depenalisation of cannabis and, the relationships between economic deprivation and problematic drug use.. Respondents stressed that, in Cork city, problematic drug use is closely linked with economic deprivation and social exclusion. There was a near consensus that criminalisation and penalisation do not deter consumption and produce unintended consequences. All participants supported safe injecting facilities and the decriminalisation of drugs for personal use. Participants were less certain about the utility of heroin assisted treatment and depenalisation of cannabis. Many discussions drifted away from alternatives policies towards the need for improved treatment provision.. Several participants were clear that none of the alternative policies discussed are silver bullets. Participates felt that, while they could reduce the harms caused by drugs and drug policies, the government's longer-term objectives should be increased treatment provision and, reduced social exclusion and economic deprivation.

Topics: Heroin; Humans; Ireland; Pharmaceutical Preparations; Public Policy; Substance-Related Disorders

The primary objective of this study was to investigate whether the fatalities of opioid abuse are not only related to respiratory depression but also as a result of other side effects such as emesis, delayed gastric emptying, a reduction of the cough reflex, and impaired consciousness leading to the aspiration of gastric contents, a finding regularly observed in drug-related deaths.. A retrospective exploratory study analyzing heroin/morphine/methadone-related deaths submitted to court-ordered autopsy.. Center for Forensic Medicine, Medical University of Vienna, Austria (2010-2015).. Two hundred thirty-four autopsy cases were included in the study: morphine (n = 200), heroin (n = 11), and methadone (n = 23) intoxication.. There are lower opioid concentrations in deceased with signs of aspiration, a fact which strongly points to aspiration as alternative cause of death in opioid-related fatalities. Furthermore, this study highlights the common abuse of slow-release oral morphine in Vienna and discusses alternative medications in substitution programs (buprenorphine/naloxone or tamper-resistant slow-release oral morphine preparations), as they might reduce intravenous abuse and opioid-related deaths.

Topics: Adolescent; Adult; Aged; Analgesics, Opioid; Austria; Autopsy; Cause of Death; Female; Forensic Toxicology; Heroin; Humans; Male; Methadone; Middle Aged; Morphine; Respiratory Aspiration of Gastric Contents; Retrospective Studies; Substance-Related Disorders; Young Adult

Understanding trends in substance use by gender among jail-based treatment program participants can inform policies and programs tailored to this population. Preprogram assessment data from 3509 individuals entering a jail-based substance use disorder treatment program in Missouri between 1998 and 2016 were analyzed. Primary outcome was program participants' strongly preferred substances. Demographic covariates and drug preferences were compared between males and females. Average yearly trends in preferred substances were calculated. While 25.8% of the sample preferred heroin, it was more strongly preferred by women (36.4%) than men (22.0%, p < 0.0001). Alcohol and marijuana were preferred more by males. Overall, preferences for heroin and methamphetamine increased over time while alcohol, marijuana, and other stimulants decreased. Women being more likely to prefer heroin and the increasing preference for heroin over time are consistent with national trends. Offering evidence-based treatment like pharmacotherapy and gender-sensitive approaches can help address the needs of this vulnerable population.

Topics: Adult; Age Distribution; Alcohol Drinking; Cannabis; Choice Behavior; Cocaine; Crack Cocaine; Female; Heroin; Humans; Male; Methamphetamine; Missouri; Prescription Drugs; Prisoners; Sex Distribution; Sex Factors; Substance-Related Disorders; Young Adult

The opioid overdose crisis is especially pronounced in Maine. The Diversion Alert Program (DAP) was developed to combat illicit drug use and prescription drug diversion by facilitating communication between law enforcement and health care providers with the goal of limiting drug-related harms and criminal behaviors. Our objectives in this report were to analyze 2014-2017 DAP for: (1) trends in drug arrests and, (2) differences in arrests by offense, demographics (sex and age) and by region.. Drug arrests (N=8193, 31.3% female, age=33.1±9.9) reported to the DAP were examined by year, demographics, and location.. The most common substances of the 10,064 unique charges reported were heroin (N=2203, 21.9%), crack/cocaine (N=945, 16.8%), buprenorphine (N=812, 8.1%), and oxycodone (N=747, 7.4%). While the overall number of arrests reported to the DAP declined in 2017, the proportion of arrests involving opioids (heroin, buprenorphine, or fentanyl) and stimulants (cocaine/crack cocaine, or methamphetamine), increased (p<.05). Women had significantly increased involvement in arrests involving sedatives and miscellaneous pharmaceuticals (e.g. gabapentin) while men had an elevation in stimulant arrests. Heroin accounted for a lower percentage of arrests among individuals age >60 (6.6%) relative to young-adults (18-29, 22.3%, p<.0001). Older-adults had significantly more arrests than younger-adults for oxycodone, hydrocodone, and marijuana.. Heroin had the most arrests from 2014 to 2017. Buprenorphine, fentanyl and crack/cocaine arrests increased appreciably suggesting that improved treatment is needed to prevent further nonmedical use and overdoses. The Diversion Alert Program provided a unique data source for research, a harm-reduction tool for health care providers, and an informational resource for law enforcement.

Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Buprenorphine; Cocaine; Drug Users; Female; Fentanyl; Harm Reduction; Heroin; Humans; Hydrocodone; Hypnotics and Sedatives; Maine; Male; Middle Aged; Narcotic-Related Disorders; Oxycodone; Public Health; Sex Distribution; Substance-Related Disorders; Young Adult

Assess relationships among non-medical use of prescription opioid analgesics (POAs), heroin use, and HIV and hepatitis C (HCV) infection among persons who inject drugs (PWID) in New York City, 2016-2018.. PWID (N = 134) were recruited from Mount Sinai Beth Israel drug treatment programs. HIV seropositive persons were oversampled. A questionnaire was administered, and serum samples were collected for HIV and HCV testing. Analyses were stratified by HIV serostatus and compared those who had used POAs to those who had not used POAs.. Among the participants, 97% reported injecting heroin, 44% reported injecting cocaine, and 47% reported smoking crack cocaine in the 6 months prior to the interview. There were 66% who reported oral non-medical use of POAs, with 42% using oral POAs in the previous 6 months. There was a clear historical pattern in median year of first injection for different groups: HIV seropositive persons (1985), HIV seronegative persons who never used POAs (1999), and HIV seronegative persons who used POAs (2009). By the time of interview (2016-2018), however, almost all participants (97%) reported injecting heroin. All PWID who reported using POAs also reported injecting heroin.. Non-medical POA use among PWID was very common and should not be considered a separate drug use epidemic, but as an additional component of the continuing heroin/poly-drug use epidemic, itself a part of the syndemic of opioid use, stimulant use, overdose, HCV and HIV occurring in New York City.

Topics: Adult; Analgesics, Opioid; Female; Hepatitis C; Heroin; HIV Infections; Humans; Male; Middle Aged; New York City; Opioid-Related Disorders; Substance Abuse, Intravenous; Substance-Related Disorders; Young Adult

Opioid misuse and deaths are increasing in the United States. In 2017, Ohio had the second highest overdose rates in the US, with the city of Cincinnati experiencing a 50% rise in opioid overdoses since 2015. Understanding the temporal and geographic variation in overdose emergencies may help guide public policy responses to the opioid epidemic.. We used a publicly available data set of suspected heroin-related emergency calls (n = 6,246) to map overdose incidents to 280 census block groups in Cincinnati between August 1, 2015, and January 30, 2019. We used a Bayesian space-time Poisson regression model to examine the relationship between demographic and environmental characteristics and the number of calls within block groups. Higher numbers of heroin-related incidents were found to be associated with features of the built environment, including the proportion of parks (relative risk [RR] = 2.233; 95% credible interval [CI]: [1.075-4.643]), commercial (RR = 13.200; 95% CI: [4.584-38.169]), manufacturing (RR = 4.775; 95% CI: [1.958-11.683]), and downtown development zones (RR = 11.362; 95% CI: [3.796-34.015]). The number of suspected heroin-related emergency calls was also positively associated with the proportion of male population, the population aged 35-49 years, and distance to pharmacies and was negatively associated with the proportion aged 18-24 years, the proportion of the population with a bachelor's degree or higher, median household income, the number of fast food restaurants, distance to hospitals, and distance to opioid treatment programs. Significant spatial and temporal heterogeneity in the risks of incidents remained after adjusting for covariates. Limitations of this study include lack of information about the nature of incidents after dispatch, which may differ from the initial classification of being related to heroin, and lack of information on local policy changes and interventions.. We identified areas with high numbers of reported heroin-related incidents and features of the built environment and demographic characteristics that are associated with these events in the city of Cincinnati. Publicly available information about opiate overdoses, combined with data on spatiotemporal risk factors, may help municipalities plan, implement, and target harm-reduction measures. In the US, more work is necessary to improve data availability in other cities and states and the compatibility of data from different sources in order to adequately measure and monitor the risk of overdose and inform health policies.

Topics: Bayes Theorem; Databases, Factual; Drug Overdose; Emergency Medical Services; Emergency Service, Hospital; Female; Heroin; Heroin Dependence; Humans; Male; Ohio; Risk Factors; Spatio-Temporal Analysis; Substance-Related Disorders; United States

The basic sources of information on drug use are epidemiological surveys, although they have some limitations: their results may be conditioned by the lack of veracity of the responses and the sampling method makes it difficult to detect lowprevalence behaviours in target populations. This study aimed to establish the epidemiological pattern of drug use in the population undergoing drug testing in hair, in the framework of judicial investigations, in order to provide an additional approach to the knowledge of high-risk drug use.. A cross-sectional study on drug use was conducted on the population subjected to drug testing in hair (N=5,292) in the forensic context. Prevalence of cannabis, cocaine, heroin, ketamine, amphetamine (AP), methamphetamine (MA), 3,4-methylenedioxy- methamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxy-N-ethylamphetamine (MDEA) and methadone uses were obtained. Association between drug use and demographics, and trends of prevalence over the period were analysed using the Pearson Chi-square test. Frequency distribution of drug concentrations in hair was obtained and it was assessed in relation to gender and age using the non-parametric Mann-Whitney U and Kruskal-Wallis H methods.. During the period 2013-2015, prevalence of cocaine use was particularly high (49%), rating second among the population studied, after cannabis use (54%). Proportions of heroin, methadone, MDMA and amphetamine use ranged from 10% to 18%. There was a significant increase in prevalence of MDMA, heroin and amphetamine use during the period 2013-2015, as well as a significant decrease in methadone use. The rates of cannabis, cocaine and MDMA use were higher in men, whereas methadone use was higher among women.. Cannabis and cocaine are the most frequently abused drugs among the population undergoing drug testing in hair in the framework of judicial investigations over the three-year period, although the proportions of heroin, MDMA and amphetamine users show an increasing trend. Drug use patterns vary according to age and sex, with a decrease in cannabis and MDMA use and an increase in heroin and methadone use as age increased; cannabis, cocaine and MDMA use are more prevalent among men and methadone use among women.. Las encuestas epidemiológicas son las fuentes básicas de información sobre el consumo de drogas, aunque presentan algunas limitaciones en este campo: sus resultados pueden verse condicionados por la falta de veracidad de las respuestas y el método de muestreo dificulta la detección de comportamientos de baja prevalencia en las poblaciones diana. El objetivo de esta investigación fue establecer el patrón epidemiológico del consumo de drogas en la población sometida a análisis de drogas en cabello en el marco de investigaciones judiciales, con el fin de aportar una fuente de información adicional al conocimiento del consumo de drogas de alto riesgo.. Se realizó un estudio transversal de consumo de drogas en la población sometida a análisis de drogas en cabello en el contexto forense (N=5.292). Se obtuvo la prevalencia de consumo de cannabis, cocaína, heroína, ketamina, anfetamina (AP), metanfetamina (MA), 3,4-metilendioxi-metanfetamina (MDMA), 3,4-metilendioxianfetamina (MDA), 3,4-metilendioxi-N-etilamphetamina (MDEA) y metadona. Se analizó la asociación entre el consumo de drogas y los factores demográficos, así como de sus tendencias, mediante la prueba de Chicuadrado de Pearson. Se obtuvo la distribución de frecuencias de las concentraciones de drogas en cabello y se evaluó en relación con el sexo y la edad, utilizando los métodos no paramétricos U de Mann-Whitney y H de Kruskal-Wallis.. En el periodo 2013-2015, la prevalencia de consumo de cocaína fue particularmente elevada (49%) en la población estudiada, próxima a la de cannabis (54%). Las tasas de consumo de heroína, metadona, MDMA y anfetamina resultaron entre un 10% y mun 18%. Durante el período estudiado, se registró un aumento significativo del consumo de MDMA, heroína y anfetamina, así como una disminución significativa del consumo de metadona.. Cannabis y cocaína son las drogas de abuso más frecuentes entre la población sometida a análisis de drogas en cabello en el marco de investigaciones judiciales en el periodo estudiado, si bien las proporciones de consumidores de heroína, MDMA y anfetamina muestran una tendencia creciente. Los patrones de consumo varían en función de la edad y del sexo, observándose disminución del consumo de cannabis y MDMA e incremento del consumo de heroína y metadona al aumentar la edad. El consumo de cannabis, cocaína y MDMA resulta más prevalente en hombres y el de metadona en mujeres.

Topics: 3,4-Methylenedioxyamphetamine; Adolescent; Adult; Amphetamine; Cannabinoids; Cocaine; Cross-Sectional Studies; Female; Forensic Sciences; Gas Chromatography-Mass Spectrometry; Hair; Heroin; Humans; Illicit Drugs; Ketamine; Male; Methadone; Methamphetamine; Middle Aged; N-Methyl-3,4-methylenedioxyamphetamine; Prevalence; Spain; Substance Abuse Detection; Substance-Related Disorders; Young Adult

The rapid emergence of novel psychoactive substances within the past decade has raised new concerns about the harms associated with unregulated drug use. Synthetic analogues-chemically related to established psychoactive substances like cannabis sativa and catha edulis-in particular have proliferated rapidly, allowing little opportunity for scientific research or the establishment of informal guidelines for safe use among consumers. To explore how synthetic substance use relates to other forms of use, this paper presents an analysis of polysubstance use among a sample of 676 people who use illicit substances in the United States. Participants were sampled from three greater metropolitan areas (Houston/Galveston, Texas; New York City; and New Orleans, Louisiana). Study researchers used cluster-type analyses to develop dendrogram visualizations of the interrelationships between substance types. Results suggest a considerable variation in substance and polysubstance use patterns across states in the U.S. Polysubstance use clustered around well-observed combinations like MDMA/cannabis and cocaine/heroin. Synthetic cannabinoids and cathinones showed no strong clustering with other substances. High rates of binge drinking among users of other substances further support the importance of interventions sensitive to the clinical challenges of polysubstance use.

Topics: Cannabis; Cities; Cluster Analysis; Cocaine; Female; Heroin; Humans; Illicit Drugs; Male; N-Methyl-3,4-methylenedioxyamphetamine; Substance-Related Disorders; United States

Heroin and fentanyl are the overwhelming and increasing cause of opioid deaths in Milwaukee County, Wisconsin. We reviewed all drug and opioid deaths from 2013 to 2017 to delineate the specific opioid drugs involved and changes in their incidence. From 2013 to 2017, 980 deaths were due to opioids, rising from 184 in 2013 to 337 in 2017. In 2017, opioid deaths exceeded combined non-natural deaths from homicide and suicide. Illicit heroin and fentanyl/analogs caused 84% of opioid deaths and 80% of drug deaths, with no increase in deaths due to oral prescription drugs such as oxycodone and hydrocodone. Any approach to decreasing this dramatic increase in opioid deaths should first focus on interdicting the supply and cheap availability of these illicit opioids. Fentanyl and its analogs represent the most deadly opioids and the greatest threat to human life in our population.

Topics: Analgesics, Opioid; Buprenorphine; Coroners and Medical Examiners; Fentanyl; Heroin; Humans; Hydrocodone; Illicit Drugs; Incidence; Methadone; Opioid-Related Disorders; Oxycodone; Substance-Related Disorders; Wisconsin

Drug abuse remains a serious public health issue, underscoring the need for additional treatment options. Agonists at serotonin (5-HT)2C receptors, particularly lorcaserin, are being considered as pharmacotherapies for abuse of a variety of drugs, including cocaine and opioids. The current study compared the capacity of lorcaserin to attenuate reinstatement of extinguished responding previously maintained by either cocaine or an opioid; this type of procedure is thought to model relapse, an important aspect of drug abuse. Six rhesus monkeys responded under a fixed-ratio schedule for cocaine (0.032 mg/kg/infusion) or remifentanil (0.00032 mg/kg/infusion). Reinstatement of extinguished responding was examined following administration of noncontingent infusions of cocaine (0.32 mg/kg) or heroin (0.0032-0.1 mg/kg) combined with response-contingent presentations of the drug-associated stimuli, or heroin alone without presentation of drug-associated stimuli. When combined with drug-associated stimuli, cocaine and heroin increased extinguished responding. On average, monkeys emitted fewer reinstated responses following 0.32 mg/kg cocaine, compared with the number of responses emitted when cocaine was available for self-administration or when extinguished responding was reinstated by 0.032 mg/kg heroin. When drug-associated stimuli were not presented, heroin did not increase responding. Lorcaserin dose dependently attenuated reinstated responding, and its potency was similar regardless of whether cocaine or heroin was given before reinstatement sessions. The generality of this effect of lorcaserin across pharmacological classes of abused drugs might make it particularly useful for reducing relapse-related behaviors in polydrug abusers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Topics: Analgesics, Opioid; Animals; Benzazepines; Cocaine; Dose-Response Relationship, Drug; Heroin; Macaca mulatta; Male; Models, Animal; Remifentanil; Self Administration; Serotonin 5-HT2 Receptor Agonists; Substance-Related Disorders

This article examined the differences in causes and health consequences between synthetic drug and heroin abuse in urban China. Two-group comparisons were conducted to quantify differences in individual characteristics, causes of drug use, and HIV/STI risky sexual behavior between synthetic drug and heroin users; logistic regressions were employed to assess the net effect of synthetic drug use on risky sexual behavior. Results revealed that causes of synthetic drug use differed from those of heroin use; a combination of the knowledge gap concerning the harmful impact of synthetic drugs and the lesser punishment for their use appeared a main reason behind the shift from heroin to synthetic drugs; and synthetic drug use was a significant and powerful risk factor for HIV/STI risky sexual behavior. Educational and behavioral interventions are urgently needed to prevent the initiation of synthetic drug use among users to reduce their HIV/STI risky sexual behavior.

Topics: Adult; China; Drug Users; Female; Heroin; Heroin Dependence; HIV Infections; Humans; Logistic Models; Male; Risk Factors; Risk-Taking; Sexual Behavior; Substance-Related Disorders; Synthetic Drugs; Urban Population

Abnormal restricted diffusion on magnetic resonance imaging is often associated with ischemic stroke or anoxic injury, but other conditions can present similarly. We present six cases of an unusual but consistent pattern of restricted diffusion in bilateral hippocampi and cerebellar cortices. This pattern of injury is distinct from typical imaging findings in ischemic, anoxic, or toxic injury, suggesting it may represent an under-recognized clinicoradiographic syndrome. Despite initial presentation with stupor or coma in the context of obstructive hydrocephalus, patients may have acceptable outcomes if offered early intervention.. We identified an ad hoc series of patients at our two institutions between years 2014 and 2017 who presented to the neurocritical care unit with severe, otherwise unexplained cerebellar edema and retrospectively identified several commonalities in history, presentation, and imaging.. Between two institutions, we identified six patients-ages 33-59 years, four male-with similar presentations of decreased level of consciousness in the context of intoxicant exposure, with acute cytotoxic edema of the cerebellar cortex, hippocampi, and aspects of the basal nuclei. All patients presented with severe cerebellar edema which led to obstructive hydrocephalus requiring aggressive medical and/or surgical management. The five patients who survived to discharge demonstrated variable degrees of physical and memory impairment on discharge and at follow-up.. We present findings of a potentially novel syndrome involving a distinct pattern of cerebellar and hippocampal restricted diffusion, with imaging and clinical characteristics distinct from ischemic stroke, hypoxic injury, and known toxidromes and leukoencephalopathies. Given the potential for favorable outcome despite early obstructive hydrocephalus, early identification and treatment of this syndrome are critical.

Topics: Adult; Alcoholic Intoxication; Amphetamines; Basal Ganglia; Benzodiazepines; Brain Edema; Central Nervous System Stimulants; Cerebellar Cortex; Cerebellum; Cocaine; Coma; Female; Heroin; Hippocampus; Humans; Hydrocephalus; Hydromorphone; Magnetic Resonance Imaging; Male; Middle Aged; Opiate Alkaloids; Pain, Postoperative; Stupor; Substance-Related Disorders; Syndrome

Substance addiction is a chronic, relapsing mental disorder Characterized by compulsive drug seeking, and loss of control over drug intake and relapse after prolonged abstinence. Genetics has been shown to contribute towards an individual's vulnerability to addiction. Acetylecholine (ACh), a cholinergic neurotransmitter hydrolyzed by acetylcholinesterase (AChE), is an essential neurotransmitter and neuromodulator in central and peripheral nervous system and has regulatory influence on numerous neuronal functions including addiction. The present study was carried out to investigate the role of acetylcholinesterase (AChE) in addiction through measurement of enzyme activity and to find potential association of ACHE gene 3'UTR variants rs17228602 and rs17228616 in heroin, hashish and poly drug addicts. Both SNPs are located within microRNA (miRNA) recognition sites with potential to affect miRNA/transcript interaction. A total of 122 addicts of heroin, hashish and polydrug were recruited from local rehabilitation centers to participate in this study. AChE activity was measured in blood by Ellman's method. SNP genotyping was performed by restriction fragment length polymorphism (PCR-RFLP) and Sanger sequencing. The AChE activity was found significantly higher (p ≤ 0.005) in addicted cohort (mean ± standard error of mean 0.020 ± 0.001 μmol/L/min; 95% confidence interval (CI) 0.018-0.022) in comparison to non-addicted healthy subjects (0.011 ± 0.001 μmol/L/min; 95% confidence interval CI 0.010-0.013). A statistically significant association of ACHE rs17228602 SNP with addiction vulnerability in dominant (DM: Odd's ratio OR = 2.095, 95% CI = 1.157-3.807 p = 0.009) and allelic genetic models (OR = 1.854 95% CI = 1.082-3.187, p = 0.016) was observed. However, no statistically significant association of rs17228616 SNP with substance abuse disorder was found. The data presented here shows that AChE could play significant role in substance addiction. Further studies with larger sample size and other variants of AChE are recommended to identify novel therapeutic approaches for cholinergic based treatment of addiction.

Topics: 3' Untranslated Regions; Acetylcholinesterase; Alleles; Asian People; Gene Frequency; Genetic Predisposition to Disease; Genotype; Heroin; Humans; Kinetics; MicroRNAs; Odds Ratio; Pakistan; Polymorphism, Single Nucleotide; Substance-Related Disorders

Pill mill laws impose strict regulations on pain management clinics to prevent them from issuing opioid prescriptions without medical indication. To date, little is known about the implementation or effects of these laws on opioid overdose deaths. A previously untested concern is that by restricting access to prescription opioids, pill mill laws could increase overdose from heroin and synthetic opioids, like illicitly produced fentanyl. We evaluated the effects of pill mill laws on opioid overdose deaths in Ohio and Tennessee. Of the 11 total U.S. states with pill mill laws, Ohio and Tennessee were the only two where: (1) the pill mill law was the only state law designed to curb opioid prescribing implemented in a two-year period, one-year pre/post law; and (2) high-quality drug-specific overdose death data were available from CDC. We conducted synthetic control analyses examining differences in post-pill mill law trends in overdose deaths in Ohio and Tennessee compared to weighted combinations of comparison states. We also conducted qualitative interviews with 11 leaders responsible for pill mill law implementation and enforcement in Ohio and Tennessee. Pill mill law enactment had no effects on overall, prescription opioid, heroin, or synthetic opioid overdose deaths in Ohio or Tennessee. Interview results suggest that both states engaged in robust enforcement and implementation of the law. A multi-pronged policy approach, including but not limited to pill mill laws, may be required to effectively address opioid overdose deaths.

Topics: Analgesics, Opioid; Drug Overdose; Fentanyl; Heroin; Humans; Interviews as Topic; Ohio; Practice Patterns, Physicians'; Prescription Drug Misuse; Substance-Related Disorders; Tennessee

This study assessed the prevalence and patterns of drug use among people living with HIV (PLHIV) in Spain. We conducted an observational cross-sectional study including 1401 PLHIV. Data were collected through 33 sites across Spain using an online computer-assisted self-administered interview. The survey measured use of illicit drugs and other substances, treatment adherence and health-related variables. To analyse patterns of drug use we performed cluster analysis in two stages. The most frequently consumed substances were: alcohol (86.7%), tobacco (55.0%), illicit drugs (49.5%), other substances (27.1%). The most prevalent illicit drugs used were cannabis (73.8%), cocaine powder (53.9%), and poppers (45.4%). Results found four clusters of PLHIV who used drugs. Two of them were composed mainly of heterosexuals (HTX): Cluster 1 (n = 172) presented the lowest polydrug use and they were mainly users of cannabis, and Cluster 2 (n = 84) grouped mostly men who used mainly heroin and cocaine; which had the highest percentage of people who inject drugs and presented the lowest level of treatment adherence (79.8±14.2; p < .0001). The other two clusters were composed mainly of men who have sex with men (MSM), who were mostly users of recreational drugs. Cluster 3 (n = 285) reported moderate consumption, both regarding frequency and diversity of drugs used, while Cluster 4 (n = 153) was characterized by the highest drug polyconsumption (7.4±2.2; p < .0001), and 4 grouped MSM who injected recreational drugs, and who reported the highest frequency of use of drugs in a sexual context (2.6±0.8; p < .0001) and rates of sexually transmitted infections (1.8±1.1; p < .01). This is the largest multi-centre cross-sectional study assessing the current prevalence and patterns of drug use among PLHIV in Spain. The highest prevalence of drug use was found among MSM, although HTX who used heroin and cocaine (Cluster 2) had the most problems with adherence to HIV treatment and the worst health status.

Topics: Adult; Cannabis; Cocaine; Cross-Sectional Studies; Female; Heroin; HIV Infections; Humans; Illicit Drugs; Male; Middle Aged; Patient Compliance; Prevalence; Sexually Transmitted Diseases; Spain; Substance-Related Disorders; Surveys and Questionnaires

Inspired by advances in immunology, in the 1970s scientists began to study the possibilities of mobilizing the human immune system against intruders other than pathogenic viruses and bacteria. In 1972 the suggestion was first made that it might be possible to provoke immunity to narcotic dependence. Because molecules of narcotics such as heroin and cocaine are too small to stimulate an immune response, researchers sought ways of coupling them to immunogenic proteins. The substances they developed soon became known as addiction vaccines. However, despite fifty years of research, and despite the growing problem of addiction, no vaccine against heroin, cocaine, methamphetamine or nicotine addiction has yet been licensed for clinical use. This paper reviews the history of addiction vaccinology, seeks to explain the unique appeal of a vaccinological approach to addiction, and argues for broad discussion of how such vaccines should ultimately be used.

Topics: Cocaine; Heroin; Humans; Methamphetamine; Nicotine; Substance-Related Disorders; Vaccines

In Europe, the highest proportion of HIV diagnoses are in gay men and other men who have sex with men (MSM). Globally, HIV prevalence is particularly high among males who report selling sex, but rates among men who buy sex from other men are less clear. This study analyzed the association of transactional sex (TS) and HIV diagnosis, sexually transmitted infection (STI) diagnoses, and various drug use; and examined the variations in TS by payment direction.. We conducted a cross-sectional, non-randomized, observational study. This European MSM Internet Survey recruited MSM from 38 European countries. For descriptive purposes we stratified according to TS behavior (frequently selling sex, frequently buying sex, neither frequently selling nor buying sex in the previous 12 months), and we constructed separate multivariable logistic regression models to investigate whether engaging in TS accounted for some of the HIV- and STI diagnoses and drug use in this population.. Of almost 161,000 sexually active MSM, 12.2% engaged in TS. The multivariable logistic regression results showed that relative to not frequently engaging in TS, frequently selling sex was independently associated with a higher odds of reporting diagnosed HIV (ever, adjusted odds ratio [aOR] 1.60, confidence interval [CI] 95% 1.39 to 1.85), bacterial STIs (past 12 months, aOR 1.75 CI 95% 1.54 to 2.00), using heroin or crack cocaine or injecting drugs (aOR 3.17, CI 95% 2.70 to 3.73), and using benzodiazepines (aOR 2.13, CI 95% 1.88 to 2.41). Compared to men not engaging in frequent TS, frequently buying sex was associated with a higher odds of using benzodiazepines (aOR 2.13, CI 95% 1.88 to 2.41).. MSM who frequently sell sex suffer greater sexual- and substance use risks than other MSM, but both men who frequently sell and those who buy sex are more likely to use benzodiazepines. MSM who sell sex to other men constitute an important at-risk population who must be offered targeted health services.

Topics: Adult; Crack Cocaine; Cross-Sectional Studies; Europe; Heroin; HIV Infections; Homosexuality, Male; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Risk Factors; Sex Work; Sexual and Gender Minorities; Sexual Behavior; Sexually Transmitted Diseases; Substance-Related Disorders; Young Adult

Rates of both opioid and sedative use and misuse are rising. Comorbid opioid and sedative use is associated with especially severe consequences (e.g., overdose and poor health outcomes). Heroin users report multiple motivations for sedative use, including self-medication. We aimed to understand differences in lifetime substance use characteristics between heroin users with different sedative use histories.. Substance use data were collected from 385 non-treatment seeking heroin users. Subjects were divided into four lifetime sedative-use groups: no use, medical use only, non-medical use only, and mixed medical and non-medical use. We examined patterns of use of various substances of abuse (tobacco, alcohol, marijuana, cocaine, heroin, and sedatives) and individual characteristics associated with each.. Non-medical sedative use (alone or in addition to medical use) was associated with more negative consequences from using all substances. Medical sedative use alone was not related to increased overdose or emergency room visits associated with heroin use. Non-medical sedative use was associated with increases in 15 of the 21 measured heroin consequences and only one of those - health problems - was also associated with medical sedative use.. Concomitant non-medical sedative use and heroin use is associated with significantly greater negative outcomes than those experienced by heroin users who report use of sedatives only as prescribed. Understanding these differences offers insight into risks related to using both substances and may help treatment providers create targeted harm reduction interventions for this population.

Topics: Adolescent; Adult; Analgesics, Opioid; Comorbidity; Drug Overdose; Female; Heroin; Heroin Dependence; Humans; Hypnotics and Sedatives; Male; Mental Health; Middle Aged; Self Medication; Substance-Related Disorders; Young Adult

Recent publications have explored the possibility of using fingerprints to confirm drug use, but none has yet dealt with environmental contamination from fingertips. Here we explored the possibility of establishing an environmental cutoff for drug testing from a single fingerprint.. Fingerprint samples (n = 100) were collected from the hands of 50 nondrug users before and after handwashing to establish separate environmental cutoff values and testing protocols for cocaine, benzoylecgonine, heroin, and 6-monoacetylmorphine. The cutoff was challenged by testing the fingerprints of drug-free volunteers after shaking hands with drug users. Fingerprints from patients who testified to taking cocaine (n = 32) and heroin (n = 24) were also collected and analyzed.. A different cutoff value needed to be applied, depending on whether the fingerprints were collected as presented or after handwashing. Applying these cutoffs gave a 0% false-positive rate from the drug-free volunteers. After application of the cutoff, the detection rate (compared to patient testimony) for washed hands of patients was 87.5% for cocaine use and 100% for heroin use.. Fingerprints show enhanced levels of cocaine, heroin, and their respective metabolites in patients who testified to taking the substances, compared with the population of naïve drug users surveyed, and a cutoff (decision level) can be established. The cutoff is robust enough to account for small increases in analyte observed after secondary transfer.

Topics: Case-Control Studies; Cocaine; Fingers; Hand Disinfection; Heroin; Humans; Limit of Detection; Morphine Derivatives; Reproducibility of Results; Skin; Substance Abuse Detection; Substance-Related Disorders

The number of poly-drug users who mix use heroin and synthetic drugs (SD) is increasing worldwide. The objective of this study is to measure the risk factors for being infected with hepatitis C (HCV), human immunodeficiency virus (HIV) and syphilis among SD-only users, heroin-only users and poly-drug users. A cross-sectional study was conducted in 2015 from a national HIV surveillance site in Southwest China, 447 poly-drug, 526 SD-only and 318 heroin-only users were recruited. Poly-drug users have higher drug-use frequency, higher rates of drug-sharing and unsafe sexual acts than other users (p < 0.05). About a third (36.7%) of poly-drug users experienced sexual arousal due to drug effects, which is higher than the rate among other drug users. Poly-drug users had the highest prevalence of HIV (10.5%) and syphilis (3.6%), but heroin-only users had the highest prevalence of HCV (66.0%) (all p < 0.05) among three groups. Logistic regression shows among poly-drug users, having sex following drug consumption and using drugs ≥1/day were the major risk factors for both HIV (Adjusted odds ratio (AOR) = 2.4, 95% CI [1.8-3.4]; 2.3, [1.6-3.1]) and syphilis infection (AOR = 4.1, [2.1-6.9]; 3.9, [1.8-5.4]). Elevated risk of both HIV and syphilis infection have been established among poly-drug users.

Topics: Adult; China; Drug Users; Epidemics; Female; Hepatitis C; Heroin; HIV Infections; Humans; Male; Population Surveillance; Prevalence; Risk Factors; Sexual Behavior; Socioeconomic Factors; Substance-Related Disorders; Synthetic Drugs; Syphilis; Young Adult

There is growing evidence regarding the numerous adverse effects of synthetic cannabinoids (SCBs) on the cardiovascular system; however, no studies have shown the cardiovascular effects of opioids using strain echocardiography. This study examines the cardiac structure and function using echocardiographic strain imaging in heroin and synthetic cannabinoid users.. This double-blind study included patients who were admitted or referred to a rehabilitation center for heroin (n=31) and synthetic cannabinoid users (n=30). Heroin users and synthetic cannabinoid users were compared with healthy volunteers (n=32) using two-dimensional (2D) speckle-tracking (ST) echocardiography.. No differences were found in the baseline characteristics and 2D echocardiography values. The mean global longitudinal strain value was -20.5%±2.4% for SCB users, -22.3%±2.4% for opioid users, and -22.5%±2.2% for healthy volunteers (p=0.024). The mean apical 2-chamber (AP2C) L-strain values were -20.1%±3.1%, -22.4%±3.0%, and -22.3%±2.8% for SCB users, opioid users, and healthy volunteers, respectively (p=0.032). The mean apical 4-chamber (AP4C) L-strain values were -20.7%±2.5% for SCB users, -23.2%±3.2% for opioid users, and -23.8%±3.1% for healthy volunteers (p<0.001).. SCBs are potential causes of subclinical left ventricular dysfunction.

Topics: Cannabinoids; Case-Control Studies; Double-Blind Method; Echocardiography; Female; Heroin; Humans; Male; Prospective Studies; Sensitivity and Specificity; Substance-Related Disorders; Ventricular Dysfunction, Left; Young Adult

Heroin-related deaths are on the rise in the US and a large portion of heroin overdoses involve co-use of other drugs such as benzodiazepines. A better understanding of heroin polysubstance use patterns could help discern better prevention measures.. Data were examined from past-month ("current") heroin users from a nationally representative sample of high school seniors in the Monitoring the Future study (2010-2016, n = 327). We examined how past-month use and frequency of use of various drugs relate to frequency of current heroin use using chi-square and multivariable ordinal logistic regression.. Prevalence of any past-month use of various other drugs (and past-month use 10+ times) tends to increase as the frequency of heroin use increases; however, other drug use tends to decline among those reporting the use of heroin 40+ times in the past month. In multivariable models controlling for demographic characteristics, most levels of alcohol use were associated with decreased odds of higher-frequency heroin use (ps<.05). Nonmedical opioid (aOR = 5.84, p = .037) and tranquilizer (aOR = 14.63, p = .045) use 40+ times in the past month were associated with increased odds of higher-frequency heroin use.. High school seniors who use heroin also use multiple other drugs. Increases in the frequency of heroin use are associated with shifts in the nature and frequency of polysubstance use, with a higher frequency of heroin use associated with the highest percentage and frequency of use of depressants (nonmedical opioid and benzodiazepine use), compounding the risk of overdose. Prevention measures should consider polysubstance use patterns among heroin-using adolescents.

Topics: Adolescent; Alcohol Drinking; Analgesics, Opioid; Benzodiazepines; Cross-Sectional Studies; Drug Overdose; Female; Heroin; Humans; Male; Prevalence; Schools; Students; Substance-Related Disorders; Tranquilizing Agents; United States; Young Adult

The changes in brain function that perpetuate opiate addiction are unclear. In our studies of human narcolepsy, a disease caused by loss of immunohistochemically detected hypocretin (orexin) neurons, we encountered a control brain (from an apparently neurologically normal individual) with 50% more hypocretin neurons than other control human brains that we had studied. We discovered that this individual was a heroin addict. Studying five postmortem brains from heroin addicts, we report that the brain tissue had, on average, 54% more immunohistochemically detected neurons producing hypocretin than did control brains from neurologically normal subjects. Similar increases in hypocretin-producing cells could be induced in wild-type mice by long-term (but not short-term) administration of morphine. The increased number of detected hypocretin neurons was not due to neurogenesis and outlasted morphine administration by several weeks. The number of neurons containing melanin-concentrating hormone, which are in the same hypothalamic region as hypocretin-producing cells, did not change in response to morphine administration. Morphine administration restored the population of detected hypocretin cells to normal numbers in transgenic mice in which these neurons had been partially depleted. Morphine administration also decreased cataplexy in mice made narcoleptic by the depletion of hypocretin neurons. These findings suggest that opiate agonists may have a role in the treatment of narcolepsy, a disorder caused by hypocretin neuron loss, and that increased numbers of hypocretin-producing cells may play a role in maintaining opiate addiction.

Topics: Animals; Brain; Cataplexy; Cell Count; Disease Models, Animal; Dose-Response Relationship, Drug; Heroin; Humans; Male; Mice, Inbred C57BL; Morphine; Narcolepsy; Neurogenesis; Neurons; Opiate Alkaloids; Orexins; Rats, Sprague-Dawley; Substance-Related Disorders

Public injecting of recreational drugs has been documented in a number of cities worldwide and was a key risk factor in a HIV outbreak in Glasgow, Scotland during 2015. We investigated the characteristics and health needs of people involved in this practice and explored stakeholder attitudes to new harm reduction interventions.. We used a tripartite health needs assessment framework, comprising epidemiological, comparative, and corporate approaches. We undertook an analysis of local and national secondary data sources on drug use; a series of rapid literature reviews; and an engagement exercise with people currently injecting in public places, people in recovery from injecting drug use, and staff from relevant health and social services.. Between 400 and 500 individuals are estimated to regularly inject in public places in Glasgow city centre: most experience a combination of profound social vulnerabilities. Priority health needs comprise addictions care; prevention and treatment of blood-borne viruses; other injecting-related infections and injuries; and overdose and drug-related death. Among people with lived experience and staff from relevant health and social care services, there was widespread - though not unanimous - support for the introduction of safer injecting facilities and heroin-assisted treatment services.. The environment and context in which drug consumption occurs is a key determinant of harm, and is inextricably linked to upstream social factors. Public injecting therefore requires a multifaceted response. Though evidence-based interventions exist, their implementation internationally is variable: understanding the attitudes of key stakeholders provides important insights into local facilitators and barriers. Following this study, Glasgow plans to establish the world's first co-located safer injecting facility and heroin-assisted treatment service.

Topics: Adult; Drug Overdose; Female; Harm Reduction; Heroin; HIV Infections; Humans; Illicit Drugs; Male; Middle Aged; Needs Assessment; Public Facilities; Risk Factors; Scotland; Substance Abuse, Intravenous; Substance-Related Disorders; Young Adult

Previously, we reported a marked increase in the use of heroin as an initiating opioid in non-tolerant, first time opioid users. In the current paper, we sought to update and expand upon these results, with a discussion of the policy implications on the overall opioid epidemic.. Opioid initiation data from the original study were updated to include surveys completed through 2017 (N = 8382) from a national sample of treatment-seeking opioid users. In addition, past month abuse of heroin and prescription were analyzed as raw numbers of treatment program entrant in the last five years (2013-2017), drawing from only those treatment centers that participated every year in that time frame.. The updated data confirm and extend the results of our original study: the use of heroin as an initiating opioid increased from 8.7% in 2005 to 31.6% in 2015, with increases in overall Ns per initiation year reflecting a narrowing of the "treatment gap", the time lag between opioid initiation from 2005 to 2015 and later treatment admission (up to 2017). Slight decreases were observed in treatment admissions, but this decline was totally confined to prescription opioid use, with heroin use continuing to increase in absolute numbers.. Given that opioid novices have limited tolerance, the risk of fatal overdose for heroin initiates is elevated compared to prescription opioids, particularly given non-oral administration and often unknown purity/adulterants (i.e., fentanyl). Imprecision of titrating dose among opioid novices may explain observed increases opioid overdoses. Future policy decisions should note that prescription opioid-specific interventions may have little impact on a growing heroin epidemic.

Topics: Adult; Age of Onset; Analgesics, Opioid; Drug Overdose; Drug Tolerance; Health Policy; Heroin; Heroin Dependence; Humans; Opioid-Related Disorders; Substance-Related Disorders

The Kreek-McHugh-Schluger-Kellogg (KMSK) scales provide a rapid assessment of maximal self-exposure to specific drugs and can be used as a dimensional instrument. This study provides a re-evaluation of the KMSK scales for cannabis, alcohol, cocaine, and heroin in a relatively large multi-ethnic cohort, and also the first systematic comparison of gender-specific profiles of drug exposure with this scale.. This was an observational study of n = 1,133 consecutively ascertained adult volunteers. The main instruments used were the SCID-I interview (DSM-IV criteria) and KMSK scales for cannabis, alcohol, cocaine, and heroin.. Participants were 852 volunteers (297 female) with specific DSM-IV abuse or dependence diagnoses, and 281 volunteers without any drug diagnoses (154 female). Receiver operating characteristic (ROC) curves were calculated for concurrent validity of KMSK scores with the respective DSM-IV dependence diagnoses. The areas under the ROC curves for men and women combined were 99.5% for heroin, 97% for cocaine, 93% for alcohol, and 85% for cannabis. Newly determined optimal KMSK "cutpoint" scores were identical for men and women for cocaine and heroin dependence diagnoses, but were higher in men than in women, for cannabis and alcohol dependence diagnoses.. This study confirms the scales' effectiveness in performing rapid dimensional analyses for cannabis, alcohol, cocaine, and heroin exposure, in a cohort larger than previously reported, with "cutpoints" changed from initial determinations, based on this larger sample. The KMSK scales also detected gender differences in self-exposure to alcohol and cannabis that are associated with the respective dependence diagnoses.

Topics: Adult; Alcoholism; Cannabis; Cocaine; Cohort Studies; Diagnostic and Statistical Manual of Mental Disorders; Female; Heroin; Heroin Dependence; Humans; Male; Marijuana Abuse; Middle Aged; ROC Curve; Sex Characteristics; Substance-Related Disorders; Young Adult

Cognitions associated with craving and substance use are important contributors for the psychological theories of Substance use disorders (SUD), as they may affect the course and treatment. In this study, we aimed to validate Turkish version of two major scales 'Beliefs About Substance Use'(BSU) and 'Craving Beliefs Questionnaire'(CBQ) in patients with heroin use disorder and define the interaction of these beliefs with patient profile, depression and anxiety symptoms, with an aim to use these thoughts as targets for treatment.. One hundred seventy-six inpatients diagnosed with heroin use disorder and 120 participants in the healthy comparison group were evaluated with CBQ, BSU, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and sociodemographic data questionnaire. Patient group was also evaluated with Addiction Profile Index. Reliability and validity analysis for scales were conducted. Linear regression analysis was conducted to evaluate the determinants of BSU and CBQ scores.. Cronbach alpha level was 0.93 for BSU and 0.94 for CBQ. Patient group showed significantly higher CBQ, BSU, BAI and BDI scores (p < 0.001). BSU score significantly correlated with API-substance use profile score, API-diagnosis, BAI, BDI and CBQ (p < 0.005), whereas CBQ scores significantly correlated with API-diagnosis, API-impact on life, API-craving, API-total score, BSU, BAI, BDI and amount of cigarette smoking (p < 0.002). Number of previous treatments and age of onset for substance use were not correlated with either BSU or CBQ. BAI and BDI scores significantly predicted BSU score, however only BDI score predicted CBQ score (p < 0.003).. Craving beliefs were highly correlated with addiction profile. Anxiety and depression are significant modulators for patients' beliefs about substance use and depression is a modulator for craving and maladaptive beliefs, validating emotion-cognition interplay in addiction.

Topics: Adult; Anxiety; Case-Control Studies; Cognition; Craving; Depression; Emotions; Female; Heroin; Humans; Male; Psychiatric Status Rating Scales; Psychometrics; Reproducibility of Results; Substance-Related Disorders; Turkey; Young Adult

Since 2000, heroin use patterns have shifted within the United States. How this change may relate to polydrug use among local heroin users is unknown. Although polydrug use has been studied, user perceptions of drug use in terms of health risks, arrest risk, availability, cost, liking, and dependence have not been considered.. Data are presented from a brief, face-to-face survey conducted in 2016 of 200 non-in-treatment heroin users from Cleveland, OH. We assessed the use of and attitudes on alcohol, marijuana, methamphetamine, heroin, crack cocaine, powder cocaine, and prescription drugs. We estimated polydrug (concurrent past month) use with cluster analysis and latent profiles. Regression analysis estimated the strength of relationships between attitudes and frequency of use.. We identified five clusters: Cluster 1 used heroin concomitantly with alcohol and occasionally crack; Cluster 2 used heroin and crack cocaine daily; Cluster 3 used heroin daily and almost exclusively; Cluster 4 used heroin and marijuana daily; and Cluster 5 were part-time drug users. Drug use frequency was associated with liking and being anxious when drugs could not be obtained. High perceived availability of heroin and cocaine and low cost facilitated polydrug use.. Understanding polydrug use clusters among heroin users is important for addressing the larger opioid epidemic. Users' perceptions of a drug's availability and cost appeared to facilitate polydrug use and justify more detailed future research on drug access.

Topics: Adult; Alcoholism; Amphetamine-Related Disorders; Analgesics, Opioid; Cocaine-Related Disorders; Crack Cocaine; Drug Users; Female; Heroin; Heroin Dependence; Humans; Male; Marijuana Abuse; Middle Aged; Ohio; Self Report; Substance-Related Disorders

Non-medical prescription opioid use (NMPOU) has become a major public health issue in the USA and is also increasing in Europe. However, little is known about neuropsychological associations of NMPOU-specifically regarding social cognition, which is essential for social functioning and treatability of opioid dependence. Previous studies with heroin users and opioid-substituted patients reported deficits in various cognitive functions, but these results are likely confounded by comorbid physical and psychiatric diseases, overdose-associated hypoxia, and adulteration of street heroin. Therefore, the purpose of the present study was to investigate social and non-social cognition in a relatively pure NMPOU sample taking opioid analgesics or antitussives.. We assessed 23 individuals with NMPOU objectively confirmed by hair analyses and 29 opioid-naïve, healthy controls, employing a comprehensive neuropsychological test battery.. Significant impairments were found between NMPOU individuals and controls regarding the cognitive domains of attention (p < .01, Hedge's g = .85), declarative memory (p < .05, g = .66), and global cognitive empathy (p < .01, g = 0.99)-the latter included problems with emotion recognition from faces, voices, and complex scenes. Opioid hair concentrations transformed to morphine equivalents were negatively correlated with global cognitive empathy (r = - 0.52, p < .01), suggesting dose-dependent deficits.. In contrast to stimulant users primarily displaying deficits in emotional empathy, opioid users showed relatively selective impairments in measures of cognitive empathy, with dose-dependent effects suggesting potential opioid-induced deficits and involvement of the opioid-system in processes of cognitive empathy. These results have important implications for future interventions of opioid dependence targeting social functioning and consequently enhancing therapy outcome and preventing relapse.

Topics: Adolescent; Adult; Analgesics, Opioid; Cognition; Empathy; Female; Heroin; Humans; Male; Morphine; Neuropsychological Tests; Opioid-Related Disorders; Social Behavior; Substance-Related Disorders; Young Adult

We are at a unique moment in United States (US) history as heroin overdose rates are higher than at any time in recent memory. Based on prior research and the developmental risks faced by young adults (ages 18-25), we examine the trends and correlates of perceived access to heroin among this group over a 15-year period.. We analyzed national trend data from the National Survey on Drug Use and Health (2002-2016) on young adults' (N = 247,679; ages 18-25) perceived access to heroin. We conducted logistic regression analyses with survey year specified as an independent variable and heroin access specified as the dependent variable while controlling for sociodemographic factors.. A majority of respondents reported that it would be difficult or impossible to obtain heroin, if desired. Young adult reports that it would be "probably impossible" to access heroin increased significantly from 31% in 2002 to 41% in 2016. The upward trend in the perceived lack of access was most robust among African Americans and Hispanics as well as those reporting no past-year substance use or drug/criminal justice system involvement.. In the midst of a very serious opioid epidemic, the present study found that most young adults in the US consider that it would be "probably impossible" to obtain heroin. This trend was observed across young adulthood and across gender, racial/ethnic, and family income differences. However, we found that these trends are largely driven by those at relatively low risk of drug misuse and deviant behaviors generally.

Topics: Adolescent; Adult; Analgesics, Opioid; Black or African American; Drug Overdose; Female; Heroin; Hispanic or Latino; Humans; Male; Perception; Risk; Substance-Related Disorders; Surveys and Questionnaires; United States; Young Adult

A robust literature documents generational trends in drug use. We examined the implications of changing national drug use patterns on drug injection histories of diverse people who inject drugs (PWID).. Drug use histories were collected from 776 active PWID in 2011-13. Using descriptive statistics, we examine drug use initiation by year and birth cohort (BC) differences in drug first injected. A multivariate linear regression model of time to injection initiation ([TTII] (year of first injection minus year of first illicit drug use) was developed to explore BC differences.. The first drug injected by BC changed in tandem with national drug use trends with heroin declining from 77% for the pre-1960's BC to 58% for the 1960's BC before increasing to 71% for the 1990's BC. Multivariate linear regression modeling found that shorter TTII was associated with the 1980's/1990's BC (-3.50 years; 95% Confidence Interval [CI]=-0.79, -6.21) as compared to the 1970's BC. Longer TTII was associated with being female (1.65 years; 95% CI=0.40, 2.90), African American (1.69 years; 95% CI=0.43, 2.95), any substance use treatment prior to injection (4.22 years; 95% CI=2.65, 5.79), and prior non-injection use of drug that was first injected (3.29 years; 95% CI=2.19, 4.40).. National drug trends appear to influence injection drug use patterns. The prescription opiate drug era is associated with shorter TTII. Culturally competent, demographically and generationally-targeted prevention strategies to combat transitions to drug injection are needed to prevent or shorten upstream increases in risky drug use practices on a national level.

Topics: Adult; Age Factors; Cohort Studies; Female; Heroin; Humans; Linear Models; Los Angeles; Male; Middle Aged; Multivariate Analysis; San Francisco; Substance Abuse, Intravenous; Substance-Related Disorders; Young Adult

Heroin and fentanyl use have reached epidemic proportions in the United States and are now blamed for the majority of drug-related overdose deaths. Both drugs are produced primarily in South America and Asia and enter the United States illegally. One result of smoking or injecting heroin or fentanyl is the development of a substance use disorder (SUD), which causes changes in brain chemistry and function. These changes result in negative behaviors and an inability to stop use. Yet, treatments are available and recovery is possible. Nurses have the potential to impact the heroin and fentanyl epidemic through developing therapeutic relationships with patients who are at risk or already have a SUD. Strategies for effective communication include maintaining a supportive, nonjudgmental attitude and incorporating motivational interviewing. All patients should be screened for opioid use and referred for treatment if indicated. It is important for nurses to be knowledgeable about heroin and fentanyl and available treatments. [Journal of Psychosocial Nursing and Mental Health Services, 55(6), 16-20.].

Topics: Drug Overdose; Fentanyl; Heroin; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Nurse-Patient Relations; Opioid-Related Disorders; Substance-Related Disorders; United States

BACKGROUND The aim of this study was to explore how changes in the expression of BDNF in MLDS change the effect of BDNF on dopamine (DA) neurons, which may have therapeutic implications for heroin addiction. MATERIAL AND METHODS We established a rat model of heroin addiction and observed changes in the expression of BDNF, DA, dopamine receptor (DRD), dopamine transporter (DAT), and other relevant pathways in NAc. We also assessed the effect of BDNF overexpression in the NAc, behavioral changes of heroin-conditioned place preference (CPP), and naloxone withdrawal in rats with high levels of BDNF. We established 5 adult male rat groups: heroin addiction, lentivirus transfection, blank virus, sham operation, and control. The PCR gene chip was used to study gene expression changes. BDNF lentivirus transfection was used for BDNF overexpression. A heroin CPP model and a naloxone withdrawal model of rats were established. RESULTS Expression changes were found in 20 of the 84 DA-associated genes in the NAc of heroin-addicted rats. Weight loss and withdrawal symptoms in the lentivirus group for naloxone withdrawal was less than in the blank virus and the sham operation group. These 2 latter groups also showed significant behavioral changes, but such changes were not observed in the BDNF lentivirus group before or after training. DRD3 and DAT increased in the NAc of the lentivirus group. CONCLUSIONS BDNF and DA in the NAc are involved in heroin addiction. BDNF overexpression in NAc reduces withdrawal symptoms and craving behavior for medicine induced by environmental cues for heroin-addicted rats. BDNF participates in the regulation of the dopamine system by acting on DRD3 and DAT.

Topics: Animals; Brain-Derived Neurotrophic Factor; Dopamine; Dopamine Plasma Membrane Transport Proteins; Gene Expression Regulation; Heroin; Male; Nucleus Accumbens; Plasmids; Rats, Sprague-Dawley; Receptors, Dopamine; Sequence Analysis, DNA; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors; Tyrosine 3-Monooxygenase

Addictions to heroin or to cocaine are associated with substantial psychiatric comorbidity, including depression. Poly-drug self-exposure (eg, to heroin, cocaine, cannabis, or alcohol) is also common, and may further affect depression comorbidity.. This case-control study examined the relationship of exposure to the above drugs and depression comorbidity. Participants were recruited from methadone maintenance clinics, and from the community. Adult male and female participants (n = 1,201) were ascertained consecutively by experienced licensed clinicians. The instruments used were the SCID-I, and Kreek-McHugh-Schluger-Kellogg (KMSK) scales, which provide a rapid dimensional measure of maximal lifetime self-exposure to each of the above drugs. This measure ranges from no exposure to high unit dose, high frequency, and long duration of exposure.. A multiple logistic regression with stepwise variable selection revealed that increasing exposure to heroin or to cocaine was associated greater odds of depression, with all cases and controls combined. In cases with an opioid dependence diagnosis, increasing cocaine exposure was associated with a further increase in odds of depression. However, in cases with a cocaine dependence diagnosis, increasing exposure to either cannabis or alcohol, as well as heroin, was associated with a further increase in odds of depression.. This dimensional analysis of exposure to specific drugs provides insights on depression comorbidity with addictive diseases, and the impact of poly-drug exposure.. A rapid analysis of exposure to drugs of abuse reveals how specific patterns of drug and poly-drug exposure are associated with increasing odds of depression. This approach detected quantitatively how different patterns of poly-drug exposure can result in increased odds of depression comorbidity, in cases diagnosed with opioid versus cocaine dependence. (Am J Addict 2017;26:632-639).

Topics: Adult; Analgesics, Opioid; Case-Control Studies; Cocaine; Comorbidity; Depression; Female; Heroin; Humans; Illicit Drugs; Male; Middle Aged; Psychiatric Status Rating Scales; Statistics as Topic; Substance-Related Disorders

Community-based overdose prevention programs first emerged in the 1990's and are now the leading public health intervention for overdose. Key elements of these programs are overdose education and naloxone distribution to people who use opioids and their social networks. We review the evolution of naloxone programming through the heroin overdose era of the 1990's, the prescription opioid era of the 2000's, and the current overdose crisis stemming from the synthetic opioid era of illicitly manufactured fentanyl and its analogues in the 2010's. We present current challenges arising in this new era of synthetic opioids, including variable potency of illicit drugs due to erratic adulteration of the drug supply with synthetic opioids, potentially changing efficacy of standard naloxone formulations for overdose rescue, potentially shorter overdose response time, and reports of fentanyl exposure among people who use drugs but are opioid naïve. Future directions for adapting naloxone programming to the dynamic opioid epidemic are proposed, including scale-up to new venues and social networks, new standards for post-overdose care, expansion of supervised drug consumption services, and integration of novel technologies to detect overdose and deliver naloxone.

Topics: Analgesics, Opioid; Community Health Services; Drug Overdose; Fentanyl; Heroin; Heroin Dependence; Humans; Illicit Drugs; Naloxone; Narcotic Antagonists; Opioid-Related Disorders; Substance-Related Disorders

Cryptomarkets offer insight into the evolving interplay between online black markets and cartel-based distribution. The types and forms of heroin, fentanyl, and prescription drugs show wide diversification. In this commentary we describe changes in the conceptualizations, technologies and structures of drug supply chains in the 21st Century, with special attention to the role of cryptomarkets as tools, contexts, and drivers of innovation in public health research.

Topics: Analgesics, Opioid; Commerce; Drug Trafficking; Fentanyl; Heroin; Humans; Illicit Drugs; Internet; Prescription Drug Diversion; Public Health; Substance-Related Disorders; Syringes

The study aims to describe recent changes in Kentucky's drug overdose trends related to increased heroin and fentanyl involvement, and to discuss future directions for improved drug overdose surveillance.. The study used multiple data sources (death certificates, postmortem toxicology results, emergency department [ED] records, law enforcement drug submissions, and prescription drug monitoring records) to describe temporal, geographic, and demographic changes in drug overdoses in Kentucky.. Fentanyl- and heroin-related overdose death rates increased across all age groups from years 2011 to 2015 with the highest rates consistently among 25-34-year-olds. The majority of the heroin and fentanyl overdose decedents had histories of substantial exposures to legally acquired prescription opioids. Law enforcement drug submission data were strongly correlated with drug overdose ED and mortality data. The 2016 crude rate of heroin-related overdose ED visits was 104/100,000, a 68% increase from 2015 (62/100,000). More fentanyl-related overdose deaths were reported between October, 2015, and September, 2016, than ED visits, in striking contrast with the observed ratio of >10 to 1 heroin-related overdose ED visits to deaths. Many fatal fentanyl overdoses were associated with heroin adulterated with fentanyl; <40% of the heroin overdose ED discharge records listed procedure codes for drug screening.. The lack of routine ED drug testing likely resulted in underreporting of non-fatal overdoses involving fentanyl and other synthetic drugs. In order to inform coordinated public health and safety responses, drug overdose surveillance must move from a reactive to a proactive mode, utilizing the infrastructure for electronic health records.

Topics: Adolescent; Adult; Aged; Analgesics, Opioid; Drug Contamination; Drug Overdose; Female; Fentanyl; Heroin; Heroin Dependence; Humans; Kentucky; Male; Middle Aged; Opioid-Related Disorders; Public Health; Substance-Related Disorders; Young Adult

There are limited data about the extent of DSM-5 substance use disorders (SUDs) among primary care patients.. This study analyzed data from a multisite validation study of a substance use screening instrument conducted in a diverse sample of 2000 adults aged ≥18 years recruited from five primary care practices in four states. Prevalence and correlates of 12-month DSM-5 SUDs were examined.. Overall, 75.5% of the sample used any substance, including alcohol (62.0%), tobacco (44.1%), or illicit drugs/nonmedical medications (27.9%) in the past 12 months (marijuana 20.8%, cocaine 7.3%, opioids 4.8%, sedatives 4.1%, heroin 3.9%). The prevalence of any 12-month SUD was 36.0% (mild disorder 14.2%, moderate/severe disorder 21.8%): tobacco 25.3% (mild 11.5%, moderate/severe 13.8%); alcohol 13.9% (mild 6.9%, moderate/severe 7.0%); and any illicit/nonmedical drug 14.0% (mild 4.0%, moderate/severe 10.0%). Among past 12-month users, a high proportion of tobacco or drug users met criteria for a disorder: tobacco use disorder 57.4% (26.1% mild, 31.3% moderate/severe) and any drug use disorder 50.2% (14.3% mild, 35.8% moderate/severe); a lower proportion of alcohol users (22.4%) met criteria for alcohol use disorder (11.1% mild, 11.3% moderate/severe). Over 80% of adults with opioid/heroin use disorder met criteria for a moderate/severe disorder. Younger ages, male sex, and low education were associated with increased odds of having SUD.. These findings reveal the high prevalence of SUDs in primary care and underscore the need to identify and address them.

Topics: Adult; Alcoholism; Cannabis; Diagnostic and Statistical Manual of Mental Disorders; Heroin; Humans; Hypnotics and Sedatives; Illicit Drugs; Opioid-Related Disorders; Prevalence; Primary Health Care; Substance-Related Disorders; Tobacco Use Disorder

Kratom use in the West has increased recently, yet the prevalence and motives for use among individuals with a history of substance use disorder (SUD) have not been fully examined. Kratom has been documented as a means of treating chronic pain, mitigating drug dependence, and easing withdrawal symptoms, yet it is unclear if substance users are utilizing kratom as a self-medication. Abuse liability, side effects, and overall appeal of kratom remain uncertain.. In April 2017, an anonymous survey regarding kratom use and motivations was completed by clients enrolled in a 12-Step-oriented residential program. 500 respondents with a self-reported history of SUD completed the survey.. 20.8% of respondents endorsed lifetime kratom use and 10.2% reported past-12-month use. Kratom-users were younger (=32.1 vs. 35.9, p<0.001) and were more versatile substance users. A majority (68.9%) of kratom-users reported having used the drug as a means of reducing or abstaining from non-prescription opioids (NPO) and/or heroin, and 64.1% reported using kratom as a substitute for NPO/heroin. 18.4% of kratom-users reported using the drug due to a disability or chronic pain. One-third of kratom-users stated that kratom was a helpful substance and that they would try it again. However, kratom was not preferred and was indicated as having less appeal than NPO, heroin, amphetamines, and Suboxone.. Among substance users, kratom use may be initiated for a variety of reasons, including as a novel form of harm-reduction or drug substitution, particularly in the context of dependence and withdrawal from other substances.

Topics: Amphetamines; Analgesics, Opioid; Buprenorphine, Naloxone Drug Combination; Chronic Pain; Heroin; Humans; Motivation; Prevalence; Residential Treatment; Self Medication; Self Report; Substance Withdrawal Syndrome; Substance-Related Disorders; Surveys and Questionnaires

Addiction to illicit substances or medicines is influenced by cultural, religious, ethnic factors as well as local availability. The purpose of this study was to evaluate the profile of drug users and characteristics of the psychoactive substances used in French overseas territories, using data from the OPPIDUM survey. OPPIDUM is an annual, nationwide, multicentric, cross-sectional study based on specialized care centres that included subjects presenting a drug addiction or under opiate maintenance treatment. The current study includes data from the 2012 and 2013 surveys and focuses on patients included by drug addiction centres located in French overseas departments and territories: French Pacific Ocean (French Polynesia, New Caledonia), French Americas (Guadeloupe, Saint Martin, French Guiana) and Reunion Island. Data from metropolitan France (2013 survey) were included as reference. Two hundred and forty-five patients were included. The sex ratio was 3.7 for the Pacific Ocean, 3.5 for the French Americas and 3.3 for Reunion Island. Cannabis was consumed in all the territories, from 50.8% in Reunion Island to 81.7% in Pacific Ocean. Cocaine was most frequently consumed in the French Americas (61%), mainly in the 'freebase' form (91%), whereas 6.5% of cocaine users in metropolitan France did so. Problematic use of medicines was most frequent in Reunion Island. Heroin seems rarely used in all overseas territories. This study highlights the complexity of substances used in French overseas territories, which often differ from that in mainland France. The relative difference between different areas provides valuable information for future investigations and possible interventions.

Topics: Adolescent; Adult; Cocaine; Female; France; French Guiana; Guadeloupe; Heroin; Humans; Illicit Drugs; Male; Martinique; New Caledonia; Polynesia; Psychotropic Drugs; Reunion; Substance-Related Disorders; Surveys and Questionnaires; Young Adult

MicroRNAs (miRNAs) are a class of evolutionarily conserved, 18-25 nucleotide non-coding sequences that post-transcriptionally regulate gene expression. Recent studies implicated their roles in the regulation of neuronal functions, such as learning, cognition and memory formation. Here we report that miR-218 inhibits heroin-induced behavioral plasticity. First, network propagation-based method was used to predict candidate miRNAs that played potential key roles in regulating drug addiction-related genes. Microarray screening was also carried out to identify miRNAs responding to chronic heroin administration in the nucleus accumbens (NAc). Among the collapsed miRNAs, top-ranked miR-218 was decreased after chronic exposure to heroin. Lentiviral overexpression of miR-218 in NAc could inhibit heroin-induced reinforcement in both conditioned place preference (CPP) test and heroin self-administration experiments. Luciferase activity assay indicated that miR-218 could regulate 3' untranslated regions (3' UTR) of multiple neuroplasticity-related genes and directly target methyl CpG binding protein 2 (Mecp2). Consistently, Mecp2

Topics: Animals; Base Sequence; Down-Regulation; Drug-Seeking Behavior; Gene Regulatory Networks; Heroin; Humans; Lentivirus; Male; Methyl-CpG-Binding Protein 2; MicroRNAs; Neuronal Plasticity; Nucleus Accumbens; Rats, Sprague-Dawley; Reinforcement, Psychology; Substance-Related Disorders

Direct evidence of the effect of drug seizures on drug use and drug-related harm is fairly sparse. The aim of this study was to see whether seizures of heroin, cocaine and ATS predict the number of people arrested for use and possession of these drugs and the number overdosing on them.. We examined the effect of seizure frequency and seizure weight on arrests for drug use and possession and on the frequency of drug overdose with autoregressive distributed lag (ARDL) models. Granger causality tests were used to test for simultaneity.. Over the short term (i.e. up to 4 months), increases in the intensity of high-level drug law enforcement (as measured by seizure weight and frequency) directed at ATS, cocaine and heroin did not appear to have any suppression effect on emergency department (ED) presentations relating to ATS, cocaine and heroin, or on arrests for use and/or possession of these drugs. A significant negative contemporaneous relationship was found between the heroin seizure weight and arrests for use and/or possession of heroin. However no evidence emerged of a contemporaneous or lagged relationship between heroin seizures and heroin ED presentations.. The balance of evidence suggests that, in the Australian context, increases in the monthly seizure frequency and quantity of ATS, cocaine and heroin are signals of increased rather than reduced supply.

Topics: Amphetamines; Australia; Cocaine; Crime; Drug Overdose; Emergency Service, Hospital; Heroin; Humans; Illicit Drugs; Law Enforcement; Models, Statistical; Substance-Related Disorders

There has been an almost exponential growth in the number of new psychoactive substances (NPS) on the drug markets in Europe during the past decade. While most users of NPS use them by routes other than injecting, percutaneous use of NPS is associated with very frequent injecting episodes and paraphernalia sharing.. We assessed to what extent new clients between 2006 and 2014 (N=3680) at Blue Point, Hungary's largest needle exchange program, exhibited a shift during these years in the drugs they primarily injected.. Until 2010, 99% of clients injected either heroin or amphetamines. After 2010, however, there was a "replacement chain" of new substances, with one appearing and disappearing after the other: between 2010 and 2014, NPS under five names appeared and gained dominant prevalence (from 0% to 80%), and gradually replaced first the two "traditional" drugs amphetamine and heroin (which diminished to 17% together in 2014) and later each other. We also saw an increase in the proportion of female and older clients.. While our findings are restricted to injected NPS, they suggest that NPS affect the vast majority of the population of people who inject drugs not only in terms of drug use patterns, but maybe also in terms of demographics. Given that over 80% of people who inject drugs use NPS and injecting NPS is associated with increased injecting risks, harm reduction services should be made more available to avoid an epidemic of blood-borne infections.

Topics: Adolescent; Adult; Amphetamine; Female; Heroin; Humans; Hungary; Male; Needle-Exchange Programs; Prevalence; Psychotropic Drugs; Substance Abuse, Intravenous; Substance-Related Disorders; Young Adult

We examined initiation patterns among different birth cohorts of people who used prescription opioids and heroin because of historical differences in drug use availability. We examined data from a community-based study of persons who inject drugs (n = 483) in California and a general population survey from the National Survey on Drug Use and Health (n = 1264) and found that individuals born after 1980 were more likely than were individuals born before 1980 to initiate opioids through nonmedical use of prescription opioids than heroin.

Topics: Adolescent; Adult; Age of Onset; Aged; Analgesics, Opioid; California; Cohort Studies; Heroin; Humans; Middle Aged; Pain; Prescription Drug Misuse; Substance-Related Disorders; Young Adult

The present study was designed to investigate the effect of a methanolic extract of Morinda citrifolia Linn. fruit (MMC) on the rewarding effect of heroin in the rat conditioned place preference (CPP) paradigm and naloxone-precipitated withdrawal in mice. In the first experiment, following a baseline preference test (preconditioning score), the rats were subjected to conditioning trials with five counterbalanced escalating doses of heroin versus saline followed by a preference test conducted under drug-free conditions (post-conditioning score) using the CPP test. Meanwhile, in the second experiment, withdrawal jumping was precipitated by naloxone administration after heroin dependence was induced by escalating doses for 6 days (3×/ day). The CPP test results revealed that acute administration of MMC (1, 3, and 5 g/kg body weight (bw), p.o.), 1 h prior to the CPP test on the 12th day significantly reversed the heroin-seeking behavior in a dose-dependent manner, which was similar to the results observed with a reference drug, methadone (3 mg/kg bw, p.o.). On the other hand, MMC (0.5, 1, and 3 g/kg bw, p.o.) did not attenuate the heroin withdrawal jumps precipitated by naloxone. These findings suggest that the mechanism by which MMC inhibits the rewarding effect of heroin is distinct from naloxone-precipitated heroin withdrawal.

Topics: Animals; Behavior, Animal; Conditioning, Psychological; Fruit; Heroin; Male; Mice, Inbred ICR; Models, Animal; Morinda; Naloxone; Plant Extracts; Rats, Sprague-Dawley; Reinforcement, Psychology; Reward; Substance Withdrawal Syndrome; Substance-Related Disorders

The present study established a novel mouse model of a runway drug self-administration in our laboratory. The operant runway apparatus consisted of three long runways arranged in a zig-zag manner. The methodology consisted of six distinct phases: habituation, preconditioning, conditioning, post-conditioning, extinction and reinstatement. The effects of saline were compared with escalating doses of either ethanol (0.5-4.0 g/kg, i.p), heroin (5-40 mg/kg, i.p), or nicotine (0.1-0.5mg/kg, i.p) administered in the goal box during the conditioning phase (day 1 to day 5). A significant decrease in the time of trained (conditioned) mice to reach the goal box confirmed the subjects' motivation to seek those drugs on day 6 (expression). The mice were then subjected to non-rewarded extinction trials for 5 days over which run times were significantly increased. After 5 days of abstinence, a priming dose of ethanol or heroin (1/5th of maximum dose used in conditioning) significantly reinstated the drug-seeking behavior. These results suggest that the modified runway model can serve as a powerful behavioral tool for the study of the behavioral and neurobiological bases of drug self-administration and, as such, is appropriate simple but powerful tool for investigating the drug-seeking behavior of laboratory mice.

Topics: Animals; Behavior, Animal; Biobehavioral Sciences; Conditioning, Operant; Drug-Seeking Behavior; Ethanol; Extinction, Psychological; Habituation, Psychophysiologic; Heroin; Injections, Intraperitoneal; Male; Mice; Mice, Inbred ICR; Motivation; Nicotine; Self Administration; Substance-Related Disorders

Clinical and preclinical evidence indicates that the setting of drug use affects drug reward in a substance-specific manner. Heroin and cocaine co-abusers, for example, indicated distinct settings for the two drugs: heroin being used preferentially at home and cocaine preferentially outside the home. Similar results were obtained in rats that were given the opportunity to self-administer intravenously both heroin and cocaine.. The goal of the present study was to investigate the possibility that the positive affective state induced by cocaine is enhanced when the drug is taken at home relative to a non-home environment, and vice versa for heroin.. To test this hypothesis, we trained male rats to self-administer both heroin and cocaine on alternate days and simultaneously recorded the emission of ultrasonic vocalizations (USVs), as it has been reported that rats emit 50-kHz USVs when exposed to rewarding stimuli, suggesting that these USVs reflect positive affective states.. We found that Non-Resident rats emitted more 50-kHz USVs when they self-administered cocaine than when self-administered heroin whereas Resident rats emitted more 50-kHz USVs when self-administering heroin than when self-administering cocaine. Differences in USVs in Non-Resident rats were more pronounced during the first self-administration (SA) session, when the SA chambers were completely novel to them. In contrast, the differences in USVs in Resident rats were more pronounced during the last SA sessions.. These findings indicate that the setting of drug taking exerts a substance-specific influence on the ability of drugs to induce positive affective states.

Topics: Analgesics, Opioid; Animals; Cocaine; Dopamine Uptake Inhibitors; Heroin; Male; Rats; Rats, Sprague-Dawley; Reward; Self Administration; Substance-Related Disorders; Ultrasonic Waves; Vocalization, Animal

Polysubstance use is associated with alterations in different components of executive functioning such as working memory and response inhibition. Nevertheless, less attention has been given to executive planning skills, which are required to benefit of low structured interventions. This study examines the association between severity of use of cocaine, heroin, alcohol, fluid and crystallized intelligence and planning tasks varying on degree of structure.. Data were collected from 60 polysubstance users and 30 healthy controls. Cognitive assessment consisted of three planning tasks with different structure levels: Stockings of Cambridge, Zoo Map test, and Multiple Errands Test.. Polysubstance users had significant planning deficits across the three tasks compared to healthy controls. Hierarchical regression models showed that severity of drug use and fluid and crystallized intelligence significantly explained performance in all the planning tasks. However, these associations were higher for low-structured real world tasks. These low-structured tasks also showed a unique association with crystallized but not fluid intelligence.. Drug abuse is negatively associated with planning abilities, and intelligence is positively associated with planning performance in real-world tasks.

Topics: Case-Control Studies; Cocaine; Cocaine-Related Disorders; Ethanol; Executive Function; Heroin; Humans; Intelligence; Psychological Tests; Substance-Related Disorders

We implemented oral fluid (OF) as an alternative specimen type to urine for detection of cocaine (COC) and opiate abuse in outpatient addiction medicine clinics.. We implemented a 2-μg/L limit of quantification OF LC-MS/MS assay and compiled and reviewed all findings from a 22-month collection period for COC, benzoylecgonine (BZE), codeine (COD), 6-acetylmorphine (MAM), and morphine (MOR). We also compared the results of our clinical samples at different OF cutoffs and analytes specified in the new 2015 SAMHSA OF guidelines.. Of 3608 OF samples, COC and BZE were positive in 593 and 508, respectively. COC or BZE was positive in 662 samples. Importantly and unexpectedly, 154 samples were COC positive and BZE negative, with 125 having COC 2.0-7.9 μg/L. A simulation with the new guideline cutoffs confirmed 65% (430 of 662) of all COC- or BZE-positive data set samples. Similarly, the new guidelines confirmed 44% (263 of 603) of data set samples positive for MOR or COD. Simulation found that the new, lower MAM guideline cutoffs detected 89% of the 382 MAM-positive samples in the data set, 104 of which the new guidelines had identified as negative for MOR and COD.. COC (not BZE) is the dominant low-concentration OF analyte in an addiction medicine setting. This information will aid OF test interpretation. It also illustrates the importance of the 2015 guideline's new immunoassay cross-reactivity requirements and the likely improvement in detection of heroin use stemming from the new, lower MAM cutoffs.

Topics: Administration, Oral; Adult; Chromatography, Liquid; Cocaine; Female; Heroin; Humans; Male; Substance Abuse Detection; Substance-Related Disorders; Tandem Mass Spectrometry; United States; United States Substance Abuse and Mental Health Services Administration

Overdose deaths from heroin and prescription opioids have reached epidemic proportions in recent years. Deaths specifically involving heroin have more than tripled since 2011, and for the first time, drug overdose deaths have exceeded deaths resulting from motor vehicle accidents. This epidemic has been receiving attention among policymakers and the media which has resulted in efforts to provide training and education on prescribing practices, increase the use of naloxone, and expand the availability and use of Medication-Assisted Treatment (MAT). What is not being talked about is the relationship between early initiation of less harmful substances such as alcohol and marijuana and subsequent use of prescription opioids and heroin. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a model which shows promise for preventing initiation and reducing risky substance use among adolescents before it progresses to use of harder drugs such as heroin. Unfortunately, though recommended by the American Academy of Pediatrics, health care providers are not even screening their adolescent patients for substance use. The heroin and prescription opioid epidemic and the dissemination of information regarding federal, state, and local efforts to combat the epidemic provide a platform for increasing awareness of SBIRT, garnering support for more research, and facilitating uptake and integration into practice. It is time to add SBIRT to the conversation.

Topics: Adolescent; Adolescent Health Services; Analgesics, Opioid; Drug Overdose; Epidemics; Heroin; Humans; Pediatrics; Referral and Consultation; Substance-Related Disorders

We investigated whether variation in the dopamine D2 receptor gene (DRD2) and tri-dimensional personality questionnaire (TPQ) scores could be used to aid adjustment of daily methadone requirements of heroin addicts. DRD2 TaqI B polymorphisms and TPQ scores were determined in 138 male Taiwanese heroin addicts who were receiving methadone treatment. Borderline index (harm avoidance + novelty seeking-reward dependence) was calculated for each subject, and three groups were defined: high (mean from all subjects plus 1 standard deviation, or greater), low (half of the calculated high score, or lower) and medium (all values between the high and low scores).. No significant differences in age (p = 0.60), mean methadone dose (p = 0.75) or borderline index group (p = 0.25) were observed between subjects bearing the B1/B1, B1/B2 and B2/B2 DRD2 TaqI genotypes. Among the individuals with low (≤10), medium (11-20) and high (≥21) borderline index scores, there was a significant difference in mean methadone dose (p = 0.04), but not age (p = 0.90). Further analysis showed that mean methadone dose was significantly higher in subjects with low borderline index scores than in those with high scores (62.5 vs. 47.0 mg/day, p = 0.03). The odds ratio for a daily methadone requirement ≥60 mg (median dose across the 138 subjects) was 2.64-fold greater in the low borderline index group than in the high group (p = 0.04).. Although the DRD2 TaqI B genotype was not associated with methadone use requirements, borderline index was revealed as a potential predictive marker for the adjustment of methadone dosage requirements in heroin addicts.

Topics: Adult; Dose-Response Relationship, Drug; Gene Frequency; Genotype; Heroin; Heroin Dependence; Humans; Male; Methadone; Middle Aged; Personality; Personality Assessment; Polymorphism, Genetic; Receptors, Dopamine D2; Substance-Related Disorders; Surveys and Questionnaires; Taiwan

Licit and illicit drug use in pregnant women constitutes a long lasting and serious problem worldwide. Information on long-term effects of maternal drug use on the child is limited. Nationwide registers provide a great potential to study short and long-term consequences for children exposed to licit and illicit drugs during pregnancy. We discuss this potential, with a special emphasis on exposure to methamphetamine, heroin and prescription drugs used for opioid maintenance treatment (OMT). We also discuss the advantages of register data and of merging such data from different regions. The Czech and Scandinavian registers are largely comparable and provide great opportunities to conduct innovative research. For instance, using Czech and Scandinavian cohorts we can compare groups with similar characteristics, such as mothers in OMT and mothers addicted to other drugs while also controlling for important confounding factors such as health and socio-economic status.

Topics: Adult; Analgesics, Opioid; Czech Republic; Female; Heroin; Humans; Illicit Drugs; Infant, Newborn; Methamphetamine; Middle Aged; Narcotic Antagonists; Opiate Substitution Treatment; Pregnancy; Pregnancy Outcome; Prenatal Exposure Delayed Effects; Registries; Scandinavian and Nordic Countries; Substance-Related Disorders

Celebrities are at risk for premature mortality as well as drug-related death. Despite being a vulnerable patient group, celebrities influence people's health behaviours through biological, psychological and social processes. Therefore, celebrity endorsement of the topic could be one way to challenge the current "opioid endemic". Our aim was to better understand the factors surrounding drug-related celebrity deaths by investigating the incidence as well as substances used between 1970 and 2015 using a cross-sectional study design.. We searched public databases for drug-related celebrity deaths between 1970 and 2015. They were categorized for sex, profession, age at death, year of death and substances involved. The main outcome measures are descriptive values including number of drug deaths per year and substances involved. Secondary outcome measures are analytical questions to examine whether and which factors influence age at death and year of death (e.g. type of substance use disorder).. We identified 220 celebrities who died a drug-related death with a clear indication of involved substances between 1970 and 2015. The average age at death was 38.6 years; 75% were male. Most celebrities died between the age of 25 and 40. The number of drug-related deaths increased in the 21st century, with a significant increase in the use of prescription opioids. Deaths involving prescription opioids and heroin were associated with a significantly lower mean age at death compared to deaths where these substances were not involved.. Compared to the 20th century, the total number of celebrities who died from a drug-related death in the 21st century increased, possibly due to an increased involvement of prescription opioids. Negative effects on individual health decisions of celebrity's followers could be the result.

Topics: Adult; Analgesics, Opioid; Cross-Sectional Studies; Drug Overdose; Famous Persons; Heroin; Humans; Male; Mortality; Substance-Related Disorders; Young Adult

This article provides an anthropological analysis of the introduction of medically prescribed heroin as part of official substance abuse treatment. While anthropological inquiries of substance abuse treatment have mainly focused on providing the users perspectives on the (ab)use or unraveling the conflicts and negotiations between users and staff, the present article argues for the merits of paying attention to the spatial dimensions of substance abuse treatment. Focusing on the spatial and material ramification of the treatment can shed a nuanced light on the still vulnerable process of altering the heroin from drug to medicine, and thereby on the attempts to settle heroin in a new practical and semantic landscape. The heroin is anchored in some powerful discourses of crime, death, and pleasure, and the analysis shows how these discourses (re-)appear in the spatial textures of the clinic, contesting the attempts to medicalize the heroin. Further, the article argues that even though the treatment aims at a marginalization of the heroin in the life of the clients, the spatial arrangements and the practices within them simultaneously enforces a centralization of the heroin, making the space for treatment highly ambivalent.

Topics: Anthropology, Medical; Denmark; Facility Design and Construction; Health Facility Environment; Heroin; Humans; Medication Therapy Management; Spatial Analysis; Substance Abuse Treatment Centers; Substance-Related Disorders

The inability to maintain drug abstinence is often referred to as relapse and consists of a process by which an abstaining individual slips back into old behavioral patterns and substance use. Animal models of relapse have been developed and validated over the last decades, and significantly contributed to shed light on the neurobiological mechanisms underlying vulnerability to relapse. The most common procedure to study drug-seeking and relapse-like behavior in animals is the "reinstatement model." Originally elaborated by Pavlov and Skinner, the concepts of reinforced operant responding and conditioned behavior were applied to addiction research not before 1971 (Stretch et al., Can J Physiol Pharmacol 49:581-589, 1971), and the first report of a reinstatement animal model as it is now used worldwide was published only 10 years later (De Wit and Stewart, Psychopharmacology 75:134-143, 1981). According to the proposed model, opioids are typically self-administered intravenously, as humans do, and although rodents are most often employed in these studies, this model has been used with a variety of species including nonhuman primates, dogs, cats, and pigeons. A variety of operant responses are available, depending on the species studied. For example, a lever press or a nose poke response typically is used for rodents, whereas a panel press response typically is used for nonhuman primates. Here, we describe a simple and easily reproducible protocol of heroin-seeking reinstatement in rats, which proved useful to study the neurobiological mechanisms underlying relapse to heroin and vulnerability factors enhancing the resumption of heroin-seeking behavior.

Topics: Analgesics, Opioid; Animals; Behavior, Addictive; Cocaine; Conditioning, Operant; Disease Models, Animal; Heroin; Humans; Opioid-Related Disorders; Rats; Receptors, Opioid; Substance-Related Disorders

Among persons who inject drugs (PWID), polydrug use (the practice of mixing multiple drugs/alcohol sequentially or simultaneously) increases risk for HIV transmission and unintentional overdose deaths. Research has shown local drug markets influence drug use practices. However, little is known about the impact of drug mixing in markets dominated by black tar heroin and methamphetamine, such as the western United States.. Data were collected through an ongoing longitudinal study examining drug use, risk behavior, and health status among PWID. Latent class analysis (LCA) was used to identify patterns of substance use (heroin, methamphetamine, prescription drugs, alcohol, and marijuana) via multiple administration routes (injecting, smoking, and swallowing). Logistic regression was used to identify behaviors and health indicators associated with drug use class.. The sample included 511 mostly white (51.5%) males (73.8%), with mean age of 43.5 years. Two distinct classes of drug users predominated: methamphetamine by multiple routes (51%) and heroin by injection (49%). In multivariable logistic regression, class membership was associated with age, race, and housing status. PWID who were HIV-seropositive and reported prior sexually transmitted infections had increased odds of belonging to the methamphetamine class. Those who were HCV positive and reported previous opioid overdose had an increased odds of being in the primarily heroin injection class (all P-values < .05).. Risk behaviors and health outcomes differed between PWID who primarily inject heroin vs. those who use methamphetamine. The findings suggest that in a region where PWID mainly use black tar heroin or methamphetamine, interventions tailored to sub-populations of PWID could improve effectiveness.

Topics: Adult; California; Drug Administration Routes; Drug Users; Female; Health Status; Heroin; Humans; Longitudinal Studies; Male; Methamphetamine; Middle Aged; Risk-Taking; Substance Abuse, Intravenous; Substance-Related Disorders

Hair specimen is necessary to complement blood and/or urine analyses as it permits differentiation of a single exposure from chronic use of a drug by segmentation of the hair for a stated growth period. Moreover, due to a frequent long delay between event and police declaration, hair can be the only solution for lack of corroborative evidence of a committed crime. With the exception of lower amount of biological material in children versus adults, there is no specific analytical problem when processing samples from children. The issue is the interpretation of the findings, with respect to the different pharmacological parameters. In some very young children, the interpretation can be complicated by potential in utero exposure. Twenty-four cases from daily practice have been reviewed. Children were less than 1 year old, hair was always longer than 4 cm and the corresponding mothers admitted having used drugs during pregnancy. Drugs involved include methadone, tramadol, diphenhydramine, diazepam, cannabis, heroin, amitriptyline and bromazepam. Analyses were achieved by hyphenated chromatographic validated procedures after hair decontamination and segmentation. The concentrations measured in the hair of children were lower than those observed in subjects using therapeutically (or illegally) these drugs. In that sense, the frequency of exposures appears as un-frequent (low level of exposure), with marked decrease in the more recent period. However, the parents denied any administration in all cases and there was no reason to suspect re-exposure after delivery and no clinical problem during the period between delivery and hair collection during regular visits to the physician was noticed. The pattern of drug distribution was similar in all these cases, low concentrations in the proximal segments and highest concentration in the distal segment (last segment). When considering the concentration in the distal segment as the 100% of the response (highest concentration), after analysis of 4 segments (irrespective of the length of the segment but longer than 1cm), it was observed the following pattern: proximal segment, 5-35% of the response; segment 2, 15-50% of the response; segment 3, 25-60% of the response; and distal segment, 100% of the response. It is proposed to consider 100% in utero contribution to the final interpretation when the ratio concentration of the proximal segment to the concentration of the distal segment is lower than 0.5. This can be applied

Topics: Amitriptyline; Bromazepam; Cannabinoids; Diazepam; Diphenhydramine; Female; Forensic Toxicology; Hair; Heroin; Humans; Hypnotics and Sedatives; Infant; Infant, Newborn; Male; Maternal-Fetal Exchange; Methadone; Narcotics; Pregnancy; Substance-Related Disorders; Tramadol

A 30-year-old man reportedly ingested pills and used illicit drugs with another person. They both fell asleep that night and the following afternoon the other person found him dead. There were used hypodermic needles and a metal spoon with dark tarry substance at the death scene, and two recent puncture sites were found on his body. It was uncertain if he had a history of illicit drug use. Postmortem blood initially screened borderline positive for methamphetamine by ELISA. An alkaline drug screen-detected ethylone which was subsequently confirmed and quantified by a specific GC-MS SIM analysis following solid-phase extraction. Concentrations were determined in the peripheral blood (0.39 mg/L), central blood (0.38 mg/L), liver (1.4 mg/kg), vitreous (0.58 mg/L), urine (20 mg/L) and gastric contents (12 mg). Other compounds detected in peripheral blood were morphine (0.05 mg/L), alprazolam (<0.05 mg/L), delta-9-THC (<1 ng/mL), delta-9-carboxy-THC (3.6 ng/mL) and naproxen (<5 mg/L). A urine screen (GC-MS) also confirmed 6-monoacetylmorphine, codeine and sildenafil. The cause of death was certified due to mixed ethylone, heroin and alprazolam intoxication. The manner of death was certified as accident.

Topics: Accidents; Acetone; Adult; Alprazolam; Autopsy; Cause of Death; Drug Overdose; Enzyme-Linked Immunosorbent Assay; Ethylamines; Fatal Outcome; Forensic Toxicology; Gas Chromatography-Mass Spectrometry; Heroin; Humans; Illicit Drugs; Male; Predictive Value of Tests; Solid Phase Extraction; Substance Abuse Detection; Substance-Related Disorders

BDNF and its gene polymorphism may be important in synaptic plasticity and neuron survival, and may become a key target in the physiopathology of long-term heroin use. Thus, we investigated the relationships between brain-derived neurotrophic factor (BDNF) plasma concentrations and the BDNF Val66Met nucleotide polymorphism (SNP) in heroin-dependent patients. The pretreatment expression levels of plasma BDNF and the BDNF Val66Met SNP in 172 heroin-dependent patients and 102 healthy controls were checked. BDNF levels were significantly lower in patients (F = 52.28, p < 0.0001), but the distribution of the SNP was not significantly different. Nor were plasma BDNF levels significantly different between Met/Met, Met/Val, and Val/Val carriers in each group, which indicated that the BDNF Val66Met SNP did not affect plasma BDNF levels in our participants. In heroin-dependent patients, plasma BDNF levels were negatively correlated with the length of heroin dependency. Long-term (>15 years) users had significantly lower plasma BDNF levels than did short-term (<5 years) users. We conclude that plasma BDNF concentration in habitual heroin users are not affected by BDNF Val66Met gene variants, but by the length of the heroin dependency.

Topics: Adult; Alleles; Asian People; Brain-Derived Neurotrophic Factor; China; Down-Regulation; Female; Gene Frequency; Genotype; Heroin; Humans; Male; Polymorphism, Single Nucleotide; Substance-Related Disorders; Time Factors

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

The need to contextualise wastewater-based figures about illicit drug consumption by comparing them with other indicators has been stressed by numerous studies. The objective of the present study was to further investigate the possibility of combining wastewater data to conventional statistics to assess the reliability of the former method and obtain a more balanced picture of illicit drug consumption in the investigated area.. Wastewater samples were collected between October 2013 and July 2014 in the metropolitan area of Lausanne (226,000 inhabitants), Switzerland. Methadone, its metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), the exclusive metabolite of heroin, 6-monoacetylmorphine (6-MAM), and morphine loads were used to estimate the amounts of methadone and heroin consumed.. Methadone consumption estimated from EDDP was in agreement with the expectations. Heroin estimates based on 6-MAM loads were inconsistent. Estimates obtained from morphine loads, combined to prescription/sales data, were in agreement with figures derived from syringe distribution data and general population surveys.. The results obtained for methadone allowed assessing the reliability of the selected sampling strategy, supporting its ability to capture the consumption of a small cohort (i.e., 743 patients). Using morphine as marker, in combination with prescription/sales data, estimates in accordance with other indicators about heroin use were obtained. Combining different sources of data allowed strengthening the results and suggested that the different indicators (i.e., administration route, average dosage and number of consumers) contribute to depict a realistic representation of the phenomenon in the investigated area. Heroin consumption was estimated to approximately 13 gd ay(-1) (118 g day(-1) at street level).

Topics: Adult; Analgesics, Opioid; Drug Residues; Female; Heroin; Humans; Illicit Drugs; Male; Methadone; Monte Carlo Method; Morphine; Needle-Exchange Programs; Opiate Substitution Treatment; Registries; Substance-Related Disorders; Switzerland; Wastewater

Inhalation/smoking has become the most common method of recreational opiate consumption in the United Kingdom and other countries. Although some heroin smokers appear to develop COPD, little is known about the association.. We present data from a cohort of 73 heroin smokers with clinician-diagnosed and spirometrically confirmed COPD, seen within our clinical service, where symptoms developed before the age of 40 years.. The whole group mean age at diagnosis was 41 years, subjects had smoked heroin for 14 years, and mean FEV1 was 1.08 L (31.5% predicted), with mean FEV1/FVC of 0.4. No subject was found to have severe α1-antitrypsin deficiency. Forty-four subjects had either a high-resolution CT (HRCT) scan (32) or measurement of lung diffusion (12). Overall HRCT scan emphysema score averaged across the upper, middle, and lower part of the lung was 2.3 (5%-25% emphysema), with 47% subjects having an upper lobe emphysema score ≥ 3 (25%-50% emphysema). Median diffusing capacity of the lung for carbon monoxide was 48% of predicted value.. Recreational smoking of heroin appears to lead to early onset COPD with a predominant emphysema phenotype. This message is important to both clinicians and the public, and targeted screening and education of this high-risk population may be justified.

Topics: Administration, Inhalation; Adult; Female; Follow-Up Studies; Forced Expiratory Volume; Heroin; Humans; Male; Narcotics; Pulmonary Emphysema; Retrospective Studies; Risk Factors; Severity of Illness Index; Substance-Related Disorders; Time Factors; Tomography, X-Ray Computed

To describe work undertaken over a 20-year period, investigating overdose characteristics among survivors, effects of acute heroin administration, clustering of risk of overdose fatality and potential interventions to reduce this fatal outcome.. Privileged-access interviewers obtained data from non-treatment as well as treatment samples; experimental study of drop in oxygen saturation following heroin/opiate injection; investigation of clusterings of death following prison release and treatment termination; and study of target populations as intervention work-force, including family as well as peers, and action research built into pilot implementation.. Overdose has been experienced by about half of heroin/opiate misusers, with even higher proportions having witnessed an overdose, and with high levels of willingness to intervene. Heroin/opiates are associated with the majority of drug-related deaths, despite relative scarcity of use. Heroin injection causes a rapid drop in oxygen saturation, recovering only slowly over the next half hour. Deaths from drug overdose are greatly more likely on prison release and post-discharge from detoxification and other in-patient or residential settings. High levels of declared willingness to intervene are matched by active interventions. Both drug-using peers and family members show ability to improve knowledge and gain confidence from training. Audit study of take-home schemes finds approximately 10% of dispensed naloxone is used in real-life emergency situations.. Overdose is experienced by most users, with heroin/opiates contributing disproportionately to drug overdose deaths. High-risk times (e.g. after prison release) are now clearly identified. Peers and family are a willing potential intervention work-force, but are rarely trained or given pre-supply of naloxone. Large-scale naloxone provision (e.g. national across Scotland and Wales) is now being delivered, while large-scale randomized trials (e.g. N-ALIVE prison-release trial) are finally under way. Better naloxone products and better-organized provision are needed. The area does not need more debate; it now needs proper implementation alongside good scientific study.

Topics: Analgesics, Opioid; Death, Sudden; Drug Overdose; England; Heroin; Humans; Naloxone; Narcotic Antagonists; Opiate Substitution Treatment; Risk Factors; Scotland; Substance Abuse, Intravenous; Substance-Related Disorders

Low plasma potassium level can cause muscle weakness, lassitude, constipation as well as rhabdomyolysis and arrhythmias, when severe. In muscle, low plasma potassium increases resting membrane potential (hyperpolarization) of myocytes that tend to make muscle more refractory to excitation, leading to muscle weakness. Hypokalemia can be associated with a myriad of causes including drugs of abuse. We present a case of hypokalemia and muscle weakness following use of cocaine and heroin.

Topics: Adult; Arrhythmias, Cardiac; Cocaine; Constipation; Female; Heroin; Humans; Hypokalemia; Muscle Weakness; Potassium; Quadriplegia; Rhabdomyolysis; Substance-Related Disorders

Memory processes may be involved in the transition from drug lapses to relapse. This study explored the role of noradrenaline (NA) in reacquisition of place preference, an animal model of relapse that involves the updating of memories about drugs and associated stimuli. Experiments involved 7 phases: habituation, conditioning (1 mg/kg heroin and vehicle; 4 pairings each), test of conditioning (Test I), extinction (vehicle and vehicle; 4 pairings each), test of extinction (Test II), reconditioning (1 mg/kg heroin and vehicle; 1 re-pairing each), and test of reconditioning (Test III). To target memory stabilization processes, various treatments were administered post-reconditioning: systemic clonidine (0, 10, 40, 100 μg/kg; α2 adrenergic receptor agonist); intra-locus coeruleus (LC) clonidine (0, 4.5, 18 nmol); and intra-basolateral amygdala (BLA) propranolol/prazosin (0, 34/2.4 nmol; β and α1 adrenergic receptor antagonists, respectively). The effect of post-reconditioning systemic clonidine on BLA c-fos expression was also assessed. It was found that systemic clonidine dose-dependently blocked heroin reacquisition when given immediately or 4 h post-reconditioning, but not 8 h later or 4 h prior to Test III. Similar effects were observed following intra-LC clonidine infusions. Post-reconditioning systemic clonidine also blocked reacquisition of cocaine place preference (20 mg/kg). Finally, BLA c-fos expression was reduced by clonidine, and blockade of BLA β and α1 receptors prevented heroin reacquisition. These findings in rats support the hypothesis that relapse involves memory stabilization processes that can be disrupted by suppression of central NA activity.

Topics: Adrenergic alpha-1 Receptor Antagonists; Adrenergic alpha-2 Receptor Agonists; Animals; Basolateral Nuclear Complex; Clonidine; Cocaine; Conditioning, Psychological; Disease Models, Animal; Dopamine Uptake Inhibitors; Dose-Response Relationship, Drug; Heroin; Locus Coeruleus; Male; Memory; Narcotics; Norepinephrine; Prazosin; Propranolol; Rats, Sprague-Dawley; Spatial Behavior; Substance-Related Disorders

In contrast to research on more restricted samples of drug users, epidemiological studies open up a view of death rates and survivorship of those who have tried heroin a few times, with no acceleration toward sustained use patterns often seen in treatment and criminal justice samples. At their best, epidemiological estimates of heroin effects on risk of dying are not subject to serious selection biases faced with more restricted samples.. Data are from 7207 adult participants aged 18-48 years in United States Epidemiologic Catchment Area Program field surveys, launched in 1980-1984. US National Death Index (NDI) records through 2007 disclosed 723 deaths. NDI enabled estimation of heroin-associated risk of dying as well as survivorship.. Estimated cumulative mortality for all 18-48 year old participants is 3.9 deaths per 1000 person-years (95% confidence interval, CI=3.7, 4.2), relative to 12.4 deaths per 1000 person-years for heroin users (95% CI=8.7, 17.9). Heroin use, even when non-sustained, predicted a 3-4 fold excess of risk of dying prematurely. Post-estimation record review showed trauma and infections as top-ranked causes of these deaths.. Drawing strengths from epidemiological sampling, standardized baseline heroin history assessments, and very long-term NDI follow-up, this study of community-dwelling heroin users may help clinicians and public health officials who need facts about heroin when they seek to prevent and control heroin outbreaks. Heroin use, even when sporadic or non-sustained, is predictive of premature death in the US, with expected causes of death such as trauma and infections.

Topics: Adolescent; Adult; Drug Users; Female; Follow-Up Studies; Heroin; Heroin Dependence; Humans; Logistic Models; Male; Middle Aged; Mortality, Premature; Public Health; Risk; Substance-Related Disorders; Survival Rate; United States; Young Adult

Norjizak is a new drug abused in the past few years in Iran with symptoms and complications distinct from other common forms of drug and characterized by higher rate of mortality. The present study aims to analyze the chemical components of this substance. Five samples were obtained from abusers referring from different areas of Tehran to a treatment clinic. All samples were 2 ml vials with yellowish fluid. Thin Layer Chromatography (TLC) was performed first to analyze the samples semi-quantitatively and the quantitative levels of components were then explored using high-performance liquid chromatography (HPLC). TLC revealed steroid (in form of betamethasone), heroin, codeine, morphine and thebaine in all five samples. Four samples contained acetaminophen and two samples contained caffeine. None of them contained amphetamine, benzodiazepine, tricyclic antidepressant, aspirin, barbiturates, tramadol and buprenorphine. HPLC revealed that heroin, codeine, morphine and thebaine constituted the narcotic foundation in all samples. In addition, the heroin to acetylcodeine ratio was significantly lower in three samples, which indicates their higher toxicity. The results of the present study on the chemical components of Norjizak showed that this substance is an opiate one similar to heroin and the heroin-based crack prevalent in Iran which contains betamethasone.

Topics: Aspirin; Betamethasone; Caffeine; Chromatography, High Pressure Liquid; Chromatography, Thin Layer; Codeine; Drug Combinations; Heroin; Iran; Orphenadrine; Substance-Related Disorders

Topics: Female; Heroin; Humans; Male; Pulmonary Emphysema; Substance-Related Disorders

Use of and acute poisoning by substances of abuse represent a major health problem and are often linked to social destitution. We describe associations between place of residence, living conditions and the incidence of poisoning by substances of abuse in Oslo.. All patients who were 12 years of age or older and resident in Oslo and who were treated for acute poisoning by substances of abuse at the Oslo Accident and Emergency Outpatient Clinic (OAEOC) were included prospectively for a continuous period of one year, from October 2011 to September 2012. The 15 districts of Oslo were categorised into three groups of living conditions, from the best (I) to the poorest (III) living conditions, based on the City of Oslo's living conditions index. Homeless people were grouped separately. The incidence of poisoning by substances of abuse treated in the OAEOC was estimated.. Of a total of 1,560 poisonings by substances of abuse, 1,094 cases (70%) affected men. The median age was 41 years. The most frequent toxic agents were ethanol, with 915 cases (59%), and heroin, with 249 cases (16%). The incidence of poisoning by substances of abuse treated in the OAEOC per year per 1,000 inhabitants amounted to 1.75 in living conditions group I, to 2.76 in living conditions group II and 3.41 in living conditions group III. Living conditions group III had a significantly higher incidence than living conditions group II (p < 0.001), and living conditions group II had a significantly higher incidence than living conditions group I (p < 0.001).. The incidence of acute poisoning by substances of abuse was higher, the poorer the living conditions in the district.

Topics: Acute Disease; Adolescent; Adult; Aged; Ambulatory Care Facilities; Analgesics, Opioid; Benzodiazepines; Central Nervous System Stimulants; Child; Ethanol; Female; Heroin; Humans; Ill-Housed Persons; Male; Middle Aged; Norway; Poisoning; Prospective Studies; Social Conditions; Socioeconomic Factors; Sodium Oxybate; Substance-Related Disorders; Urban Population

Addiction severity has been associated with numerous social- and health-related harms. This study sought to examine the prevalence and correlates of high-intensity drug use among street-involved youth in a Canadian setting with a focus on high-risk drug use practices and health service access.. Data were derived from the At-Risk Youth Study, a Vancouver-based prospective cohort of street-involved youth aged 14-26. We used generalized estimating equations to examine variables associated with high-intensity drug use, defined as daily use of crack cocaine, cocaine, heroin, or crystal methamphetamine.. From September 2005 to November 2012, of 1017 youth included in the analyses, 529 (52%) reported high-intensity drug use as defined above at least once during the study period. In a multivariate analysis, older age (Adjusted Odds Ratio [AOR] = 1.47); residing in the Downtown Eastside of Vancouver (AOR = 1.46); homelessness (AOR = 1.30); recent incarceration (AOR = 1.25); inability to access addiction treatment (AOR = 1.42); and crack pipe sharing and/or used syringe injecting (AOR = 2.64), were all positively and independently associated with high-intensity drug use (p < 0.05). The most common barrier to accessing addiction treatment reported by these youth was long waiting lists.. High-intensity drug use among street-involved youth was prevalent and associated with structural and geographical disadvantages in addition to high-risk drug administration practices. Youth reporting more frequent drug use also reported barriers to accessing addiction treatment, highlighting the need to expand addiction services tailored to youth at greatest risk of harm from illicit drug use and street-involvement.

Topics: Adolescent; Adolescent Behavior; Adult; Age Distribution; Canada; Cocaine; Female; Health Services Accessibility; Heroin; Homeless Youth; Humans; Illicit Drugs; Male; Methamphetamine; Multivariate Analysis; Needle Sharing; Prospective Studies; Risk Factors; Risk-Taking; Substance-Related Disorders; Surveys and Questionnaires; Young Adult

Heroin trafficking and consumption has increased steadily over the past decade in Tanzania, but limited information regarding HIV and drug use exists for the city of Mwanza. Our study investigates the epidemiology of drug use, and HIV risk behaviors among drug users in the northwestern city of Mwanza. Using a combination of targeted sampling and participant referral, we recruited 480 participants in Mwanza between June and August 2014. The sample was 92% male. Seventy-nine (16.4%) participants reported injecting heroin, while 434 (90.4%) reported smoking heroin. Unstable housing and cohabitation status were the only socioeconomic characteristics significantly associated with heroin injection. More than half of heroin injectors left syringes in common locations, and half reported sharing needles and syringes. Other risk behaviors such as lack of condom use during sex, and the use of illicit drugs during sex was widely reported as well. Among the study sample, there was poor awareness of health risks posed by needle/syringe sharing and drug use. Our results show that heroin use and HIV risk related behaviors are pressing problems that should not be ignored in Mwanza. Harm reduction programs are urgently needed in this population.

Topics: Adult; Female; Heroin; HIV Infections; Humans; Male; Narcotics; Risk-Taking; Substance Abuse, Intravenous; Substance-Related Disorders; Tanzania; Young Adult

Natural and synthetic opioids have efficient analgesic activity but can also be addictive. Thus, the determination of opioids and their metabolites in biological specimens is of interest in clinical and forensic toxicology laboratories. The analysis of drugs in hair provides valuable information on previous chronic drug use and has been successfully applied to the diagnosis of drug abuse, tolerance, compliance and gestational drug exposure. Despite the abuse of prescription opioids along with heroin and other illegal opiates, few studies have been conducted on the simultaneous determination of the broad range of opioids covering those drugs in hair. In the present study, an analytical method for the simultaneous detection in hair of 18 opioids and metabolites considered to have a high abuse risk based on the results of urine drug screening was established and validated using liquid chromatography-tandem mass spectrometry (LC-MS/MS) for the purpose of clinical and forensic applications. The drugs and metabolites were extracted from hair using methanol and analyzed using LC-MS/MS. The validation results proved that the method was selective, accurate and precise with acceptable linearity within calibration ranges. No significant variation was observed by different sources of matrices. The limits of detection and the limits of quantification ranged from 0.05 to 0.25ng/10mg hair and from 0.05 to 0.5ng/10mg hair, respectively. The developed method was successfully applied to 15 hair samples from opioids users. This method will be very useful for monitoring the inappropriate use of opioid drugs.

Topics: Adult; Aged; Analgesics, Opioid; Chromatography, Liquid; Female; Forensic Toxicology; Hair; Heroin; Humans; Illicit Drugs; Limit of Detection; Male; Middle Aged; Substance Abuse Detection; Substance-Related Disorders; Tandem Mass Spectrometry

Scientific literature offers few measurements of the quantities consumed by individual drug users. Such measurements are used for calculating the total drug consumption by the quantity-frequency method, and are extremely important for the comparison with waste water derived consumption estimates. The aim of this study was to measure quantities of amphetamines, cocaine and heroin consumed by marginalized drug users, using a multi-city questionnaire survey design. Variation by gender, age, frequency of use, main drug used and city was explored.. The self-reported quantity used on the last day of use was for amphetamines on average 800 mg, for cocaine 1,014 mg and for heroin 682 mg. The self-reported usual dose was on average 297 mg, 487 mg and 297 mg respectively, while the median value was 250 mg for all three drugs. Overall, gender and age group were less important than frequency of use and the main drug used for establishing differences regarding the outcome variables. There were some differences regarding cities. No measure of purity was carried out at the interview sites, so the calculation of pure quantities was based on aggregate results from analyses of seizures by police and customs.. The self-reported quantities of drugs consumed in three cities in Norway was equal to or somewhat higher among marginalized users than earlier assumed, where assumptions were based on limited literature and anecdotal information.

Topics: Adult; Amphetamines; Cities; Cocaine; Data Collection; Drug Users; Female; Heroin; Humans; Male; Norway; Self Report; Substance-Related Disorders

Topics: Anthrax; Bacillus anthracis; Bacterial Typing Techniques; DNA, Bacterial; Europe; Heroin; Humans; Phylogeny; Polymorphism, Single Nucleotide; Substance-Related Disorders

Cholinergic input to the ventral tegmental area (VTA) is known to contribute to reward. Although it is known that the pedunculopontine tegmental nucleus (PPTg) provides an important source of excitatory input to the dopamine system, the specific role of PPTg cholinergic input to the VTA in cocaine reward has not been previously determined. We used a diphtheria toxin conjugated to urotensin-II (Dtx::UII), the endogenous ligand for urotensin-II receptors expressed by PPTg cholinergic but not glutamatergic or GABAergic cells, to lesion cholinergic PPTg neurons. Dtx::UII toxin infusion resulted in the loss of 95.78 (±0.65)% of PPTg cholinergic cells but did not significantly alter either cocaine or heroin self-administration or the development of cocaine or heroin conditioned place preferences. Thus, cholinergic cells originating in PPTg do not appear to be critical for the rewarding effects of cocaine or of heroin.

Topics: Acetylcholine; Animals; Cell Death; Cholinergic Agents; Cholinergic Neurons; Cocaine; Conditioning, Psychological; Diphtheria Toxin; Dopamine; Heroin; Male; Neurotoxins; Pedunculopontine Tegmental Nucleus; Rats; Rats, Long-Evans; Recombinant Fusion Proteins; Self Administration; Substance-Related Disorders; Urotensins

The prevalence of HIV-associated neurocognitive disorders (HAND) remains high despite effective antiretroviral therapies. Multiple etiologies have been proposed over the last several years to account for this phenomenon, including the neurotoxic effects of antiretrovirals and co-morbid substance abuse; however, no underlying molecular mechanism has been identified. Emerging evidence in several fields has linked the gut to brain diseases, but the effect of the gut on the brain during HIV infection has not been explored. Saliva is the most accessible gut biofluid, and is therefore of great scientific interest for diagnostic and prognostic purposes. This study presents a longitudinal, liquid chromatography-mass spectrometry-based quantitative proteomics study investigating saliva samples taken from 8 HIV-positive (HIV+), 11 -negative (HIV-) heroin addicts. In addition, saliva samples were investigated from 11 HIV-, non-heroin addicted healthy controls. In the HIV+ group, 58 proteins were identified that show significant correlations with cognitive scores, implicating disruption of protein quality control pathways by HIV. Notably, only one protein from the HIV- heroin addict cohort showed a significant correlation with cognitive scores, and no proteins correlated with cognitive scores in the healthy control group. In addition, the majority of correlated proteins have been shown to be associated with exosomes, allowing us to propose that the salivary glands and/or oral epithelium may modulate brain function during HIV infection through the release of discrete packets of proteins in the form of exosomes.

Topics: Adult; Cognition; Demography; Enzyme-Linked Immunosorbent Assay; Female; Heat-Shock Proteins; Heroin; HIV Seropositivity; Humans; Interleukin 1 Receptor Antagonist Protein; Male; Methadone; Models, Biological; Proteome; Proteomics; Saliva; Salivary Proteins and Peptides; Substance-Related Disorders

Various surveys now ask respondents to describe their most recent purchase of illicit drugs, as one mechanism through which market size can be estimated. This raises the question of whether issues surrounding the timing of survey administration might make a sample of most recent purchases differ from a random sample of all purchases. We investigate these issues through a series of questions which ask about the three most recent purchases, and about drug use.. Data were drawn from 688 respondents in the Melbourne Injecting Drug User Cohort Study across the period 2008-2013 and 2782 respondents to the Washington Cannabis Consumption Study in 2013. Responses to questions about the most recent purchases were compared to larger subsets of all recent purchases.. For heroin, methamphetamine and cannabis no differences were found between the amount spent by participants on their most recent purchase and the average amount spent on three or more recent purchases. There were also no differences concerning the locations and types of deals, and the duration between consecutive cannabis purchases was the same for first and second most recent, and second and third most recent.. Asking about the most recent purchase appears to be an economical way to learn about purchases more generally, with little evidence of substantial variation between the most recent purchase and other recent purchases reported by participants. In spite of consistent findings across our two surveys, further replication of the work reported in this paper involving other populations of users is warranted.

Topics: Cannabis; Commerce; Drug Users; Heroin; Humans; Illicit Drugs; Marijuana Smoking; Methamphetamine; Substance-Related Disorders; Surveys and Questionnaires

Topics: Adult; Anabolic Agents; Androgens; Focus Groups; Heroin; Heroin Dependence; Humans; Male; Substance-Related Disorders; Young Adult

A potential new treatment for drug addiction is immunization with vaccines that induce antibodies that can abrogate the addictive effects of the drug of abuse. One of the challenges in the development of a vaccine against drugs of abuse is the availability of an optimum procedure that gives reproducible and high yielding hapten-protein conjugates. In this study, a heroin/morphine surrogate hapten (MorHap) was coupled to bovine serum albumin (BSA) using maleimide-thiol chemistry. MorHap-BSA conjugates with 3, 5, 10, 15, 22, 28, and 34 haptens were obtained using different linker and hapten ratios. Using this optimized procedure, MorHap-BSA conjugates were synthesized with highly reproducible results and in high yields. The number of haptens attached to BSA was compared by 2,4,6-trinitrobenzenesulfonic acid (TNBS) assay, modified Ellman's test and matrix assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). Among the three methods, MALDI-TOF MS discriminated subtle differences in hapten density. The effect of hapten density on enzyme-linked immunosorbent assay (ELISA) performance was evaluated with seven MorHap-BSA conjugates of varying hapten densities, which were used as coating antigens. The highest antibody binding was obtained with MorHap-BSA conjugates containing 3-5 haptens. This is the first report that rigorously analyzes, optimizes and characterizes the conjugation of haptens to proteins that can be used for vaccines against drugs of abuse. The effect of hapten density on the ELISA detection of antibodies against haptens demonstrates the importance of careful characterization of the hapten density by the analytical techniques described.

Topics: Animals; Cattle; Chemistry Techniques, Synthetic; Enzyme-Linked Immunosorbent Assay; Haptens; Heroin; Humans; Mass Spectrometry; Mice; Serum Albumin, Bovine; Substance-Related Disorders; Vaccines

Epidemiological studies report that individuals who exercise are less likely to abuse drugs. Preclinical studies report that exercise, in the form of treadmill or wheel running, reliably decreases the self-administration of psychomotor stimulants and opioids. To date, preclinical studies have only examined the effects of exercise on responding maintained by individual drugs and not by combinations of multiple drugs. This limits the translational appeal of these studies because polydrug abuse is common among substance abusing populations. The purpose of this study was to examine the effects of exercise on the self-administration of speedball, a combination of cocaine and heroin that is frequently encountered in intravenous drug abusing populations.. Female rats were obtained at weaning and assigned to sedentary or exercising conditions. Sedentary rats were housed in standard cages that permitted no exercise beyond normal cage ambulation; exercising rats were housed in similar cages with an activity wheel. After 6weeks, rats were implanted with intravenous catheters and trained to self-administer cocaine, heroin, and dose combinations of cocaine and heroin (i.e., speedball) on a progressive ratio schedule of reinforcement.. Doses of speedball maintained greater levels of responding than corresponding doses of cocaine and heroin alone. Importantly, responding maintained by cocaine, heroin, and speedball was lower in exercising rats than sedentary rats.. These data indicate that exercise decreases the self-administration of speedball and suggest that exercise may reduce the abuse of drug combinations that have traditionally been resistant to treatment.

Topics: Analysis of Variance; Animals; Cocaine; Exercise Therapy; Female; Heroin; Physical Exertion; Rats; Rats, Long-Evans; Self Medication; Substance-Related Disorders

We report three cases of tricuspid valve infective endocarditis associated with intravenous nyoape use. Nyoape is a variable drug combination of an antiretroviral (efavirenz or ritonavir), heroin, metamphetamines and cannabis. Its use is becoming increasingly common among poor communities in South Africa. All our patients were young HIV-positive men from disadvantaged backgrounds. They all presented with tricuspid regurgitation and septic pulmonary emboli. They were treated with prolonged intravenous antibiotic courses, and one required referral for surgery.

Topics: Adult; Alkynes; Anti-Bacterial Agents; Benzoxazines; Cannabis; Cyclopropanes; Endocarditis; Heroin; HIV Infections; Humans; Illicit Drugs; Male; Methamphetamine; Pulmonary Embolism; Ritonavir; South Africa; Substance-Related Disorders; Tricuspid Valve; Tricuspid Valve Insufficiency; Young Adult

Telomeres are protective chromosomal structures that play a key role in preserving genomic stability. Telomere length is known to be associated with ageing and age-related diseases. To study the impairment of telomeres induced by drug abuse, we conducted an association study in the Chinese Han population. Multivariate linear regression analyses were performed to evaluate the correlation of leukocyte telomere length (LTL) with addiction control status adjusted for age and gender. The results showed that drug abusers exhibited significantly shorter LTLs than controls (P = 1.32e-06). The time before relapse also presented an inverse correlation with LTL (P = 0.02). Drug abusers who had used heroin and diazepam displayed a shorter LTL than those taking other drugs (P = 0.018 and P = 0.009, respectively). Drug abusers who had ingested drugs via snuff exhibited longer LTLs than those using other methods (P = 0.02). These observations may offer a partial explanation for the effects of drug addiction on health.

Topics: Adult; Analgesics, Opioid; Cohort Studies; Diazepam; Female; Heroin; Humans; Hypnotics and Sedatives; Leukocytes; Linear Models; Male; Multivariate Analysis; Substance-Related Disorders; Telomere; Telomere Shortening

This study sought to quantify the perceptions of damage and benefit, for users and society, associated with five addictive substances (alcohol, tobacco, cannabis, cocaine and heroin) and one addictive behavior (gambling), in a large sample representative of the French population. We compared with expert assessments and investigated the effects of substance consumption on these perceptions.. The ranking of substances by the lay public is very divergent from that of experts. The public overestimates damage to users and to society and underestimates the benefit, in comparison with experts, for all substances. Alcohol is the only exception, with damage and benefit perceptions similar to those of experts. Heroin and cocaine are perceived as the two most dangerous substances. The damage of cannabis and alcohol are judged to be equivalent. The three legal substances are associated with the highest overall benefit, although cannabis has the highest perceived benefit for users. Substances with the highest perceived benefit tend to be associated with perception of lower levels of damage. Individuals with an history of substance use have a perception of the damage and the benefit for that substance which is more congruent with experts, including a similar ranking of substances.. Prevention campaigns focused on perceptions of damage alone have reached their limits. The perception of benefit should be taken into account in early interventions with illegal substance users.

Topics: Adult; Behavior, Addictive; Cannabis; Cocaine; Drug Users; Ethanol; Female; Heroin; Humans; Male; Nicotiana; Substance-Related Disorders; Surveys and Questionnaires

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

The study was to survey and assess the drug dependence and abuse potential of tramadol with no history of substance abuse. Subjects of tramadol dependence with no prior history of substance abuse were surveyed by interview. Physical dependence of tramadol was assessed using 10 items opiate withdrawal scale (OWS), and psychological dependence was assessed by Addiction Research Center Inventory-Chinese Version (ARCI-CV). Twenty-three male subjects (the median age was 23.4 ± 4.1 years) referred to the addiction unit in Medical Hospital of Guangzhou with tramadol abuse problems were included in this cross-sectional study. The control group included 87 heroin addicts, 60 methamphetamine (MA) abusers, and 50 healthy men. The scores of OWS of tramadol were 0.83-2.30; the mean scores of identifying euphoric effects-MBG, sedative effects-PCAG, and psychotomimetic effects-LSD of ARCI were 8.96 ± 3.08, 6.52 ± 3.25, and 6.65 ± 2.50, respectively, F = 4.927, P < 0.001. Scores of MBG scale in tramadol did not differ from those in heroin and MA groups (P > 0.05) but were higher than those in healthy men (P < 0.05). Tramadol with no history of substance abuse has a clear risk of producing high abuse potential under the long-term infrequent abuse and the high doses.

Topics: Analgesics, Opioid; China; Cross-Sectional Studies; Heroin; Humans; Male; Methamphetamine; Substance-Related Disorders; Tramadol; Young Adult

Data from surveys of arrestees and the household population in the U.S. suggest there is only modest overlap among demand for the big three expensive illegal drugs (cocaine/crack, heroin, and methamphetamine). In particular, the number of chronic users of these substances (defined as consuming on four or more days in the previous month) is only about 10% below a naïve estimate obtained by simply summing the numbers of chronic users for each of the three substances, while ignoring polydrug use entirely. This finding does not gainsay that polydrug use is common or important. One would estimate greater overlap if one adopted a more expansive definition of polydrug use (e.g., has the individual ever used another substance at any time in their life) or a more expansive list of substances (e.g., allowing marijuana or alcohol to count as one of the substances makes polydrug use seem much more common). However, it does suggest that when focusing on the illegal drug markets that generate the most crime, violence, and overdose death in the U.S., one can usefully think of three more or less separate markets populated at any given time by largely distinct populations of drug users.

Topics: Crack Cocaine; Data Collection; Heroin; Humans; Illicit Drugs; Methamphetamine; Substance-Related Disorders; United States

Spondylodiscitis leads to debility, and few data exist on Candida spondylodiscitis in patients with intravenous drug use.. We present a case of Candida albicans lumbar spondylodiscitis in a patient with intravenous drug use. This patient was treated with surgical debridement and 9 months of fluconazole therapy, and the neurological deficits resolved completely. The infection did not recur clinically or radiologically during 9 months of follow-up.. Although Candida albicans lumbar spondylodiscitis is rare, Candida should be suspected as a causative pathogen in patients with intravenous drug use except for Staphylococcus aureus, Pseudomonas aeruginosa, and Mycobacterium tuberculosis. As soon as Candida albicans lumbar spondylodiscitis is suspected, magnetic resonance imaging and percutaneous biopsy should be performed. Surgical intervention combined with treatment with antifungal medications can successfully eradicate the infection and resolve the neurological deficits.

Topics: Adult; Candida albicans; Candidiasis; Discitis; Heroin; Humans; Injections, Intravenous; Lumbosacral Region; Male; Substance-Related Disorders

To date, it has been difficult to address the issue of sexual functioning and drug use, and many approaches to it have basic problems and methodological errors.. The present cross-sectional study compared the sexual functioning scores of a group of drug users with those of a group of nondrug users. It explored the relationship between drug abstinence and sexual functioning.. A sample of 905 males participated in this study (549 met the substance dependence criteria and 356 were controls). All of them were assessed with the Changes in Sexual Functioning Questionnaire-Drugs version.. The assessment was conducted from September 2009 to January 2011. The clinical sample was evaluated in nine different substance abuse treatment facilities.. Results show that, overall, all dimensions (pleasure, desire, arousal, and orgasm) were moderately impaired. Yet, differences regarding preferred substance were observed. Pleasure and orgasm were the two areas most significantly impaired. In these areas, all drugs seemed to negatively affect sexual functioning. However, desire and arousal were not affected by all the substances. In addition, at least after 2 weeks of drug abstinence, no relationship was found between drug abstinence and improvement in sexual functioning. The sample studied had an average of 1 year of drug abstinence and was found to have poorer sexual functioning than the control group.. Therefore, these results seem to contradict those that argue that drug use only impairs sexual functioning temporarily. Moreover, they suggest that sexual functioning does not improve just by stopping drug use.

Topics: Adult; Alcoholism; Arousal; Cocaine; Drug Synergism; Ethanol; Follow-Up Studies; Heroin; Humans; Illicit Drugs; Libido; Male; Middle Aged; Orgasm; Pleasure; Sexual Dysfunction, Physiological; Sexuality; Substance Abuse Treatment Centers; Substance Abuse, Intravenous; Substance Withdrawal Syndrome; Substance-Related Disorders

Alprazolam is a benzodiazepine anxiolytic widely prescribed for treatment of panic-disorder and social phobias, although this medication is also subject to abuse. In this paper, the concentrations of alprazolam in venous blood samples from impaired drivers were compared with femoral blood samples from forensic autopsies classified as intoxication or other causes of death (e.g. natural, trauma). After liquid-liquid extraction (n-butyl acetate) alprazolam was determined in blood by capillary gas chromatography with a nitrogen-phosphorous detector. The mean (median) and range of alprazolam concentrations in blood from impaired drivers (n = 773) were 0.08 mg/L (0.05 mg/L) and 0.02-3.9 mg/L, respectively. Many traffic offenders had co-ingested ethanol (13%), amphetamine (46%), cannabis (32%), or heroin (14%), as well as other drugs. In deaths attributed to drug intoxication, the mean (median) and range of alprazolam concentrations in blood (n = 438) were 0.10 mg/L (0.06 mg/L) and 0.02-1.6 mg/L, respectively, which were not much different from other causes of death (n = 278); 0.08 mg/L (0.05 mg/L) and 0.02-0.9 mg/L. Median concentrations of alprazolam in blood from living and deceased persons did not seem to depend on the number of co-ingested substances. The result of this pharmacoepidemiological study suggests that alprazolam is a fairly innocent drug when used as monotherapy, but toxicity problems arise when co-ingested with illicit drugs and/or psychoactive medication.

Topics: Age Factors; Alcoholism; Alprazolam; Amphetamine; Anti-Anxiety Agents; Automobile Driving; Crime; Databases, Factual; Female; Forensic Toxicology; Heroin; Humans; Illicit Drugs; Male; Marijuana Abuse; Psychotropic Drugs; Substance Abuse Detection; Substance-Related Disorders; Sweden; Wounds and Injuries

Topics: Atracurium; Biomarkers; Diagnostic Errors; False Positive Reactions; Forensic Toxicology; Heroin; Humans; Illicit Drugs; Papaverine; Substance Abuse Detection; Substance-Related Disorders

During the summer of 2005, multiple cities in the United States began to report outbreaks of fentanyl-associated fatalities among illicit drug users. The objectives of this study were to (1) determine if an outbreak of fentanyl-associated fatalities occurred in mid-2005 to mid-2006 and (2) to examine trends and compare features of fentanyl-contaminated heroin-associated fatalities (FHFs) with non-fentanyl, heroin-associated fatalities (NFHFs) among illicit drug users.. Baseline prevalence of fentanyl- and heroin-associated deaths was estimated from January to May 2005 based on recorded cause of death (determined by the medical examiner (ME)) using the Wayne County, MI, USA toxicology database. The database was then queried for both FHFs and NFHFs between July 1, 2005 and May 12, 2006. A FHF was defined as having fentanyl or norfentanyl (metabolite) detected in any postmortem biological sample and either (1) detection of heroin or its metabolite (6-acetylmorphine) and/or cocaine or its metabolite (benzoylecgonine) in a postmortem biological specimen or (2) confirmation of fentanyl abuse as the cause of death by the ME or a medical history available sufficient enough to exclude prescription fentanyl or other therapeutic opioid use. A NFHF was defined as detection of heroin, 6-acetylmorphine (heroin metabolite) or morphine in any postmortem biological specimen, heroin overdose listed as the cause of death by the ME, and absence of fentanyl detection on postmortem laboratory testing. Information was systematically collected, trended for each group and then compared between the two groups with regard to demographic, exposure, autopsy, and toxicology data. Logistic regression was performed using SAS v 9.1 examining the effects of age, gender, and marital status with fentanyl group status.. Monthly prevalence of fentanyl-associated fatalities among illicit drug users increased from an average of two in early 2005 to a peak of 24 in May, 2006. In total, 101 FHFs and 90 NFHFs were analyzed. The median age of decedents was 46 and 45 years for the fentanyl and non-fentanyl groups, respectively. Fentanyl-contaminated heroin-associated fatalities (FHFs) were more likely to be female (p = 0.003). Women aged over 44 years (OR = 4.67;95 % CI = 1.29-16.96) and divorced/widowed women (OR = 14.18;95 % CI = 1.59-127.01) were more likely to be FHFs when compared to women aged less than 44 years and single, respectively. A significant interaction occurred between gender and age, and gender and marital status. Most FHFs had central (heart) blood samples available for fentanyl testing (n = 96; 95 %): fentanyl was detected in most (n = 91; 95 %). Of these, close to half had no detectable heroin (or 6-acetylmorphine) concentrations (n = 37; 40.7 %). About half of these samples had detectable cocaine concentrations (n = 20; 54 %). Median fentanyl concentration in central blood samples was 0.02 μg/ml (n = 91, range <0.002-0.051 μg/ml) and 0.02 μg/ml (n = 32, range <0.004-0.069 μg/ml) in peripheral blood samples. The geometric mean of the ratio of central to peripheral values was 2.10 (median C/P = 1.75). At autopsy, pulmonary edema was the most frequently encountered finding for both groups (77 %).. Illicit drugs may contain undeclared ingredients that may increase the likelihood of fatality in users. Gender differences in fentanyl-related mortality may be modified by age and/or marital status. These findings may help inform public health and prevention activities if fatalities associated with fentanyl-contaminated illicit drugs reoccur.

Topics: Adolescent; Adult; Cause of Death; Drug Contamination; Drug Overdose; Female; Fentanyl; Heroin; Humans; Illicit Drugs; Male; Michigan; Middle Aged; Narcotics; Opioid-Related Disorders; Prevalence; Pulmonary Edema; Sex Factors; Substance-Related Disorders; Survival Rate; Young Adult

This paper aims to develop a mixture model to study heterogeneous longitudinal data on the treatment effect of heroin use from a California Civil Addict Program. Each component of the mixture is characterized by a varying coefficient mixed effect model. We use the Bayesian P-splines approach to approximate the varying coefficient functions. We develop Markov chain Monte Carlo algorithms to estimate the smooth functions, unknown parameters, and latent variables in the model. We use modified deviance information criterion to determine the number of components in the mixture. A simulation study demonstrates that the modified deviance information criterion selects the correct number of components and the estimation of unknown quantities is accurate. We apply the proposed model to the heroin treatment study. Furthermore, we identify heterogeneous longitudinal patterns.

Topics: Algorithms; Bayes Theorem; California; Computer Simulation; Heroin; Humans; Longitudinal Studies; Markov Chains; Models, Biological; Models, Statistical; Monte Carlo Method; Substance-Related Disorders

Although high anxiety is commonly associated with drug addiction, its causal role in this disorder is unclear.. In light of strong evidence for dissociable neural mechanisms underlying heroin and cocaine addiction, the present study investigated whether high anxiety predicts the propensity of rats to lose control over intravenous cocaine or heroin self-administration.. Sixty-four rats were assessed for anxiety in the elevated plus-maze, prior to extended access to intravenous cocaine or heroin self-administration.. High-anxious rats, identified in the lower quartile of the population, showed a greater escalation of cocaine, but not heroin, self-administration compared with low-anxious rats selected in the upper quartile of the population. Anxiety scores were also positively correlated with the extent of escalation of cocaine self-administration.. The present data suggest that high anxiety predisposes rats to lose control over cocaine-but not heroin-intake. High anxiety may therefore be a vulnerability trait for the escalation of stimulant but not opiate self-administration.

Topics: Animals; Anxiety; Cocaine; Disease Models, Animal; Heroin; Male; Maze Learning; Rats; Self Administration; Substance-Related Disorders

During the last decade, the veterinary anesthetics have gained popularity as recreational drugs. The aim of this study was to document the use of "anestecia de caballo" (xylazine) and its consequences among drug users in Puerto Rico. The study combined a cross-sectional survey with 89 drug users and two focus groups conducted in Mayagüez with frontline drug treatment providers. Drug users were recruited from communities of the San Juan metropolitan area using a variety of ethnographic and outreach strategies. A short questionnaire developed for the study collected information on sociodemographics, xylazine use, and its consequences. The two focus groups were conducted to discuss the details related to xylazine use, its consequences, and utilization awareness. The sample comprised 63 males (70.8%) and 26 females with a mean age of 37.2 years. The mean number of years of drug use was 14.3, with a mean frequency of drug use of 5.9 times daily. More than 65% reported speedball as the principal drug of use. The prevalence of xylazine use was 80.7%. More than 42% of the sample used xylazine in a mixture with speedball. The main route of administration of xylazine was injection but 14% reported the use of xylazine by inhalation. More than 35% of the sample reported skin lesions and 21.1% reported at least one overdose episode. Multiple logistic regression analysis revealed that males (OR = 3.47, CI = 1.10-12.00) and those who reported speedball as their main drug of use (OR = 9.34, CI = 2.51-34.70) were significantly more likely to be xylazine users. Focus groups revealed that drug users claimed to recognize the presence of xylaxine in a mixture of speedball based on its effects, taste, the color of the drug (dark brown), and its odor. In conclusion, the use of xylazine among drug users in Puerto Rico seems to be an emerging trend with potentially serious health consequences.

Topics: Administration, Inhalation; Adult; Cocaine; Cross-Sectional Studies; Drug Combinations; Female; Focus Groups; Heroin; Humans; Hypnotics and Sedatives; Male; Middle Aged; Prevalence; Puerto Rico; Skin Ulcer; Substance Abuse, Intravenous; Substance-Related Disorders; Surveys and Questionnaires; Xylazine; Young Adult

Illicit drug users, entering a detention center and two psychiatric hospitals in Northern Taiwan, were interviewed for lifetime drug-use-related psychiatric disorders and suicide attempts. Among 197 participants, 17.3%, 16.8%, and 14.2% had a drug-induced psychotic disorder (DIP), a drug-induced mood disorder (DIM), and a history of suicide attempts, respectively. Continuous use of methamphetamine and joblessness were associated with DIP and DIM, accordingly. Polysubstance use was collectively correlated with DIP and DIM. Female gender and history of having any mood disorder were predictors of suicide. These results provide useful clues for detecting drug-related psychiatric disorders and suicide among illicit drug users. The study's limitations are noted.

Topics: Adult; Central Nervous System Stimulants; Cross-Sectional Studies; Female; Heroin; Humans; Illicit Drugs; Interview, Psychological; Male; Mental Disorders; Methamphetamine; Risk Factors; Substance-Related Disorders; Suicide, Attempted; Surveys and Questionnaires; Taiwan; Young Adult

Functional imaging studies of addiction following protracted abstinence have not been systematically conducted to look at the associations between severity of use of different drugs and brain dysfunction. Findings from such studies may be relevant to implement specific interventions for treatment. The aim of this study was to examine the association between resting-state regional brain metabolism (measured with 18F-fluorodeoxyglucose Positron Emission Tomography (FDG-PET) and the severity of use of cocaine, heroin, alcohol, MDMA and cannabis in a sample of polysubstance users with prolonged abstinence from all drugs used.. Our sample consisted of 49 polysubstance users enrolled in residential treatment. We conducted correlation analyses between estimates of use of cocaine, heroin, alcohol, MDMA and cannabis and brain metabolism (BM) (using Statistical Parametric Mapping voxel-based (VB) whole-brain analyses). In all correlation analyses conducted for each of the drugs we controlled for the co-abuse of the other drugs used.. The analysis showed significant negative correlations between severity of heroin, alcohol, MDMA and cannabis use and BM in the dorsolateral prefrontal cortex (DLPFC) and temporal cortex. Alcohol use was further associated with lower metabolism in frontal premotor cortex and putamen, and stimulants use with parietal cortex.. Duration of use of different drugs negatively correlated with overlapping regions in the DLPFC, whereas severity of cocaine, heroin and alcohol use selectively impact parietal, temporal, and frontal-premotor/basal ganglia regions respectively. The knowledge of these associations could be useful in the clinical practice since different brain alterations have been associated with different patterns of execution that may affect the rehabilitation of these patients.

Topics: Adult; Brain; Cannabis; Cocaine; Demography; Ethanol; Female; Heroin; Humans; Illicit Drugs; Male; N-Methyl-3,4-methylenedioxyamphetamine; Positron-Emission Tomography; Rest; Substance-Related Disorders

To contrast the characteristics of two groups of anabolic-androgenic steroid (AAS) users-those with versus those without AAS dependence.. Subanalysis of data from the Anabolic 500, a cross-sectional survey.. One hundred twelve male AAS-dependent users and 367 AAS-nondependent users who completed an online survey between February 19 and June 30, 2009.. Respondents were recruited from the Internet discussion boards of 38 fitness, bodybuilding, weightlifting, and steroid Web sites. The respondents provided online informed consent and completed the Anabolic 500, a 99-item Web-based survey. Self-reported data included demographics, exercise patterns, use of AAS and other performance-enhancing agents, adverse effects of AAS use, behavior consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for AAS dependence, history of illicit drug and alcohol use, history of sexual or physical abuse, and psychiatric conditions diagnosed according to the DSM-IV-TR. Behavior consistent with AAS dependence was identified in 23.4% of the survey participants. These AAS-dependent users were more excessive in their AAS use (e.g., higher doses, higher quantity of agents, longer duration of use), more likely to report a history of illicit heroin use in the last 12 months (5.4% vs 1.9%, p=0.049), and more likely to report a diagnosis of an anxiety disorder (16.1 vs 8.4%, p=0.020) or major depressive disorder (15.2% vs 7.4%, p=0.012) than AAS-nondependent users.. Data from the Anabolic 500 survey showed that almost one quarter of AAS users were dependent on these drugs. These AAS-dependent users had a higher rate of heroin use as well as anxiety and major depressive disorders compared with AAS-nondependent users. These findings can help clinicians and researchers better understand and address the potential illicit drug use and psychiatric comorbidities that may be present among AAS-dependent users.

Topics: Adolescent; Adult; Anabolic Agents; Androgens; Anxiety Disorders; Cohort Studies; Cross-Sectional Studies; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Dose-Response Relationship, Drug; Health Surveys; Heroin; Humans; Internet; Male; Middle Aged; Performance-Enhancing Substances; Steroids; Substance-Related Disorders; Young Adult

Retrospective study of urinary heroin outcomes of a cohort (123) of patients commenced on a methadone treatment program. Significantly poorer outcomes were associated with urines positive for cocaine (OR 0.69 CI 0.59-0.81) benzodiazepines (OR 0.7 CI 0.53-0.93) with prescribing of low dose methadone (OR 0.65 CI 0.48-0.87), with urines positive for heroin at time of admission (OR 0.74 CI 0.56-0.97) and with behavioural sanctions (OR 0.8, CI 0.65-0.98). Improved outcomes were associated with granting of take away methadone (OR 1.34 CI 1.1-1.62). with an indication of improved outcomes associated with alcohol positive urines (OR 1.34 CI 0.95-1.9) and increased duration of clinic attendance (OR 1.21 CI 0.99-1.47). On multiple regression analysis low dose methadone (0.07 CI 0.01-0.33) prescribing remained negatively associated with urine heroin outcomes.

Topics: Adult; Cannabinoids; Cocaine; Cohort Studies; Comorbidity; Female; Heroin; Heroin Dependence; Humans; Illicit Drugs; Inpatients; Male; Methadone; Middle Aged; Outcome Assessment, Health Care; Regression Analysis; Retrospective Studies; Risk Factors; Secondary Prevention; Substance Abuse Detection; Substance Abuse Treatment Centers; Substance-Related Disorders; Young Adult

The aim of the study was to investigate predictors of offending among prisoners from official records after controlling for age at first conviction and antisocial personality disorder. The participants were 198 Scottish prisoners, who had completed Diagnostic Statistical Manual IV screens for child and adult attention-deficit hyperactivity disorder (ADHD) symptoms and the Millon Clinical Multiaxial Inventory III for Axis I and Axis II disorders. The ADHD symptomatic group had significantly higher rates of total, acquisitive and violent offending than other prisoners, as well as greater regular heroin use. Hierarchical multiple regressions, using child and adult symptoms as dimensions, showed that frequent use of heroin in the year prior to imprisonment was the single most powerful predictor of the extent of total offending, with ADHD symptoms also adding independently to the variance in offending. In contrast, for violent offending, ADHD symptoms were the strongest predictor followed by alcohol dependence. The findings demonstrate the importance of heroin use and ADHD symptoms in the persistence of offending. There is an urgent need to treat drug addiction and ADHD symptoms in order to reduce offending among the most persistent offenders. Recently, treatment programmes have been developed for adults with ADHD, heroin and crack cocaine addiction which can be applied to this population.

Topics: Alcoholism; Antisocial Personality Disorder; Attention Deficit Disorder with Hyperactivity; Criminals; Heroin; Heroin Dependence; Humans; Male; Prisoners; Scotland; Substance-Related Disorders; Surveys and Questionnaires; Violence

Intracorporeal concealment of illicit drugs is a rare observation at coronial autopsy examinations. The article reports 5 cases of accidental drug overdoses at the Westmead Coronial Morgue, Sydney New South Wales, over a 6-year period with evidence of intracorporeal drug concealment known as body packing or body stuffing. Three different forms of anatomic concealment of drugs are illustrated, Case 2 involving therapeutic medication in the form of glass ampoules for parenteral injection not previously reported. Three deaths were the result of acute toxicity due to polydrug abuse rather than as a consequence of the body packing behavior and rupture of the drug packaging, with the intracorporeal drug concealments an adjunct finding at the autopsy examinations. The cause of death in Case 3 was the direct result of acute cocaine intoxication due to rupture of drug packages in the rectum and mucosal absorption. The article details forensic sociological aspects of drug concealment and subcultural group human behavior that can assist in providing information for the initiation of investigations.

Topics: Adult; Anal Canal; Benzodiazepines; Cocaine; Crime; Drug Overdose; Forensic Pathology; Forensic Toxicology; Foreskin; Heroin; Humans; Illicit Drugs; Male; Methadone; Middle Aged; Narcotics; Neck; Penis; Rectum; Substance-Related Disorders

The sewage epidemiology approach was applied to a one-year sampling campaign in the largest wastewater treatment plant (WWTP) in Belgium. The consumption of cocaine (COC), amphetamine (AMP), methylenedioxymethamphetamine (MDMA), methamphetamine (METH), methadone (MTD) and heroin (HER) was evaluated based on measured concentrations of the parent compound and/or metabolites in daily 24-hour composite influent wastewater samples. The inevitable back-calculations used in the sewage epidemiology approach were adapted to newly available information regarding the stability of the compounds in wastewater and the excretion pattern of illicit drugs. For COC, three different back-calculation approaches were evaluated. In addition, for the first time, efforts were made to calculate the number of inhabitants living in the catchment area of the WWTP in a real-time and dynamic way, based on concentrations of nitrogen, phosphorus and oxygen in the wastewater samples. Clear variations in the amount of inhabitants in the catchment area of the WWTP were observed. For COC, AMP and MDMA a significant higher weekend use was observed while for HER and MTD no significant daily variations could be found. METH consumption was negligible. Generally, the sewage epidemiology calculations were in agreement with official statistics. This manuscript shows that sewage epidemiology provides consistent and logical results and that it is a promising tool that can be used in addition to classical studies to estimate illicit drug use in populations. Therefore, efforts should be made to further optimize this approach in the future.

Topics: Belgium; Biological Oxygen Demand Analysis; Cocaine; Demography; Heroin; Humans; Illicit Drugs; Methadone; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; Nitrogen; Phosphorus; Sewage; Substance Abuse Detection; Substance-Related Disorders; Water Pollutants, Chemical; Water Pollution, Chemical

Topics: Analgesics, Opioid; Buprenorphine; Cocaine; Drug Overdose; Drug Prescriptions; Health Knowledge, Attitudes, Practice; Heroin; Humans; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders; Pain; Substance-Related Disorders; United States

The Office of the Chief Medical Examiner of Maryland recorded a total of 149 drug abuse deaths of teenagers aged 13-19 years between 1991 and 2006. Of these deaths, 96 (64.4%) were caused by the use of narcotic drugs only, 29 (19.5%) by both narcotics and cocaine, four (2.7%) by both narcotics and methylenedioxymethamphetamine, six (4.0%) by cocaine only, and 14 (9.4%) by volatile substances (e.g., butane, Freon, nitrous oxide, and propane). The annual death rate from drug abuse for teenagers increased from 1.4 deaths per 100,000 population in 1991 to 2.7 deaths per 100,000 population in 2006 (chi-square test for time trend, p<0.01). The increase in teenager drug abuse deaths occurred in 1999 and since has remained at a higher rate. Further analysis revealed that the increase in drug abuse deaths was attributable to a large degree to narcotic drugs, particularly heroin/morphine and methadone, and was confined to teenagers residing in the suburban and rural areas.

Topics: Adolescent; Age Distribution; Black People; Butanes; Cause of Death; Chlorofluorocarbons, Methane; Cocaine; Female; Forensic Pathology; Forensic Toxicology; Hepatitis B Antibodies; Heroin; HIV Antibodies; Humans; Male; Maryland; Methadone; Morphine; Myocarditis; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Nitrous Oxide; Pneumonia; Propane; Retrospective Studies; Sex Distribution; Substance-Related Disorders; White People

The rewarding effects of drugs of abuse are often studied by means of the conditioned place preference (CPP) paradigm. CPP is one of the most widely used models in behavioral pharmacology, yet its theoretical underpinnings are not well understood, and there are very few studies on the methodological and theoretical aspects of this model. An important drawback of the classical CPP paradigm is that it often does not show dose-dependent results. The persistence of the conditioned response, i.e. the time required until the CPP effect is extinct, may be related to the strength of conditioning, which in turn may be related to the rewarding efficacy of a drug. Resistance to extinction may therefore be a useful additional measure to quantify the rewarding effect of drugs. In the present study we examined the persistence of drug-environment associations after conditioning with morphine (1, 3 and 10 mg/kg i.p.), oxycodone (0.3, 1 and 3 mg/kg i.p.) and heroin (0.05, 0.25 and 0.5 mg/kg i.p.) by repeated retesting in the CPP apparatus (15-min sessions, 5 days/week) until the rats reached extinction (i.e. less than 55% preference over 3 consecutive sessions). Following an unbiased CPP protocol, morphine, oxycodone and heroin induced CPP with minimal effective doses of 3, 1 and 0.25 mg/kg, respectively, and with similar effect sizes for each CPP-inducing dose. The number of sessions required for extinction was positively correlated with the dose of the drug (experiment 1: 18 and 45 sessions for 3 and 10 mg/kg morphine, and 19 and 27 sessions for 1 and 3 mg/kg oxycodone; experiment 2: 12 and 24 sessions for 3 and 10 mg/kg morphine, and 10 and 14 sessions for 0.25 and 0.5 mg/kg heroin). These findings suggest that the use of an extinction paradigm can extend the quantitative assessment of the rewarding effect of drugs - however, within certain limits only. The present paradigm appears to be less suited for comparing the rewarding efficacy of different drugs due to great test-retest variability. Finally, the additional potential gain of information using this paradigm has to be weighed against the considerably large amount of additional time and effort.

Topics: Analgesics, Opioid; Animals; Conditioning, Psychological; Dose-Response Relationship, Drug; Extinction, Psychological; Heroin; Male; Morphine; Oxycodone; Rats; Rats, Sprague-Dawley; Substance-Related Disorders

The detection of illicit drugs in environmental matrices may be a cause for concern, both from the perspective of their potential environmental impacts and the fact that their presence in detectable concentrations would be an indicator of significant drug use. The primary goal behind recent studies on this subject has been to use measured influent concentrations of selected illicit drugs or their in vivo metabolites in the environment as a means of estimating the abuse level of these drugs and patterns of consumption. Thus-far, such calculations have hinged on the use of solitary excretion estimates from single studies of limited scope and/or studies of limited applicability. Therefore, the need exists to conduct a comprehensive meta-analysis of metabolic disposition studies to construct excretions profiles for the various illicit drugs and their in vivo metabolites. The constructed excretory profiles should not only provide mean excretion values but also indicate the expected variations in excreted fractions that arise due to differences not only in the metabolic capacity of users but also in the efficiencies of various routes of administration for a given illicit drug. Therefore, the primary goal of the research presented here was to refine sewer epidemiology extrapolation mass balances for various illicit drugs of interest by constructing their excretory profiles segregated by route-of-administration. After conducting such a study with a multi-national scope on illicit drugs including cocaine, heroin and ecstasy, the results obtained clearly indicate that extrapolation factors currently being used in literature for these drugs to enumerate prevalence of abuse required significant refinement to increase their reliability.

Topics: Cocaine; Heroin; Humans; Illicit Drugs; N-Methyl-3,4-methylenedioxyamphetamine; Sewage; Substance Abuse Detection; Substance-Related Disorders; Water Pollutants, Chemical

Suicide attempts and non-fatal overdoses are both associated with substance use. The aim of the present study was to examine correlates of suicide attempts and non-fatal overdoses simultaneously among individuals seeking addictions treatment.. A large U.S. national sample of individuals entering addictions treatment participated in a cross-sectional survey (n=5892). Multinomial logistic regression modeling tested the adjusted associations of violence, injection drug use, specific substances, and depressive symptoms with a four-category outcome variable based on prior histories of suicide attempt and non-fatal overdose (neither, suicide attempt only, overdose only, both), adjusting for demographic and treatment characteristics.. Sexual and physical victimization was associated with suicide attempts with or without overdoses (ORs 1.25-2.84), while perpetrating violence was associated with having experienced either or both outcomes (ORs 1.25-1.56). Depressive symptoms had a stronger association with suicide attempts (OR=3.05) than overdoses (OR=1.29). Injection drug use was associated with overdoses with or without suicide attempts (ORs 2.65-3.22). Individuals seeking treatment for marijuana use were less likely have overdosed or attempted suicide (ORs 0.39-0.67), while individuals seeking treatment for heroin use were more likely to have overdosed (OR=1.46). Seeking treatment for use of more than one substance was associated with overdose and overdose and suicide attempt (ORs 1.58-2.51), but not suicide attempt alone.. The present findings indicate that suicide and overdose are connected yet distinct problems. Individuals who have had a history of both may be a group with particularly poor psychological functioning as well as more severe drug-related problems.

Topics: Adolescent; Adult; Battered Child Syndrome; Battered Women; Behavior, Addictive; Child; Cross-Sectional Studies; Drug Overdose; Female; Heroin; Humans; Male; Middle Aged; Risk Factors; Sexual Behavior; Substance-Related Disorders; Suicide; Suicide, Attempted; United States; Violence; Young Adult

We investigated fatal poisonings among drug addicts in 2007. The cause of death, abuse pattern and geographic differences are presented.. All drug-related deaths examined at the three forensic medicine institutes in Denmark in 2007 were evaluated.. The number of drug-related deaths in 2007 was 226. Methadone deaths had increased since 1997 while heroin/morphine deaths decreased. In earlier studies, very few deaths from central stimulants like cocaine and amphetamines occurred (1-1.5%), but in 2007 6% of the deaths were caused by these drugs. Multiple drug use was common. Heroin/morphine, cocaine, amphetamine, cannabis, methadone, benzodiazepines and alcohol were included in the poly-drug use.. This investigation shows stabilization in the number of fatal poisonings in drug addicts. Geographic differences were observed. Methadone was the most frequent cause of fatal poisoning and there was a continuous decrease in heroin/morphine deaths. Fatal deaths from cocaine and amphetamine have increased considerably. Multiple drug use was common.. not relevant.

Topics: Adolescent; Adult; Age Distribution; Amphetamines; Denmark; Female; Heroin; Humans; Male; Methadone; Middle Aged; Morphine; Narcotics; Prevalence; Risk Factors; Substance-Related Disorders; Young Adult

Topics: Analgesics, Opioid; Follow-Up Studies; Heroin; Humans; India; Opiate Substitution Treatment; Opioid-Related Disorders; Substance-Related Disorders

To estimate and compare prevalence rates of lifetime health conditions by inferred duration of illicit drug use among the general U.S. adult population and to investigate associations between duration of use of each specific illicit drug (marijuana, cocaine, heroin, hallucinogens, or inhalant) and each lifetime health condition after controlling for potential confounding factors.. Data from respondents aged 35 to 49 (N = 29,195) from the 2005-2007 National Surveys on Drug Use and Health (NSDUH) were analyzed.. The prevalence rates of a broad range of health conditions by duration of use of specific illicit drug among persons 35 to 49 years of age in the United States were estimated and compared. After adjustment for potential confounding factors, the results of 20 multivariate logistic regression models indicated positive associations between duration of marijuana use and anxiety, depression, sexually transmitted disease (STD), bronchitis, and lung cancer; between duration of cocaine use and anxiety and pancreatitis; between duration of heroin use and anxiety, hepatitis, and tuberculosis; between duration of hallucinogen use and tinnitus and STD; and between duration of inhalant use and anxiety, depression, HIV/AIDS, STD, tuberculosis, bronchitis, asthma, sinusitis, and tinnitus.. This study provides initial analyses on the relationships between illicit drug use and health conditions based on a large nationally representative sample. These results can help prepare for treating health problems among former and continuing illicit drug users.

Topics: Adult; Age Factors; Drug Users; Female; Health Status; Health Status Indicators; Health Surveys; Heroin; Humans; Illicit Drugs; Logistic Models; Male; Marijuana Smoking; Middle Aged; Prevalence; Risk Factors; Socioeconomic Factors; Substance-Related Disorders; Surveys and Questionnaires; Time Factors; United States

A comprehensive study of various psychoactive substances and their metabolites was performed in the wastewater treatment plant of the city of Zagreb (780 000 inhabitants) using liquid chromatography/tandem mass spectrometry (LC-MS-MS). The estimation of drug abuse for five different illicit drugs, including heroin, cocaine, marijuana, amphetamine and ecstasy, was made on the basis of their representative excretion rates, which were determined over a period of 8 months. Marijuana (1000 kg/year), heroin (75 kg/year) and cocaine (47 kg/year) were found to be the most frequently consumed illicit drugs, while the consumption of amphetamine-type drugs was much lower (1-3 kg/year). A comparison with other reports indicated that drug abuse profiles in transition countries might be different from those reported for Western Europe, in particular with respect to the comparatively increased consumption of heroin. Enhanced consumption of stimulating drugs (cocaine and ectasy) was systematically detected during weekends.

Topics: Amphetamines; Cannabinoids; Chromatography, Liquid; Cities; Cocaine; Croatia; Environmental Monitoring; Epidemiological Monitoring; Heroin; Illicit Drugs; Substance-Related Disorders; Tandem Mass Spectrometry; Waste Disposal, Fluid; Water Pollutants, Chemical; Water Pollution, Chemical

Topics: Creatine Kinase; Flunitrazepam; Heroin; Humans; Illicit Drugs; Injections, Intra-Articular; Leg; Male; Microcirculation; Myoglobin; Substance-Related Disorders; Young Adult

Heroin availability and purity decreased precipitously in Australian markets between 2000 and 2001. This led to increased use of non-opiate drugs in the general community but whether pregnant drug users and their newborn infants were affected remains unknown.. To determine if perinatal drug exposure and outcomes are affected by changes in street drug availability.. Retrospective review was carried out of known drug-exposed mothers delivering live-born infants at the Royal Hospital for Women, Randwick, Australia (n = 316). Study periods were divided into preshortage (A = 1998-2000, n = 79), shortage (B = 2001-2002, n = 92) and post-shortage (C = 2003-2006, n = 122) periods. Cannabis-only users were excluded (n = 23).. The percentage of confined women who admitted to using heroin decreased significantly (65%(A) vs 34%(B), P < 0.01) as did women on methadone programmes (90%(A), 80%(B), 75%(C), P = 0.024). The use of cocaine (7% (A) vs 33% (B), P = 0.031) and amphetamines (4% (A) vs 22% (C), P = 0.01), tripled. Most infants were born full-term and healthy but the duration of infant hospitalisation increased significantly from (median [interquartile range]) 8 [10, 38](A) to 13 [7, 23](C) days (P < 0.01). Approximately 50% of infants required withdrawal treatment but more needed phenobarbitone as an adjunct to morphine during the shortage (4/80 (0.5%) vs 15/93 (16%), P = 0.026), probably because of increased exposure to non-opiate drugs.. The types of drugs used by pregnant drug users follow street trends and may affect infant hospitalisation and withdrawal treatment. Of concern is the rise in amphetamine-use and there needs to be increased vigilance for similar trends, especially in previously unidentified drug users.

Topics: Australia; Drug Users; Female; Heroin; Humans; Illicit Drugs; Infant, Newborn; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Retrospective Studies; Substance-Related Disorders; Time Factors

A key aim of supply-side drug law enforcement is to reduce drug use by increasing the retail price of drugs. Since most illicit drug users are polydrug users the effectiveness of this strategy depends on the extent to which drug users reduce their overall consumption of drugs. The literature shows that drug users do reduce their consumption of a drug when its price increases. However the extent of that decrease and the implications for the use of other drugs vary across studies.. A sample of 101 Australian methamphetamine users was surveyed using a behavioural economics approach. Participants were given a hypothetical fixed drug budget, presented with a range of drug price lists and asked how many units of each drug they would purchase. Methamphetamine and heroin prices were varied independently across trials.. While demand for both methamphetamine and heroin was found to be price elastic, elasticity estimates were influenced by the nature of participants' drug dependence. The group least responsive to changes in methamphetamine price were those dependent only on methamphetamine, while the group most responsive were dependent only on heroin. Similar findings emerged in relation to changes in heroin price. Cross-price elasticity analysis showed limited substitution into other drugs as the price of methamphetamine increased. In contrast, for heroin, there was significant substitution into pharmaceutical opioids and to a lesser extent, benzodiazepines and methamphetamine. However, for the most part, the decreases in methamphetamine or heroin consumption outweighed any substitution into other drugs.. The reduction in overall drug consumption and expenditure in response to price increases in heroin and methamphetamine observed in this sample lend support to supply-side enforcement strategies that aim to increase retail drug price. Notably, this analysis highlights the importance of accounting for the nature of users' drug dependence in estimating price responsiveness.

Topics: Adolescent; Adult; Amphetamine-Related Disorders; Australia; Commerce; Female; Heroin; Heroin Dependence; Humans; Illicit Drugs; Law Enforcement; Male; Mental Health Services; Methamphetamine; Middle Aged; Substance Abuse, Intravenous; Substance-Related Disorders; Surveys and Questionnaires; Young Adult

gamma-Hydroxybutyrate (GHB) is a drug of abuse with a status as being safe. In spite of a reputation of low toxicity, a huge number of deaths associated with this drug have been recorded during recent years in Sweden. It is unclear whether coingestion with other drugs or ethanol causes death in GHB overdoses or whether GHB itself is the main cause of death.. The aim of this study was to analyze the cause of death in GHB-related fatalities seen in our region.. All cases of deaths with GHB during the year 2000-2007 in the region of western Sweden were studied retrospectively. The cases were classified as either GHB poisonings without any, with a minor or a major influence of other drugs on the cause of death.. Twenty-three cases were diagnosed as deaths due to GHB overdose. Ninety-one percent coingested other substances. Ninety-one percent of the decedents were male. Age varied between 16 and 46, with the median age at 25 years. Forty-three percent of the cases were classified as GHB poisonings without any or a minor influence of other drugs on the cause of death. Thirty percent also ingested ethanol. Two patients (9%) were only intoxicated with GHB.. Intoxication with GHB carries some mortality. Combining GHB with ethanol does not explain the many deaths in our region, nor do extremely high plasma concentrations of GHB. The intake of opioids increases the toxicity of GHB. The drug itself has such biological activities that an overdose is dangerous and may lead to death.

Topics: Adolescent; Adult; Central Nervous System Stimulants; Cocaine; Drug Overdose; Female; Hallucinogens; Heroin; Humans; Immunoassay; Male; Marijuana Abuse; Methamphetamine; Middle Aged; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Prescription Drugs; Retrospective Studies; Sodium Oxybate; Substance-Related Disorders; Sweden; Young Adult

We have recently observed an unforeseen dissociation in the effect of environmental context on heroin versus cocaine self-administration in rats. Rats housed in the self-administration chambers (Residents) took more heroin than rats that were transferred to the self-administration chambers only for the test sessions (Nonresidents). The contrary was found for cocaine. The twofold aim of the present study was to investigate: 1) drug choice as a function of ambience in rats given access to both cocaine and heroin, and 2) ambience of choice for cocaine- versus heroin-taking in human addicts.. Resident and Nonresident rats with double-lumen intrajugular catheters were trained to self-administer cocaine (400 microg/kg/infusion) and heroin (25 microg/kg/infusion) on alternate days and then given the opportunity to choose between the two drugs during seven daily sessions. In the human study, we asked heroin and cocaine abusers where they preferred to take these drugs.. Approximately 46.7% of Resident rats exhibited a preference for heroin over cocaine; 33.3% preferred cocaine, and 20% expressed no preference. In contrast, only 8.3% of Nonresident rats preferred heroin, whereas 66.7% preferred cocaine, and 25% expressed no preference. In the human study, 73% of co-abusers reported that they used heroin exclusively or mostly at home (22% used it outside the home), whereas only 25% reported using cocaine at home (67% took it outside their homes).. Environmental context plays an important role in drug choice in both humans and rats self-administering heroin and cocaine.

Topics: Adult; Animals; Choice Behavior; Cocaine; Conditioning, Operant; Environment; Extinction, Psychological; Female; Heroin; Humans; Injections, Intravenous; Male; Rats; Rats, Sprague-Dawley; Self Administration; Substance-Related Disorders

This study is the first study that addresses drug abuse associated fatalities in Jordan. It is aimed to give a close picture to the demography, toxicological data, manner, cause of death and other associated findings in such cases. Postmortem forensic pathology reports for all autopsies examined in the National Institute of Forensic Medicine were reviewed over a 5-year period and drug abuse associated deaths were selected. The study revealed that 44 cases (0.76%) out of the 5789 total autopsies were attributed to drug abuse associated deaths. The age range was from 20 to 60 years (mean+/-S.D.=32.7+/-7.2). More than 80% of cases were Jordanian males. The reported abuse substances as single drug or in combination were alcohol in 56.8%, morphine 36.4%, heroin 15.9%, benzodiazepines in 11.4% and cocaine in one body packer case. Surprisingly, neither a case with amphetamine or amphetamine analogue, nor with marijuana or methadone was recorded. In 75% of cases the death was accidental and only one case was reported to be suicidal, while in 18.2% and 4.5% death was due to sudden death and road traffic accidents, respectively. Regarding the cause of death, it was related to drug overdose in 50% of cases and in 34.1%, 11.4% and 4.5% of cases it was attributed to drug related medical complications, non-drug related complications, and trauma, respectively. Alcohol was mainly associated with accidental death; morphine and heroin were associated with drug overdose and abused through intravenous route. Injection marks were reported in 56.8% of cases and in 52.3% death occurred at home. This study confirmed the variation in the incidence and type of abused substances in Jordan compared with different countries.

Topics: Accidents; Accidents, Traffic; Adult; Benzodiazepines; Cause of Death; Central Nervous System Depressants; Cocaine; Death, Sudden; Drug Overdose; Ethanol; Female; Forensic Toxicology; Heroin; Humans; Jordan; Male; Middle Aged; Morphine; Narcotics; Retrospective Studies; Substance-Related Disorders; Suicide

HIV infection is prevalent among substance abusers. The effects of specific illicit drugs on HIV disease progression have not been established. We evaluated the relationship between substances of abuse and HIV disease progression in a cohort of HIV-1-positive active drug users.. A prospective, 30-month, longitudinal study was conducted on 222 HIV-1 seropositive drug users in Miami, FL. History of illicit drug, alcohol, and medication use, CD4+ cell count, and viral load were performed every 6 months.. Crack-cocaine users were 2.14 times [95% confidence interval (CI): 1.08 to 4.25, P = 0.029] more likely to present a decline of CD4 to

Topics: Adult; Alcoholism; Antiretroviral Therapy, Highly Active; Cannabis; CD4 Lymphocyte Count; Cocaine-Related Disorders; Cohort Studies; Crack Cocaine; Disease Progression; Female; Heroin; HIV Infections; Humans; Longitudinal Studies; Male; Middle Aged; Prospective Studies; Substance-Related Disorders; Viral Load

Topics: Bacterial Infections; Cocaine; Heroin; Humans; Narcotics; Pemphigus; Substance-Related Disorders

The diffusion and trends in use of each substance is a basic information in policy planning of strategies aiming at deterrence of drug abuse or in the organization of the fight against drug trafficking. The actual diffusion of illicit drugs in a population is hardly measurable, but, among the various measures available, the analysis of waste water plants represents one of the most reliable source of data. We analyzed waste water in order to monitor illicit drug use by local population. We investigated the use of cocaine and heroin in the city of Florence, Italy, over a 1-year (July 2006-June 2007) period using state-of-the-art measuring techniques from waste water samples. Cocaine, benzoylecgonine, and morphine were determined in water samples by gas chromatography-mass spectrometer, and the amount of illicit substance was estimated. Data indicate for cocaine a bimodal distribution (December and March), while heroin showed a main peak in April. The heroin-to-cocaine use ratio in terms of estimated doses per month ranged from 0.11 to 0.76, representing new evidence of wider distribution of cocaine than heroin in Florence. Waste water analysis can become a valuable tool in monitoring use of illicit drugs over time. In particular, it can highlight changes in the magnitude and relative use of illicit drug at a population level thereby becoming useful to develop strategies against drug trafficking and abuse. If routinely performed, it can be part of Epidemiologic Surveillance Programmes on drug abuse.

Topics: Cocaine; Gas Chromatography-Mass Spectrometry; Heroin; Humans; Illicit Drugs; Italy; Morphine; Narcotics; Seasons; Substance-Related Disorders; Waste Disposal, Fluid; Water

Patients who have overdosed on drugs commonly present to emergency departments, with only the most severe cases requiring intensive care unit (ICU) admission. Such patients typically survive hospitalisation. We studied their longer term functional outcomes and recovery patterns which have not been well described. All patients admitted to the 18-bed ICU of a university-affiliated teaching hospital following drug overdoses between 1 January 2004 and 31 December 2006 were identified. With ethical approval, we evaluated the functional outcome and recovery patterns of the surviving patients 31 months after presentation, by telephone or personal interview. These were recorded as Glasgow outcome score, Karnofsky performance index and present work status. During the three years studied, 43 patients were identified as being admitted to our ICU because of an overdose. The average age was 34 years, 72% were male and the mean APACHE II score was 16.7. Of these, 32 were discharged from hospital alive. Follow-up data was attained on all of them. At a median of 31 months follow-up, a further eight had died. Of the 24 surviving there were 13 unemployed, seven employed and four in custody. The median Glasgow outcome score of survivors was 4.5, their Karnofsky score 80. Admission to ICU for treatment of overdose is associated with a very high risk of death in both the short- and long-term. While excellent functional recovery is achievable, 16% of survivors were held in custody and 54% unemployed.

Topics: Adolescent; Adult; Aged; Alcohol Drinking; Analgesics, Opioid; Cocaine; Drug Overdose; Employment; Female; Follow-Up Studies; Glasgow Outcome Scale; Heroin; Humans; Illicit Drugs; Intensive Care Units; Karnofsky Performance Status; Male; Middle Aged; Substance-Related Disorders; Treatment Outcome; Young Adult

Researchers working on drug addiction may, for a variety of reasons, want to carry out research which involves giving addicts their drug of choice. In carrying out this research consent needs to be obtained from those addicts recruited to participate in it. Concerns have been raised about whether or not such addicts are able to give this consent. Despite their differences, however, both sides in this debate appear to be agreed that the way to resolve this issue is to determine whether or not addicts have irresistible cravings for drugs - if they do, then they cannot consent to this type of research; if they do not, then they can. This I will argue is a mistake. Determining whether or not addicts can say 'No' to offers of drugs will not help us to make much progress here. Instead we need to look at the various ways in which different types of research may undermine an addict's competence to give consent. What we will find is that the details of the research make a big difference here and that, as such, we need to steer a course between, on the one hand, painting all addicts as being unable to consent to research which involves providing them with drugs, and, on the other, maintaining that there are no problems in obtaining consent from addicts to take part in such research.

Topics: Clinical Trials as Topic; Heroin; Humans; Informed Consent; Motivation; Research Design; Substance-Related Disorders

The social and medical problems of drug abuse are a matter of increasing global concern. To tackle drug abuse in changing scenarios, international drug agencies need fresh methods to monitor trends and patterns of illicit drug consumption.. We tested a sewage epidemiology approach, using levels of excreted drug residues in wastewater, to monitor collective use of the major drugs of abuse in near real time.. Selected drug target residues derived from use of cocaine, opiates, cannabis, and amphetamines were measured by mass spectrometry in wastewater collected at major sewage treatment plants in Milan (Italy), Lugano (Switzerland), and London (United Kingdom). The amounts of drug residues conveyed to the treatment plants, reflecting the amounts collectively excreted with urine, were used to estimate consumption of the active parent drugs.. Reproducible and characteristic profiles of illicit drug use were obtained in the three cities, thus for the first time quickly revealing changes in local consumption (e.g., cocaine consumption rose significantly on weekends in Milan). Profiles of local drug consumption based on waste-water measurements are in line with national annual prevalence estimates.. Patterns and trends of drug abuse in local communities can be promptly monitored by this tool, a convenient new complement to more complex, lengthy survey methods. In principle, searching the sewage for excreted compounds relevant to public health issues appears to have the potential to become a convenient source of real-time epidemiologic information.

Topics: Amphetamines; Cannabis; Cocaine; Dronabinol; Environmental Monitoring; Epidemiological Monitoring; Heroin; Illicit Drugs; Italy; London; Mass Spectrometry; Sewage; Substance Abuse Detection; Substance-Related Disorders; Switzerland; Water Pollutants, Chemical

Lead toxicity has been associated with behavioral handicaps, reading disability, antisocial and hyperactive behavior, juvenile delinquency, and impaired cognition. In addition, preclinical studies suggest an association with drug addiction; e.g., animals treated with lead either pre- or postnatally self-administer opiates at a much higher rate than untreated animals. Iron deficiency further increases the risk of lead toxicity through enhanced absorption of lead in the gastrointestinal tract. Female injection drug users have a high prevalence of iron deficiency, although the question remains as to whether this relationship is either a partial function of high lead exposure or heroin use. Specific aims were to preliminarily determine whether female injection heroin users have high tibial lead concentrations, a marker for cumulative lead exposure, compared with normal reference populations, and whether cognitive deficits potentiated the relationship between lead exposure and frequency of heroin use. Tibial lead concentrations were measured via 109 Cd-based K-shell X-ray fluorescence. In 26 female injection heroin users, mean (standard deviation (SD)) tibial lead concentration was 14.5 (6.8) microg/(g bone mineral), which was 1.8 times higher than the tibial lead concentration found among age-adjusted normal community-dwelling women. Interaction effects of tibial lead concentration and selected cognitive functions on frequency with which heroin was used were significant. Further research is warranted to determine whether a history of lead exposure is associated with increased proclivity to drug addiction.

Topics: Adult; Cognition; Environmental Exposure; Female; Heroin; Humans; Lead; Maryland; Neuropsychological Tests; Pilot Projects; Spectrometry, X-Ray Emission; Substance-Related Disorders; Tibia

Topics: Adult; Crack Cocaine; England; Heroin; Humans; Male; Poisoning; Substance-Related Disorders; Wales

To determine the contribution of heroin, prescription opioids, cocaine and alcohol/drug combinations to the total overdose death rate and identify changes in drug overdose patterns among New Mexico subpopulations.. We analyzed medical examiner data for all unintentional drug overdose deaths in New Mexico during 1990-2005. Age-adjusted drug overdose death rates were calculated by sex and race/ethnicity; we modeled overall drug overdose death adjusting for age and region.. The total unintentional drug overdose death rate in New Mexico increased from 5.6 per 100 000 in 1990 to 15.5 per 100 000 in 2005. Deaths caused by heroin, prescription opioids, cocaine and alcohol/drug combinations together ranged from 89% to 98% of the total. Heroin caused the most deaths during 1990-2005, with a notable rate increase in prescription opioid overdose death during 1998-2005 (58%). During 1990-2005, the 196% increase in single drug category overdose death was driven by prescription opioids alone and heroin alone; the 148% increase in multi-drug category overdose death was driven by heroin/alcohol and heroin/cocaine. Hispanic males had the highest overdose death rate, followed by white males, white females, Hispanic females and American Indians. The most common categories causing death were heroin alone and heroin/alcohol among Hispanic males, heroin/alcohol among American Indian males and prescription opioids alone among white males and all female subpopulations.. Interventions to prevent drug overdose death should be targeted according to use patterns among at-risk subpopulations. A comprehensive approach addressing both illicit and prescription drug users, and people who use these drugs concurrently, is needed to reduce overdose death.

Topics: Adult; Analgesics, Opioid; Cause of Death; Cocaine; Drug Overdose; Drug Prescriptions; Ethanol; Female; Heroin; Humans; Illicit Drugs; Male; New Mexico; Risk Factors; Sex Factors; Substance-Related Disorders

Striatal enkephalin and dynorphin opioid systems mediate reward and negative affect, respectively, relevant to addiction disorders. We examined polymorphisms of proenkephalin (PENK) and prodynorphin (PDYN) genes in relation to heroin abuse and gene expression in the human striatum and the relevance of genetic dopaminergic tone, critical for drug reward and striatal function. Heroin abuse was significantly associated with PENK polymorphic 3' UTR dinucleotide (CA) repeats; 79% of subjects homozygous for the 79-bp allele were heroin abusers. Such individuals tended to express higher PENK mRNA than the 81-bp homozygotes, but PENK levels within the nucleus accumbens (NAc) shell were most strongly correlated to catecholamine-O-methyltransferase (COMT) genotype. Control Met/Met individuals expressed lower PENK mRNA than Val carriers, a pattern reversed in heroin users. Up-regulation of NAc PENK in Met/Met heroin abusers was accompanied by impaired tyrosine hydroxylase (TH) mRNA expression in mesolimbic dopamine neurons. In contrast to PENK, no association was detected between PDYN genotype (68-bp repeat element containing one to four copies of AP-1 binding sites in the promoter region) and heroin abuse, although there was a clear functional association with striatal PDYN mRNA expression: an increased number of inducible repeats (three and four) correlated with higher PDYN levels than adult or fetal subjects with noninducible (one and two) alleles. Moreover, PDYN expression was not related to COMT genotype. Altogether, the data suggest that dysfunction of the opioid reward system is significantly linked to opiate abuse vulnerability and that heroin use alters the apparent influence of heritable dopamine tone on mesolimbic PENK and TH function.

Topics: Adult; Analgesics, Opioid; Autopsy; Brain; Dopamine; Enkephalins; Female; Gene Expression Regulation; Heroin; Humans; Male; Neuropeptides; Nucleus Accumbens; Protein Precursors; Receptors, Opioid, mu; Substance-Related Disorders; Tyrosine 3-Monooxygenase

Exposure to cocaine in utero results in behavioral and neurodevelopmental abnormalities that persist into adulthood. Conventional MR imaging has generally failed to reveal the expected structural lesions to explain these clinical findings. We report a case of focal MR imaging signal-intensity changes in the substantia nigra, locus ceruleus, and other selected nerve tracts and nuclei in a child exposed prenatally to cocaine and other drugs. The patient also had dilated cardiomyopathy.

Topics: Cardiomyopathy, Dilated; Child Development; Cocaine; Failure to Thrive; Female; Heroin; Humans; Infant; Magnetic Resonance Imaging; Narcotics; Pregnancy; Prenatal Exposure Delayed Effects; Substance-Related Disorders; Substantia Nigra

A description of the illicit drug market in Denmark's second largest city is provided based upon the prevalence of narcotics and illicitly sold medicals during the years 2002 and 2003. The changes on the illicit drug market are described by comparing the results to a similar study conducted ten years earlier.. The study is comprised of 469 cases of seized material by Aarhus Police during the period January 1st 2002-December 31st 2003. Additional information relating to the 341 persons charged is also included in the study.. Heroine, cocaine and amphetamine were seized in 31%, 30% and 28% of the cases, respectively, and comprise the most frequently encountered hard drugs on the market. The prevalence of cocaine in Aarhus Police District has increased more than tenfold during the past ten years. The purity of the three drugs decreased significantly during the same period, although large variations in the quality of drugs were observed. Medicals were found in 16% of the seizures (containing 32 different active substances). The most frequent group of medicals was benzodiazepines, which made up a total of 74% of the medicals in the study. Anabolic steroids, ecstasy and methamphetamine were each found in 4% of the seizures. Men with an average age of 29.1 years comprised 92% of the persons charged in the study. Persons with a foreign nationality comprised 15% of the charged, while 25% had a birthplace outside Denmark.. The prevalence of stimulants especially cocaine have increased significantly during the past ten years. Meanwhile the purity of the drugs has decreased. The benzodiazepines are still the most frequent group of medicals on the illicit market.

Topics: Adult; Amphetamine; Cocaine; Crime; Denmark; Female; Heroin; Humans; Illicit Drugs; Male; Middle Aged; Narcotics; Prevalence; Substance-Related Disorders

Topics: Continuity of Patient Care; Health Services Accessibility; Heroin; Humans; Narcotics; New South Wales; Prisoners; Prisons; Program Development; Rehabilitation Centers; Substance-Related Disorders

Most of the prevalent cases of hepatitis C virus (HCV) infection are attributable to intravenous drug using. However, a substantial number of individuals, particularly noninjecting drug users (NIDU), report no identifiable source of HCV exposure. This may be interpreted as inaccurate reporting of past intravenous exposure or as the presence of an unidentified source of HCV infection. Because of this, we evaluated the prevalence of and factors associated with HCV infection among NIDU.. One hundred and eighty-two individuals who were attended from 2003 to 2004 in a drug addiction facility because of noninjecting drug use were included.. HCV infection was detected in 23 (12.6%) participants. Sharing the inhalation tube of crack cocaine [adjusted odds ratio (AOR) 3.6, 95% confidence interval (CI) 1.3-9.8, P=0.01], presence of tattoos (AOR 3.5, 95% CI 1.3-9.1, P=0.02) and age >or=34 years (AOR 3.9, 95% CI 1.3-11.6, P=0.01) 3.9 were independently associated with HCV infection.. The prevalence of HCV infection in NIDU is higher than in general population. HCV infection is more likely among older drug users, those with tattoos and crack cocaine users that share the inhalation implements.

Topics: Administration, Inhalation; Adult; Bodily Secretions; Comorbidity; Crack Cocaine; Cross-Sectional Studies; Equipment Contamination; Female; Hepacivirus; Hepatitis C; Heroin; Humans; Male; Narcotics; Odds Ratio; Prevalence; Risk-Taking; RNA, Viral; Saliva; Sexual Behavior; Spain; Substance-Related Disorders

Heroin-assisted treatment (HAT) is a new form of treatment for heroin-dependent patients not responding to conventional interventions such as methadone maintenance treatment. No pregnancies or births under HAT have been reported until now.. The pregnancy course of a 31-year-old severely dependent multi-morbid woman receiving HAT and the birth of a healthy baby after premature delivery is described. HAT helped to reduce the use of illicit substances both before and during pregnancy. The neonatal abstinence syndrome was clinically well compensated.. HAT seems to be feasible in pregnant women and normal birth is possible under HAT, which therefore may act as a harm reduction measure for polydrug-using pregnant women not responding to methadone maintenance treatment.

Topics: Adult; Female; Heroin; Humans; Infant, Newborn; Male; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications; Substance-Related Disorders

Topics: Adolescent; Common Cold; Crime; Heroin; Humans; Illicit Drugs; Substance-Related Disorders; Texas

The simultaneous i.v. administration of heroin and cocaine, called a 'speedball,' is often reported clinically, and identification of effective pharmacotherapies is a continuing challenge. We hypothesized that treatment with combinations of a monoamine releaser d-amphetamine, and a mu partial agonist, buprenorphine, might reduce speedball self-administration by rhesus monkeys. Speedballs (0.01 mg/kg/inj cocaine+0.0032 mg/kg/inj heroin) and food (1 g banana-flavored pellets) were available during four daily sessions on a second-order schedule of reinforcement (fixed ratio (FR)2 (variable ratio (VR)16:S)). Monkeys were treated for 10 days with saline or ascending doses of d-amphetamine (0.0032-0.032 mg/kg/h)+buprenorphine (0.075 or 0.237 mg/kg/day) in combination. d-Amphetamine+both doses of buprenorphine produced an amphetamine dose-dependent decrease in speedball self-administration in comparison to the saline treatment baseline (P<0.01-0.001), but food-maintained responding did not change significantly. d-Amphetamine alone (0.032 mg/kg/h) significantly decreased both food (P<0.01) and speedball-maintained responding (P<0.05). During saline control treatment, speedball unit doses of 0.0032 mg/kg/inj cocaine+0.001 mg/kg/inj heroin were at the peak of the speedball dose-effect curve. Daily treatment with 0.01 mg/kg/h d-amphetamine+0.237 mg/kg/day buprenorphine produced a significant downward and rightward shift in the speedball dose-effect curve (P<0.01) and no significant effect on food-maintained responding. A significant decrease in speedball self-administration was sustained over 10 days of treatment. These findings are consistent with our previous reports and suggest that medication mixtures designed to target both the stimulant and the opioid component of the speedball may be an effective approach to polydrug abuse treatment.

Topics: Animals; Behavior, Animal; Buprenorphine; Central Nervous System Stimulants; Cocaine; Dextroamphetamine; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Interactions; Drug Therapy, Combination; Feeding Behavior; Food Preferences; Heroin; Macaca mulatta; Male; Narcotics; Self Administration; Substance-Related Disorders

A 55-year-old Hispanic male found unresponsive at home was brought to our emergency department. The patient was found to have rapid atrial fibrillation and acute inferior ST-elevation myocardial infarction on electrocardiogram. Cardiac catheterization failed to reveal any significant stenotic lesions in the coronary arteries. Initial laboratory studies revealed leukocytosis, hypokalemia, hyperglycemia, an anion-gap metabolic acidosis, as well as an osmolal-gap. Initial toxicology screen was negative. The patient was admitted to the Cardiac Intensive Care Unit. After 24 hours of appropriate medical management the clinical picture had improved. Further blood analysis revealed the presence of clenbuterol. Clenbuterol is a long-acting B-2 agonist used in veterinary medicine. Several patients in the Northeast have recently presented with a similar constellation of symptoms attributed to use of heroin adulterated with clenbuterol.

Topics: Acute Disease; Clenbuterol; Drug Contamination; Emergency Service, Hospital; Heroin; Humans; Male; Middle Aged; Substance-Related Disorders

Police Services in a number of Australian states have indicated random roadside drug testing will be implemented to target drug driving. This paper outlines research conducted to provide an estimate of the prevalence of drug driving in a sample of Queensland drivers. Oral fluid samples were collected from 781 drivers who volunteered to participate at Random Breath Testing (RBT) sites in a large Queensland regional area. Illicit substances tested for included cannabis (delta 9 tetrahydrocannibinol [THC]), amphetamine type substances, heroin and cocaine. Drivers also completed a self-report questionnaire regarding their drug-related driving behaviour. Samples that were drug-positive at initial screening were sent to a government laboratory for confirmation. Oral fluid samples from 27 participants (3.5%) were confirmed positive for at least one illicit substance. The most common drugs detected in oral fluid were cannabis (delta 9 THC) (n = 13) followed by amphetamine type substances (n = 11). A key finding was that cannabis was also confirmed as the most common self-reported drug combined with driving and that individuals who tested positive to any drug through oral fluid analysis were also more likely to report the highest frequency of drug driving. Furthermore, a comparison between drug vs drink driving detection rates for the study period revealed a higher detection rate for drug driving (3.5%) vs drink driving (0.8%). This research provides evidence that drug driving is relatively prevalent on Queensland Roads. The paper will further outline the study findings and present possible directions for future drug driving research.

Topics: Adolescent; Adult; Aged; Amphetamine; Automobile Driving; Breath Tests; Cocaine; Cross-Sectional Studies; Dronabinol; Female; Heroin; Humans; Illicit Drugs; Male; Mass Screening; Middle Aged; Queensland; Saliva; Sensitivity and Specificity; Substance Abuse Detection; Substance-Related Disorders

Topics: Analgesics, Opioid; Drug Implants; Drug Overdose; Heroin; Humans; Naltrexone; Narcotic Antagonists; Substance-Related Disorders

To evaluate the effect of rooming-in (rather than standard nursery care) on the incidence and severity of neonatal abstinence syndrome among opioid-exposed newborns and on the proportion of mothers who retain custody of their babies at hospital discharge.. Retrospective cohort study.. Lower mainland in southwestern British Columbia.. We selected 32 women in the city of Vancouver known to have used heroin or methadone during pregnancy between October 2001 and December 2002. Comparison groups were a historical cohort of 38 women in Vancouver and a concurrent cohort of 36 women cared for in a neighbouring community hospital.. Need for treatment with morphine, number of days of treatment with morphine, and whether babies were discharged in the custody of their mothers.. Rooming-in was associated with a significant decrease in need for treatment of neonatal abstinence syndrome compared with the historical cohort (adjusted relative risk [RR] 0.40, 95% confidence interval [CI] 0.20 to 0.78) and the concurrent cohort (adjusted RR 0.39, 95% CI 0.20 to 0.75). Rooming-in was also associated with shorter newborn length of stay in hospital compared with both comparison groups. Newborns who roomed in at BC Women's Hospital were significantly more likely to be discharged in the custody of their mothers than babies in the historical cohort (RR 2.23, 95% CI 1.43 to 3.98) or the concurrent cohort (RR 1.52, 95% CI 1.15 to 2.53) were.. Rooming-in might ease opioid-exposed newborns' transition to extrauterine life and promote more effective mothering.

Topics: Adult; Breast Feeding; British Columbia; Child Custody; Cohort Studies; Comorbidity; Female; Heroin; Humans; Infant, Newborn; Length of Stay; Methadone; Neonatal Abstinence Syndrome; Opioid-Related Disorders; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Prevalence; Rooming-in Care; Smoking; Socioeconomic Factors; Substance-Related Disorders

This study investigates trajectories of heroin use and subsequent consequences in a sample of 471 male heroin addicts who were admitted to the California Civil Addict Program in 1964-1965 and followed over 33 years. Applying a two-part growth mixture modeling strategy to heroin use level during the first 16 years of the addiction careers since first heroin use, the authors identified three groups with distinctive profiles: stably high-level heroin users (n = 278), late decelerated users (n = 149), and early quitters (n = 44). Study findings empirically demonstrate the chronic nature of heroin addiction and subsequent adverse consequences including mortality, mental health, and employment.

Topics: Adolescent; Adult; Age Factors; California; Demography; Heroin; Humans; Interviews as Topic; Male; Models, Theoretical; Prospective Studies; Psychological Tests; Psychometrics; Risk Factors; Socioeconomic Factors; Substance-Related Disorders; Time Factors

There are a few studies with conflicting results on the effects of opioids on the functioning of immune system. This study was performed to investigate the in vitro production of interferon-gamma and interleukin-10 after antigenic stimulation of cells using whole blood from opioid addicts. Blood samples were taken from 20 chronically opioid-addicted persons, who voluntarily enrolled for detoxification (10 opium and 10 heroin addicts). Blood samples were also taken from 10 healthy individuals with no history of drug abuse as the control. Cell culture was performed in a whole blood culture assay. Diluted blood samples were stimulated with phytohemagglutinin or with lipopolysaccharide and the supernatants were collected to measure cytokine production. The results demonstrated a significant decrease in interferon-gamma production and an increase in interleukin-10 secretion in heroin addicts, relative to the control group (35.9+/-26.3 versus 110.2+/-60.3 pg/mL, p<0.01 and 71.8+/-28.4 versus 17.1+/-13.5 pg/mL, p<0.01, respectively), however the changes in these values in opium addicts were not significant compared to healthy individuals. The results could suggest that opioid addiction leads to a shift in the Th1/Th2 cytokine balance of peripheral CD4+ cells towards the Th2 response, and opioid addicts demonstrate reduced mitogenic responsiveness of lymphocytes relative to healthy individuals.

Topics: Adult; Analgesics, Opioid; Antigens; CD4-Positive T-Lymphocytes; Cytokines; Hemagglutinins; Heroin; Humans; Interleukin-10; Lipopolysaccharides; Mitogens; Opium; Substance-Related Disorders; Th1 Cells; Th2 Cells

To examine the relationship between herpes simplex virus 2 (HSV-2) seroprevalence and human immunodeficiency virus (HIV) seroprevalence among noninjecting heroin and cocaine users in New York City.. Four hundred sixty-two noninjecting cocaine and heroin users were recruited from a drug detoxification program in New York City. Smoking crack cocaine, intranasal use of heroin, and intranasal use of cocaine were the most common types of drug use. A structured interview was administered and a serum sample was collected for HIV and HSV testing.. HIV prevalence was 19% (95% CI 15%-22%) and HSV-2 seroprevalence was 60% (95% CI 55%-64%). The adjusted risk ratio for the association between HSV-2 and HIV was 1.9 (95% CI 1.21%-2.98%). The relationship between HSV-2 and HIV was particularly strong among females, among whom 86% were HSV-2 seropositive, 23% were HIV seropositive, and all HIV seropositives were also HSV-2 seropositive.. HSV-2 appears to be an important factor in sexual transmission of HIV among noninjecting cocaine and heroin users in New York City, especially among females. The estimated population attributable risk for HIV infection attributable to HSV-2 infection in this sample was 38%. Programs to manage HSV-2 infection should be developed as part of comprehensive HIV prevention for noninjecting drug users.

Topics: Adult; Cocaine; Female; Heroin; Herpes Genitalis; Herpesvirus 2, Human; HIV Infections; Humans; Male; New York City; Risk Factors; Seroepidemiologic Studies; Substance-Related Disorders

Between about 1964 and 1969, drug consumption was embedded into the transnational networks of a countercultural youth underground. In London, the high mobility of the underground members was evoking a deep-rooted fear of a casual way of life. The West Berlin underground was much more politicized than its London counterpart. In West Berlin, until the last third of the 1970s, there was no coordinated anti-drug policy. This changed when the situation of heroin users deteriorated. Politicians as well as the members of the self-help organizations began to realize that a close cooperation and an improved communication were imperative. The situation for heroin users in 1970s London was not that bad when compared to Berlin because a relatively well-functioning civil society already existed, and there were special clinics, the Drug Treatment Centers, and a relatively well-working network of voluntary organizations.

Topics: Adolescent; Adolescent Behavior; Berlin; Cultural Characteristics; Drug Users; Government Programs; Health Promotion; Heroin; Heroin Dependence; History, 20th Century; Humans; Illicit Drugs; London; Public Health; Self-Help Groups; Social Behavior; Social Change; Substance Abuse Treatment Centers; Substance-Related Disorders

Prescribing of injectable diacetylmorphine (DAM) for heroin dependence has raised concerns about its safety. In light of various reports by heroin-maintained patients of DAM-related adverse events, and previously established unwanted effects of opioids in pain management, we undertook a survey in February 2001 of a random sample of 132 (127 participated) of 1061 patients prescribed DAM in Switzerland at that time. The purpose was to document the prevalence rates of a list of unintended symptoms experienced and attributed to DAM by patients. To assess symptom complaints and other data, staff administered a six-page self-report questionnaire. The patients ascribed numerous symptoms to DAM, with the best-known being the most frequently reported (e.g. skin itching, sweating, constipation). Among potentially more problematic complaints ranged irregular menses, cognitive deficits, muscle twitches, labored breathing, pains in the cardiac region, and temporary paralysis of limbs. In the absence of a control group, however, these may also be due to other factors, such as expectation, co-medication, concomitant substance use or co-morbidity. This pilot study emphasizes the necessity of rigorous assessment of the true rates, types, severity and preventability of such complications, especially given the current efforts to establish heroin maintenance as an optional treatment for heroin dependence.

Topics: Adult; Cognition Disorders; Drug Prescriptions; Female; Health Status; Heroin; Heroin Dependence; Humans; Male; Myoclonus; Narcotics; Substance-Related Disorders; Surveys and Questionnaires; Time Factors

In preparation for a trial on co-prescription of heroin to chronic treatment-resistant addicts, a pharmaceutical dosage form for smokable heroin was developed. During development of this product (a mixture of diacetylmorphine and caffeine), in vitro experiments were performed simulating 'chasing the dragon': the technique used by addicts for inhalation of heroin after volatilisation. Samples were heated on aluminium foil using a heating device and the vapours were collected and analysed using a HPLC-UV method. The recovery of diacetylmorphine and caffeine in vapours was studied after volatilisation of different powder mixtures at temperatures between 200 and 350 degrees C. Furthermore, the volatilisation set-up was combined with an Andersen sampler to determine the sizes of aerosol particles. Only small differences in recovery of diacetylmorphine and caffeine were found between temperatures and between powder mixtures: 46-62% of diacetylmorphine from the sample was recovered in vapour and 65-83% of caffeine. The only degradation product detected in vapour was 6-acetylmorphine (4.1-7.1%). In the temperature range studied, temperature mainly influenced the volatilisation rate. Mass median aerodynamic diameters of aerosols from diacetylmorphine-containing samples ranged from 1.8-4.1 microm; 45-60% of each sample was recovered as aerosol particles <5 microm. Volatilising pharmaceutical smokable heroin resulted in sufficient amounts of diacetylmorphine in vapour and in particles suitable for effective deposition in the lungs.

Topics: Aerosols; Biological Availability; Caffeine; Central Nervous System Stimulants; Chromatography, High Pressure Liquid; Heroin; Models, Chemical; Narcotics; Particle Size; Substance-Related Disorders; Temperature; Volatilization

Switzerland has been criticised for its liberal drug policy, which could attract new users and lengthen periods of heroin addiction. We sought to estimate incidence trends and prevalence of problem heroin use in Switzerland.. We obtained information about first year of regular heroin use from the case register of substitution treatments in the canton of Zurich for 7256 patients (76% of those treated between 1991 and March, 2005). We estimated the proportion of heroin users not yet in substitution treatment programmes using the conditional lag-time distribution. Cessation rate was the proportion of individuals leaving substitution treatment programmes and not re-entering within the subsequent 10 years. Overall prevalence of problematic heroin use was modelled as a function of incidence and cessation rate.. Every second person began their first substitution treatment within 2 years of starting to use heroin regularly. Incidence of heroin use rose steeply, starting with about 80 people in 1975, culminating in 1990 with 850 new users, and declining substantially to about 150 users in 2002. Two-thirds of those who had left substitution treatment programmes re-entered within the next 10 years. The population of problematic heroin users declined by 4% a year. The cessation rate in Switzerland was low, and therefore, the prevalence rate declined slowly. Our prevalence model accords with data generated by different approaches.. The harm reduction policy of Switzerland and its emphasis on the medicalisation of the heroin problem seems to have contributed to the image of heroin as unattractive for young people. Our model could enable the study of incidence trends across different countries and thus urgently needed assessments of the effect of different drug policies.

Topics: Adult; Analgesics, Opioid; Female; Health Policy; Heroin; Humans; Incidence; Male; Methadone; Registries; Substance-Related Disorders; Switzerland; Urban Population

HIV-infected substance users have poorer health outcomes than other HIV risk groups. Few studies have examined the impact of specific types of substance use on health care. This study investigated the associations between specific types of substances of abuse and access to health care. HIV-infected individuals living in eight different single room occupancy hotels in the Bronx, New York, were interviewed between August 1999 and February 2001 regarding demographics, health care access and utilization, and drug and alcohol use. Of the 238 participants, the majority were male (59%), black or Hispanic (93%), and active drug users (61%). Individuals reporting any drug or crack/cocaine use were less likely to have a regular provider than those reporting no drug or no crack/cocaine use (adjusted odds ratio [AOR] = 0.50, p = 0.05; AOR =0.35, p = 0.004, respectively), while those with binge alcohol use were more likely to have a regular doctor than those without binge alcohol use (AOR = 2.61, p = 0.05). Individuals reporting any drug or crack/cocaine use were also less likely to perceive quality of health care positively (AOR = 0.50, p = 0.02; AOR = 0.37, p = 0.002, respectively). Heroin use, and injection drug use were not associated with these outcomes. When the sample was limited to recent drug users, similar patterns were found. Although drug use in general is associated with negative health outcomes, in this study, poorer measures of access to health care among substance users was associated predominantly with crack/cocaine use. It is important that clinicians and researchers working with substance-using populations understand how specific types of substance use differentially impact on health care.

Topics: Adult; Alcoholism; Cocaine; Female; Health Services Accessibility; Heroin; HIV; HIV Infections; Humans; Male; Middle Aged; New York City; Substance-Related Disorders

Illicit drug users are generally considered both patients and criminals in Taiwan. This study presents drug use behaviors and criminal recidivism of male subjects incarcerated for illicit drug use in Taiwan after detoxification at a detention center. This study also examined the relationship between drug use behaviors and subsequent recidivism. Charts and crime records of 794 male patients from the acute detoxification unit in a detention center in northern Taiwan were reviewed. These subjects were incarcerated for methamphetamine or/and heroin use. The authors examined the relationship between the variables collected during detoxification and subsequent recidivism of illicit drug use in the following 5 years after detoxification. Of 794 subjects, 539 (67.9%) were repeat offenders during the following 5 years after detoxification. Their recidivism occurred primarily within the first 2 years after being released into the community. The recidivism rate for heroin users was significantly higher than that of methamphetamine users. Aged under 30 years, a previous criminal record, and a positive urine analyses test for illicit drugs upon entering the detoxification unit were significantly associated with recidivism. Recidivism rates of illicit drug users in Taiwan after detoxification in the detention center were substantially high. The efficacy of detoxification programs at detention centers in Taiwan needs to be re-evaluated.

Topics: Adult; Age Factors; Central Nervous System Stimulants; Crime; Heroin; Humans; Illicit Drugs; Male; Methamphetamine; Narcotics; Prisoners; Recurrence; Regression Analysis; Substance-Related Disorders; Survival Analysis; Taiwan

I measured the role of opioid analgesics in drug abuse-related deaths in a consistent panel of 28 metropolitan areas from the Drug Abuse Warning Network. The number of reports of opioid analgesics increased 96.6% from 1997 to 2002; methadone, oxycodone, and unspecified opioid analgesics accounted for 74.3% of the increase. Oxycodone reports increased 727.8% (from 72 to 596 reports). By 2002, opioid analgesics were noted more frequently than were heroin or cocaine. Dramatic increases in the availability of such opioids have made their abuse a major, growing problem.

Topics: Analgesics, Opioid; Cocaine; Heroin; Humans; Methadone; Oxycodone; Substance-Related Disorders; United States; Urban Population

Topics: Australia; Canada; Drug Overdose; Heroin; Humans; Law Enforcement; Narcotics; Substance-Related Disorders

Previous studies suggest that fatal poisoning deaths involving methadone occur more frequently on the weekends. We assessed changes in the daily pattern of mortality because of methadone poisoning following a review of drug misuse services in 1996 and publication of revised clinical guidelines in 1999. We also compared this to the daily pattern of deaths involving heroin/morphine. The Office for National Statistics provided data on all deaths in England and Wales between 1993 and 2003 for which methadone and heroin/morphine were mentioned on the coroner's certificate of death registration after inquest, with or without alcohol or other drugs. There were 3098 deaths involving methadone. The death rate increased up to 1997 and then declined. Initially, there was a marked excess of deaths occurring on Saturdays. The rate of decline was greatest for deaths occurring on Saturdays. As a result, the Saturday peak disappeared (P = 0.006). There were 6328 deaths involving heroin/morphine. No change in the daily pattern of heroin/morphine deaths was observed during the study period. Although the marked change in the epidemiology of methadone deaths coincided with recommendations for service redevelopment and clinical management of methadone treatment, the contribution of improved prescribing practice or treatment services is unclear.

Topics: Death Certificates; Drug Overdose; England; Heroin; Holidays; Humans; Methadone; Morphine; Narcotics; Periodicity; Risk Assessment; Substance Abuse Treatment Centers; Substance-Related Disorders; Time Factors; Wales

Drug abuse is hazardous and known to be prevalent among young adults, warranting efforts to increase awareness about harmful effects and to change attitudes. This study was conducted to assess the perceptions of a group of medical students from Pakistan, a predominantly Muslim country, regarding four drugs namely heroin, charas, benzodiazepines and alcohol.. In total, 174 self-reported questionnaires were received (87% response rate). The most commonly cited reasons for why some students take these drugs were peer pressure (96%), academic stress (90%) and curiosity (88%). The most commonly cited justifiable reason was to go to sleep (34%). According to 77%, living in the college male hostel predisposed one to using these drugs. Sixty percent of students said that the drugs did not improve exam performance, while 54% said they alleviated stress. Seventy-eight percent said they did not intend to ever take drugs in the future. Females and day-scholars were more willing to discourage a friend who took drugs. Morality (78%), religion (76%) and harmful effects of drugs (57%) were the most common deterrents against drug intake. Five suggestions to decrease drug abuse included better counseling facilities (78%) and more recreational facilities (60%).. Efforts need to be made to increase student awareness regarding effects and side effects of drugs. Our findings suggest that educating students about the adverse effects as well as the moral and religious implications of drug abuse is more likely to have a positive impact than increased policing. Proper student-counseling facilities and healthier avenues for recreation are also required.

Topics: Adolescent; Adult; Alcohol Drinking; Attitude of Health Personnel; Benzodiazepines; Cannabis; Female; Health Knowledge, Attitudes, Practice; Health Surveys; Heroin; Humans; Male; Pakistan; Students, Medical; Substance-Related Disorders; Surveys and Questionnaires; Young Adult

Study 1: The aim of this study was to analyze in persons detoxified of heroin, compensatory conditioned responses (CCRs) that are opposite to the unconditioned physiological, and subjective effects that are induced by this substance. The procedure consisted in presenting slides with images of neutral stimuli (NSs) and conditioned stimuli (CSs) of heroin to both non-addicted and detoxified addicted persons. The evaluated responses were heart rate (HR) and desire for heroin (DH). Study 2: The aim was to facilitate the emission of mimetic conditioned responses (MCRs) to the unconditioned physiological, and subjective effects of heroin in detoxified heroin addicts. Three different stimulus series were manipulated: SA, during which the participant remained alone; SB, administration of a needle prick given by the researcher; SC, performance of the "pump" ritual without drug by the participants. The responses measured were HR and DH. The results of both studies are considered, respectively, to be indicators of compensatory and mimetic conditioned responses.

Topics: Adult; Conditioning, Classical; Cues; Female; Habits; Heart Rate; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Needles; Photic Stimulation; Physical Stimulation; Punctures; Stress, Psychological; Substance-Related Disorders; Syringes

2015 subjects were interviewed at musical events and raves in Northern Italy: average age 25.1, 42% female, 67% work, 42% study, 61% have higher certificate of education. 3.8% used drugs for the first time in the last year, and 60% have been using drugs for over 5 years, age of first use 16.3. In the last year, 26% have tried a mix of drugs, 52% alcohol and drugs, 48% have driven after drinking; drug consumption was: marijuana 58%, hashish 55%, cocaine 24%, popper 12%, hallucinogenic mushrooms 13%, ecstasy 13%, amphetamines 13%, Salvia divinorum 11%, LSD 9%, opium 9%, ketamine 7%, heroin 5%. In the last year, 27% subjects had depression, 25.7% anxiety, 23.7% sleep disorders, 15% financial problems, 13% road accidents, 9% addiction, 6% judicial problems. All problems were correlated to CAGE (Cut, Annoyed, Guilty, Eye-opener) test, drug use and mix drug use; psychological problems were higher for females: anxiety for cocaine, memory and psychosomatic for opium, sleeping disorders for crack, anxiety for popper, hallucinations for LSD and hallucinogenic mushrooms.

Topics: Accidents, Traffic; Adult; Alcoholism; Amphetamines; Anxiety; Crack Cocaine; Depression; Female; Hallucinogens; Heroin; Humans; Italy; Ketamine; Male; Marijuana Abuse; Nicotine; Opium; Sleep Wake Disorders; Substance-Related Disorders; Surveys and Questionnaires

Concurrent abuse of cocaine and heroin is a common form of polydrug abuse, but the interactions between the reinforcing effects of cocaine and heroin are poorly understood. Dose-addition analysis is a tool for the quantitative assessment of drug interactions, but this analysis has not been applied to evaluation of the reinforcing effects of cocaine and heroin.. To evaluate interactions between the reinforcing effects of cocaine and heroin using dose-addition analysis.. Rhesus monkeys were trained under a concurrent-choice schedule of food delivery (1 gm pellets) and drug injections (cocaine or heroin, 0-0.1 mg kg(-1) injection(-1)). Full dose-effect curves were determined for cocaine alone and heroin alone. Subsequently, full dose-effect curves were determined for three fixed-proportion mixtures of cocaine and heroin (fixed proportions of 1:3.2, 1:1 and 3.2:1 cocaine/heroin). Dose-addition analysis was used to assess whether cocaine/heroin interactions were super-additive, additive, or sub-additive.. Cocaine, heroin, and all cocaine/heroin mixtures maintained dose-dependent and monotonic increases in drug choice and dose-dependent decreases in response rates. Choice dose-effect curves for cocaine/heroin mixtures were shifted to the left of dose-effect curves for cocaine or heroin alone, and dose-addition analysis indicated that cocaine/heroin interactions on drug choice were sub-additive or additive. Cocaine/heroin interactions on response-rate measures were also sub-additive or additive.. These results confirm that mixtures of cocaine and heroin produce reinforcing effects in rhesus monkeys; however, cocaine/heroin interactions were only or sub-additive or additive. Thus, these results do not support the hypothesis that simultaneously delivered cocaine and heroin produces super-additive reinforcing effects.

Topics: Animals; Behavior, Addictive; Choice Behavior; Cocaine; Dose-Response Relationship, Drug; Drug Interactions; Eating; Heroin; Macaca mulatta; Male; Reinforcement, Psychology; Substance-Related Disorders

At the end of 2000, in Sydney, Australia, there was a dramatic reduction in heroin availability. This study examines how health agencies treating clients for drug and alcohol related issues were able to respond to the changes that took place in their clients and their treatment needs. Key informant interviews were conducted with 48 staff from a wide range of health services in Sydney to provide the data for a thematic analysis. Changes experienced by health agencies included changed patterns of drug use in their clients, increased aggressive incidents, changed numbers of clients accessing treatment services, and a need for more assistance from outside agencies. A strong evidence base for a range of drug treatment options, support of staff development in aggression management skills, and development of good interagency links between mental health, drug and alcohol, and law enforcement services would make health services better prepared for future changes in the drug use of their clients.

Topics: Health Planning; Health Services Needs and Demand; Heroin; Heroin Dependence; Humans; Illicit Drugs; New South Wales; Patient Acceptance of Health Care; Substance-Related Disorders

We recently described a reinstatement procedure that models relapse to drug abuse in cases where abstinence results from aversive consequences of drug use. The potential value of this punishment-based model of relapse depends on its sensitivity to relapse-inducing events that are ineffective in the widely used extinction-based model.. It is known that certain drugs can have anti-punishment effects, but these drugs have not been tested in the punishment-based reinstatement procedure. Therefore, the effects of the benzodiazepine, lorazepam, were examined using punishment-based and extinction-based reinstatement procedures.. Rats self-administered the opioid, remifentanil (4 microg/kg per infusion). Two punishment groups were trained with response-contingent footshock that suppressed baseline rates of responding to zero. In an extinction group, remifentanil delivery was discontinued, and baseline responding stabilized at a low rate (mean=0.06 responses/min). Lorazepam (0.08-10 mg/kg, IP) was given during test sessions with the shock contingency discontinued for both punishment groups. Remifentanil delivery was maintained during testing in one punishment group but not the other.. Lorazepam reinstated self-administration responding in both punishment groups but not in the extinction group. Priming injections of heroin reinstated responding in both the punishment and extinction groups, but combining heroin and lorazepam did not enhance reinstatement.. This is the first demonstration that a trigger for relapse may have different effects depending on whether aversive conditioning contributed to the achievement of abstinence. It may be important to consider potential anti-punishment effects of both abused drugs and therapeutic agents in the treatment of individuals with a history of drug abuse.

Topics: Analgesics, Opioid; Animals; Anti-Anxiety Agents; Conditioning, Operant; Dose-Response Relationship, Drug; Electroshock; Extinction, Psychological; Heroin; Heroin Dependence; Lorazepam; Male; Piperidines; Punishment; Rats; Rats, Sprague-Dawley; Remifentanil; Self Administration; Substance-Related Disorders

Topics: Australia; Heroin; Humans; Illicit Drugs; Law Enforcement; Public Policy; Substance-Related Disorders

Topics: Australia; Heroin; Humans; Illicit Drugs; Public Health; Substance-Related Disorders

Topics: Australia; Drug and Narcotic Control; Harm Reduction; Heroin; Humans; Illicit Drugs; Social Control Policies; Substance-Related Disorders

The risk of relapse into frequent heroin use was studied among 732 participants of the Amsterdam Cohort Study (ACS) on HIV/AIDS among drug users, who experienced an episode of abstinence from or occasional use of heroin. Participants of the ACS were recruited primarily from easy access ("low-threshold") methadone programs. The duration of abstinence/occasional use and relative risks (RR) of relapse were estimated by analyzing 1577 episodes by means of survival analysis using characteristics of patients and methadone treatment as covariates. The majority of episodes (85.8%) were followed by relapse within 5 years. Less education, intense use of heroin prior to the episode of abstinence or well-controlled use, occasional use of heroin and intense use of cocaine during the episode, and having a drug-using partner or having no partner were significantly associated with a higher risk of relapse. Among frequent attendees of a "low-threshold" methadone program, relapse was associated with the daily dose of methadone: RR for dosages <40 and 40-60 mg, compared with doses of >100mg, were 1.45 (P<0.01) and 1.59 (P<0.01), respectively. No beneficial influence was revealed of methadone dosage or program attendance in itself on the risk of relapse into cocaine. High doses of methadone in a harm-reduction setting extend the duration of an episode of no or occasional use of heroin. Other factors, such as no occasional use of heroin during the episode, no use of cocaine, and having a non-using partner, seem to be equally important.

Topics: Adult; Cohort Studies; Drug Prescriptions; Female; Harm Reduction; Heroin; Humans; Male; Methadone; Narcotics; Netherlands; Risk Factors; Secondary Prevention; Substance Abuse, Intravenous; Substance-Related Disorders

Identifying the long-term neurocognitive sequelae of drug addiction may have important implications for understanding the compulsive, chronically relapsing nature of this brain disorder.. Our aim was to investigate the consequences of chronic intravenous self-administration of cocaine or heroin on visual attentional processes in rats.. Adult male rats were pretrained on a five-choice serial reaction time task (5-CSRTT) of sustained visual attention and impulsivity and later trained to self-administer cocaine or heroin intravenously during multiple 'long-access' self-administration cycles. Control rats had identical training and surgical experience, but received passive infusions of saline during self-administration sessions. Executive cognitive processes of selection and inhibitory response control were evaluated 24 h after drug discontinuation and for a further 6 days prior to the next cycle of self-administration.. Findings indicate similar behavioural disturbances on the five-choice task in cocaine- and heroin-withdrawn rats with significantly impaired attentional accuracy, increased omissions and slower latencies to respond correctly during the early, but not late, withdrawal period. The self-administration of either drug was not associated with significant alterations in impulsive actions, and there was no evidence of persistent alterations in visual attentional performance. However, unlike rats self-administering cocaine, the motivation to collect food reward on the 5-CSRTT was significantly reduced in heroin-withdrawn animals for a period of at least 6 weeks.. These data, together with recent findings of attentional dysfunction during the withdrawal of intravenous self-administration of amphetamine, suggest that generically different drugs of abuse produce similar disturbances in visual attentional performance during the early withdrawal period.

Topics: Analgesics; Analysis of Variance; Animals; Attention Deficit Disorder with Hyperactivity; Behavior, Animal; Choice Behavior; Cocaine; Conditioning, Operant; Drug Administration Routes; Extinction, Psychological; Heroin; Male; Motivation; Rats; Reaction Time; Reinforcement, Psychology; Self Administration; Substance-Related Disorders; Time Factors

A case of ventricular tachycardia in a 37-year-old man after ingestion of heroin and cocaine, treated with naloxone is described. The arrhythmia is attributed to unopposed sympathomemetic effects of cocaine following administration of naloxone. The pro-rhythmogenic effects of naloxone may have contributed to the arrhythmia. He was initially treated sequentially with intravenous magnesium sulphate, calcium gluconate, sodium bicarbonate and lignocaine infusion, with no resolution of the ventricular tachycardia. He was admitted to the coronary care unit and was given an amiodarone infusion which converted the rhythm to sinus rhythm. Forensic physicians administering naloxone to poly-drug abuser in a custodial setting should be aware of potentially fatal consequences which they will be unable to detect. It is recommended that all such patients should be transferred to hospital for observation and investigation.

Topics: Adult; Amiodarone; Analgesics, Opioid; Anti-Arrhythmia Agents; Cocaine; Dopamine Uptake Inhibitors; Drug Combinations; Forensic Medicine; Heroin; Humans; Injections, Intramuscular; Male; Naloxone; Narcotic Antagonists; Substance-Related Disorders; Tachycardia, Ventricular

This is a collaborative piece of work undertaken between the PCA and a Principal FME. The study is based on 16 cases of internal drug concealment drawn from 43 drug-related deaths in custody in England and Wales between 1997 and 2002. These data are supplemented by three case studies from a county force involving non-fatal drug concealment to illustrate practical custody issues. The majority of the 16 deaths were white (n = 12) and male (n = 13) with a mean age of 34 years. In half of the cases, the deceased was known or believed to have concealed drugs orally at the point of initial contact with police. In 4/16 cases, the individual first showed signs of medical distress in a public place, a further 4 collapsed on arrival at the police station and two more detainees were subsequently found collapsed in their cell. Drug toxicity was the most common cause of death (10/16). In 5 cases death was caused by airway obstruction by swallowed packages. Both cocaine (14/16) and cannabis (8/16) traces were found in post-mortem samples. The report emphasises the need for a safety first approach.

Topics: Adolescent; Adult; Airway Obstruction; Amphetamines; Cannabinoids; Cocaine; Crime; Deglutition; Dopamine Uptake Inhibitors; Drug Packaging; Female; Foreign Bodies; Forensic Medicine; Hallucinogens; Heroin; Humans; Hypoxia; Male; Middle Aged; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Police; Prisoners; Substance-Related Disorders

The types and frequency of drug use among 1200 students aged 10-19 years was investigated and a prevalence rate of 40.1% found; currently used drugs included mild stimulants such as kolanut and coffee 294 (26.2%), alcohol 164 (14.5%), sniffing agents 80 (7.2%), amphetamine and ephedrine 66 (6.7%), cigarette 54 (4.8%), heroin 45 (4%) cocaine 40 (3.6%) and cannabis 38 (3.4%). Multiple drug use was found among the students, with the abuse of cannabis, cocaine and heroin being significant among those who smoked cigarette (P<0.001). The relative risk (RR) for cannabis use when cigarette was smoked was 37.4 (24.1-57.8); RR for cigarette smoking when alcohol was used, 6.8, while RR for cocaine abuse when cigarette was used, 21.8 (13.9-34.5) and 52.8 (29.2-95.5) when cannabis was used. It is therefore concluded that the use of the licit and "socially" acceptable drugs may pave the way for the abuse of illicit ones.

Topics: Adolescent; Adolescent Behavior; Adult; Alcohol Drinking; Child; Cocaine; Female; Health Knowledge, Attitudes, Practice; Heroin; Humans; Illicit Drugs; Male; Marijuana Smoking; Nigeria; Smoking; Substance-Related Disorders

This paper describes the process evaluation of an out-patient detoxification service (ODS) established by Drug Health Services (DHS) to increase the supervised withdrawal options for substance users in a Sydney metropolitan Area Health Service. The ODS aimed to provide a safe and effective supervised withdrawal to substance users who were at low risk of severe withdrawal, engage those with severe dependence in further treatment and increase the involvement of general practitioners (GPs) in the medical care of ODS clients. During its first 10 months of operation, the ODS received 199 inquiries, assessed 82 individuals and admitted 76 clients for detoxification. Withdrawal treatment proceeded without complications and within the expected time frames. Fifty-four clients completed withdrawal, 10 ceased treatment, 10 remained in treatment without completing withdrawal and two were transferred elsewhere. Clients who injected substances (mainly heroin) daily at admission, compared to others, were less likely to complete withdrawal and more likely to use a range of non-prescribed substances during withdrawal. One-fifth of clients went on to further treatment with DHS, attending at least once. Overall, the ODS met its goals, providing a safe and effective supervised withdrawal to local residents, especially women, young people and those withdrawing from benzodiazepines who had significant substance dependence, impairment and previous alcohol and other drug (AOD) treatment. Non-injecting substance users benefited most from the ODS in terms of withdrawal completion and ongoing treatment. The level of GP involvement in the conjoint care of ODS clients remained constant over time. The development and expansion of the ODS are discussed.

Topics: Adolescent; Adult; Anxiety; Benzodiazepines; Cannabis; Depression; Ethanol; Evaluation Studies as Topic; Female; Heroin; Humans; Male; Middle Aged; New South Wales; Outpatients; Stress, Physiological; Substance Abuse Treatment Centers; Substance Withdrawal Syndrome; Substance-Related Disorders

Active immunization of rats with mouse antibodies to morphine leads to the formation of antiidiotypic antibodies. This is paralleled by an increase in animal sensitivity to the analgesic and positive reinforcing effects of morphine, slower development of tolerance and formation of craving. These data indicate the possibility of active immunization against antibodies to morphine/heroin for the prevention of opium addiction relapses.

Topics: Analgesics, Opioid; Animals; Dose-Response Relationship, Drug; Drug Tolerance; Heroin; Morphine; Opium; Rats; Rats, Inbred F344; Substance-Related Disorders; Time Factors

Young and middle-aged CBA mice were injected with "street" heroin in increasing doses for 14 days. Volume density of perisinusoid argirophilic fibers increased in both age groups (the increase being more pronounced in middle-aged mice), while the levels of spontaneous, LPS- and ConA-stimulated splenocyte proliferation decreased in young mice. Six months after heroin discontinuation further progress of liver fibrosis was observed in young mice.

Topics: Age Factors; Animals; Cells, Cultured; Concanavalin A; Fibrosis; Heroin; Lipopolysaccharides; Liver; Mice; Mice, Inbred CBA; Spleen; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors

We seek to establish whether a substantial decline in the supply of heroin, as measured by indicators such as drug purity, is related to changes in drug-related health indicators such as ambulance callouts to heroin overdoses and numbers participating in methadone treatment programmes, and to changes in levels of property crime. The guiding hypothesis is that reduced supply will result in positive health and social outcomes.. Standard time-series methods are employed to analyse official data from local law-enforcement and heroin supply indicators and several health and social outcome indicators within the Australian Capital Territory (ACT), spanning the late 1990s to early 2002. Autoregressive moving average (ARMA) models are estimated to remove autocorrelation from these series. Cross-correlation and autoregression models are then employed to identify the best predictive models.. When autocorrelation has been removed, a reduction in heroin purity predicts a large decline in heroin-related ambulance callouts and an increase in methadone treatment programme enrolments. There is little evidence of an increase in negative outcomes due to heroin users switching to other drugs. A reduction in purity also predicts declines in robbery and burglary but not in theft.. The overall evidence indicates modest links between the declines in heroin supply and increases in positive health outcomes and decreases in crime, as predicted by a simple economic model. Due to the shortness of some of the series and consequent limitations in statistical power, these conclusions should be regarded as tentative.

Topics: Australian Capital Territory; Crime; Drug and Narcotic Control; Health Status; Heroin; Heroin Dependence; Humans; Substance-Related Disorders

Diabetic ketoacidosis (DKA) and poor glycaemic control in young adults with Type 1 diabetes may be associated with street drug use. There are few studies in the UK looking at the prevalence of drug use in young adults with diabetes.. One hundred and fifty-eight young adults, aged sixteen to thirty years, with Type 1 diabetes attending an urban diabetes clinic were sent an anonymous confidential postal questionnaire to determine the prevalence of street drug use.. We received 85 completed responses. Twenty-nine percent of respondents admitted to using street drugs. Of those, 68 percent habitually took street drugs more than once a month. Seventy-two percent of users were unaware of the adverse effects on diabetes.. Self-reported street drug usage in young adults with Type 1 diabetes is common and may contribute to poor glycaemic control and serious complications of diabetes.

Topics: Adolescent; Adult; Cannabis; Cocaine; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Dopamine Uptake Inhibitors; Hallucinogens; Heroin; Humans; Illicit Drugs; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Prevalence; Substance-Related Disorders; Surveys and Questionnaires; United Kingdom

Autopsy investigations, toxicological analyses, and calculation of body mass index were performed in 1180 deceased illicit drug addicts (IDAs) in Stockholm. Sweden during 1988-2000, i.e., during a period of time when the general population in numerous countries showed a dramatic increase in the prevalence of overweight. Nutritional deficit in IDAs has been pointed out as a threat to their health as well as to their quality of life. The prevalence of overweight in deceased IDAs increased from 27.4% in 1988 to 45.5% in 2000. The prevalence of overweight among all heroin users, heroin injectors, methadone, cocaine, and amphetamine users was 36.0, 38.4, 43.1, 45.0 and 50.9%, respectively, the lowest prevalence being among users of cannabis alone and HIV-positive IDAs (22.0 and 16.1%, respectively). In conclusion, Stockholm's IDAs are affected by the past decade's dramatically increased prevalence of overweight, at least to the same degree as the general population. The increased body weight seems not to influence the danger of dying upon heroin administration.

Topics: Adolescent; Adult; Age Distribution; Amphetamine; Body Mass Index; Cannabis; Cocaine; Dopamine Uptake Inhibitors; Female; Heroin; HIV Infections; Humans; Longitudinal Studies; Male; Methadone; Narcotics; Nutritional Status; Obesity; Prevalence; Sex Distribution; Substance-Related Disorders; Sweden

Pharmacotherapies utilizing long-acting agonists and mixed function agonists-antagonists have been successful in the treatment of opiate addiction but no comparable treatment exists for cocaine abuse. Long-acting tropane analogues have been synthesized that could be candidates for such pharmacotherapies. 2beta-propanoyl-3beta-(4-tolyl)-tropane (PTT) is one such compound that is a relatively selective dopamine (DA) transporter blocker that has a significantly longer duration of action than cocaine. The purpose of this study was to assess the effects of PTT on the intravenous self-administration of cocaine, heroin, or cocaine/heroin combinations. Groups of rats were trained to self-administer cocaine, heroin, or cocaine/heroin combinations using a within session dosing procedure in which three doses were available each session. PTT pretreatment reduced cocaine and cocaine/heroin combinations intake in a dose-dependent manner while having only minor effects on heroin intake. These results suggest that the neurobiological substrates of cocaine and heroin self-administration are different, and that these cocaine/heroin combinations may function more like cocaine alone, even when the dose of heroin in the mixture will function independently as a reinforcer. These results further support the potential use of long-acting dopamine reuptake inhibitors as pharmacotherapeutic adjuncts to a comprehensive treatment program for cocaine and cocaine/heroin abuse.

Topics: Analysis of Variance; Animals; Cocaine; Dopamine Uptake Inhibitors; Heroin; Male; Rats; Rats, Inbred F344; Reinforcement, Psychology; Self Administration; Substance-Related Disorders

Although it is well established that methadone can be an effective treatment for opiate addiction, it is not clear how methadone maintenance affects cocaine use and cravings in individuals who self-administer both opiates and cocaine. In our attempt to explore the effect of methadone maintenance on the effects of cocaine, we first assessed the locomotor stimulatory effects of cocaine in rats maintained on methadone (0, 10, 20, or 30 mg/kg/day, via osmotic minipumps). Chronic methadone elevated baseline locomotion in a dose-dependent manner and did not reduce the direct stimulatory effects of cocaine (5 mg/kg). We then investigated the effects of the highest methadone maintenance dose (30 mg/kg/day) on heroin and cocaine seeking in extinction, and when it was precipitated by exposure to heroin, cocaine, or foot-shock stress in rats trained to self-administer both drugs in the same experimental context (heroin 0.05 mg/kg/inf; cocaine 0.5 mg/kg/inf, eight 3-h sessions each). In tests of reinstatement, rats responded selectively on the appropriate drug-associated lever after priming injections of heroin (0.25 mg/kg) or cocaine (20 mg/kg). Methadone maintenance blocked both cocaine- and heroin-induced reinstatement, but not stress-induced reinstatement, which was not lever selective. These results suggest that although methadone maintenance may not reduce the direct stimulatory effects of cocaine, it has the potential to reduce both spontaneous and cocaine-primed cocaine-seeking behavior.

Topics: Analysis of Variance; Animals; Behavior, Addictive; Behavior, Animal; Cocaine; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Interactions; Heroin; Locomotion; Methadone; Narcotics; Rats; Rats, Long-Evans; Secondary Prevention; Self Administration; Stress, Psychological; Substance-Related Disorders

In recent years we have noticed an increasing proportion of mortalities resulting from an overdose of heroin that involve routes of administration other than injection. Of 239 cases of fatal heroin intoxication examined at our department during the period 1997-2000, 18 deaths were associated with non-parental administration. Seven of these fatalities were experienced heroin users who had begun to use more sporadically, seven were recreational "party-users", while the remaining four persons had relapsed into heroin use following long periods of abstinence. The median blood morphine concentration of these non-injectors was 0.095 microg/g (range: 0.02-0.67 microg/g), significantly lower than that of the injectors. Concurrent use of alcohol, other illicit drugs and/or pharmaceutical preparations was observed in 17 of the 18 cases. However, there were no statistically significant differences between the victims of heroin intoxication by injection or by other routes with respect to the proportion who had simultaneously consumed alcohol or benzodiazepines. Pathological alterations like lung fibrosis, liver cirrhosis, endocarditis, etc. were not found to play a significant role in any of the 18 mortalities. We conclude that snorting or smoking heroin probably involves a reduced risk of obtaining high blood concentrations of morphine but still constitutes a considerable risk of lethal outcome due to high variability in blood concentrations. Furthermore, decreased tolerance resulting from periods of reduced or sporadic use appears to be an important risk factor in connection with heroin overdosing by snorting or smoking, which indicate that some heroin addicts may inaccurately assume that these routes of administration are safe when resuming their use of heroin after a period of abstinence.

Topics: Administration, Inhalation; Administration, Intranasal; Adolescent; Adult; Central Nervous System Depressants; Drug Overdose; Ethanol; Female; Heroin; Humans; Male; Middle Aged; Morphine; Narcotics; Substance-Related Disorders; Sweden

Limited animal data suggest that the dopaminergic neurotoxin methamphetamine is not toxic to brain (striatal) cholinergic neurons. However, we previously reported that activity of choline acetyltransferase (ChAT), the cholinergic marker synthetic enzyme, can be very low in brain of some human high-dose methamphetamine users. We measured, by quantitative immunoblotting, concentrations of a second cholinergic marker, the vesicular acetylcholine transporter (VAChT), considered to be a "stable" marker of cholinergic neurons, in autopsied brain (caudate, hippocampus) of chronic users of methamphetamine and, for comparison, in brain of users of cocaine, heroin, and matched controls. Western blot analyses showed normal levels of VAChT immunoreactivity in hippocampus of all drug user groups, whereas in the dopamine-rich caudate VAChT levels were selectively elevated (+48%) in the methamphetamine group, including the three high-dose methamphetamine users who had severely reduced ChAT activity. To the extent that cholinergic neuron integrity can be inferred from VAChT concentration, our data suggest that methamphetamine does not cause loss of striatal cholinergic neurons, but might damage/downregulate brain ChAT in some high-dose users. However, the finding of increased VAChT levels suggests that brain VAChT concentration might be subject to up- and downregulation as part of a compensatory process to maintain homeostasis of neuronal cholinergic activity. This possibility should be taken into account when utilizing VAChT as a neuroimaging outcome marker for cholinergic neuron number in human studies.

Topics: Adult; Aged; Blotting, Western; Brain; Carrier Proteins; Central Nervous System Stimulants; Choline O-Acetyltransferase; Cocaine; Dopamine Uptake Inhibitors; Heroin; Humans; Immunohistochemistry; Male; Membrane Transport Proteins; Methamphetamine; Narcotics; Neurons; Substance-Related Disorders; Vesicular Acetylcholine Transport Proteins; Vesicular Transport Proteins

The present study extends the findings of a pilot study conducted among regular amphetamine users in Newcastle, NSW, in 1998. It compares key features between current participants in a state capital city (Brisbane) and a regional city (Newcastle) and between the 1998 and current Newcastle sample.. Cross-sectional survey. Setting Brisbane and Newcastle, Australia.. The survey was conducted among 214 regular amphetamine users within the context of a randomized controlled trial of brief interventions for amphetamine use.. Demographic characteristics, past and present alcohol and other drug use and mental health, treatment, amphetamine-related harms and severity of dependence.. The main findings were as follows: (i). the rate of mental health problems was high among regular amphetamine users and these problems commonly emerged after commencement of regular amphetamine use; (ii). there were regional differences in drug use with greater accessibility to a wider range of drugs in a state capital city and greater levels of injecting risk-taking behaviour outside the capital city environment; and (iii). there was a significant increase in level of amphetamine use and percentage of alcohol users, a trend for a higher level of amphetamine dependence and a significant reduction in the percentage of people using heroin and benzodiazepines among the 2002 Newcastle cohort compared to the 1998 cohort.. Further longitudinal research is needed to elucidate transitions from one drug type to another and from recreational to injecting and regular use and the relationship between drug use and mental health in prospective studies among users.. Intervention research should evaluate the effectiveness of interventions aimed at: preventing transition to injecting and regular use of amphetamines; toward reducing levels of depression among amphetamine users and interventions among people with severe psychopathology and personality disorders; and toward reducing the prevalence of tobacco dependence among amphetamine users.

Topics: Adolescent; Adult; Amphetamine-Related Disorders; Analysis of Variance; Australia; Cross-Sectional Studies; Female; Heroin; Humans; Male; Mental Health; Middle Aged; Narcotics; Residence Characteristics; Substance-Related Disorders

Topics: Administration, Intranasal; Adolescent; Adult; Female; Heroin; Heroin Dependence; Humans; Life Style; Male; Pilot Projects; Risk-Taking; Sexual Behavior; Substance-Related Disorders; Surveys and Questionnaires

Topics: Adolescent; Adult; Heroin; Heroin Dependence; Humans; Narcotics; Needle-Exchange Programs; New South Wales; Substance Abuse, Intravenous; Substance-Related Disorders

Conditioned environmental stimuli are known to be important determinants of drug seeking. Traditional models of drug seeking under the control of conditioned stimuli have focused on the ability of conditioned reinforcers either to reinstate extinguished responding or to maintain prolonged chains of drug seeking under second-order schedules. These models have consistently suggested that it is the conditioned reinforcing, rather than other, effects of Pavlovian drug stimuli that most profoundly influence drug seeking. However, the impact of drug-associated conditioned reinforcers has not been studied directly and in isolation, not least because the instrumental seeking response is invariably the same as that which was previously reinforced with the drug itself. The purpose of the present study was, therefore, to investigate the conditioned reinforcing properties of drug-paired CSs using an acquisition of a new response procedure in which an animal learns to make a new instrumental response reinforced solely by the CS. It was found that CSs paired with either cocaine, heroin or sucrose supported the rapid acquisition of lever pressing for the CS that persisted over months of repeated, intermittent testing. Furthermore, rats did not acquire the lever press response when the CS was not paired with drug, suggesting that for this stimulus to acquire conditioned reinforcing properties, it must be predictively associated with the drug's effect. Moreover, lever pressing for the CS could not be explained as coincidental to an over-riding Pavlovian approach response to the location of the lever, since animals also acquired discriminated lever pressing when the CS was above the opposite, inactive lever. Extinction decreased responding with conditioned reinforcement, but only when the CS-US association was devalued prior to, and not after, acquisition of the lever press response, providing evidence for the establishment of habitual CS-maintained responding that may explain the persistence of drug-seeking responses in animal models of addiction and relapse.

Topics: Animals; Cocaine; Cocaine-Related Disorders; Conditioning, Operant; Dose-Response Relationship, Drug; Extinction, Psychological; Heroin; Heroin Dependence; Injections, Intravenous; Male; Mental Recall; Narcotics; Rats; Self Administration; Substance-Related Disorders; Sucrose

G protein-coupled receptor kinase 5 (GRK5) plays an important role in the regulation of GPCR-transduced signals. Our previous study showed that acute administration of morphine could significantly increase GRK5 mRNA level in the cerebral cortex and hippocampus of the rat brain. The current study investigated the potential effects of acute administration of addictive drugs including morphine, heroine and cocaine on GRK5 mRNA level in the rat brain using in situ hybridization and analyzed the effects of acute and chronic morphine treatments on GRK5 protein level in the rat brain using Western blotting assay. Our results showed that 2 h after the initial morphine (10 mg/kg), cocaine (15 mg/kg) and heroine (1 mg/kg) treatment, the mRNA level of GRK5 in the parietal cortex increased about 110% (P<0.01), 70% (P<0.05) and 100% (P<0.01), respectively. In the temporal cortex, GRK5 mRNA level increased about 90% (P<0.01), 40% (P<0.05) and 80.0% (P<0.01), respectively . In the hippocampus, the mRNA level of GRK5 increased about 60% (P<0.01), 30% (P<0.05) and 80% (P<0.01). However, the mRNA level of GRK5 remained unchanged after acute morphine, cocaine or heroine treatment. In the cerebral cortex of the rat brain, the acute administration of morphine (NS-Mor) increased GRK5 protein level by about 60% while the chronic morphine treatment (Mor-Mor) increased GRK5 protein level even higher [about 130% compared with the control group (chronic saline treatment, NS-NS) group, P<0.01]. In the hippocampus, GRK5 protein level remained unchanged after acute administration of morphine (P>0.1),while the level of GRK5 protein tended to decrease after chronic morphine treatment (P=0.098). In the thalamus, acute morphine treatment caused no change in GRK5 protein level (P>0.1) while after chronic morphine treatment, GRK5 protein level decreased significantly (more than 90%, P<0.01), Taken together, our results indicate that addictive drugs can regulate GRK5 in the rat brain on protein level as well as on mRNA level and suggest that GRK5 may play a role in addiction of psychoactive substances.

Topics: Animals; Brain; Cocaine; G-Protein-Coupled Receptor Kinase 5; Heroin; Male; Morphine; Protein Serine-Threonine Kinases; Rats; Rats, Sprague-Dawley; RNA, Messenger; Substance-Related Disorders

Conditioned stimuli (CSs) previously associated with heroin are critically involved in activating long-lasting relapse and compulsive drug seeking. This study examined the magnitude of heroin seeking induced by drug-related cues in relation to the total amount of drug exposure during training. Five groups of male Sprague-Dawley rats (n=6/group) were trained by the nose-poking response to self-administer different doses of heroin (0, 0.01, 0.025, 0.05, and 0.1 mg/kg per infusion respectively, one 4-h session daily, limited to 25 infusions per session) under an identical progressive ratio schedule with gradual incremental response requirements. All the rats established stable heroin self-administration within 14 days of self-administration training, and the time needed to obtain all the 25 heroin infusions decreased across sessions. After 14 days of abstinence, heroin seeking elicited by contextual cues (self-administration chamber) or discrete contingent CSs previously associated with heroin infusions was measured in two consecutive 1-h test phases. During both test phases, the rats trained with heroin even at the lowest dose (0.01 mg/kg) showed higher active responses than saline controls, and the active responses were also higher in rats trained with doses of 0.025, 0.05, and 0.10 mg/kg in comparison with those trained with a dose of 0.01 mg/kg. There was no observable dose-dependence increase of responses at doses above 0.025 mg/kg. The results suggested that an increased motivation to seek heroin induced by drug-related cues is associated with the total amount of heroin intake.

Topics: Animals; Behavior, Animal; Heroin; Male; Motivation; Rats; Rats, Sprague-Dawley; Self Administration; Substance-Related Disorders

It has been presumed that the combination of cocaine (COC)+heroin (HER) is more reinforcing than either of the two drugs alone, thus leading to their coadministration ("speedballing"). An alternative hypothesis is that HER serves to attenuate the undesired negative effects of COC. To test this notion, male Sprague-Dawley rats (n=31) were trained to run a straight alley for a daily intravenous (IV) injection of COC (1.0 mg/kg/injection) for 14 trials. Studies in our laboratory have shown that such animals begin to exhibit approach-avoidance behaviors ("retreats") stemming from concurrent positive and negative associations with the goal box (which, in turn, are the result of COC's immediate rewarding and subsequent dysphoric actions). Thus, retreats can be used as a reliable index of COC's anxiogenic side effects. Following 14 COC-reinforced trials, animals were split into three groups matched on mean retreat frequency. One group (n=11) received IV COC (1.0 mg/kg/injection) for seven additional trials; the remaining two groups (n=10 each) received an IV injection of COC mixed in a single solution with either a low dose (0.025 mg/kg/injection) or a high dose (0.1 mg/kg/injection) of HER. It was hypothesized that adding HER would attenuate the negative consequences of COC administration and thereby produce a reliable decrease in the occurrence of retreats. The resulting data were consistent with this hypothesis, suggesting that "speedballing" in human addicts may be motivated by a desire to reduce the negative impact of COC use.

Topics: Animals; Avoidance Learning; Cocaine; Conditioning, Operant; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Interactions; Heroin; Male; Rats; Rats, Sprague-Dawley; Reinforcement, Psychology; Self Administration; Substance-Related Disorders

More than 93% of the nearly $500 million spent annually on Canada's drug strategy goes toward efforts to reduce the illicit drug supply. However, little is known about the effectiveness of this strategy. On Sept. 2, 2000, Canadian police seized approximately 100 kg of heroin in one of the nation's largest-ever seizures of this drug. An ongoing prospective cohort study of injection drug users afforded an opportunity to evaluate the impact of this seizure.. The Vancouver Injection Drug User Study is a prospective cohort study of injection drug users that began in 1996. The present study relied primarily on data acquired from participants who were seen during the 30-day periods immediately before and after the seizure. We compared drug use and behavioural characteristics, heroin and cocaine prices, and participants' reports of whether law enforcement had affected their source of drugs or the types of drugs available on the street, as well as overdoses, in these 2 periods.. The 138 participants seen before the seizure were similar to the 123 participants seen after the seizure with respect to age, sex, ethnic background, education, HIV serostatus, neighbourhood residence, instability of housing, employment status, use of methadone maintenance therapy and all other measured potential confounders (all p > 0.10). We found no difference in the extent to which participants in the 2 groups reported daily use of heroin, frequency of nonfatal overdoses, or whether law enforcement had affected their source of drugs or the types of drugs available on the street (all p > 0.10). Although we detected no difference in the price of cocaine, the median reported price of heroin went down after the seizure (p = 0.034), which suggests that other shipments compensated for the seizure. External evaluations of deaths from overdoses and heroin purity indicated that the seizure had no impact, nor was any impact seen when the periods of analysis were extended.. The massive heroin seizure appeared to have no measurable public health benefit. Closer scrutiny of enforcement efforts is warranted to ensure that resources are delivered to the most efficient and cost-effective public health programs.

Topics: Acquired Immunodeficiency Syndrome; British Columbia; Drug and Narcotic Control; Female; Heroin; Humans; Law Enforcement; Male; Substance-Related Disorders

This article describes an investigation of illicit drugs at street level in six selected police districts in different regions of Denmark. The investigation was carried out during a 6-year period from 1995 to 2000. During the period, a total of 1244 samples were examined, as about 200 samples were seized each year. A total of 94% of the seized samples were familiar drugs: heroin base, heroin hydrochloride, cocaine hydrochloride and amphetamine sulphate. Only 2% of the samples contained designer drugs. From having constituted 53% of the samples in 1995, the frequency of heroin base fell during the period to 27% of the samples in 2000. The frequency of heroin hydrochloride was unchanged. In the same period, the frequency of cocaine hydrochloride increased from 10% of the samples in 1995 to about 25% of the samples in 2000. Apart from a few exceptions, cocaine had the same extension in all regions of Denmark after 1996. Amphetamine was more frequent in the west of Denmark, while heroin hydrochloride was more frequent in central Denmark. The purity of heroin base was lower in the period 1997-1999 than in the other years. During the entire period, the purity of cocaine hydrochloride and amphetamine sulphate fell, while the purity of heroin hydrochloride was unchanged. No significant differences between the various regions of Denmark were detected during the period in the purity of heroin hydrochloride, heroin base, cocaine hydrochloride or amphetamine sulphate. MDMA was the most frequent designer drug, but other types of designer drugs such as MDA and MDE and the less common PMA, PMMA and MBDB were also found.

Topics: Amphetamine; Analysis of Variance; Cocaine; Denmark; Drug Contamination; Drug Packaging; Hallucinogens; Heroin; Humans; Illicit Drugs; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Prospective Studies; Substance-Related Disorders

The present study was designed to obtain human data on the speed of intravenous (i.v.) injection of cocaine, heroin, and morphine as well as on the rate of onset of their subjective effects and their duration in order to improve the accuracy of animal and human experimental models of i.v. drug abuse. To that end, a questionnaire was submitted both to clients of a substitution therapy outpatient clinic and to members of the drug abuse research community. It was found that i.v. drug abusers injected cocaine, heroin, or morphine much faster and also experienced the drug effects much faster than assumed by the drug abuse researchers. The time course of the reemergence of craving was also greatly misjudged by the researchers. On the other hand, the i.v. drug users' self-reports were internally consistent and corresponded well to data obtained in several different human behavioral laboratories. Interestingly, more than half of the i.v. drug users reported that injection speed was not important when injecting cocaine (57%), heroin (72%) or morphine (73%) under conditions that guarantee a maximum effect, suggesting that the rate of the rise in the brain concentration of a drug of abuse is less important for its reinforcing effect and, thus, for its abuse liability, than previously assumed, at least within the time frame of an i.v. drug injection.

Topics: Adult; Cocaine; Female; Heroin; Humans; Male; Morphine; N-Methyl-3,4-methylenedioxyamphetamine; Outpatients; Research Personnel; Substance Abuse, Intravenous; Substance-Related Disorders; Surveys and Questionnaires; Time Factors

We describe the first case of paroxysmal nonkinesogenic dyskinesia secondary to pallidal ischaemia, which is uniquely and specifically triggered by alcohol.

Topics: Adult; Alcohol-Induced Disorders, Nervous System; Alcoholic Intoxication; Alcoholism; Basal Ganglia Diseases; Chorea; Drug Overdose; Dyskinesia, Drug-Induced; Globus Pallidus; Heroin; Humans; Hypoxia-Ischemia, Brain; Illicit Drugs; Magnetic Resonance Imaging; Male; Neurologic Examination; Risk Factors; Substance-Related Disorders

All drug-associated deaths from 1989 to 2000 were analysed at the Institute of Forensic Medicine in Cologne. Information concerning sex, gender, drug consumption, time, place and circumstances of death were analysed. A number of 605 cases were recorded; in 518 cases a toxicological analysis was possible and in 171 an autopsy was performed. When it was possible to determine the cause of death form the information available, acute drug intoxication was recorded in 65%. Heroin head the list of identified substances. Sixty-three percent of the specimens showed a combination of several substances, especially a combination of morphine, benzodiazepines, other medications and alcohol. In comparison with other studies the percentage of methadone-positive specimens is low, even though the proportion of specimens positive for methadone increased from 1989 to 2000. This analysis is discussed using background information concerning the management of substitution therapy and the available literature.

Topics: Benzodiazepines; Cause of Death; Drug Overdose; Ethanol; Female; Germany; Heroin; Humans; Illicit Drugs; Male; Methadone; Morphine; Narcotics; Substance-Related Disorders

Diamorphine is a semisynthetic derivative of morphine that is currently licensed for use in the treatment of moderate to severe acute pain, administered by the intramuscular, intravenous or subcutaneous routes. It is highly water-soluble and has a number of properties that render it suitable for administration via the nasal route. Administration via the intranasal route is well described for other drugs, but has only recently been evaluated in a clinical setting for diamorphine. A well-tolerated and rapidly effective analgesic agent has proven elusive in the paediatric setting. The pharmacokinetic profile of intranasal diamorphine in adults has been systematically studied. It is rapidly and dose-dependently absorbed as a dry powder, with peak plasma concentrations occurring within 5 minutes, and has a similar pharmacokinetic profile to that of intramuscular diamorphine. It is rapidly converted to 6-acetylmorphine (peak concentrations within 5-10 minutes) and thence to morphine (peak concentrations within 1 hour). The pharmacodynamic properties of intranasal diamorphine have also been studied in comparison with intramuscular diamorphine. Intranasal and intramuscular administration of diamorphine resulted in similar physiological responses (including pupil diameter, respiration rate and temperature). Changes in behavioural measures (including euphoria, sedation and dysphoria) were also similar. Intranasal administration of diamorphine, therefore, produces the expected drug effects on the same timescale and of the same magnitude as intramuscular injection. Intranasal diamorphine has been clinically evaluated in a randomised controlled trial versus intramuscular morphine in the setting of acute orthopaedic pain in children with fractures. Intranasal diamorphine provided the same overall degree of pain relief as intramuscular morphine, but with a quicker onset of action. It was found to be well tolerated with an acceptable safety profile. It has also been studied in the setting of patient-controlled analgesia for postoperative pain in adults, with encouraging results. The pharmacokinetic and pharmacodynamic properties of intranasal diamorphine, and particularly the ability to administer it without a needle (and therefore reduce the incidence of transmissible infection), have made this a popular route for abuse amongst opioid addicts. In this setting, however, the intranasal route is not free from adverse events, including deaths. The primary clinical need in t

Topics: Administration, Intranasal; Administration, Oral; Analgesics, Opioid; Heroin; Humans; Injections, Intramuscular; Morphine; Substance-Related Disorders

Topics: Alcohol Drinking; Follow-Up Studies; Heroin; Humans; Substance-Related Disorders; Time Factors

This study was performed on a representative sample of the Danish population in order to investigate the connection to the use of psychoactive drugs and quality of life (QOL) by way of a questionnaire-based survey. The questionnaire was mailed in February 1993 to 2,460 persons aged between 18 and 88, randomly selected from the CPR (Danish Central Register), and 7,222 persons from the Copenhagen Perinatal Birth Cohort 1959-61. A total of 1,501 persons between the ages 18 and 88 years and 4,626 persons between the ages 31 and 33 years returned the questionnaire (response rates of 61.0% and 64.1%, respectively). Variables investigated in this study were ten different psychotropic drugs and quality of life. Our study showed that over half the Danish population had used illegal psychotropic drugs. The most commonly used was cannabis (marijuana) though experience of this drug appeared not to co-vary with QOL to any significant extent. Cocaine, amphetamine, and psilocybin had been used by 1.2 to 3.3% of the population and this varied with QOL to a clear albeit small extent. LSD has been used by 1.2% of the population and the users had a QOL score 10% lower than those who had never used psychotropic drugs. The group with the lowest quality of life was found to be persons who had used heroin, morphine, methadone, and a mixture of alcohol and tranquilizers (10-20% below the group with the highest quality of life).

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphetamines; Cocaine; Cohort Studies; Data Collection; Hallucinogens; Heroin; Humans; Marijuana Abuse; Methadone; Middle Aged; Morphine; Psychotropic Drugs; Quality of Life; Stimulants, Historical; Substance-Related Disorders; Surveys and Questionnaires

Topics: Child Development; Cocaine; Female; Growth Disorders; Heroin; Hospitalization; Humans; Infant, Newborn; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Substance-Related Disorders

Acute symmetric deep cerebellar lesions suggest toxic exposure.. To describe a patient with striking neurologic and magnetic resonance image features.. Case report.. Emergency department and office.. Personal observation.. A middle-aged man had a day of unsteadiness, followed by acute and pronounced cerebellar signs. The degree of disability was remarkable. Magnetic resonance imaging showed almost perfectly symmetric deep cerebellar damage that ultimately became cavitated. Serial querying of the patient revealed the use of heroin by inhalation just prior to the emergence of the ataxic syndrome.. An acute and purely ataxic syndrome with symmetric deep cerebellar lesions suggests toxic exposure, in this case, the smoking of heroin.

Topics: Administration, Inhalation; Adult; Cerebellar Diseases; Heroin; Humans; Male; Narcotics; Substance-Related Disorders

Drugs of abuse induce the release of dopamine in the central nervous system, particularly in the mesolimbic-mesocortical pathway. As dopamine may act as a neurotoxin, in this study, we analyzed the effects of the drugs of abuse, cocaine, heroin, and amphetamine, on the neurodegeneration of PC12 cells, a dopaminergic cell line, by evaluating the activity of caspase-3 and mitochondrial cytochrome c release. All the drugs were shown to induce caspase-3 activation, similarly to staurosporine, a classical inducer of apoptotic cell death. Furthermore, like staurosporine, the drugs of abuse induced a decrease in mitochondrial cytochrome c content, suggesting the involvement of the mitochondrial apoptotic pathway.

Topics: Amphetamine; Animals; Apoptosis; Caspase 3; Caspases; Cell Differentiation; Cocaine; Cytochromes c; Heroin; Mitochondria; PC12 Cells; Rats; Substance-Related Disorders

This report describes the investigation and management of an unprecedented outbreak of severe illness among injecting drug users (IDUs) in Scotland during April to August 2000. IDUs with severe soft tissue inflammation were prospectively sought among acute hospitals and a mortuary in Scotland. Cases were categorised as definite or probable: probable cases had severe injection site inflammation or multi-system failure; definite cases had both. Information about clinical course, mortality, post-mortem findings and laboratory data was gathered by standardised case-note review and interview. Sixty cases were identified--23 definite and 37 probable. Most had familial or social links with each other and 50 were from Glasgow. Median age was 30 years; 31 were female. The majority, especially definite cases, injected heroin/citric acid extravascularly. Of definite cases, 20 died (87% case-fatality rate; 13 after intensive care), 15 had necrotising fasciitis, 22 had injection site oedema and 13 had pleural effusion. Median white cell count was 60 x 10(9)/L. Of 37 probable cases, three died (8% case-fatality rate). Overall, the most frequently isolated pathogen was Clostridium novyi type A (13 cases: 8 in definite cases). The findings are consistent with an infection resulting from injection into soft tissue of acidified heroin contaminated with spore-forming bacteria. Toxin production led to a severe local reaction and, in many, multi-system failure.

Topics: Adult; Autopsy; Clostridium Infections; Disease Outbreaks; Drug Contamination; Edema; Fasciitis, Necrotizing; Female; Heroin; Humans; Leukocyte Count; Male; Middle Aged; Multiple Organ Failure; Pleural Effusion; Practice Guidelines as Topic; Scotland; Soft Tissue Infections; Substance-Related Disorders

An outbreak of serious illness and death occurred in injecting drug users during 2000 in Scotland, Ireland and England. National and international collaboration was necessary for the investigation and management of this outbreak. In England and Wales active case-finding was initiated, coupled with standardised data collection and microbiological investigation of cases. Twenty-six definite or probable cases were identified in England between 1 April and 31 Aug. 2000; 17 of these occurred in the North. The overall case fatality was 50% (13/26). The principal apparent risk factor was a history of intramuscular or subcutaneous injection of heroin and the limited duration of the outbreak suggested that the problem might have been related to a particular supply of heroin. Clostridium novyi was isolated from two English cases. Taken in conjunction with contemporaneous microbiological and epidemiological results from Scottish and Irish cases, the probable aetiology for this outbreak was infection with C. novyi associated with both a particular supply of heroin and the method of preparation and injection used. A 'toolkit' was distributed in Sept. 2000 to all Consultants for Communicable Disease Control in England and Wales to assist them with the ongoing surveillance, investigation and management of this condition. Lessons learned have been used to produce guidance for the investigation and management of outbreaks of unexplained serious illness of possible infective aetiology.

Topics: Adult; Clostridium Infections; Data Collection; Disease Outbreaks; Heroin; Humans; Injections, Intramuscular; Injections, Subcutaneous; Male; Population Surveillance; Risk Factors; Substance-Related Disorders; Telecommunications; United Kingdom

Pathogenic species of the genus Clostridium may contaminate the materials used in the injection of drugs and under the right conditions may cause serious or life-threatening disease. C. novyi type A was implicated in an outbreak of severe infection with high mortality in injecting drug users who injected heroin extravascularly. The isolation of such highly oxygen-sensitive clostridia from clinical material may require adherence to enhanced methods and, once isolated, commercially available anaerobe identification kits alone may not give an accurate identification. Additional phenotypic tests that are useful in recognising the main pathogenic species are described. Differentiation of C. novyi type A from C. botulinum type C in reference laboratories was based on 16S rDNA sequence data and specific neutralisation of cytopathic effects in tissue culture.

Topics: Bacterial Typing Techniques; Clostridium; Clostridium Infections; Heroin; Humans; RNA, Bacterial; RNA, Ribosomal, 16S; Species Specificity; Substance-Related Disorders; United Kingdom; Wound Infection

As part of the follow-up investigations associated with an outbreak of severe illness and death among illegal injecting drug users during 2000, 43 cultures of Clostridium novyi type A, 40 C. perfringens type A and 6 isolates of Bacillus cereus were characterised by amplified fragment length polymorphism (AFLP) analysis. Among the 43 C. novyi isolates, 23 different AFLP profiles were detected. The same AFLP profile was detected in isolates from 18 drug users investigated during 2000 from Scotland, England, the Republic of Ireland and Norway and a wound from a patient in 2000 who was not identified as a drug user. Unique AFLP profiles were obtained from four drug users from England and the Republic of Ireland, 10 historical isolates from culture collections, an isolate from food (1989) and three isolates from wounds (1995, 1991, 1988). The 40 C. perfringens isolates were from 13 drug users, the contents of one syringe and two samples of heroin. Sixteen AFLP types of C. perfringens were distinguished and there was little evidence for commonality among the isolates. The AFLP types of C. perfringens from heroin differed and were unique. Six isolates of B. cereus were from four drug users and two samples of heroin. Four different AFLP patterns were distinguished. Three AFLP types were isolated from four drug users. B. cereus isolates from an aspirate and a heroin sample collected from the same drug user were identical, and were also indistinguishable from an isolate from a groin infection in a second drug user. The AFLP type of the isolate from a second and unrelated heroin sample was unique. The AFLP results showed no or very limited evidence for commonality between the different isolates of B. cereus and C. perfringens. In marked contrast, the C. novyi isolates from the majority of the drug users during 2000 were homogeneous, suggesting a common source or clonal selection of a C. novyi type, or both, which either had an adaptive advantage in spore germination, survival or growth following the drug preparation and the injection procedure, or produced a more severe clinical presentation.

Topics: Animals; Bacillaceae Infections; Bacillus cereus; Clostridium; Clostridium Infections; DNA, Bacterial; Female; Heroin; Humans; Male; Norway; Polymorphism, Restriction Fragment Length; Substance-Related Disorders; United Kingdom; Wound Infection

Chronic exposure to opiates eventually leads to drug addiction, which is believed to involve maladaptive changes in brain function, but the underlying neuronal mechanisms remain primarily unknown. Given the known effects of opiates such as morphine and heroin on hippocampal function, we investigated the potential effect of chronic opiate treatment on long-term potentiation (LTP) at CA1 synapses in rat hippocampus, a leading experimental model for studying synaptic plasticity. Our results revealed that chronic exposure of rats to morphine or heroin, which induced severe drug tolerance and dependence, markedly reduced the capacity of hippocampal CA1 LTP during the period of drug withdrawal (from approximately 190% in control to approximately 120%). More interestingly, the capacity of LTP could be restored to the normal level by re-exposure of the animals to opiates, indicating that the synaptic function was already adapted to opiates. Morris water maze test, which measures behavioral consequences of synaptic plasticity, showed parallel learning deficits after chronic exposure to opiates. Moreover, the opiate-reduced LTP could also be restored by inhibitors of cAMP-dependent protein kinase A (PKA), suggesting that upregulation of cAMP pathway was likely one of the underlying mechanisms of the observed phenomena. These findings demonstrated that chronic opiate treatment can significantly modulate synaptic plasticity in the hippocampus, leading to an opiate dependence of the plasticity.

Topics: Animals; Behavior, Animal; Cyclic AMP-Dependent Protein Kinases; Drug Administration Schedule; Electric Stimulation; Electrodes, Implanted; Enzyme Inhibitors; Excitatory Postsynaptic Potentials; GABA Antagonists; Heroin; Hippocampus; In Vitro Techniques; Injections, Subcutaneous; Long-Term Potentiation; Male; Maze Learning; Morphine; Narcotics; Neuronal Plasticity; Opioid-Related Disorders; Patch-Clamp Techniques; Rats; Rats, Sprague-Dawley; Substance-Related Disorders; Synapses

It has been suggested that heroin and morphine may act on different opioid receptor populations in rodents. In support of this hypothesis, the opioid antagonist 3-methoxynaltrexone was reported to be more potent as an antagonist of the antinociceptive effects of heroin than of morphine in mice and rats. To assess the generality of this finding across species and experimental endpoints, the present study compared the potencies of naltrexone and 3-methoxynaltrexone as antagonists of heroin and morphine in two behavioral assays in rhesus monkeys. In the thermal nociception study, tail-withdrawal latencies were measured from water heated to 50 degrees C. In the heroin discrimination study, monkeys were trained to discriminate 0.1 mg/kg heroin from saline in a two-key, food-reinforced drug discrimination procedure, and percentage of heroin-appropriate responding and response rates were measured. Both heroin and morphine produced dose-dependent antinociception, increases in percentage of heroin-appropriate responding, and decreases in response rates. Heroin was approximately 20-fold more potent than morphine. Naltrexone (0.032-0.1 mg/kg) was equipotent in antagonizing all effects of heroin and morphine (pA(2) values = 7.90-8.22). 3-Methoxynaltrexone (0.1-3.2 mg/kg) was also equipotent in antagonizing the antinociceptive, discriminative stimulus, and rate-suppressant effects of heroin and morphine; however, 3-methoxynaltrexone was approximately 100-fold less potent than naltrexone (pA(2)/pK(B) values = 5.96-6.36). These results suggest that heroin and morphine act on pharmacologically similar populations of opioid receptors in rhesus monkeys, and also indicate that 3-methoxynaltrexone does not differentially antagonize the effects of heroin and morphine in rhesus monkeys.

Topics: Analgesics; Analgesics, Opioid; Animals; Cues; Discrimination Learning; Discrimination, Psychological; Dose-Response Relationship, Drug; Heroin; Hot Temperature; Kinetics; Macaca mulatta; Male; Morphine; Naltrexone; Narcotic Antagonists; Pain Measurement; Substance-Related Disorders

The present paper describes the type and prevalence of co-morbid psychiatric disorders in a group of opioid dependent addicts.. In 17 Swiss centres for heroin-assisted treatment 85 opiate addicts were assessed at entry using the SKID interview.. Lifetime prevalence of co-morbid Axis I or Axis II disorders was 86 %. Most frequently patients were diagnosed with a personality disorder (58 %). Second frequently were mood disorders with a prevalence of 55 %, followed by anxiety disorders with a prevalence of 26 %.. The high prevalence of co-morbid psychiatric disorders indicate the urgent necessity to further develop and adapt health services for opioid addicts.

Topics: Adult; Alcoholism; Cocaine-Related Disorders; Comorbidity; Cross-Sectional Studies; Diagnosis, Dual (Psychiatry); Female; Heroin; Heroin Dependence; Humans; Male; Mental Disorders; Opioid-Related Disorders; Psychiatric Status Rating Scales; Rehabilitation Centers; Substance-Related Disorders; Switzerland

To assess the prevalence of HIV infection among young drug users in Haiphong and, secondarily, to document the current patterns of drug use and sexual behavior in them. Design, setting and participants. A cross-sectional survey of drug users 15-30 years old, identified from police lists and by the snowballing method between March 15 and May 30, 1999, was conducted in Haiphong City.. Subjects (n = 520: 514 males and six females) were interviewed and donated blood specimens for HIV-1 antibody testing.. Mean age of the subjects was 25 years (range 15-30 years). The prevalence of HIV among injecting drug users (IDUs) was 74% and among drug users not reporting injecting was 46% (92/201). Sixty-one per cent (319) reported injecting drugs. Among injectors, 72% used heroin, and 68% had shared needles. Factors related to the presence of HIV antibody among IDUs were sharing needles (OR: 4.12) and injecting more than 31 times per month (OR: 2.37). Extramarital sex within the last 6 months was reported by 44% of single and 24% of married IDUs.. The high HIV-1 prevalence in drug users and their frequent sexual mixing with the non-drug-using population suggests that preventive interventions for reduction of high-risk drug taking and sexual activities are urgently needed in these populations. Interventions through public sexually transmitted infection (STI) clinics are unlikely to have much impact, as only 16% of IDUs with an STI attended a public STI clinic.

Topics: Adolescent; Adult; Agglutination Tests; Condoms; Cross-Sectional Studies; Disinfection; Enzyme-Linked Immunosorbent Assay; Female; Heroin; HIV Seropositivity; HIV-1; Humans; Logistic Models; Male; Multivariate Analysis; Needle Sharing; Needles; Risk Factors; Sexual Behavior; Substance Abuse, Intravenous; Substance-Related Disorders; Vietnam

Clinical judgement of intoxicated patients is difficult. In the emergency department of the inner city of Oslo this is done every day.. During a one-year period from 1998-99, a group of 429 first-time admitted intoxicated patients were included in a study. The patients and the method of observation are described.. 75% of the patients were men; 45% reported to have consumed alcohol only, while 10% had taken a heroin overdose. The rest had used various combinations of legal and illegal drugs. Female patients were younger than male patients (29 versus 36 years, p < 0.00), and patients intoxicated only on alcohol were on the average older than patients who had taken drugs (38 versus 31 years, p < 0.00). 57 patients were hospitalized, seven of them had serious intracerebral conditions.. Our study indicates that systematic observation over some hours, repeated clinical examinations, and the systematic use of a modified Glasgow Coma Scale makes it possible to sort out the seriously ill from "only" intoxicated patients.

Topics: Adult; Alcoholic Intoxication; Critical Illness; Diagnosis, Differential; Drug Overdose; Emergency Service, Hospital; Female; Glasgow Coma Scale; Heroin; Heroin Dependence; Humans; Male; Monitoring, Physiologic; Norway; Poisoning; Substance-Related Disorders; Wounds and Injuries

Cannabis sativa preparations are some of the most widely used illicit recreational drugs. In addition to their direct addictive potential, cannabinoids may influence the sensitivity to other drugs. The aim of the present study was to determine if a cross-sensitization between Delta(9)-tetrahydrocannabinol (Delta(9)-THC) and other drugs (amphetamine and heroin) could be demonstrated. We examined the effects of a chronic treatment with Delta(9)-THC (0.6, 3 and 15mg/kg, ip) on the locomotor response to amphetamine (1mg/kg, ip) and heroin (1mg/kg, ip). Chronic treatment with Delta(9)-THC resulted in tolerance to the initial hypothermic and anorexic effects. Pre-treatment with Delta(9)-THC increased the locomotor responses to amphetamine and heroin. This cross-sensitization was time-dependent as it was observed three days after the last injection of Delta(9)-THC for amphetamine, and a relatively long time after the end of chronic treatment (41 days) for heroin. Moreover, the enhanced response to amphetamine or heroin was noted in some individuals only: the high-responder rats (HR). These animals have previously been shown to be vulnerable to drug taking behaviors. It is hypothesised that repeated use of Cannabis derivates may facilitate progression to the consumption of other illicit drugs in vulnerable individuals.

Topics: Amphetamine; Analgesics, Opioid; Animals; Body Temperature; Central Nervous System Stimulants; Drinking; Dronabinol; Drug Synergism; Eating; Hallucinogens; Heroin; Male; Motor Activity; Rats; Rats, Sprague-Dawley; Substance-Related Disorders

Guillain-Barré Syndrome is the most common form of polineuropathy. It is suggested that some infectious, immune and allergic factors are involved in developing the syndrome. "Kompot" or "Polish heroine", a domestic product, is produced from poppy straw or juice of poppy head (Papaver somniferum) and it is administered intravenously. "Kompot" shows variable contents of heroine, 6-MAM, 3-MAM, morphine, acetylo-codeine and codeine as well as papaverine, thebaine and narcotine. The case history of a young man dependent on "Polish heroine" who developed the Guillain-Barré Syndrome due to severe intoxication induced by home made heroine, barbiturates and benzodiazepines is described.

Topics: Adult; Barbiturates; Benzodiazepines; Codeine; Guillain-Barre Syndrome; Heroin; Humans; Illicit Drugs; Injections, Intravenous; Male; Morphine; Morphine Derivatives; Substance-Related Disorders

To determine the neonatal outcome in the form of use of morphine and triclofos to treat the neonatal abstinence syndrome following maternal opiate use in late pregnancy.. Retrospective case study of 51 pregnancies associated with maternal opiate use between January 1992 and December 1997.. There were 51 pregnancies which resulted in 51 live births. In the third trimester 22 women took methadone only, 19 women used heroin and 10 women stopped opiate use during pregnancy. Babies of methadone using mothers were less likely to be treated with morphine or triclofos than heroin using women. Morphine, triclofos use was more common in high dose methadone users compared with low users.. Successful methadone substitution compared with continued heroin use results in reduced morphine and triclofos use in the babies exposed.

Topics: Analgesics, Opioid; Female; Heroin; Humans; Infant, Newborn; Morphine; Neonatal Abstinence Syndrome; Organophosphates; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Retrospective Studies; Substance-Related Disorders

To examine the relationship between attempted suicide and non-fatal heroin overdose among methadone maintenance patients.. Cross-sectional survey.. Sydney, Australia.. Two hundred and twenty-three methadone maintenance patients.. Forty per cent of participants reported a history of at least one suicide attempt. Females were significantly more likely than males to have attempted suicide (50% vs. 31%), and to have done so on more than one occasion (28% vs. 15%). There was a large difference between males and females in the onset of attempted suicide. Females reported an initial attempt, on average, 6 years earlier than males (18.3 vs. 24.7 years), and were significantly more likely than males to have attempted suicide prior to the onset of heroin use (69% vs. 11%). While heroin overdose was common among the sample (66%), the most common methods employed for suicide attempts were overdose of a non-opioid drug (21%) and slitting of wrists (20%). A deliberate heroin overdose as a means of attempted suicide was reported by 10% of participants. Heroin overdoses appeared overwhelmingly to be accidental. Ninety-two per cent of those who had overdosed reported that their most recent overdose was accidental.. Attempted suicide presents a major clinical problem to staff at drug treatment programmes, but one distinct from heroin overdose. While both overdose and suicide present increasing clinical problems, they are separate problems, and require different responses.

Topics: Cross-Sectional Studies; Drug Overdose; Female; Heroin; Humans; Male; Methadone; Narcotics; New South Wales; Substance-Related Disorders; Suicide, Attempted

Topics: Drug and Narcotic Control; Heroin; Humans; Narcotics; Substance-Related Disorders

NHSDA and MTF survey data indicate "epidemic"-like growth in hallucinogen use from 1992-1996 and associated increases in cocaine, crack, heroin and amphetamine use. These trends might have resulted from a proliferation of raves and dance clubs in the U.S. as occurred in Europe and elsewhere, although in contrast to evidence regarding European experiences the American epidemic involves primarily teens as opposed to persons in their twenties and involves primarily use of LSD as opposed to MDMA. This analysis highlights the need for further research into the context, significance, and consequences of these recently popular American drug use practices.

Topics: Adolescent; Age Factors; Amphetamine-Related Disorders; Cocaine-Related Disorders; Disease Outbreaks; Female; Hallucinogens; Health Surveys; Heroin; Humans; Lysergic Acid Diethylamide; Male; Models, Theoretical; Substance-Related Disorders; United States

The use of naloxone hydrochloride (0.2-0.4 mg) in complex therapy of adolescent heroin addicts significantly prolonged the half-life of serum leu-enkephalin, slightly elevated the thresholds of thermal nociceptive reactions, and improved some clinical indices (considerably reduced drug addiction, eliminated affective disorders, etc.), which are important for deactualization of drug addiction and promoting remission.

Topics: Adolescent; Age Factors; Heroin; Humans; Male; Naloxone; Narcotic Antagonists; Substance Withdrawal Syndrome; Substance-Related Disorders; Temperature; Time Factors

The transition from stable to escalated levels of cocaine self-administration has been shown to depend upon drug availability. The generality of this phenomenon is assessed here by studying the effects of availability on heroin self-administration. Two groups of rats were trained on a 1-h continuous schedule of self-administration, after which, access to heroin (40 microg/injection) was increased to 11 h in one group (long access or LgA rats) or kept to 1 h in the other group (short access or ShA rats). After 18 sessions on this regimen, both ShA and LgA rats were tested for extinction and stress-induced reinstatement of heroin-seeking behavior. In LgA rats, both total and first hour intake gradually escalated over time. After escalation, LgA rats were slower to extinguish heroin-seeking behavior and responded more to the reinstating effect of stress after extinction. These findings show that: (1) the escalation process in drug consumption is common to both opiate and stimulant self-administration; (2) escalation in heroin consumption is associated with a persistent increase in the motivation for taking heroin.

Topics: Animals; Heroin; Male; Motivation; Psychomotor Performance; Rats; Rats, Wistar; Self Administration; Substance-Related Disorders

Although the nucleus accumbens is assumed to be a critical brain "pleasure center," its function in humans is unknown. As animal data suggest that a unique feature of this small brain area is its high sensitivity to down-regulation of an inhibitory G protein by drugs of abuse, we compared G protein levels in postmortem nucleus accumbens with those in seven other brain regions of chronic users of cocaine, methamphetamine, and heroin, and of matched controls. Biochemical changes were restricted to the nucleus accumbens in which concentrations of G(alpha)1 and/or G(alpha)2 were reduced by 32-49% in the methamphetamine and heroin users. This selective responsiveness to these abused drugs implies a special role for the human nucleus accumbens in mechanisms of drug reinforcement and suggests that some features of the drug-dependent state (e.g., tolerance) might be related to inhibition of G(alpha)1-linked receptor activity.

Topics: Adult; Brain; Cadaver; Central Nervous System Stimulants; Cocaine; Down-Regulation; Female; GTP-Binding Proteins; Heroin; Humans; Male; Methamphetamine; Narcotics; Nucleus Accumbens; Reference Values; Substance-Related Disorders

Illicit drug taking in Australia, with its attendant social and medical consequences, is increasing and the effects extend to maternity hospitals where infants born to addicted mothers have more health problems in the neonatal period. The aims of this study were to evaluate (1) the patterns of illness of such infants and (2) the burden imposed on the neonatal department of a large tertiary maternity centre.. An audit was conducted of all Chemical Dependency Unit (CDU) mothers and babies delivered at the Royal Women's Hospital, Melbourne, Australia during 1997. Data were compared with those from a concurrent control group of mothers and babies randomly generated from the hospital's obstetric database.. Ninety-six infants born to CDU mothers were compared with a control group of 200 infant/mother pairs. The majority of women in the CDU clinic were treated for narcotic addiction with methadone (90%) but most continued to use heroin during pregnancy (68%). Infants born to CDU mothers were significantly less mature and lighter than control infants. Fifty-three (55%) CDU infants required admission to the Special Care Nursery either because of neonatal abstinence syndrome (n = 29) or other medical reasons (n = 24). The median length of hospital stay was significantly longer in CDU compared with control infants (8 vs 3 days, P < 0.01).. Infants born to drug dependent mothers have more neonatal problems requiring specialized medical and nursing expertise, compared with control infants. These infants are large consumers of scarce health resources.

Topics: Adult; Ambulatory Care Facilities; Amphetamines; Australia; Benzodiazepines; Cannabis; Cocaine; Comorbidity; Female; Health Resources; Heroin; Hospitals, Urban; Humans; Incidence; Infant, Newborn; Infant, Newborn, Diseases; Length of Stay; Lysergic Acid Diethylamide; Male; Maternal-Fetal Exchange; Medical Audit; Methadone; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Substance-Related Disorders

Intermittent footshock reinstates drug-taking behavior in rats, but not behaviors previously maintained by food reinforcers. Here we tested further the generality of this phenomenon by determining whether restraint and food deprivation stressors would reinstate heroin seeking, whether the environment in which footshock is given modulates footshock-induced reinstatement, and whether footshock would reinstate operant responding previously maintained by brain stimulation reward (BSR).. Groups of rats were trained to self-administer for 10 days either heroin (0.05-0.1 mg/kg/infusion, IV, three 3-h sessions/day) or brain stimulation into the septal area (trains of monopolar cathodal pulses of 100 micros for 500 ms, one 60-min session/day). After extinction of the heroin-reinforced behavior (10-13 days), the rats were tested for reinstatement after exposure to food deprivation (1 and 21 h), restraint given outside the self-administration environment (5, 15 and 30 min), or intermittent footshock (0.8 mA, 15 min) given in the self-administration environment or in a novel (non-drug) environment. For BSR-trained rats, the effect of footshock on reinstatement after extinction (6-10 days) was compared with that induced by noncontingent brain stimulation (three or six discrete stimulations at the start of the test sessions).. Food deprivation reinstated heroin seeking. Footshock reliably reinstated heroin seeking when given in the drug environment, but not when given in a non-drug environment. Similarly, restraint given outside the self-administration environment failed to reinstate heroin seeking. In addition, footshock was as effective as priming brain stimulation in reinstating operant responding previously maintained by BSR.. The effect of footshock on reinstatement of heroin seeking generalizes to food deprivation, and appears to be dependent on the environment in which the stressor is given. The data with BSR indicate that the phenomenon of footshock-induced reinstatement is not selective for drug reinforcers.

Topics: Animals; Electric Stimulation; Electroshock; Food Deprivation; Heroin; Heroin Dependence; Male; Narcotics; Rats; Rats, Long-Evans; Reward; Septum of Brain; Stress, Psychological; Substance-Related Disorders

The purpose of this study was to investigate fatal poisonings among drug addicts in 1997 and to compare the results to similar investigations from 1985 and 1991.. All fatal intoxications among drug addicts in Denmark in 1997, investigated at the three Institutes of Forensic Medicine in Denmark.. The number of fatal intoxications increased by 32% from 1991 to 1997, mainly outside the metropolitan area, The average age increased from 32 to 36 years. The proportion of heroin/morphine intoxications increased from 57% to 71%. The most commonly used drugs were as in 1991 heroin/morphine, diazepam and methadone. The frequency of cocaine increased from one positive case in 1991 to 14% positive cases in 1997.. This study showed an increasing number of fatal intoxications and changes in drug abuse pattern and place of death since 1991.

Topics: Adolescent; Adult; Analgesics, Opioid; Cause of Death; Denmark; Drug Overdose; Female; Forensic Medicine; Heroin; Humans; Male; Methadone; Middle Aged; Morphine; Opioid-Related Disorders; Substance-Related Disorders

To study prospectively social networks and behavior in a group of persons at risk for HIV because of their drug-using and sexual practices, with particular emphasis on the interaction of risks and concomitant network structure.. A longitudinal study was conducted of 228 respondents in Atlanta, Georgia in six inner-city community chains of connected persons, interviewing primary respondents and a sample of their contacts every 6 months for 2 years. Ascertained were: HIV and immunologic status; demographic, medical, and behavioral factors; and the composition of the social, sexual, and drug-using networks.. The prevalence of HIV in this group was 13.3% and the incidence density was 1.8% per year. Substantial simultaneity of risk-taking was observed, with a high level of both non-injecting (crack, 82%) and injecting (heroin, cocaine or both, 16 30%) drug use, the exchange of sex or money for drugs by men (approximately 35%) and women (57-71%), and high frequency of same-sex sexual activity by men (9.4%) and women (33%). The intensity of interaction, as measured by network features such as microstructures and concurrency, was significantly greater than that observed in a low prevalence area with little endemic transmission.. The traditional hierarchical classification of risk for HIV may impede our understanding of transmission dynamics, which, in the setting of an inner-city population, is characterized by simultaneity of risk-taking, and moderately intense network interactions. The study provides further evidence for the relationship of network structure to transmission dynamics, but highlights the difficulties of using network information for prediction of individual seroconversion.

Topics: Adult; Crack Cocaine; Female; Follow-Up Studies; Heroin; HIV Infections; Humans; Incidence; Interviews as Topic; Male; Prevalence; Sex Factors; Sexual Behavior; Social Behavior Disorders; Substance Abuse, Intravenous; Substance-Related Disorders; United States; Urban Population

Topics: Cocaine; Hallucinogens; Heroin; Humans; Illicit Drugs; N-Methyl-3,4-methylenedioxyamphetamine; Spain; Substance-Related Disorders

Dublin has an estimated 13,460 opiate drug users. The role of general practice in providing care for this group has increased over the last four years. A Central Methadone Treatment List (CMTL) registers all clients currently on treatment. To obtain a social, demographic and drug using profile of opiate users attending general practitioners (GPs) for methadone maintenance. A cross sectional survey of opiate users attending general practice for methadone maintenance in the Dublin area in early 1999. Data was collected on 571 clients (62% of total number attending general practice), of whom 97% had used heroin in the past and 12% had never injected. Although clients had been receiving methadone maintenance in general practice for a mean of 14 months, 16% were still using heroin, of whom 31% were still injecting. The mean age of first drug use was 15.5 years and of first injecting was 19.4 years. Younger clients are starting both to use drugs and inject drugs at an earlier age. Record keeping was good, with most items of information present in over 70% of the charts surveyed. A total of 17% of clients recorded on the CMTL could not be traced to the GP recorded as providing care. Despite treatment with methadone maintenance, there is a high level of continued risk activity in this group. Furthermore, a trend towards earlier initiation to drug use is apparent. The CMTL registration process requires further exploration.

Topics: Adolescent; Adult; Age Distribution; Chi-Square Distribution; Confidence Intervals; Cross-Sectional Studies; Family Practice; Female; Heroin; Humans; Incidence; Ireland; Male; Middle Aged; Odds Ratio; Population Surveillance; Risk Factors; Sex Distribution; Substance Abuse, Intravenous; Substance-Related Disorders; Utilization Review

The purpose of the current study was to assess neuropeptidergic alterations during a phase of the drug addiction cycle associated with drug craving as compared to a time period when the drug had been recently self-administered. Male Wistar rats were allowed to self-administer cocaine, heroin or saline for 6 h for 5 consecutive days. Immediately following the last self-administration session ('acute drug on board' state), and just before the next scheduled session ('drug expecting' state), the animals were decapitated and the levels of dynorphin A and B, [Met5]- and [Leu5]-enkephalin and substance P were measured in different brain areas. During the 'acute drug on board' state, peptide levels in animals that self-administered heroin or cocaine were not significantly changed. In contrast, during the 'drug expecting' state, heroin-treated animals had increased levels of dynorphin A, dynorphin B and [Met5]-enkephalin in the caudal striatum as compared to the cocaine- and saline-treated animals, and the level of [Leu5]-enkephalin was increased as compared to the cocaine-treated group. In the septum, an increase of [Met5]-enkephalin and substance P was observed in the animals expecting heroin as compared to the saline- and/or cocaine-treated animals. In the caudal striatum, substance P levels were elevated in the heroin- and cocaine-expecting animals. In conclusion, heroin, as compared to cocaine, appears to have a more pronounced effect on dynorphin, enkephalin and substance P levels in the caudal striatum and septum, especially during periods when self-administration of the drug is expected.

Topics: Animals; Behavior, Animal; Brain; Cocaine; Dynorphins; Enkephalins; Heroin; Injections, Intravenous; Male; Neuropeptides; Radioimmunoassay; Rats; Rats, Wistar; Self Administration; Substance P; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors

The goal of this exploratory study of drug use in greater Accra, Ghana, is to expand our understanding of the rapidly changing drug problem in Africa. Until the last decade, Ghana, with its excellent transportation links, was only a transit point in the narcoscape. Drug use was confined to Indian hemp or marijuana use. This exploratory study, conducted in the summer of 1996, confirms that such drugs as heroin and cocaine, as well as psychotropic substances, are now diverted for local consumption. This conclusion is based on a survey of 1 17 former and current drug users in the greater Accra area. The portrait of the typical drug user that emerges from this pilot study is a 30-year old, working class or underclass male who uses cocaine or heroin. In addition, many drug users resort to petty theft to support their habit because they are usually unemployed.

Topics: Adult; Cocaine; Crime; Female; Ghana; Heroin; Humans; Incidence; Male; Middle Aged; Narcotics; Pilot Projects; Substance-Related Disorders

Demographic characteristics and patterns of illegal drug use were assessed among 833 Chinese drug addicts in 1996 at six drug cessation programs in Yunnan and Guangxi, People's Republic of China. The majority of addicts were male, young, single, and with little education. About half were unemployed when they entered the programs. Heroin was the predominant drug. The two most common routes of drug administration were intravenous injection and sniffing or snorting. Two-thirds of the addicts reported at least daily use. Although they were only a small proportion of drug addicts in this sample, females reported earlier onset and a longer history of drug use than males.

Topics: Adolescent; Adult; Age of Onset; China; Demography; Drug Administration Routes; Female; Health Surveys; Heroin; Humans; Illicit Drugs; Male; Middle Aged; Sampling Studies; Substance Abuse Treatment Centers; Substance Abuse, Intravenous; Substance-Related Disorders; Surveys and Questionnaires

An emerging hypothesis to explain the mechanism of heroin-induced positive reinforcement states that opiates inhibit gamma-aminobutyric acid (GABA)-ergic interneurons within the mesocorticolimbic dopamine (DA) system to disinhibit DA neurons. In support of this hypothesis, we report that the development of heroin self-administration (SA) behavior in drug-naive rats and the maintenance of SA behavior in heroin-trained rats were both suppressed when the GABA(B) receptor agonist baclofen was coadministered with heroin. Microinjections of baclofen into the ventral tegmental area (VTA), but not the nucleus accumbens, decreased heroin reinforcement as indicated by a compensatory increase in SA behavior. Additionally, baclofen administered alone or along with heroin dose-dependently reduced heroin-induced DA release. This effect was blocked partially by intra-VTA infusion of the GABA(B) antagonist 2-hydroxysaclofen, suggesting an additional, perhaps GABA(A) receptor-mediated, disinhibitory effect. Taken together, these experiments, for the first time, demonstrate that heroin-reinforced SA behavior and nucleus accumbens DA release are mediated predominantly by GABA(B) receptors in the VTA and suggest that baclofen may be an effective agent in the treatment of opiate abuse.

Topics: Animals; Baclofen; Behavior, Animal; Dopamine; Electrodes; GABA Agonists; Heroin; Limbic System; Male; Mesencephalon; Narcotic Antagonists; Narcotics; Nucleus Accumbens; Rats; Rats, Sprague-Dawley; Self Administration; Substance-Related Disorders; Ventral Tegmental Area

The article describes the recent developments in drug treatment systems in several European countries. The article is based on the up-dated papers delivered in the closing meeting of the ISDRUTS-project (International Study of the Drug Treatment Systems) in Lisbon, October 7-9, 1998. In the article latest trends in drug situation and drug-related harm in different countries are represented. Also recent changes in legal measures, the proceeding of the harm reduction measures, the situation with heroin trials, the implosion of the drug treatment system into the alcohol treatment system and alternatives to imprisonment and other diversion mechanisms for addicts are described. In the concluding chapter recent trends in drug treatment are analysed in the framework of the political climate in Europe.

Topics: Crime; Europe; Health Policy; Health Promotion; Heroin; Humans; Legislation, Drug; Mental Health Services; Narcotics; Politics; Substance Abuse Treatment Centers; Substance-Related Disorders

An analytical method for the determination of heroin, 6-monoacetylmorphine, morphine, codeine, cocaine, benzoylecgonine, and cocaethylene in human hair using gas chromatography-tandem mass spectrometry is presented. The analytes were extracted from finely cut hair with methanol at 56 degrees C for 18 h in the presence of nalorphine as the internal standard. After the incubation, methanol was evaporated to dryness, and all the analytes, except heroin, cocaine, and cocaethylene, were converted to their trimethylsilyl derivatives. The reaction products were identified and quantitated using product ions formed from the parent ions by collision-induced dissociation in the ion-trap mass spectrometer. This method provided excellent sensitivity and specificity for analytes at the concentrations usually found in the keratin matrix.

Topics: Cocaine; Codeine; Gas Chromatography-Mass Spectrometry; Hair; Heroin; Humans; Indicators and Reagents; Morphine; Morphine Derivatives; Narcotics; Reference Standards; Reproducibility of Results; Sensitivity and Specificity; Substance Abuse Detection; Substance-Related Disorders; Trimethylsilyl Compounds

There is growing concern about increase in illicit drug use and associated fatalities in young people.. This longitudinal analysis of successive cohorts of addicts in England and Wales aged 15-19 years followed up over a 20-year period covering 1974 to 1993 (1) investigated trends in all-causes mortality; (2) examined teenage-specific mortality, i.e. deaths during ages 15-19 years; (3) determined excess teenage-specific mortality; and (4) identified the main underlying causes of teenage-specific death in this population. The main outcome measures were overall mortality rates, teenage-specific mortality and standardised mortality ratios calculated for four 5-year (period) successive cohorts.. Overall mortality rate in the study population (N = 9491) was 4.7/1000 person-years. The median age at death was 23 years (semi interquartile range = 3), with the majority (91.3%) of deaths occurring between ages 15 and 29 years. Excess teenage-specific mortality in the population was 10.7 in males and 21.2 in females (general population = 1), and increase in excess mortality in both sexes was evident in the last 5-year period of study. The majority of deaths (64.3%) resulted from accidental poisoning. Methadone and heroine/morphine accounted for about two-thirds of accidental poisoning deaths, while suicide accounted for 11.4% of teenage-specific deaths.. It is strongly recommended that treatment services should be more responsive to the need for careful prescribing, dispensing and administration of substitute medication to teenage addicts in their care. The development of needs-led, case-sensitive treatment services for young addicts is indicated.

Topics: Adolescent; Adult; Age Distribution; Behavior, Addictive; England; Female; Heroin; Humans; Longitudinal Studies; Male; Methadone; Morphine; Mortality; Narcotics; Sex Distribution; Substance-Related Disorders; Suicide; Wales

We provide a 25-fold range for the ecstacy-related death rate per 10,000 15-24-year-old users in the UK: from 0.2 to 5.3, compared with the death rate of 1.0 from road traffic accidents in the same age-group. The heroin-related death rate in 15-24-year-old heroin users was much higher, but also imprecisely estimated: from 9.1 to 81.5 deaths per 10,000 15-24-year-old users. Data deficiencies which inhibit the calculation of drug-specific rates in this population should be remedied.

Topics: Accidents, Traffic; Adolescent; Adult; England; Hallucinogens; Heroin; Humans; Meta-Analysis as Topic; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Scotland; Substance-Related Disorders

A case is reported of a patient who experienced sudden onset of severe respiratory failure, shock and coma after first-time intranasal heroin abuse. During the following days full consciousness was restored, revealing persistent oculogyric crises, axial retropulsive dystonia and ataxia. Initially computer tomography (CT) scans of the brain were normal and cerebral spinal fluid examination showed a slight elevation of lactate. Magnetic resonance imaging (MRI) scans of the brain demonstrated diffuse bilateral subcortical white matter hyperintensities, with sparing of the U-fibers, symmetric bilateral hyperintensities of the globus pallidum and very hyperintensive subcortical foci in the right hemisphere. Differential diagnostic assessment, treatment, clinical and MRI course of a 6-month follow-up are discussed.

Topics: Administration, Intranasal; Adult; Dystonia; Heroin; Humans; Magnetic Resonance Imaging; Male; Narcotics; Respiratory Insufficiency; Substance-Related Disorders; Tomography, X-Ray Computed

Topics: Africa, Western; Heroin; Humans; Ibogaine; Receptors, Glutamate; Substance-Related Disorders; United States

(i) To describe illegal drug use patterns in an adolescent normal population sample with special emphasis on MDMA, ecstasy; (ii) to investigate where ecstasy is introduced in a hypothesized drug use sequence, and (iii) to contrast the predictors of ecstasy use with those of other illegal substances. Special attention was given to the relationship to subcultural music preferences and house-party-going.. A school-based survey of the total cohort of adolescents enrolled in the school system in a city.. 10,812 adolescents, age 14-17 years, response rate 94.3%.. Oslo, the capital and only metropolitan town in Norway.. Social class was measured by the occupation standard ISCO 88, questions were posed as regards frequency of alcohol use and alcohol intoxication, cigarette smoking and use of cannabis, amphetamines, ecstasy and heroin. Alcohol problems were measured by a shortened version of Rutgers Alcohol Problem Index (RAPI), conduct problems were measured according to the four categories of acts forming the basis of the diagnosis conduct disorder in DSM-IV, internalizing mental health problems were measured using items from Hopkins Symptoms Checklist (HCL). A number of questions were asked as regards subcultural music preferences and house-party-going. STATISTICAL MODELS: A hypothesized cumulative sequence in drug use was investigated by means of latent class analysis, and the predictors of the various patterns of drug use were estimated and compared by means of multinominal logistic regression analysis.. The use of ecstasy was often intermingled with the use of cannabis, amphetamines and heroin, in a pattern of polydrug use. The latent class analysis revealed the following drug use sequence: (1) alcohol, (2) cigarettes, (3) cannabis, (4) amphetamines, (5) ecstasy and (6) heroin. There was no significant association between ecstasy use and parental social class or residential area of the town. All patterns of illegal drug use were highly associated with cigarette smoking, alcohol use, alcohol problems and conduct problems, whereas the associations with internalizing mental health problems were of less magnitude. Multinominal logistic regression analysis revealed that the use of ecstasy (E) was significantly more weakly associated with cigarette smoking than were the use of cannabis only (C), amphetamines (A) and the combination of ecstasy and amphetamines (A + E). The association between E and conduct problems (CP) was weaker than the association between CP and A and A + E. Finally, there were associations between E and A + E and House/Techno preferences and house-party-going, which were not found for C and A.. Ecstasy is used by adolescents who use other legal and illegal substances in a polydrug-use pattern. The substance is introduced late in a hypothesized drug use sequence. Even so, ecstasy use seems to differ from the use of, e.g. amphetamines, in that the association with smoking and conduct problems is weaker and that the associations with subcultural music preferences and house-party-going are much stronger.

Topics: Adolescent; Alcoholism; Amphetamines; Cannabis; Cohort Studies; Female; Hallucinogens; Heroin; Humans; Logistic Models; Male; N-Methyl-3,4-methylenedioxyamphetamine; Norway; Prevalence; Smoking; Social Behavior; Substance-Related Disorders

To compare neuronal activity within the mesocorticolimbic circuit during the self-administration of cocaine and heroin, multiple-channel single-unit recordings of spike activity within the rat medial prefrontal cortex (mPFC) and nucleus accumbens (NAc) were obtained during the consecutive self-administration of cocaine and heroin within the same session. The variety of neuronal responses observed before the lever press are termed anticipatory responses, and those observed after the lever press are called post-drug infusion responses. For the total of the 110 mPFC and 111 NAc neurons recorded, 30-50% of neurons, depending on the individual sessions, had no alteration in spike activity in relation to either cocaine or heroin self-administration. Among the neurons exhibiting significant neuronal responses during a self-administration session, only a small portion (16-25%) of neurons responded similarly under both reinforcement conditions; the majority of neurons (75-84%) responded differently to cocaine and heroin self-administration as revealed by variations in both anticipatory and/or post-drug infusion responses. A detailed video analysis of specific movements to obtain the self-administration of both drugs provided evidence against the possibility that locomotive differences contributed to the observed differences in anticipatory responses. The overall mean activity of neurons recorded in mPFC and NAc measured across the duration of the session segment for either cocaine or heroin self-administration also was different for some neurons under the two reinforcement conditions. This study provides direct evidence that, in mPFC and NAc, heterogeneous neuronal circuits mediate cocaine and heroin self-administration and that distinct, but overlapping, subpopulations of neurons in these areas become active during operant responding for different reinforcers.

Topics: Action Potentials; Animals; Behavior, Animal; Cerebral Cortex; Cocaine; Dopamine Uptake Inhibitors; Electrophysiology; Heroin; Limbic System; Locomotion; Male; Narcotics; Neurons; Nucleus Accumbens; Rats; Rats, Sprague-Dawley; Reward; Self Administration; Substance-Related Disorders

Topics: 3,4-Methylenedioxyamphetamine; Acute Disease; Designer Drugs; Heroin; Humans; Narcotic Antagonists; Narcotics; Substance-Related Disorders

A case is presented involving a young woman on several illicit drugs (heroin, cocaine and cannabis) as well as two medications and a solvent used for their anesthetic and narcotic properties: thiopental, ketamine and chloroform. This complex drug use was supported by hair analysis over a 10.5 cm segment of the hair taken at autopsy. The average measured concentrations in hair were: thiopental = 5.3 ng/mg, pentobarbital = 10.0 ng/mg, ketamine = 11.3 ng/mg norketamine = 1.0 ng/mg, diazepam = 1.2 ng/mg, nordiazepam = 0.1 ng/mg, 6-acetylmorphine = 4.4 ng/mg, morphine = 3.4 ng/mg, codeine = 1.2 ng/mg, cocaine = 5.5 ng/mg, benzoylecgonine = 1.5 ng/mg and methylecgonine ester = 1.0 ng/mg. While the ketamine/norketamine ratio is consistent with that already reported on drug detection in hair, the thiopental/pentobarbital ratio seems to be inverted.

Topics: Adult; Cannabinoids; Chloroform; Chromatography, High Pressure Liquid; Cocaine; Fatal Outcome; Female; Forensic Medicine; Gas Chromatography-Mass Spectrometry; Hair; Heroin; Humans; Illicit Drugs; Ketamine; Substance Abuse Detection; Substance-Related Disorders; Thiopental

Over the past twenty years many MMPI studies of substance abuse have investigated the complex relationship between personality profile and drug of choice. This work has repeatedly established that alcoholics, heroin, cocaine and polydrug addicts share 4-2/2-4 (Psychopathy and Depression) or 4-8/8-4 (Psychopathy and Thought Disorder) MMPI profiles, but that the substance abuse populations differ in the plane of severity in that general profile. The alcoholics occupy the least disturbed sector, the polydrug abusers the most disturbed level and the heroin and cocaine addicts positions of moderate disturbance. The vast majority of studies, however, cite only group means to buttress their conclusions. Our work probed more deeply into the data using Discriminant Function Analysis. With this methodology we discovered important differences between the groups, previously hidden, which may carry differential treatment implications.

Topics: Adult; Analysis of Variance; Cocaine; Discriminant Analysis; Ethanol; Female; Heroin; Humans; Male; MMPI; Personality Disorders; Substance-Related Disorders

Concurrent abuse of cocaine and opioids is frequently observed clinically, and we have developed a model of "speedball" self-administration involving the simultaneous injection of cocaine and heroin combinations in rhesus monkeys (Mello et al. (1995) J Pharmacol Exp Ther 274:1325). In the present study, we evaluated the effects of buprenorphine (0.0075-0.75 mg/kg/day i.v.) and saline on speedball combinations of cocaine [0.001, 0.01 or 0.10 mg/kg/inj] and heroin [0.0001-0.032 mg/kg/inj]. We also examined the effects of buprenorphine (0.075 and 0.237 mg/kg/day i.v.) on self-administration of heroin alone (0.0001-0.01 mg/kg/inj). Drug and food (1-g banana pellets) self-administration were maintained on a second-order FR4 (VR16:S) schedule in four 1-hr sessions each day. Each buprenorphine or saline control treatment was evaluated for 10 consecutive days, and monkeys returned to base-line performance between each treatment condition. Buprenorphine (0.075-0.75 mg/kg/day) selectively reduced self-administration of speedball combinations of low-dose cocaine (0.001 mg/kg/inj) and heroin (0.001 or 0.0032 mg/kg/inj) (P < .05-.01), and buprenorphine (0.237 mg/kg/day) shifted dose-effect curves for speedball combinations of cocaine (0.001 mg/kg/inj) and heroin (0.0001-0.032 mg/kg/inj) downward (P < .05-.01) and approximately 1 log unit to the right. Buprenorphine treatment was less effective in decreasing responding maintained by speedball combinations of heroin and 0.01 and 0.10 mg/kg/inj cocaine. Buprenorphine treatment (0.075 and 0.237 mg/kg/day) also shifted the heroin dose-effect curve downward (P < .01-.001) and to the right. Both speedball and heroin self-administration were associated with dose-dependent decreases in food-maintained responding during saline control treatment. However, food-maintained responding was often higher than control levels during buprenorphine treatment (P < .05-.001), which suggests that buprenorphine antagonized the rate-decreasing effects of speedballs and of heroin. Buprenorphine's selective reduction of speedball and heroin self-administration is consistent with clinical treatment trials in opioid abusers and polydrug abusers. Thus, these primate models of speedball and heroin self-administration should be useful for preclinical evaluation of novel drug abuse treatment medications.

Topics: Animals; Buprenorphine; Cocaine; Conditioning, Psychological; Dose-Response Relationship, Drug; Female; Heroin; Macaca mulatta; Male; Self Administration; Substance-Related Disorders

The present study examined differences in neuropsychological performance among chronic cocaine, alcohol, and polysubstance abusers. A comprehensive neuropsychological battery was completed by 355 incarcerated adult male felons who were classified by DSM-IV criteria into four subgroups: (1) alcohol dependence or abuse (ETOH) (n = 101), (2) cocaine dependence or abuse (COC) (n = 60), (3) polysubstance dependence or abuse (POLY (n = 56), and (4) a group of age and education matched adult male felons with no history of drug abuse (n = 138). Results showed no significant differences in neuropsychological performance between COC and control subjects. However, both the POLY and ETOH groups were found to perform significantly worse on nearly all measures compared to the COC and control groups. Further, analysis of neuropsychological domains showed the POLY group to perform significantly worse compared to the other groups in the areas of short-term memory, long-term memory and visual motor ability. Correlations between neuropsychological performance and length of abstinence from drug use showed the ETOH group to have made the greatest amount of improvement on individual measures and domains. The COC group showed the least amount of improvement, but their performance was not significantly different from controls. Results provide further support for the differential effects of drug use on neuropsychological functioning.

Topics: Adult; Alcohol Drinking; Alcohol-Related Disorders; Amphetamines; Chi-Square Distribution; Cocaine; Cocaine-Related Disorders; Cognition Disorders; Cross-Sectional Studies; Drug Interactions; Forensic Psychiatry; Heroin; Humans; Male; Multivariate Analysis; Neuropsychological Tests; Prisoners; Substance-Related Disorders; Time Factors

To describe the prevalence and patterns of use of crack and cocaine hydrochloride among heroin users in Spain. To explore if the expansion of heroin smoking is accompanied by a similar phenomenon for cocaine.. Cross sectional study in 1995. Face to face interviews using a structured questionnaire.. Three cities with different prevalences of heroin use by smoking: high (Seville), intermediate (Madrid), and low (Barcelona).. 909 heroin users, 452 in treatment and 457 out of treatment.. Last month prevalence of crack use was 62.3% in Seville, 19.4% in Madrid, and 7.7% in Barcelona. Most users in Madrid (86.5%) and Barcelona (100%) generally prepared their own crack, usually with ammonia as alkali; in Seville most users (69.7%) bought preprocessed crack. The proportion of users who began taking cocaine (crack or cocaine hydrochloride) by smoking has increased progressively since the seventies, rising to 74.1% in Seville, 61.5% in Madrid, and 28% in Barcelona in 1992-1995, with the earliest increase in Seville. The factors associated with crack use were: residence in Seville (odds ratio (OR) = 16.3), cocaine hydrochloride use mainly by smoking (OR = 5.0), by sniffing (OR = 2.7) or by injecting (OR = 2.5), heroin use mainly by smoking (OR = 2.8) and weekly use of cannabis (OR = 1.9).. In Spain smoking cocaine may be progressively diffusing from the south west to the north east, similar to what has happened with smoking heroin, but beginning later in time. The factors associated with smoking cocaine are basically ecological or cultural in nature (characteristics of the available drugs and the main route of heroin administration in each city).

Topics: Administration, Inhalation; Adult; Aged; Cocaine; Crack Cocaine; Cross-Sectional Studies; Female; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Middle Aged; Prevalence; Smoking; Spain; Substance-Related Disorders

Topics: Fatal Outcome; Heroin; HIV Infections; Humans; Male; Needle-Exchange Programs; Substance-Related Disorders

It has been postulated that behavioral sensitization could reflect drug-induced changes that are central to the development of drug abuse; however, it is still unknown whether behavioral sensitization can arise during a "voluntary" and "self-controlled" consumption of drugs and consequently play a role in drug abuse. For this reason, we studied the possible sensitization of motor activity during ten consecutive intravenous self-administration (SA) sessions of one of the most largely abused opiates the mu agonist heroin [30 microg/infusion (inf)]. We also studied in similar conditions the new kappa agonist RU 51599 (6.5, 20 and 100 microg/inf). Heroin and RU 51599 were compared because both drugs are self-administered by rodents, but the reinforcing properties of RU 51599 are very weak compared to those of heroin. At low ratio requirement rats developed SA of both heroin and RU 51599; however, a progressive increase in drug-induced locomotor activity over subsequent sessions was observed only for heroin but not for RU 51599. Sensitization of the motor effects of heroin developed over a period of time during which the intake of the drug was constant. In conclusion, sensitization can develop during the voluntary consumption of an addictive drug such as heroin. These results are in line with the hypothesis that sensitization could play a role in the etiology of drug abuse.

Topics: Animals; Benzeneacetamides; Diuretics; Heroin; Locomotion; Male; Narcotics; Pyrrolidines; Rats; Rats, Sprague-Dawley; Receptors, Opioid, kappa; Self Administration; Substance-Related Disorders

Topics: Cocaine; Data Collection; Drug Overdose; Emergency Service, Hospital; Heroin; Humans; Substance-Related Disorders; United States

To assess how price and income affect hypothetical drug-purchasing decisions of polydrug abusers undergoing treatment for heroin addiction.. Forty subjects participated in experiments in which they hypothetically "purchased" drugs as price or income varied.. Experiment 1 examined effects of heroin price on purchases of heroin, valium, cocaine, marijuana and alcohol. Experiment 2 examined the effects of both heroin and valium prices on purchases of these drugs. In both these experiments, income remained constant. Experiment 3 examined the effects of increasing income on drug choices, with drug prices constant.. As price of heroin rose in Experiment 1, heroin purchases decreased. Reductions in heroin purchases were proportionally less than price increases, demonstrating inelastic demand for heroin. Valium and cocaine purchases increased as heroin price rose, and cross-price elasticity coefficients indicated that these drugs substituted for heroin. In Experiment 2, demand for both heroin and valium was inelastic. Valium substituted for heroin, but heroin purchases were independent of valium prices, suggesting an asymmetrical substitution effect. Marijuana and alcohol purchases were independent of valium price, but both these drugs substituted for heroin. In Experiment 3 demand for heroin and cocaine was income elastic, with purchases rising in greater proportion than income. Marijuana, alcohol and valium purchases did not vary with income, demonstrating that demand for these drugs was income inelastic. Hypothetical choices were reliable both between and within subjects. Moreover, drug choices in this hypothetical situation were correlated with urinalysis results, demonstrating initial validity of this methodology.. This methodology may be useful for understanding the phenomenon of polydrug abuse.

Topics: Adult; Choice Behavior; Cocaine; Diazepam; Ethanol; Female; Heroin; Humans; Income; Male; Marijuana Abuse; Substance-Related Disorders

A systematic determination method for 10 drugs of abuse, morphine, codeine, 6-monoacetylmorphine, heroin, levorphanol, pethidine, ethylmorphine, anadol, pentazocine and ethamivan, using high performance liquid chromatography is described. Separation of the 10 drugs was achieved on a 25 cm x 4.6 mm ID, 10 microns Zorbax C8 column, using methanol--0.05 mol.L-1 KH2PO4--diethyl amine (27:73:0.5, pH 4) as mobile phase. Codeine was used as the interal standard. Calibration graphs were linear over the concentration range of 10-200 micrograms.ml-1 and regression equations showed correlation coefficients of greater than 0.999. Precision (RSD) were found to be better than 3% for each compound. Precision and linearity of the method are satisfactory for clinical toxicological applications. The extraction procedure yielded cleaner extracts. The recovery rates from urine were all above 87% without interference. This method is rapid, sensitive and specific.

Topics: Chromatography, High Pressure Liquid; Codeine; Heroin; Humans; Morphine; Substance-Related Disorders

Topics: Drug Overdose; Half-Life; Heroin; Humans; Naloxone; Patient Education as Topic; Substance-Related Disorders

We report a 30-year-old man who developed painful swelling of his right leg and complete sciatic nerve palsy after an i.v. injection of heroin. Excessive elevation of serum creatine phosphokinase indicated the presence of rhabdomyolysis. Fasciotomy of the gluteus maximus led to rapid and complete recovery from sciatic nerve palsy. Nontraumatic rhabdomyolysis may cause a gluteal compartment syndrome that requires immediate fasciotomy.

Topics: Adult; Buttocks; Heroin; Humans; Inflammation; Injections, Intravenous; Leg; Male; Paralysis; Peripheral Nervous System Diseases; Rhabdomyolysis; Sciatic Nerve; Substance-Related Disorders; Syndrome

Topics: Administration, Inhalation; Adult; Brain Diseases; Cocaine; Female; Heroin; Humans; Male; Substance-Related Disorders

To provide epidemiological information on the extent of design drug use in Spain, the characteristics of users, and the types of substances consumed.. We analyzed two surveys on drug use carried out in 1993 and 1994 (one in the general population older than 15 years and the other in heroin and/or cocaine users who were not in treatment) as well as data on designer drug seizures confiscated by the General Police Headquarters and Ministry of Health laboratories.. According to the general population survey, 4.5% of persons 16-40 years of age have tried design drugs at some time, 2.1% more than once, and 0.6% are current users. Design drug use is associated with age of 20-24 years and use of crack (odds ratio [OR] = 28.6), cannabis (OR = 12.5), cocaine (OR = 7.6) or heroin (OR = 3.8). According to the survey of heroin/cocaine users, 25% of cocaine users have used design drugs in the last 30 days, 11% of heroin users, and 18% of those who use both substances. Use is associated with the use of hallucinogens (OR = 4.8), non-use of the injected route (OR = 2), and having been interviewed in recreational areas (OR = 1.8). Police data reflect a stability in the quantities of amphetamines confiscated, a large increase in those of MDMA, and an absence of MDA and MDEA. Ministry of Health laboratories show an increase in confiscations of amphetamines and the presence of MDA, MDMA and MDEA in all years and areas studied, as well as the appearance of MBDB in 1994.. The occasional use of different design drugs has spread to some degree among young people, varies considerably by geographic region, and is associated with the use of other legal and illegal substances, specially stimulants.

Topics: 3,4-Methylenedioxyamphetamine; Adolescent; Adult; Cocaine; Designer Drugs; Female; Heroin; Humans; Male; N-Methyl-3,4-methylenedioxyamphetamine; Prevalence; Spain; Substance-Related Disorders

The receptors for tetrahydrocannabinol, the active ingredient of marijuana, have been identified. A microsatellite polymorphism (AAT)n at the cannabinoid CB1 (brain) receptor gene (CNR1) consists of 9 alleles. Since the cannabinoid system is part of the reward pathway we examined the hypothesis that genetic variants of the CNR1 gene might be associated with susceptibility to alcohol or drug dependence. The study consisted of 92 subjects on an Addiction Treatment Unit (ATU) and 114 controls. All were non-Hispanic Caucasians. The ATU subjects were screened for all types of substance dependence using the Diagnostic Interview Schedule (DIS), and for a variety of substance abuse symptoms using the Addiction Severity Index (ASI). Since inspection of the distribution of alleles in controls vs i.v. drug use showed a decrease in the frequency of the 4 allele, and the < 4 alleles were rare, the alleles were divided into two groups, < 5 and < or = 5, and three genotypes < 5/< 5, heterozygotes, and > or =/> or = 5. When all variables were subjected to factor analysis, factor 1 showed a clustering of drug dependence variables and factor 2 of alcohol dependence variables. By ANOVA only factor 1 showed significant differences by genotype consistent with a model where homozygosity for the > or = 5 repeat alleles showed the greatest effect. The number of i.v. drugs used was significantly greater for those carrying the > or =/> or = 5 genotype than for other genotypes (P = 0.005). The association with specific types of drug dependence was greatest for cocaine, amphetamine, and cannabis dependence. The results are consistent with a role of cannabinoid receptors in the modulation of dopamine and cannabinoid reward pathways. Independent studies should be designed to further confirm the hypothesis that cannabinoid receptors may contribute to the susceptibility to drug abuse.

Topics: Administration, Inhalation; Administration, Oral; Adult; Alcoholism; Alleles; Amphetamines; Cocaine; Comorbidity; Disease Susceptibility; Evoked Potentials; Female; Gene Frequency; Genotype; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Middle Aged; Receptors, Cannabinoid; Receptors, Drug; Reward; Risk Factors; Smoking; Substance Abuse, Intravenous; Substance-Related Disorders; Trinucleotide Repeats

The test-retest reliability of lifetime substance abuse and dependence diagnoses obtained by telephone interviewers was investigated. Trained personnel administered two identical interviews based on a modified Diagnostic Interview Schedule-Substance Abuse Module (DISSAM) approximately a week apart for 100 respondents, of whom 55 were receiving alcohol or other drug treatment and 45 and randomly selected from residential households in one Michigan county. The uncorrected agreement for all lifetime dependence diagnoses exceeded 93% for all six categories assessed and the more conservative chance corrected agreement (Cohen's Kappa coefficient kappa) was .92 (alcohol),.76 (marijuana),.87 (cocaine), and .71 (other opiates). Kappa coefficients for hallucinogens and heroin dependence could not be calculated due to low (i.e., 5% or less) base rates. Likewise, kappa was calculated only for a single abuse diagnosis, alcohol, with kappa = .42 and 95% agreement. In the interpretation of kappa, the standard applied was: kappa ranging from .41 to .60 represented moderate agreement, kappa ranging from .61 to .80 represented substantial agreement, and kappa ranging from .81 to 1.00 represented excellent agreement. Thus, test-retest reliability was excellent for lifetime alcohol and cocaine dependence and was substantial for lifetime marijuana and other opiates dependence. These results indicate that lifetime psychoactive substance abuse diagnoses can be obtained fairly reliably over the telephone using trained lay interviewers.

Topics: Adolescent; Adult; Aged; Alcoholism; Cocaine; Data Collection; Evaluation Studies as Topic; Female; Heroin; Humans; Interviews as Topic; Male; Marijuana Abuse; Middle Aged; Narcotics; Psychotropic Drugs; Reproducibility of Results; Sensitivity and Specificity; Substance-Related Disorders

Dihydroetorphine is a novel opioid that is an extremely potent analgesic in rodents. The reinforcing potency was determined in rats trained to self-administer heroin and compared to those of fentanyl, heroin, 6-acetylmorphine and morphine for assessment of the abuse potential of dihydroetorphine using a procedure that determines the dose-effect curve in individual sessions. Dihydroetorphine produced a bimodal dose-effect curve similar to that of other opioids. Potency ratios were determined with morphine for the ascending and descending limbs of the dose-effect curve, as well as the dose that yielded maximal response rate. Fentanyl, heroin and 6-acetylmorphine were approximately 100, 8 and 2 times more potent than morphine in maintaining self-administration, respectively. Dihydroetorphine was roughly 1500 to 3000 times more potent than morphine, however, depending upon the limb of the dose-effect curve used for comparison. These potency ratios of dihydroetorphine to morphine were somewhat less than has been reported for analgesia assays, and therefore this compound may have some clinical advantages over other opioids. However, these studies indicate significant abuse liability for dihydroetorphine given its potency in maintaining self-administration in these animals.

Topics: Analgesics, Opioid; Animals; Dose-Response Relationship, Drug; Etorphine; Fentanyl; Heroin; Male; Morphine; Morphine Derivatives; Rats; Rats, Inbred F344; Substance Withdrawal Syndrome; Substance-Related Disorders

The current study examined whether stimuli predictive of heroin availability were capable of inducing a relapse of drug-seeking behavior in an operant runway task. Olfactory stimuli (orange and almond food extract) served as discriminative cues about the availability (S+) or unavailability (S-) of heroin reinforcement (a single 0.1 mg/kg IV infusion) in the goal box of a straight arm runway. Following discrimination training, the running response was extinguished in the absence of the olfactory cues. On a single trial, the discriminative stimuli were then tested for their ability to reinstate running behavior prior to presentation of the heroin reinforcer. Subjects presented with the S+ on test day took significantly less time to traverse the alley than they did on the final day of extinction, while those subjects presented with the S- on test day continued to run slowly. These results demonstrate, in an animal model of drug self-administration, that environmental discriminative cues can produce a relapse in drug seeking behavior following a period of abstinence. The response-reinstating properties of the S+ odor were unaltered by pretreatment with any of three doses of haloperidol (0.0, 0.15 or 0.3 mg/kg IP), suggesting that the motivating properties of heroin-predictive stimuli or cues remain intact during dopamine receptor antagonism.

Topics: Animals; Behavior, Animal; Conditioning, Operant; Discrimination, Psychological; Heroin; Rats; Rats, Sprague-Dawley; Substance-Related Disorders

Topics: Cocaine; Female; Heroin; HIV Infections; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Methadone; Pregnancy; Pregnancy Complications, Infectious; Substance-Related Disorders

In order to recruit heroin and/or cocaine users outside treatment settings, recruitment of subjects through Privileged Access Interviewers (PAI) was tested and implemented in the Swiss Hidden Population Study. This article discusses practical aspects of the PAI method as well as issues of reliability and validity. From June 1994 to June 1995, 31 Privileged Access Interviewers were recruited in the main regions of Switzerland. They conducted 943 standardized interviews altogether, of which 917 could be considered valid. Fifty-four per cent of the respondents correspond to the criteria of the target population. The PAI method collects reliable data in a relatively short amount of time, given adequate means of control. Analysis of the age distribution and of the patterns of drug use in our sample shows that the question of validity is mainly linked to the diversity of the milieus from which PAIs recruit the respondents. Encouraging PAIs to do as many interviews as possible did not skew the data. Hence, well-founded inferences on a PAI generated database relies on the analysis of qualitative information on the ways in which the Privileged Access Interviewers have recruited their respondents.

Topics: Adolescent; Adult; Analysis of Variance; Cocaine; Epidemiologic Methods; Heroin; Humans; Middle Aged; Reproducibility of Results; Substance-Related Disorders; Switzerland

The purpose of this investigation was to compare the self-administration of heroin and cocaine base, alone and in combination, in rhesus monkeys (Macaca mulatta) self-administering a combination of heroin (0.1 mg/kg/delivery) and cocaine base (1.0 mg/kg/delivery) via the smoking route. Smoke deliveries were contingent on completion of a chained fixed ratio (FR; lever press), FR 5 (inhalation) schedule. The lever press FR values (64, 128, 256, 512, and 1024) represented increasing drug price. Demand functions (Consumption X price) were obtained for the heroin and cocaine combination and compared with previously determined demand functions for smoked heroin and cocaine alone. As the FR increased and the number of responses emitted increased, the number of drug deliveries decreased. The demand functions were not different for heroin versus cocaine alone or for the cocaine alone versus the cocaine-heroin combination. However, the demand for heroin alone was significantly less than the demand for the cocaine-heroin combination, suggesting that smoked cocaine base enhances the behavioral effects of smoked heroin.

Topics: Administration, Inhalation; Animals; Cocaine; Conditioning, Operant; Drug Combinations; Drug Synergism; Heroin; Macaca mulatta; Male; Narcotics; Reinforcement Schedule; Substance-Related Disorders

Drug use prevalence data were obtained from 969 adolescents, high school students and imprisoned offenders who reported use of cough medicine, organic solvents, cannabis, heroin, tranquilizers, and narcotics over the past six months. Incarcerated youths, in particular girls, had higher prevalence rates than students. Drug use frequencies were associated with psychosocial variables such as disinhibition, peer drug use, susceptibility to peer pressure, attitudes, encouragement by peers, and perceived availability of drugs. The psychosocial process of the initiation and maintenance of substance use was specified as a path model that considered 1) personality and social environment as distal precursors and 2) a drug-use predisposition and perceived availability as proximal precursors of three kinds of outcome variables: drug use, the intention to try illicit drugs if they were legal, and adverse outcomes of drug use. It was found that the same structural equation model fit the data of both samples of offenders and students, however, with very different weights assigned to the paths.

Topics: Adolescent; Adolescent Behavior; Analysis of Variance; Cannabis; Chi-Square Distribution; Factor Analysis, Statistical; Female; Health Knowledge, Attitudes, Practice; Heroin; Hong Kong; Humans; Life Style; Male; Models, Statistical; Peer Group; Prevalence; Sex Distribution; Social Problems; Solvents; Substance-Related Disorders; Surveys and Questionnaires; Tranquilizing Agents

A 25-year-old man presented in March 1996 with progressive dysarthria, cerebellar ataxia, and dystonia, which began after he inhaled heroin vapor for a full day 2 months previously. The patient had a 2-year history of heroin inhalation. Magnetic brain stimulation showed waveform dysynchronization suggestive of motor pathway perturbation above the cervical spinal level. Brain computed tomography and magnetic resonance imaging revealed extensive symmetric white matter involvement of bilateral cerebral and cerebellar hemispheres and the brainstem, especially along the corticospinal tract. The clinical features, electrophysiologic manifestations, and imaging studies strongly indicated a lipophilic toxin-induced demyelinating process, mainly involving the central motor system, as the most likely cause of heroin leukoencephalopathy. This is the first reported case of heroin-related leukoencephalopathy in Taiwan.

Topics: Administration, Inhalation; Adult; Brain Diseases; Heroin; Humans; Male; Substance-Related Disorders

What are we talking about when we speak of pain in a drug abuser? Physical and psychiatric pain are confounded. Heroin anesthesizes pain in general and grief pain in particular. Is there a relationship between stomatology and pain? A drug abuser's psychopathology evolves over time. The biological effects of morphine, compared with the biological effects of subutex and methadone, are sufficient in themselves to justify their use in substitution therapy. But in practice, the psychopathological situation of the drug abuser requires us to construct a close rigorous relationship to maintain treatment. Once this relationship has been constructed within the frame work of the substitution therapy, the drug abuser will accept dental, medical and surgical care.

Topics: Anesthesia; Comprehensive Health Care; Heroin; Heroin Dependence; Humans; Methadone; Morphine; Narcotics; Pain; Physician-Patient Relations; Substance Abuse Treatment Centers; Substance-Related Disorders

Topics: Adult; Analgesia; Drug Tolerance; Female; Heroin; Humans; Inactivation, Metabolic; Male; Middle Aged; Naltrexone; Narcotic Antagonists; Pain Threshold; Perceptual Disorders; Receptors, Opioid; Substance-Related Disorders

This study was designed to assess the prevalence of conduct disorder (CD) among runaway and homeless adolescents and to investigate associations between CD and HIV risk behaviors. The Diagnostic Interview Schedule for Children and a standardized HIV risk assessment questionnaire were administered to 219 runaway and homeless adolescents recruited from a drop-in center serving high-risk youth. One-half of the males and 60% of the females were diagnosed with CD. In multivariate analyses, CD was the strongest predictor of lifetime use of heroin and/or cocaine and exchanging sex for money, drugs, food or shelter, as well as the number of drugs used and the number of sex partners in the 3 months preceding the interview. The high rate of CD in this population, and the association between CD and both drug and sex-related HIV risk behaviors, indicate a need for interventions that consider the influence of this psychiatric diagnosis on high-risk behaviors.

Topics: Adolescent; Adolescent Behavior; Cocaine; Conduct Disorder; Female; Heroin; HIV Infections; Humans; Ill-Housed Persons; Male; Psychiatric Status Rating Scales; Risk Factors; Risk-Taking; Runaway Behavior; Sexual Behavior; Substance-Related Disorders; Surveys and Questionnaires

These experiments examined whether dihydroetorphine (DHE) could serve as a reinforcer in rhesus monkeys and evoke the discriminative stimulus effects of heroin (HER) in rats, two procedures useful in predicting the overall abuse potential of compounds. Rhesus monkeys were trained to self-administer i.v. HER (10 micrograms/kg for monkeys M-BA, M-NI, and M-HO; 3 micrograms/kg for monkey M-PO) during daily; 2-h experimental sessions under FR 10 Timeout 4 min schedules. VEH and doses of HER (1-30 micrograms/kg), codeine (COD; 30-1000 micrograms/kg), and DHE (1-100 ng/kg) were then substituted for the HER maintenance doses. Results indicated that DHE served as a reinforcer. The dose of DHE that maintained peak numbers of infusions was 171 and 8571 times smaller than those maintaining peak numbers of infusions of heroin and codeine, respectively. Additionally, male Sprague-Dawley rats were trained to discriminate 0.3 mg/kg HER s.c. from vehicle (VEH) in an FR 10 (fixed-ratio 10), food-reinforced, operant procedure. During tests, HER, morphine (MOR), and DHE dose-dependently evoked heroin-lever responding with ED50s of 0.055, 0.74, and 0.00033 mg/kg, respectively. These results indicate that DHE is self-administered by rhesus monkeys, and potently produces the discriminative stimulus effects of HER in rats, and suggest that DHE would have a substantial potential for abuse.

Topics: Analgesics, Opioid; Animals; Discrimination Learning; Dose-Response Relationship, Drug; Etorphine; Heroin; Macaca mulatta; Male; Rats; Rats, Sprague-Dawley; Reinforcement, Psychology; Self Administration; Substance-Related Disorders

Topics: Cocaine; Colombia; Female; Heroin; HIV Infections; HIV-1; Humans; Male; Sexual Behavior; Substance-Related Disorders

To identify perinatal factors that are predictive of disruption in primary caregiving among infants of substance abusing women.. A randomized longitudinal cohort study. One hundred and fifty two mother/infant dyads were assessed for evidence of disruption of primary caregiving or neglect during the first 18 months of life, defined by mother's inability to provide care. Data analyzed included neonatal characteristics, urine toxicology at delivery, maternal history of drug use, maternal depression, social support, and social and health history.. Sixty-six infants (43.4%) had disruption in their primary care during the first 18 months of their life, 86 infants (56.6%) remained in the care of their mothers. Women who were younger, were heroin users, had two or more children, had other children in foster care, and reported depressive symptoms were least likely to provide ongoing primary care for their infant.. Although all infants born to substance abusing women are at a high risk for disruption in the continuity of their primary caregiving, maternal demographic and psychosocial factors present at delivery can predict which infants are likely to experience an early disruption in their primary caregiving. Identifying these families can enable health care providers to monitor them more closely and, when appropriate, encourage support from the extended family.

Topics: Adolescent; Adult; Child Abuse; Child Care; Cocaine; Depression; Female; Foster Home Care; Heroin; Humans; Infant, Newborn; Longitudinal Studies; Male; Marital Status; Maternal Age; Mother-Child Relations; Risk Factors; Social Support; Substance-Related Disorders

To compare the characteristics of heroin, cocaine and amphetamine users having no history of contact with services with those of a group in contact.. Multiple agency sampling and field work which included 'snowballing' using 'privileged access interviewers'. Each subject underwent a structured interview which included the Severity of Dependency Scale (SDS), and completed a confidential, self-report questionnaire.. Three contrasting provincial urban locations.. Five hundred and eighty-one regular users of the target drugs. Of these, 380 (65%) denied any contact with police or helping agencies in connection with drug use.. Most zero-contact users (79%) expressed little or no concern about their drug use, and no wish for help or advice. They were much more likely to use stimulants only; less likely ever to inject any drug or, for those that did, to share equipment; less likely to use opioids, amphetamine or cocaine powder on a daily basis; more likely to use Ecstasy; and yielded significantly lower SDS scores for all target drugs save crack. Prevalence of crack use was lower, but the proportion of daily users was the same as in the contact group. Most (69%) contact users remained concerned about their drug use, but 58% expressed little or no confidence that local services could meet their needs. In both groups, SDS scores for cocaine powder were comparable to those for cannabis, LSD and Ecstasy. Of the 495 cannabis smokers identified (85% of the sample), 72% reported daily consumption.. The findings are consistent with the hypothesis that 'visible' and 'invisible' drug users are distinct populations in terms of behavioral characteristics, vulnerability to compulsive use, and prevalence of drug-related problems or concern. Purchasers and providers with limited resources should concentrate on improving the range and quality of services for users already in contact rather than attempting to uncover invisible populations. On the basis of SDS scores, cocaine HCI seems to have a relatively modest addictive potential.

Topics: Adolescent; Adult; Amphetamine-Related Disorders; Cocaine; England; Female; Heroin; Humans; Male; Prevalence; Substance-Related Disorders; Urban Health

To measure the current prevalence of different routes of heroin administration among users and to describe the most frequent patterns in the evolution of the main route from the time of first use to the present and their implications for the control of the HIV epidemic.. Cross-sectional study. Face-to-face interviews using a structured questionnaire.. Nine hundred and nine regular heroin users from Madrid, Barcelona and Seville (about 300 per city), half of them recruited in treatment centres and the other half out of treatment.. Socio-demographic characteristics, current and historical behaviours related to route of administration.. Before 1980 injection was the first main route of heroin administration for most users in Barcelona and Madrid; in Seville smoking already predominated, although 40% of users began by injecting. Sniffing subsequently became predominant in Barcelona, while smoking became the predominant first route in Madrid and Seville (smoking has been the only first route in Seville since 1991). The prevalence of injection as the main route of administration during the last 30 days was 77.3% in Barcelona, 24.3% in Madrid and 23.9% in Seville; smoking predominated in the latter two cities. The factors most strongly associated with injection as the preferred route were city of recruitment and having a partner who injected. Some 73% of those who stopped injecting in their last change of route stated that the results of their HIV test or fear of becoming infected had been important in making this decision.. The change from injecting to smoking will greatly facilitate the control of HIV infection in Spain. However, the main causal factor does not appear to be the perception of HIV risk, but rather other, ecological factors (cultural or market-related). The absence of these factors in some areas may impede the spread of smoking.

Topics: Acquired Immunodeficiency Syndrome; Adult; Cross-Sectional Studies; Fear; Female; Heroin; Humans; Male; Prevalence; Smoking; Spain; Substance Abuse, Intravenous; Substance-Related Disorders

Heroin is mixed ("cut") frequently with other substances primarily to increase its weight for retail sale (e.g., mannitol and starch) and to add pharmacologic effects (e.g., dextromethorphan and lidocaine). During 1995 and 1996, health departments and poison-control centers in New York City (NYC); Newark, New Jersey; Philadelphia; and Baltimore reported at least 325 cases of drug overdoses requiring medical treatment in persons who had used "street drugs" sold as heroin that probably also contained scopolamine, an anticholinergic drug. This report summarizes the clinical and epidemiologic features of these cases, which represent a new type of drug overdose.

Topics: Baltimore; Drug Overdose; Heroin; Humans; Illicit Drugs; Muscarinic Antagonists; Narcotics; New Jersey; New York City; Philadelphia; Scopolamine; Substance-Related Disorders

Topics: Administration, Inhalation; Adult; Brain; Cognition Disorders; Heroin; Humans; Magnetic Resonance Imaging; Male; Neuropsychological Tests; Prion Diseases; Substance-Related Disorders

Topics: Australia; Heroin; Humans; Methadone; Substance-Related Disorders

Topics: Baltimore; Drug Overdose; Heroin; Humans; Illicit Drugs; Muscarinic Antagonists; Narcotics; New Jersey; New York City; Philadelphia; Scopolamine; Substance-Related Disorders

Nutritional assessment comprising dietary and anthropometric measurements was conducted in a group of 86 women attending a methadone maintenance clinic in South Western Sydney, Australia. Dietary data were obtained by two 24-hour recall interviews using a standardized interview format. Nutrient intake was analysed using the NUTTAB data base of Australian foods (1992). Mean age of the sample was 29.8 (range 18-46) years and mean body mass index was 22.7 (range 16.2-43.4) kg/m2. The diet of the study group was characterized by a low energy intake of 6.48 MF (95% CI 6.02-6.94), a high sugars intake of 122 g (95% CI 112-132), a high percentage of total energy (31%, 95% CI 29-32) derived from sugars, and a low dietary fibre intake of 10.7 g (95% CI 9.7-12.3). This eating pattern may contribute to the high prevalence of a dental caries and chronic constipation observed in the group. The results pattern also support anecdotal evidence of a craving for sweetness described by addicts. Despite the low energy intake, body mass indices of the group were no different from the normal population. It is possible that 2 days' intake was insufficient to accurately measure accustomed diet in this group of women. Alternatively, the low intake may be a consequence of their largely sedentary life-styles.

Topics: Adolescent; Adult; Analgesics, Opioid; Anthropometry; Australia; Body Mass Index; Carbohydrates; Cross-Sectional Studies; Energy Intake; Female; Heroin; Humans; Methadone; Middle Aged; Substance-Related Disorders; Women

The case is reported of a 35 year old heroin addict presenting with acute confusion which was later found to be due to meningococcal meningitis. Other than his altered mental state, the only abnormal finding on examination was a mild pyrexia.

Topics: Adult; Confusion; Diagnosis, Differential; Emergency Service, Hospital; Heroin; Humans; Male; Meningitis, Meningococcal; Substance-Related Disorders

The present study employed an animal model of drug relapse in which previously extinguished heroin self-administration behavior was reinstated following a single reinforced trial. Male albino rats were trained to traverse a straight-alley for a reinforcer consisting of a single IV injection of 0.06 mg/kg diacetylmorphine (heroin). Once the alley-running had been established, the heroin reinforcer was removed and the operant behavior permitted to extinguish over trials. On treatment day, animals were injected 45 min prior to testing with 0.0, 0.075, 0.10, 0.15 or 0.3 mg/kg of the dopamine receptor antagonist, haloperidol. A single trial was then conducted during which some animals continued to experience extinction conditions while others were injected with the heroin reinforcer upon entry into the goal box. The effects of these manipulations were determined during an additional single test trial conducted 24 h later when the subjects were no longer drugged. While heroin produced a reliable reinstatement in operant responding, this effect was dose-dependently prevented by pretreatment with haloperidol. These data suggest that dopamine receptor antagonism alters the reinforcing consequences of heroin administration as measured by heroin's ability to reinstate operant behavior following a prolonged period of nonreinforced responding.

Topics: Animals; Dopamine Antagonists; Extinction, Psychological; Haloperidol; Heroin; Male; Narcotics; Rats; Rats, Sprague-Dawley; Substance-Related Disorders

Although gender-related issues are often cited as playing an important part in determining patterns of illicit drug use, little is known about the differences between male and female drug users outside treatment settings. In the present study, 558 heroin and cocaine users recruited from a range of community settings were interviewed by Privileged Access Interviewers. The women were found to be younger than the men. Differences existed in their drug use; women used smaller amounts, for a shorter duration, and were less likely to inject than their male counterparts. No differences existed between treatment contact for the heroin users, but differences were found among the cocaine-using sample, with men being more likely to have contacted a treatment agency. Men were financing themselves through more criminal activities than women. Drug-using sexual partners were found to be an important influence over women's drug use, with most female injectors having been given their first injection by a male sexual partner. Structural differences in patterns of drug use found among female drug users and the influence of male sexual partners are likely to play an important role in determining appropriate treatment options for women drug users.

Topics: Adolescent; Adult; Cocaine; Female; Heroin; Humans; Incidence; Male; Middle Aged; Severity of Illness Index; Sex Factors; Substance Abuse, Intravenous; Substance-Related Disorders

To study the incidence and risk factors for pneumonia in a cohort of HIV infected and non-infected drug users (DU).. A prospective epidemiological study.. Injecting and non-injecting DU who attended the Municipal Health Service in Amsterdam for follow-up visits in the study.. 203 HIV infected and 437 non-infected DU were followed for a total of 1749 person-years. HIV infected DU reported 111 episodes of pneumonia, which required hospitalization in 29 cases, and HIV negative DU reported 55 episodes, which required hospitalization in nine cases. The incidences among HIV positive and HIV negative DU were 0.19 and 0.05 per person-year respectively. With multivariate Poisson regression current injecting (RR 2.13), recent seroconversion (RR 3.92), asthmatic constitution (RR 2.72), CD4+ cell count between 200-500 (RR 1.67 compared to > 500), CD4+ cell count less than 200 (RR 2.23 compared to > 500) and a previous history of pneumonia (RR 2.43) were independently associated with self-reported pneumonia among HIV infected DU. Among HIV negative DU heroin smoking (RR 1.87), asthmatic constitution (RR 3.62) and a previous history of pneumonia (RR 2.84) were independently associated with self-reported pneumonia. Also a higher Quetelet Index (QI) appeared to be protective (QI > or = 21 RR 0.42, QI 19-21 RR 0.82 compared to QI < 19) among HIV negative DU. Risk factors for reported and hospitalized cases of pneumonia were comparable among HIV positive DU.. HIV infected DU are at increased risk for pneumonia and the rate increases with lower CD4 cell counts. Also behavioural characteristics, such as injecting drug use and smoking heroin, and clinical history variables, such as a history of pneumonia or an asthmatic constitution, are risk factors for pneumonia among DU. Pneumococcal vaccination should not only be focused on HIV positive DU but also on the identified risk groups among HIV negative DU.

Topics: Adult; CD4 Lymphocyte Count; Female; Heroin; HIV Seropositivity; Humans; Incidence; Male; Netherlands; Pneumonia; Prospective Studies; Regression Analysis; Risk; Risk Factors; Substance-Related Disorders

British Columbia, which holds the dubious distinction of being the country's heroin capital, has introduced a number of programs in an attempt to reduce the number of drug-overdose deaths. A BC coroner who headed a provincial government task force into overdose fatalities in 1994 has recommended a number of harm-reduction strategies such as needle exchanges to reduce the negative consequences associated with illicit drug use. In addition, the College of Physicians and Surgeons of British Columbia is a world leader in methadone maintenance, with 1800 patients and 250 physicians registered in the program.

Topics: British Columbia; Female; Heroin; HIV Infections; Humans; Male; Methadone; Needle-Exchange Programs; Risk Factors; Substance-Related Disorders

Fatal poisonings among young drug addicts (15-34 years) in the five Nordic countries, Denmark, Finland, Iceland, Norway and Sweden in 1991 were investigated and compared to a similar investigation for 1984-1985 (Sweden for 1984 only). A common definition of 'drug addict' has been applied by the participating countries. In both investigations, the greatest number of drug addict deaths was seen in Denmark calculated per 10(5) inhabitants, followed in descending order by Norway, Sweden, Finland and Iceland. An increased number of deaths was observed from 1984-1985 to 1991 in all five countries. The increase in Denmark and Sweden was small while the number of deaths was more than doubled in Norway and Finland. The increased number of cases in Norway and Sweden in 1991 is mainly due to a greater number of deaths in the age group 25-34 years. In Finland, the increased number was seen mainly in the age group 15-24 years. In the two investigations heroin/morphine caused most of the fatal poisonings in Norway and Sweden. In Denmark, heroin/morphine caused about half of the fatal poisonings only, and strong analgesics other than heroin/morphine caused about one third of the deaths. In 1984-1985 it was methadone, propoxyphene and ketobemidone and in 1991 mostly methadone. The number of heroin/morphine related deaths in Finland increased from 1984-1985 to 1991, but other drugs and poisons caused a much higher proportion of the deaths. Pentobarbital caused the only fatal poisoning in Iceland in 1991.

Topics: Adolescent; Adult; Age Distribution; Finland; Heroin; Humans; Iceland; Methadone; Morphine; Narcotics; Scandinavian and Nordic Countries; Substance-Related Disorders

To evaluate the relationship of drug use with maternal HIV culture positivity at delivery and perinatal HIV transmission.. Multicenter prospective cohort study.. Obstetric and pediatric clinics in five cities in the United States.. Five hundred and thirty HIV-infected pregnant women and their infants.. Multivariate logistic regression was used to evaluate the association of 'hard drug' use (one or more of the following: cocaine, heroin/opiates, methadone, injecting drug use) assessed by self-report and urine toxicology with positive maternal HIV culture at delivery and perinatal HIV transmission.. Forty-two per cent of women used hard drugs during pregnancy. Increased probability of a positive maternal delivery HIV culture was significantly associated with prenatal hard drug use [odds ratio (OR), 3.08] and maternal cocaine use (OR, 2.98) among HIV-infected women with > 29% CD4+ lymphocytes. After adjusting for maternal culture positivity at delivery, CD4+ lymphocyte percentage and gestational age, significantly greater transmission risk was observed with hard drug use among women with membrane rupture > 4 h.. On the basis of self-report and urine toxicology, overall maternal hard drug use and cocaine use in the WITS cohort were associated with maternal HIV culture positivity at delivery, and maternal hard drug use was associated with perinatal transmission.

Topics: Alcohol Drinking; Cocaine; Cohort Studies; Female; Heroin; HIV Infections; HIV-1; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Marijuana Smoking; Methadone; Pregnancy; Pregnancy Complications, Infectious; Prospective Studies; Smoking; Substance-Related Disorders

In October of 1995, a prevalence study of serious substance abusers was carried out in the Czech Republic. The prevalence study focused on: 1. persons hospitalized because of drug addiction as of 31.10.1995; 2. persons who visited one of the treatment/contact centres during October of 1995. Data on serious addictive substance abusers were collected from 142 treatment/contact centres. The overall prevalence in the 15-39-year age group is 30.3/100,000 inhabitants, the highest in Prague (115.0/100,000 inhabitants), followed by Northern Bohemia (34.1) and Northern Moravia (32.0). The most frequently used primary drug remains pervitin (349 users, i.e. 35.5%), followed by heroin in the second place (126, i.e. 12.9%), marihuana in the third place (94, i.e. 9.4%) and toluene in the fourth place (81, 8.1%). The 15-19-year age group is the most affected, and corresponds to 36.9% of all users. In this age category, women predominate (47.2% of all users). Heroin is equally used in the 15-19-year and 20-24-year age groups, while pervitin is used most in the 15-19-year age group, as are marihuana and toluene; the frequency of gambling increases more or less with age. Heroin is used most in Northern Bohemia (48.4%) and Prague (24.6%), and pervitin in Prague (34.7%) and Northern Moravia (18.9%). Data on injection administration of drugs, which is dangerous because of the possibility of transmission of hepatitis and HIV, confirm that almost two thirds of all users prefer this means of application. The great majority of all serious abusers are persons with only elementary schooling.

Topics: Adolescent; Adult; Age Distribution; Ambulatory Care Facilities; Czech Republic; Epidemiologic Methods; Female; Heroin; Hospitalization; Humans; Male; Narcotics; Prevalence; Sex Factors; Substance Abuse, Intravenous; Substance-Related Disorders

A sensitive and specific method for the quantitative determination of D,L-methadone (MD) and its metabolites, D,L-2-ethyl-1,5-dimethyl-3, 3-diphenylpyrrolinium (EDDP) and D,L-2-ethyl-5-methyl-3, 3-diphenyl-1-pyrroline (EMDP), in hair has been developed. Deuterated internal standards of MD, EMDP, and EDDP were added to 20-mg hair samples and digested overnight at room temperature with 1N sodium hydroxide. Calibration standards containing known concentrations of MD, EMDP, and EDDP dried onto human hair were also digested. Digest solutions were extracted by a liquid-liquid extraction procedure and analyzed with splitless injection on a Finnigan MagnumTM ion trap mass spectrometer. Chromatographic separation was achieved with helium carrier gas on a DB-5MS-30M-0.25-micron capillary column. Positive chemicaionization was used with acetone as the reagent gas. The assay was linear from 0.5 ng/mg (MD and EDDP) or 1.0 ng/mg (EMDP) to 50.0 ng/mg of human hair with correlation coefficients greater than 0.99. Intra-assay and interassay coefficients of variation were determined to be less than 20% for all three analytes at 2.0 and 10.0 ng/mg of hair. Recovery was estimated to be greater than 70% (MD and EDDP) and 53% (EMDP) at 2.0 and 10.0 ng/mg of hair. The method has been applied to the analysis of both human and rat hair. Male long-Evans rats were shaved prior to dosing to obtain their drug-free hair. Animals were then administered 15 mg/kg MD by intraperitoneal injection daily for five days. Fourteen days after the first dose, hair was collected and analyzed for MD, EMDP, and EDDP. The mean plus standard error of the mean (SEM; n = 3) concentrations of MD and EDDP in pigmented hair were 31.1 ng/mg +/- 9.6 ng/mg and 8.6 +/- 2.4 ng/mg, respectively. EMDP was detected in the hair of one of three rats. In another experiment, hair was collected from two human subjects who had received long-term methadone therapy for the treatment of heroin addiction. Subject A received 60 mg of methadone daily for at least six months; subject B received 80 mg of methadone daily for at least six months. The hair concentrations of MD were 10.1 ng/mg and 21.0 ng/mg for Subjects A and B, respectively. The hair concentrations of EDDP were 0.5 ng/mg and 2.6 ng/mg for Subjects A and B, respectively. EMDP was not detected in the hair of these two subjects. This method is being used to evaluate the incorporation of MD, EMDP, and EDDP in human and rat hair in dose-response studies.

Topics: Animals; Calibration; Deuterium; Dose-Response Relationship, Drug; Female; Gas Chromatography-Mass Spectrometry; Hair; Heroin; Humans; Isotope Labeling; Male; Methadone; Narcotics; Pyrrolidines; Rats; Reference Standards; Sodium Hydroxide; Substance-Related Disorders

Previous studies have described sleep disturbance secondary to chronic opiate use and abuse. Drug-dependency insomnia is of interest because chronic sleep disturbances can promote depressive symptoms which could lead to a drug relapse. For the first time we compared the polysomnographic parameters of 10 methadone-substituted outpatients and 10 naltrexone-treated outpatients. Methadone (mu-opioid agonist) produced a marked fragmentation of the sleep architecture with frequent awakenings and a decrease in EEG arousals. In comparison with methadone and controls, the naltrexone (mu-opioid antagonist) group showed the shortest sleep latency and the longest total sleep time. These data indicate that mu-agonists and mu-antagonists have different effects on sleep. The implications, especially the involvement of opioid-dopamine interactions on sleep and movements during sleep, are discussed.

Topics: Adult; Analgesics, Opioid; Female; Heroin; Humans; Male; Methadone; Naltrexone; Narcotic Antagonists; Sleep; Substance-Related Disorders

The combination of severe hypothermia and noncardiogenic pulmonary edema secondary to an opiate overdose is presented. This case emphasizes the importance of ventilatory support and rewarming techniques available in the emergency department setting.

Topics: Drug Overdose; Heroin; Humans; Hypothermia; Male; Pulmonary Edema; Substance-Related Disorders

Topics: Cocaine; Heroin; Humans; Research Support as Topic; Substance-Related Disorders

Cocaine, mainly in the form of crack, continues to dominate New York City's illicit drug scene. Trends in cocaine-involved deaths, hospital emergencies, arrest and treatment admissions are reviewed from the late 1980s to the early 1990s. Also, street studies conducted at drug coping areas throughout New York City during this period yield ethnographic insights. At the same time that cocaine trends were showing increases in the 1990s, heroin trends and marijuana trends were also showing decisive increases. An upsurge in heroin activity may be directly related to cocaine activity. Heroin's ameliorative effects for the cocaine user are the most direct association. The sequence-first cocaine, then heroin-has been documented by historians in the field. The association between cocaine trends and marijuana trends is less direct, and may represent the substitution of or a retreat to marijuana, a drug that is perceived as much safer.

Topics: Cocaine; Crack Cocaine; Epidemiology; Heroin; Hospitalization; Humans; Marijuana Abuse; New York City; Substance-Related Disorders

Twenty-three methadone-maintained individuals seeking admission into a cocaine study were interviewed using the Pattern-of-Drug-Use assessment. Sample characteristics included: 96% male, 91% Caucasian, and 36 +/- 5 mean years of age. Mean methadone dose was 81 +/- 20 mg. On average, subjects reported using greater than $200 or 5 grams of cocaine per week. "Binge/crash" cocaine use did not appear to be the typical pattern of use. However, during daily periods of cocaine use, repeated injections of large amounts of cocaine were taken, which may place patients at risk for medical complications. These findings emphasize the importance of developing novel treatment strategies to treat these dually-addicted individuals.

Topics: Adult; Alcoholism; Cannabis; Cocaine; Female; Heroin; Humans; Male; Methadone; Narcotics; Substance-Related Disorders; Time Factors

Drug abuse has been controversially linked to polyarteritis nodosa. A 28-year-old man with a history of drug abuse with inhaled heroin presented with an enigmatic illness consisting of refractory fever, bilateral pleural effusions, migratory polyarthritis, and a leukaemoid reaction. An abdominal angiography confirmed the diagnosis of polyarteritis nodosa, and treatment with both prednisone and cyclophosphamide resulted in significant clinical and laboratory improvement.

Topics: Adult; Anti-Inflammatory Agents; Antirheumatic Agents; Cyclophosphamide; Drug Therapy, Combination; Heroin; Humans; Male; Polyarteritis Nodosa; Prednisone; Substance-Related Disorders

Since the beginning of the 'Janus' opiate project in Basel in which severely opiate-dependent persons are treated intravenously with heroin, morphine or methadone 11 from 160 participants (to november 1995) were treated in the withdrawal and intervention unit at the psychiatry clinic of the university of Basel. 7 patients sought a total, 4 a partial withdrawal. Whereas the 4 patients wanting withdrawal from consumption of drugs in addition to study drugs all reached their goal 4 of the 7 persons aiming at total withdrawal interrupted treatment prematurely. The 3 patients who were successful are-as far as the authors know-still off opiates. Substitution of intravenous opiates provided by 'Janus' with oral methadone and slow tapering off of the latter over days to weeks occurred mostly without problems. Participants of the 'Janus' project thus desired a withdrawal oriented treatment with equal frequency and had not less success than persons substituted with oral methadone in achieving this goal.

Topics: Adult; Female; Heroin; Humans; Injections, Intravenous; Male; Methadone; Morphine; Substance Abuse Treatment Centers; Substance-Related Disorders; Treatment Outcome

We report on two patients with severe rhabdomyolysis and peripheral nerve involvement after drug intoxication. Nerve conduction studies of the paretic extremities of both patients could be performed within 12 h of the onset. Several nerves revealed evidence of conduction blocks in the paretic extremities. One of the patients who had taken heroin died and postmortem examination was performed. A drug-induced immune vasculitis could not be demonstrated. Besides striated muscle necrosis, extensive myocardial fragmentation was shown. Territorial ischemia, resulting from systemic hypotension and mechanical compression of arteries, seems to have been the cause of the myonecroses and peripheral nerve damage in the unconscious patients.

Topics: Adolescent; Adult; Cannabinoids; Ethanol; Fatal Outcome; Female; Flunitrazepam; Heart Arrest; Heroin; Humans; Illicit Drugs; Ischemia; Leg; Male; Muscle, Skeletal; Neurologic Examination; Peripheral Nerves; Psychotropic Drugs; Rhabdomyolysis; Substance-Related Disorders; Synaptic Transmission

The Dutch policy on drugs has yielded positive results from the public health point of view. Drug related nuisance, however, is an enduring problem and society's acceptance of this nuisance is diminishing. This article discusses the concept of drug-related nuisance and addresses the question how this nuisance can be measured. Next to it, attention is paid to the question whether the so-called Dutch "harm reduction policy" will survive.

Topics: Crime; Drug Prescriptions; Health Policy; Heroin; Legislation, Drug; Netherlands; Public Health; Public Opinion; Social Problems; Substance-Related Disorders

This analysis examines the use of heroin by 481 adolescents in Dade County, Florida public schools during 1992. Statistically significant factors which tend to increase the probability of heroin use by adolescents include: peer use of heroin and students' involvement in school clubs. Not significantly related to heroin use is their access to the drug, their ethnic background or race, and their gender. Although not statistically significant, adolescents were more likely to use heroin if they knew of the risks associated with heroin use. There are no statistically significant variables which inhibit the rise of heroin by Miami adolescents. When religion was an important part of their lives, they were at lower risk for heroin use, but this was not significant. Also not significantly related to heroin use are a number of other variables, including family-related variables (whether adolescents live with their mothers, fathers, or alone: and whether someone in the family has a problem with drugs or alcohol). Similarly, early cigarette smoking and alcohol rise did not serve as gateways to later heroin use. Academic performance, and extracurricular school activities (athletics, music, and other activities) were all unrelated to the use of heroin by adolescents, with the exception of involvement in school clubs which substantially increased the risk of heroin use.

Topics: Adolescent; Data Collection; Florida; Health Surveys; Heroin; Humans; Parents; Peer Group; Religion; Risk-Taking; Schools; Students; Substance-Related Disorders

During January-November 1995, a total of 19 laboratory-confirmed cases of wound botulism were reported to the California Department of Health Services (CDHS); of these, 13 had occurred since August. Since 1990, the number of wound botulism cases reported annually in California has increased steadily (one case in 1990, two in 1991, three in 1992, four in 1993, and 11 in 1994). All cases except one since 1991 have occurred in injecting-drug users, and many involved subcutaneous injection or "skin popping" of black tar heroin. This report summarizes the findings of the investigation of two cases.

Topics: Adult; Botulism; Clostridioides difficile; Female; Heroin; Humans; Injections, Subcutaneous; Male; Pregnancy; Substance-Related Disorders; Wound Infection

A regional survey on peoples' attitudes towards drugs was conducted in the fall of 1992 on 2500 individuals aged 14-70 years. The great majority of those surveyed considered the taking of heroin (98%), cocaine (95.9%) and amphetamines (94.7%) to be "very risky" for one's health. These percentages were considerably lower in the case of tobacco (41.3%) and alcohol (26.7%). Those surveyed pointed to 'heroin' (35.6%), 'all illegal drugs' (27%), 'legal drugs' (17.2%) and 'cocaine' (14.2%) as the most dangerous drugs for society. The study shows how alcohol and tobacco are perceived by Spaniards as less dangerous than illegal drugs.

Topics: Adolescent; Adult; Aged; Alcohol Drinking; Cocaine; Female; Heroin; Heroin Dependence; Humans; Illicit Drugs; Male; Middle Aged; Psychotropic Drugs; Public Opinion; Smoking; Social Problems; Substance-Related Disorders

Abuse of cocaine-opiate combinations ("speedballs") reported clinically was simulated in a rhesus monkey model of simultaneous cocaine and heroin self-administration. The reinforcing effects of nine cocaine-heroin combinations (cocaine [0.001, 0.01 and 0.10 mg/kg per injection i.v.] and heroin [0.0001, 0.001 and 0.01 mg/kg per injection i.v.]) were evaluated for 10 days on a second-order fixed ratio of 4 (variable ratio of 16:S) schedule and compared with self-administration of cocaine and heroin alone. Dose-effect curves for cocaine-heroin combinations usually were similar to those for cocaine and heroin alone, and intermediate doses maintained equivalent high levels of drug self-administration. No toxic effects were observed. In drug discrimination studies, cocaine (0.004-1.3 mg/kg) substitution resulted in a dose-dependent generalization to the training dose (0.4 mg/kg i.m.) in all five monkeys. Heroin substitution (0.01-1.0 mg/kg i.m.) resulted in dose-dependent and complete generalization to cocaine in three of five monkeys. Heroin pretreatment (0.1-0.18 mg/kg i.m.) did not change the cocaine discrimination dose-effect curve. Pretreatment with an opiate antagonist, quadazocine (0.1 mg/kg i.m.), had no effect on the discriminative stimulus effects of cocaine but antagonized the cocaine-like discriminative stimulus effects of heroin. Pretreatment with a dopamine antagonist, flupenthixol (0.018 mg/kg), antagonized the discriminative stimulus effects of cocaine but did not affect the cocaine-like effects of heroin. These findings demonstrate the feasibility of maintaining self-administration of cocaine-heroin combinations and suggest that cocaine and heroin have similar reinforcing and discriminative stimulus effects in rhesus monkeys.

Topics: Animals; Azocines; Cocaine; Discrimination Learning; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Combinations; Food; Heroin; Macaca mulatta; Male; Narcotic Antagonists; Narcotics; Self Administration; Substance-Related Disorders

Topics: Health Promotion; Heroin; Humans; Methadone; National Health Programs; Substance-Related Disorders

The purpose of this study was to evaluate the role of ethanol in deaths due to heroin intoxication. Over a 12 month period, all cases investigated by the Office of the Chief Medical Examiner, State of Maryland where a blood screen by Roche Abuscreen radioimmunoassay (RIA) was positive at a cutoff of 100 ng/mL were included in the study. Free morphine was quantitated using the Coat-A-Count RIA and ethanol was quantitated by head space gas chromatography. All presumptive morphine positive cases were confirmed by gas chromatography/mass spectrometry. Seventy of the 119 cases where death was attributed to narcotic or alcohol and narcotic intoxication had blood ethanol concentrations (BAC) greater than or equal to 0.02 g/dL; 48 had BAC > or = 0.10 g/dL. Only 3 of 45 cases where morphine was identified but was unrelated to death had BAC > or = 0.02 g/dL. At all ranges of free morphine concentrations, there was a greater percentage of narcotic deaths when ethanol was present. From the data, we conclude that 1) the use of even small amounts of ethanol with heroin is clearly a risk factor in deaths due to heroin, 2) there are some heroin deaths where no free morphine is identified in the blood. In these deaths, ethanol is unlikely to be present, 3) at blood ethanol concentrations between 0.20 and 0.29 g/dL, the morphine concentrations in heroin deaths increased significantly, 4) at blood ethanol concentrations greater than 0.30 g/dL, morphine became less of a factor than the ethanol in causing death.

Topics: Alcoholic Intoxication; Cause of Death; Chromatography, Gas; Drug Overdose; Ethanol; Heroin; Humans; Morphine; Radioimmunoassay; Risk Factors; Substance-Related Disorders

The purpose of this review of all appropriate, available medical examiner (ME) studies is to provide information on cases with positive toxicologies for cocaine, morphine (the heroin metabolite) and methadone that have positive blood or brain alcohol concentrations (BACs).. Criteria for inclusion of U.S. ME studies in this review are (1) at least 20 cases with a positive toxicology for cocaine, morphine or methadone and (2) BAC test findings according to specific drug positivity. Only 19 studies conducted from 1969 to 1992 met these criteria; most studies reviewed were not included primarily because of their failure to present or link available BAC test findings with positive toxicologies for these other drugs.. The BAC-positive ranges were similar for cocaine and heroin. In reports on both heroin and methadone or on all three drugs, heroin-positive cases had the highest proportions and methadone-positive cases had the lowest proportions with positive BACs.. Published data confirm the substantial presence of alcohol in combination with cocaine, heroin and methadone among ME cases. Future ME studies should endeavor to link BAC and toxicology findings for other drugs according to drug-induced or drug-related manner of death. These data would advance our knowledge about the role of alcohol in drug deaths and provide additional information on substance abuse trends.

Topics: Adolescent; Adult; Aged; Alcoholism; Cause of Death; Child; Cocaine; Comorbidity; Coroners and Medical Examiners; Ethanol; Female; Heroin; Heroin Dependence; Humans; Male; Methadone; Middle Aged; Substance-Related Disorders; United States

This study was conducted to investigate the relationship between the indicators of psychiatric disorders of individuals and their choice of either cocaine or heroin, drugs that differ markedly in their pharmacological effects. Cocaine acts as an intense stimulant, and heroin has profound sedative effects. This investigation examined the relationship between preference for heroin or cocaine and indicators of psychiatric impairment. Data from 282 subjects were grouped according to drug of choice and analyzed. Ninety-three percent of these subjects were African-American, 32% were female, and the average age was 34. Univariate and multivariate statistical analyses, such as discriminant analyses, were used to determine group differences. The results are evaluated and interpreted in relation to both the current empirical findings and to the hypotheses and theories postulated as a result of earlier clinical observations on drug of choice and psychopathology. Discriminant analysis yielded an overall correct classification rate of 75%. The discriminant function suggests that members in the cocaine drug of choice group as contrasted with members in the heroin preference group can be characterized as more socially inhibited and more self-defeating after adjusting for differences in age, duration of use of illicit substances, and marital status. Those who favored cocaine as contrasted with those who favored heroin were more likely to have never married, be younger, and have used illicit substances for a shorter period of time.

Topics: Adult; Age of Onset; Cocaine; Female; Heroin; Humans; Illicit Drugs; Male; Mental Disorders; Personality Disorders; Substance-Related Disorders

Topics: Health Surveys; Heroin; Hospitalization; Humans; Marijuana Abuse; Students; Substance-Related Disorders

Self-administration of drugs by different intravenous routes may induce a reduction in the organic complications of drug addiction (DA). The aim of this study was to evaluate the changes in the way of drug administration in a series of DA individuals in the province of Cádiz, Spain, and the evolution of the frequency of infection by the human immunodeficiency virus (HIV) in these patients.. The reports of all the drug users from the province of Cádiz admitted to the Detoxication Unit of the Hospital Punta de Europa in Algeciras, from January, 1989 to July, 1993 were reviewed. At the time of admission many data were evaluated, fundamentally the main route of drug administration, and anti-HIV seropositivity.. Seven hundred ten drug users were included in the study. Ninety-seven percent used mainly heroin. The route of drug administration on admission was intravenous in 56.1%, pulmonary in 39.7%, inhalatory in 3.2% and oral in 0.8%. Forty-one point seven percent patients were seropositive for HIV. The frequency of the use of the intravenous route throughout the semesters analyzed was I/89: 85.7%, II/89: 89.6%, I/90: 80%, II/90: 80.8%, I/91: 59.8%, II/91: 50%, I/92: 44.9%, II/92: 39%, I/93: 34.3% (p < 0.00001). The use of the respiratory route significantly increased. The percentage of anti HIV positivity in the drug users evaluated was 67.4, 80.8, 56.4, 46.9, 40.7, 34.1, 30.6, 36.3, 23.2% (p < 0.00001), respectively for the same periods. The decrease in the use of the intravenous route and the reduction in anti HIV seropositivity demonstrated a correlation coefficient of 0.91 with a confidence interval from 0.62 to 0.98 (p < 0.05).. The decrease, over time, in the use of the intravenous route for heroin administration in the collective analyzed was significantly associated with a decrease in HIV infection in these patients.

Topics: Adult; Drug Administration Routes; Female; Heroin; Heroin Dependence; HIV Infections; Humans; Male; Substance-Related Disorders

Topics: Heroin; Humans; Male; Middle Aged; Sensation Disorders; Substance-Related Disorders; Ulnar Nerve

To explore the proportion and characteristics of adolescents who use illicit drugs and contrast them with adolescents who do not use such drugs in Switzerland. To facilitate the detection of adolescents with drug related difficulties.. We used data from a national survey on adolescent health in Switzerland (N = 9,273) conducted in 1992 and 1993. The survey is based on self-administered questionnaires among a representative sample of adolescents enrolled in schools and apprenticeship programs. We used exploratory analysis for identifying characteristics which set the drug user apart from non-users and performed confirmatory multivariate logistic regression analysis to examine which variables remain independently associated with heroin or cocaine use.. In Switzerland, 3.1% of adolescents have taken heroin or cocaine at least once in their life, and 27.7% have already used cannabis. Analysis of lifestyles and health of adolescents show that young drug users present difficulties in integrating in society, have health problems and difficulties in relationships, situations which tend to be less common among other adolescents. Yet, they also display marked similarities, most notably in that over 70% had seen a physician in the past year. However, while 40% of the drug users expressed a need for help with drug related problems, only 6% had actually talked about them with a physician. Characteristics that remained independently associated with heroin and cocaine use after controlling for confounding factors were age, sex, nationality, type of education, feelings of suicide, past and present smoking, and use of cannabis.. The level of illicit drug use among Swiss adolescents is high compared to other European countries but lower than the United States. Drug-using adolescents display a constellation of characteristics which should make it possible to identify them and offer help. Yet, even though they may have frequent contact with the health services, their drug problems are generally not recognized by the gatekeepers of the health services and no specific aid is available to them. Drug prevention must be intensified and medical doctors sensitized to the drug problems which adolescents may face.

Topics: Adolescent; Adolescent Behavior; Adult; Cannabis; Cocaine; Female; Health Status; Health Surveys; Heroin; Humans; Illicit Drugs; Logistic Models; Male; Multivariate Analysis; Patient Acceptance of Health Care; Risk Factors; Risk-Taking; Substance-Related Disorders; Switzerland

Drug abusers, particularly those who inject drugs s.c. ("skin popping"), may develop amyloidosis. Chronic infections are thought to play a pathogenetic role in this setting. A patient is presented who had a history of "skin popping" cocaine and heroin and developed nephrotic syndrome, with an elevated serum creatinine and a creatinine clearance of 61 mL/min. Renal biopsy demonstrated amyloidosis. Treatment with colchicine was initiated, and proteinuria decreased to near normal levels after 12 months. Concomitant with the decrease in proteinuria, creatinine clearance improved, although a repeat renal biopsy failed to show any significant improvement in amyloid burden. These observations suggest that colchicine may be a useful treatment in reversing the proteinuria of renal amyloidosis associated with drug abuse. Furthermore, clinical improvement may occur before any demonstrable regression in the amyloidosis.

Topics: Adult; Amyloidosis; Cocaine; Colchicine; Female; Heroin; Humans; Injections, Intravenous; Kidney Diseases; Substance-Related Disorders

Based on surveys and clinical data, it is concluded that the use of illegal drugs is spreading in Hungary. The social composition of drug users is changing and new forms of drugs and uses have appeared, such as heroin use and cocaine snorting. The legal regulation of access to drugs changed in 1993: stricter sentences can be imposed on drug traffickers, while the possibility has been created for drug users to undertake therapy in place of punishment. The Interministerial Committee on Drug Affairs and the Hungarian Association on Drug Use and Addiction have been set up. There are a few scientifically-based prevention programs. A number of clear paradigms have emerged in prevention policy and therapy, although it is not yet possible to see which of these will be confirmed by time and practice.

Topics: Cocaine; Heroin; Humans; Hungary; Legislation, Drug; Substance Abuse Treatment Centers; Substance-Related Disorders

This work studies the distribution of cocaine and heroin metabolites in hair and urine of living polidrug abusers. Cocaine, benzoylecgonine (BEG), ecgonine methyl ester (EME), morphine, codeine and 6-monoacetylmorphine (6-MAM) were simultaneously extracted and analyzed by GC/MS in SIM mode. The results obtained show a different distribution of heroin and cocaine metabolites in urine and hair. In urine, we generally find BEG and EME for cocaine abuse, and morphine for heroin abuse. In hair, we detect cocaine and MAM as major metabolites for cocaine and heroin abuse, respectively.

Topics: Cocaine; Codeine; Gas Chromatography-Mass Spectrometry; Hair; Heroin; Humans; Morphine; Morphine Derivatives; Narcotics; Substance-Related Disorders

Segmental hair analysis was performed to obtain information about the history of drug abuse of subjects in a rehabilitation programme. The analytical data from hair samples were correlated, when possible, with urine analysis and to toxicological anamnesis. Toxicological analysis of hair seems to be a valid tool in this specific field.

Topics: Cocaine; Female; Hair; Heroin; Humans; Methods; Substance-Related Disorders

Topics: Australia; Heroin; Humans; Methadone; Substance-Related Disorders

All heroin addicts who registered for methadone treatment in Albuquerque in 1969-1971, 1019 in all, were the subjects of this follow-up study, conducted in 1991-1993. The cohort was almost entirely of Hispanic (Chicano) ethnicity, 86% male, with median age 27 at entry. We located 776, dead or alive, and we were able to interview 243 concerning many aspects of their lives. At least one-third of the original group had died during the 22-year period, representing standard mortality ratios 4.0 for males and 6.8 for females. Drug overdose, violence, alcohol, or suicide accounted for nearly all deaths of which the causes were known. Despite the availability of treatment, including methadone maintenance, both heroin use and criminality continued at a high rate. Of the 428 known survivors, 48% were currently enrolled in a methadone program after 22 years. They were using significantly less heroin, alcohol, and other drugs (except nicotine) than those not on methadone. Similar beneficial effects of methadone maintenance were reported retrospectively at interview. Our findings offer an insight into heroin addiction as a chronic lifelong relapsing disease with a high fatality rate.

Topics: Adolescent; Adult; Crime; Female; Follow-Up Studies; Heroin; Humans; Interview, Psychological; Male; Methadone; Middle Aged; New Mexico; Retrospective Studies; Substance-Related Disorders; United States

Recent cross-sectional studies have indicated that inhalant use might be a vulnerability marker for the development of heroin use. This study is the first prospective investigation of the hypothesized association between early inhalant use and later heroin use. Analyses were conducted using longitudinal data from a community sample of Woodlawn (an all African American community on the South side of Chicago). Six-hundred subjects participated in both the adolescent and the adult assessments (approximately ages 16 and 32, respectively). Youths with a history of inhalant use by age 16 were over nine times more likely to begin heroin use by age 32, even when other plausible risk factors for the development of heroin use were held constant (RR = 9.3; 95% C.I. = 1.3 - 51.3). These findings add to and are consistent with prior cross-sectional evidence from data based on treatment samples and national survey data. The results from this longitudinal assessment support the idea that youthful inhalant use should be regarded as a vulnerability marker for the development of more serious drug use involvement in the form of heroin use.

Topics: Administration, Inhalation; Adolescent; Adolescent Behavior; Adult; Female; Heroin; Humans; Longitudinal Studies; Male; Prospective Studies; Substance-Related Disorders

Comprehensive investigation is necessary for determining the cause of death in cases with positive drug screens. We investigated the case of a male who reportedly expired from an acute asthma attack. He had limited access to both therapeutic drugs and drugs of abuse because he was a state prisoner. His autopsy was remarkable because the weights of his right and left lungs were 690 and 760 g, respectively. His upper airway was clear of debris. There was an abundant amount of blood and frothy fluid in the pulmonary parenchyma. There were no focal lesions. The pulmonary vasculature was unremarkable. Microscopic evaluation of the lung tissue showed that the bronchi contained dense inflammatory infiltrates consisting mostly of eosinophils and a few lymphocytes and plasma cells. Basement membrane thickening was evident in the bronchi, and mucous plugs were identified in some of the bronchial lumina. A morphine concentration of 80 ng/mL was found in the blood. Theophylline and albuterol were detected in trace amounts. The opinion of the coroner was that the patient died of an acute asthma attack, and the presence of morphine may have contributed to his death. A careful review of his medical history and the mechanisms of drug-induced asthma revealed that the etiology of his death was more likely due to heroin abuse and noncardiogenic pulmonary edema. Episodic exacerbations of his chronic asthma were a contributing factor in his demise. However, in and of itself, asthma was not responsible for his death. Pertinent information associated with this case is presented, along with additional findings of toxicological screens and other evidence demonstrating that his asthma treatment did not contribute to his death. In addition, opiate-induced asthma, as well as other drug-induced diseases that can contribute to mortality in patients who abuse narcotics, is reviewed.

Topics: Administration, Inhalation; Adult; Albuterol; Asthma; Fatal Outcome; Heroin; Humans; Lung; Male; Morphine; Pulmonary Edema; Rhinitis, Allergic, Perennial; Substance-Related Disorders; Theophylline

In Switzerland, harm-reduction programs have the support of the national government and many localities, in congruence with much of the rest of Europe and in contrast with the United States, and take place in public settings. The threat of AIDS is recognized as the greater harm. This paper describes the overall national program and highlights the experience from one city; the program is noteworthy because it is aimed at gathering comparative data from controlled trials.

Topics: Drug and Narcotic Control; Drug Prescriptions; Health Policy; Heroin; Humans; Methadone; Morphine; Narcotics; Substance Abuse, Intravenous; Substance-Related Disorders; Switzerland

Urinary selenium (Se) concentrations (micrograms Se/l and microgram Se/g creatinine) have been determined in heroin abusers and in healthy controls. Heroin abusers showed significantly (P < 0.050) lower urinary Se concentrations (microgram Se/l and microgram Se/g creatinine) than healthy controls. The decrease of the urinary Se concentration (microgram Se/g creatinine) observed with the increase in age of heroin abusers may be due to the higher exposure to heroin with increased age. No significant differences (P > 0.100) of urinary Se concentrations (both as microgram Se/l and microgram Se/g creatinine) are observed between heroin abusers during methadone treatment and heroin abusers who have stopped taking the drug, with respect to healthy controls.

Topics: Adult; Creatinine; Heroin; HIV Antibodies; Humans; Methadone; Selenium; Substance-Related Disorders; Urine

Substance abuse is associated diagnostically with existing depression, pathological mourning of the traumatic event itself, with the inevitable experience of object loss, and loss of love. Inability to form object representation insures primitive lack of object constancy, resulting in pre-oedipal longing and neediness and malignant affect. Ambivalence towards the sadistic love objective is recognized and allows for a healthier, more complete period of mourning (Freud, 1917). Indeed, depression is banished from family acknowledgement in the service of homeostatic denial. This only reinforces the identified patient's feeling of unreality, shame and guilt over verbalizing the depression and the frequent underlying traumatic history. The enormous role of socio-economic stress is pervasive, yet the focus here is on individuals with complex dynamic constellations which are often ignored in the face of external factors. Addiction as attempt to self-medicate depression and trauma remains the overarching theme.

Topics: Adult; Depressive Disorder; Female; Heroin; Humans; Psychoanalytic Therapy; Substance Withdrawal Syndrome; Substance-Related Disorders

Hair samples were obtained from 14 subjects admitted 2 or 3 months previously to a detoxification center. All reported an history of intravenous heroin abuse. After decontamination by two dichloromethane washes, about 50 mg hair were pulverized in a ball mill and incubated at 56 degrees C overnight in 1 mL 0.1 HCl. After neutralization, buprenorphine analyzed by RIA was in the range of 0.01 to 0.47 ng/mg. To confirm buprenorphine, liquid chromatography was used. After neutralization, drugs were extracted with toluene at pH 8.5 during a 3-step extraction procedure. A portion of the reconstituted residue was injected into a Lichrosorb CN column, with a mobile phase of phosphate buffer (pH 4.0)-acetonitrile-1-heptane sulfonic acid-butylamine (85:17:2:0.01, v/v). Detection was achieved by coulometry, and the potential of the electrodes was 0.15 and 0.50 V, respectively. Linear calibration curves were obtained from 0.02 to 2.0 ng/mg with a correlation coefficient r > 0.99 for both drugs. The detection limit for the major metabolite was about 0.01 ng/mg and 0.02 ng/mg for buprenorphine, using a 50 mg hair sample. Recovery (at 0.2 ng/mg) was 54 and 62% for norbuprenorphine and buprenorphine, respectively. Drugs concentrations in hair were in the range 0.02-0.59 and not detected--0.15 ng/mg for buprenorphine and norbuprenorphine, respectively. Results suggest that a dose-response relationship exists between the concentration of buprenorphine in hair and the administered dose.

Topics: Adult; Buprenorphine; Calibration; Chromatography, High Pressure Liquid; Dose-Response Relationship, Drug; Female; Hair; Heroin; Humans; Male; Mass Spectrometry; Radioimmunoassay; Substance Abuse Detection; Substance-Related Disorders

Topics: Buprenorphine; Clinical Trials as Topic; Heroin; Heroin Dependence; Humans; Methadone; Narcotics; Quality of Life; Social Support; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors

Topics: Heroin; Humans; Methadone; Substance-Related Disorders; United Kingdom

In clinical or forensic practice there are few studies assessing which risk factors are associated with heroin overdoses. A series of 76 consecutive non-fatal heroin overdoses were compared to 22 consecutive subjects who self-injected heroin within 1 h before admission to the emergency room. Whereas blood levels of alcohol and IgE and urinary cocaine metabolite levels were similar in both groups, higher benzodiazepine plasma levels were detected in the heroin overdose group. The assessment of methadone, dextropropoxyphene, amphetamines and cannabis in urine analysis did not show differences between both groups. The interview revealed that only 48% of subjects in the heroin overdose group self-administered the last dose of heroin before admission in the usual setting as compared to 100% of subjects in the non-overdose group. The application of a log-linear regression model identified self-injection of heroin in an unusual place and plasma concentrations of total morphine and benzodiazepines as risk factors for heroin overdose.

Topics: Adolescent; Adult; Anti-Anxiety Agents; Benzodiazepines; Drug Overdose; Ethanol; Female; Heroin; Heroin Dependence; Humans; Male; Morphine; Psychotropic Drugs; Risk Factors; Social Environment; Substance Abuse Detection; Substance Abuse, Intravenous; Substance-Related Disorders

We report on 2 road accidents where 4 people--drivers and front-seat passengers--were injured so badly that they consequently died. All four had consumed heroin, in addition to which both passengers had also consumed cocaine and dihydrocodeine respectively. The blood samples of one of the drivers was only taken after the onset of intensive medical treatment including infusions and transfusions. Nevertheless the result of the analysis clearly showed that the driving ability had been impaired by heroin. In the remaining cases the opiat concentrations were so high that they could have justified a fatal intoxication in themselves. This applies especially to one of the passengers who displayed an unconjugated morphine blood concentration of 0.96 m/l. However, also in this case at the time of the accident the blood circulation and heartbeat did not stop immediately.

Topics: Accidents, Traffic; Cause of Death; Cocaine; Codeine; Fatal Outcome; Heroin; Heroin Dependence; Humans; Morphine; Substance-Related Disorders

Topics: Adult; Body Weight; CD4-Positive T-Lymphocytes; Cocaine; Female; Heroin; HIV Infections; Humans; Substance-Related Disorders

A prospective longitudinal study on the development of children of drug-dependent mothers who used combinations of cocaine, heroin and methadone during pregnancy was carried out in Amsterdam. The children and a contrast reference group were followed from birth to the age of 5 1/2 years. Cognitive functioning was assessed at 3 1/2, four, 4 1/2 and 5 1/2 years. The children of drug-dependent mothers repeatedly showed delays in cognitive functioning at preschool-age. Individual difficulties, as well as differences in developmental patterns over time, were found most clearly when facets of language development formed part of the assessments. Intervention programmes should focus on improvements of early language development and communication, in addition to the children's ability to adapt to task situations.

Topics: Child, Preschool; Cocaine; Cognition; Female; Heroin; Humans; Infant; Infant, Newborn; Language; Male; Methadone; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Prospective Studies; Psychological Tests; Risk Factors; Social Support; Substance-Related Disorders

In the period 1987-1991 a total of 739 fatalities among drug addicts was investigated at the three University Institutes of Forensic Medicine in Denmark. The annual number rose from 130-140 in the first 4 years to 192 in 1991, and 80% were males. The mean and median age for both males and females increased by 1 year in the period. The main drug of abuse was heroin, in most cases supplemented by various other drugs, and in almost all cases taken intravenously. In about one-third of the cases each year there was information of abuse of alcohol in addition. In the poisoning cases, the main drug of poisoning was morphine/heroin, constituting 35-55% of the cases each year. As regards methadone-poisoning cases, the number increased significantly in 1991 compared to the first 4 years. Furthermore, the number and proportion of addicts dying while in methadone treatment increased during the 5-year period. In about half of the methadone poisoning cases, there was information of methadone treatment at the time of death. The other half obviously obtained the methadone completely illegally. Ketobemidone was the third most frequent drug of poisoning, while propoxyphene and barbituric acid only were found in a very few cases each. The results are compared to those from an earlier investigation concerning drug deaths in Denmark in 1968-1986. The importance of registering drug deaths is emphasized.

Topics: Adolescent; Adult; Alcoholism; Amphetamine; Analgesics, Opioid; Barbiturates; Cannabis; Cause of Death; Denmark; Dextropropoxyphene; Female; Heroin; Humans; Male; Meperidine; Methadone; Morphine; Substance-Related Disorders; Suicide; Survival Rate

Fifty-nine persons addicted to heroin and maintained by methadone reported on daily heroin and cocaine use during 2 timeline calendar interviews administered 6 weeks apart. Retrospective reports covering 6 months were compared with urine samples taken weekly during the interval. Test-retest correlations were high and timeline estimates of drug use frequency were significantly correlated with the frequency of drug-positive urine results. Thus, timeline reports of drug-use frequency appeared both reliable and valid. Individual participants either over- or under-reported by an average of about 15%, and they did not identify instances of drug use with greater than chance accuracy when particular episodes of drug use occurred. These results support the use of timeline reports to make group comparisons of long-term drug use, but suggest that timeline data should not be used to identify specific drug-use episodes. Work with other drug-use population is necessary to extend these conclusions.

Topics: Adult; Cocaine; Female; Heroin; Humans; Male; Methadone; Middle Aged; Reproducibility of Results; Retrospective Studies; Self Disclosure; Substance-Related Disorders

Pulmonary oedema lasting six days occurred in a 68 year old man after sniffing cocaine. He also had evidence of parenteral self-administration of heroin. Pulmonary microvascular filtration pressure and permeability were normal. Delayed resolution of the pulmonary oedema may have been caused by a cocaine-induced impairment of sodium and thus fluid transport across alveolar epithelium. Recognition may be important, since lowering filtration pressure with diuretics may not hasten resolution of oedema.

Topics: Aged; Cocaine; Heroin; Humans; Lung; Male; Pulmonary Edema; Radiography; Substance-Related Disorders; Time Factors

We report a 23 years old woman exhibiting localized chronic venous insufficiency of the forefeet after cocaine and heroin application into the foot veins. The diagnosis was confirmed by capillaroscopy (characteristic microangiopathy).

Topics: Adult; Cocaine; Female; Forefoot, Human; Heroin; Heroin Dependence; Humans; Substance Abuse, Intravenous; Substance-Related Disorders; Venous Insufficiency

This paper reports the DHE substitution clinical trial in 38 heroin addicts. The CINA (Clinical Institute Narcotic Assessment) scale was used to assess physical dependence potential. The CINA scale contains 10 opioid withdrawal signs (nausea, vomiting, gooseflesh, sweating, restlessness, tremor, larcrimation, nasal congestion, yawning, changes in heart rate and systolic blood pressure) and 3 opiate withdrawal symptoms (abdominal pain, muscle pain and feeling hot or cold). For each subject admitted to the Drug Detoxification and Treatment Center his (her) status on each of the 13 items of CINA were immediately rated. Then, naloxone 0.4 mg was injected iv to precipitate withdrawal symptoms and at 5, 10, 15 min after the naloxone injection, the CINA score of each patient was rated again. The differences among the scores of pre- and post-naloxone injection is a measurement of the degree of withdrawal symptoms. Then, a single dose of DHE was administered sublingually to each patient, all withdrawal symptoms disappeared. These results show that DHE can compete with naloxone for opioid receptors. A good dose-response relationship was found between the 100% suppressive withdrawal sign doses of DHE and the degree of withdrawal sign in heroin addicts. The physical dependence potential of DHE given to heroin addicts sublingually was probably more than that of methadone given to heroin addicts orally by making reference to the report of Dr. Peachy.

Topics: Administration, Sublingual; Adolescent; Adult; Analgesics, Opioid; Etorphine; Female; Heroin; Heroin Dependence; Humans; Male; Methadone; Substance Withdrawal Syndrome; Substance-Related Disorders

Wound botulism is a rare infectious and toxicologic complication of trauma and i.v. drug abuse. Only 39 cases have been reported in detail in the English literature. This case report describes a patient with wound botulism who presented to four medical facilities before receiving definitive diagnosis and treatment. Although his history and physical examination were consistent with wound botulism, diagnosis and therapy were delayed because this rare disease was not considered initially in the differential diagnosis. Wound botulism should be considered in trauma patients and i.v. drug abusers who present with cranial nerve palsies and descending paresis.

Topics: Abscess; Adult; Botulism; Clostridium botulinum; Diagnostic Errors; Heroin; Humans; Male; Skin Diseases, Bacterial; Substance-Related Disorders; Wound Infection

Gluteal compartment syndrome is a rare disorder that most often occurs in conjunction with prolonged immobility after a sedative overdose but also may result from direct trauma. Patients present with localized tenderness, induration, and pain with passive flexion of the gluteal muscles. Signs of sciatic nerve compression occur frequently, and rhabdomyolysis may be associated with the syndrome. If the diagnosis of gluteal compartment syndrome is suspected, intracompartmental pressures should be measured. If pressures are high or if sufficient clinical suspicion remains, the patient should undergo prompt fasciotomy.

Topics: Adult; Alcoholism; Buttocks; Compartment Syndromes; Emergencies; Heroin; Humans; Male; Pressure; Rhabdomyolysis; Substance-Related Disorders

The effect of assessment and intake procedures on the outcome of methadone maintenance treatment was investigated in a natural experiment in which a single methadone clinic admitted 89 patients by a rapid intake procedure, and 74 patients who had been on a waiting list and underwent formal assessment interviews. Outcome measures were frequency of illicit drug use as detected by urine tests, and risk of dropping out or being expelled from treatment. Subjects admitted after prolonged, formal assessment were more likely to be expelled, and were more than twice as likely to leave during the first 400 days of maintenance treatment (95% Cl relative risk 1.1 to 5.2). The odds of formally assessed subjects using heroin in the first 6 months of treatment were twice those of the rapid intake group (95% Cl odds ratio 1.5 to 2.2). The formal assessment process deterred half the initial applicants, yet seems to have either selected individuals with a worse prognosis or to have had a negative effect on in-treatment performance.

Topics: Female; Heroin; Humans; Male; Methadone; Patient Compliance; Substance Abuse Treatment Centers; Substance-Related Disorders; Treatment Outcome

Neonatal abstinence syndrome (NAS) is one of the most frequent manifestations in the neonates of drug-addicted mothers. It is caused by the abrupt interruption of the transplacentar passage of drugs from the mother to the fetus. The aim of this study was to evaluate the correlation between drugs taken during pregnancy and NAS. Data were examined relating to 223 neonates born during 1975-1992 to drug-addict mothers. Neonates were subdivided into four groups according to the maternal toxicological profile. It was thus possible to observe that there is a greater prevalence of NAS in cases of polypharmacomania and that it gradually diminishes in the children of heroin addicts and those receiving methadone treatment. Moreover, the intensity of the syndrome is correlated to the high doses of methadone and/or heroin. In the group of neonates whose mothers had complied with the methadone treatment protocol, the severity of NAS was proportional to the dose taken by the mother. In conclusion, the management of pregnant drug addicts following a controlled methadone treatment programme is accompanied by improved obstetric help and is the most suitable way of reducing perinatal complications and the prevalence of NAS.

Topics: Dose-Response Relationship, Drug; Female; Gestational Age; Heroin; Humans; Infant, Newborn; Maternal-Fetal Exchange; Methadone; Mothers; Neonatal Abstinence Syndrome; Pregnancy; Prenatal Exposure Delayed Effects; Substance-Related Disorders

Trends in major drugs-of-abuse, cocaine, heroin/morphine, phencyclidine (PCP), and amphetamines, in Los Angeles County were reported. Death toil of drug abusers in Los Angeles County climbed up high in 1986 due to dramatic increase in cocaine-related deaths. Cocaine-related deaths were responsible for 66.0% (580 cases) of all drugs-of-abuse-related deaths in the first six months of 1988. In the same period, 212, 67, and 20 deaths were related to heroin/morphine, PCP, and amphetamines use, respectively. Emergency room mentions for cocaine in Los Angeles County have greatly been increased since 1982 and recorded 2,331 in the first six months of 1989. Also, heroin/morphine-related emergency room mentions in the County have steadily been increased since 1982 and reached 1,216 in the first six months of 1989. Contrary to these, PCP-related emergency room mentions in the County were decreased from 1,259 in the first six months of 1982 to 630 in those of 1989. There were only 174 emergency room mentions for amphetamines in the County in the first six months of 1989. In 1992, 5,754 patients were admitted to Los Angeles County+University of Southern California Medical Center for treatment of poisoning. Cocaine poisoning, 1,965 cases, was secondly frequent following ethanol poisoning, 2,132 cases. Thirdly and fourthly frequent poisoning were by heroin/morphine, 712 cases, and PCP, 218 cases, respectively. Drug abusers in an age group of 30s were encountered much more frequently at the Medical Center than those in any other age groups, and male dominated greater part of age groups of 30s or more.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Amphetamines; Cocaine; Female; Heroin; Humans; Infant, Newborn; Los Angeles; Male; Morphine; Phencyclidine; Pregnancy; Pregnancy Complications; Substance-Related Disorders

Estimates of the total dollar value of the markets for illicit drugs are valuable for policy making. Such estimates are usually produced by multiplying estimated consumption by price. This paper argues that the relevant price for such calculations is not simply the price of one standard unit. There are substantial quantity discounts for illicit drugs, and there is a distribution of retail purchase sizes. Hence, the average price paid per gram need not equal the price of one gram. This concept is illustrated with calculations for heroin and cocaine.

Topics: Cocaine; Costs and Cost Analysis; Heroin; Heroin Dependence; Humans; Illicit Drugs; Substance-Related Disorders; United States

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

Topics: Cocaine; Heroin; Humans; Substance-Related Disorders; United States

Hyperamylasemia has been reported in heroin addicts and ascribed to an increase of salivary isoamylase. Ours is the first report on acute pancreatitis in a heroin user. All prognostic parameters indicating a severe course of the disease were present, and computed tomography showed an edematous pancreatitis, but the acute pancreatitis took a benign clinical course.

Topics: Acute Disease; Adult; Amylases; Heroin; Humans; Isoamylase; Lipase; Male; Pancreatitis; Substance-Related Disorders

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Adult; Asthma; Female; Heroin; Humans; Pulmonary Eosinophilia; Substance-Related Disorders

The methodological issues surrounding the use of a privileged access interviewer team to generate a network sample of drug users are examined. Traditionally network samples have tended to be used by qualitative researchers. Privileged access interviewing provides a mechanism for the application of a structured instrument to a network sampling model. In doing so some problematic issues in this area for structured methodology are overcome, reduced or standardized. The use of this method is appraised in terms of meeting the methodological requirements of the Drug Transitions study. The practical experiences of our group in using a privileged access interviewer team to interview more than 400 heroin users, many of whom were not in contact with treatment services, are discussed. This method is most appropriate for the quick collection of data, from diverse networks of drug users, by use of a structured instrument. Success is likely to be dependent on careful implementation. The ongoing monitoring of data quality is of particular importance, as is good management practice and the establishment of supportive and non exploitative relationships with the interviewer team.

Topics: Adult; Data Collection; Female; Heroin; Humans; Interview, Psychological; Male; Saliva; Severity of Illness Index; Substance-Related Disorders

A direct treatment of methanol-washed hair with a silylating solution is proposed to extract heroin, O-6-monoacetylmorphine, morphine, acetylcodeine, and codeine, obtaining the simultaneous derivatization of the hydroxylated metabolites and reducing potential sample contamination. Analysis is performed by capillary gas chromatography-tandem mass spectrometry (GC/MS/MS) using multiple selected reaction monitoring. Owing to the selectivity and sensitivity of the GC/MS/MS analysis, and to the extremely simple treatment of the sample, the method fulfils the requirements of both clinical and forensic diagnosis of heroin use.

Topics: Codeine; Gas Chromatography-Mass Spectrometry; Hair; Heroin; Humans; Illicit Drugs; Morphine; Morphine Derivatives; Nalorphine; Reference Values; Sensitivity and Specificity; Substance Abuse Detection; Substance-Related Disorders

First-degree relatives (FDRs) of 162 schizophrenic and 106 control probands were investigated [corrected]. Psychiatric morbidity was present in 34.8% of FDRs of schizophrenic probands and in 9.2% of FDRs of controls. There was significantly more psychiatric illness in the siblings and parents than in the offspring of both schizophrenic and control subjects. The morbidity risks for schizoid-schizotypal personality disorders, cannabis-use disorder and paranoid personality disorder were significantly higher in the FDRs of schizophrenic patients than in those of controls, suggesting a biological relationship.

Topics: Adolescent; Adult; Cannabis; Female; Heroin; Humans; Male; Middle Aged; Prevalence; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenic Psychology; Sex Factors; Substance-Related Disorders

Twenty-five HIV-seropositive drug abusers (DA+HIV+) (groups II-III and IV [A, C2 and E] of the CDC classification) were evaluated by use of the WAIS scale to determine any possible involvement of cognitive functions in the not yet overt phases of AIDS. The results were compared with those obtained in two control populations composed of 19 seronegative drug abusers (DA+HIV-) and 24 healthy subjects (DA-HIV-) to evaluate, in addition to the disease, the possible effect of the use of alcohol and toxic substances on cognitive performance. In spite of the small number of subjects, the study indicated that drug abuse is the main factor, among those analyzed, in determining a decline in cognitive functions.

Topics: Acquired Immunodeficiency Syndrome; Adult; Brain; Cognition Disorders; Dementia; Ethanol; Female; Heroin; HIV Seropositivity; HIV-1; Humans; Italy; Male; Risk Factors; Severity of Illness Index; Substance Abuse, Intravenous; Substance-Related Disorders; Task Performance and Analysis; Wechsler Scales

A systems dynamics computer model to predict birth complications for individual pregnant woman was developed from prospectively conducted data on a database of 125 pregnant women. The model is based upon nonlinear mathematics derived from the study of chaos and complex systems. The model was then tested prospectively on 27 additional pregnant women, making predictions on their level of obstetrical risk. The model was refined until it correctly predicted the outcomes of all 125 cases in the development database. Prediction was made with an accuracy of 25/27 cases for the prospective test cases. Predictions were made for fetal condition at birth, presence or absence of operative delivery, and presence or absence of uterine dysfunction. Then the model was used to explore alcohol use during pregnancy. A reasonable spread of alcohol use existed among subjects, allowing consideration of alcohol effects. Alcohol was found to have differential effects on fetal condition at birth depending upon the presence or absence of high levels of psychosocial stress and the use of other substances. In all cases, the effect of alcohol was only evident after the 10 drinks per week level was reached. For the high-stress/one other substance group, there could be an 18-fold effect on fetal condition at birth. For the low-stress/one other substance group, the effect was only 3-fold, and for the alcohol alone group, the effect was negligible.

Topics: Alcohol Drinking; Caffeine; Cannabis; Cocaine; Computer Simulation; Female; Fetus; Heroin; Humans; Models, Biological; Nonlinear Dynamics; Predictive Value of Tests; Pregnancy; Pregnancy Complications; Prospective Studies; Stress, Physiological; Substance-Related Disorders

We assessed the prevalence of consumption of buprenorphine and other drugs among heroin addicts under ambulatory treatment in two cross-sectional studies conducted in 1988 (188 subjects) and in 1990 (197 subjects). Patients were enrolled in one of three different programmes: methadone maintenance programme (MMP), antagonist maintenance programme (AMP) and drug-free programme (DFP). Information given by participants was compared with results of urine screening for drugs. Urine samples were tested using enzyme immunoassay for the detection of heroin, cocaine, dextropropoxyphene, cannabis and benzodiazepines, and radioimmunoassay for buprenorphine. Sixty-six percent of patients in 1988 and 71% of patients in 1990 reported having consumed buprenorphine at some time during their history of drug dependence (period prevalence) and 5.9% and 6.1%, respectively, tested positive to the drug (point prevalence). In over 70% of these patients consumption was by the intravenous route. Consumption of cannabis, cocaine and benzodiazepines was also very high in the study population. Overall, patients in the DFP group consumed the largest number of the drugs tested, while those in the AMP group consumed the smallest number. Abuse of buprenorphine could be more widespread than previously reported.

Topics: Adult; Ambulatory Care; Benzodiazepines; Buprenorphine; Cannabis; Cross-Sectional Studies; Female; Heroin; Humans; Male; Methadone; Psychiatric Status Rating Scales; Sex Factors; Substance Abuse Detection; Substance Abuse, Intravenous; Substance-Related Disorders

The authors describe three patients in whom septic arthritis of the sternoclavicular joint (SCJ) occurred, drug addiction and human immunodeficiency virus (HIV) infection representing the predisposing conditions. Infectious arthritis is well known in intravenous drug users, but it is rare in HIV positive patients, who are prone to bacterial infections from usual or unusual microorganisms. In one case, staphylococcus aureus methicillin sensitive was responsible for septic arthritis. In another case, SCJ infection was associated with pneumonitis.

Topics: Adult; Arthritis, Infectious; Heroin; HIV Seropositivity; Humans; Male; Staphylococcal Infections; Sternoclavicular Joint; Substance-Related Disorders; Tomography, X-Ray Computed

We report a successful transplantation of a human tricuspid valve in a human. We used a fresh tricuspid homograft with its chordae tendineae and papillary muscles, harvested 5 days earlier under sterile conditions from a multiorgan donor a few minutes after cardiectomy (the heart was not suitable for cardiac transplantation) and immediately stored at 4 degrees C. We elected to implant the homograft in a young heroin addict. Our experience demonstrates that the implantation of an atrioventricular homograft in the orthotopic position is technically feasible and can achieve good results, at least in the short term.

Topics: Adolescent; Endocarditis; Heroin; Humans; Male; Staphylococcal Infections; Substance-Related Disorders; Transplantation, Homologous; Tricuspid Valve; Tricuspid Valve Insufficiency

Topics: Heroin; Humans; Methadone; Substance-Related Disorders; Travel

The concept of a dependence syndrome with graded levels of severity was originally derived from work with alcoholics. The applicability and clinical utility of the dependence syndrome across a wider range of substances was examined as part of the DSM-IV field trials. When using a criterion count method to assess severity, it was found that persons cluster at different severity levels according to the drug on which they are dependent. Across all drug classes, severity correlated reasonably well with measures of quantity and frequency of use and with associated problems. The relationship between severity ratings and outcome was not tested, however data from other studies indicate that severity is only one of many factors that can influence outcome.

Topics: Amphetamines; Cannabis; Cocaine; Ethanol; Female; Heroin; Humans; Male; Narcotics; Nicotiana; Plants, Toxic; Psychiatric Status Rating Scales; Severity of Illness Index; Substance-Related Disorders

Topics: Adolescent; Adult; Age Factors; Attitude to Health; Cocaine; Emergency Service, Hospital; Female; Heroin; Humans; Male; Sex Factors; Spain; Substance-Related Disorders; United States

Complete toxicology screens were performed on Bexar County homicide victims in four recent representative years (1985, 1986, 1990, and 1991). A high positivity rate for drugs and/or alcohol, ranging from 66 to 73%, was found for each year. Alcohol was present in more than half of the cases, ranging from 54.2 to 60.3%. Detection of cocaine or cocaine metabolites increased drastically during this study period, from 1.6% of cases in 1985 to 18.7% in 1991. Heroin metabolites, indicative of recent heroin use, were detected in only 2-5% of the cases in each of the years studied. Drugs other than alcohol, cocaine, or heroin were detected in 7-25% of the cases.

Topics: Adolescent; Adult; Alcoholism; Cocaine; Heroin; Homicide; Humans; Illicit Drugs; Prevalence; Substance-Related Disorders; Texas

To assess the possible relationship between maternal drug use during pregnancy and subsequent sudden infant death syndrome (SIDS), we identified 1760 cases of SIDS from a population of more than 1.2 million infants (1.45/1000) born in New York City between 1979 and 1989. The SIDS rate in drug-exposed infants was 5.83 per 1000 infants, compared with 1.39 per 1000 infants who were not drug exposed. With control for known associated high-risk variables, the risk ratio for SIDS in each individual drug group (methadone, 3.6; heroin, 2.3; methadone and heroin, 3.2; cocaine, 1.6; cocaine and methadone or heroin, 1.1) was higher than in the non-drug-exposed group. Higher rates of SIDS were found in infants exposed to opiates alone than in cocaine-exposed infants, but increasing rates of SIDS in cocaine-exposed infants toward the end of the decade suggested that "crack" cocaine may be linked to these increasing rates. Declines in the overall rate of SIDS during the decade were observed for both the drug-exposed (11.28 to 4.09 per 1000) and the nonexposed groups (1.70 to 1.05 per 1000). Differences in rates of SIDS between major racial-ethnic groups in nonexposed infants were not apparent if the mothers used drugs during pregnancy. Seasonal variation and distribution of ages at time of SIDS death did not differ between the drug-exposed group and the nonexposed group, suggesting that drug-associated SIDS may provide clues as to the cause or causes of SIDS.

Topics: Adult; Age Factors; Chi-Square Distribution; Cocaine; Confidence Intervals; Female; Heroin; Humans; Incidence; Infant; Infant, Newborn; Logistic Models; Male; Methadone; New York City; Pregnancy; Prenatal Exposure Delayed Effects; Risk; Sex Factors; Substance-Related Disorders; Sudden Infant Death; Urban Population

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

A survey was undertaken in Sydney in 1989 to identify factors associated with behaviour involving risk for human immunodeficiency virus infection. Self-report data on needle-sharing and sexual practices were collected from 91 heroin users entering a residential, drug-free detoxification unit. Data were analysed using polytomous and ordinal logistic regressions. Heroin-dependent subjects who also had a current alcohol problem were significantly more likely than others to report high risk needle-sharing behaviour. Subjects with more than one sexual partner in the last three months were significantly more likely to use condoms while those with a current benzodiazepine problem were significantly less likely to use condoms. Qualitative data suggest that high risk needle-sharing behaviour most often occurred around the time of relapse to injecting drug use and among homeless drug users occupying derelict buildings in inner-city suburbs.

Topics: Acquired Immunodeficiency Syndrome; Alcoholism; Benzodiazepines; Female; Heroin; Humans; Male; Needle Sharing; New South Wales; Risk-Taking; Sexual Behavior; Substance Abuse, Intravenous; Substance-Related Disorders

The incidence of HIV infection among women in Europe and the US is growing rapidly. Women who inject drugs are particularly vulnerable--they may acquire the infection through sharing injecting equipment and through sexual contact with an infected male. Opioids and stimulants are reputed to have different effects upon sexual activity and a sex life enhanced by drugs may increase the risk further. In the context of two larger studies of HIV-related risk behaviours among opioid and amphetamine users in the North West of England, the sexual behaviour and sharing of two groups of female injectors were compared, one whose primary use was heroin, the other amphetamine. Reported incidence of sharing was similar and high. Marked differences were observed in sexual behaviour, amphetamine injectors reporting greater interest in sex and greater frequency of intercourse. However, more of them perceived their personal risk to infection through unprotected sex as negligible. Over 80% in both groups had engaged in unprotected sex in the 6 months prior to interview. Women injectors tend to have injecting partners--more research is needed if health education strategies are to be devised that will protect them.

Topics: Adolescent; Adult; Amphetamine; Female; Heroin; HIV Seropositivity; Humans; Male; Risk Factors; Sexual Behavior; Substance-Related Disorders; United States; Women

The aim of the present work was to analyse, at the ultrastructural level, the action of heroin of 150 centrilobular sinusoids from liver biopsies of five intravenous drug abusers, who presented clinical and biological manifestations of hepatic impairment. A comparative study of 90 sinusoids from liver biopsies of three control patients was performed. Electron microscopic observations showed a thickening of the sinusoidal wall related to endothelial cell hypertrophy and to fibrosis of the space of Disse. This was generally associated with basement-membrane-like material and hepatocyte microvilli flattening. In addicts, hepatic vascular pole changes were a constant finding, accompanied by interhepatocyte space disjunction and perisinusoidal collagenization. Morphometric assessment confirmed a significant increase of sinusoidal wall surface, endothelial cell body and processes and Ito cell process surface was significantly different between the patient groups. This cellular hypertrophy may represent hyperactivation of the sinusoidal cell functional capacity, triggering the fibrogenesis in the space of Disse. While this mechanical barrier might hinder the free exchange through the space of Disse, it may equally well protect the liver against heroin toxicity.

Topics: Adult; Endothelium, Vascular; Extracellular Matrix; Heroin; Humans; Hypertrophy; Liver; Liver Cirrhosis; Male; Microscopy, Electron; Substance-Related Disorders

A solid-phase extraction procedure was developed for the isolation of heroin, 6-acetylmorphine, and morphine from blood, plasma, saliva, and urine with subsequent assay by gas chromatography/mass spectrometry. Aprotic solvents, mild elution conditions, and an enzyme inhibitor were used to ensure maximum analyte stability. Samples were extracted and the extract was divided into two equal portions. One portion was assayed directly for heroin; detector response was linear over a concentration range of 1.0 to 250 micrograms/L. The second part of the extract was reacted with N-methyl-bis-trifluoroacetamide and assayed for the trifluoroacetyl derivatives of 6-acetylmorphine and morphine; detector response was linear over a concentration range of 1.0 to 500 micrograms/L. The limit of sensitivity was 1.0 microgram/L for each analyte. Hydrolysis of heroin to 6-acetylmorphine during extraction and analysis was < 5%. The method can be used to corroborate heroin use and to study the pharmacological effects of heroin and its metabolites.

Topics: Body Fluids; Gas Chromatography-Mass Spectrometry; Heroin; Humans; Indicator Dilution Techniques; Male; Morphine; Morphine Derivatives; Quality Control; Saliva; Substance-Related Disorders

Brain perfusion is abnormal in chronic cocaine users. To determine whether these perfusion abnormalities are reversible following treatment, we studied 10 cocaine-dependent polydrug users with 99mTc-HMPAO SPECT 2 to 3 days after admission to an inpatient treatment facility and at 7 to 8 days and 17 to 29 days after abstinence from drugs. The patients also received buprenorphine, an opioid mixed agonist-antagonist, beginning 10 days after admission and continuing to the end of the study. Imaging began 10-15 min after injection of 99mTc-HMPAO (20 mCi) using an annular gamma camera system. MRI was performed during hospitalization using a 1.5 Tesla system. SPECT and MRI were merged and five axial SPECT slices centered at the level of the basal ganglia were selected for analysis. Activity ratios were derived for cortical regions relative to cerebellar activity and were corrected for linearity with respect to regional cerebral blood flow. The cortical regions were classified as abnormal (activity ratio < 0.6), borderline (0.6-0.72) and normal (> 0.72) based on the results of the first SPECT study. In abnormal zones, regional cerebral blood flow (rCBF) increased 11.0% +/- 9.0% at 7 to 8 days and 23.8% +/- 9.4% at 17 to 29 days after initiation of treatment. The increase in rCBF was 4.8% +/- 7.1% (7 to 8 days) and 11.1% +/- 8.0% (17 to 29 days) in borderline cortex and decreased 2.9% +/- 6.3% (7 to 8 days) and increased only 2.7% +/- 13.4% (17 to 29 days) in normal cortex. The increase in rCBF did not vary significantly by location. The perfusion defects observed in chronic cocaine polydrug users are partially reversible with short-term abstinence and buprenorphine treatment.

Topics: Adult; Buprenorphine; Cerebrovascular Circulation; Cocaine; Heroin; Humans; Magnetic Resonance Imaging; Male; Organotechnetium Compounds; Oximes; Substance-Related Disorders; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Pituitary gland volume was measured in 16 men between the ages of 26-33 with magnetic resonance imaging. Eight male patients had a Diagnostic and Statistical Manual III-Revised, American Psychiatric Association Axis I diagnosis of concurrent opioid and cocaine dependence. The average duration of opioid and cocaine abuse was 7.8 +/- 2.0 and 6.9 +/- 1.4 yr, respectively. All patients were in good physical health as determined by physical examination, blood chemistry, hemogram and hormone analysis, and all tested negatively for the HIV antibody. No patient had any other Diagnostic and Statistical Manual III-Revised Axis I diagnosis or neurological disorder. Eight healthy males served as age-matched control subjects. None of the control subjects had any past or current history of substance abuse or any clinical indication for magnetic resonance imaging. Opioid and cocaine dependent men had significantly larger pituitary gland volumes (730.0 +/- 24.4 mm3) than control subjects (540.0 +/- 26.6 mm3) (P < 0.01). The significant increase in pituitary gland volume in men who abuse opiates and cocaine may be antecedent to detection of abnormal anterior pituitary hormone function.

Topics: Adult; Cocaine; Heroin; Hormones; Humans; Male; Pituitary Gland; Reference Values; Substance-Related Disorders

Topics: Adult; Cocaine; Dyspnea; Female; Heroin; Humans; Substance-Related Disorders; Ventilation-Perfusion Ratio

Inhalation of heroin is known to provoke asthma. We report on the case of a patient who, after repeated inhalation of heroin, presented with decreased lung volume associated with bronchial hyperresponsiveness, diffuse pulmonary infiltrates, and bronchoalveolar lavage fluid eosinophilia. Rapid remission was obtained after heroin abstinence and initiation of corticosteroid treatment.

Topics: Acute Disease; Administration, Inhalation; Adult; Female; Heroin; Humans; Pulmonary Eosinophilia; Substance-Related Disorders

Methadone maintenance therapy is designed to reduce the need for addicts to use heroin or other illegal opiates. Death in patients starting on such a program has not previously been documented. We report the death of 10 persons who died within days of starting a methadone maintenance program administered by general practitioners. Their bodies were subject to a full autopsy by forensic pathologists, with a full toxicological examination. The mean starting dose had been 53 mg, which had been increased to a mean of 57 mg by the final dose. Death occurred after a mean of 3 days. The mean blood methadone concentration at death was 2.1 mumol/L. Complete toxicological analysis showed that six subjects had additional drugs present including two with alcohol, two with benzodiazepines and morphine, and one with benzodiazepines alone. Pathological examination revealed the presence of chronic persistent hepatitis in all subjects and bronchopneumonia in five. The causes of death were given as methadone toxicity or methadone toxicity in combination with bronchopneumonia. Our observations highlight the dangers of methadone in the first days of starting on a maintenance program, particularly when the starting doses are relatively high and subjects have no demonstrated tolerance to opiates.

Topics: Adult; Chemical and Drug Induced Liver Injury; Drug Administration Schedule; Female; Half-Life; Heroin; Humans; Male; Methadone; Substance-Related Disorders

Topics: Drug Tolerance; Female; Heroin; Humans; Substance Abuse Treatment Centers; Substance-Related Disorders; United Kingdom

Topics: Adult; Drug Interactions; Drug Synergism; Gas Chromatography-Mass Spectrometry; Heroin; Heroin Dependence; Humans; Hypnotics and Sedatives; Male; Pyridones; Substance-Related Disorders

Topics: Heroin; Humans; Substance-Related Disorders

Beta endorphin (BE) is a polypeptide agonist for the brain's endogenous opioid system. Levels of BE are elevated by opioid antagonists such as naloxone and depressed by short-acting agonists such as heroin and morphine; they become normalized during steady-state methadone. Buprenorphine (BUP) is a partial opioid agonist whose effects on BE levels were examined in six former heroin addicts and 14 methadone-maintained patients before and after being switched to sublingual BUP 2 mg daily for 1 month. In six former methadone-treated subjects BE levels also were measured after stopping BUP and after naloxone challenge. Levels of BE were not significantly lower in subjects started on BUP after stopping heroin (n = 6) (8.0 versus 8.1 ng/ml) or in subjects started on BUP after stopping methadone (n = 14) (11.6 vs 15.6 ng/ml). However, BE levels were lower on BUP than after naloxone challenge (n = 6) (7.0 versus 34.9 ng/ml). Levels of BE did not significantly change between the first 2 weeks ("early") and "later," although BE levels on methadone significantly correlated with BE levels on BUP in the "early" but not the "later" phase. The BE levels on BUP also did not differ from BE levels of unmedicated normals.

Topics: Adult; beta-Endorphin; Buprenorphine; Female; Heroin; Humans; Male; Methadone; Middle Aged; Naloxone; Radioimmunoassay; Substance Withdrawal Syndrome; Substance-Related Disorders

This study investigates severity of dependence upon heroin, cocaine and amphetamines in a group of 200 heroin users, 75% of whom were not in contact with any treatment agency. For drug takers who were current users of more than one drug, heroin produced more severe dependence than either cocaine or amphetamine and many users of these stimulant drugs reported having experienced no problems of dependence. Severity of dependence was influenced by route of administration as well as type of drug. Heroin taken by injection was associated with more severe dependence than smoked heroin. For cocaine, injection and smoking were associated with equivalent dependence ratings, and both of these routes were associated with more severe dependence than cocaine used intranasally. For amphetamine, there were no differences in severity of dependence ratings for injection, intranasal or oral use. Severity of dependence was correlated with dose and duration of drug use; it was also associated with previous attendance at a drug treatment agency, though dependence problems were also common among heroin users who had never received treatment. Implications of these findings are discussed.

Topics: Adult; Amphetamines; Cocaine; Compulsive Behavior; Female; Heroin; Humans; Interview, Psychological; Male; Models, Psychological; Social Problems; Substance Abuse Detection; Substance-Related Disorders

We used data from different sources to estimate the extent and the trend of the epidemic of drug use in Italy in the second half of the '80s. During the study period, the number of subjects attending drug dependency units increased from 13,905 to 61,689. Mortality and morbidity indicators showed an increase in both drug related deaths (mainly from overdose) and AIDS cases reported in injecting drug users, particularly among older subjects. However, the number of young adults detected as drug users at the army recruitment remained virtually stable from 1986 on. These findings suggest that both demand and availability of treatment increased through the years 1985-89, and that clinical consequences of drug use related behaviour have become an important public health priority.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Delivery of Health Care; Drug Overdose; Female; Health Promotion; Heroin; Humans; Italy; Male; Methadone; Middle Aged; Public Health; Substance-Related Disorders; Surveys and Questionnaires

Topics: Female; Heroin; Humans; Illicit Drugs; Infant; Substance-Related Disorders

Topics: Drug Overdose; Heroin; Humans; Mass Media; Substance-Related Disorders

A histological and morphometric study demonstrated a relationship between vascular changes in the hepatic lobule and heroin consumption. To establish the role of hepatocytes in the genesis of sinusoidal dilatation, morphometric analysis was performed on ten drug abusers and eight controls. A total of 1800 hepatocytes, in 67 centrilobular areas, were analysed from biopsies from the total patient number. Computerized results of hepatocyte surface area, perimeter, maximum linear dimension and minimum linear dimension demonstrated no statistically significant difference for these variables, particularly for hepatocyte surface area (Controls: 268.66 +/- 95.25; drug abusers: 252.00 +/- 78.94, p = 0.24), when the two groups of patients were compared. Hepatocyte morphology at the time of the biopsy was unaltered, although transaminase values were elevated for all drug abusers. It is, therefore, possible that the hepatocytes were not implicated in the pathogenesis of sinusoidal dilatation. This suggestion supports our previous results, which suggested that heroin was capable of inducing direct vascular hepatotoxicity.

Topics: Adult; Enterohepatic Circulation; Heroin; Heroin Dependence; Humans; Liver; Substance-Related Disorders; Vasodilation

Topics: Heroin; Humans; Illicit Drugs; Rhabdomyolysis; Substance-Related Disorders

A 28-year old Japanese man with heroin abuse was reported. He is an ex-beautician and has abused a variety of substances such as toluene, marihuana, methamphetamine, LSD, and so on since he was in a junior high school in Japan. He experienced an intravenous injection of heroin for five days on his first trip to Thailand in 1989. Soon after he returned home, he went back there to use heroin again. He also experienced tearing and running nose as withdrawal at the end of his ten-day trip. During his third stay there he got a job as a wholesale dealer of heroin under a illegal drug organization in the northern part of Thailand. Before he returned home in Japan, he managed to withdraw from heroin by reducing the dose and replacing it with opium smoking. On his fourth trip he failed to withdraw from heroin and injected the drug intravenously at Chiang Mai Airport before leaving Thailand. He began to show acute heroin withdrawal just after he arrived in Osaka, Japan and sought treatment without telling heroin abuse. He was hospitalized next day and soon showed more severe withdrawal and delirium for next ten days. The delirium was thought to be due to not only heroin but the other drugs which he used. Recently heroin abuse, once prevalent during the latter half of 1950s in Japan, has been hardly seen owing to changing the law to severe punishment in 1963. To avoid strict regulations in home some of young Japanese seem to travel abroad and abuse drugs in Asian countries where the drugs are easily available.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Asia; Heroin; Humans; Male; Substance Withdrawal Syndrome; Substance-Related Disorders; Travel

Topics: Administration, Inhalation; Cocaine; Heroin; Heroin Dependence; Humans; Semantics; Substance-Related Disorders

Topics: Heroin; Humans; Methadone; Substance-Related Disorders

At the autopsy of a 25-year-old man who had died from combined morphine and cocaine intoxication, depositions of metallic mercury were incidentally found in the myocardium of the right ventricular septum and posterior wall. Deposits, toxicologically identified as mercury, were also found radiologically and histologically in the lungs. All these deposits were probably the result of intravenous injections of mercury many months previously, as is known to be done occasionally by addicts. Judging by the histological picture the greatest proportion of the mercury collected in the right ventricular cavity after injection, a smaller amount by embolization in the small pulmonary arteries. The mercury spheres which came to lie in the right ventricle then penetrated into the myocardium, moving outward and causing a chronic and partly transmural inflammatory response.

Topics: Adult; Autopsy; Cocaine; Heroin; Humans; Injections, Intravenous; Lung; Male; Mercury; Mercury Poisoning; Myocardium; Substance-Related Disorders

Topics: Heroin; Heroin Dependence; Humans; Morphine; Morphine Derivatives; Naloxone; Substance-Related Disorders

Topics: Adult; Alcoholism; Cholesterol; Cocaine; Heroin; Humans; Substance-Related Disorders

Topics: Expert Testimony; Hair; Heroin; Humans; Morphine; Substance-Related Disorders

Topics: Adolescent; Adult; Aggression; Cannabis; Cocaine; Crime; Female; Heroin; Humans; Male; New York City; Social Control, Informal; Substance-Related Disorders; Violence

Topics: Adult; Amyloidosis; Female; Heroin; Humans; Kidney Diseases; Nephrotic Syndrome; Remission, Spontaneous; Substance-Related Disorders

The prevalence, risk factors, and incidence of hepatitis C virus (HCV) infection were studied in a cohort of drug users in Amsterdam. In intravenous drug users, the seroprevalence was 74% (224/304) versus 10% (4/42) in nonintravenous drug users. Risk factors independently associated with HCV antibody seropositivity were history and duration of intravenous drug use and frequency of injections. Daily smoking of heroin in the previous 6 months was independently associated with the absence of HCV antibodies. Periods of fever, tiredness, and diarrhea in the preceding 6 months were associated with HCV antibodies even after correction for human immunodeficiency virus infection. The incidence rate of HCV infection appeared high and stable over the years 1986 to 1989. Thus, HCV infections are common among intravenous drug users and are mainly due to the intravenous use of drugs.

Topics: Adult; Analysis of Variance; Cohort Studies; Female; Follow-Up Studies; Hepatitis Antibodies; Hepatitis C; Hepatitis, Viral, Human; Heroin; Homosexuality; Humans; Incidence; Longitudinal Studies; Male; Multivariate Analysis; Netherlands; Prevalence; Regression Analysis; Risk Factors; Sex Work; Sexually Transmitted Diseases; Substance Abuse, Intravenous; Substance-Related Disorders

The object of this study is to describe the behaviour of heroin users from an economic point of view in such a way as to enable tracing the influence of policy measures. In order to describe the heroin users' behaviour, data have been collected regarding relevant variables and relations between variables by interviewing 80 heroin users in the Netherlands. Based on these data a computer model has been developed. The objective of the model is two-fold: 1) Describing the behaviour of a group of heroin users in connection with the process of obtaining money and heroin in order to determine the factors which influence the quantity of heroin bought and consumed. 2) Carrying out some scenario analyses in order to examine the effects policy changes might have on variables such as heroin use and quantity of money obtained illegally.

Topics: Computer Simulation; Crime; Group Processes; Heroin; Humans; Models, Theoretical; Netherlands; Policy Making; Substance-Related Disorders

The hepatotoxic effect of heroin has been demonstrated in liver biopsies by morphometric analysis of four groups of patients: twenty-one drug abusers (DA) at the time of the biopsy, eighteen patients who had stopped drug consumption for at least six months (ex-DA), twelve patients with post-transfusional chronic active hepatitis (PTCAH), and eleven controls (CONTROL). Semiquantitative assessment showed the extent of sinusoidal dilatation and the inflammatory and fibrotic reaction in the terminal hepatic vein (THV). Thickening and cellularity of the venular wall and the volume density of sinusoidal lumen (Vsl) in the Zone I and III of the hepatic acinus, were also evaluated. The morphometric analysis used computerized measurements. In DA, the sinusoidal dilatation (100% of cases), the sinusoidal and THV inflammation (81% and 67.7%, respectively), localized mainly in the centrilobular zone, were more pronounced than in ex-DA, in patients with PTCAH and in CONTROL (significantly different P less than 0.0001). Conversely, the fibrotic reaction (perisinusoidal fibrosis--44.4% and perivenular fibrosis--61.1%) was more frequent in ex-DA. The THV inflammation in DA was replaced by a fibrotic matrix deposit in the THV wall (wall surface/internal surface = 2.72 +/- 0.37 in ex-DA; 1.38 +/- 0.32 in DA; 0.87 +/- 0.14 in PTCAH and 0.45 +/- 0.03 in CONTROL--significantly different P less than 0.001), associated with a perisinusoidal fibrosis, after drug withdrawal. Moreover, there was significantly decreased venular wall cellularity in ex-DA (wall surface/mesenchymal cells = 949 +/- 158 in ex-DA; 622 +/- 40 in DA; 619 +/- 61 in PTCAH; 547 +/- 23 in CONTROL--P less than 0.001). Semiquantitative and morphometric data suggest that these vascular lesions and their reversibility may be due to the direct hepatotoxic effects of heroin.

Topics: Adult; Fibrosis; Hepatic Veins; Heroin; Humans; Substance-Related Disorders; Vasculitis; Vasodilation

Topics: Adult; Breast Feeding; Child of Impaired Parents; Cocaine; Ethics, Medical; Female; Heroin; Humans; Infant, Newborn; Law Enforcement; Maternal Behavior; Substance-Related Disorders

Topics: Acquired Immunodeficiency Syndrome; Heroin; Humans; Male; Substance-Related Disorders

Topics: Acute Kidney Injury; Cocaine; Heroin; Humans; Rhabdomyolysis; Substance-Related Disorders

This paper describes patterns of drug use such as choice of drug, other substances abused, and route of administration in 174 women who reported methamphetamine, cocaine, heroin, or "Ts and blues" abuse during pregnancy. Seventy-five percent (130/174) reported using more than one drug. Other than tobacco, alcohol and cocaine were the drugs most frequently used in combination with other drugs (7% to 53% and 12% to 54% of the time, respectively). The extent of polydrug use observed in this study emphasizes (1) the difficulty in ascribing adverse maternal or fetal health effects to single substances, and (2) the potential for interaction effects due to multiple substance abuse.

Topics: Adolescent; Adult; Age Factors; Alcoholism; Cocaine; Female; Fetal Diseases; Heroin; Humans; Marijuana Abuse; Methadone; Methamphetamine; Odds Ratio; Pentazocine; Pregnancy; Pregnancy Complications; Smoking; Substance-Related Disorders; Tripelennamine

Topics: Adult; Analgesia; Candidiasis; Discitis; Heroin; HIV Seropositivity; Humans; Injections, Spinal; Male; Substance-Related Disorders

This article examines the commonly used laboratory indicators of heavy alcohol use (elevated MCV, GGTP and AST values) in subgroups of drug-using and non-drug-using alcoholic men admitted to an inpatient alcoholism treatment program. A total of 380 consecutive admissions meeting DSM-III diagnostic criteria for alcohol use or dependence were studied. Of these subjects, 75% used both alcohol and drugs. The most frequently used drugs were marijuana, cocaine, amphetamines and tranquilizers. Overall, subjects who used drugs with alcohol had significantly lower MCV and GGTP values than subjects who used alcohol alone. More specifically, cocaine use was associated with lower MCV values, marijuana use with lower AST values and heroin use with higher AST and GGTP values. These differences between drug-using and non-drug-using alcoholics were significant even after controlling for variables that affect the laboratory values such as age, quantity, frequency and duration of alcohol consumption. These findings indicate that any study of laboratory markers of alcoholism needs to consider concomitant illicit drug use patterns.

Topics: Adult; Aged; Alcoholism; Amphetamines; Analysis of Variance; Barbiturates; Biomarkers; Cannabis; Cocaine; Hallucinogens; Heroin; Humans; Male; Middle Aged; Narcotics; Substance-Related Disorders

Two heroin addicts, aged 30 and 35 years, developed severe ischemic stroke shortly after intravenous injection of heroin. Arteriograms, CT-scans, and Technesium-99 scintigrams demonstrated non-occlusive extensive infarctions in the carotid territory. Cerebral blood flow investigation in one showed severe hyperemia of the entire left carotid artery territory, including areas, where infarction did not develop. Stroke was not due to arterial occlusion. It was more likely due to generalized hypoxia combined with decreased perfusion pressure in the carotid territory on one site because of external compression of the carotid artery during the intoxicated comatose state.

Topics: Adult; Cerebrovascular Disorders; Female; Heroin; Humans; Male; Radionuclide Imaging; Substance Abuse, Intravenous; Substance-Related Disorders

Topics: Acute Disease; Adult; Drug Overdose; Heroin; Humans; Male; Naloxone; Pulmonary Edema; Substance-Related Disorders

Topics: Abducens Nerve; Adult; Cranial Nerve Diseases; Drug Overdose; Female; Heroin; Humans; Ophthalmoplegia; Substance-Related Disorders

Topics: Adolescent; Adult; Aflatoxin B1; Aflatoxins; Drug Contamination; England; Heroin; Humans; Male; Netherlands; Substance-Related Disorders

The significance of beta-endorphin for drug dependence was explored by measuring the levels of beta-endorphin-immunoreactivity (beta E-IR) in plasma and parts of pituitary and brain of rats self-administering heroin or cocaine as compared to animals offered saline. Rats that had intravenously self-administrated heroin for 5 consecutive daily sessions of 6 h, and were decapitated immediately after the last session, showed a decreased concentration of beta E-IR in the anterior lobe (AL) of the pituitary while rats that had taken cocaine showed a decreased concentration of beta E-IR in the septum. Rats that had self-administrated heroin or cocaine and were decapitated 18 h after the last session, showed an increased concentration of beta E-IR in plasma and decreased concentrations in the AL of the pituitary and in specific areas of the brain limbic system, i.e. nucleus accumbens, septum, hippocampus and rostral striatum. The finding that self-administration of both the opiate heroin, inducing psychic and physical dependence, and the non-opiate cocaine, inducing psychic but not physical dependence, is accompanied by similar changes in beta E-IR concentrations particularly in limbic brain structures, and that these effects are present 18 h but not immediately after the last session, suggests that beta E and related peptides in limbic brain regions may represent a neurochemical correlate for psychic dependence on drugs.

Topics: Animals; beta-Endorphin; Brain; Cocaine; Heroin; Limbic System; Male; Osmolar Concentration; Radioimmunoassay; Rats; Rats, Inbred Strains; Substance-Related Disorders; Tissue Distribution

Epidemiology has recently been used to effectively track and analyze drug abuse patterns. This article generally describes methods used in the United States for estimating and monitoring drug abuse. It outlines the advantages and limitations of such data sources as surveys, indicators, and ethnography, and briefly explores the work and utility of local, national, and international drug surveillance networks. In addition, it describes national and local patterns for heroin, cocaine, and marijuana abuse.

Topics: Adolescent; Adult; Child; Cocaine; Heroin; Humans; Marijuana Abuse; Substance-Related Disorders; United States

Topics: Black or African American; Cocaine; Heroin; Hispanic or Latino; HIV Seropositivity; Humans; Injections, Intravenous; Methadone; Retroviridae Infections; San Francisco; Sexual Behavior; Substance-Related Disorders

The possible toxical effect of heavy metals in the pathogenesis of brachial and lumbar plexopathies during heroin addiction has been previously hypothesized by some authors, but never detected. A 24-year-old man, addicted to heroin showed the clinical picture of a symmetrical brachial neuropathy, without other neurological involvement. Lead poisoning was detected in this patient and the chelating therapy induced a marked improvement of the clinical symptoms.

Topics: Adult; Brachial Plexus; Heroin; Humans; Lead Poisoning; Male; Nervous System Diseases; Substance-Related Disorders

Topics: Acquired Immunodeficiency Syndrome; Administration, Intranasal; Adult; Female; Heroin; Humans; Injections, Intravenous; Male; Substance-Related Disorders

Topics: Animals; Antipsychotic Agents; Buprenorphine; Cocaine; Female; Heroin; Humans; Macaca mulatta; Male; Obsessive-Compulsive Disorder; Schizophrenia; Substance-Related Disorders; Trichotillomania

This survey deals with the Danish part of a study on fatal intoxications conducted in the Nordic countries in 1984 and 1985 with special reference to drug addicts. There were 315 cases of fatal intoxications in people 15-34 years of age. These were examined at the Forensic Institutes in Denmark and described with reference to cause of death, sex, age and drug addiction. Of the deceased, 194 were drug addicts according to a specific definition of this term. Women accounted for 28% of all the fatalities investigated in the study and 24% of those in addicts. More than 90% of the deaths were caused by drugs, with ethanol as a contributory factor in approximately 40% of cases. Deaths caused by heroin/morphine predominated, causing 50% of the deaths among drug addicts, but legal drugs, such as dextropropoxyphene, methadone and ketobemidone were also frequent causes of death in this group. In half the cases the concentration of morphine in blood following injection of heroin/morphine was found to be equal to or less than 0.5 mumol/kg, and in only about one-tenth of cases was the blood concentration above 2.0 mumol/kg.

Topics: Adolescent; Adult; Analgesics, Opioid; Barbiturates; Cause of Death; Cross-Sectional Studies; Denmark; Dextropropoxyphene; Drug Overdose; Heroin; Humans; Incidence; Meperidine; Methadone; Morphine; Substance-Related Disorders

Group-housed and individually housed rats were tested for the acquisition of a lever-pressing response reinforced by intravenous heroin or cocaine; animals in each housing condition quickly learned to self-administer drug. In the first experiment the isolated rats learned to self-administer heroin earlier than the group-housed animals, but the two groups self-administered similar levels of heroin by the fifth week of testing. In the second experiment cocaine self-administration was learned with equal speed in the two groups, and similar levels of cocaine were self-administered by both groups throughout the experiment. These data indicate that while social isolation can influence levels of heroin self-administration, isolation is not a necessary condition for heroin or heroin or cocaine injections to be reinforcing.

Topics: Animals; Behavior, Animal; Cocaine; Heroin; Housing, Animal; Injections, Intravenous; Male; Rats; Self Administration; Social Isolation; Substance-Related Disorders

A study of socio-demographic features of 680 cannabis and heroin addicts showed that the factors like, age, religion, family structure, peer groups and the easy availability of these drugs contribute to the problem of addiction.

Topics: Adolescent; Adult; Child; Female; Heroin; Humans; India; Male; Marijuana Abuse; Substance-Related Disorders

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

Topics: Abscess; Epidural Space; Heroin; Humans; Male; Middle Aged; Nocardia Infections; Spinal Diseases; Substance-Related Disorders

Topics: Adult; Amphetamines; Heroin; Humans; Hypertension, Pulmonary; Male; Substance-Related Disorders

An analysis of drug samples received by the National Toxicology Institute at Madrid during the period from September 1985 to May 1987 was undertaken with a view to carrying out an epidemiological assessment of drug abuse. Of 414 street drug samples, 63.5 per cent contained heroin, 12.5 per cent cocaine, 8.5 per cent amphetamine and 15.4 per cent other substances. The concentration of heroin ranged from 21 to 60 per cent in most of the samples (91.8 per cent) that contained it. Similar concentrations of cocaine were found in the samples containing that substance. Adulterants were detected in 78.8 per cent of the samples containing heroin, 59.6 per cent of the samples containing cocaine and 56 per cent of the samples containing amphetamine. The most common adulterants in the samples containing heroin were caffeine (68.4 per cent), phenobarbital (19.7 per cent), methaqualone (13.4 per cent) and procaine (13.4 per cent), while lidocaine was the most common adulterant (52 per cent) in the samples containing cocaine.

Topics: Amphetamines; Caffeine; Cocaine; Drug Contamination; Heroin; Humans; Illicit Drugs; Lidocaine; Methaqualone; Phenobarbital; Procaine; Spain; Substance-Related Disorders

Meconium specimens (first 3 days' stool) obtained from 20 infants of drug-dependent mothers and five control infants were analyzed by radioimmunoassay for the metabolites of three commonly abused drugs, heroin, cocaine, and cannabinoids. Control stools contained no drug. Meconium from the infants of drug-dependent mothers showed the presence of at least one drug metabolite: 80% of the infants of drug-dependent mothers showed cocaine (range 0.14 to 19.91 micrograms/gm stool), 55% showed morphine (range 0.41 to 14.97 micrograms/gm stool), and 60% showed cannabinoid (range 0.05 to 0.67 micrograms/gm stool). The concentrations of metabolites were highest during the first 2 days; some stools tested positive up to the third day. In contrast, only 37% of the infants had positive results on a urine screen (fluorescent polarization immunoassay method). Paired urine and meconium specimens, both analyzed by radioimmunoassay, showed a higher concentration of drug metabolites in the latter; eight urine samples had no detectable drugs despite a corresponding positive stool test result. We conclude that meconium is useful for drug screening in the neonate.

Topics: Animals; Cannabinoids; Cocaine; Feces; Female; Heroin; Humans; Infant, Newborn; Mass Screening; Maternal-Fetal Exchange; Meconium; Morphine; Predictive Value of Tests; Pregnancy; Psychotropic Drugs; Rats; Rats, Inbred Strains; Substance-Related Disorders

Analyzing self-report interview data from a multi-site collaborative study of mental disorders in the community, we examined suspected differences between 611 cocaine users and 126 heroin users in relation to indicators of drug dependence. Cocaine users were less likely to report dependence-related problems as compared to heroin users. These epidemiologic sample data underscore concerns about the generalizability of published clinical sample data on self-reported cocaine dependence.

Topics: Catchment Area, Health; Cocaine; Epidemiologic Methods; Heroin; Humans; Substance-Related Disorders; United States

Data from 110 IV-drug abusing persons in methadone maintenance were analyzed to determine the correlates of needle sharing. Sharing was directly related to peer group behavior, attitudes conducive to sharing, economic motivation to share, not owning injection equipment, and fatalism about developing AIDS. Sharers were aware of their AIDS risk. Indicated measures to reduce needle sharing would be positive peer support groups to help resist pressures to share, legal and free access to fresh injection equipment, education on the utility of risk reduction, and increased treatment options for IV cocaine users.

Topics: Acquired Immunodeficiency Syndrome; Adult; Attitude to Health; Cocaine; Cross-Sectional Studies; Female; Heroin; Humans; Injections, Intravenous; Male; Needles; New York City; Peer Group; Sterilization; Substance-Related Disorders

We retrospectively identified 49 cases of recreational drug-induced seizures in 47 patients seen at the San Francisco General Hospital between 1975 and 1987. Most patients experienced a single generalized tonic-clonic seizure associated with acute drug intoxication, but 7 patients had multiple seizures and 2 patients developed status epilepticus. The recreational drugs implicated were cocaine (32 cases), amphetamine (11), heroin (7), and phencyclidine (4). A combination of drugs was responsible in 11 cases. Seizures occurred independent of the route of administration, and occurred in both first-time and chronic abusers. Ten patients (21%) reported having had prior seizures, all with a close temporal association with drug abuse. Other than 1 patient who developed prolonged status epilepticus that caused a fixed neurologic deficit, most patients had no obvious short-term neurologic sequelae.

Topics: Adult; Amphetamines; Cocaine; Drug Combinations; Female; Heroin; Humans; Lysergic Acid Diethylamide; Male; Marijuana Abuse; Phencyclidine; Seizures; Status Epilepticus; Substance-Related Disorders; Time Factors

A general practice based study of 117 heroin users receiving minimal intervention for their drug use examines the patterns and frequency of use from onset to last medical contact. Patterns of abstinence and relapse, and episodes of dependent and nondependent use are defined and quantified, demonstrating variations between and within individuals over time. This evidence of both controlled heroin use and remission and relapse not related to intervention is discussed and contrasted with the continued fixed belief of the public and professionals that heroin use is continuous, incurable, and permanent. Implications for therapy, especially in a "post-AIDS" era, are discussed.

Topics: Adult; Criminal Law; Female; Heroin; Heroin Dependence; Humans; Male; Recurrence; Scotland; Substance-Related Disorders

Lever-pressing behavior reinforced by intravenous infusion of various concentrations of heroin, and consequent development of physical dependence, were examined in rats. In addition, the influence of opiate dependence, and of its disappearance following withdrawal, on heroin self-administration were investigated. It was found that intravenous self-administration of heroin at 0.03 mg/kg/infusion maintained self-administration behavior without producing physical dependence. Total responses per session decreased with increasing unit dose of heroin, whereas the total amount of drug self-administered was directly related to unit dose. Significantly greater numbers of withdrawal signs and percentage body weight losses in response to naloxone injections were observed following self-administration of heroin at 0.1, 0.3 or 0.6 mg/kg/infusion. Intake of heroin at 0.03 mg/kg/infusion, but not at 0.1, 0.3 or 0.6 mg/kg/infusion, was found to increase significantly in opiate-dependent and postdependent animals. These findings support the previous use of 0.03 mg/kg/infusion as a suitable dose for illustrating the reinforcing effect of heroin without the influence of physical dependence.

Topics: Animals; Behavior, Animal; Dose-Response Relationship, Drug; Heroin; Male; Naloxone; Rats; Self Administration; Substance Withdrawal Syndrome; Substance-Related Disorders

We assessed risk factors for human immunodeficiency virus (HIV) infection in 633 heterosexual intravenous drug users. The HIV seroprevalence was 26% in blacks, 10% in Hispanics, and 6% in whites. Intravenous cocaine use significantly increased the risk of HIV infection, with a seroprevalence of 35% in daily cocaine users (odds ratio, 6.4; 95% confidence interval, 3.0 to 13.3). Black subjects were more likely to use cocaine regularly. Drug use in shooting galleries and sharing of drug injection equipment were also associated with HIV infection and were more common in cocaine users. By multivariate analysis, black race, daily cocaine injection by blacks and Hispanics, all other cocaine injection, heavy use prior to entry into methadone treatment by blacks, and use of drugs in shooting galleries were independent predictors of HIV infection. Methadone therapy was associated with substantial reductions in heroin use and some reduction in cocaine use, but 24% of cocaine users receiving methadone began or increased cocaine injection after entry into treatment.

Topics: Black or African American; Cocaine; Endocarditis, Bacterial; Female; Heroin; Hispanic or Latino; HIV Seropositivity; Humans; Injections, Intravenous; Male; Methadone; San Francisco; Substance-Related Disorders; Syphilis; White People

We describe the case of a young man addicted to heroin with the clinical pattern of symmetrical brachial neuropathy, without other neurological involvement. Lead poisoning was detected and chelating therapy induced a marked improvement of the clinical symptoms. The possible toxic effect of heavy metals in the pathogenesis of brachial and lumbar plexopathies during heroin addiction has previously been suggested by other authors, but never detected.

Topics: Adult; Heroin; Humans; Lead Poisoning; Male; Substance-Related Disorders

We report seven fatalities resulting from the ingestion of illicit drugs packaged in condoms, rubber balloons, or plastic bags which were observed in the last 4 years at the Office of the Chief Medical Examiner, State of Maryland. All the victims, with the exception of one, were men ranging in age from 19 to 37 years. There was no racial predominance. No drug paraphernalia was found at any scene. In two cases, seizure-like activity was documented. One victim had recently returned from Nigeria; therefore, Lassa fever was initially suspected. Two of the victims were "body packer" contrabanders who had just arrived from Africa. They used body cavities to hide large amounts of heroin to avoid U.S. Customs. The other five cases were "mini-packers," small-time illicit drug dealers who had swallowed a single bag of cocaine to avoid police detection. The possible mechanism of leaking or rupture of the latex container is discussed.

Topics: Adolescent; Adult; Baltimore; Cocaine; Death, Sudden; Female; Heroin; Humans; Illicit Drugs; Male; Nigeria; Substance-Related Disorders; Travel

Rats made dependent on heroin and morphine exhibit both qualitative and quantitative differences in the characteristics of radioligand binding to mu-opioid receptors in the central nervous system. In brain membranes prepared from control animals, [3H]dihydromorphine (DHM) binding was best described by a two-site model, while in morphine-dependent rats, [3H]DHM binding was best described by a single-site model. In contrast, [3H]DHM binding to membranes from heroin-dependent animals was best described by a two-site model, with an increased density of the high-affinity, and no change in the low-affinity population compared to controls. Furthermore, both the number of binding sites for [3H]DAGO (a ligand that selectively labels a population of high-affinity mu-opiate receptors) and the sensitivity of [3H]DHM to sodium ions was increased in heroin; but not in morphine-dependent rats. These studies demonstrate that opiate receptors are differentially regulated in heroin- and morphine-dependent animals. Such neurochemical changes in mu-opiate receptors may underlie differences in the behavioral and pharmacological profiles of heroin and morphine reported in man.

Topics: Animals; Brain; Cell Membrane; Dihydromorphine; Enkephalin, Ala(2)-MePhe(4)-Gly(5)-; Enkephalins; Heroin; Male; Morphine; Naloxone; Rats; Rats, Inbred Strains; Receptors, Opioid; Receptors, Opioid, mu; Sodium; Substance-Related Disorders

Topics: Adolescent; Adult; Cannabis; Cocaine; Denmark; Female; France; Germany, West; Heroin; Heroin Dependence; Humans; Illicit Drugs; Ireland; Male; Substance-Related Disorders; Switzerland

Topics: Administration, Inhalation; Adolescent; Adult; Female; Heroin; Humans; Infant, Low Birth Weight; Infant, Newborn; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications; Substance-Related Disorders

A case-control study of heroin users in general practice showed a prevalence of roughly two per 1000 of the urban population or four per "average" general practice list of patients. A method of studying heroin users who attend general practice was used that has advantages over existing techniques. Thirty six heroin users had a statistically significantly higher yearly doctor-patient consultation rate than a group of matched controls. More heroin users also failed to attend appointments than controls. When consultations directly related to heroin and its effects were excluded, however, the consultation rates in the two groups were similar. The heroin users did not have an excess of psychiatric disorder or disturbed family background compared with controls but had a noticeable history of dishonest and violent behaviour towards medical staff. A high proportion of heroin users in the study were antibody positive for the human immunodeficiency virus. General practitioners should take advantage of their frequent contacts with heroin users and their families to give them support and counselling about the acquired immune deficiency syndrome.

Topics: Family Practice; Heroin; HIV Seropositivity; Humans; Patient Acceptance of Health Care; Scotland; Substance-Related Disorders; Urban Population

Topics: Acquired Immunodeficiency Syndrome; Cocaine; Health Policy; Heroin; Humans; Injections, Intravenous; Narcotics; National Institutes of Health (U.S.); Substance-Related Disorders; United States; United States Public Health Service

Topics: Adult; Female; Heroin; Hospitalization; Humans; India; Male; Substance-Related Disorders

Topics: Adolescent; Adult; Drug Administration Routes; Drug Contamination; Female; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Lung; Male; Pulmonary Embolism; Radionuclide Imaging; Respiratory Function Tests; Substance-Related Disorders; Talc

The neuropsychological and behavioral status of children exposed to narcotics in utero was investigated using the Wechsler Intelligence Scale for Children-Revised, the Bender-Gestalt, the Quick Neurological Screening Test, and the Burks Behavior Rating Scales. The narcotic-exposed children scored significantly lower than control children on Performance and Full-Scale IQs and most of the performance subtests. They scored significantly in the more pathological direction on Hand Skill, Figure Recognition and Reproduction, and Behavioral Irregularities. The narcotic-exposed children were significantly lower on the neurological indicators of the Bender-Gestalt. They scored significantly in the more pathological direction on almost all of the behavioral variables. The children exposed to methadone in utero scored in the more pathological direction than those exposed to heroin so as to raise questions directed toward the societal and ethical implications of methadone treatment.

Topics: Adolescent; Child; Follow-Up Studies; Heroin; Humans; Infant, Newborn; Intelligence; Methadone; Neonatal Abstinence Syndrome; Neuropsychological Tests; Psychometrics; Substance-Related Disorders

Topics: Acquired Immunodeficiency Syndrome; Heroin; Humans; Illicit Drugs; Injections, Intravenous; Scotland; Social Problems; Substance-Related Disorders

Postpneumonic empyema (EMP) may develop in substance abuse patients, requiring prolonged hospitalization. An algorithm that provides quality care and a rational basis for timely surgical intervention would be advantageous. We report our five-year experience with EMP in substance abuse patients and present such a treatment plan. Sixty-one substance abuse patients were treated for EMP. Posteroanterior, lateral, and decubitus x-ray studies were obtained before treatment to assess fluid movement. Chest tubes were placed to drain frank pus and to obtain material for positive smears. X-ray studies and computed tomography were done 24 hours later to assess parenchymal pathology and to detect any multiple loculations. Thirty-three substance abuse patients recovered following initial tube thoracostomy and 7 after a second chest tube was introduced. Twenty-one had multiple loculations and underwent thoracotomy. Twenty of the 21 required extensive debridement or decortication, or both; 2 required lobectomy and 1 pneumonectomy. Chest tubes were removed on an average of 6 +/- 1.5 days. Average postoperative stay was 10.7 +/- 2 days. There were 2 early deaths and 1 late death and no recurrent EMP. Bacteriology findings were nonspecific and often polymicrobial. We conclude that early thoracotomy can be lifesaving in the presence of a benign clinical course.

Topics: Adolescent; Adult; Aged; Empyema; Female; Heroin; Humans; Lung Diseases; Male; Middle Aged; Radiography; Substance-Related Disorders

In the latter part of 1985, a dramatic rise in the number of illicit narcotic (heroin) related deaths in the State of New Mexico became apparent, and this increase persisted through the majority of the following year. A careful inspection of samples of narcotics found at the scenes of death, coupled with changes in the illicit drug traffic detected by local and state law enforcement agencies, revealed that the rising death rate corresponded with the distinctively increased availability of a form of heroin that is produced in Mexico, commonly termed "black tar" heroin. An analysis of heroin deaths, comparing characteristics of cumulative deaths in the six years before the increase with those deaths associated with the apparent epidemic, revealed several significant observations. These factors, along with the distinctive physical features of black tar heroin, suggest that the rise in the narcotic abuse death rate may be related to both unfamiliarity with this type of heroin on the part of the user and the inherent difficulty of diluting nonpowdered forms of the drug to sublethal levels.

Topics: Adult; Female; Heroin; Hispanic or Latino; Humans; Middle Aged; New Mexico; Substance-Related Disorders

Topics: Bacterial Infections; Bacteroides Infections; Endocarditis, Bacterial; Fusobacterium Infections; Heroin; Humans; Male; Middle Aged; Staphylococcal Infections; Streptococcal Infections; Substance-Related Disorders; Veillonella

Thirteen patients developed a renal disease after using heroin alone or in combination with other drugs, for a period of 3 to 12 years. Eleven were IV drug addicts, 2 were sniffers. Six patients had acute tubular necrosis, due to rhabdomyolysis in 5 and to prolonged gentamicin therapy for bacterial endocarditis in 1. Five patients manifested a nephrotic syndrome, and renal biopsy showed various types of glomerulonephritis (GN) without glomerular sclerosis. The two last patients had hypertension with intrarenal vascular lesions and HBsAg was present in their serum. Chronic hemodialysis and/or renal transplantation were required in 2 cases with GN; all other patients recovered normal serum creatinine. There was no specific pathologic picture of heroin abuse in this series.

Topics: Adult; Endocarditis, Bacterial; Female; Gentamicins; Glomerulonephritis; Heroin; Humans; Hypertension, Renovascular; Kidney; Kidney Diseases; Kidney Tubular Necrosis, Acute; Male; Rhabdomyolysis; Substance-Related Disorders

Laos in the period 1965-1975 provided an opportunity to study sex differences in drug and alcohol use, as influenced by ethnicity. Several psychoactive substances were locally consumed, including opium, heroin, alcohol, tobacco, betel-areca, and cannabis. Much diversity occurred among the various ethnic groups with regard to male-female use of drugs and alcohol. Trends in these use patterns suggested the existence of certain principles which govern the male-female dimension of drug use. Social changes going on in the society were reflected in choice of substance forms by younger people as compared to their elders (e.g., cigarettes vs pipes or cigars, heroin vs opium, manufactured vs village-produced alcohol). Ecological factors, which contributed to drug availability, also were powerful in determining type of drugs and patterns of use.

Topics: Adult; Alcohol Drinking; Alcoholism; Areca; Ethnicity; Female; Heroin; Humans; Laos; Male; Middle Aged; Opium; Plants, Medicinal; Sex Factors; Smoking; Substance-Related Disorders

Topics: Acquired Immunodeficiency Syndrome; Administration, Oral; Adolescent; Adult; Heroin; Humans; Injections, Intravenous; Male; Methadone; Patient Dropouts; Substance-Related Disorders

We studied the clinical, scintigraphic, and histopathologic characteristics of 26 intravenous drug abusers with costochondral involvement secondary to systemic infection with Candida albicans. The clinical findings were of a mass appearing in the anterior region of the thorax. In general, signs of inflammation were absent. Histopathologic study of this costochondral mass in 12 patients showed perichondritis in 100% and myositis in 87%, with secondary involvement of cartilage in 43% and of bone in 75%. Results of bone scintigrams using 99mTc-methylene diphosphonate were positive in only 7 of 15 patients (47%), with a correlation between positive uptake and osteitis. Gallium scintigraphy findings were positive in 9 of 10 patients (90%). The greater sensitivity of 67Ga was probably because the invariably present pericartilaginous inflammatory mass was not always accompanied by secondary cartilage and bone involvement.

Topics: Adolescent; Adult; Candida albicans; Candidiasis; Cartilage; Female; Heroin; Humans; Male; Ribs; Substance-Related Disorders; Syndrome; Tomography, Emission-Computed

A 20-year-old male heroin addict had a sudden onset of progressive medullary dysfunction and died within 12 days. Postmortem examination disclosed mycotic granulomas due to primary chromoblastomycosis strictly limited to the medulla oblongata and adjacent leptomeninges. Similar lesions were absent outside the central nervous system. Such pathologic lesions related to narcotic addiction have not been reported previously.

Topics: Adult; Brain Diseases; Chromoblastomycosis; Heroin; Humans; Male; Medulla Oblongata; Substance-Related Disorders

Topics: Cocaine; Heroin; Humans; Louisiana; Substance-Related Disorders

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Heroin; Humans; Infant; Infant, Newborn; Ireland; Male; Middle Aged; Substance-Related Disorders; Urban Population

A 25 year old woman who had received intravenous heroin over one year previously developed an intervertebral abscess due to infection with Candida albicans. Immunological investigation of this patient showed no evidence of a specific defect in the host response to candida.

Topics: Abscess; Adult; Candidiasis; Female; Heroin; Humans; Spinal Diseases; Substance-Related Disorders

Topics: Adolescent; Adult; Female; Heroin; Humans; Male; Middle Aged; Prospective Studies; Substance-Related Disorders; United Kingdom

Topics: Adult; Clinical Protocols; Clonidine; Drug Therapy, Combination; Female; Heroin; Humans; Male; Naltrexone; Substance-Related Disorders

Topics: Female; Heroin; Humans; Infant, Newborn; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications; Substance-Related Disorders

Topics: Adult; AIDS-Related Complex; Female; Heroin; Humans; Male; Splenectomy; Substance-Related Disorders; Thrombocytopenia

We report a sensitive, rapid, quantitative gas chromatographic/mass spectroscopic method for measuring the 6-monoacetylmorphine (6-MAM) metabolite of heroin in 0.5 mL of human urine. After a simple liquid-liquid extraction and derivatization, the trimethylsilyl derivative of 6-MAM is identified from its retention time (total ion current) and by selected ion monitoring. The limit of detection was 10 micrograms/L, corresponding to 0.2 ng of trimethylsilyl-6-MAM injected into the gas chromatograph/mass spectrometer. The presence of 6-MAM in urine is indicative of heroin. 6-MAM is not present in poppy seeds or in urine after the ingestion of products containing poppy seed.

Topics: False Positive Reactions; Gas Chromatography-Mass Spectrometry; Heroin; Humans; Morphine; Morphine Derivatives; Papaver; Plants, Medicinal; Seeds; Substance-Related Disorders; Trimethylsilyl Compounds

Topics: Acute Kidney Injury; Adult; Cocaine; Female; Heroin; Humans; Male; Myoglobinuria; Rhabdomyolysis; Substance-Related Disorders

Topics: Acute Kidney Injury; Adult; Heroin; Humans; Male; Rhabdomyolysis; Substance-Related Disorders

Topics: Abscess; Adult; Cerebellar Diseases; Female; Heroin; Humans; Nocardia Infections; Substance-Related Disorders

Topics: Drug Prescriptions; Heroin; Humans; Methadone; Morphine; Substance-Related Disorders

Topics: Heroin; Humans; Methods; Morphine; Substance-Related Disorders

The toxicological screening of 200 urine samples from 55 known heroin users claiming to be abstinent revealed that in 18% of samples (24% of users tested) opiates were unexpectedly detected. Other substances, many of which were psychoactive drugs, were identified in 35% of samples. Cocaine was not detected in any samples. In addition, nicotine was found in 91% of users and caffeine in 44%. The data showed the presence of polydrug abuse in 29% of subjects and suggested there is an illegal supply of drugs originating from doctors' prescriptions. The requirement for more general use of toxicological screening and the implications of the results for management of drug takers in general practices are discussed.

Topics: Female; Heroin; Humans; Male; Narcotics; Substance-Related Disorders

On the basis of a review of the available information, this article summarizes the situation, patterns and trends in respect of the use of cannabis, heroin and other opiates, cocaine, amphetamines, hallucinogens and inhalants, as well as multiple drug use. The review clearly shows that since the early 1980s there has been an increasing trend in the use of drugs, particularly heroin and cannabis. Drug use predominantly affects young people. The use of two or more drugs simultaneously or successively, often involving alcohol, is reported as the most common pattern of drug use among youth. Drug use has become incorporated into the current youth culture, with all the individual, social and economic implications this engenders. The average age of users at first use of inhalants was 16.3 years, cannabis 17.5 years, hallucinogens 18.8 years, cocaine 20.6 years and amphetamines 23.5 years.

Topics: Adolescent; Adult; Age Factors; Amphetamine; Cocaine; Hallucinogens; Heroin; Humans; Marijuana Abuse; Spain; Substance-Related Disorders

Topics: Adult; Aged; Arthritis, Infectious; Candidiasis; Candidiasis, Cutaneous; Chorioretinitis; Heroin; Humans; Male; Osteoarthritis; Substance-Related Disorders

Vascular complications resulting from drug abuse constitute a widespread and common clinical problem. A 3-year experience with 32 vascular complications (13 arterial, 19 venous) related to intravenous drug abuse is reported. Fourteen (48%) of the 29 patients in this series presented with septic vascular complications. These infections were a major cause of morbidity and mortality, resulting in two hospital deaths and a disrupted arterial repair. In addition, intra-arterial drug injection caused digital gangrene in two patients. Early recognition, diagnostic arteriography and venography, and planned therapeutic interventions are possible if a high level of suspicion is maintained.

Topics: Adult; Arteries; Cocaine; Heroin; Humans; Injections, Intra-Arterial; Injections, Intravenous; Male; Substance-Related Disorders; Vascular Diseases

Topics: Adolescent; Flunitrazepam; Heroin; Humans; Male; Rhabdomyolysis; Substance-Related Disorders

Patterns of initiation, persistence, and cessation of use of licit, illicit, and prescribed drugs are presented for a longitudinal cohort from their middle to the late twenties. The cohort is representative of adolescents formerly enrolled in public secondary high schools in New York State. No additional initiation of cigarettes, alcohol, and illicit drugs occurred in the four-year follow-up interval, except for cocaine and pills. The largest proportional increase of new users occurred for prescribed psychoactive drugs. Alcohol showed the most persistence of use, followed by cigarettes and marijuana. As the cohort ages, those who continue to use illicit drugs actively do so at lower levels of intensity than at younger ages. For each drug class, the persistence of use is strongly related to earlier intensity of involvement. By age 29, men have accumulated almost twice as many months of use of illicit drugs as women.

Topics: Adult; Cocaine; Ethanol; Female; Heroin; Humans; Longitudinal Studies; Male; Sex Factors; Smoking; Substance-Related Disorders; Tranquilizing Agents

Topics: Chromatography, Thin Layer; Glucuronidase; Heroin; Humans; Morphine; Substance-Related Disorders

Systemic candidiasis in intravenous drug abusers (IVDA) is a new syndrome caused by Candida albicans and characterized by the sequential development of skin, eye, and osteoarticular lesions, which together form a typical clinical picture. We studied 30 patients with suggestive skin lesions: papules, nodules, and pustules in hair-bearing areas, particularly the scalp and beard area, associated with hair invasion by candidal hyphae. Ocular and osteoarticular involvement and presence of candidemia in some of the patients suggested blood-borne colonization of C. albicans. The infection has been related to "brown" heroin. The origin of C. albicans and the reasons for its exclusive localization in the skin and these organs are discussed. The characteristic clinical picture is widely different from that of classic disseminated candidiasis in immunodeficient patients. Therapy is also discussed.

Topics: Adult; Candidiasis; Candidiasis, Cutaneous; Female; Heroin; Humans; Male; Substance-Related Disorders

A 22 year old heroin addict was admitted with tonic-clonic seizures, confusion and agitation 10 hours after taking mefenamic acid 5 grams orally and 2.25 grams intravenously. This appears to be the first recorded case of intravenous mefenamic acid abuse and, although not fatal, is a cause of concern. This is a commonly used drug and its seizure inducing potential is well recognised. It may therefore be worthwhile considering the possibility of intravenous abuse of mefenamic acid in heroin addicts admitted with confusion or seizures.

Topics: Administration, Oral; Adult; Confusion; Heroin; Humans; Injections, Intravenous; Male; Mefenamic Acid; Seizures; Substance-Related Disorders

Topics: Adult; Antibodies, Viral; Female; Heroin; HIV; Humans; Lymphocyte Activation; Male; Substance-Related Disorders

Topics: Adolescent; Adult; Antibodies, Viral; Disease Outbreaks; Female; Heroin; HIV; Humans; Ireland; Male; Substance-Related Disorders

The recovery of heroin in fumes was investigated. In the Netherlands the common mode of heroin smoking is the 'chasing the dragon' procedure: heroin is heated on an aluminium foil by a lighter and the fumes are inhaled. The efficiency of the volatilization of heroin using this procedure was studied under laboratory conditions using thin layer chromatography, gas chromatography and high pressure liquid chromatography. A considerable influence of the form (salt or base) of the heroin was found as well as strong influences of other substances that may be present in illicit heroin samples as diluents. The danger of the inhalation of fumes containing unknown pyrolysis products is mentioned and a hypothesis is given for the phenomenon of 'heroin'-leucoencephalopathy that was observed in heroin smokers in Amsterdam in 1981. The types of heroin encountered in the Netherlands are discussed with regard to their suitability for smoking.

Topics: Barbital; Caffeine; Chromatography, Gas; Chromatography, High Pressure Liquid; Chromatography, Thin Layer; Codeine; Heroin; Hot Temperature; Morphine Derivatives; Strychnine; Substance-Related Disorders; Volatilization

The study was designed to assess glycaemic homeostasis in different situations of chronic stimulation of the opiate receptors by exogenous opiates. After an OGTT, levels of glycosylated haemoglobin (HbA1c) and serum fructosamine were measured in 3 groups of male drug addicts of comparable age. Group A consisted of 10 subjects undergoing substitution treatment with oral methadone. Group B consisted of 10 subjects addicted to intravenous injection of the syrup based methadone intended for oral administration. Group C consisted of 10 heroin addicts. Ten healthy subjects of the same age and sex were used as controls. Analysis of the results showed normal glucose tolerance in all groups with tendentially higher basal glycaemia levels in group B. HbA1c levels were significantly higher, though within normal limits, in group B than in either those receiving oral methadone (p less than 0.01) or the heroin addicts (p less than 0.01). The group B subjects also showed the highest fructosamine levels that were both well above normal limits and higher than those in the other groups in whom fructosamine levels were normal. The data therefore confirm normal glycaemia compensation in those taking oral methadone and in heroin addicts during the period considered. A new type of drug addiction involving the intravenous injection of methadone was also encountered. This produces an outstanding short-term change in glycaemic homeostasis and may well lead to future alterations in glucose tolerance.

Topics: Adult; Blood Glucose; Fructosamine; Glucose Tolerance Test; Glycated Hemoglobin; Heroin; Hexosamines; Homeostasis; Humans; Male; Methadone; Narcotics; Substance-Related Disorders

Topics: Adult; Anxiety; Cocaine; Heroin; Humans; Male; Middle Aged; Pain; Pain Measurement; Substance-Related Disorders

The influence of heroin availability on the aggregate level of use of this drug was investigated for a normal Black cohort (born between 1952 and 1957) who grew up in Harlem (New York City). Data obtained on the second and third waves of a panel study were used to estimate annual rates of heroin initiation and cessation from the mid-1960s through 1983. The aggregated time-series variables indicated that initiation into heroin use was largely confined to adolescence and that cessation rates exhibited substantial year-to-year fluctuations with no apparent relationship to either chronological age or calendar year. Respondents born before 1955, however, had much higher rates of heroin use than those born in later years. Temporal trends in initiation and cessation were uncorrelated with changes in the purity of heroin sold in New York City between 1973 and 1983, suggesting that aggregate levels of heroin use in this sample were little affected by changes in supply. More speculatively, cohort differences in lifetime prevalence may reflect varying availability at the times younger and older cohorts entered adolescence. This possibility could not be directly tested because of the absence of reliable purity data going back sufficiently far in time.

Topics: Adolescent; Adult; Black or African American; Female; Heroin; Humans; Longitudinal Studies; Male; New York City; Substance-Related Disorders; Urban Population

Topics: Candidiasis; Hepatitis; Heroin; Humans; Substance-Related Disorders

Topics: Adult; Aerosols; Bronchial Spasm; Heroin; Humans; Male; Substance-Related Disorders

Topics: Adult; Bronchial Spasm; Female; Heroin; Humans; Illicit Drugs; Injections, Intravenous; Pharmaceutical Preparations; Substance-Related Disorders

Two patients deliberately ingested single paper packages containing heroin. These were recovered intact by induction of emesis with syrup of ipecacuanha.

Topics: Adult; Emergencies; Foreign Bodies; Heroin; Humans; Ipecac; Male; Radiography; Stomach; Substance-Related Disorders

The analysis of drugs of abuse in urine is a valuable tool for the detection of illicit drug use and the treatment and rehabilitation of addicts. In order for the results to be conclusive, however, several precautions have to be taken during the collection, storage, mailing and analysis of the urinary specimen. Since immunological methods for the determination of drugs of abuse are not completely specific, all positive results on immunoassay should be confirmed, at least for forensic purposes, by a chromatographic technique. Although much more complicated and time-consuming, some chromatographic techniques such as gas chromatography-mass spectrometry offer the possibility of unambiguously identifying drugs of abuse. However, in some cases, even with this method it is not possible to decide whether the identified metabolite of a drug of abuse stems from food or illicit or elicit drug use. A single urinary analysis is, therefore, sometimes not sufficient to provide unambiguous proof of the use of illicit drugs. However, definite evidence of repeated drug abuse can be obtained if the person involved is carefully instructed as to which medicines or food must not be taken during the investigation period and yet the analysis of several urinary specimens taken at intervals of one or two days proves positive.

Topics: Amphetamines; Anti-Anxiety Agents; Barbiturates; Benzodiazepines; Cannabinoids; Chromatography; Cocaine; Heroin; Heroin Dependence; Humans; Illicit Drugs; Immunologic Techniques; Morphine; Morphine Dependence; Pharmaceutical Preparations; Specimen Handling; Substance-Related Disorders

Topics: Adult; Amphetamines; Heroin; Humans; Illicit Drugs; Male; Paranoid Disorders; Psychoses, Substance-Induced; Substance-Related Disorders

Topics: Administration, Inhalation; Adult; Airway Obstruction; Heroin; Humans; Male; Prospective Studies; Substance-Related Disorders; Time Factors

Lymphocyte subpopulations were studied in 29 symptom-free Spanish prisoners who were active parenteral drug abusers. In 16/29 drug addicts (55%) the helper-inducer/suppressor-cytotoxic ratio (Leu 3a/Leu 2a) was less than 1. None of these 16 patients had lymphopenia and only 2 had a reduction in the number of Leu 3a cells. In drug addicts the number of lymphocytes (p less than 0.01) and the number and percentage of Leu 2a cells (p less than 0.001) were significantly raised. The addicts also had a higher absolute number of T cells when measured by their ability to react with the Leu 4 antibody (p less than 0.01). However, the E-rosette forming cells were significantly reduced. Thus the E-rosette test may lead to an overestimation of "null" cells. Furthermore drug addicts had a higher percentage (p less than 0.001) of Leu 7 positive cells (NK and K cells), but a normal percentage of B and phagocytic cells. Five drug addicts had generalized persistent lymphadenopathies, and 2 had skin anergy. We believe that most of the immunologic abnormalities seen in these apparently healthy drug abusers can be explained by an antigenic overload.

Topics: Adolescent; Adult; Alanine Transaminase; Aspartate Aminotransferases; Hepatomegaly; Heroin; Homosexuality; Humans; Immunoglobulins; Leukocyte Count; Lymphocytes; Male; Prisoners; Rosette Formation; Spain; Substance-Related Disorders; T-Lymphocytes, Helper-Inducer; T-Lymphocytes, Regulatory

The prolonged generalized lymphadenopathy syndrome (PGL) has been considered a prodromal condition to the Acquired immunodeficiency syndrome (AIDS), but the clinical, virological and immunological characteristics of patients who will develop AIDS are not known. We report on the immunological profile of intravenous drug abusers with or without PGL in Northeastern Italy. We found a reduction of lymphocyte-absolute numbers with reversal of the T4/T8 ratio and decreased Leu-11b+ cells. The response to mitogens and natural killer activity are compromised in PGL patients. Neutrophil function is reduced both in drug abusers with or without lymphadenopathy. The serological investigations revealed a high prevalence of antibodies against HTLV III and the Epstein-Barr viruses. The recognition of immune dysfunction in the intravenous drug abusers appears to be important since these patients develop AIDS and these abnormalities may precede AIDS.

Topics: Adult; AIDS-Related Complex; Antibodies, Viral; Deltaretrovirus; Female; Heroin; HIV Antibodies; Humans; Italy; Killer Cells, Natural; Leukocyte Count; Lymphatic Diseases; Lymphocyte Activation; Male; Phagocytosis; Substance-Related Disorders; T-Lymphocytes

Centres for the treatment of drug abusers are often integrated with regional psychiatric hospitals and are the focus of the British response to opiate addiction. Little is known, however, about the use made of these services by drug users in the community or about the success of these services. This study examined the use made of one centre offering a detoxification service by a cohort of 183 heroin users from a large Scottish general practice. Over half of this cohort were referred to the psychiatric drug treatment service, but less than one third started treatment. The evidence did not indicate that patients who had extended contact with the psychiatric service showed prolonged abstinence, though methodological difficulties necessitate further prospective studies. This study raises important questions about the value and appropriateness of this type of service in the light of the pattern of voluntary remission and relapse displayed by heroin users and in the absence of adequate provision for drug abusers in the community.

Topics: Heroin; Humans; Patient Acceptance of Health Care; Psychiatric Department, Hospital; Psychotherapy; Referral and Consultation; Substance-Related Disorders; United Kingdom

Topics: Animals; Cocaine; Desipramine; Dopamine; Heroin; Heroin Dependence; Hydroxydopamines; Oxidopamine; Pargyline; Rats; Reinforcement, Psychology; Self Administration; Substance-Related Disorders; Tegmentum Mesencephali

The effect of maternal abuse of heroin on newborn babies was studied in 25 babies born during 1982-6 to 23 heroin users, most of whom smoked the drug. Nineteen of the babies developed withdrawal symptoms, which in 12 were severe enough to require treatment. Five babies were born prematurely; 17 were adequately grown for their gestational age. Four mothers successfully established breast feeding. Twenty two infants were discharged from the hospital into their mother's care with support from the family and community services; at the end of the study only six were living in families in which the parents were married or had a stable relationship. Withdrawal symptoms were short lasting and often self limiting, and no evidence of adverse effect on postnatal growth and development was found. Unstable social circumstances with changes in family dynamics made follow up difficult. Further assessment needs to be carried out to investigate the long term effect of maternal heroin abuse on children.

Topics: Adolescent; Adult; Female; Heroin; Humans; Infant, Newborn; Pregnancy; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors

Topics: Acute Disease; Adult; Hepatitis D; Hepatitis Delta Virus; Heroin; Humans; Male; New Zealand; Substance-Related Disorders

Issues regarding the use of epidemiology in drug abuse research are discussed and systems for monitoring national trends and identifying risk factors are described. Data indicate a general decline in marijuana use among youth, a cohort aging effect among heroin and marijuana users, and increased prevalence and health consequences associated with cocaine use.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Child; Cocaine; Epidemiologic Methods; Female; Heroin; Humans; Male; Marijuana Abuse; Population Surveillance; Risk; Substance-Related Disorders

Topics: Candida albicans; Candidiasis; Citrus; Food Microbiology; Heroin; Humans; Substance-Related Disorders

Topics: Candidiasis; Citrus; Heroin; Humans; Substance-Related Disorders

Topics: Adolescent; Adult; Child; Female; Heroin; Humans; Ireland; Male; Socioeconomic Factors; Substance-Related Disorders

Long-term intravenous heroin abusers have problems of vascular access. After the accessible sites are sclerosed, the neck, axillae and groins are then used frequently. We report on 3 heroin abusers who presented with localized gangrene of the genitalia after injection into the femoral vessels. We postulate that the pathophysiology of this entity is related to arterial embolization of particulate matter into the microcirculation of the genitalia, which causes arterial thrombosis leading to localized gangrene. Of the 3 patients 2 were treated with local excision, débridement and primary closure. A fourth addict who injected heroin directly into the scrotum and perineum, presented with Fournier's gangrene, a completely different, more lethal entity.

Topics: Adult; Femoral Artery; Femoral Vein; Gangrene; Genital Diseases, Male; Heroin; Humans; Injections, Intra-Arterial; Injections, Intravenous; Male; Middle Aged; Penile Diseases; Scrotum; Substance-Related Disorders

A patient with methicillin-resistant Staphylococcus aureus bacteremia received vancomycin (MIC = 0.8 microgram/ml, MBC = 15 micrograms/ml) and heparin simultaneously through the same intravenous line to treat a septic deep venous thrombosis. Bacteremia persisted for 7 days. Bacteremia terminated when the simultaneous infusion of heparin and vancomycin through the same line was stopped. This suggested that an interaction between vancomycin and heparin may have occurred, which resulted in a reduction in vancomycin activity. To test for such an interaction, mixtures of heparin and vancomycin in various concentrations were made and tested for antimicrobial activity against the organisms in the patient. A precipitate formed at the concentrations achieved in the intravenous lines, and when the vancomycin concentrations were measured by bioassay, a 50 to 60% reduction in activity was noted. In contrast, when these solutions were prepared and mixed at microgram concentrations, a precipitate was no longer observed, and antimicrobial activity was not reduced. Heparin appeared to interact unfavorably with vancomycin at the concentrations in the intravenous lines when these drugs were administered simultaneously to patients. This may be the cause of poor therapeutic responses to vancomycin in some patients, especially those infected with tolerant organisms.

Topics: Adult; Drug Combinations; Heparin; Heroin; Humans; Infusions, Parenteral; Male; Sepsis; Staphylococcal Infections; Staphylococcus aureus; Substance-Related Disorders; Thrombophlebitis; Vancomycin

Topics: Adult; Cerebral Hemorrhage; Heroin; Humans; Male; Methamphetamine; Substance-Related Disorders

Infants born to opiate-abusing mothers have a decreased ventilatory response to carbon dioxide and a five to ten times increased risk of sudden infant death syndrome (SIDS). These abnormalities of ventilatory control may be associated with abnormal sleeping ventilatory patterns. Therefore, 28 overnight pneumograms (respiratory pattern recording and electrocardiogram) were obtained from 27 infants of substance-abusing mothers (ISAM) (five opiate, seven phencyclidine hydrochloride, three cocaine, and 12 polydrug abusers) and compared with pneumograms from 43 control infants. Pneumograms were quantitated for total sleep time, greatest duration of apnea, total duration of apnea greater than or equal to 6 s, periodic breathing, and mean heart and respiratory rates. The ISAM had a longer total sleep time, greater durations of apnea, a higher total duration of apneas greater than or equal to 6 s, more periodic breathing, a higher mean respiratory rate, and a lower mean heart rate. Thirty-two percent of pneumograms from ISAM were abnormal compared with 9.3% of the control pneumograms. We conclude that ISAM have abnormal sleeping ventilatory patterns that may be related to their increased SIDS risk.

Topics: Age Factors; Cocaine; Female; Heart Rate; Heroin; Humans; Infant; Male; Methadone; Narcotics; Phencyclidine Abuse; Pregnancy; Pregnancy Complications; Respiration; Retrospective Studies; Risk; Sleep; Sleep Apnea Syndromes; Substance-Related Disorders; Sudden Infant Death

Topics: Adult; Aneurysm, Infected; Bronchoscopy; Hemoptysis; Heroin; Humans; Male; Pulmonary Artery; Substance-Related Disorders

Topics: Adult; Endocarditis, Bacterial; Female; Haemophilus; Haemophilus Infections; Heroin; Humans; Streptococcal Infections; Streptococcus sanguis; Substance-Related Disorders

Systemic amyloidosis has recently emerged as a major cause of nephropathy among heroin abusers in New York City. Although focal glomerulosclerosis is typically seen in intravenous drug abusers who present with the nephrotic syndrome, those who escape this complication are at risk for the later development of amyloidosis related to their use of the subcutaneous route. Twenty such addicts identified between 1981 and 1984 are described. Patients typically present with chronic suppurative skin infections, edema, the nephrotic syndrome, benign urinary sediment, and normal-sized or enlarged kidneys. Tubular dysfunction, particularly renal tubular acidosis and diabetes insipidus, is frequent. Progression of renal insufficiency is characteristically rapid. Prolonged survival of heroin abusers and exhaustion of intravenous access requiring recourse to the subcutaneous route underlie the occurrence of amyloidosis in the addict population. Chronic suppurative skin infection consequent to repeated subcutaneous injection appears to be the underlying cause.

Topics: Adult; Amyloidosis; Female; Heroin; Humans; Injections, Subcutaneous; Kidney Diseases; Male; Middle Aged; Substance-Related Disorders

Topics: Contraceptive Devices, Male; Female; Heroin; Humans; Male; Substance-Related Disorders

The nature and severity of drug use has been measured both directly and indirectly by various studies employing different indicators, although the majority of studies still tend to use single measures of drug use. The need to employ multiple measures in examining drug abuse is constrained by the fact that available data may have been collected through diverse methodologies and measured on different levels or units. The purpose of this study was to develop and test in Philadelphia a model using qualitatively different types of data integrated by the common geographic unit of a census tract. The types of data used included: archival data, key informant data, and survey data. Using this approach the paper examines the relationships of drug use measures to each other, to the social environment, and to drug market factors. Major findings of the analysis indicate that there are several independent measures of drug use as reflected in five composite indicators which differentiate behavioral activities or consequences of drug use. Moreover, heroin use indicators exhibit relationships with social-environmental characteristics and drug market factors which are different from those existing with amphetamine or synthetic drug use.

Topics: Adult; Amphetamines; Archives; Crime; Data Collection; Family; Female; Heroin; Humans; Illicit Drugs; Interviews as Topic; Male; Models, Theoretical; Pennsylvania; Socioeconomic Factors; Substance-Related Disorders

Topics: Heroin; Humans; Psychotherapy; Substance-Related Disorders

The Centers for Disease Control hierarchical classification of those at risk for acquired immunodeficiency syndrome (AIDS) underestimates the number of cases in which illicit drug use may play a role in the exposure to human T-cell leukemia virus type III. The immunosuppressive effects of nitrite inhalants are not sufficiently documented to elucidate their role as a cofactor in the development of AIDS. The currently available data on the immunosuppressive effects of self-administered parenteral drugs and their diluents indicate an associated elevation of immunoglobulin M, depressed helper/suppression T-cell ratios, and even damage to DNA. Illicit psychoactive drugs and their diluents may influence the virulence of the virus among parenteral drug users. An association between parenteral drug use and prostitution is not unexpected. Female prostitutes who use parenteral drugs may be at high risk for exposure to the virus and thus may transmit this infectious agent to their clients and their families.

Topics: Acquired Immunodeficiency Syndrome; Amyl Nitrite; Antibodies, Viral; Chromosome Aberrations; Cocaine; Female; Heroin; Heroin Dependence; HIV Antibodies; Humans; Immune Tolerance; Immunoglobulin M; Injections, Intravenous; Male; Retroviridae Infections; Risk; Substance-Related Disorders; T-Lymphocytes; United States

Topics: Anti-Anxiety Agents; Benzodiazepines; Drug Utilization; Heroin; Humans; Italy; Narcotic Antagonists; Self Medication; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Diabetes Mellitus, Type 2; Endorphins; Heroin; Humans; Islets of Langerhans; Narcotics; Substance-Related Disorders

Anonymous surveys on drug use were administered to 7th-12th grade students in Indian reservation schools. A large number of tribes were surveyed from 1975 through 1983. There is reason to believe the results are reasonably representative of Indian youth living on reservations. Lifetime prevalence for most drugs is higher than that for non-Indian youth throughout this period, and rates for alcohol, marijuana, and inhalants, the most frequently tried drugs, were particularly high. Since 1981 there has been a slight drop in lifetime prevalence for most drugs. Current use figures show the same trends, with increasing current use through 1981 and a drop since that time. Analysis of patterns of drug use, classifying youth according to number, type, and depth of involvement with drugs, shows a similar trend, with radical increases until 1981 and then a drop in all but one of the more serious drug use types. Despite this drop, 53% of Indian youth would still be classified as "at risk" in their drug involvement, compared with 35% of non-Indian youth. Reasons probably relate to severely detrimental conditions on reservations; unemployment, prejudice, poverty, and lack of optimism about the future.

Topics: Adolescent; Adult; Age Factors; Cannabis; Central Nervous System Stimulants; Child; Cocaine; Ethanol; Female; Hallucinogens; Heroin; Humans; Hypnotics and Sedatives; Indians, North American; Male; Solvents; Substance-Related Disorders; United States

Hepatic cirrhosis is infrequently diagnosed in young adults. In a hospital for addictive diseases in New York City, we found cirrhosis in 53 patients under age 35 within just 40 months. The cirrhosis was biopsy-proven in 37 patients (group I) and diagnosed clinically in 16 patients with severe liver disease (group II). Alcohol abuse was found in 51 patients (96%), and parenteral heroin abuse was seen in 52 (98%). The duration of alcohol abuse was seven or fewer years in 24 patients (45%) and 10 or fewer in 39 (74%). In 44 (83%), the substance abuse began in adolescence. Comparison of group I cirrhotic patients with 65 non-cirrhotic biopsied patients showed that cirrhosis was significantly associated with abuse of both alcohol and parenteral heroin (p less than 0.001). The distribution of 66 HLA antigens from A, B, C, and DR loci showed no differences when 42 patients were compared with 42 ethnically-matched control substance abusers. The early development of cirrhosis in these young patients may be related to multiple hepatic injuries induced by alcohol and parenteral heroin abuse and to the onset of addictive diseases during adolescence or early adult life.

Topics: Adult; Age Factors; Female; Heroin; Histocompatibility Antigens Class II; HLA Antigens; HLA-DR Antigens; Humans; Injections; Liver Cirrhosis; Liver Cirrhosis, Alcoholic; Male; Substance-Related Disorders

Ingested cocaine can be a cause of severe bowel ischemia or gangrene. Two cocaine addicts who ingested large quantities of the drug developed severe abdominal symptoms and signs caused by bowel ischemia. In one patient gangrene of the bowel necessitated repeated resections and was followed, several weeks later, by death. The other patient suffered less severe ischemia and the bowel returned to normal. The diagnosis of bowel ischemia should be suspected whenever a cocaine addict has severe abdominal symptoms and signs. The presence of marked leukocytosis suggests bowel gangrene and demands prompt surgical intervention.

Topics: Adult; Cocaine; Colectomy; Colon; Female; Gangrene; Gastrointestinal Hemorrhage; Heroin; Humans; Ileostomy; Ileum; Intestinal Obstruction; Intestines; Ischemia; Necrosis; Substance-Related Disorders; Suicide, Attempted

The presentation and management of 10 cases of proven or presumptive fungal endophthalmitis in narcotic-drug abusers is described. Miconazole was found to be an effective agent in some patients when administered in a dosage of 2400 mg/day. Eight patients received treatment with a combination of miconazole and flucytosine (5-fluorocytosine). Regression of the infection with preservation of the eye was observed in each case. However, visual acuity in the affected eye improved only in four of the eight patients; it was unchanged in two and had deteriorated in the other two. In two patients, who received amphotericin B and flucytosine as initial treatment, control of the infection was achieved, but vision remained unchanged. Vitrectomy was performed in three patients to remove residual sites of infection. However, vision remained unchanged in two of these patients and worsened in the third. The selection of individual modalities of therapy and responses to treatment are discussed.

Topics: Adult; Amphotericin B; Candidiasis; Drug Therapy, Combination; Endophthalmitis; Female; Flucytosine; Heroin; Humans; Male; Miconazole; Mycoses; Substance-Related Disorders; Visual Acuity; Vitrectomy

We studied the demographic characteristics, drug use patterns, and sexual habits of intravenous (IV) drug abusers to further define this population at risk for acquired immunodeficiency syndrome (AIDS). Sixteen IV drug abuser patients with AIDS, 24 IV drug abuser patients with AIDS-related complex (ARC), and 14 IV drug abuser controls without evidence of AIDS or ARC were evaluated. The subjects in each group were similar demographically, in drug use practice, and in sexual orientation and experience. Of the AIDS and ARC patients, 34 (88%) of 40, including all seven homosexual men, shared needles, as did all drug abusers without AIDS or ARC. Seventy-four percent of patients, including all homosexual men, attended "shooting galleries," where anonymous multiple-partner needle sharing took place. Needle sharing supports the hypothesis of AIDS transmission by a blood-borne route, can explain the spread of AIDS and the high rate of seropositivity to the putative AIDS agent among IV drug abusers, and is a logical link between IV drug abusers and male homosexuals, the two largest groups with AIDS.

Topics: Acquired Immunodeficiency Syndrome; Adult; Cocaine; Demography; Female; Heroin; Humans; Injections, Intravenous; Male; Middle Aged; New York; Nitrites; Puerto Rico; Sexual Behavior; Skin Tests; Substance-Related Disorders; T-Lymphocytes

Topics: Adolescent; Adult; Heroin; Hospitalization; Humans; Male; Substance-Related Disorders; T-Lymphocytes

Topics: Heroin; Humans; Scotland; Substance-Related Disorders

A patient presented with a painful, oedematous, cyanosed hand having injected a solution of diamorphine and methylphenidate into his radial artery. Treatment was started with heparin and vasodilators. Benefit from this was limited and a course of intra-arterial urokinase was instituted. This gave almost total resolution of the injury. The mechanisms producing ischaemia following intra-arterial injection of drugs of abuse and possible treatment are discussed.

Topics: Accidents; Adult; Forearm; Heroin; Humans; Injections, Intra-Arterial; Ischemia; Male; Methylphenidate; Substance-Related Disorders; Urokinase-Type Plasminogen Activator

The relationship between self-reported illicit heroin use and pupillary response to a low-dose methadone challenge was examined in 28 men beginning methadone therapy for opiate dependence. Pupil diameter was assessed before and 60, 90, and 120 minutes after a 20 mg methadone dose on day 1 of treatment. Self-reports of opiate drug effects were also taken at these times. There was a significant negative correlation (r = -0.53) between pupillary constriction 120 minutes after drug dosing and the average dollar value of subjects' reported heroin use per week. In other words, those who showed the least pupillary constriction generally reported the highest amount of illicit heroin use. Total years since first opiate use was also a significant predictor of pupillary response (r = -0.46). Self-reported amount of heroin use and years since first opiate use together accounted for 60% of the total variance in pupillary response to the challenge (Mult r = 0.77). Pupillary response to a low-dose methadone challenge appears to be a clinically practical and objective method for determining opiate tolerance levels in applicants for methadone therapy.

Topics: Adult; Dose-Response Relationship, Drug; Drug Tolerance; Heroin; Humans; Male; Methadone; Pupil; Regression Analysis; Substance-Related Disorders

Two cases of heroin abusers who developed disseminated candidiasis are reported. Cultures of skin lesions revealed Candida albicans, which on histology were shown to be located in and around hair shafts. Both patients recovered after treatment with amphotericin B combined with 5-fluorocytosine and either ketoconazole or dexamethasone. This unusual cutaneous syndrome of candidal infection associated with extensive folliculitis seems to be related to the use of a particular type of heroin, the so-called brown Iranian heroin.

Topics: Adult; Amphotericin B; Candidiasis; Conjunctivitis; Female; Flucytosine; Folliculitis; Heroin; Humans; Iran; Ketoconazole; Male; Substance-Related Disorders

The efficacy of a rapid detoxification schedule (8 to 10 days) with clonidine or methadone was evaluated in 30 patients addicted to heroin. The dose of study drug was preestablished according to the subject's weight and the amount of opioid consumption, and the total daily dose was reduced by approximately 15% during the study. All subjects completed the detoxification program and stayed in the hospital for at least 12 days. Clonidine and methadone therapies proved to be highly effective. There was a marked reduction in anxiety during opioid detoxification, although subjects' experiences differed according to the drug used. On the day of discharge, subjects who had received methadone still had attenuated withdrawal symptoms, whereas there were no such symptoms in the clonidine group. Muscular aching, flatulence, and daily drowsiness were more common among subjects in the methadone group, while subjects in the clonidine group had more sleep disturbances and weeping. Syncopal episodes and bradycardia occurred more frequently in the clonidine group.

Topics: Adolescent; Adult; Analysis of Variance; Anxiety; Blood Pressure; Clonidine; Double-Blind Method; Drug Administration Schedule; Drug Evaluation; Female; Flunitrazepam; Heart Rate; Heroin; Humans; Inactivation, Metabolic; Male; Methadone; Substance-Related Disorders

Laboratory rats were given unlimited access to intravenous cocaine hydrochloride or heroin hydrochloride. Animals self-administering cocaine quickly developed a pattern of episodic drug intake, with periods of excessive cocaine self-administration alternating with brief periods of abstinence. Subjects allowed continuous access to intravenous heroin showed stable drug self-administration, with a gradual increase in daily heroin intake over the first two weeks of testing. The general health of the animals became markedly different: those self-administering heroin maintained grooming behavior, pretesting body weight, and a good state of general health; rats self-administering cocaine tended to cease grooming behavior, to lose up to 47% of their pretesting body weight, and to show a pronounced deterioration in general health. The mortality rate for 30 days of continuous testing was 36% for animals self-administering heroin and 90% for those self-administering cocaine. These results suggest that cocaine is a much more toxic compound than heroin when animals are given unlimited access to intravenous drug.

Topics: Animals; Body Weight; Cocaine; Grooming; Heroin; Heroin Dependence; Humans; Infusions, Parenteral; Male; Rats; Self Administration; Substance-Related Disorders

Topics: Adult; Heroin; Humans; Illicit Drugs; Myoglobinuria; Rhabdomyolysis; Substance-Related Disorders

A population including homosexual or heroinoman patients with lymphadenopathy is reported with special reference to Beta-2-microglobulin. This molecule seems to be more related to concomitant infection rather than to a high risk group. Thus, elevated Beta-2-microglobulin is useful to exclude infected donors but no high risk SIDA population.

Topics: Acquired Immunodeficiency Syndrome; beta 2-Microglobulin; Blood Donors; Heroin; Homosexuality; Humans; Lymphatic Diseases; Risk; Substance-Related Disorders

Topics: Family; Female; Heroin; History, 20th Century; Humans; Opioid-Related Disorders; Politics; Prisons; Religion; Substance-Related Disorders; Therapeutic Community

Topics: Adolescent; Adult; Heroin; Humans; Male; Pakistan; Substance-Related Disorders

Deaths associated with injected street preparations of heroin increased substantially in the District of Columbia between April 1979 and December 1982. The 1981 population-based mortality rate (17.4 per 100,000) is possibly the highest ever reported. A case-control study based on toxicologic analyses of postmortem blood samples indicates that concentrations of both heroin and ethanol are substantial risk factors for heroin-related deaths. Analyses of the composition of street-level preparations of heroin and quarterly mortality indicate that the quantity of heroin in packages sold on the street, the price of heroin in these packages, and the quinine weight per package each predict deaths equally as well. An increase in the causal use of heroin in combination with ethanol and quinine is the probable cause of this epidemic.

Topics: Adolescent; Adult; Alcoholic Intoxication; Costs and Cost Analysis; District of Columbia; Drug Contamination; Ethanol; Female; Heroin; Humans; Illicit Drugs; Male; Morphine; Pharmaceutical Preparations; Quinine; Risk; Substance-Related Disorders

Topics: Adult; Crime; Drug Administration Schedule; Family; Female; Heroin; Heroin Dependence; Humans; Illicit Drugs; Life Style; Male; Social Environment; Socioeconomic Factors; Substance-Related Disorders

The clinical pharmacology of the narcotic-type analgesics is discussed in depth. Relative analgesic potency, peak and duration of analgesia, oral potency, and adverse effects are reviewed, With an emphasis on the clinical application of this knowledge. The differences among psychologic dependence, physical dependence, and tolerance are carefully delineated. Guidelines are provided for using narcotic-type analgesics in the management of patients with cancer.

Topics: Administration, Oral; Analgesics; Drug Therapy; Drug Tolerance; Heroin; Humans; Morphine; Narcotics; Neoplasms; Primary Health Care; Substance-Related Disorders

Topics: Adult; Arthritis, Infectious; Heroin; Humans; Knee Joint; Male; Streptococcal Infections; Substance-Related Disorders

Seven young men developed disseminated candidiasis within 10 days of a single episode of intravenous heroin abuse. Sequential development of eye and skin lesions was noted in all cases. The bone or costal cartilage was involved in five. Ocular manifestations of candidiasis included episcleritis, chorioretinitis, and endophthalmitis. A presumptive diagnosis of candida chorioretinitis was established rapidly by culture of Candida albicans from involved skin and costal cartilage. Systemic therapy with amphotericin B plus 5-fluorocytosine resulted in cure of the episcleritis, chorioretinitis, osteomyelitis, costochondritis, and skin infection. Pars plana vitrectomy with local instillation of amphotericin B was required to cure chorioretinitis associated with vitreal extension of infection.

Topics: Adult; Amphotericin B; Candidiasis; Eye Diseases; Flucytosine; Heroin; Humans; Male; Substance-Related Disorders

An involvement of calcitonin in the mechanism of pain perception has recently been hypothesized. In order to collect information about the relationship between this hormone and well known analgesic substances such as opioids, we have studied the serum levels of calcitonin in a group of heroin addicts, finding higher average concentrations than in normal subjects of matched age and sex. In these addicts there were no severe signs of impaired renal or hepatic function, or alterations of the serum levels of calcium and phosphate. So we think that opioids, in a direct or indirect way, can stimulate the secretion of calcitonin.

Topics: Adolescent; Adult; Analysis of Variance; Bilirubin; Calcitonin; Calcium; Creatinine; Female; Heroin; Humans; Male; Phosphates; Substance-Related Disorders

Topics: Heroin; Humans; Male; Naloxone; Physostigmine; Substance-Related Disorders

Drug-related deaths encompass fatal overdoses, the medical derangements from chronic consumption, and violent death from the alteration of normal behavioral patterns. Determining the extent to which a drug contributed to a death necessitates correlation of all aspects of the death investigation; autopsy and toxicologic findings must be interpreted in the light of antecedent events, medical and social history, and thorough scene investigation. The approach to the medicolegal investigation of drug-related deaths is discussed along with some legal ramifications and certain potential problems of death certification.

Topics: Autopsy; Cocaine; Death, Sudden; Drug Prescriptions; Ethanol; Forensic Medicine; Heroin; Humans; Illicit Drugs; Marijuana Abuse; Pharmaceutical Preparations; Substance-Related Disorders; Tattooing; Toxicology

A review of records of the Toxicology Laboratory of the New Jersey State Medical Examiner's Office yielded a total of 36 deaths attributable to overdose of "hits," an oral combination of codeine and glutethimide, during 1980-1981. During the same period, 126 deaths due to heroin overdose and 46 deaths due to methadone overdose occurred. The majority of hits cases (77.8%) occurred in the Newark vicinity. Demographic features of persons who died of the three agents are presented, and some explanations are advanced for the unexpectedly high mortality due to the oral narcotic combination.

Topics: Adult; Codeine; Drug Interactions; Epidemiologic Methods; Female; Glutethimide; Heroin; Humans; Male; Methadone; New Jersey; Substance-Related Disorders

We studied antibiotic intake in 197 abusers of alcohol, sedatives, or parenteral heroin or cocaine. Thirteen patients, all abusers of parenteral heroin or cocaine, had taken antibiotics without prescription, obtained from friends, from old prescriptions, or by purchase on the street. Past or present street purchase of antibiotics was noted in 27 patients and was more common (P less than .02) in parenteral substance abusers. Four parenteral substance abusers had infection or colonization with methicillin-resistant Staphylococcus aureus, and three of them had purchased antibiotics on the street before the present or a recent past hospitalization. Physicians treating abusers of parenteral heroin or cocaine should be aware that such patients may be taking antibiotics without medical supervision. This practice may be an important factor in the development and spread of methicillin-resistant S aureus.

Topics: Anti-Bacterial Agents; Cocaine; Drug Resistance, Microbial; Heroin; Humans; Illicit Drugs; Injections, Intravenous; Nonprescription Drugs; Self Medication; Skin Ulcer; Staphylococcal Infections; Substance-Related Disorders; Surveys and Questionnaires

The construct validity of two methodologically unrelated procedures for estimating the prevalence of heroin abuse was studied using a covariance structure model-fitting approach. A factor analytic estimation procedure and a log-linear-based capture-recapture method of estimation were simultaneously applied to 24 major metropolitan areas of the nation. A test of the construct validity of these procedures for estimating the prevalence of heroin abuse was carried out in the context of structural equation models where the results of the two methods were compared directly.

Topics: Data Collection; Factor Analysis, Statistical; Heroin; Humans; Models, Psychological; Substance-Related Disorders; United States; Urban Population

To gain information concerning the natural history and prevalence of pulmonary gas exchange abnormalities resulting from intravenous drug abuse, 45 intravenous drug users were studied. Twenty subjects used a mixture of the synthetic opiate pentazocine and the antihistamine tripelennamine, which, under the street name T's and B's, has become very popular in some urban areas as an available substitute for heroin. Compared with the 19 heroin addicts studied, the pentazocine and tripelennamine users had a significantly shorter mean duration of intravenous drug abuse (2.7 +/- 0.4 years versus 7.6 +/- 0.9 years, p less than 0.01), a greater frequency of respiratory symptoms (75 percent versus 36 percent, p less than 0.05), a significant reduction in the mean diffusing capacity of the lung for carbon monoxide (58.4 +/- 3.3 percent predicted versus 75.5 +/- 5.6 percent predicted, p less than 0.01), and abnormal responses to submaximal steady-state exercise testing. The intravenous use of pentazocine and tripelennamine and probably most other drug preparations intended for nonparenteral use represents a particularly noxious form of drug abuse that may lead to early respiratory complications in a large proportion of users.

Topics: Adult; Exercise Test; Female; Heroin; Humans; Lung; Male; Pentazocine; Respiration Disorders; Substance-Related Disorders; Time Factors; Tripelennamine

Fourteen previously healthy young patients with unusual community-acquired opportunistic infections were seen over a period of three years. They differ from patients previously described in that 11 were heterosexual drug abusers (including two women) and only three were homosexual men. There were eight Puerto Ricans, five blacks, and one white. Infections included Pneumocystis carinii pneumonia (seven), disseminated Mycobacterium intracellulare infection, histoplasmosis, cryptococcosis, and cytomegalovirus infection (one each), oral thrush (13), and Candida esophagitis (two). All patients had impaired cellular immunity manifested by cutaneous anergy and lymphopenia, and all 11 tested had a markedly decreased ratio of T helper/inducer cells to T suppressor/cytotoxic cells. Twelve had evidence of associated viral infection (Epstein-Barr virus in nine, cytomegalovirus in five, Herpes simplex type 2 in two). Clinical presentation was with a severe opportunistic infection or with a prodrome consisting of oral thrush and nonspecific findings including malaise, fever, lymphadenopathy, or cough. The syndrome of immunodeficiency and opportunistic infection occurs in nonwhite heterosexual drug abusers, not exclusively in white homosexual men, and patients may present for medical care before the onset of a severe opportunistic infection.

Topics: Acquired Immunodeficiency Syndrome; Adult; Black People; Candidiasis, Oral; Female; Heroin; Homosexuality; Humans; Immunity, Cellular; Infections; Male; New York City; Pneumonia, Pneumocystis; Puerto Rico; Substance-Related Disorders; T-Lymphocytes; T-Lymphocytes, Regulatory; Virus Diseases

A new syndrome of acquired immunodeficiency has been identified in seven children who were small for gestational age at birth and subsequently have exhibited failure to thrive, lymphadenopathy, parotitis, hepatosplenomegaly, interstitial pneumonia, and recurrent infections. All have a profound cell-mediated immunodeficiency with reversed T4/T8 ratios. Six are hypergammaglobulinemic and one has low IgG levels. The mothers of five of the seven children are sexually promiscuous and/or drug addicts. Three mothers have an immunodeficiency similar to that found in their infants. One of them died at age 33 years with a diagnosis of acquired immunodeficiency syndrome. In five of the children and in three of their mothers, there is evidence of a persistent Epstein-Barr virus (EBV) infection. We speculate that a perinatal or in utero transmission of EBV can induce an "infectious immunodeficiency." The clinical, histopathologic, and immunologic features resemble those described in adult homosexuals and drug addicts.

Topics: Acquired Immunodeficiency Syndrome; Age Factors; Child, Preschool; Female; Heroin; Humans; Infant; Male; Maternal-Fetal Exchange; Pregnancy; Prenatal Exposure Delayed Effects; Sexual Behavior; Substance Withdrawal Syndrome; Substance-Related Disorders; T-Lymphocytes; T-Lymphocytes, Helper-Inducer; T-Lymphocytes, Regulatory

Twenty-five ambulatory patients with acquired immunodeficiency syndrome (AIDS) were studied over a 6-month period. Fourteen (56%) of the patients were heterosexuals with a history of intravenous drug abuse. Ocular involvement was seen in 40% of patients, cotton-wool spots being the major manifestation. Findings consistent with cytomegalovirus retinitis were seen in only one patient. Ophthalmologists should be aware of the ocular findings and epidemiology of AIDS.

Topics: Acquired Immunodeficiency Syndrome; Adult; Cytomegalovirus Infections; Eye Diseases; Female; Fluorescein Angiography; Heroin; Humans; Male; Middle Aged; Retinal Diseases; Retinitis; Sarcoma, Kaposi; Skin Neoplasms; Substance-Related Disorders

Topics: Ambulatory Care; Heroin; Humans; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adult; Bacteroides Infections; Eikenella corrodens; Heroin; Humans; Male; Methylphenidate; Skin Diseases, Infectious; Substance-Related Disorders

Within our study population of 100 women for whom 3,980 urine toxicology reports were accomplished, 98 percent were multi-drug users. This proportion is far greater than would have been calculated from the percent of urines that were positive for the drugs of abuse and is a more realistic estimate of the extent of the problem than is often reported. Despite this high percentage of multi-drug use, due to the uniqueness of our patient population (pregnant women), it is not possible to deny them pharmacologic therapy for their addiction. Therefore, the use of urine toxicology reports in our clinical setting has broader implications than adherence to the methadone regulations. These reports serve as excellent devices to assess newborn abstinence symptomatology, in addition to helping us monitor the physical and psychological status of our patients. The implications are that self-medication may be used to achieve a particular effect concomitant with methadone therapy. The effects are generally to enhance the action of methadone and to decrease undesirable side effects.

Topics: Amphetamine; Diazepam; Female; Heroin; Humans; Methadone; Narcotics; Opioid-Related Disorders; Pregnancy; Substance-Related Disorders

Seven young men developed similar manifestations of disseminated candidiasis after a single episode of intravenous heroin abuse. Sequential development of lesions of the eye, skin, and bone or costal cartilage was noted within 10 days after injection. Skin lesions were confined to the scalp and other hair bearing areas. Candida albicans was cultured readily from affected skin and costal cartilage. Histological examination of scalp biopsy specimens showed infiltration of hair follicles with chronic inflammatory cells and C albicans. Pseudohyphas of C albicans were also identified in and around hair shafts. The skin, skeletal, and small eye lesions resolved on systemic treatment with 1 g amphotericin B plus flucytosine. Pars plana vitrectomy plus local instillation of amphotericin B cured progressive chorioretinitis. These features may represent a distinctive syndrome of disseminated candidiasis in heroin abusers. Systemic antifungal treatment is curative in most cases.

Topics: Candidiasis; Candidiasis, Cutaneous; Eye Diseases; Heroin; Humans; Male; Osteochondritis; Osteomyelitis; Ribs; Substance-Related Disorders; Syndrome

Topics: Adolescent; Adolescent Behavior; Adult; Cannabis; Child; Child Abuse; Child Development; Female; Heroin; Humans; Male; Pregnancy; Pregnancy in Adolescence; Substance-Related Disorders; Violence

Topics: Female; Fetal Alcohol Spectrum Disorders; Fetal Diseases; Heroin; Humans; Methadone; Opioid-Related Disorders; Pregnancy; Substance-Related Disorders

Reported is a case of Brown-Sequard syndrome following attempted heroin injection into the right external jugular vein. A right-sided hemiparalysis with a contralateral sensory loss of touch, pain, proprioception, and temperature developed over several hours to the C3 dermatome level. A myelogram showed a vasculitis pattern in the lower cervical region. Treatment was with high-dose dexamethasone for ten days. After six weeks of inpatient physical therapy, only minimal motor and sensory return was seen. Although this syndrome is usually due to lateral hemisection of the spinal cord by a stab wound or a gunshot wound, in this case we believe it resulted from chemical transection due to the heroin or quinine diluent or both.

Topics: Adult; Heroin; Humans; Injections, Intravenous; Jugular Veins; Male; Paralysis; Spinal Cord Injuries; Substance-Related Disorders; Syndrome

Acute bacterial endocarditis, a fulminating disorder most often caused by Staphylococcus aureus, is uncommon in pregnancy. However, the frequency of this disease may be increasing due to the prevalence of intravenous drug abuse. Three cases occurred during pregnancy at Charity Hospital, New Orleans; all three patients were intravenous drug abusers. One patient had polymicrobial disease.

Topics: Acute Disease; Adult; Endocarditis, Bacterial; Female; Heroin; Humans; Injections, Intravenous; Pentazocine; Pregnancy; Pregnancy Complications, Infectious; Staphylococcus aureus; Substance-Related Disorders; Tripelennamine

The acceptability of nonmedical use for a particular drug is a function of diverse social needs. Drug dependence is due less to intrinsic effects than to the situation in which drug taking occurs. An addictive level of drug self-administration is a symptom of behavioral troubles rather than a definition of the trouble itself. The intrinsic effects of drugs do not in themselves produce either misuse or evoke specific kinds of behavior such as sexual or aggressive activities. Drugs can, however, come to function as discriminative stimuli for socially sanctioned behavior that would not under other circumstances be tolerated. The intrinsic reinforcing potential of an agent evolves in and dominates situations in which other reinforcing opportunities are either absent or remain unavailable to an individual who is unprepared to exploit them. While certain intrinsic properties of a drug contribute to its potential as a reinforcer (e.g., rapid onset and brief duration of action), reinforcing efficacy is notoriously malleable. It is a function of historic and currently-acting factors, particularly social reinforcers. The importance of physical dependence in the maintenance of drug seeking and taking is mainly unproven and probably overrated. Situations under which important reinforcers are available only in small portions intermittently can induce various excessive activities, including an untoward concern with obtaining and using drugs. Drug dependence prevention as a species of environmental dependence can be best effected by either alterations in the intermittent reinforcement situations inducing excessive behavior or by providing opportunities and training with respect to reinforcing alternatives other than drugs.

Topics: Aggression; Alcoholism; Animals; Attitude to Health; Environment; Ethanol; Heroin; Humans; Indians, North American; Phencyclidine; Rats; Reinforcement Schedule; Reinforcement, Social; Sexual Behavior; Social Problems; Substance-Related Disorders; Violence

Topics: Adult; Alcoholic Intoxication; Anuria; Arm; Heroin; Humans; Male; Oliguria; Paralysis; Substance-Related Disorders

A 50-year-old man, a "mainline" heroin abuser for 25 years, with a five-year history of x-ray findings compatible with asbestosis is presented. Multiple open biopsies failed to prove a diagnosis of asbestosis. The microscopic analyses of tissues revealed the presence of granulomatosis, secondary to talc from chronic intravenous heroin abuse. The need for open lung biopsy in establishing a diagnosis is emphasized, as x-ray findings can be and often are misleading. A tissue diagnosis is necessary, particularly in cases in which drug abuse is suspected.

Topics: Asbestosis; Diagnosis, Differential; Granuloma; Heroin; Humans; Injections, Intravenous; Lung Diseases; Male; Middle Aged; Radiography; Substance-Related Disorders; Talc

Topics: Adolescent; Age Factors; Female; Germany, West; Heroin; Humans; Male; Social Problems; Substance-Related Disorders

Topics: Adult; Emergencies; Heroin; Humans; Male; Naloxone; Substance-Related Disorders

Topics: Dextropropoxyphene; Drug Tolerance; Heroin; Humans; Methadone; Narcotics; Pentazocine; Substance-Related Disorders; Tripelennamine; United States

Topics: Adolescent; Cannabis; Heroin; Heroin Dependence; Humans; Italy; Malingering; Social Conformity; Substance-Related Disorders; Suicide, Attempted

Analyses of data from two nationwide surveys of high school students, one carried out in 1974 and the other in 1978, suggest that problem drinking may be seen as yet another step along an underlying dimension of involvement with both licit and illicit drugs. The dimension of involvement with drugs consists of the following levels: nonuse of alcohol or illicit drugs; nonproblem use of alcohol; marijuana use; problem drinking; use of pills (amphetamines, barbiturates, hallucinogenic drugs); and the use of "hard drugs" such as cocaine or heroin. The dimension possesses excellent Guttman-scale properties in both national samples as well as in subsamples differing in gender and ethnic background. The ordering of the levels of involvement was confirmed by the ordering of the alcohol-drug involvement groups based on their mean scores on measures of psychosocial proneness for involvement in problem behavior. The excessive use of a licit drug, i.e., problem drinking, appears to indicate greater involvement in drug use than does the use of an illicit drug, marijuana. This finding points to the importance of distinguishing between use and problem use of drugs in efforts to understand adolescent drug involvement.

Topics: Adolescent; Alcohol Drinking; Cannabis; Cocaine; Ethnicity; Female; Heroin; Humans; Illicit Drugs; Male; Pharmaceutical Preparations; Substance-Related Disorders; Surveys and Questionnaires; United States

A case of acute left ventricular failure following an intravenous dose of amphetamine is described. The diagnosis was made by right heart catheterization. This is the first description of acute amphetamine cardiomyopathy in the medical literature.

Topics: Acute Disease; Adult; Amphetamine; Cardiomyopathies; Catheterization; Heroin; Humans; Male; Pulmonary Edema; Substance-Related Disorders

Topics: Adolescent; Adult; Cesarean Section; Female; Heroin; Humans; Infant, Newborn; Ireland; Male; Maternal-Fetal Exchange; Methadone; Pregnancy; Pregnancy Complications; Prenatal Care; Smoking; Socioeconomic Factors; Substance Withdrawal Syndrome; Substance-Related Disorders

A follow-up study was done in 31 rehabilitation probands who were discharged consecutively from a long term drug withdrawal centre for heroin and multiple drug addiction. Referral had been on the basis of section 64 of the penal code and a motivation for treatment had to be established first. After discharge the majority of probands could be reassessed repeatedly. A total of 180 follow-up investigations included also urinanalysis and in 170 of these cannabinoids were looked for. Cannabis was detected in only two cases. When other addictives were demonstrated in a few cases they could be attributed to codeine-containing medicines beyond doubt. Regular follow-up assessments of past drug addicts including urinanalyses serve for further stabilisation of the patients and at the same time indicate long-term success of treatment.

Topics: Cannabinoids; Female; Follow-Up Studies; Heroin; Heroin Dependence; Humans; Male; Narcotics; Substance-Related Disorders

On-site investigations involving interviews with spouses, friends, coworkers, supervisors, and commanders were conducted following 37 deaths or near-deaths by drug overdose among U.S. soldiers stationed in Europe. Subjects were all active-duty soldiers put on the seriously ill list at any Army hospital with an initial diagnosis which included suspected drug overdose. Victims were typically single Black males, less than 22, high school graduates in excellent health. They had been in Germany 7-24 months, liked their jobs, and were judged better than average workers by both peers and supervisors. Fifty percent played on a unit sports team, 6 of 10 had German girlfriends, and one-third had prior disciplinary problems. Although nearly half had been previously identified as having a drug or alcohol problem, only two or three could be called addicts in even the broadest sense. Six cases were suicide gestures, and only these six cases did not involve heroin and/or alcohol. The modal case followed a party, with substantial drinking. In only 25% of the cases did the victim collapse upon injection. More often he went to bed, vomited during the night, and choked on or inhaled vomitus. The data suggest reexamination of two common myths: that heroin users comprise a very unique, albeit undesirable, sample of the general population; and that "overdose" deaths are the result of ignorance, incompetence, or indifference.

Topics: Adult; Age Factors; Alcoholic Intoxication; Black or African American; Black People; Europe; Heroin; Heroin Dependence; Humans; Male; Marriage; Military Personnel; Substance-Related Disorders; Suicide

The mortality amongst 530 out-patient drug-addicts, dependent mainly on opiates and being first registered between 1969 and 1977, was analysed. This grand total (27% females, median age 19 years, 73% males, median age 20 years) was subdivided into three groups with variable observation follow-up according to the time-shift of consumed main drugs. Until the demarcation day 31 December 1982 81 clients (15%) died. Mortality rates were determined according to the death cases for the three groups. In comparison with the mortality of the age-matched whole population male heroin addicts had a twelve-fold and females a 29-fold death rate. Survival curves of all three groups showed a rather linear course indicating a surprisingly long period of danger. For optimisation of advice methods and for treatment of drug-addicts long-term analyses of larger unselected groups involving further parameters are required.

Topics: Adolescent; Adult; Age Factors; Female; Germany, West; Heroin; Humans; Illicit Drugs; Longitudinal Studies; Male; Narcotics; Outpatients; Patients; Psychotropic Drugs; Risk; Sex Factors; Substance-Related Disorders

Two patients with talc emboli of the retinal vasculature, both of them intravenous drug abusers, are described. One underwent a pars plana vitrectomy for removal of the vascularized vitreous mass that obscured the retina. The vitreous mass was presumably a result of retinal neovascularization secondary to the talc embolic. Other ocular findings that may be observed in the intravenous drug abuser are described.

Topics: Adult; Embolism; Eye Diseases; Female; Heroin; Humans; Injections, Intravenous; Methylphenidate; Neovascularization, Pathologic; Retinal Vessels; Substance-Related Disorders; Talc; Vitreous Body

Studies of acquisition and maintenance patterns of drug intake, including dependence, necessitate voluntary intake of drugs. Voluntary intake in animal studies is difficult to achieve because of aversive taste factors associated with most drugs, and involuntary or forced choice methods obscure the behavior which is the object of study. The schedule-induced polydipsia paradigm has been used to induce oral ingestion of large volumes of alcohol, barbiturate and other drug solutions. We have developed a method of schedule-induced self-injection which allows the study of acquisition and maintenance of drug intake behavior with changing environments free from the interference of taste factors or imbalances due to excessive water intake. In this paper we review our findings on the acquisition and maintenance patterns of amphetamine, methadone, heroin, alcohol, nicotine, cocaine, delta 9-THC and haloperidol. For all drugs except amphetamine, the combination of schedule and nutritional deprivation leads to the highest rates of drug intake as compared to controls. The schedule does not appear to be a potent factor at 90% and free feeding weight, and drug intake is the result of interaction of environmental factors and pharmacological properties of the drugs, rather than the effects of drug or environmental factors separately. The maintenance patterns of nicotine, cocaine, heroin and alcohol are also discussed and the advantages of schedule-induced self-injection over schedule-induced polydipsia methods are presented.

Topics: Amphetamine; Animals; Behavior, Animal; Cocaine; Conditioning, Operant; Dronabinol; Ethanol; Feeding Behavior; Food Deprivation; Heroin; Humans; Infusions, Parenteral; Methadone; Models, Biological; Psychotropic Drugs; Rats; Reinforcement Schedule; Substance-Related Disorders

A 42-year-old abuser of intravenous drugs developed fulminant aortic insufficiency necessitating a prosthetic valve replacement. Trichosporon cutaneum was isolated from the surgical specimen. The patient received a total of 3,195 g of amphotericin B, and 148 g of 5-fluorocytosine during his four-month hospitalization. He manifested no additional signs of persistent fungal infection, but died one year later from an intracerebral hemorrhage.

Topics: Adult; Endocarditis; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Mitosporic Fungi; Mycoses; Substance-Related Disorders

Experimental data are presented in support of the hypothesis on the role of positive and negative reinforcing systems in the mechanism of drug dependence. Drugs with abuse potential (DAP) may change the manner of response to negative emotional stimuli, activate positive emotional reactions in animals, and possess primary reinforcing properties. Reward and punishment systems respond sensitively to withdrawal from DAP or antagonist administration. Catecholaminergic and peptidergic processes are of importance in the mechanisms of the emotionally positive action of DAP.

Topics: Amphetamines; Animals; Cats; Chlordiazepoxide; Cocaine; Diazepam; Drug Tolerance; Escape Reaction; Ethanol; Heroin; Humans; Morphine; Pentobarbital; Psychophysiology; Rats; Reinforcement, Psychology; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adult; Heroin; Humans; Male; Methadone; Psychotic Disorders; Self Medication; Substance-Related Disorders

A sample survey of 712 Iranian youths aged 14 - 18 years, attending secondary schools in the city of Isfahan, indicated that 11% had had experience of drug abuse. The most common pattern was the experimental use of opium, with a minority of users having also used hashish or heroin. No other drugs were reported, but a significant association between the use of opium and of cigarettes and, to a lesser extent, alcohol was observed. However, given a relatively early peak in initiation to opium smoking, it seems that the initiation to the use of cigarettes and alcohol is contemporary with, rather than preceding the initiation to opium. Drug migration patterns described in Western samples and in some areas of South East Asia are not applicable to more traditional societies.

Topics: Adolescent; Age Factors; Alcohol Drinking; Heroin; Humans; Iran; Marijuana Abuse; Opium; Smoking; Substance-Related Disorders

A case of bilateral necrotizing scleritis due to Aspergillus oryzae is reported. The patient was a former addict of intravenous narcotics treated five years previously for meningitis due to the same organism. A seeding focus in the thoracic spine was eventually found. The patient responded well to combined local and systemic therapy with amphotericin B, flucytosine, and natamycin. This represents, to the best of our knowledge, both the first reported case of ocular disease due to this species of Aspergillus and of isolated scleral, nonintraocular involvement in endogenous oculomycosis.

Topics: Adolescent; Adult; Amphotericin B; Aspergillosis; Aspergillus oryzae; Child; Cocaine; Eye Diseases; Female; Flucytosine; Heroin; Humans; Inflammation; Injections, Intravenous; Meningitis; Natamycin; Sclera; Substance-Related Disorders

A survey by the Department of Justice in 1978 of inmates of local jails in the United States found that 68% had ever used drugs like heroin, cocaine, marijuana, amphetamines, or barbiturates outside a treatment program, and without a doctor's prescription. Offenses for which relatively larger proportions of inmates reported drug use included robbery, burglary, auto theft, larceny, and drug offenses. During the month prior to jail, 44% of inmates reported using drugs. Some 21% of convicted inmates reported being under the influence of drugs at the time of an offense for which convicted. One-fourth of inmates reporting drug use had ever been enrolled in drug treatment. Treatment and rehabilitation of the drug abuser in a jail setting is discussed.

Topics: Adolescent; Adult; Amphetamines; Barbiturates; Cannabis; Crime; Data Collection; Female; Heroin; Humans; Male; Middle Aged; Prisoners; Prisons; Substance-Related Disorders; United States; Violence

Experienced polydrug abusers (N = 190) were asked to indicate previous drugs used as well as drug preferences. The 11 most frequently used drugs were ranked according to percentage of subjects preferring each drug relative to reference compounds (marijuana, alcohol, amphetamine, and cocaine). A highly consistent ranking of drug preference was obtained across reference compounds. The mean ordinal ranking of drug preference was heroin (highest), amphetamine, alcohol, pentobarbital, secobarbital, marijuana, cocaine, codeine, diazepam, LSD, and hashish (lowest). The ranking of drugs by preference was unrelated to incidence of use of drug accessibility.

Topics: Adolescent; Adult; Amphetamines; Cannabis; Cocaine; Codeine; Diazepam; Ethanol; Female; Heroin; Humans; Lysergic Acid Diethylamide; Male; Pentobarbital; Secobarbital; Substance-Related Disorders

A 24-year-old man with respiratory failure, severe bradycardia, and coma following heroin overdose was successfully resuscitated using endotracheally administered naloxone hydrochloride (Narcan). Post-treatment naloxone assays demonstrated the presence of large amounts of naloxone in the patient's blood and urine. Serial serum naloxone levels over the ensuing three hours showed pharmacokinetics which appear similar to those previously reported for intravenous naloxone.

Topics: Adult; Esophagus; Heroin; Humans; Intubation; Male; Naloxone; Substance-Related Disorders

Topics: Adult; Apnea; Female; Heroin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Lysergic Acid Diethylamide; Morphine; Pentazocine; Pregnancy; Pregnancy Complications; Respiration, Artificial; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Heroin; Humans; Substance-Related Disorders; Switzerland; Tranquilizing Agents

A 34-year-old male intravenous drug abuser had acute monocular loss of central vision nine days after fundus examination that had given normal results. He had a presumed septic submacular choroidal embolus in association with septic retinitis. No organism was recovered from the blood cultures. The lesion resolved with a residual chorioretinal scar in the macula and permanent loss of central vision.

Topics: Adult; Choroiditis; Embolism; Heroin; Humans; Male; Phenmetrazine; Retinal Detachment; Retinitis; Substance-Related Disorders

Three patients involved in illicit drug smuggling via the swallowing of high dose, high purity drugs packed in multiple condoms are reported. Two of these patients experienced drug overdose symptoms due to leakage or rupture of the condoms in the GI tract. They were treated successfully.

Topics: Adult; Cannabinoids; Cannabis; Crime; Drug and Narcotic Control; Female; Heroin; Humans; Male; New York City; Substance-Related Disorders

Prisoners deserve to be taken seriously and treated with respect by the physician, as does any person seeking medical care. Treatment should include an adequate history and physical examination as well as indicated laboratory tests. Anxiety is a ubiquitous problem in prison life and can adversely affect any medical condition. The diagnosis of malingering is and should be one of exclusion, and the physician should keep in mind that a seemingly healthy prisoner might have several other reasons for seeking medical help. The physician needs to be confident of the diagnosis before returning the person to the cell block, as prisoners do not have freedom of access to medical care. New standards, programs, literature, journals, and conferences have drawn attention to the jail as a place where the physician can intervene in a positive way to decrease the recycling of crime and illness. It is not enough to be able to practice good medicine in a jail. Such practice must recognize the special needs of prisoners and the special problems inherent in the jail environment.

Topics: Adult; Alcoholism; Cannabis; Diazepam; Ethics, Medical; Female; Health Services; Heroin; Humans; Male; Mental Disorders; Physician-Patient Relations; Prisoners; Prisons; Seizures; Substance-Related Disorders; Tuberculosis; United States

The effect of in utero exposure to drugs of abuse on certain neurological and behavioral characteristics of the newborn was studied in 10 infants of drug-dependent mothers. Fourteen newborns of mothers not receiving drugs served as matched controls. Infants exposed to drugs of abuse during fetal life exhibited a high level of arousal and irritability, and extreme muscle tone fluctuations--i.e., a predominant hypertonicity (rigidity) alternating with short periods of a very low tone (flaccidity). These newborns were also highly active, tremulous, and motorically immature, and displayed near-constant crying and disturbed sleep patterns. However, their orientation to external stimuli and the findings on neurological examination were similar to those of control neonates.

Topics: Arousal; Child Behavior; Female; Habituation, Psychophysiologic; Heroin; Humans; Infant, Newborn; Male; Methadone; Motor Activity; Muscle Tonus; Pregnancy; Prenatal Exposure Delayed Effects; Substance-Related Disorders

Death in drug addicts is frequently caused by intoxication due to drug overdose or additional ingestion of hypnotic drugs. Only 25 (1%) of 2594 well documented cases in a poison control center linked to an intensive care unit were concerned with drugs. Ten patients were severely intoxicated and all were hospitalized. Of 612 patients treated in the ICU, 8 (1.5%) were drug addicts with severe intoxications. Heroin was regularly involved, but only 3 had pure heroin intoxication. In 5 patients hypnotic drug poisoning predominated, most frequently due to deliberate barbiturate ingestion. All 8 patients were unconscious, 6 were artificially ventilated, and 5 received antidotes.

Topics: Adolescent; Adult; Barbiturates; Critical Care; Drug Combinations; Female; Heroin; Humans; Male; Poisoning; Substance-Related Disorders

Topics: Adult; Heroin; Humans; Hypercalcemia; Kidney Papillary Necrosis; Male; Muscular Diseases; Myoglobinuria; Renal Dialysis; Substance-Related Disorders

Topics: Adolescent; Adult; Amphetamine; Arizona; Barbiturates; Cannabis; Cocaine; Female; Heroin; Humans; Male; Middle Aged; Substance-Related Disorders

Topics: Animals; Association; Conditioning, Classical; Cues; Drug Tolerance; Extinction, Psychological; Heroin; Humans; Morphine; Rats; Recurrence; Substance Withdrawal Syndrome; Substance-Related Disorders

A model of "overdose" deaths among heroin addicts is proposed which emphasizes recent findings concerning the contribution of drug-associated environmental cues to drug tolerance. Results of animal experiments performed to evaluate this model suggest that conditioned drug-anticipatory responses, in addition to pharmacological factors, affect heroin-induced mortality.

Topics: Animals; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Tolerance; Environment; Heroin; Humans; Male; Rats; Substance-Related Disorders

Topics: Afghanistan; Amphetamine; Dextropropoxyphene; Drug and Narcotic Control; Global Health; Heroin; Humans; Iran; Pakistan; Substance-Related Disorders

Topics: Cannabis; Cocaine; Drug and Narcotic Control; Government; Heroin; Humans; International Cooperation; Substance-Related Disorders; United States

Red blood cells values of 100 male heroin addicts, 100 male smokers and 100 normal men, all of like age, have been examined. Nearly all of the heroin addicts are heavy cigarette smokers. The GRC/mm3, Hb g%, Ht%, MCHC and MCV values did not show significant statistical differences between the three groups, except the MCV in the average appeared 2,8 mu3 higher in the smokers, than the normal non smokers. In heroin addicts there did not appear any variation related to abnormalities in liver function and dependency life time. The differences between the results of our studies and the literature are determined from a longer exposition to the damage caused from heroin and smoke.

Topics: Adolescent; Adult; Erythrocyte Count; Erythrocyte Indices; Hematocrit; Hemoglobinometry; Heroin; Humans; Male; Smoking; Substance-Related Disorders

Forty-seven people who first attended any London drug clinic in 1971 were asked at what age they first used various drugs and how frequently each was used during every subsequent year. For age of first use, substantial significant variance components due both to drugs and subjects and to the interaction between them confirmed that certain substances were commonly tried at an earlier age, that some subjects consistently used all drugs earlier than did other subjects, and that there were numerous exceptions to these regularities. For initial frequencies of use, much of the variance was due to the interaction of drugs and subjects--meaning, in effect, that various subjects had preferences (or sources of supply) for different drugs, even though nominally all were polydrug users attending opiate clinics. However, very little variance in frequency was due to years of use or its two-way interactions with drugs or subjects. That is, once established, drugs tended to be used at about the same frequency levels over a 3-year period. The conclusions seem reasonably robust despite the comparatively small sample.

Topics: Adult; Age Factors; Alcohols; Amphetamines; Cannabis; Female; Heroin; Humans; London; Male; Methadone; Substance-Related Disorders; Time Factors

Urine specimens from methadone treatment clinics were screened for various abused drugs between 1974-1979 by thin-layer chromatography (TLC) and immunoassay techniques (IAT). A comparison of the relative incidence of drugs abused reveals that IAT are more sensitive and detect far greater number of subjects abusing drugs than TLC. The results also show a significant abuse of heroin and cocaine during the period studied and a variation of the incidence of other drugs used during the same period. While these patients did not receive benzodiazepenes and tricyclic antidepressants by prescription, their abuse alone and in combination with each other was also found to be widespread. Low levels of PCP and/or its analogs were found in 1978 and 1979. The frequent finding of low levels of PCP in combination with other drugs indicates the availability of this hallucinogen and point to its use in combination with other illicit drugs such as cocaine, amphetamine, and heroin. The suggestion is made that more sensitive analytical methods for drugs screening be utilized in methadone monitoring programs, and that other classes of drugs be added than are currently required.

Topics: Amphetamines; Antidepressive Agents, Tricyclic; Barbiturates; Benzodiazepines; Chromatography, Thin Layer; Cocaine; Heroin; Heroin Dependence; Humans; Methadone; New York City; Phencyclidine Abuse; Radioimmunoassay; Substance-Related Disorders

Topics: Heroin; Humans; Morphine; Psychotropic Drugs; Substance-Related Disorders

Topics: Heroin; History, Modern 1601-; Substance-Related Disorders; United States

The purpose of this paper is to examine the extent of Dilaudid use and characteristics of users in a population of individuals admitted to drug treatment programs over a four-year period. It was found that the number and rate of Dilaudid use had increased from 1% of those admitted in 1974 to 10% in late 1977. In comparison to other drug users, Dilaudid users were more likely to be white and middle-class. Dilaudid users were also likely to use the drug intravenously and to obtain it by street buys and to also use heroin. Data suggest that Dilaudid use is easily integrated into a heroin-using life style and may serve as a heroin substitute, and that Dilaudid users are a population that has characteristics similar to the type described as the Southern addict.

Topics: Adult; Analgesics, Opioid; Cross-Sectional Studies; Female; Florida; Heroin; Heroin Dependence; Humans; Hydromorphone; Injections, Intramuscular; Injections, Intravenous; Male; Opioid-Related Disorders; Social Class; Socioeconomic Factors; Substance-Related Disorders; Time Factors; White People

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

In 1975 Singapore experienced a sudden heroin epidemic, and within two years an estimated 3 per cent of the males, 15-24, were involved. In 1977 the Government responded with an all-out enforcement strategy aimed at rapid containment. Demand reduction involved the large scale arrest of suspected users, and the immediate commitment of those with positive urines to Drug Rehabilitation Centres. The primary rehabilitation emphasis is on instilling discipline, social responsibility and sound work habits. Releases are placed on two years of compulsory supervision with a 5-day cycle for reporting and urine specimens. Sixty-three per cent show no detected drug use within the first year of supervision. Supply reduction efforts are equally strong and, while these were not immediately successful in limiting availability, heroin is currently very scarce and expensive. While there is some evidence of the substitution of cannabis, psychotropic drugs and alcohol, the number of new heroin cases is minimal. Overall, the epidemic appears to have been controlled.

Topics: Drug and Narcotic Control; Heroin; Heroin Dependence; Humans; Singapore; Substance-Related Disorders

We interviewed 258 prisoners in Nordern-Switzerland. At that time, 55% suffered from a chronic or an acute illness. 32% smoked 20 and 37% more than 20 cigarettes a day. 46% had consumed drugs in the past (marihuana, LSD, heroin).

Topics: Adult; Aged; Cannabis; Health; Health Status; Heroin; Heroin Dependence; Humans; Lysergic Acid Diethylamide; Male; Marijuana Abuse; Middle Aged; Prisoners; Sexual Behavior; Smoking; Sports; Substance-Related Disorders; Suicide

Newborn infants, chronically exposed in utero to low doses of methadone with or without concomitant heroin, display more rapid eye movement sleep and less quiet sleep than control infants, while babies fetally exposed to both opiates and nonopiates have less organization of sleep states. Other perinatal factors, such as birth weight and gestational age, are related more to the amount of fetal drug exposure than to the type.

Topics: Birth Weight; Female; Heroin; Heroin Dependence; Humans; Infant, Newborn; Infant, Newborn, Diseases; Maternal-Fetal Exchange; Methadone; Nervous System Diseases; Pregnancy; Sleep; Substance-Related Disorders

Topics: Animals; Dose-Response Relationship, Drug; Heroin; Humans; Hypothalamic Area, Lateral; Rats; Reward; Self Stimulation; Substance-Related Disorders

Topics: Adult; Female; Heroin; Heroin Dependence; Humans; Infant, Newborn; Infant, Newborn, Diseases; Maternal-Fetal Exchange; Morphine; Morphine Dependence; Pregnancy; Pregnancy Complications; Substance-Related Disorders

Candida endophthalmitis after intravenous heroin is described. Our patient had an initial rapid deterioration on systemic corticosteroids. Systemic amphotericin B, 5 flucytosine, vitrectomy and retinal surgery were required to achieve a final visual acuity of 6/24. The difficulty of an early diagnosis and the deleterious effect of corticosteroid use are emphasized.

Topics: Adult; Candidiasis; Eye Diseases; Heroin; Humans; Inflammation; Injections, Intravenous; Male; Substance-Related Disorders

Topics: Adolescent; Adult; Age Factors; Appetite Depressants; Black or African American; Body Weight; Data Collection; Drug and Narcotic Control; Female; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Obesity; Phenmetrazine; Random Allocation; Sex Factors; Substance-Related Disorders; United States; White People

Topics: Endocarditis, Bacterial; Heroin; Humans; Illinois; Injections, Intravenous; Pseudomonas Infections; Substance-Related Disorders; Syringes

One thousand eight emergency room patient records from which reports were contributed to the federal Drug Abuse Warning Network (DAWN) system from the Los Angeles County/University of Southern California Medical Center in 1977 were studied. The drugs reported to DAWN for these patients were compared with the available toxicology laboratory reports for some of these same patients. The purpose was to test the validity of the data reported to DAWN. Toxologic analyses had been performed on only 528 patients (52%) of the entire sample. Eighty percent of these tested had some positive toxicology result. The DAWN reports were verified in 20% of the tested sample, found to be incorrect in 11%, and partially correct or partially incorrect in 69%. Drugs identified toxicologically had varied concentrations, some below or within therapeutic range and some at toxic levels. This study suggests that the reliability of DAWN REPORTS SHOULD BE TESTed prospectively in an unbiased definitive material study.

Topics: Alcohol Drinking; Diazepam; Drug and Narcotic Control; Emergency Service, Hospital; Heroin; Humans; Phencyclidine; Substance-Related Disorders; United States

This study investigates the attitudes of a group of 185 London schoolchildren towards a number of legal and illegal drugs, and examines the ways in which they discriminate between these drugs. Heroin and LSD were seen as the most dangerous drugs, and alcohol and cigarettes as the safest. Subjects who had a negative attitude towards drugs in general regarded cannabis, amphetamines, alcohol and tobacco as more dangerous than subjects with a neutral or pro-drug attitude. There was also a sex difference: boys claimed to know more about drugs, were more likely to know a cannabis user and to have been "really drunk" than the girls. The implications of these results for drug and alcohol education programmes are discussed.

Topics: Adolescent; Alcohol Drinking; Amphetamines; Attitude; Barbiturates; Cannabis; Discrimination, Psychological; Female; Health Education; Heroin; Humans; Lysergic Acid Diethylamide; Male; Pharmaceutical Preparations; Sex Factors; Smoking; Substance-Related Disorders

Topics: Abnormalities, Drug-Induced; Adult; Amphetamines; Female; Fetus; Heroin; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Substance-Related Disorders

Topics: Adolescent; Adult; Female; Fetal Diseases; Fetus; Genitalia, Female; Heroin; Humans; Lysergic Acid Diethylamide; Morphine; Pregnancy; Pregnancy Complications; Psychotropic Drugs; Substance-Related Disorders

One hundred and fourteen male and female drug abusers were interviewed regarding their histories of self-destructive behaviors. The data were analyzed to determine if, and identify what, differences existed between males and females with respect to types and extent of self-destructiveness. The analyzed data indicate that male and female drug abusers present very different self-destructive portraits. These portraits and their component parts are presented along with possible explanations for the differences. The paper also presents some of the differences between drug abusers and the general population with respect to self-destructiveness.

Topics: Accidents, Traffic; California; Female; Heroin; Heroin Dependence; Humans; Male; Sex Factors; Substance-Related Disorders; Suicide

Recent sharp decline in treatment admissions by opiate abusers stimulated the conduct of a study designed to provide timely data to treatment system administrators for the next cycle of program and budgetary planning. The process of designing the study involved definition of required study characteristics, review of four categories of drug abuse research, and generation of seven locally relevant hypotheses. Interviews were conducted with 335 heroin adicts: 196 new admissions to treatment and 139 "street" addicts not currently in treatment. Major findings were a marked reduction in the quality, availability, and price of heroin; very negative perceptions of methadone maintenance, especially by female respondents; decline in heroin popularity and increase in reported use of alcohol, amphetamines, and barbiturates; and differing perceptions of treatment by sex of respondent. Response patterns suggest that users who are not entering treatment are less "strung-out than those entering treatment because of decline in availability and quality of heroin and consequent increased mixing of drugs. The emphasis in the report is on the conduct of a study which can be timely, feasible, and useful to local planners. The study weaknesses and recommended remedies are discussed, as well as the characteristics which made the findings immediately useful to administrators and planners.

Topics: Adolescent; Adult; Female; Health Planning; Health Surveys; Heroin; Heroin Dependence; Humans; Male; Methadone; Middle Aged; Pennsylvania; Rehabilitation, Vocational; Substance-Related Disorders

Topics: Attitude; British Columbia; Canada; Coercion; Commitment of Mentally Ill; Heroin; Humans; Law Enforcement; Legislation as Topic; Mandatory Programs; Physicians; Social Change; Social Control, Formal; Substance-Related Disorders; Treatment Refusal; United States

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

Complex zinc tannate salts of heroin, hydromorphone and l-alpha-acetylmethadol were synthesized and injected in a slow-release vehicle, into rats. One, 3, 7, 10 and 14 days after the drug was administered rats were injected with naloxone hydrochloride (10 mg/kg) and during the following 4 hours body weights, core temperature and behavioral signs such as diarrhea, writhing, teeth chattering and wet dog shakes were recorded. On every naloxone testing day the narcotic-treated groups presented behavioral signs of abstinence, but weight loss and temperature changes were much less consistent. Reduction of core temperature following naloxone administration seems to be an earlier indicator of physical dependence than weight loss. According to the parameters tested a level of physical dependence can persist for at least two weeks after a single injection of these narcotic salts.

Topics: Animals; Behavior, Animal; Body Temperature; Body Weight; Heroin; Heroin Dependence; Humans; Hydromorphone; Methadone; Methadyl Acetate; Naloxone; Rats; Substance Withdrawal Syndrome; Substance-Related Disorders

A 38-year-old male drug abuser had multiple emboli in the retinal circulation of the posterior pole of both eyes. He showed widespread peripheral retinal capillary nonperfusion and neovascular proliferation at the junction of perfused and nonperfused retina. The emboli were considered to be talc particles from the intravenous administration of suspensions of oral medications. The presumed mechanism of development of neovascularization in this case was the filtering out of the particles by the retinal vasculature with vaso-occlusion, ischemia and subsequent retinal neovascularization.

Topics: Adult; Embolism; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Ophthalmoscopy; Pentazocine; Retinal Vessels; Substance-Related Disorders; Talc; Tripelennamine

Topics: Alcoholism; Drug and Narcotic Control; Heroin; Humans; Substance-Related Disorders; United Kingdom

Topics: Animals; Behavior, Animal; Discrimination, Psychological; Endorphins; Enkephalins; Fentanyl; Heroin; Humans; Male; Raphe Nuclei; Rats; Self Administration; Substance-Related Disorders

Topics: Adult; Heroin; Humans; Illicit Drugs; Male; Methods; Myoglobinuria; Substance-Related Disorders

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

Topics: Government Regulation; Heroin; Humans; Pain; Social Control, Formal; Stress, Psychological; Substance-Related Disorders; Terminal Care; Terminally Ill

Topics: Heroin; Humans; Methadone; Social Adjustment; Substance-Related Disorders; United Kingdom; United States

The abuse of heroin (diacetylmorphine) in Singapore escalated sharply in 1975 and 1976, as indicated by the 35-fold increase in the number of heroin seizures and the 20-fold increase in the urine samples containing morphine since 1974. A rapid and simple GC method has been described to estimate diacetylmorphine (and caffeine). Monoacetylmorphine and acetylcodeine may be ascertained by an additional step involving acetylation. All gas chromatograms of a large number of samples analyzed consistently had the same pattern, indicating that they possibly had a common origin. This GC "fingerprint," together with the quantitative data, appears to be characteristic of the illicit Asian or Chinese type of heroin found in Singapore. The proportions of the four major ingredients in some twelve typical samples have been tabulated. Statistical data confirming the accuracy and reproducibility of the analytical method have also been presented.

Topics: Calibration; Chromatography, Gas; Heroin; Humans; Singapore; Substance-Related Disorders

The presence of systemic disease may further increase the risk of bacterial endocarditis in the patient on chronic hemodialysis. Three patients are described; one with primary amyloidosis, a second with insulin dependent diabetes mellitus, and a third with heroin nephropathy who developed S.B.E. While the presence of the uremic state may hinder the recognition of endocarditis, the development of transient neurologic deficits, recent access infections and recurrent bacteremic episodes should be looked for as early clues to the diagnosis in this patient population.

Topics: Adult; Amyloidosis; Diabetic Nephropathies; Endocarditis, Bacterial; Heroin; Humans; Male; Middle Aged; Renal Dialysis; Substance-Related Disorders; Uremia

This paper reviews the part which prior consumption of alcohol played in motor vehicular fatalities in Geelong and district between January, 1967, and June, 1978. There were 344 deaths of persons aged 17 years and older within four hours after the accident. Of 147 such victims who were aged 17 to 50 years and who were drivers of motor vehicles. 54% had a blood alcohol concentration (BAC) greater than 0.1 g/100 mL (22 mmol/L) at autopsy. Of 35 male pedestrians, 60% had a BAC greater than 0.15 g/100 mL (33 mmol/L) at autopsy, and 80% of such accidents occurred between 6 p.m. and 10 p.m. A high degree of sobriety was noted among all female road traffic victims. The increasing road toll related to motorcycle accidents and the problem of legal and illegal drug use are also briefly discussed.

Topics: Accidents, Traffic; Adolescent; Adult; Aged; Alcohol Drinking; Alcoholism; Australia; Automobile Driving; Diphenhydramine; Ethanol; Female; Heroin; Humans; Male; Methaqualone; Middle Aged; Risk; Safety; Substance-Related Disorders

A twenty-year-old man suffered a left homonymous hemianopia after self-administration of heroin. Investigations revealed right occipital infarction with angiographic changes of arteritis in the posterior cerebral arteries.

Topics: Adult; Arteritis; Cerebral Angiography; Cerebral Arterial Diseases; Heroin; Humans; Male; Substance-Related Disorders

Topics: Antipsychotic Agents; Heroin; History, 19th Century; Humans; Morphine; Psychotic Disorders; Substance-Related Disorders; United Kingdom

Topics: California; Costs and Cost Analysis; Disease Outbreaks; Epidemiologic Methods; Heroin; Heroin Dependence; Humans; Substance-Related Disorders

Topics: Adult; Alcoholism; Amphetamine; Barbiturates; Depression; Hallucinogens; Heroin; Humans; Male; Mental Disorders; Schizophrenia; Schizophrenia, Paranoid; Substance-Related Disorders

An interview study was conducted on a sample of experimental heroin users involved in an adolescent heroin epidemic. Results showed that heroin use patterns varied, with high users stabilizing at a low frequency of use over a long period of time. Results also showed that experimental users were more likely to occur in the late phase of a local heroin outbreak. Psychosocial data indicated that high users differed from low users in that they had less supportive family experiences, more experience with the criminal justice system, and less positive feelings about self and future.

Topics: Adolescent; Cocaine; Family; Heroin; Humans; Peer Group; Self Concept; Substance-Related Disorders

Trends in drug use and criminal charges of 44,223 consecutive admissions to the District of Columbia Superior Court lock-up between December 1971 and April 1975 were analyzed. While the number of persons arrested and admitted to the lock-up remained relatively constant during this time, drug use as measured by positive urinalysis declined substantially in 1973 and remained at a lower level through 1975. Heroin use showed a decline similar to the overall trends in 1973, but began to increase in mid-1974. Arrestees who were drug positive were generally less likely to be charged with major crimes of violence than those who were drug negative. Exceptions to this pattern as well as trends in drug use and crime in the arrested population are discussed.

Topics: Amphetamines; Crime; District of Columbia; Heroin; Humans; Morphine; Narcotics; Phenmetrazine; Substance-Related Disorders

Blood samples from deceased narcotic addicts were analyzed for morphine, and the results form persons who died from narcotic addiction were compared with those from homicide victims. In most instances morphine was detectable in both types of death, and usually the values obtained were less than 30 microgram/dl. Narcotic addiction deaths involving only morphine, or morphine plus a combination of ethanol, quinine, or diazepam (Valium), were also evaluated. In some cases high quantities of ethanol were present, and death could be attributed to the combined CNS depressant effects of morphine and ethanol. The quinine levels would not normally be considered toxic, however, and it could not be ascertained that the quantity of this drug present contributed to death. Diazepam was present in elevated concentrations, and its depressant effect may have been a factor in some narcotic addiction deaths.

Topics: Diazepam; Ethanol; Heroin; Homicide; Humans; Morphine; Poisoning; Quinine; Substance-Related Disorders

The authors report the case of a patient with spinal abscess in whom operation was withheld because of severe concomitant medical problems. Conservative management resulted in apparent cure.

Topics: Abscess; Anti-Bacterial Agents; Cefazolin; Cocaine; Duodenal Ulcer; Heroin; Humans; Kidney Failure, Chronic; Male; Meninges; Methicillin; Middle Aged; Myelography; Oxacillin; Renal Dialysis; Spinal Cord Diseases; Staphylococcal Infections; Staphylococcus aureus; Subdural Space; Substance-Related Disorders

Behavioral and familial correlates of predominantly White, suburban heroin abusers were investigated to determine whether such abuse was self-contained experimentation or suggestive of generalized personality disorders and impaired family relationships. Twenty of 296 male high school students recruited from 10 middle-class suburban schools had engaged in episodic heroin abuse. Of 29 antisocial behaviors other than heroin abuse assessed, heroin abusers engaged in 16 significantly more frequently. Heroin abusers found their fathers to be significantly less nice, honest, strong, and kind than did nonabusers, according to semantic differential technique. They found themselves to be significantly less strong than did nonabusers, suggesting failure to model themselves after adequately coping fathers. Heroin abusers also found their mothers to be significantly less fair, honest, and valuable than did nonabusers. It was concluded that episodic heroin abuse among suburban adolescents is suggestive both of generalized antisocial behavior and of impaired family relationships.

Topics: Adolescent; Alcoholic Intoxication; Family; Father-Child Relations; Heroin; Humans; Male; Mother-Child Relations; New Jersey; Self Concept; Social Behavior; Substance-Related Disorders; Urban Population

Phenelzine administration, monitored via a pharmacy-controlled program, was employed in 38 subjects over a 6-month period to prevent amphetamine-type drug abuse, in much the same manner as disulfiram programs are employed against alcohol abuse. Advantages of the program were apparent, with a majority of subjects abstaining during the enforced phenelzine trial. Subjects generally made use of this abstinent period to benefit from a variety of psychotherapeutic modes, and demonstrated enhanced job and school performance and improved marital relationships. Results based on subject and observer reports, reports from dispensing pharmacies, and random urinalyses for drugs were encouraging. However, the study was uncontrolled and observational, and thus results are merely suggestive at present. Potential dangers as well as benefits of administering phenelzine to such a population are discussed.

Topics: Adolescent; Adult; Alcohol Drinking; Amphetamines; Barbiturates; Drug Antagonism; Drug Evaluation; Female; Follow-Up Studies; Heroin; Humans; Male; Phenelzine; Substance-Related Disorders

32 pregnancies in 29 drug-addicted women were studied ouver eight years in one obstetric department working in close liaison with a drug dependency centre. Of the 24 pregnancies which came to term, only 10 were seen at the antenatal clinic before 22 weeks' gestation. 19 of the women were addicted to heroin or methadone or a mixture of both, 4 were taking soft drugs, and 1 was taking pethidine only. Labour commenced spontaneously in 17 pregnancies and was induced in 7. All labours lasted less than twenty hours. 23 infants survived. Those born to the mother taking pethidine and to 4 mothers who withdrew their drug of dependence four weeks before delivery showed no signs of narcotic withdrawal, but 13 out of 14 infants born to mothers taking heroin or methadone developed narcotic withdrawal syndrome. It is recommended that drug therapy during pregnancy in addicts should be supervised by a psychiatrist known to the patient and that oral methadone be substituted for heroin. Planned induction will ensure delivery in hospital, at the hospital which has supervised the pregnancy. Babies in danger of developing narcotic withdrawal syndrome should be observed in the special care baby unit for the first week of life.

Topics: Adult; Female; Follow-Up Studies; Heroin; Heroin Dependence; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Obstetric; London; Methadone; Postpartum Period; Pregnancy; Pregnancy Complications; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors

Both acute overdose reaction and near-drowning may present as pulmonary edema. With both, the heart is usually not enlarged and clearing occurs within 48 hours, unless complicated by infection or aspiration. In near-drowning there is metabolic acidosis, whereas in acute overdose reaction there is combined respiratory and metabolic acidosis.

Topics: Adult; Barbiturates; Carbon Dioxide; Cardiomegaly; Dextropropoxyphene; Diagnosis, Differential; Drowning; Female; Heroin; Heroin Dependence; Humans; Male; Methadone; Middle Aged; Oxygen; Pulmonary Edema; Radiography; Substance-Related Disorders

Topics: Amphetamine; Amphetamines; Cannabis; Cocaine; Dronabinol; Heroin; Humans; Lysergic Acid Diethylamide; Mescaline; Opium; Pharmaceutical Preparations; Psilocybin; Substance-Related Disorders

During the period October, 1970, to October, 1972, a sample of 295 patients attending Special Clinics in the City of Glasgow participated in an investigation into drug misuse. Results show that, of the 136 males and 159 females who took part--all within an age range of 16 to 24 years, 43 per cent. of the males and 36 per cent. of the females admitted to having experimented with drugs. These percentage figures on the prevalence of drug misuse compare with 36 per cent. of males and 24 per cent. of females obtained from other Glasgow-domiciled target groups, comprising a sample of 2,514 individuals. The principal drug of misuse is shown to be cannabis, followed by LSD and sleeping pills. Data on drug availability suggest that little difficulty is experienced in obtaining drugs illicitly from a variety of sources. Comparison between drug misusers and non-misusers on domestic, educational, and social variables revealed no very distinctive patterns. Results of screening for personality characteristics, using Eysenck's Psychoticism, Extraversion and Neuroticism Inventory generally confirmed previous findings related to atypical scores on the P, E, and N parameters. Even so, results obtained by means of the PEN Inventory and IPAT Anxiety Scale revealed a pattern in which drug misuse is shown to be related to even higher scores of psychoticism, neuroticism, and anxiety. The results of the investigation are discussed with particular reference to the nature of the appeal of drugs to the sexually permissive and promiscuous.

Topics: Adolescent; Adult; Amphetamines; Attitude; Barbiturates; Cannabinoids; Female; Heroin; Humans; Lysergic Acid Diethylamide; Male; Outpatient Clinics, Hospital; Psychiatric Status Rating Scales; Scotland; Sexual Behavior; Substance-Related Disorders

Topics: Adolescent; Alcoholism; Attitude; Caffeine; Cannabis; Female; Heroin; Homosexuality; Humans; Lysergic Acid Diethylamide; Male; Nicotine; Sex; Sex Education; Sexual Behavior; Substance-Related Disorders

Topics: Heroin; Humans; Methadone; Narcotics; Substance-Related Disorders

Urinary amines were measured in 122 drug-addiction pregnancies. The profile of the patient indicates that 86 per cent were black and had a total of 2.98 pregnancies and 1.97 living children. She made 5.4 prenatal visits to our special drug-abuse prenatal clinic. The 208 antepartum 24 hour urine determinations indicated a mean excretion of epinephrine to be 28 +/- 1.6 mug which rises to 60 mug on the first day post partum. These values indicate increased adrenal gland activity and are more than six times greater than seen in normal pregnancy. The antepartum mean 24 hour urine excretion of norepinephrine is 49.7 +/- 2.6 mug which does not change on the first postpartum day. The antepartum norepinephrine values are 50 per cent higher than seen in normal pregnancy. Drug-addiction pregnancy in patients who are well controlled on methadone have markedly increased adrenal gland activity as evidence by increased levels of epinephrine. The sympathetic nervous system activity as evidenced by urinary norepinephrine is only slightly increased. Drug addiction alters the normal homeostatic mechanisms of pregnancy.

Topics: Adolescent; Adult; Epinephrine; Female; Heroin; Humans; Methadone; Norepinephrine; Pregnancy; Pregnancy Complications; Substance-Related Disorders; Sympathetic Nervous System

In a series of 103 psychotic patients with evidence of drug abuse, the following facts came to light. 1. A definitive diagnosis was made in 94%. In 6% of these cases the diagnosis remained unclear even after having been admitted for a second time. 2. Seventy-four percent (72 of 97) of the patients, who abused various drugs, usually in combination had organic psychoses, and 26% (25 of 97) were diagnosed as schizophrenics. 3. Of 36 patients, who suffered psychotic episodes due to the abuse of cannabis, or LSD, or heroin, 21 (= 58%) were schizophrenics. 4. In those cases showing organic psychoses, thought insertion, thought withdrawal, and thought broadcasting were not found. However all other first- (and second-) rank symptoms (Kurt Schneider) of schizophrenia were found. Perhaps this might be of help as a differential criterion. 5. The fact of drug abuse at the outset of a schizophrenia is dependent on the schizophrenic symptomatology. The use of and attitude to the drug as well as the experiencing of the drug's effects changes in the further course of the psychosis. This last point might also be of value in the differential diagnosis.

Topics: Analgesics; Cannabis; Heroin; Humans; Lysergic Acid Diethylamide; Neurocognitive Disorders; Schizophrenia; Substance-Related Disorders; Tranquilizing Agents

Highlights are presented on the issue of drug use among servicemen in Vietnam and its aftereffects. Two stages of Vietnam drug use are identified-a period of increasing marijuana use followed by the 1970 influx of highly potent heroin to which 1/5 of the enlisted troops were addicted at some time during their tour. The major contributing factors appear to be: (1) the need of troops in stressful combat situations for self-medication, escape, and hedonistic indulgence; (2) the relaxation of taboos against drug use in the United States; and (3) the availability of illicit drugs at low cost, which was apparently the result of profiteering by a number of South Vietnamese officials. Related to the above was the growing disenchantment with the war and the progressive deterioration in unit morale. These drugs are seen as serving many of the functions performed by alcohol in earlier millitary conflicts. There is no hard evidence that duty performance in Vietnam was seriously affected by drug use. Since 95% of those who were addicted to narcotics in Vietnam have not become readdicted, the situation does not appear to be as severe as originally supposed. Myths as to the persistence and intractibility of physiological narcotic addiction were dispelled. A major negative effect has been the difficulty that soldiers with less-than-honorable discharges due to drug abuse have had in obtaining jobs. Other long-term effects from drug use are less clear and are difficult to separate from the overall effects of the war.

Topics: Cannabis; Heroin; Humans; Military Medicine; Opium; Substance-Related Disorders; United States; Vietnam

Topics: Adolescent; Alcohol Drinking; Amphetamines; Barbiturates; Cannabis; Cocaine; Female; Heroin; Humans; Lysergic Acid Diethylamide; Male; Students; Substance-Related Disorders; United States

A two-wave panel survey was carried out on a representative sample of New York State public secondary school students in fall 1971 and spring 1972. The majority of adolsecents have drunk beer or wine (82 per cent) smoked cigarettes (72 per cent) or used hard liquor (65 per cent). Better than one third (35 per cent) report the use of one or more illegal drugs. The illicit drugs most frequently used are marijuana (29 per cent) and hashish (21 per cent). About one in eight adolescents have used pills such as amphetamines and barbiturates, and about one in 12 have tried LSD or other psychedelics. Four per cent have used cocaine and 3 per cent heroin. Use of illicit drugs tends to be experimental and sporadic rather than regular. By contrast, about one in four regularly use beer or wine or smoke cigarettes. Self-reported rates of use increase over the course of a school year, and there is considerable turnover with respect to which adolescents are users. The increased number of hard liquor and marijuana users through the high school years results predominantly from more stability among users, rather than increased conversion of nonusers to users over the teen years.

Topics: Adolescent; Age Factors; Alcohol Drinking; Amphetamines; Barbiturates; Cannabis; Cocaine; Ethnicity; Female; Heroin; Humans; Longitudinal Studies; Lysergic Acid Diethylamide; Male; New York; Residence Characteristics; Schools; Sex Factors; Smoking; Students; Substance-Related Disorders

We observed a patient who developed diffuse bronchiectasis subsequent to heroin-induced pulmonary edema. Unlike the previously reported cases, there was rapid clearing of pulmonary infiltrates and little evidence of severe aspiration. The development of bronchiectasis was attributed to a bronchial infection subsequent to clearing of the pulmonary edema. Physiologic dysfunction was characterized by marked obstruction, pulmonary hypertension, and mild hypoxemia.

Topics: Adult; Bronchiectasis; Heroin; Humans; Male; Pulmonary Edema; Respiratory Function Tests; Substance-Related Disorders

Topics: Analgesics, Opioid; Animals; Behavior, Animal; Conditioning, Classical; Electroshock; Food; Heroin; Humans; Narcotic Antagonists; Reinforcement Schedule; Reinforcement, Psychology; Substance-Related Disorders

The authors compared a groups of heroin-dependent American servicemen stationed in Thailand with a matched control groups of men not dependent on heroin. The data gathered regarding social history, attitudes, work record, previous drug use, personality, and intelligence show significant differences between the heroin-dependent men and the control group in four areas: intelligence, work record, number of years of schooling and number of drug used before using heroin. The data suggest that many of the heroin-dependent men had difficulties related to a distant or negative relationship to their fathers; however, in contrast to previous studies of heroin addicts, they do not confirm a relationship between heroin dependence and any particular personality pattern.

Topics: Adolescent; Adult; Educational Status; Family Characteristics; Father-Child Relations; Heroin; Heroin Dependence; Humans; Intelligence; Intelligence Tests; Juvenile Delinquency; Male; Military Medicine; MMPI; Personal Satisfaction; Personality; Sexual Behavior; Sexually Transmitted Diseases; Social Adjustment; Substance-Related Disorders; Thailand; United States; Urban Population; Work

The ability of morphine to block ovulation in animals prompted investigation of the frequency and mechanisms of menstrual abnormalities in women addicted to narcotic analgesics. Menstrual histories obtained from 76 former heroin addicts receiving daily methadone maintenance revealed that more than one-half of these women had experienced menstrual abnormalities while taking heroin or methadone. In order to determine the specific physiologic effects of narcotic analgesics on reproductive function, detailed endocrinologic studies were carried out in seven of these patients who complained of amenorrhea or irregular menses while receiving methadone. Four of the seven women manifested abnormalities of the control of gonadotropin secretion. Three of these four failed to exhibit cyclic gonadotropin release, as evidenced by an absence of increased levels of follicular phase follicle-stimulating hormone, midcycle gonadotropin peaks or luteal phase progesterone increments. In the fourth patient a prolonged follicular phase (30 days) of the menstrual cycle was detected. One of these four patients also had low basal gonadotropin levels and failed to exhibit luteinizing hormone increments greater than control levels in response to ethinyl estradiol (positive feedback). The remaining three women exhibited normal patterns of gonadotropin secretion during the observation period. In these women, menstrual bleeding occurred in response to withdrawal from luteal phase (10 to 20 ng/ml) progesterone levels and to exogenous ethinyl estradiol, suggesting normal uterine responsivity to progesterone and estrogen. Although not documented, it is likely that oligo-ovulation was the cause of the irregular menses in these three patients. Amenorrhea is commonly associated with methadone ingestion or heroin addiction and appears to be related to an alteration of the hypothalamic mechanisms controlling gonadotropin secretion. Tolerance to these effects of methadone may develop after chronic ingestion.

Topics: Adult; Amenorrhea; Barbiturates; Central Nervous System; Corpus Luteum; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Gonadotropins; Heroin; Heroin Dependence; Histamine H1 Antagonists; Humans; Luteinizing Hormone; Menstruation Disturbances; Methadone; Ovulation; Phenothiazines; Pituitary Gland; Pregnancy; Progesterone; Radioimmunoassay; Substance-Related Disorders; Surveys and Questionnaires; Uterus

Topics: Adolescent; Alcohol Drinking; Amphetamine; Barbiturates; Cannabis; Child; Female; Heroin; Humans; Ireland; Lysergic Acid Diethylamide; Male; Smoking; Students; Substance-Related Disorders; Surveys and Questionnaires; Universities

Samples of six specific groups (both students and adults) were intensively surveyed on their differential attitudes toward the use and sale of eight drug types. Resulting comparisons between groups, drugs, and attitudes provide a relative picture of the attitudes on drug sale and use held by those surveyed.

Topics: Adolescent; Adult; Alcoholism; Amphetamine; Attitude; Barbiturates; Cannabis; Cocaine; Drug and Narcotic Control; Faculty; Female; Hallucinogens; Heroin; Heroin Dependence; Humans; Legislation, Drug; Male; Parents; Smoking; Students; Substance-Related Disorders; United States

Topics: Alcoholism; Animals; Cannabis; Genitalia, Male; Heroin; Heroin Dependence; Humans; Male; Methadone; Spermatogenesis; Substance-Related Disorders; Testosterone

Opiate-dependent patients who are hospitalized for medical, surgical, or obstetrical reasons require proper management of their addiction to care of their presenting illness. Guidelines are offered for methadone support during hospitalization for the patient enrolled in a treatment program and for the street addict. The important clinical features of withdrawal reactions are outlined, and a method is presented for establishing an initial and supportive dose of methadone for street addicts. The use of analgesics in the addicted patient, the treatment of methadone overdose, and some problems in the management of mixed-drug abuse are discussed.

Topics: Analgesia; Drug Administration Schedule; Drug Combinations; Drug Interactions; Female; Heroin; Hospitalization; Humans; Legislation, Drug; Male; Methadone; Morphine; Physician-Patient Relations; Pregnancy; Substance Withdrawal Syndrome; Substance-Related Disorders; United States

Topics: Anesthetics, Local; Cocaine; Drug Contamination; Heroin; Humans; Quinine; Substance-Related Disorders

Sixty-two secondary school students were observed in their classrooms over 5 weeks of intensive drug information for within-group changes in their perceptions. "Peer pressure" and "kicks" were cited as reasons for starting and using drugs; but peer pressure had relatively greater strength for girls than for boys, and curiosity increased for girls. Boys and girls differed in reasons for stopping drugs (peer and professional help for girls, and punishment for boys). In rating the relative dangers and pleasures of marijuana and heroin, most students did not discriminate effectively between the two drugs, although ratings of marijuana dangers decreased. Unexpectedly, responses concerning the health hazards of heroin did not increase. In a situation simulating risk under peer pressure, boys chose targets as appropriate for their skill as did the girls.

Topics: Adolescent; Attitude; Cannabis; Choice Behavior; Discrimination, Psychological; Exploratory Behavior; Female; Game Theory; Health Education; Heroin; Humans; Male; Peer Group; Perception; Probability; Risk; Sex Factors; Students; Substance-Related Disorders; United States

From all US Army enlistees leaving Vietnam in September 1971, a random sample of 943 men was selected. Of these, 470 represented a "general" sample of all enlistees returning at that time, and 495 represented a "drug positive" sample whose urine samples had been positive for opiates at the time of departure. We attempted to locate and personally interview all of the men in the samples. Results indicate that before arrival, hard drug use was largely casual, and less than 1% had ever been addicted to narcotics. In Vietnam, almost half of the general sample tried narcotics and 20% reported opiate addiction. After return, usage and addiction essentially decreased to pre-Vietnam levels. We discuss the use of nonnarcotic drugs, predictors and correlates of drug use in the samples, and the relationship of drugs to post-Vietnam social adjustment.

Topics: Age Factors; Alcohol Drinking; Amphetamine; Barbiturates; Cannabis; Heroin; Humans; Injections, Intravenous; Male; Military Psychiatry; Narcotics; Opium; Socioeconomic Factors; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors; United States; Veterans; Vietnam

Topics: Administration, Oral; Amphetamine; Barbiturates; Heroin; Humans; Injections, Intravenous; Legislation, Drug; Methamphetamine; Psychoses, Substance-Induced; Substance-Related Disorders; United States

Topics: Administration, Oral; Adolescent; Adult; Amphetamine; Cocaine; Drug Prescriptions; Family Characteristics; Female; Hallucinogens; Heroin; Heroin Dependence; Humans; London; Male; Methadone; Prospective Studies; Substance-Related Disorders

Liver function tests were performed in 500 young servicemen with a history of drug abuse. Serum glutamic oxaloacetic transaminase (SGOT) level was abnormal in 66% of 68 patients with a history of parenteral drug abuse. Forty-one percent of 432 patients with a history of only nonparenteral drug abuse also had elevated SGOT levels. A high incidence of liver disease in parenteral drug abusers is well established; however, to our knowledge, the magnitude of the problem in nonparenteral drug abusers has not been noted previously. Liver biopsy specimens in 34 of our patients showed either a classic viral hepatitis or a mild nonspecific hepatitis. Limited follow-up suggested a slowly resolving process. We conclude that hepatitis may be a common sequel to epidemic nonparenteral drug abuse.

Topics: Adolescent; Adult; Alkaline Phosphatase; Asia, Southeastern; Aspartate Aminotransferases; Cannabis; Chemical and Drug Induced Liver Injury; Clinical Enzyme Tests; Confidentiality; Hepatitis B Antigens; Heroin; Humans; Liver; Liver Diseases; Liver Function Tests; Male; Military Medicine; Phytotherapy; Substance-Related Disorders; United States

Topics: Administration, Oral; Adult; Ambulatory Care; Attitude; Female; Heroin; Hospitalization; Humans; Injections, Intramuscular; Injections, Intravenous; London; Male; Methadone; Narcotics; Psychotropic Drugs; Semantic Differential; Substance-Related Disorders

Topics: Codeine; Heroin; Humans; Mexico; Morphine; Opium; Papaver; Plants, Medicinal; Politics; Substance-Related Disorders; Thebaine; Turkey; United States

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

Two longitudinal surveys based on random samples of high school students in New York State indicate four stages in the sequence of involvement with drugs: beer or wine, or both; cigarettes or hard liquor; marihuana; and other illicit drugs. The legal drugs are necessary intermediates between nonuse and marihuana. Whereas 27 percent of high school students who smoke and drink progress to marihuana within a 5- to 6-month follow-up period, only 2 percent of those who have not used any legal substance do so. Marihuana, in turn, is a crucial step on the way to other illicit drugs. While 26 percent of marihuana users progress to LSD, amphetamines, or heroin, only 1 percent of nondrug marihuana users and 4 percent of legal drug users do so. This sequence is found in each of the 4 years in high school and in the year after graduation. The reverse sequence holds for regression in drug use.

Topics: Adolescent; Alcoholic Beverages; Beer; Cannabis; Cocaine; Heroin; Humans; Lysergic Acid Diethylamide; New York; Nicotiana; Plants, Toxic; Substance-Related Disorders; Time Factors; Wine

This study investigated a sample of persons treated for acute drug reactions (overdoses) in a hospital emergency room setting to determine the general characteristics of these drug abusers and the incidence of drugs responsible for their admission. Detailed information is provided on the race and sex composition of these drug abusing patinets and comparisons are made with the general population of the area serviced by the hospital. The sample consisted of 1,128 persons who entered Jackson Memorial Hospital, Miami, Dade County, Florida during 1972. A profile of the typical admission for emergency care of a nonfatal overdose reveals a white female, who is 18 to 24 years old and who has overdosed on a single legally manufactured and distributed substance, usually a sedative. Implications from the data for changes in health care delivery for acute drug reactions are provided.

Topics: Accidents; Adolescent; Adult; Age Factors; Analgesics; Black or African American; Drug and Narcotic Control; Emergency Service, Hospital; Female; Florida; Hallucinogens; Heroin; Humans; Hypnotics and Sedatives; Male; Poisoning; Psychotropic Drugs; Sex Factors; Substance-Related Disorders; Suicide; Tranquilizing Agents

The behavior of narcotics-addicted and nonaddicted newborns on the first 2 days of life was assessed with the Brazelton Neonatal Behavioral Assessment Scale. In addition to classic signs of narcotics abstinence, addicted infants were less able to be maintained in an alert state and less able to orient to auditory and visual stimuli. These deficits were especially pronounced at 48 hours of age. Addicted infants were as capable of self-quieting and responding to soothing intervention as normal neonates, although they were substantially more irritable. These characteristics and addicted infants' greater resistance to cuddling are discussed in terms of their potential impact on early infant-care-giver interaction.

Topics: Adult; Attention; Female; Habituation, Psychophysiologic; Heroin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Obstetric; Male; Maternal-Fetal Exchange; Methadone; Orientation; Pregnancy; Substance Withdrawal Syndrome; Substance-Related Disorders

This study investigated a sample of persons treated for acute drug reactions (overdoses) in a hospital emergency room setting to determine the general characteristics of these drug abusers and the incidence of drugs responsible for their admission. Detailed information is provided on the race and sex composition of these drug-abusing patients and comparisons are made with the general population of the area serviced by the hospital. The sample consisted of 506 persons who entered Jackson Memorial Hospital, Miami, Dade County, Florida during January-June 1972. A profile of the typical admission for emergency care of a nonfatal overdose reveals a White female who is 18-24 hears old and who has overdosed on a single legally manufactured and distributed substance, usually a sedative.

Topics: Adolescent; Adult; Age Factors; Alcohol Drinking; Emergency Service, Hospital; Ethnicity; Female; Florida; Heroin; Humans; Hypnotics and Sedatives; Male; Nonprescription Drugs; Psychotropic Drugs; Sex Factors; Substance-Related Disorders; Suicide, Attempted

Topics: Crush Syndrome; Drug Contamination; Fever of Unknown Origin; Heroin; Humans; Infant, Newborn; Injections, Intravenous; Respiratory Distress Syndrome, Newborn; Substance-Related Disorders

Topics: Amphetamine; Apomorphine; Barbiturates; Chromatography, Thin Layer; Cocaine; Codeine; Cross Reactions; Cyclazocine; Dextromethorphan; Dextropropoxyphene; Evaluation Studies as Topic; Hemagglutination Inhibition Tests; Heroin; Humans; Hydromorphone; Levorphanol; Methadone; Methods; Microchemistry; Morphine; Nalorphine; Radioimmunoassay; Spectrometry, Fluorescence; Substance-Related Disorders; Time Factors; Tritium

Topics: Adult; Heroin; Heroin Dependence; Humans; Male; Methadone; MMPI; Personality Assessment; Substance-Related Disorders; Time Factors

Topics: Adult; Barbiturates; Central Nervous System Stimulants; Community Health Services; Demography; District of Columbia; Female; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Methadone; Phenmetrazine; Substance-Related Disorders

Topics: Amphetamine; Barbiturates; Body Fluids; Chromatography; Chromatography, Paper; Chromatography, Thin Layer; Hallucinogens; Hemagglutination Inhibition Tests; Heroin; Heroin Dependence; Humans; Hypnotics and Sedatives; Immunoassay; Immunologic Techniques; International Cooperation; Methadone; Narcotics; Psychotropic Drugs; Spectrophotometry; Substance-Related Disorders; Tranquilizing Agents; World Health Organization

Topics: Adult; Age Factors; Back Pain; Heroin; Humans; Joints; Lumbar Vertebrae; Male; Osteomyelitis; Pseudomonas aeruginosa; Pseudomonas Infections; Spinal Diseases; Substance-Related Disorders; Time Factors

Topics: Amphetamine; Attitude of Health Personnel; Barbiturates; Cannabis; Cocaine; Community Mental Health Services; Connecticut; Drug and Narcotic Control; Hallucinogens; Heroin; Heroin Dependence; Humans; Methadone; Substance-Related Disorders; Therapeutic Community

Topics: Age Factors; Attitude; Attitude to Health; Drug and Narcotic Control; Drug Prescriptions; Employment; Female; Heroin; Heroin Dependence; Humans; Interpersonal Relations; Male; Malingering; Methadone; Opium; Personality; Sex Factors; Substance-Related Disorders; United Kingdom

Topics: Adolescent; Adult; Age Factors; Amphetamine; Barbiturates; Black or African American; Cannabis; Cocaine; Educational Status; Female; Hallucinogens; Heroin; Humans; Male; Marriage; Mexico; Puerto Rico; Recurrence; Religion; Solvents; Substance-Related Disorders; Time Factors; United States

Topics: Adolescent; Adult; Age Factors; Alcohol Drinking; Alcoholism; Amphetamine; Attitude; Attitude of Health Personnel; Attitude to Health; Barbiturates; Cannabis; Communication; Drug and Narcotic Control; Faculty; Health Education; Heroin; Humans; Illinois; Lysergic Acid Diethylamide; Middle Aged; Smoking; Social Control, Informal; Students; Substance-Related Disorders

Topics: Adolescent; Adult; Aggression; Alcoholism; Amphetamine; Barbiturates; California; Cannabis; Cocaine; Criminal Psychology; Ethanol; Ethnicity; Heroin; Humans; Male; Prisoners; Psychotropic Drugs; Secobarbital; Sex Offenses; Social Class; Substance-Related Disorders; Violence

Topics: Cocaine; Drug Combinations; Heroin; Humans; Substance-Related Disorders

Topics: Cyclazocine; Cyclopropanes; Drug Evaluation; Female; Heroin; Heroin Dependence; Humans; Male; Morphine Derivatives; Naloxone; Narcotic Antagonists; Opium; Pain; Pupil; Respiration; Sleep; Substance-Related Disorders

Topics: Adolescent; Alcoholism; Amphetamine; Barbiturates; Cannabis; Cocaine; Heroin; Humans; Lysergic Acid Diethylamide; New York City; Smoking; Students; Substance-Related Disorders; Tranquilizing Agents

Topics: Amphetamines; Barbiturates; Chromatography; Cocaine; DOM 2,5-Dimethoxy-4-Methylamphetamine; Dronabinol; Hallucinogens; Heroin; Humans; Hypnotics and Sedatives; Lysergic Acid Diethylamide; Mescaline; Methadone; Phencyclidine; Pressure; Psychotropic Drugs; Solvents; Spectrum Analysis; Substance-Related Disorders; Tryptamines

Topics: Abscess; Aneurysm, Infected; Arteritis; Arthritis; Chemical and Drug Induced Liver Injury; Drainage; Endocarditis; Gastrointestinal Diseases; Hand; Heart Valve Prosthesis; Heroin; Heroin Dependence; Humans; Injections, Intra-Arterial; Injections, Intravenous; Injections, Subcutaneous; Lung Diseases; Myositis; Narcotics; Pancreatitis; Phlebitis; Substance-Related Disorders; Surgical Procedures, Operative

Topics: Amphetamine; Barbiturates; Cannabis; Cocaine; DOM 2,5-Dimethoxy-4-Methylamphetamine; Hallucinogens; Health Education; Heroin; Humans; Lysergic Acid Diethylamide; Male; Mescaline; Military Medicine; Opium; Self Concept; Self-Assessment; Substance-Related Disorders

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: Adolescent; Adult; Aged; Electrophoresis; False Positive Reactions; Female; Fluorescent Antibody Technique; Hemagglutination Tests; Hepatitis B Antigens; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Middle Aged; Substance-Related Disorders; Syphilis Serodiagnosis; Treponema pallidum

Topics: Adolescent; Adult; Amphetamine; Barbiturates; Caffeine; Cannabis; Chromatids; Chromosome Aberrations; Drug Synergism; Female; Heroin; Humans; Lysergic Acid Diethylamide; Male; Mescaline; Middle Aged; Phytotherapy; Polyploidy; Sex Factors; Substance-Related Disorders; Time Factors; Tranquilizing Agents

Complications resulting from drug abuse more frequently affect the lung than any other organ. The spectrum of pulmonary complications associated with drug abuse is wide. The current practice of using mixtures of drugs is mainly responsible for the increase in pulmonary complications. The chief complications observed in a series of 241 drug abuse patients were aspiration pneumonitis (12.9 percent), pulmonary edema (10.0 percent), and pneumonia (7.5 percent).

Topics: Adult; Alcoholism; Barbiturates; Cannabis; Cocaine; Coma; Female; Heroin; Humans; Lung Abscess; Lung Diseases; Male; Pneumonia; Pneumonia, Aspiration; Pulmonary Atelectasis; Pulmonary Edema; Pulmonary Embolism; Pulmonary Fibrosis; Substance-Related Disorders

Topics: Adult; Bronchography; Drug-Related Side Effects and Adverse Reactions; Granuloma; Heart Valve Diseases; Heroin; Heroin Dependence; Humans; Hypertension, Pulmonary; Injections, Intravenous; Lung; Lung Diseases; Male; Narcotics; Pulmonary Edema; Respiratory Tract Infections; Sepsis; Substance-Related Disorders; Syringes; Talc; Tricuspid Valve; Tuberculosis, Pulmonary

Topics: Adult; Amphetamine; Barbiturates; Cannabis; Educational Status; Follow-Up Studies; Heroin; Heroin Dependence; Humans; Male; Methadone; Military Medicine; Narcotics; Opium; Phytotherapy; Prognosis; Smoking; Substance-Related Disorders; United States; Vietnam

Topics: Adolescent; Adult; Age Factors; Community Health Services; Disease Outbreaks; District of Columbia; Drug and Narcotic Control; Heroin; Heroin Dependence; Humans; Jurisprudence; Methadone; Prisons; Seasons; Social Control, Formal; Substance-Related Disorders; United States

Topics: Administration, Oral; Adult; Cyclazocine; Cyclopropanes; Dose-Response Relationship, Drug; Headache; Heroin; Heroin Dependence; Humans; Methadone; Morphinans; Narcotic Antagonists; Reflex, Pupillary; Substance-Related Disorders; Time Factors

Topics: Abnormalities, Drug-Induced; Adult; Age Factors; Barbiturates; Camphor; Chlorpromazine; Codeine; Diazepam; Female; Fetus; Heroin; Heroin Dependence; Humans; Infant, Newborn; Infant, Newborn, Diseases; Maternal Age; Methadone; Opium; Phenobarbital; Pregnancy; Pregnancy Complications; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Alcoholism; Angina Pectoris; Aortic Aneurysm; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Hemodynamics; Heroin; Humans; Hypertension; Hyperthyroidism; Migraine Disorders; Myocardial Infarction; Pacemaker, Artificial; Pheochromocytoma; Propranolol; Substance-Related Disorders; Tachycardia, Paroxysmal; Tetralogy of Fallot; Tremor; Wolff-Parkinson-White Syndrome

Topics: Barbiturates; England; Female; Follow-Up Studies; Heroin; Heroin Dependence; Homosexuality; Humans; Methadone; Narcotics; Sepsis; Social Behavior; Substance-Related Disorders

Topics: Costs and Cost Analysis; Heroin; Humans; Legislation, Drug; Narcotics; Substance-Related Disorders; Thebaine; United States

Topics: Adult; Heroin; Heroin Dependence; Humans; Male; Peripheral Nervous System Diseases; Substance-Related Disorders

Topics: Adult; Brain; Cocaine; Demyelinating Diseases; Electrocardiography; Heroin; Heroin Dependence; Humans; Infarction; Male; Morphine; Myelitis; Myelitis, Transverse; Myocardial Infarction; Paralysis; Substance-Related Disorders

Topics: Amphetamine; Antipsychotic Agents; Barbiturates; Cannabis; Child Welfare; Chlorpromazine; Diazepam; Female; Heroin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Lysergic Acid Diethylamide; Maternal-Fetal Exchange; Pregnancy; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Amphetamine; Barbiturates; Central Nervous System Stimulants; Dextropropoxyphene; Hallucinogens; Heroin; Humans; Indicators and Reagents; Meperidine; Methods; Morphine; Pharmaceutical Preparations; Quinacrine; Salicylates; Stomach; Substance-Related Disorders; Tranquilizing Agents

Topics: Adolescent; Adult; Antisocial Personality Disorder; Female; Heroin; Heroin Dependence; Humans; Mental Disorders; Military Psychiatry; MMPI; Personality; Substance-Related Disorders; United States; Vietnam; Warfare

Topics: Heroin; Heroin Dependence; Humans; MMPI; Personality; Prisoners; Substance-Related Disorders

Topics: Adolescent; Adult; Analgesics; Anti-Anxiety Agents; Appetite Depressants; Cannabis; Child; Europe; Female; Heroin; Humans; Lysergic Acid Diethylamide; Male; Psychotropic Drugs; Substance-Related Disorders

Topics: Abscess; Adult; Arthritis, Infectious; Blood; Cartilage; Female; Heroin; Heroin Dependence; Humans; Knee Joint; Male; Osteomyelitis; Pseudomonas aeruginosa; Radiography; Ribs; Staphylococcus; Sternoclavicular Joint; Sternum; Substance-Related Disorders; Suppuration

Topics: Animals; Blood Gas Analysis; Dose-Response Relationship, Drug; Drug Contamination; Drug Tolerance; Habituation, Psychophysiologic; Haplorhini; Heroin; Heroin Dependence; Humans; Papio; Respiratory Function Tests; Seizures; Substance-Related Disorders; Time Factors

Topics: Adult; Heroin; Heroin Dependence; Humans; Immunodiffusion; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Immunoglobulins; Liver Diseases; Liver Function Tests; Substance-Related Disorders

The diagnosis of pyogenic vertebral osteomyelitis was made in seven narcotic addicts between 1967 and 1972. Vertebrae involved were either cervical or lumbar. Bacteriologic diagnosis was made in each case by percutaneous needle biopsy and aspiration. Staphylococcus aureus was cultured in two patients. Five patients had infections due to Gram-negative bacteria, including Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterobacter. All patients were cured by treatment with antibiotics and immobilization.

Topics: Adolescent; Adult; Bacteria; Bacterial Infections; Biopsy, Needle; California; Cervical Vertebrae; Female; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Klebsiella pneumoniae; Lumbar Vertebrae; Male; Osteomyelitis; Pseudomonas aeruginosa; Radiography; Staphylococcal Infections; Substance-Related Disorders

Topics: Acanthosis Nigricans; Acne Vulgaris; Dental Caries; Dermatitis, Contact; Drug Eruptions; Edema; Gangrene; Hepatitis A; Heroin; Humans; Impetigo; Life Style; Pigmentation Disorders; Pruritus; Psychophysiologic Disorders; Purpura; Skin Diseases; Skin Manifestations; Substance-Related Disorders; Thrombophlebitis; Urticaria

Topics: Aneurysm, Infected; Arterial Occlusive Diseases; Cardiomegaly; Edema; Endocarditis, Bacterial; Hand; Heroin; Humans; Injections, Intra-Arterial; Injections, Intravenous; Ischemia; Lung Diseases; Lymphadenitis; Pneumonia; Pneumonia, Aspiration; Pulmonary Edema; Pulmonary Embolism; Substance-Related Disorders; Tuberculosis, Pulmonary; Vascular Diseases; Venous Insufficiency

Topics: Amphetamine; Antigen-Antibody Reactions; Barbiturates; Binding Sites, Antibody; Cocaine; Electron Spin Resonance Spectroscopy; Glucuronates; Heroin; Humans; Immunoassay; Methadone; Methods; Morphine; Muramidase; Pharmaceutical Preparations; Spectrophotometry; Substance-Related Disorders

Topics: Animals; Antibodies; Antigen-Antibody Reactions; Chromatography, Thin Layer; Cocaine; Codeine; Electron Spin Resonance Spectroscopy; Evaluation Studies as Topic; Glucuronates; Heroin; Humans; Mass Screening; Methadone; Methods; Morphine; Rabbits; Saliva; Spin Labels; Substance-Related Disorders; Time Factors

Topics: Adolescent; Adult; Anxiety; Criminal Psychology; Depression; Female; Heroin; Heroin Dependence; Hostility; Humans; Internal-External Control; Male; Middle Aged; MMPI; Personality; Psychological Tests; Psychotic Disorders; Substance-Related Disorders; Therapeutic Community; Voluntary Health Agencies

Topics: Adult; Criminal Psychology; Heroin; Heroin Dependence; Humans; Male; MMPI; Personality; Prisoners; Prisons; Substance-Related Disorders

Topics: Adolescent; Adult; Analgesics; California; Community Health Services; Counseling; Heroin; Heroin Dependence; Humans; Hypnotics and Sedatives; Methadone; Social Problems; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adult; Coma; Endocarditis, Bacterial; Heroin; Heroin Dependence; Humans; Jaundice; Male; Sepsis; Staphylococcal Infections; Substance-Related Disorders

Topics: Counseling; Cyclazocine; Day Care, Medical; Female; Heroin; Heroin Dependence; Humans; Male; Methadone; New York City; Pregnancy; Substance-Related Disorders; Therapeutic Community

Topics: Adult; Cross Infection; Dentists; Hepatitis A; Heroin; Humans; Male; Maxillofacial Injuries; Occupational Diseases; Substance-Related Disorders; Surgery, Oral; Tooth, Impacted

Topics: Adult; Heroin; Heroin Dependence; Humans; Impetigo; Male; Substance-Related Disorders

Topics: Acetates; Child; Drug and Narcotic Control; Heroin; Heroin Dependence; Humans; Methadone; New Zealand; Substance-Related Disorders; United States

Topics: District of Columbia; Heroin; Heroin Dependence; Humans; Methods; Statistics as Topic; Substance-Related Disorders; Urban Population

Topics: Accidents; Adult; Heroin; Humans; Male; Methadone; Prisons; Substance-Related Disorders; Suicide

Topics: Adolescent; Adult; England; Heroin; Heroin Dependence; Humans; Methadone; Models, Biological; Substance-Related Disorders

Topics: Adolescent; Adult; Age Factors; Educational Status; Family Characteristics; Heroin; Humans; Methadone; Racial Groups; Substance-Related Disorders

Topics: Adult; Heroin; Humans; Male; Middle Aged; Opium; Psychological Tests; Regression Analysis; Substance-Related Disorders; Surveys and Questionnaires

Topics: Adult; Affective Symptoms; Amphetamine; Cannabis; Heroin; Humans; Lysergic Acid Diethylamide; Students; Substance-Related Disorders; Universities

Topics: Acute Kidney Injury; Adolescent; Adult; Aged; Anti-Bacterial Agents; Endocarditis, Bacterial; Enterobacteriaceae Infections; Female; Gastrointestinal Hemorrhage; Hemiplegia; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Prospective Studies; Pseudomonas Infections; Pulmonary Embolism; Respiratory Insufficiency; Splenomegaly; Staphylococcal Infections; Streptococcal Infections; Substance-Related Disorders

Topics: Adult; Candida; Candidiasis; Endocarditis, Bacterial; Female; Haemophilus Infections; Haemophilus influenzae; Heart Failure; Heroin; Heroin Dependence; Humans; Male; Neurologic Manifestations; Panophthalmitis; Skin Manifestations; Splenomegaly; Staphylococcal Infections; Staphylococcus; Streptococcal Infections; Streptococcus; Substance-Related Disorders

Topics: Adolescent; Adult; Anxiety; Attitude to Health; Female; Heroin; Heroin Dependence; Humans; Intelligence Tests; Interpersonal Relations; Interview, Psychological; Male; Motivation; Personality; Personality Inventory; Pilot Projects; Projective Techniques; Self Medication; Social Behavior; Social Class; Substance-Related Disorders

Topics: Adolescent; Adult; California; Disease Outbreaks; England; Ethnicity; Female; Fluorescent Antibody Technique; Heroin; Humans; Injections, Intravenous; Malaria; Male; Mexico; Plasmodium vivax; Substance-Related Disorders

Topics: Endocarditis, Bacterial; Heroin; Humans; Infections; Osteomyelitis; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Substance-Related Disorders

Topics: Adolescent; Adult; Animals; Antibody Specificity; Aspartate Aminotransferases; Female; Hepatitis B Antigens; Heroin; Heroin Dependence; Humans; Immune Sera; Immunodiffusion; Immunoelectrophoresis; Immunoglobulin A; Immunoglobulin D; Immunoglobulin G; Immunoglobulin M; Male; Precipitin Tests; Rabbits; Substance-Related Disorders; Waldenstrom Macroglobulinemia

Topics: Adult; Ampicillin; Diagnosis, Differential; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Penile Diseases; Skin Ulcer; Staphylococcal Infections; Substance-Related Disorders

Topics: Heroin; Heroin Dependence; Humans; Methadone; Substance-Related Disorders; United States

Topics: Behavior; Heroin; Heroin Dependence; Humans; Methadone; Morphine; Narcotic Antagonists; Psychotherapy; Reinforcement, Psychology; Substance-Related Disorders; Therapeutic Community; United States

Topics: Analgesics; Drug Industry; Drug Prescriptions; Education, Medical, Continuing; Heroin; Humans; Meperidine; Morphine; Narcotics; Substance-Related Disorders

Topics: Adolescent; Child; Child Development; Child Welfare; Child, Preschool; Family; Heroin; Heroin Dependence; Humans; Infant; Substance-Related Disorders; United States

Topics: Adolescent; Child; Family; Female; Heroin; Heroin Dependence; Humans; Male; Substance-Related Disorders

Topics: Communicable Diseases; Epidemiologic Methods; Heroin; Heroin Dependence; Humans; Substance-Related Disorders

Topics: Adult; Arm; Heart Atria; Heart Failure; Heroin; Humans; Injections, Intravenous; Phonocardiography; Substance-Related Disorders; Thrombophlebitis; Tricuspid Valve Insufficiency; Venous Pressure

Topics: Adolescent; California; Community Mental Health Services; Contraception; Contraceptive Devices; Contraceptives, Oral; Counseling; Family Planning Services; Female; Group Processes; Heroin; Humans; Marriage; Parent-Child Relations; Pregnancy; Sex Education; Sexual Behavior; Social Behavior Disorders; Social Problems; Substance-Related Disorders; Suicide

Topics: Heroin; Heroin Dependence; Humans; Legislation, Drug; Methadone; Substance-Related Disorders; United Kingdom; United States

Topics: Heroin; Heroin Dependence; Humans; Legislation, Drug; Substance-Related Disorders; United States

Topics: Adult; Attitude; Cannabis; Crime; Educational Status; Heroin; Heroin Dependence; Humans; Intelligence; Male; Military Medicine; Substance-Related Disorders; United States; Vietnam

Topics: Adolescent; Amphetamine; Barbiturates; Cannabis; Cocaine; Heroin; Humans; Lysergic Acid Diethylamide; Mescaline; Social Change; Social Class; Substance-Related Disorders

Topics: Adolescent; Adult; Costs and Cost Analysis; Employment; Female; Heroin; Heroin Dependence; Humans; Male; Michigan; Peer Group; Residence Characteristics; Socioeconomic Factors; Substance-Related Disorders

Topics: Dose-Response Relationship, Drug; Heroin; Heroin Dependence; Humans; Methadone; Morphine Dependence; Substance-Related Disorders

Topics: Amphetamine; Atropa belladonna; Barbiturates; Cannabis; Cocaine; Emergency Service, Hospital; Hallucinogens; Heroin; Hospitalization; Humans; Narcotic Antagonists; Plants, Medicinal; Plants, Toxic; Poisoning; Psychoses, Alcoholic; Psychoses, Substance-Induced; Substance-Related Disorders; Unconsciousness

Topics: Adolescent; Adult; Amphetamine; Cannabis; Child; Educational Status; Family; Family Characteristics; Health Education; Heroin; Humans; Lysergic Acid Diethylamide; Male; Mescaline; Military Medicine; Peer Group; Racial Groups; Religion; Substance-Related Disorders; Surveys and Questionnaires; United States

Topics: Adolescent; Adult; Ejaculation; Heroin; Heroin Dependence; Humans; Libido; Male; Middle Aged; Orgasm; Reinforcement, Psychology; Sexual Behavior; Substance-Related Disorders

Topics: Community Pharmacy Services; Heroin; Heroin Dependence; Humans; Legislation, Drug; Methadone; Pain; Pharmacy Service, Hospital; Substance-Related Disorders; United States; United States Food and Drug Administration

Topics: Adult; Bronchiectasis; Heroin; Heroin Dependence; Humans; Hypoxia; Inhalation; Lung Diseases, Obstructive; Male; Radiography; Respiratory Function Tests; Respiratory Insufficiency; Substance-Related Disorders

Topics: Adolescent; Adult; Aged; Barbiturates; Female; Glutethimide; Heroin; Heroin Dependence; Humans; Iron; Male; Maryland; Middle Aged; Poisoning; Salicylates; Substance-Related Disorders; Suicide

Topics: Alcohol Drinking; Alcoholism; Disulfiram; Heroin; Heroin Dependence; Hospitalization; Humans; Methadone; Reinforcement, Psychology; Social Adjustment; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adolescent; Adult; Attitude; Black or African American; Death; Depression; District of Columbia; Female; Heroin; Heroin Dependence; Humans; Interview, Psychological; Male; Methadone; Personality Inventory; Racial Groups; Substance Withdrawal Syndrome; Substance-Related Disorders; Suicide; Violence

Topics: Heroin; Heroin Dependence; Humans; Methadone; Methods; Parent-Child Relations; Psychoses, Substance-Induced; Socioeconomic Factors; Substance-Related Disorders; United States

Topics: Heroin; Heroin Dependence; Humans; Substance-Related Disorders

Topics: Emergencies; Heroin; Heroin Dependence; Humans; Nalorphine; Naloxone; Pulmonary Edema; Respiratory Insufficiency; Substance-Related Disorders

Topics: Adult; Barbiturates; Female; Foreign Bodies; Heroin; Heroin Dependence; Humans; Injections; Injections, Intra-Articular; Injections, Intramuscular; Injections, Intravenous; Injections, Subcutaneous; Ischemia; Male; Muscles; Opium; Phlebography; Substance-Related Disorders; Surgical Procedures, Operative; Thrombophlebitis

Topics: Heroin; Humans; Nalorphine; Naloxone; Pulmonary Edema; Respiration; Respiratory Insufficiency; Substance-Related Disorders

Topics: Acute Kidney Injury; Adult; Coma; Contracture; Female; Heroin; Humans; Ischemia; Male; Muscles; Muscular Diseases; Pressure; Pressure Ulcer; Secobarbital; Skin Diseases; Substance-Related Disorders

Topics: Amphetamine; Barbiturates; Cannabis; Counseling; Educational Status; Hallucinogens; Heroin; Humans; Occupations; Social Control, Formal; Social Perception; Students; Substance-Related Disorders; Teaching; United States

Topics: Alcohol Drinking; Alcoholic Beverages; Alcoholism; Counseling; Female; Heroin; Heroin Dependence; Humans; Male; Sex Factors; Social Adjustment; Social Behavior; Social Control, Formal; Substance-Related Disorders

Topics: Criminal Psychology; Family; Florida; Heroin; Heroin Dependence; Humans; Interpersonal Relations; Interview, Psychological; Jurisprudence; Male; Occupations; Personality; Probability; Social Adjustment; Substance-Related Disorders; Surveys and Questionnaires

Topics: Adolescent; Adult; Age Factors; Alcoholism; Amphetamine; Cannabis; Child; Drug and Narcotic Control; Female; Heroin; Heroin Dependence; Humans; Hypnotics and Sedatives; Lysergic Acid Diethylamide; Male; Solvents; Substance-Related Disorders; Tranquilizing Agents; United States

Topics: Amphetamine; Association; Barbiturates; Cannabis; Ethanol; Heroin; Humans; Substance-Related Disorders; Word Association Tests

Topics: Adult; Birth Weight; Black or African American; Ethnicity; Female; Heroin; Heroin Dependence; Humans; Illegitimacy; Infant, Newborn; Maternal Age; New York City; Pregnancy; Pregnancy Complications; Puerto Rico; Substance-Related Disorders

Topics: Adaptation, Psychological; Amphetamine; Anxiety; Defense Mechanisms; Ego; Heroin; Humans; Personality; Personality Development; Repression-Sensitization; Self Concept; Social Values; Substance-Related Disorders

Topics: Heroin; Heroin Dependence; Humans; Jurisprudence; Methadone; New York City; Substance-Related Disorders

Topics: Adolescent; Adult; Alcoholism; Child; Criminal Psychology; Ethnicity; Female; Follow-Up Studies; Heroin; Heroin Dependence; Humans; Life Style; Male; Methadone; Middle Aged; New Mexico; Prisons; Social Adjustment; Substance Withdrawal Syndrome; Substance-Related Disorders