TITLE:
Active heroin injectors' perceptions and use of methadone maintenance treatment:
cynical performance or self-prescribed risk reduction?
Subst Use Misuse 1999
Dec;34(14):2135-53 (ISSN: 1082-6084)
Koester S; Anderson K; Hoffer L, Urban
Links, Center for Research in the Health & Behavioral Sciences, University of
Colorado at Denver, USA.
skoester
In addition to the numerous heroin users
who voluntarily enter methadone treatment as a way to free themselves from
illicit drug addiction and those ordered to do so by the courts, there are a
large number of opioid users who enter methadone treatment with other objectives
in mind. These include shorter-term goals that users do not necessarily equate
with complete heroin abstinence. In this paper we report the results of a
qualitative study designed to identify and describe the motivations active
heroin users have for entering methadone treatment, and to suggest that many of
these short-term methadone episodes may operate as self-prescribed attempts at
risk reduction, and act as pilot tests for users considering or anticipating
entering treatment to quit the use of illicit drugs. We argue that heroin users'
motivations, perceptions about methadone, and the strategies they devise for
adapting methadone treatment for their own needs should be recognized for their
value in reducing the multiple risks associated with drug use.
TITLE:
The role of alcohol abuse in the etiology of heroin-related
deaths. Evidence for pharmacokinetic interactions between heroin and alcohol.
J Anal Toxicol 1999
Nov-Dec;23(7):570-6 (ISSN: 0146-4760)
Polettini A; Groppi A; Montagna M,
Department of Legal Medicine and Public Health, University of Pavia, Italy.
apole
Элекроинструменты шуруповерт makita 6313.|Форум где купить бани Строительство. homeowners insurance In order to evaluate pharmacokinetic
interactions between heroin and alcohol and their role in the etiology of
heroin-related deaths (HRD), the alcohol concentration in blood (BAC), the free
(FM) and total morphine (TM) concentrations in blood (determined by DPC
Coat-A-Count radioimmunoassay before and after enzymatic hydrolysis), and the TM
concentration in urine and bile (DPC Coat-A-Count after enzymatic hydrolysis) in
a population of 39 lethal cases included in the records of the Department of
Legal Medicine and Public Health at the University of Pavia from the period
January 1997-April 1998 were examined. The cause of death in each case was
attributed to either heroin or associated heroin-ethanol intoxication. Cases
were arbitrarily divided into two groups according to BAC (low-ethanol group,
LE, BAC < or = 1000 mg/L and high-ethanol group, HE, BAC > 1000 mg/L). The
differences in the FM and TM concentrations in blood, bile, and urine and in the
FM/TM ratios between the two . groups were statistically evaluated (Mann-Whitney
U test). A similar statistical evaluation was carried out on data from a
previously published study concerning the disposition of heroin and its
metabolites (6-acetylmorphine and morphine) in blood and urine in 23 lethal
cases attributed to either heroin or heroin and alcohol intoxication. The values
of the following variables in the LE and HE groups were compared: FM, TM, and
6-acetylmorphine concentrations in blood (6-AM); the FM/ (FM + 6-AM) ratio; the
FM/TM ratio; and the urinary concentrations of heroin, 6-acetylmorphine, and
free morphine. Statistical analyses of data indicated that high BACs are
associated with reduced hydrolysis of 6-AM to morphine (FM/[FM + 6-AM], p =
0.0022) and that a good inverse correlation exists between BAC and hydrolysis of
6-AM to morphine (r2 = 0.67). High BACs were also found to be associated with an
increased FM/TM ratio and with reduced excretion of free and total morphine.
These results suggest the hypothesis that pharmacokinetic interactions between
heroin and alcohol do occur in individuals exposed to high doses of these
substances.
TITLE:
Naltrexone maintenance treatment for Opioid Dependence
Kirchmayer U, Davoli M, Verster A
A substantive amendment to this
systematic review was last made on 23 February 1999. Cochrane reviews are
regularly checked and updated if necessary.
Data collection and analysis: Reviewers
evaluated data independently and analysed outcome measures taking into
consideration adherence to and success of the study intervention. Data was
extracted and analysed stratifying for the three categories of study quality.
Where possible, meta-analysis was performed.
Citation: Kirchmayer U, Davoli M,
Verster A. Naltrexone maintenance treatment for Opioid Dependence (Cochrane
Review). In: The Cochrane Library, Issue 3, 1999. Oxford: Update Software.
Background and objectives
To evaluate the effects of naltrexone
maintenance treatment in preventing relapse in opioid addicts after
detoxification.
Reviewers' conclusions
The available trials do not allow a
final evaluation of naltrexone maintenance treatment yet. A trend in favour of
treatment with naltrexone was observed for certain target groups, as described
in the literature before.A well-done clinical trial is needed in order to get
better evidence as soon as possible.
Search strategy
We searched MEDLINE, EMBASE, CCTR and
handsearched the "Bolletino per le Farmacodipendenze e lAlcolismo"; contact was
sought with pharmaceutical producers of naltrexone, with authors and other CRGs;
references of obtained studies. Trials were reliably identified and data
extracted. Date of most recent searches: June 1998.
Selection criteria
All studies controlled for naltrexone;
treatment of heroin addicts after detoxification with naltrexone. Studies were
classified into three categories (high, moderate or low risk of bias) according
to their methodological quality.
Main results
Eleven studies were included in this
review, and not all of them were randomised. Meta-analysis could be done to a
low degree only, because the studies and their outcomes were very heterogeneous.
The result of this quantitative analysis was statistically poor, and so was the
methodological quality of the included studies.
TITLE:
Unusual consequences of heroin overdose:
rhabdomyolysis, acute renal failure, paraplegia and hypercalcaemia.
Br J Anaesth 1999 Sep;83(3):496-498
(ISSN: 0007-0912)
Kumar R, Ormskirk and District General
Hospital, UK.
A 29-yr-old man, known to be a heroin
addict, was found at home totally unrousable, bent on his hips in the lotus
position. On admission, he required frequent ventricular defibrillation,
external pacing and infusion of calcium. A diagnosis of rhabdomyolysis caused by
heroin and cocaine overdose was made. He developed paraplegia below T12, acute
renal failure, acute compartment syndrome in one leg and a coagulation defect.
Despite a fasciotomy, a through-knee amputation of the leg was required.
Haemodialysis was required for 26 days, and this period was complicated by
increased serum calcium concentrations, which was treated with disodium
pamindrate. Calcium deposits were palpable in the muscles and could be seen in
vessels on limb x-rays. After 34 days, he was eventually discharged to a general
surgical ward and subsequently into the community.
TITLE:
The influence of heroin dose and route of administration on
the severity of the opiate withdrawal syndrome.
Addiction 1999 Aug;94(8):1191-1198
(ISSN: 0965-2140)
Smolka M, Department of Psychiatry,
Freie Universitat Berlin, Germany. smolka
AIMS
To determine the relationship between
severity of opiate withdrawal and prior heroin dose and route of administration
(smoking versus intravenous injection).
DESIGN
Retrospective analysis of withdrawal
data and assessment of associations with baseline variables including heroin
dose, route of administration, duration of use, concomitant use of cocaine,
severity of opiate dependence, previous treatment, sex or age.
SETTING
Psychiatric inpatient unit specialized
in withdrawal treatments.
PARTICIPANTS
Twenty-two opiate addicts injecting or
smoking heroin who were abruptly withdrawn after admission.
MEASUREMENTS
Daily assessment of withdrawal severity
with the Opiate Withdrawal Scale (OWS) during the first week after drug
cessation.
FINDINGS
Severity and duration of withdrawal
symptoms were greater in injectors compared to smokers (with comparable doses)
and also in patients with higher heroin dose. Heroin dose and route of
administration were related significantly to total and maximum withdrawal scores
and together accounted for about 50% of variance. Similar levels of total
withdrawal distress were associated with approximately five times higher heroin
consumption in chasers than in injectors.
CONCLUSIONS
The impact of heroin dose and route of
administration on withdrawal severity is marked. The influence of the route of
administration on withdrawal severity might be due to differences in
bioavailability.
TITLE:
The Swiss heroin trials. Scientifically sound?
J Subst Abuse Treat 1999
Dec;17(4):331-5 (ISSN: 0740-5472)
Satel SL; Aeschbach E, Department of
Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
slsatel
The objective of this article is to
critique a study conducted by the Swiss Federal Office of Public Health to
evaluate Switzerland's heroin maintenance project.
Heroin abusers (N = 1,146) were enrolled
in 18 research clinics. Subjects were recruited into three study arms--heroin,
morphine, or methadone maintenance, but randomisation was unsuccessful, and all
received heroin. Medications were self-administered by injection on site.
Patients were interviewed at intake and 6-month intervals up to 18 months.
A review of the study revealed design
weaknesses, including the absence of control groups, lack of corroboration of
self-reports, failure to control for the influence of social services on
outcome, and the absence of follow-up on those who left the trial prematurely.
The program's ability to avert human immunodeficiency virus (HIV) transmission
could not be fully evaluated because patients did not consistently submit to HIV
testing. The Swiss trials of supervised heroin prescription trials do not
withstand scientific scrutiny.
TITLE:
Comparative analysis of heroin and cocaine seizures.
J Chromatogr B Biomed Sci Appl 1999 Oct
15;733(1-2):127-36 (ISSN: 1387-2273)
Chiarotti M; Fucci N, Istituto di
Medicina Legale Universita' Cattolica, Rome, Italy.
In this brief review the analytical
techniques mainly used for comparative analysis of both cocaine and heroin
seizures are reported. The characterization of illicit
samples is carried out by means of a
variety of techniques including thin-layer chromatography, high-performance
liquid chromatography, gas chromatography and
capillary electrophoresis. By means of
these technique it is possible to resolve some component in illicit drugs and
their application for comparative analyses is described in this review. Owing to
the complexity and the variability of the mixture related to the origin and
manufacturing impurities a unique analytical approach based on the application
of a single technique it is not sufficient to achieve the requested global
characterization of the sample for comparative purposes. Generally a complete
characterization is obtained focusing on the identification of minor and major
components, origin and manufacturing impurities other than trace compounds such
as solvent residues. Nevertheless the application of a single robust methods
able to resolve any possible significant marker compounds, is still not
described and there is a need for a standardized general procedure suitable for
a complete cross-examination of analytical data related to comparative analyses
that can be carried out at an international level.
TITLE:
Fatal uncertainty: death-rate from use of ecstasy or heroin [letter]
Lancet 1999 Oct 9;354(9186):1265-6
(ISSN: 0140-6736)
Gore SM
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.
TITLE:
Acute respiratory problems and cocaine or heroine smoking
[Problemas respiratorios agudos
y uso de cocaina o heroina por via pulmonar.]
Med Clin (Barc) 1999 Jun
5;112(20):775-7 (ISSN: 0025-7753)
Barrio G; de la Fuente L; Royuela L; Bravo MJ; Regidor E;
Rodriguez-Artalejo F, Departamento de Medicina Preventiva, Universidad Autonoma
de Madrid.
BACKGROUND
To explore if cocaine or heroin smoking
was positively associated to acute respiratory complications (ARC).
SUBJECTS AND METHODS
We collected data from medical records
for 717 cocaine users who were attended in 14 hospital emergency rooms. The
association was studied by logistic regression.
RESULTS
The most frequent ARC were respiratory
infections and complications with chest pain or dyspnea. Cocaine smokers (OR =
3.3; CI 95% = 1.5-6.9) and cocaine sniffers (OR = 2.5; CI 95% = 1.1-5.6) had
greater risk of ARC than cocaine injectors. Heroin smokers (OR = 3.5; COI 95% =
1.8-7.0) and heroin sniffers (OR = 2.8; CI 95% = 1.4-5.6) had greater risk of
ARC than non heroin users.
CONCLUSIONS
These results suggest that cocaine or
heroin smoking increases the risk of ARC.
TITLE:
Are heroin overdose deaths related to patient release after prehospital
treatment with naloxone?
Prehosp Emerg Care 1999
Jul-Sep;3(3):183-6 (ISSN: 1090-3127)
Vilke GM; Buchanan J; Dunford JV; Chan
TC, Department of Emergency Medicine, University of California, San Diego
Medical Center, 92103, USA.
gmvilke
OBJECTIVE
Naloxone is frequently used by
prehospital care providers to treat suspected heroin and opioid overdoses. The
authors' EMS system has operated a policy of allowing these patients, once
successfully treated, to sign out against medical advice (AMA) in the field.
This study was performed to evaluate the safety of this practice.
METHODS
The authors retrospectively reviewed all
1996 San Diego County Medical Examiner's (ME's) cases in which opioid overdoses
contributed to the cause of death. The records of all patients who were found
dead in public or private residences or died in emergency departments of reasons
other than natural causes or progression of disease, are forwarded to the ME
office. ME cases associated with opiate use as a cause of death were
cross-compared with all patients who received naloxone by field paramedics and
then refused transport. The charts were reviewed by dates, times, age, sex,
location, and, when available, ethnicity.
RESULTS
There were 117 ME cases of opiate
overdose deaths and 317 prehospital patients who received naloxone and refused
further treatment. When compared by age, time, date, sex, location, and
ethnicity, there was no case in which a patient was treated by paramedics with
naloxone within 12 hours of being found dead of an opiate overdose.
CONCLUSIONS
Giving naloxone to heroin overdoses in
the field and then allowing the patients to sign out AMA resulted in no death in
the one-year period studied. This study did not evaluate for return visits by
paramedics nor whether patients were later taken to hospitals by private
vehicles.
TITLE:
Methadone dosing, heroin affordability, and the severity of addiction.
Am J Public Health 1999
May;89(5):662-5 (ISSN: 0090-0036)
Bach PB; Lantos J, Robert Wood Johnson
Clinical Scholars Program, Department of Medicine, University of Chicago, Ill.,
USA.
bachp
OBJECTIVES
This study sought to track changes in US
heroin prices from 1988 to 1995 and to determine whether changes in the
affordability of heroin were associated with changes in the use of heroin by
users seeking methadone treatment, as indexed by methadone dose levels.
METHODS
Data on the price of heroin were from
the Drug Enforcement Administration; data on methadone doses were from surveys
conducted in 1988, 1990, and 1995 of 100 methadone maintenance centers.
Multivariable models that controlled for time and city effects were used to
ascertain whether clinics in cities where heroin was less expensive had patients
receiving higher doses of methadone, which would suggest that these patients had
relatively higher physiological levels of opiate addiction owing to increased
heroin use.
RESULTS
The amount of pure heroin contained in a $100 (US) purchase has increased on
average 3-fold between 1988 and 1995. The average dose of methadone in clinics
was positively associated with the affordability of local heroin (P < .01).
CONCLUSIONS
When heroin prices fall, heroin addicts
require more methadone (a heroin substitute) to stabilize their
addiction--evidence that they are consuming more heroin.
TITLE:
Fluctuations in heroin purity and the incidence of fatal heroin overdose.
Drug Alcohol Depend 1999 Apr
1;54(2):155-61 (ISSN: 0376-8716)
Darke S; Hall W; Weatherburn D; Lind B,
National Drug and Alcohol Research Centre, University of New South Wales,
Sydney, Australia.
In order to determine the role played by
heroin purity in fatal heroin overdoses, time series analyses were conducted on
the purity of street heroin seizures in south western Sydney and overdose
fatalities in that region. A total of 322 heroin samples were analysed in
fortnightly periods between February 1993 to January 1995. A total of 61
overdose deaths occurred in the region in the study period. Cross correlation
plots revealed a significant correlation of 0.57 at time lag zero between mean
purity of heroin samples per fortnight and number of overdose fatalities.
Similarly, there was a significant correlation of 0.50 at time lag zero between
the highest heroin purity per fortnight and number of overdose fatalities. The
correlation between range of heroin purity and number of deaths per fortnight
was 0.40. A simultaneous multiple regression on scores adjusted for first order
correlation indicated both the mean level of heroin purity and the range of
heroin purity were independent predictors of the number of deaths per fortnight.
The results indicate that the occurrence of overdose fatalities was moderately
associated with both the average heroin purity and the range of heroin purity
over the study period.
TITLE:
Heroin fatality due to penile injection.
Am J Forensic Med Pathol 1999
Mar;20(1):90-2 (ISSN: 0195-7910)
Winek CL; Wahba WW; Rozin L , School of
Pharmacy, Duquesne University, Pittsburgh, Pennsylvania, USA.
Death due to heroin overdose and/or
rapid injection of heroin is a frequent occurrence among opioid addicts. We
present an unusual case of heroin fatality due to the injection of the drug in
the penis. Blood, urine, bile, and vitreous humor concentrations of morphine
were 0.68, 0.49, 0.32 and 0.062 microg/ml, respectively. Ethanol was detected at
concentrations of 104, 124, 106, and 94 mg/dl in the blood, urine, bile, and
vitreous humor, respectively. The cause of death was determined to be due to
heroin and ethanol intoxication.
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