Abstract
Aims: (a) To compare in the laboratory the effectiveness of various filters at removing particles from
heroin injections; (b) To measure the amount of heroin retained by the filters; and (c) To describe the
relevance of these preliminary findings to future research.
Design: A laboratory-based investigation. Injections were prepared with street heroin obtained from
the police, copying the methods of injectors. Pieces of cigarette filter, hand-rolling cigarette filter,
cotton wool from buds and commercially produced syringe filters were tested. The Coulter Multisizer
(IIe) was used to count and size particles; Capillary Zone Electrophoresis was used to measure the
amount of heroin retained in the filters.
Findings: All methods of filtration reduced the amount of particles, with the commercially produced
syringe filter producing the largest reduction. The syringe filter retained the most heroin after use;
however, less drug material was evident on the spoon, suggesting further work is needed with a range
of quantities. The cigarette, hand-rolling and cotton bud filters all retained some drug with no
significant difference detected between the different filters.
Conclusions: This preliminary study suggests all the filters tested may convey health benefits. Further
work is needed with varying quantities of drug, acid and water and to establish safety in use. Then
future studies can establish the health consequences for injecting drug users from the use of such
filters.
Archive for Dezember, 2009
A manual prepared by the harm reduction coalition that gives IV drug users detailed information on safe injection, do’s and don’t, health risks, and much more. Very comprehensive with usefull illustrations.
The 23 images on the poster and postcards represent opportunities for initiating
and developing discussions on various aspects related to taking better care of
one’s veins and reducing the likelihood of disease transmission through the
process of injection. These two protective pursuits are complementary and
synergistic in the spirit of reducing drug-related harm. Please use these materials
to engage people in discussions about positive changes they may choose to
make. These images are not meant to be prescriptive or exhaustive about the
practice of injection, merely a beginning to what is a bountiful set of options for
improvement and a tool for overcoming the damage caused by silence and
shame around injection.
Eine sich immer wiederholdende Anleitung zum safer injecting!
Abstract: So-called „balanced“ drug policy couples enforcement initiatives targeting drug dealers with health-focused interventions serving addicted individuals. There are few evaluations of this approach, and little is known about how these two populations may overlap. We evaluated factors associated with drug dealing among injection drug users (IDUs) in Vancouver, Canada, and examined self-reported drug-dealing roles and reasons for dealing. Among 412 IDUs seen from March through December 2005, 68 (17%) had dealt drugs during the previous six months. Variables independently associated with drug dealing included: recent incarceration (adjusted odds ratio [AOR] = 2.9; 95%CI: 1.4-6.0); frequent heroin injection (AOR = 2.5; 95%CI: 1.4-4.6); frequent cocaine injection (AOR = 2.0; 95%CI: 1.1-3.8); and recent overdose (AOR = 2.7; 95%CI: 1.0-7.3). The most common drug-dealing roles were direct selling (82%), middling (35%), and steering (19%), while the most common reasons for dealing included obtaining drugs (49%) and money (36%). Drug dealing among IDUs was predicted by several markers of higher intensity addiction, and drug-dealing IDUs tended to occupy the most dangerous positions in the drug-dealing hierarchy. These findings suggest that elements of „balanced“ drug policies may undermine each other and indicate the need for alternative interventions.
Abstract
Background: The authors present a case illustrating a mechanism leading directly to death which
is not rare but has received little attention.
Case presentation: The case was evaluated by autopsy, investigation of morphine concentration
in the blood, and clinical data. The heroin dose causing the ‚overdose‘ death of a young man who
had previously been treated a number of times for heroin addiction did not differ from his dose of
the previous day taken in the accustomed circumstances. The accustomed dose taken in a strange
environment caused fatal complications because the conditioned tolerance failed to operate. The
concentration of morphine in the blood did not exceed the level measured during earlier
treatment.
Conclusion: These results are in line with the data in the literature indicating that morphine
concentrations measured in cases of drug-related death do not differ substantially from those
measured in cases where the outcome is not fatal. A knowledge of the conditioning mechanism can
contribute to prevention of fatal cases of a similar type. The harm reduction approach places great
stress on preventive intervention based on data related to drug-related death.
Increased drug availability can precipitate a rapid transition to compulsive drug use in both vulnerable humans and laboratory animals.
Recent studies have shown that despite equivalent levels of psychomotor sensitization, only rats with prolonged, but not limited, access
to cocaine self-administration respond to the priming effects of cocaine on drug seeking, as measured in a within-session reinstatement
model of drug craving. In this model, drug seeking is first extinguished and then reinstated by non-contingent presentations of the drug
alone in the absence of response-contingent stimuli. Here, we assessed the generality of this observation in rats with daily short (1 h, ShA)
vs long access (6 h, LgA) to i.v. heroin self-administration. As expected, heroin intake by LgA rats (n¼24) increased over time to become
excessive compared to heroin intake by ShA rats (n¼24). After escalation, LgA rats tended to be less sensitive to heroin-induced
locomotion (7.5–30 mg, i.v.) than ShA rats. In contrast, only LgA rats, not ShA rats, responded to the priming effects of heroin, as
measured by the ability of heroin alone (7.5–30 mg, i.v.) to reinstate extinguished drug-seeking behavior. Finally, during the course of
heroin intake escalation, a large proportion of LgA rats developed self-injury (mostly targeting the nails and digit tips of the forepaws), a
negative consequence not seen in ShA rats. This study reproduces and extends previous research on compulsive cocaine use by showing
that heroin-induced reinstatement is also specific to compulsive drug use and dissociable from heroin-induced reward and psychomotor
sensitization
MethadoneUsersandRiskydecisions 12
Reinforcing properties of psychoactive substances are considered to be critically involved in the development and maintenance of
substance dependence. While accumulating evidence suggests that the sensitivity to reinforcement values may generally be altered in
chronic substance users, relatively little is known about the influence reinforcing feedback exerts on ongoing decision-making in these
individuals. Decision-making was investigated using the Cambridge Risk Task, in which there is a conflict between an unlikely large reward
option and a likely small reward option. Responses on a given trial were analyzed with respect to the outcome on the previous trial,
providing a measure of the impact of prior feedback in modulating behavior. Five different groups were compared: (i) chronic
amphetamine users, (ii) chronic opiate users in methadone maintenance treatment (MMT), (iii) chronic users of illicit heroin, (iv) ex-drug
users who had been long-term amphetamine/opiate users but were abstinent from all drugs of abuse for at least 1 year and (v) matched
controls without a history of illicit substance use. Contrary to our predictions, choice preference was modified in response to feedback
only in opiate users enrolled in MMT. Following a loss, the MMT opiate group chose the likely small reward option significantly less
frequently than controls and heroin users. Our results suggest that different opiates are associated with distinctive behavioral responses
to feedback. These findings are discussed with respect to the different mechanisms of action of heroin and methadone.
Beschreibt die notwendigen Indikation fuer eine Diamorphin-Verschreibung
im Vereinigten Koenigreich (England, Wales, Scotland and the nothern of Eire!
Ebenso natuerlich die Praxis!
Heroin: What’s In the Mix?
Heroin abuse is a public health problem within the United
States. Heroin intoxication has a well-recognized toxicity
syndrome involving central nervous system depression,
respiratory depression, and pupillary constriction. However,
over the past decade, our poison control center has encountered
several heroin adulterants that changed the toxicity syndrome
observed after overdose.
In the late 1990s, contamination of heroin with the
anticholinergic drug scopolamine led to heroin overdose victims
presenting with unusual manifestations of hallucination,
mydriasis, tachycardia, and dry mucous membranes.1 More
recently, a heroin-laced acetaminophen and diphenhydramine
mixture known as “cheese” has become a popularized heroin
source for inexperienced users, and may also produce notable
anticholinergic features.2
An epidemic of naloxone-resistant heroin overdoses due to
fentanyl adulteration has led to significant morbidity and
mortality throughout the central and eastern United States.
According to records of the Philadelphia County Medical
Examiner’s office, at least 250 overdose deaths have been
associated with fentanyl between April 1, 2006, and March 1,
2007. At our poison control center, xylazine, an alpha-2
adrenergic agonist which may produce pupil constriction and
somnolence mimicking heroin effects, has also been found as an
occasional contaminant of heroin.
heroindoseandwithdrawalseverity
Hat die Route der Applikation (also Iv. oder zb. Im.) von Heroin einen Einfluss auf die schwere eines Entzuges,
wenn ja wie sieht das aus und was kann man evt. vermeiden?
Beschreibt in einer Doppel-Blind Studie den Effekt von Heroin versus Morphin.
We measured tnast-cell tryptase in postmortem blood from 22 heroin addiets
dying suddenly after injection. In 32%, the eoncentration of tryptase was
elevated (slO |J.g/l), and the mean value of tryptase was significantly
different from a control group dying from knowti, nonimtnunologic eauses
(f <0.05). The increased tryptase concentrations indicate that death was
preceded by systemic tnast-cell degranulatioti. All victims of drug deaths had
morphine in tjlood, most below 0.2 |J,g/ml. In 71% of the victims of drugrelated
deaths with tryptase values slO |j,g/l, the intermediate degradation
product, 6-monoacetyl-tnorphine, was tiot found in blood, whereas this was
the case in only two vietitns with values below that cutoff point. This indicates
that those with high tryptase concentrations survived longer than those with
lower values. No correlation was found between the IgE levels and tryptase
in either group, supporting the hypothesis that tryptase release was not
mediated by an allergie reaetion. Tlie well-known property of opiates to
stitnulate unspecifically the liberation of histamine and other constituents of
mast-cell granules offers one explatiation of our observations. Tlie results
suggest that many heroin fatalities arc eaused by an anaphylactoid reaetion.
Introduction
An estimated 25 000 heroin addicts live in the Netherlands
(population 16 000 000 inhabitants).1 Most users
(75-90%) inhale heroin (“chasing the dragon”).2 About
three quarters of these addicts are served by a comprehensive
treatment system, including various kinds of
abstinence oriented treatment facilities and a wide
range of facilities focusing on stabilisation or
minimisation of harm.1 However, 5000-8000 people
on methadone maintenance treatment regularly use
illegal heroin, have serious physical and mental health
problems, and live in socially marginalised conditions,
characterised by illegal activities and a lack of social
contacts outside the drug scene.3–5
A large cohort study in Switzerland ascertained the
feasibility, safety, and efficacy ofmedical prescription of
injectable heroin to 1969 addicts. There were considerable
improvements in physical and mental health, various
aspects of social integration, and illegal drug use in
237 patients who completed 18 months of heroin
treatment.6 Although this study indicated that heroin
assisted substitution treatment is feasible, the effectiveness
of treatment was difficult to judge because no
(random) controls were available, before and after
comparisons were restricted to those who completed
treatment, and participants were obliged to take part in
mandatory psychosocial counselling and care.7–9 In a
small randomised controlled trial (n = 51) in which
intravenous heroin was compared with some standard
treatment, functioning of the participants in the heroin
group was significantly better after six months.10 However,
these positive effects could have been the result of
the additional, and mandatory, psychosocial interventions
in the group allocated to heroin.
We examined the effectiveness of medically coprescribed
heroine in two open label randomised controlled
trials among heroin addicts who had responded
insufficiently to methadone maintenance treatment.
heroinapplikationsform_Nebenwirkung
Executive Summary
Basierend auf statistischen Analysen der Meldungen im Spontanmeldesystem der Heroin
gestützten Behandlung sowie einer gesondert erhobenen Stichtagsbefragung wurden die
beiden Applikationsformen i.v. und i.m. hinsichtlich unerwünschter Arzneimittelwirkungen
(UAW) verglichen.
Dabei zeigte sich im Spontanmeldesystem:
• i.v. Applikationen wurden im Vergleich zu anderen Applikationen bei den Meldungen
häufiger genannt, als dies aufgrund der statistischen Verteilung der verschiedenen
Applikationsformen in der HegeBe zu erwarten war.
• Hinsichtlich des Anteils schwerwiegender UAWs ergaben sich keine überzufälligen
Unterschiede zwischen den Applikationsformen.
• Bei der Einzelanalyse der von UAW betroffenen Organsysteme zeigten sich marginal
signifikante statistische Zusammenhänge in dem Sinn, dass die i.m. Applikation
tendenziell mit mehr schwerwiegenden UAWs im Nervensystem und bei
Atemwegen/Lunge verbunden war als die i.v. Applikation.
• Hinsichtlich der beurteilten Kausalität dieser Zusammenhänge mit der Medikation
ergaben sich keine nachweislichen Unterschiede zwischen den Applikationsformen
i.v. vs. i.m.
001_Klous_MK_et_al_2006_J_Anal_Tox
Pharmaceutical smokable heroin was developed for a clinical
trial on medical co-prescription of heroin and methadone.
This product, consisting of 75% w/w diacetylmorphine base
and 25% w/w caffeine anhydrate, was intended for use via
“chasing the dragon”, that is, inhalation after volatilization.
This procedure involves heating the powder mixture, which
may lead to formation of degradation products that could
subsequently be inhaled. We developed a method that used a
high-performance liquid chromatography system that was
compatible with photodiode-array detection and mass
spectrometric detection to separate diacetylmorphine- and
caffeine-related compounds in a wide polarity range for analysis
of the vapor. This method was used to analyze the contents of the
plastic drinking straws that were used by patients to inhale the
vapors from pharmaceutical heroin used via chasing the dragon,
which were considered to be representative of the vapors the
patients inhaled. They contained primarily unchanged
diacetylmorphine, its main metabolite 6-acetylmorphine, caffeine,
and some morphine. Several unidentified peaks were observed
in the straw chromatograms. Chemical structures were proposed
for nine degradation products: morphine derivatives with
different substitution patterns of the C3, C6, and/or N17
positions, which comprised 0.4–9.7% of the straw sample
residue weight. Activity and toxicity of most of these compounds
are unknown and require further investigation.
Summary
Contrary to what might be thought initially, the pharmacology of methadone is only partly known, and current research continues to investigate into its distinctive aspects. Clinical evidence provides key guidance to pharmacological research on the opiate system; on the other hand, evolving expectations from therapeutic drugs or putative agents for addiction treatment provide a key incentive to the broadening of pharmacological knowledge. Apart from the classic description of receptorial opioid agonism, narcotic blockade and tolerance/withdrawal dynamics, some crucial issues need to be clarified in a comprehensive way. For instance, studies have proved the importance of metabolic polymorphism in treatment planning and offered interpretations of apparent resistance to normal dosages, so authorizing the employment of high dosages on a sound pharmacological basis. Also, dosages should not be regarded as stable through time, especially in the first few months, and clinicians may schedule dose variations that take into account such expected variations while pursuing stabilization. Methadone’s action profile in the central nervous system is not exclusively based on opioid receptors, and a thorough knowledge of its ‚collateral‘ effects may explain its beneficial action against specific psychopathological abnormalities. The role of the inactive enantiomer in the context of racemous methadone’s tolerability and action profile has also been outlined. Lastly, some of the therapeutic effects of methadone endure without being neutralized by the emergence of tolerance; one of these is its crucial anticraving property. In order to clarify this issue, the mechanisms of cell membrane endocytosis and signal transduction have been illustrated and compared between different opiates
- When a New Drug Promotes the Integration of Treatment Modalities: Suboxone and Harm Reduction
- Pseudo-Addiction: The Illustrative Case of Howard Hughes
- The Under Treatment of Pain: A Global Problem. An Educational Approach
- Finnish Experience With Buprenorphine-Naloxone Combination (Suboxone®): Survey Evaluations With Intravenous Drug Users
- Fifteen Years of Office-Based Prescribing in Croatia. Attitudes, Obstacles and Outcomes
CONTENTS
- Sexual Behaviour of Heroin Addicts in Treatment
- First Experience of Opioid Therapy with Buprenorphine in Ukraine
- Administration of Nalbuphine to Heroin Addicts. Feasibility and Short-Term Effects
- Evidence of Reliability and Validity of the Opiate Dosage Adequacy Scale (ODAS) in a Sample of Methadone Maintenance Patients
- Improvement in the Quality of Live in Heroin Addicts: Differences Between Methadone and Buprenorphine Treatment
- Methadone: A Fast and Powerful Anti-anxiety, Anti-depressant and Anti-psychotic Treatment
- Explaining Agonist Treatment Through Movie Language: The Interesting Allegory of ‘Videodrome’
- CONTENTS
Effects of Opioid Pharmacotherapy on Psychomotor and Cognitive
Performance: A Review of Human Laboratory Studies of
Methadone and Buprenorphine - The Vincent P. Dole Research and Treatment Institute for Opiate
Dependence: An Integrated Biopsychosocial Model for the
Treatment of Methadone Maintained Patients - Opioid Substitution with Methadone and Buprenorphine: Sexual
Dysfunction as a Side Effect of Therapy - Paxil (Paroxetine) in Complex Therapy in Heroin Addicts 45-54
MAYA ROKHLINA, TATIANA KITKINA AND GEORGI GUBANOV
Use of Sodium Gamma-Hydroxybutyrate (GHB) in Alcoholic
Heroin Addicts and Polydrug-Abusers
55-76
- CONTENTS
Combating the Stigma: Discarding the Label “Substitution Treatment” in Favour of “Behaviour-Normalization Treatment” - In the Service of Patients: The Legacy of Dr. Dole
- Injecting Buprenorphine Tablets: A Manageable Risk
- QTc Prolongation in Methadone Maintenance: Fact and Fiction
- Methadone: Is It Enough?
- CONTENTS
Harm reduction and specific treatments for heroin addiction.
Different approaches or levels of intervention? An illnesscentred
perspectiveMethadone Treatment in Croatia
The renaissance of methadone treatment in America
Methadone and commonplaces
Methadone maintenance and HIV infection
Breast-feeding for a methadone-maintened mother: a case
reportMethadone Maintenance treatments in European
extracommunity target
- Introduction ………………………………………………………………………………………………….8
The Clinical and Therapeutic Aspects of Personality Disorders
in Addicted Patients …………………………………………………………………………………….14
Addiction and symptoms of psychopathology ………………………………………………….14
Addiction and psychopathological dimensions ………………………………………………..14
Addiction and Personality Disorders ………………………………………………………………16
Antisocial Personality Disorder (APD) …………………………………………………………………………18
Personality and the etiopathogenesis of addiction …………………………………………..19
The self-medication hypothesis for addictive disorders …………………………………………………..19
The role of subjective effects: the self-selection hypothesis …………………………………………….20
Sensation-seeking behaviour and impairment of gratification: what is too little
or too much? ……………………………………………………………………………………………………………..21
The psychology of addiction: evolution of theoretical models. ………………………….22
Psychodynamic theories ………………………………………………………………………………………………22
Beyond psychodynamics …………………………………………………………………………………………….24
Addiction and Bipolar Spectrum ……………………………………………………………………25
Treatment of Personality Disorders during Methadone Maintenance ……………….30
Conclusions …………………………………………………………………………………………………31
The Clinical and Therapeutic Aspects of Mood Disorders
in Addicted Patients …………………………………………………………………………………….32
Epidemiology ……………………………………………………………………………………………….32
Assessment and evaluation of depression in addicted patients ………………………….34
Family History of Mood Disorders …………………………………………………………………35
Primary or secondary nature of comorbid mood disorder in relation
to addiction ………………………………………………………………………………………………….36
Impact of comorbid mood disorders on the natural course
of heroin addiction ……………………………………………………………………………………….37
Substance use among Bipolar Patients …………………………………………………………..38
Addiction and Suicide …………………………………………………………………………………..38
Heroin addiction and its consequences on mood …………………………………………….41
Widmet sich dem Bedarf der immer aelter werdenen IV. Heroin-Konsumenten!
Was brauchen diese und wie muss die Mindestsversorgung aussehen!
Fragestellung:
Wie entwickelt sich die Lage älterer
Konsument(inn)en hinsichtlich gesundheitlicher und
sozialer Probleme und Bedarfe?
Wie viele ältere Drogenkonsument(inn)en sind mit
welchen Problemlagen in 5 bzw. 10 Jahren in
Hamburg zu erwarten?
Welche neuen Anforderungen entwickeln sich für
das Versorgungssystems (medizinischer Sektor,
Schnittstellen von Sucht- und Altenhilfe)?
Depressive.symptoms.during.buprenorphine.vs.methadone.maintenance
Ein Vergleich zwischen Buprenorphin (Subutex/ Suboxone) und Methadon!
Dies ist ein Bericht aus der Schweiz welcher sich dem Thema
„Beikonsum waehrend der Substitution“ widmet
Interessant weil die Fakten ungeschminkt wiedergegeben werden!
The main goals of opioid treatment in heroin addiction are to eliminate or reduce the use of heroin and other substances of abuse, to promote patients’ social rehabilitation and to improve their quality of life. The purpose of this study is to evaluate the efficacy of buprenorphine and methadone on the quality of life of patients. These subjects were sampled on the basis of the same severity of illness and the same impairment of quality of life at the start of treatment. 50 patients (41 male and 9 female) in buprenorphine treatment and 83 patients (63 males and 20 females) in methadone treatment, were evaluated regarding their retention in treatment, the use of substances, their clinical improvement and their quality of life over a one year period. In markedly ill patients buprenorphine and methadone both successfully and similarly reduce substance abuse and the severity of illness. Patients treated with buprenorphine show a better improvement of quality of life especially regarding improvements in jobs, leisure activities, income and self-acceptance. We conclude that Buprenorphine is a good choice for markedly ill patients with severe impairment in their quality of life parameters.
Das da unten ist der Link!
(das da oben ist der link)
Renal disease in cocaine and heroin users is associated with the nephrotic syndrome, acute glomerulonephritis, amyloidosis,
interstitial nephritis, and rhabdomyolysis. The pathophysiologic basis of cocaine-related renal injury involves renal hemodynamic
changes, glomerular matrix synthesis and degradation, and oxidative stress and induction of renal atherogenesis.
Heroin is the most commonly abused opiate in the United States. Previous studies identified a spectrum of renal diseases in
heroin users. The predominant renal lesion in black heroin users is focal segmental glomerulosclerosis and in white heroin
users is membranoproliferative glomerulonephritis. Although the prevalence of heroin use in the United States has increased,
the incidence of “heroin nephropathy” has declined. Because reports of heroin nephropathy predated the surveillance of
hepatitis C virus and HIV, the varied findings might be related to the spectrum of viral illnesses that are encountered in
injection drug users. Socioeconomic conditions, cultural and behavioral practices, or differences in genetic susceptibilities
may be more associated with the development of nephropathy in heroin users than the drug’s pharmacologic properties.
Administration of cocaine in animal models results in nonspecific glomerular, interstitial, and tubular cell lesions, but there
is no animal model of heroin-associated renal disease. The heterogeneity of responses that are associated with heroin is not
consistent with a single or simple notion of nephropathogenesis. There are no well-designed, prospective, epidemiologic
studies to assess the incidence and the prevalence of renal disease in populations of opiate users and to establish the validity
of a syndrome such as heroin nephropathy. It is concluded although there is a paucity of evidence to support a heroinassociated
nephropathy, the evidence from in vitro cellular and animal studies to support the existence of cocaine-induced
renal changes is more convincing.
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