rome and Heroin-Dependence

To examine the prevalence of former heroin dependence (FHA) in Alcohol Use Disorder (AUD) patients; to compare the clinical characteristics of FHA-AUD patients versus AUD patients without any past use of heroin at alcohol treatment entry; to document the heroin dependence history of FHA-AUD patients, and review treatment strategies for this group.. Retrospective case review of 448 consecutive AUD patients.. The annual entry of FHA-AUD showed stability over the study period of 3 years overall 60/448 (13.3%). FHA-AUD patients showed higher concomitant use of cocaine, benzodiazepines, cannabis and hallucinogens than other heroin addicts. They consumed higher amounts of alcohol at the beginning of their alcohol dependence history, and reached a high maximum level of alcohol consumption, than other AUD patients, and tended to have more physical disorders. The most important signals of FHA-AUD were polyabuse and older age at the time of presentation. FHA-AUD patients tended to have had a severe pattern of heroin dependence associated with inadequate agonist opiate treatment.. The prevalence of FHA-AUD patients is not negligible. This may relate to previous inadequate treatment of heroin addiction contributing to the development of severe AUD. For these patients we propose a reconsideration of 'soft' (low dose) agonist opiate treatment.

Topics: Adult; Aged; Alcoholism; Female; Heroin Dependence; Humans; Male; Middle Aged; Prevalence; Retrospective Studies; Risk Factors; Rome; Young Adult

Between September 1993 and December 1995, 528 foreign individuals at risk of HIV infection attended the drug treatment centre located in the Santo Spirito Hospital in Rome, undergoing medical examination, HIV testing and counselling. The geographic distribution showed that the majority of the participants were from South America (40.0%), most of whom were transsexual sex workers (from Brazil or Columbia), and from North Africa (37.5%); all the individuals coming from Western and Eastern Europe and the USA were heroin users. The overall HIV prevalence was high (21.6%), though it varied by nationality, ranging from 5.1% among North Africans to 68.3% among Brazilian transsexuals. During the study period, 170 of the individuals returned for at least one follow-up visit. Three seroconversions occurred among the 118 initially HIV-negative immigrants who were retested, all three among the 26 HIV-negative Columbian transsexuals; the seroconversion rate within this group was 10.1 per 100 persons/years. During follow-up, there was no reduction observed in drug-related practices associated with HIV infection, yet a general increase in regular condom use was reported. The increasing number of foreign persons contacting our programme emphasizes the need for easy access to care and treatment for marginalized populations possibly engaging in behaviour at risk for HIV infection. Counselling strategies seem to be relatively effective in promoting safer sex among these population groups.

Topics: Adult; Africa; Ambulatory Care; Cross-Sectional Studies; Europe, Eastern; Female; Heroin Dependence; HIV Infections; HIV Seroprevalence; Humans; Male; Middle Aged; Patient Acceptance of Health Care; Risk-Taking; Rome; Sex Work; South America; Transsexualism; United States

Sixty-seven transvestite prostitutes from Latin America (49 from Brazil and 18 from Colombia) who attended an HIV unit located in the inner city of Rome between January 1991 and June 1992 were studied for syphilis markers by means of both the Treponema pallidum haemoagglutination test (TPHA) and a solid phase haemadsorption test for detection of specific IgM (SPHA-IgM) which are typically present in recent infections. All participants reported more than 500 sexual partners in the past year, and 67.1% of them more than 1500 partners (between 5 and 10 partners per working day). The overall prevalence of anti-HIV antibodies in this population was 65.7%. The prevalence of positive TPHA tests in the population studied was 73.1%, while that of positive SPHA-IgM tests was 10.4%. The prevalence of positive TPHA and SPHA-IgM tests was higher among Columbians than among Brazilians (83.3% vs 69.4% and 22.2% vs 6.1%, respectively) and also showed a positive correlation with the duration of their permanence in Italy. The TPHA and SPHA-IgM positivities were significantly higher among subjects older than 29 years. Positive TPHA was also significantly higher in subjects who reported a history of heroin and/or cocaine abuse while positive SPHA-IgM was higher in subjects who did not use condoms or reported irregular use of them than in subjects who regularly used condoms. No overall correlation was evident between TPHA positivity and anti-HIV positivity, while SPHA-IgM positivity was found to be higher among anti-HIV-negative subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Age Factors; Antibodies, Bacterial; Brazil; Cocaine; Colombia; Condoms; Follow-Up Studies; Hemadsorption; Hemagglutination; Heroin Dependence; HIV Antibodies; HIV Infections; HIV Seronegativity; HIV Seropositivity; Humans; Immunoglobulin M; Middle Aged; Rome; Sex Work; Sexual Partners; Substance-Related Disorders; Syphilis Serodiagnosis; Transvestism; Treponema pallidum

Overdose mortality is the major adverse health effect of drug injection. The potential determinants of overdose death are poorly understood; the aim of this study was to investigate risk factors for overdose mortality among intravenous drug users (IVDU). A cohort of 4200 IVDU attending methadone treatment centres in Rome during the period 1980-1988, was enrolled. Data were collected from clinical records. Vital status and cause of death were ascertained as of 31 December 1988. A matched case-control analysis within the cohort was performed to identify risk factors of death from overdose. All overdose deaths were included as cases and four controls, matched on year of birth and sex, were selected for each case from among the cohort members still alive at the time of death of the corresponding case. In all, 81 deaths from overdose were identified as cases and compared with 324 controls. A high risk of overdose death occurred among subjects who left treatment compared with those still in treatment (odds ratio [OR] = 3.55, 95% confidence interval [CI]: 1.82-6.90). The OR was particularly elevated in the first 12 months after drop-out compared with those retained in treatment (OR = 7.98, 95% CI: 3.40-18.73). The risk of overdose death was higher for unmarried compared with married people (OR = 2.48, 95% CI: 1.31-4.68); a higher risk of overdose death was also associated with lower educational status and younger age at first drug use, but such association was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Case-Control Studies; Cause of Death; Cohort Studies; Drug Overdose; Educational Status; Heroin Dependence; Humans; Marriage; Risk Factors; Rome; Substance Abuse, Intravenous

Although in several countries heroin addicts have been found to engage in illicit use of methadone, no studies have been addressed to this behavior in Italy. The present study gives evidence that methadone dispensed by public health services in Rome is paralleled by a black market in this drug. Of sixty-five heroin addicts hospitalized for medical or surgical problems, the majority (89.2%) referred to the existence of an illicit methadone market in Rome, and 38% used it. When asked why they bought illicit methadone the addicts stated that the daily dose obtainable from public health services was inadequate. However this statement is in contrast with the evidence that the heroin addicts using illicit methadone had highest daily doses similar to those of heroin addicts not referring to the illicit methadone market. We wonder whether illicit use of methadone is influenced by the therapeutic benefit that addicts expect to obtain from methadone. These "expectations" may lead heroin addicts to extend consumption of methadone to alleviate problems altogether unrelated to the withdrawal syndrome. If so, the illicit market in methadone may be sustained not by the drug's addictive properties but by its therapeutic effects.

Topics: Adolescent; Adult; Drug Utilization; Female; Heroin Dependence; Humans; Legislation, Drug; Male; Methadone; Middle Aged; Rome; Substance Withdrawal Syndrome