Age differences in heroin and prescription opioid abuse among enrolees into opioid treatment programs

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Fong Chunki

2011-06-01

Full Text Available Abstract Background In the United States, among those entering opioid treatment programs (OTPs, prescription opioid (PO abusers tend to be younger than heroin users. Admissions of older persons to OTPs have been increasing, and it is important to understand typical patterns of use among those older enrolees. Methods To disentangle the effect of age on recent heroin and PO abuse 29,114 enrolees into 85 OTPs were surveyed across 34 states from 2005-2009. OTPs where PO use was prevalent were oversampled. Results Mean age was 34; 28% used heroin only. Younger enrolees had increased odds of using POs relative to using heroin only but mixed model analysis showed that much of the total variability in type of use was attributed to variation in age between OTPs rather than within OTPs. Conclusions Organizational and cultural phenomena (e.g., OTP characteristics must be examined to better understand the context of individual characteristics (e.g., age. If nesting of enrolees within OTPs is ignored, then associations that primarily operate at the OTP level may be misinterpreted as exclusively dependent on individuals.

Chronic nephropathies of cocaine and heroin abuse: a critical review.

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Jaffe, Jared A; Kimmel, Paul L

2006-07-01

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 heroin-associated nephropathy, the evidence from in vitro cellular and animal studies to support the existence of cocaine-induced renal changes is more convincing.

The price elasticity of demand for heroin: Matched longitudinal and experimental evidence.

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Olmstead, Todd A; Alessi, Sheila M; Kline, Brendan; Pacula, Rosalie Liccardo; Petry, Nancy M

2015-05-01

This paper reports estimates of the price elasticity of demand for heroin based on a newly constructed dataset. The dataset has two matched components concerning the same sample of regular heroin users: longitudinal information about real-world heroin demand (actual price and actual quantity at daily intervals for each heroin user in the sample) and experimental information about laboratory heroin demand (elicited by presenting the same heroin users with scenarios in a laboratory setting). Two empirical strategies are used to estimate the price elasticity of demand for heroin. The first strategy exploits the idiosyncratic variation in the price experienced by a heroin user over time that occurs in markets for illegal drugs. The second strategy exploits the experimentally induced variation in price experienced by a heroin user across experimental scenarios. Both empirical strategies result in the estimate that the conditional price elasticity of demand for heroin is approximately -0.80. Copyright © 2015 Elsevier B.V. All rights reserved.

The price elasticity of demand for heroin: matched longitudinal and experimental evidence#

Science.gov (United States)

Olmstead, Todd A.; Alessi, Sheila M.; Kline, Brendan; Pacula, Rosalie Liccardo; Petry, Nancy M.

2015-01-01

This paper reports estimates of the price elasticity of demand for heroin based on a newly constructed dataset. The dataset has two matched components concerning the same sample of regular heroin users: longitudinal information about real-world heroin demand (actual price and actual quantity at daily intervals for each heroin user in the sample) and experimental information about laboratory heroin demand (elicited by presenting the same heroin users with scenarios in a laboratory setting). Two empirical strategies are used to estimate the price elasticity of demand for heroin. The first strategy exploits the idiosyncratic variation in the price experienced by a heroin user over time that occurs in markets for illegal drugs. The second strategy exploits the experimentally-induced variation in price experienced by a heroin user across experimental scenarios. Both empirical strategies result in the estimate that the conditional price elasticity of demand for heroin is approximately −0.80. PMID:25702687

Heroin in brown, black and white: structural factors and medical consequences in the US heroin market.

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Ciccarone, Daniel

2009-05-01

associated with soft tissue infections caused by Clostridium bacteria. Source and type of heroin are structural factors in the risk environment of heroin users: source dictates distribution and type predicts practice. How specific types of heroin are used and with what risk is therefore distributed geographically. Continued flux in the heroin market and its effects on the risk environment for drug users deserves further attention.

Heroin in brown, black and white: Structural factors and medical consequences in the US heroin market

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Ciccarone, Daniel

2009-01-01

HIV prevalence. BTH is associated with soft tissue infections caused by Clostridium bacteria. Conclusion Source and type of heroin are structural factors in the risk environment of heroin users: source dictates distribution and type predicts practice. How specific types of heroin are used and with what risk is therefore distributed geographically. Continued flux in the heroin market and its effects on the risk environment for drug users deserves further attention. PMID:18945606

Gender differences in prevalence and correlates of antisocial personality disorder among heroin dependent users in compulsory isolation treatment in China.

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Yang, Mei; Mamy, Jules; Zhou, Liang; Liao, Yan-Hui; Wang, Qiang; Seewoobudul, Vasish; Xiao, Shui-Yuan; Hao, Wei

2014-03-01

Little is known about gender difference in correlates of antisocial personality disorder (ASPD) among drug users. To detect gender difference in correlates of ASPD in a Chinese heroin dependent sample. Structured interviews were conducted among 882 heroin dependent users in two compulsory isolation settings in Changsha, China. Descriptive statistics were employed to report sample characteristics by gender. Bivariate relationships were examined between co-occurring ASPD and variables measuring demographic, drug use, and psychiatric co-morbidities. Multivariate logistic regressions with stepwise forward method were conducted to determine independent predictors for co-occurring ASPD. All analyses examining correlates of co-occurring ASPD were conducted for the total, the male and the female participants respectively to detect both the common and the unique correlates of ASPD by gender. Of the total participants, 41.4% (54.2% of males and 15.4% of females) met the DSM-IV criteria of ASPD. For male participants, lower educational level, unemployment, unmarried, younger age at first heroin use, previous history of compulsory treatment, larger amounts of heroin used per day and poly-drug abuse during past month before admission, as well as psychiatric co-morbidities of lifetime major depressive disorder and borderline personality disorder were independent predictors for co-occurring ASPD; while for female participants, only three variables: younger age at first heroin use, paranoid personality disorder and borderline personality disorder were independent predictors for co-occurring ASPD. Gender differences in prevalence and correlates of ASPD among heroin dependent users were detected. The findings highlight a need for gender-specific interventions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Heroin-assisted treatment showed better efficacy than methadone

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ANSSEAU, Marc; Demaret, Isabelle

2014-01-01

Background: A fraction of patients receiving methadone treatment pursues their use of street heroin. In Switzerland, a new treatment with prescribed diacetylmorphine (pharmaceutical heroin) was developed to help these heroin addicts resistant to methadone treatment to decrease their street heroin use. In this heroin-assisted treatment (HAT), diacetylmorphine is prescribed to severe heroin user and diacetylmorphine is administered by patients under the supervision of nurses in a...

The societal cost of heroin use disorder in the United States.

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Ruixuan Jiang

Full Text Available Heroin use in the United States has reached epidemic proportions. The objective of this paper is to estimate the annual societal cost of heroin use disorder in the United States in 2015 US dollars.An analytic model was created that included incarceration and crime; treatment for heroin use disorder; chronic infectious diseases (HIV, Hepatitis B, Hepatitis C, and Tuberculosis and their treatments; treatment of neonatal abstinence syndrome; lost productivity; and death by heroin overdose.Using literature-based estimates to populate the model, the cost of heroin use disorder was estimated to be $51.2 billion in 2015 US dollars ($50,799 per heroin user. One-way sensitivity analyses showed that overall cost estimates were sensitive to the number of heroin users, cost of HCV treatment, and cost of incarcerating heroin users.The annual cost of heroin use disorder to society in the United States emphasizes the need for sustained investment in healthcare and non-healthcare related strategies that reduce the likelihood of abuse and provide care and support for users to overcome the disorder.

DNA Methylation Profiling of Human Prefrontal Cortex Neurons in Heroin Users Shows Significant Difference between Genomic Contexts of Hyper- and Hypomethylation and a Younger Epigenetic Age

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Alexey Kozlenkov

2017-05-01

Full Text Available We employed Illumina 450 K Infinium microarrays to profile DNA methylation (DNAm in neuronal nuclei separated by fluorescence-activated sorting from the postmortem orbitofrontal cortex (OFC of heroin users who died from heroin overdose (N = 37, suicide completers (N = 22 with no evidence of heroin use and from control subjects who did not abuse illicit drugs and died of non-suicide causes (N = 28. We identified 1298 differentially methylated CpG sites (DMSs between heroin users and controls, and 454 DMSs between suicide completers and controls (p < 0.001. DMSs and corresponding genes (DMGs in heroin users showed significant differences in the preferential context of hyper and hypo DM. HyperDMSs were enriched in gene bodies and exons but depleted in promoters, whereas hypoDMSs were enriched in promoters and enhancers. In addition, hyperDMGs showed preference for genes expressed specifically by glutamatergic as opposed to GABAergic neurons and enrichment for axonogenesis- and synaptic-related gene ontology categories, whereas hypoDMGs were enriched for transcription factor activity- and gene expression regulation-related terms. Finally, we found that the DNAm-based “epigenetic age” of neurons from heroin users was younger than that in controls. Suicide-related results were more difficult to interpret. Collectively, these findings suggest that the observed DNAm differences could represent functionally significant marks of heroin-associated plasticity in the OFC.

Heroin: From Drug to Ambivalent Medicine

DEFF Research Database (Denmark)

Johansen, Birgitte Schepelern; Johansen, Katrine Schepelern

2015-01-01

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...

Exposure to fentanyl-contaminated heroin and overdose risk among illicit opioid users in Rhode Island: A mixed methods study.

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Carroll, Jennifer J; Marshall, Brandon D L; Rich, Josiah D; Green, Traci C

2017-08-01

Illicit fentanyl use has become wide spread in the US, causing high rates of overdose deaths among people who use drugs. This study describes patterns and perceptions of fentanyl exposure among opioid users in Rhode Island. A mixed methods study was conducted via questionnaire with a convenience sample of 149 individuals using illicit opioids or misusing prescription opioids in Rhode Island between January and November 2016. Of these, 121 knew of fentanyl and reported known or suspected exposure to fentanyl in the past year. Semi-structured interviews were conducted with the first 47 participants. Study participants were predominantly male (64%) and white (61%). Demographic variables were similar across sample strata. Heroin was the most frequently reported drug of choice (72%). Self-reported exposure to illicit fentanyl in the past year was common (50.4%, n=61). In multivariate models, regular (at least weekly) heroin use was independently associated with known or suspected fentanyl exposure in the past year (adjusted prevalence ratio (APR)=4.07, 95% CI: 1.24-13.3, p=0.020). In interviews, users described fentanyl as unpleasant, potentially deadly, and to be avoided. Participants reporting fentanyl exposure routinely experienced or encountered non-fatal overdose. Heroin users reported limited ability to identify fentanyl in their drugs. Harm reduction strategies used to protect themselves from fentanyl exposure and overdose, included test hits, seeking prescription opioids in lieu of heroin, and seeking treatment with combination buprenorphine/naloxone. Participants were often unsuccessful in accessing structured treatment programs. Among illicit opioid users in Rhode Island, known or suspected fentanyl exposure is common, yet demand for fentanyl is low. Fentanyl-contaminated drugs are generating user interest in effective risk mitigation strategies, including treatment. Responses to the fentanyl epidemic should be informed by the perceptions and experiences of

Effects of transnational migration on drug use: an ethnographic study of Nepali female heroin users in Hong Kong.

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Tang, Wai-Man

2015-01-01

Past studies of female drug users in South Asia tend to focus on their plights, for instance, how they have been driven to drug use and encounter more problems than their male counterparts, such as HIV/AIDS and sexual abuse. Few studies focus on their active role--how they actively make use of resources in the external environment to construct their desired femininity through drug consumption. Furthermore, little is known about the situation of female South Asian drug users who are living overseas. This paper is a study of transnational migration, drug use and gender--how transnational migration influences the drug use of female transnational migrants. An 18-month ethnography has been carried out in a Nepali community in Hong Kong and 13 informants were interviewed. Data were coded and analyzed by using the grounded-theory approach. Themes related to the drug use of the female Nepali heroin users were identified. The findings show that there are three important themes that significantly affect the drug use of female Nepali heroin users, which include (1) their relationships with intimate partners, (2) their means of support, and (3) their legal status in migration. The findings are consistent with the concept of post-structuralism in gender and transnationalism theories. Female Nepali heroin users in Hong Kong are neither active agents nor passive victims; their active/passive role is largely dependent on their reconfigured opportunities and constraints in transnational migration. Thus, transnationalism should be taken as an important perspective to study the situation of female drug users in a globalized context. Copyright © 2014 Elsevier B.V. All rights reserved.

Mortality in heroin-assisted treatment in Switzerland 1994-2000.

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Rehm, Jürgen; Frick, Ulrich; Hartwig, Christina; Gutzwiller, Felix; Gschwend, Patrick; Uchtenhagen, Ambros

2005-08-01

A major goal of heroin-assisted treatment in Switzerland has been to reduce the drug-related mortality of heroin users. Therefore, a continuous monitoring of deaths under treatment is essential. To assess mortality of participants in heroin-assisted treatment in Switzerland over a 7-year period from 1994 to 2000, and to compare this mortality to the general population and to other populations of opioid users, as reported in the literature. Estimation of person years under heroin-assisted treatment from the complete case registry of heroin-assisted treatment in Switzerland. Estimation of standardized mortality ratios comparing the population in treatment to the Swiss population (standardized to the year 2000). Over the 7-year period, the crude death rate of patients in heroin-assisted treatment, and including one month after discharge from treatment, was 1% per year. The standardized mortality ratio for the entire observation period was 9.7 (95% C.I. 7.3-12.8), with females having higher standardized mortality ratios (SMR 17.2) than males (SMR 8.4). There was no clear time trend. Mortality in heroin-assisted treatment was low compared to the mortality rate of Swiss opioid users 1990s (estimated to be between 2.5 and 3%). It was also low compared to mortality rates of opioid users in other maintenance treatments in other countries as reported in the literature. The SMR was also lower than that reported in the only meta-analysis in the literature: 13.2 (95% C.I. 12.3-14.1). The low mortality rate is all the more noteworthy as heroin-assisted treatment in Switzerland included only refractory opioid addicts with existing severe somatic and/or mental problems. No conflicts of interest declared.

Heroin on trial: systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction

NARCIS (Netherlands)

Strang, John; Groshkova, Teodora; Uchtenhagen, Ambros; van den Brink, Wim; Haasen, Christian; Schechter, Martin T.; Lintzeris, Nick; Bell, James; Pirona, Alessandro; Oviedo-Joekes, Eugenia; Simon, Roland; Metrebian, Nicola

2015-01-01

Background Supervised injectable heroin (SIN) treatment has emerged over the past 15 years as an intensive treatment for entrenched heroin users who have not responded to standard treatments such as oral methadone maintenance treatment (MMT) or residential rehabilitation. Aims To synthesise

Overdose beliefs and management practices among ethnic Vietnamese heroin users in Sydney, Australia

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Maher Lisa

2009-04-01

Full Text Available Abstract Background Ethnic Vietnamese injecting drug users (IDUs in Australia draw on a range of beliefs and etiologic models, sometimes simultaneously, in order to make sense of health and illness. These include understandings of illness as the result of internal imbalances and Western concepts of disease causation including germ/pollution theory. Methods Observational fieldwork and in-depth interviews were conducted between 2001 and 2006 in neighbourhoods characterised by high proportions of Asian background IDUs and street-based drug markets. Eligibility criteria for the study were: 1 ethnic Vietnamese cultural background; 2 aged 16 years and over and; 3 injected drugs in the last 6 months. Results Participants commonly attempted to treat heroin overdose by withdrawing blood (rút máu from the body. Central to this practice are cultural beliefs about the role and function of blood in the body and its relationship to illness and health. Participants' beliefs in blood were strongly influenced by understandings of blood expressed in traditional Chinese and Vietnamese medicine. Many participants perceived Western drugs, particularly heroin, as "hot" and "strong". In overdose situations, it was commonly believed that an excessive amount of drugs (particularly heroin entered the bloodstream and traveled to the heart, making the heart work too hard. Withdrawing blood was understood to reduce the amount of drugs in the body which in turn reduced the effects of drugs on the blood and the heart. Conclusion The explanatory model of overdose employed by ethnic Vietnamese IDUs privileges traditional beliefs about the circulatory, rather than the respiratory, system. This paper explores participants' beliefs about blood, the effects of drugs on blood and the causes of heroin overdose in order to document the explanatory model of overdose used by ethnic Vietnamese IDUs. Implications for overdose prevention, treatment and management are identified and

Self-identification of nonpharmaceutical fentanyl exposure following heroin overdose.

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Griswold, Matthew K; Chai, Peter R; Krotulski, Alex J; Friscia, Melissa; Chapman, Brittany; Boyer, Edward W; Logan, Barry K; Babu, Kavita M

2018-01-01

To compare user self-identification of nonpharmaceutical fentanyl exposure with confirmatory urine drug testing in emergency department (ED) patients presenting after heroin overdose. This was a cross-sectional study of adult ED patients who presented after a heroin overdose requiring naloxone administration. Participants provided verbal consent after which they were asked a series of questions regarding their knowledge, attitudes and beliefs toward heroin and nonpharmaceutical fentanyl. Participants also provided urine samples, which were analyzed using liquid chromatography coupled to quadrupole time-of-flight mass spectrometry to identify the presence of fentanyl, heroin metabolites, other clandestine opioids, common pharmaceuticals and drugs of abuse. Thirty participants were enrolled in the study period. Ten participants (33%) had never required naloxone for an overdose in the past, 20 participants (67%) reported recent abstinence, and 12 participants (40%) reported concomitant cocaine use. Naloxone was detected in all urine drug screens. Heroin or its metabolites were detected in almost all samples (93.3%), as were fentanyl (96.7%) and its metabolite, norfentanyl (93.3%). Acetylfentanyl was identified in nine samples (30%) while U-47700 was present in two samples (6.7%). Sixteen participants self-identified fentanyl in their heroin (sensitivity 55%); participants were inconsistent in their qualitative ability to identify fentanyl in heroin. Heroin users presenting to the ED after heroin overdose requiring naloxone are unable to accurately identify the presence of nonpharmaceutical fentanyl in heroin. Additionally, cutting edge drug testing methodologies identified fentanyl exposures in 96.7% of our patients, as well as unexpected clandestine opioids (like acetylfentanyl and U-47700).

Analysis of a Heroin Epidemic Model with Saturated Treatment Function

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Isaac Mwangi Wangari

2017-01-01

Full Text Available A mathematical model is developed that examines how heroin addiction spreads in society. The model is formulated to take into account the treatment of heroin users by incorporating a realistic functional form that “saturates” representing the limited availability of treatment. Bifurcation analysis reveals that the model has an intrinsic backward bifurcation whenever the saturation parameter is larger than a fixed threshold. We are particularly interested in studying the model’s global stability. In the absence of backward bifurcations, Lyapunov functions can often be found and used to prove global stability. However, in the presence of backward bifurcations, such Lyapunov functions may not exist or may be difficult to construct. We make use of the geometric approach to global stability to derive a condition that ensures that the system is globally asymptotically stable. Numerical simulations are also presented to give a more complete representation of the model dynamics. Sensitivity analysis performed by Latin hypercube sampling (LHS suggests that the effective contact rate in the population, the relapse rate of heroin users undergoing treatment, and the extent of saturation of heroin users are mechanisms fuelling heroin epidemic proliferation.

Heroin-related overdose: The unexplored influences of markets, marketing and source-types in the United States

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Mars, Sarah G.; Fessel, Jason N.; Bourgois, Philippe; Montero, Fernando; Karandinos, George; Ciccarone, Daniel

2015-01-01

Heroin overdose, more accurately termed ‘heroin-related overdose’ due to the frequent involvement of other drugs, is the leading cause of mortality among regular heroin users. (Degenhardt et al., 2010) Heroin injectors are at greater risk of hospital admission for heroin-related overdose (HOD) in the eastern United States where Colombian-sourced powder heroin is sold than in the western US where black ‘tar’ heroin predominates. (Unick et al., 2014) This paper examines under-researched influences on HOD, both fatal and non-fatal, using data from a qualitative study of injecting drug users of black tar heroin in San Francisco and powder heroin in Philadelphia Data were collected through in-depth, semi-structured interviews carried out in 2012 that were conducted against a background of longer-term participant-observation, ethnographic studies of drug users and dealers in Philadelphia (2007–12) and of users in San Francisco (1994–2007, 2012). Our findings suggest three types of previously unconsidered influences on overdose risk that arise both from structural socio-economic factors and from the physical properties of the heroin source-types: 1) retail market structure including information flow between users; 2) marketing techniques such as branding, free samples and pricing and 3) differences in the physical characteristics of the two major heroin source forms and how they affect injecting techniques and vascular health. Although chosen for their contrasting source-forms, we found that the two cities have contrasting dominant models of drug retailing: San Francisco respondents tended to buy through private dealers and Philadelphia respondents frequented an open-air street market where heroin is branded and free samples are distributed, although each city included both types of drug sales. These market structures and marketing techniques shape the availability of information regarding heroin potency and its dissemination among users who tend to seek out

Heroin-related overdose: The unexplored influences of markets, marketing and source-types in the United States.

Science.gov (United States)

Mars, Sarah G; Fessel, Jason N; Bourgois, Philippe; Montero, Fernando; Karandinos, George; Ciccarone, Daniel

2015-09-01

Heroin overdose, more accurately termed 'heroin-related overdose' due to the frequent involvement of other drugs, is the leading cause of mortality among regular heroin users. (Degenhardt et al., 2010) Heroin injectors are at greater risk of hospital admission for heroin-related overdose (HOD) in the eastern United States where Colombian-sourced powder heroin is sold than in the western US where black 'tar' heroin predominates. (Unick et al., 2014) This paper examines under-researched influences on HOD, both fatal and non-fatal, using data from a qualitative study of injecting drug users of black tar heroin in San Francisco and powder heroin in Philadelphia Data were collected through in-depth, semi-structured interviews carried out in 2012 that were conducted against a background of longer-term participant-observation, ethnographic studies of drug users and dealers in Philadelphia (2007-12) and of users in San Francisco (1994-2007, 2012). Our findings suggest three types of previously unconsidered influences on overdose risk that arise both from structural socio-economic factors and from the physical properties of the heroin source-types: 1) retail market structure including information flow between users; 2) marketing techniques such as branding, free samples and pricing and 3) differences in the physical characteristics of the two major heroin source forms and how they affect injecting techniques and vascular health. Although chosen for their contrasting source-forms, we found that the two cities have contrasting dominant models of drug retailing: San Francisco respondents tended to buy through private dealers and Philadelphia respondents frequented an open-air street market where heroin is branded and free samples are distributed, although each city included both types of drug sales. These market structures and marketing techniques shape the availability of information regarding heroin potency and its dissemination among users who tend to seek out the

The BOLD-fMRI study of behavior inhibition in chronic heroin addicts

International Nuclear Information System (INIS)

Yuan Fei; Yuan Yi; Liu Yinshe; Zhao Jun; Weng Xuchu

2011-01-01

Objective: To identify the neural mechanisms of impulsivity and the response inhibition deficits of the chronic heroin users using event-related functional MRI (stop-signal task). Methods: Seventeen individuals with heroin dependence and 17 healthy control subjects underwent fMRI scan while executing stop -signal task after anatomical scanning in 3.0 T scanner. The AFNI package was used for fMRI data preprocessing and statistical analysis. Results: The behavioral data showed that the stop signal reaction rime (SSRT) of heroin users was significantly longer than that of the control group. There was no significant difference in activation of the primary motor cortex and supplementary motor area between two groups. Comparing to the control group, heroin users had weaker activation in the right dorsal lateral prefrontal cortex, right inferior prefrontal cortex, and anterior cingulated cortex, but stronger activation in bilateral striatum and amygdala while behavioral inhibition needed. Conclusion: The results suggest that heroin users have significant changes within impulsivity and inhibitory network, where the right prefrontal cortex is considered as main region for inhibition, while the anterior cingulated cortex is associated with error monitoring, and the amygdale controls impulsivity and emotion. (authors)

Heroin mismatch in the Motor City: addiction, segregation, and the geography of opportunity.

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Draus, Paul; Roddy, Juliette; Greenwald, Mark

2012-01-01

In this article, the authors used data from economic and ethnographic interviews with heroin users from Detroit, Michigan, as well as other sources, to illustrate the relationship between heroin users' mobility patterns and urban and suburban environments, especially in terms of drug acquisition and the geography of opportunity. The authors found that although geographic location and social networks associated with segregation provided central city residents and African Americans with a strategic advantage over White suburbanites in locating and purchasing heroin easily and efficiently, this same segregation effectively focuses the negative externalities of heroin markets in central city neighborhoods. Finally, the authors consider how the heroin trade reflects and reproduces the segregated post-industrial landscape and discuss directions for future research about the relationship between ethnic and economic ghettos and regional drug markets.

Acute effects of heroin on emotions in heroin-dependent patients.

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Blum, Julia; Gerber, Hana; Gerhard, Urs; Schmid, Otto; Petitjean, Sylvie; Riecher-Rössler, Anita; Wiesbeck, Gerhard A; Borgwardt, Stefan J; Walter, Marc

2013-01-01

Euphoria has been described in heroin-dependent individuals after heroin administration. However, affective disturbances and disorders are common in heroin dependence. The present study examined the acute effects of heroin on emotions in heroin-dependent patients. This randomized controlled crossover trial included 28 heroin-dependent patients (67.9% male, n = 19) in stable heroin-assisted treatment and 20 healthy controls. The patients were administered heroin or saline (placebo), the controls were administered saline. Data measuring mood, affects and heroin craving (BDI, AMRS, STAI, STAXI, and HCQ) were assessed before and 60 minutes after substance injection. Before substance injection, heroin-dependent patients showed significantly higher levels of anxiety and depression than healthy controls (p emotions, including craving, and a significant increase in emotional well-being (p emotions, once they had received heroin. Heroin dampens craving, negative emotions, and increases positive emotions. These findings indicate that heroin regulates emotions and underscore the clinical benefit of opioid substitution treatment for heroin-dependent patients. Copyright © American Academy of Addiction Psychiatry.

Heroin purchasing is income and price sensitive.

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Roddy, Juliette; Steinmiller, Caren L; Greenwald, Mark K

2011-06-01

Semi-structured interviews were used to assess behavioral economic drug demand in heroin dependent research volunteers. Findings on drug price, competing purchases, and past 30-day income and consumption, established in a previous study, are replicated. We extended these findings by having participants indicate whether hypothetical environmental changes would alter heroin purchasing. Participants (n = 109) reported they would significantly (p purchasing amounts (DPA) from past 30-day levels (M = $60/day) if: (a) they encountered a 33% decrease in income (DPA = $34), (b) family/friends no longer paid their living expenses (DPA = $32), or (c) they faced four-fold greater likelihood of police arrest at their purchasing location (DPA = $42). Participants in higher income quartiles (who purchase more heroin) show greater DPA reductions (but would still buy more heroin) than those in lower income quartiles. For participants receiving government aid (n = 31), heroin purchasing would decrease if those subsidies were eliminated (DPA = $28). Compared to participants whose urine tested negative for cocaine (n = 31), cocaine-positive subjects (n = 32) reported more efficient heroin purchasing, that is, they live closer to their primary dealer; are more likely to have heroin delivered or walk to obtain it (and less likely to ride the bus), thus reducing purchasing time (52 vs. 31 min, respectively); and purchase more heroin per episode. These simulation results have treatment and policy implications: Daily heroin users' purchasing repertoire is very cost-effective, more so for those also using cocaine, and only potent environmental changes (income reductions or increased legal sanctions) may impact this behavior. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Heroin overdose

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... is the gateway to heroin use for many people. This is because the street price of heroin is often the cheaper than ... There is no legal medical use for heroin. Street names for heroin include "junk", "smack", dope, brown sugar, white horse, China white, and "skag".

Pleasure, power and dangerous substances: applying Foucault to the study of 'heroin dependence' in Germany.

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Bergschmidt, Viktoria B

2004-04-01

Taking the observation of disciplining and controlling everyday practices of methadone substitution as a point of departure, this paper explores the question of what exactly is so threatening or dangerous about heroin and heroin users. Drawing on the work of Michel Foucault and Judith Butler, the main argument of this article is that the danger of heroin use is a discursive construction in accordance with bio-power. On the one hand, the juridical governance of heroin dependence is shifting from punishment to therapy, and biomedical discourses proclaim the substitution of a moral notion of heroin dependence by a disease model. Nevertheless, in the context of the anxiety associated with HIV, heroin remains the dangerous drug par excellence, and heroin users are constructed as 'abject others', unable to subordinate to certain social norms. As a reaction to such injurious ascriptions, I argue, applicants to the methadone programme in their life stories intensely narrate a desire for normalization, which I read as a desire to emerge from the realm of the abject. Both the danger and the pleasure associated with heroin use are bound to fundamental processes of subject formation, which are often ignored in biomedical and anthropological discourses.

The effect of methamphetamine and heroin price on polydrug use: A behavioural economics analysis in Sydney, Australia.

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Chalmers, Jenny; Bradford, Deborah; Jones, Craig

2010-09-01

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

[The history of heroin].

Science.gov (United States)

Hosztafi, S

2001-08-01

The discovery of heroin and the development of heroin abuse are introduced. Heroin, the hydrochloride of diacetylmorphine, was discovered by acetylation of morphine. Heroin, in pharmacological studies, proved to be more effective than morphine or codeine. The Bayer Company started the production of heroin in 1898 on a commercial scale. The first clinical results were so promising that heroin was considered a wonder drug. Indeed, heroin was more effective than codeine in respiratory diseases. It has turned out, however, that repeated administration of heroin results in the development of tolerance and the patients become heroin-addicts soon. In the early 1910s morphine addicts "discovered" the euphorising properties of heroin and this effect was enhanced by intravenous administration. Heroin became a narcotic drug and its abuse began to spread quickly. Restrictions on its production, use and distribution were regulated by international treties. The total ban on heroin production was also proposed. As a result of the strict regulations the production and cosumption of heroin showed a significant decrease after 1931. At the same time the underworld recognized the shortage of heroin and started the illicit production and trafficking. The quantity of heroin seized by law enforcement agencies in the past decades rose gradually. As an indicator of the worldwide heroin market, the quantity of confiscated heroin underwent a tenfold increase since 1970. The paper surveys the most important heroin-producing and trafficking countries. Heroin, prepared in clandestine ("kitchen" or "jungle") laboratories, is diluted ("cut") by every member of the illegal heroin distributing chain, i.e. smugglers, traffickers, dealers and vendors.

Borderline personality disorder, antisocial personality disorder and risk-taking among heroin users: findings from the Australian Treatment Outcome Study (ATOS).

Science.gov (United States)

Darke, Shane; Williamson, Anna; Ross, Joanne; Teesson, Maree; Lynskey, Michael

2004-04-09

To determine the relationship between borderline personality disorder (BPD), antisocial personality disorder (ASPD) and harm among current heroin users. Cross-sectional survey. Sydney, Australia. 615 current heroin users. Forty-six percent met criteria for BPD, 71% for ASPD, and 38% met criteria for both diagnoses. ASPD was related to attempted suicide, lifetime overdose, polydrug use, depression and overall psychological distress. BPD was also related to each of these risk domains, and to needle risk and recent suicide as well. When analysed separately, both BPD and ASPD thus appeared to predict harm. For the purposes of further analysis, the relationships between BPD, ASPD and harm, the sample was divided into four independent diagnostic groups: no diagnosis (ND, 21%), ASPD only (ASPD, 33%), BPD only (BPD, 7%), ASPD plus BPD (DUAL, 38%). The division of the sample into four distinct diagnostic groups produced substantially different results. There were strong relationships between BPD and attempted suicide, needle sharing and psychopathology. In none of these domains did the ASPD group significantly differ from the ND group. Also, the levels of harm among the DUAL group were identical to BPD, suggesting no additive risk from ASPD. Thus, while initial analyses suggested an increased risk for ASPD patients for suicide and psychopathology, these relationships disappeared after BPD was taken into account. The only domain in which there appeared to be an additive risk for ASPD and BPD was heroin overdose. The extensive comorbidity between BPD and ASPD means that, unless BPD is controlled for, artefactual relationships may emerge between ASPD and harm.

Designing Effective Web Forms for Older Web Users

Science.gov (United States)

Li, Hui; Rau, Pei-Luen Patrick; Fujimura, Kaori; Gao, Qin; Wang, Lin

2012-01-01

This research aims to provide insight for web form design for older users. The effects of task complexity and information structure of web forms on older users' performance were examined. Forty-eight older participants with abundant computer and web experience were recruited. The results showed significant differences in task time and error rate…

Differences in the Limits of Stability Between Older Rolling Walker Users and Older Single-Tip-Cane Users - A Preliminary Study.

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Liu, Hao Howe; Quiben, Myles; Holmes, Clayton; Connors, Michael; Salem, Yasser

To identify the differences in the limits of stability (LOS) between older rolling walker and single-tip-cane users. This was a matched paired t-test design with repeated measure. Eighteen older subjects were matched based on age, gender, and functional level. The subjects were assessed using the multidirectional reach test initially and 5-month later in four directions: forward, backward, leftward, and rightward. Initially, there were no differences between cane users and rolling walker users in the LOS in all directions. However, 5-month later, the cane users who held their canes in their right hand had significantly better stability in forward and rightward reach than the walker users (p walker users demonstrated significantly decreased functional reach in forward reach (p walker users in the forward direction and in the direction toward the side holding the cane. This study may provide guide for clinicians including nurses for selecting appropriate rehabilitative interventions for older adults using walkers and canes.

Humoral Dysregulation Associated with Increased Systemic Inflammation among Injection Heroin Users.

Directory of Open Access Journals (Sweden)

Michael S Piepenbrink

Full Text Available Injection drug use is a growing major public health concern. Injection drug users (IDUs have a higher incidence of co-morbidities including HIV, Hepatitis, and other infections. An effective humoral response is critical for optimal homeostasis and protection from infection; however, the impact of injection heroin use on humoral immunity is poorly understood. We hypothesized that IDUs have altered B cell and antibody profiles.A comprehensive systems biology-based cross-sectional assessment of 130 peripheral blood B cell flow cytometry- and plasma- based features was performed on HIV-/Hepatitis C-, active heroin IDUs who participated in a syringe exchange program (n = 19 and healthy control subjects (n = 19. The IDU group had substantial polydrug use, with 89% reporting cocaine injection within the preceding month. IDUs exhibited a significant, 2-fold increase in total B cells compared to healthy subjects, which was associated with increased activated B cell subsets. Although plasma total IgG titers were similar between groups, IDUs had significantly higher IgG3 and IgG4, suggestive of chronic B cell activation. Total IgM was also increased in IDUs, as well as HIV Envelope-specific IgM, suggestive of increased HIV exposure. IDUs exhibited numerous features suggestive of systemic inflammation, including significantly increased plasma sCD40L, TNF-α, TGF-α, IL-8, and ceramide metabolites. Machine learning multivariate analysis distilled a set of 10 features that classified samples based on group with absolute accuracy.These results demonstrate broad alterations in the steady-state humoral profile of IDUs that are associated with increased systemic inflammation. Such dysregulation may impact the ability of IDUs to generate optimal responses to vaccination and infection, or lead to increased risk for inflammation-related co-morbidities, and should be considered when developing immune-based interventions for this growing population.

Hearing aid user guides: suitability for older adults.

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Caposecco, Andrea; Hickson, Louise; Meyer, Carly

2014-02-01

The aim of this study was to analyse the content, design, and readability of printed hearing aid user guides to determine their suitability for older adults, who are the main users of hearing aids. Hearing aid user guides were assessed using four readability formulae and a standardized tool to assess content and design (SAM - Suitability Assessment of Materials). A sample of 36 hearing aid user guides (four user guides from nine different hearing aid manufacturers) were analysed. Sixty nine percent of user guides were rated 'not suitable' and 31% were rated 'adequate' for their suitability. Many scored poorly for scope, vocabulary, aspects of layout and typography, and learning stimulation and motivation. The mean reading grade level for all user guides was grade 9.6 which is too high for older adults. The content, design, and readability of hearing aid user guides are not optimal for older adults and thus may serve as a barrier to successful hearing aid outcomes for this population.

Tips for Older Dietary Supplement Users

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... Information for Consumers Tips for Older Dietary Supplement Users Share Tweet Linkedin Pin it More sharing options ... site are provided as a service to our users and do not represent FDA endorsement of these ...

Crystal in Iran: Methamphetamine or Heroin Kerack

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Zahra Alam Mehrjerdi

2013-03-01

Full Text Available In recent years, methamphetamine use has dramatically increased in Iran while there is a crucial misunderstanding about the colloquial words related to methamphetamine among health providers, policy makers, clinicians, scholars and people in the community. The word Crystal refers to methamphetamine in some parts of Iran while in some other parts of the country, Crystal refers to a high purity street-level heroin which is called Kerack and its abuse is epidemic. Methamphetamine and heroin Kerack are different drugs in Iran. Methamphetamine is a stimulant drug while heroin Kerack is an opioid. Health providers especially clinicians and emergency medicine specialists should consider colloquial words that Iranian drug users apply. Special training courses should be designed and implemented for clinicians in Iran to inform them about methamphetamine and its frequently used colloquial words in the community. This issue has important clinical and health implications.

Family Atmosphere and Relationships as Predictors of Heroin Addiction.

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Mirković-Hajdukov, Mitra; Spahić, Tamara Efendić; Softić, Rusmir; Bećirović, Elvir; Šimić, Josip

2017-05-01

Studies show that dysfunctional family relationships are important predictors of addictions to all psychoactive substances. To establish if there is a connection between family relations and heroin addiction and if found to exist, what is the quality of this connection. This research was conducted on the sample comprised of 160 subjects divided into two groups. The first group consisted of 61 heroin addicts treated at the Tuzla University Clinical Centre Psychiatric Hospital. The second group consisted of 99 subjects who were students at the Tuzla University Faculties of Philosophy and Electrical Engineering and who were not using any psychoactive substances. The subjects were tested with the Quality of Family Interactions Scale (KOBI) which measures the interactions between children and parents in two dimensions, described in literature as 'acceptance' and 'rejection'. The research team established statistically significant differences between the heroin addicts and the students, the non-users, in terms of their family relationships. The results show that the addicts families were characterized by lack of understanding, by conflicts, rejection, non-acceptance by parents, while the non-users families were characterized by understanding, acceptance by parents and good communication. There is a connection between inter-family relationships and addiction. Namely, rejection and non-acceptance of children/persons by their families and parents, bad communication and dysfunctional family relationships are significant predictors of heroin addiction.

Cold Preparation of Heroin in a Black Tar Market.

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Roth, Alexis M; Armenta, Richard F; Wagner, Karla D; Strathdee, Steffanie A; Goldshear, Jesse L; Cuevas-Mota, Jazmine; Garfein, Richard S

2017-07-29

Black tar heroin is typically prepared for injection with heat which decreases the risk of HIV transmission by inactivating the virus. We received reports that persons who inject drugs (PWID) in Tijuana, Baja California, Mexico, a black tar heroin market, were using only water to dissolve heroin. Because Tijuana abuts San Diego County, CA, United States, we undertook the present analyses to determine the prevalence of this practice among PWID in San Diego, California. PWID completed quarterly behavioral assessments and serological testing for blood-borne viruses. Bivariate and multivariable logistic regression models were constructed to assess for individual, social, and structural correlates of preparing heroin without heat within the preceding 6 months. Nearly half of black tar heroin users (149/305) reported they had prepared heroin without heat within 6 months. In multivariable analysis, cold preparation was independently associated with younger age (10 year decrease; AOR = 1.25; 95% CI 1.03, 1.53), more drug injecting acquaintances (per 5 acquaintance increase; AOR = 1.05; 95% CI 1.01, 1.09) and prefilled syringe use (injecting drugs from syringes that are already filled with drugs before purchase; AOR = 1.86; 95% CI 1.14, 3.02). Conclusions/Importance: To our knowledge, this is the first paper to report that PWID living in a black tar heroin market are preparing heroin without heat. Additional research is needed to determine whether this is an endemic practice or PWID are engaging in new forms of drug preparation in response to changes in the environment.

The relationship between US heroin market dynamics and heroin-related overdose, 1992-2008.

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Unick, George; Rosenblum, Daniel; Mars, Sarah; Ciccarone, Daniel

2014-11-01

Heroin-related overdose is linked to polydrug use, changes in physiological tolerance and social factors. Individual risk can also be influenced by the structural risk environment including the illicit drug market. We hypothesized that components of the US illicit drug market, specifically heroin source/type, price and purity, will have independent effects on the number of heroin-related overdose hospital admissions. Yearly, from 1992 to 2008, Metropolitan Statistical Area (MSA) price and purity series were estimated from the US Drug Enforcement Administration data. Yearly heroin overdose hospitalizations were constructed from the Nationwide Inpatient Sample. Socio-demographic variables were constructed using several databases. Negative binomial models were used to estimate the effect of price, purity and source region of heroin on yearly hospital counts of heroin overdoses controlling for poverty, unemployment, crime, MSA socio-demographic characteristics and population size. Purity was not associated with heroin overdose, but each $100 decrease in the price per pure gram of heroin resulted in a 2.9% [95% confidence interval (CI) = 4.8%, 1.0%] increase in the number of heroin overdose hospitalizations (P = 0.003). Each 10% increase in the market share of Colombian-sourced heroin was associated with a 4.1% (95% CI = 1.7%, 6.6%) increase in number of overdoses reported in hospitals (P = 0.001) independent of heroin quality. Decreases in the price of pure heroin in the United States are associated with increased heroin-related overdose hospital admissions. Increases in market concentration of Colombian-source/type heroin is also associated with an increase in heroin-related overdose hospital admissions. Increases in US heroin-related overdose admissions appear to be related to structural changes in the US heroin market. © 2014 Society for the Study of Addiction.

Screening for illicit heroin use in patients in a heroin-assisted treatment program

NARCIS (Netherlands)

Rook, Elisabeth J.; Huitema, Alwin D. R.; van den Brink, Wim; Hillebrand, Michel J. X.; van Ree, Jan M.; Beijnen, Jos H.

2006-01-01

The aim of this study was to investigate the use of illicit heroin among patients in a heroin-assisted treatment program. In this program, pharmaceutical-grade heroin was administered to heroin-addicted patients. Monitoring of illicit heroin use was considered important for the evaluation of this

The BDNF Val66Met polymorphism and plasma brain-derived neurotrophic factor levels in Han Chinese heroin-dependent patients.

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Chen, Shiou-Lan; Lee, Sheng-Yu; Chang, Yun-Hsuan; Wang, Tzu-Yun; Chen, Shih-Heng; Chu, Chun-Hsien; Chen, Po See; Yang, Yen Kuang; Hong, Jau-Shyong; Lu, Ru-Band

2015-02-02

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 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 (BDNF concentration in habitual heroin users are not affected by BDNF Val66Met gene variants, but by the length of the heroin dependency.

Fatal intoxication as a consequence of intranasal administration (snorting) or pulmonary inhalation (smoking) of heroin.

Science.gov (United States)

Thiblin, I; Eksborg, S; Petersson, A; Fugelstad, A; Rajs, J

2004-01-28

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.

Craving and illicit heroin use among patients in heroin-assisted treatment

NARCIS (Netherlands)

Blanken, Peter; Hendriks, Vincent M.; Koeter, Maarten W. J.; van Ree, Jan M.; van den Brink, Wim

2012-01-01

Aims: To investigate in heroin-assisted treatment (HAT) compared to methadone maintenance treatment (MMT): the course of heroin craving and illicit heroin use, their mutual association, and their association with multi-domain treatment response. Design: RCTs on the efficacy of 12 months

Heroin detoxification during pregnancy: A systematic review and ...

African Journals Online (AJOL)

Background. There is general consensus that methadone maintenance is the gold standard in the management of pregnant heroin users. However, in South African state hospitals, methadone withdrawal is the routine procedure offered to these patients, as methadone maintenance programmes are unavailable in the ...

Clinical characteristics and risk behavior as a function of HIV status among heroin users enrolled in methadone treatment in northern Taiwan

Directory of Open Access Journals (Sweden)

Shih Chien-Yu

2011-04-01

Full Text Available Abstract Background Methadone treatment was introduced in Taiwan in 2006 as a harm-reduction program in response to the human immunodeficiency virus (HIV, which is endemic among Taiwanese heroin users. The present study was aimed at examining the clinical and behavioral characteristics of methadone patients in northern Taiwan according to their HIV status. Methods The study was conducted at four methadone clinics. Participants were patients who had undergone methadone treatment at the clinics and who voluntarily signed a consent form. Between August and November 2008, each participant completed a face-to-face interview that included questions on demographics, risk behavior, quality of life, and psychiatric symptoms. Data on HIV and hepatitis C virus (HCV infections, methadone dosage, and morphine in the urine were retrieved from patient files on the clinical premises, with permission of the participants. Results Of 576 participants, 71 were HIV positive, and 514 had hepatitis C. There were significant differences between the HIV-positive and HIV-negative groups on source of treatment payment, HCV infection, urine test results, methadone dosage, and treatment duration. The results indicate that HIV-negative heroin users were more likely to have sexual intercourse and not use condoms during the 6 months prior to the study. A substantial percent of the sample reported anxiety (21.0%, depression (27.2%, memory loss (32.7%, attempted suicide (32.7%, and administration of psychiatric medications (16.1%. There were no significant differences between the HIV-positive and HIV-negative patients on psychiatric symptoms or quality of life. Conclusions HIV-positive IDUs were comorbid with HCV, indicating the need to refer both HIV- and HCV-infected individuals for treatment in methadone clinics. Currently, there is a gap between psychiatric/psychosocial services and patient symptoms, and more integrated medical services should be provided to heroin

Polydrug Use and HIV Risk Among People Who Inject Heroin in Tijuana, Mexico: A Latent Class Analysis.

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Meacham, Meredith C; Rudolph, Abby E; Strathdee, Steffanie A; Rusch, Melanie L; Brouwer, Kimberly C; Patterson, Thomas L; Vera, Alicia; Rangel, Gudelia; Roesch, Scott C

2015-01-01

Although most people who inject drugs (PWID) in Tijuana, Mexico, primarily inject heroin, injection and non-injection use of methamphetamine and cocaine is common. We examined patterns of polydrug use among heroin injectors to inform prevention and treatment of drug use and its health and social consequences. Participants were PWID residing in Tijuana, aged ≥18 years who reported heroin injection in the past six months and were recruited through respondent-driven sampling (n = 1,025). Latent class analysis was conducted to assign individuals to classes on a probabilistic basis, using four indicators of past six-month polydrug and polyroute use: cocaine injecting, cocaine smoking or snorting, methamphetamine injecting, and methamphetamine smoking or snorting. Latent class membership was regressed onto covariates in a multinomial logistic regression. Latent class analyses testing 1, 2, 3, and 4 classes were fit, with the 3-class solution fitting best. Class 1 was defined by predominantly heroin use (50.2%, n = 515); class 2 by methamphetamine and heroin use (43.7%, n = 448), and class 3 by methamphetamine, cocaine, and heroin use (6.0%, n = 62). Bivariate and multivariate analyses indicated a group of methamphetamine and cocaine users that exhibited higher-risk sexual practices and lower heroin injecting frequency, and a group of methamphetamine users who were younger and more likely to be female. Discrete subtypes of heroin PWID were identified based on methamphetamine and cocaine use patterns. These findings have identified subtypes of heroin injectors who require more tailored interventions to reduce the health and social harms of injecting drug use.

Deadly heroin or the death of heroin -- overdoses caused by illicit drugs of abuse in Budapest, Hungary between 1994 and 2012.

Science.gov (United States)

Horváth, Mónika; Dunay, György; Csonka, Renata; Keller, Éva

2013-12-01

Rates of illicit drug use and drug-related deaths have continuously increased in developed countries since the 1960s even though the patterns of use and thus the related mortality differ from region to region. In Europe heroin is the drug most often implicated in overdoses. The decedents are most often male, between 20 and 30 years of age and have a long history of drug use. According to the majority of available studies a concomitant use of alcohol and benzodiazepines is one of the risk factors of heroin overdose. In our study we have examined the basic demographic and toxicological features of illicit drug related death cases in Budapest, Hungary between 1994 and 2012. Drug overdose death cases have been divided into two subgroups according to the substances responsible for the death of the subjects: an opioid group and a non-opioid group. The huge majority (87.9%) of decedents died due to heroin overdose and were male (87%). There has been a significant increase in the mean age of the opioid group for the past 19 years. The majority of heroin overdose cases (58%) has had no other psychofarmacons present at the toxicological examination. We have found a slight but significant positive correlation (p=0.0204, r=0.349) between the number of heroin overdose death cases and the mean concentration of street level purity heroin. Most of the examined demographic and toxicological features of the population studied have been in concordance with data previously reported. However, in contrast to other studies we report a strikingly high proportion of "pure" heroin overdose cases where no other psychoactive substances were found. The reason for this is currently unknown; we can only speculate that it can be related to the fact that heroin is used and abused differently from other countries. The remarkable phenomenon of the "ageing" of heroin users may also support a change in the drug use habits of the youngest population. The emergence and spread of new designer drugs also

Heroin refusal self-efficacy and preference for medication-assisted treatment after inpatient detoxification.

Science.gov (United States)

Kenney, Shannon R; Bailey, Genie L; Anderson, Bradley J; Stein, Michael D

2017-10-01

An individual's self-efficacy to refuse using heroin in high-risk situations is believed to minimize the likelihood for relapse. However, among individuals completing inpatient heroin detoxification, perceived refusal self-efficacy may also reduce one's perceived need for medication-assisted treatment (MAT), an effective and recommended treatment for opioid use disorder. In the current study, we examined the relationship between heroin refusal self-efficacy and preference for MAT following inpatient detoxification. Participants (N=397) were interviewed at the start of brief inpatient opioid detoxification. Multiple logistic regression was used to estimate the adjusted association of background characteristics, depressed mood, and perceived heroin refusal self-efficacy with preference for MAT. Controlling for other covariates, depressed mood and lower perceived refusal self-efficacy were associated with a significantly greater likelihood of expressing preference for MAT (versus no MAT). Perceived ability to refuse heroin after leaving detox is inversely associated with a heroin user's desire for MAT. An effective continuum of care model may benefit from greater attention to patient's perceived refusal self-efficacy during detoxification which may impact preference for MAT and long-term recovery. Copyright © 2017. Published by Elsevier Ltd.

The divide within: Older active ICT users position themselves against different 'Others'.

Science.gov (United States)

Kania-Lundholm, Magdalena; Torres, Sandra

2015-12-01

Although research into older people's internet usage patterns is rapidly growing, their understandings of digital technologies, particularly in relation to how these are informed by their understandings of aging and old age, remain unexplored. This is the case because research on older active ICT users tends to regard old age as an empirically interesting part of the life-course as opposed to a theoretically profuse source of information about why and how older people engage with digital technologies. This article explores - through focus group interviews with 30 older adults (aged 66-89) - the ways in which the social position of old age is used by older active ICT users in order to make sense of how and why they engage with these technologies. In this article, positioning theory is used to shed light on how the older people interviewed positioned themselves as 'active older users' in the interviews. The analysis brings to the fore the divide that older people themselves create as they discursively position themselves against different types of ICT users and non-users (young and old) when describing how and why they engage with digital technologies. Copyright © 2015 Elsevier Inc. All rights reserved.

Syncope and QT prolongation among patients treated with methadone for heroin dependence in the city of Copenhagen

DEFF Research Database (Denmark)

Fanoe, Søren; Hvidt, Christian; Ege, Peter Preben

2007-01-01

Methadone is prescribed to heroin addicts to decrease illicit opioid use. Prolongation of the QT interval in the ECG of patients with torsade de pointes (TdP) has been reported in methadone users. As heroin addicts sometimes faint while using illicit drugs, doctors might attribute too many episodes...

Needles in the haystacks: the social context of initiation to heroin injection in rural Ohio.

Science.gov (United States)

Draus, Paul J; Carlson, Robert G

2006-01-01

Although there has been much research on the social context of heroin injection, little has been reported outside of major urban areas. This article examines contextual factors associated with initiation to heroin injection in rural Ohio, based on semistructured qualitative interviews and focus groups involving 25 recent heroin injectors (12 women, 13 men) recruited from three contiguous counties between June 2002 and February 2004. Curiosity about the drug's effects, the growing pressures of drug dependence and economic need, and the influence of intimate and group relations were all identified as factors that offset fears commonly associated with injection. This study complements other research on the social ecology of heroin injection and may contribute to improved services for injection drug users in rural areas and small communities.

Social networking sites and older users - a systematic review.

Science.gov (United States)

Nef, Tobias; Ganea, Raluca L; Müri, René M; Mosimann, Urs P

2013-07-01

Social networking sites can be beneficial for senior citizens to promote social participation and to enhance intergenerational communication. Particularly for older adults with impaired mobility, social networking sites can help them to connect with family members and other active social networking users. The aim of this systematic review is to give an overview of existing scientific literature on social networking in older users. Computerized databases were searched and 105 articles were identified and screened using exclusion criteria. After exclusion of 87 articles, 18 articles were included, reviewed, classified, and the key findings were extracted. Common findings are identified and critically discussed and possible future research directions are outlined. The main benefit of using social networking sites for older adults is to enter in an intergenerational communication with younger family members (children and grandchildren) that is appreciated by both sides. Identified barriers are privacy concerns, technical difficulties and the fact that current Web design does not take the needs of older users into account. Under the conditions that these problems are carefully addressed, social networking sites have the potential to support today's and tomorrow's communication between older and younger family members.

Research Reports: Heroin

Science.gov (United States)

... D. Director National Institute on Drug Abuse Research Report Series HEROIN What is heroin and how is ... and Human Services | National Institutes of Health Research Report Series drug abuse and its consequences to identify ...

Social networking sites and older users - a systematic review

OpenAIRE

Nef, Tobias; Ganea, Raluca L.; Müri, René M.; Mosimann, Urs P.

2017-01-01

BACKGROUND Social networking sites can be beneficial for senior citizens to promote social participation and to enhance intergenerational communication. Particularly for older adults with impaired mobility, social networking sites can help them to connect with family members and other active social networking users. The aim of this systematic review is to give an overview of existing scientific literature on social networking in older users. METHODS Computerized databases were sea...

Respiratory Depression Caused by Heroin Use

Directory of Open Access Journals (Sweden)

Kadir Hakan Cansiz

2012-04-01

Full Text Available Summary Heroin is a semisynthetic narcotic analgesic and heroin abuse is common due to its pleasure-inducing effect. For the last 30 years heroin abuse has become an important worldwide public health problem. Heroin can be administered in many different ways as preferred. Heroin affects many systems including respiratory system, cardiovascular system and particulary the central nervous system. Overdose use of heroin intravenously can be fatal due to respiratory depression. In this letter, we wanted to engage attention to respiratory depression caused by heroin abuse and potential benefits of using naloxone. [TAF Prev Med Bull 2012; 11(2.000: 248-250

Heroin delay discounting: Modulation by pharmacological state, drug-use impulsivity, and intelligence.

Science.gov (United States)

Stoltman, Jonathan J K; Woodcock, Eric A; Lister, Jamey J; Lundahl, Leslie H; Greenwald, Mark K

2015-12-01

Delay discounting (DD) refers to how rapidly an individual devalues goods based on delays to receipt. DD usually is considered a trait variable but can be state dependent, yet few studies have assessed commodity valuation at short, naturalistically relevant time intervals that might enable state-dependent analysis. This study aimed to determine whether drug-use impulsivity and intelligence influence heroin DD at short (ecologically relevant) delays during two pharmacological states (heroin satiation and withdrawal). Out-of-treatment, intensive heroin users (n = 170; 53.5% African American; 66.7% male) provided complete DD data during imagined heroin satiation and withdrawal. Delays were 3, 6, 12, 24, 48, 72, and 96 hours; maximum delayed heroin amount was thirty $10 bags. Indifference points were used to calculate area under the curve (AUC). We also assessed drug-use impulsivity (subscales from the Impulsive Relapse Questionnaire [IRQ]) and estimated intelligence (Shipley IQ) as predictors of DD. Heroin discounting was greater (smaller AUC) during withdrawal than satiation. In regression analyses, lower intelligence and IRQ Capacity for Delay as well as higher IRQ Speed (to return to drug use) predicted greater heroin discounting in the satiation condition. Lower intelligence and higher IRQ Speed predicted greater discounting in the withdrawal condition. Sex, race, substance use variables, and other IRQ subscales were not significantly related to the withdrawal or satiation DD behavior. In summary, heroin discounting was temporally rapid, pharmacologically state dependent, and predicted by drug-use impulsivity and estimated intelligence. These findings highlight a novel and sensitive measure of acute DD that is easy to administer. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Signs of Heroin Abuse and Addiction

Science.gov (United States)

... Used Drugs in the Past Drug Use Prevention Phone Numbers and Websites Search Share You are here Home » Drugs That People Abuse » Heroin (Smack, Junk) Facts » Signs of Heroin Use and Addiction Signs of Heroin Use and Addiction Listen Heroin ...

Heroin: MedlinePlus Health Topic

Science.gov (United States)

... Drug-Free America) Substance Abuse Treatment Facility Locator (Substance Abuse and Mental Health Services Administration) Children What You Need to Know About Drugs: Heroin (Nemours Foundation) Also in Spanish Teenagers Heroin (Nemours Foundation) Also in Spanish Heroin (National ...

Heroin use is associated with suppressed pro-inflammatory cytokine response after LPS exposure in HIV-infected individuals.

Directory of Open Access Journals (Sweden)

Hinta Meijerink

Full Text Available Opioid use is associated with increased incidence of infectious diseases. Although experimental studies have shown that opioids affect various functions of immune cells, only limited data are available from human studies. Drug use is an important risk factor for HIV transmission; however no data are available whether heroin and/or methadone modulate immune response. Therefore, we examined the effect of heroin and methadone use among HIV-infected individuals on the production of cytokines after ex vivo stimulation with various pathogens.Treatment naïve HIV-infected individuals from Indonesia were recruited. Several cohorts of individuals were recruited: 1 using heroin 2 receiving methadone opioid substitution 3 using heroin over 1 year ago and 4 controls (never used opioids. Whole blood was stimulated with Mycobacterium tuberculosis, Candida albicans and LPS for 24 to 48 hours. Cytokine production (IL-1 β, IL-6, IL-10, IFN-α, IFN-γ and TNF-α was determined using multiplex beads assay.Among 82 individuals, the cytokine levels in unstimulated samples did not differ between groups. Overall, heroin users had significantly lower cytokine response after exposure to LPS (p<0.05. After stimulation with either M. tuberculosis or C. albicans the cytokine production of all groups were comparable.The cytokine production after exposure to LPS is significantly down-regulated in HIV-infected heroin users. Interesting, methadone use did not suppress cytokine response, which could have implications guidelines of opioid substitution.

‘We the Avant-Garde’. A History from Below of Dutch Heroin Use in the 1970s

Directory of Open Access Journals (Sweden)

Gemma Blok

2017-03-01

Full Text Available In the 1970s the Netherlands (like many other western countries was shocked by a sudden wave of heroin use. The heroin ‘epidemic’ is  currently framed as a public health problem that has been solved in a commendably humane fashion. In the mean time heroin users have gained a ‘loser image’. Using memoirs written by and interviews with former heroin users, this article argues that heroin use was initially linked to cultural rebellion, self-development and social criticism. We need to take this forgotten aspect of the history of the Dutch heroin ‘epidemic’ into account when we try to explain this historical phenomenon. ‘Wij de avant-garde’. Een history from below van heroïnegebruik in Nederland in de jaren zeventigIn de jaren zeventig van de vorige eeuw werd Nederland (net als veel andere westerse landen opgeschrikt door een plotselinge golf van heroïnegebruik. Deze ‘heroïne-epidemie’ wordt momenteel beschouwd als volksgezondheidsprobleem dat succesvol is bedwongen, op een bewonderenswaardig humane wijze. Ondertussen hebben heroïnegebruikers een ‘loser’ imago gekregen. Op basis van memoires geschreven door en interviews met voormalige heroïnegebruikers, betoogt dit artikel dat het gebruik van heroïne oorspronkelijk verbonden was met culturele rebellie, zelfontplooiing en cultuurkritiek. Dit vergeten aspect van de ‘epidemie’ is onderdeel van de verklaring voor de populariteit van opiaten destijds.

Addiction, agency, and the politics of self-control: doing harm reduction in a heroin users' group.

Science.gov (United States)

Gowan, Teresa; Whetstone, Sarah; Andic, Tanja

2012-04-01

Our 2007-2009 ethnography describes and analyses the practice of harm reduction in a heroin users' group in the midwestern United States. While dominant addiction interventions conceptualize the addict as powerless - either through moral or physical weakness - this group contested such "commonsense," treating illicit drug use as one of many ways that modern individuals attempt to "fill the void." Insisting on the destigmatization of addiction and the normalization of illicit drug use, the group helped its members work on incremental steps toward self-management. Although "Connection Points" had very limited resources to improve the lives of its members, our work suggests that the users' group did much to restore self-respect, rational subjectivity, and autonomy to a group historically represented as incapable of reason and self-control. As the users cohered as a community, they developed a critique of the oppressions suffered by "junkies," discussed their rights and entitlements, and even planned the occasional political action. Engaging with literature on the cultural construction of agency and responsibility, we consider, but ultimately complicate, the conceptualization of needle exchange as a "neoliberal" form of population management. Within the context of the United States' War on Drugs, the group's work on destigmatization, health education, and the practice of incremental control showed the potential for reassertions of social citizenship within highly marginal spaces. Copyright © 2012 Elsevier Ltd. All rights reserved.

Prescribing Heroin

DEFF Research Database (Denmark)

Jourdan, Michael

2008-01-01

En lang række spørgsmål indgår i overvejelserne om at ordinere heroin til heroinafhængige. I leksikon form gives svar på i alt 36 spørgsmål - som hver især og samlet - er en del af det problem- og videnskompleks, som indgår i afvejningerne af om, hvordan og hvorfor man kan vælge at ordinere heroin...

Team research methods for studying intranasal heroin use and its HIV risks.

Science.gov (United States)

Ouellet, L J; Wiebel, W W; Jimenez, A D

1995-01-01

qualitative methods were combined to a degree uncommon in social science research. While many of these research groups have since disbanded, COIP was fortunate enough to remain in operation. The authors have described how they assembled a field research team composed of COIP members that combined ethnographers with selected indigenous staff to address a particular problem--new heroin use and its implications for HIV/AIDS. The goals the researchers set for the study would have been impossible for a single ethnographer or for a survey research team acting alone: to discern potential trends in new heroin use (though researchers were limited to studying mostly poor people); to develop fairly deep understandings regarding the study's central concerns (e.g., factors likely to influence the decision to inject heroin); and to quickly and economically collect data that were useful and valid. The authors note that all members of the research team had a host of other responsibilities; thus, this study was conducted as a sort of side job, that is, researchers had to fit it in when time and circumstances allowed. Altogether, the team field research method as applied to new heroin use in Chicago has enabled the research team to quickly and economically generate data that can be used to inform public policy on this issue (Ouellet et al. 1993; Ouellet et al., submitted). The authors believe that they can make a reasonably strong case for the following: New heroin use deserves greater study--the prevalence and incidence of use are probably sufficient to form a new cohort of potentially longtime users. New users are most likely to be found where major heroin street drug markets operate. Among youth there is a need for education about heroin--current users often report being surprised by heroin's addictiveness. Intranasal use is the predominant form of heroin administration among young, new users, and there is strong peer pressure against injection. Experimentation with injection, how

Heroin - Multiple Languages

Science.gov (United States)

... Spanish) PDF The basics - Opioids, part 1 - English MP3 The basics - Opioids, part 1 - español (Spanish) MP3 The basics - Opioids, part 1 - English MP4 The ... Spanish) PDF Heroin - Opioid addiction, part 7 - English MP3 Heroin - Opioid addiction, part 7 - español (Spanish) MP3 ...

How to find non-dependent opiate users: a comparison of sampling methods in a field study of opium and heroin users.

Science.gov (United States)

Korf, Dirk J; van Ginkel, Patrick; Benschop, Annemieke

2010-05-01

The first aim is to better understand the potentials and limitations of different sampling methods for reaching a specific, rarely studied population of drug users and for persuading them to take part in a multidisciplinary study. The second is to determine the extent to which these different methods reach similar or dissimilar segments of the non-dependent opiate-using population. Using ethnographic fieldwork (EFW) and targeted canvassing (TARC; small newspaper advertisements and website announcements), supplemented by snowball referrals, we recruited and interviewed 127 non-dependent opiate users (lifetime prevalence of use 5-100 times; 86.6% had used heroin and 56.7% opium). Average age was 39.0; 66.1% were male and 33.9% female. In addition to opiates, many respondents had wide experience with other illicit drugs. The majority had non-conventional lifestyles. Both EFW and TARC yielded only limited numbers of snowball referrals. EFW requires specific skills, is labour-intensive, thus expensive, but allows unsuitable candidates to be excluded faster. Respondents recruited through EFW were significantly more likely to have experience with opium and various drugs other than opiates. TARC resulted in larger percentages of women and respondents with conventional lifestyles. TARC is less labour-intensive but requires more time for screening candidates; its cost-effectiveness depends on the price of advertising for the recruitment. Different methods reach different segments of the population of non-dependent opiate users. It is useful to employ a multi-method approach to reduce selectivity. Copyright 2009 Elsevier B.V. All rights reserved.

The SPECT study on the regional cerebral blood flow of heroin addicts during cue-induced heroin craving

International Nuclear Information System (INIS)

Wang Zhengqing; Liu Qinglong; Wang Yuhua; Wang Jinmin; Wang Shuo; Zhao Geyuan

2003-01-01

Objective: To explore the character of the regional cerebral blood flow (rCBF) of heroin addicts during the exposure to the heroin-related cues. Methods: Twenty-five heroin dependent individuals undergoing detoxification for more than one month were enrolled in the present study. All subjects were exposed to the heroin-related cues for 15 min. The rCBF was measured in these patients before and after exposure to heroin-related cues. Result: The rCBF in the frontal, temporal cortex and amygdala was significantly increased during the exposure to heroin-related cues. Conclusion: The findings indicate that drug-related cues play a critical role in the relapse of drug dependence; and the frontal, temporal cortex and amygdala are involved in the relapsing process

Motivational assessment of non-treatment buprenorphine research participation in heroin dependent individuals.

Science.gov (United States)

Papke, Gina; Greenwald, Mark K

2012-06-01

Heroin abuse remains an important public health problem, particularly in economically disadvantaged areas. Insight into this problem is gained from interviewing addicted individuals. However, we lack systematic data on factors that motivate heroin users to participate in non-treatment research that offers both financial incentives (compensation) and non-financial incentives (e.g., short-term medication). To better understand the relative importance of several types of personal motivations to participate in non-treatment buprenorphine research, and to relate self-motivations to social, economic, demographic and drug use factors. Heroin dependent volunteers (N=235 total; 57 female and 178 male; 136 African American, 86 Caucasian, and 13 Other) applied for non-therapeutic buprenorphine research in an urban outpatient setting from 2004 to 2008. We conducted a semi-structured behavioral economic interview, after which participants ranked 11 possible motivations for research participation. Although the study was repeatedly described as non-treatment research involving buprenorphine, participants often ranked some treatment-related motivations as important (wanting to reduce/stop heroin use, needing a medication to get stabilized/detoxify). Some motivations correlated with income, heroin use, and years since marketing of buprenorphine. Two dimensions emerged from principal component analysis of motivation rankings: (1) treatment motivation vs. greater immediate needs and (2) commitment to trying alternatives vs. a more accepting attitude toward traditional interventions. In summary, heroin addicts' self-motivations to engage in non-therapeutic research are complex--they value economic gain but not exclusively or primarily--and relate to variables such as socioeconomic factors and drug use. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Long-term antagonism of κ opioid receptors prevents escalation of and increased motivation for heroin intake.

Science.gov (United States)

Schlosburg, Joel E; Whitfield, Timothy W; Park, Paula E; Crawford, Elena F; George, Olivier; Vendruscolo, Leandro F; Koob, George F

2013-12-04

The abuse of opioid drugs, both illicit and prescription, is a persistent problem in the United States, accounting for >1.2 million users who require treatment each year. Current treatments rely on suppressing immediate withdrawal symptoms and replacing illicit drug use with long-acting opiate drugs. However, the mechanisms that lead to preventing opiate dependence are still poorly understood. We hypothesized that κ opioid receptor (KOR) activation during chronic opioid intake contributes to negative affective states associated with withdrawal and the motivation to take increasing amounts of heroin. Using a 12 h long-access model of heroin self-administration, rats showed escalation of heroin intake over several weeks. This was prevented by a single high dose (30 mg/kg) of the long-acting KOR antagonist norbinaltorphimine (nor-BNI), paralleled by reduced motivation to respond for heroin on a progressive-ratio schedule of reinforcement, a measure of compulsive-like responding. Systemic nor-BNI also significantly decreased heroin withdrawal-associated anxiety-like behavior. Immunohistochemical analysis showed prodynorphin content increased in the nucleus accumbens core in all heroin-exposed rats, but selectively increased in the nucleus accumbens shell in long-access rats. Local infusion of nor-BNI (4 μg/side) into accumbens core altered the initial intake of heroin but not the rate of escalation, while local injection into accumbens shell selectively suppressed increases in heroin intake over time without altering initial intake. These data suggest that dynorphin activity in the nucleus accumbens mediates the increasing motivation for heroin taking and compulsive-like responding for heroin, suggesting that KOR antagonists may be promising targets for the treatment of opioid addiction.

A series of forensic toxicology and drug seizure cases involving illicit fentanyl alone and in combination with heroin, cocaine or heroin and cocaine.

Science.gov (United States)

Marinetti, Laureen J; Ehlers, Brooke J

2014-10-01

The Montgomery County Coroner's Office Toxicology Section and the Miami Valley Regional Crime Lab (MVRCL) Drug Chemistry Section have been receiving case work in drug seizures, death cases and human performance cases involving products marketed as heroin or as illicit fentanyl. Upon analysis by the Drug Chemistry Section, these products were found to contain various drug(s) including illicit fentanyl only, illicit fentanyl and heroin, illicit fentanyl and cocaine and illicit fentanyl, heroin and cocaine. Both the Chemistry and Toxicology Sections began seeing these combinations starting in late October 2013. The percentage of the combinations encountered by the MVRCL as well as the physical appearance of the product, and the results of presumptive screening tests will be discussed. The demographics of the users and the results of toxicology and autopsy findings on the decedents will also be discussed. According to regional drug task force undercover agents, there is evidence that some of the products are being sold as illicit fentanyl and not just as a heroin product. Also, there is no evidence to support that the fentanyl source is being diverted from pharmaceutical grade fentanyl. The chemistry section currently has over 109 confirmed cases, and the toxicology section currently has 81 confirmed drug deaths, 8 driving under the influence of drugs and 1 suicidal hanging. Both sections are continuing to see these cases at the present time. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Older active users of ICTs make sense of their engagement

Directory of Open Access Journals (Sweden)

Magdalena Kania-Lundholm

2017-05-01

Full Text Available Research on older people’s ICT usage tends to focus on either the ways in which they go about learning to use these technologies or the impact that ICTs have on their lives. This research seems, in other words, to take for granted that older people are ‘digital immigrants’ as the digital divide debate proposed. Research that specifically looks at the ways in which older ICT users make sense of their engagement with these technologies is still limited. This article explores therefore – through focus group interviews – how a group of older people who are active ICT users make sense of their ‘digital nativeness’. The analysis shows that the interviewees are well aware that their ICT proficiency differentiated them from their peers, which is why they make sense of their ICT usage by making reference to the issues that make them ‘exceptional’ older people. These include the fact that they have used computers for many years and therefore made ICT usage an everyday habit early on; the fact that most older people do not have the skills that they themselves have, which is why they feel the need to share them with others; and the fact that their lifelong experience means they can use these technologies in judicious ways. By bringing attention to how older active ICT users make sense of their engagement, this article contributes to the notion of the digital spectrum and the debate on the inequalities that ICT proficiency brings about. 

A social network perspective on heroin and cocaine use among adults: evidence of bidirectional influences.

Science.gov (United States)

Bohnert, Amy S B; Bradshaw, Catherine P; Latkin, Carl A

2009-07-01

While several studies have documented a relationship between initiation of drug use and social network drug use in youth, the direction of this association is not well understood, particularly among adults or for stages of drug involvement beyond initiation. The present study sought to examine two competing theories (social selection and social influence) in the longitudinal relationship between drug use (heroin and/or cocaine) and social network drug use among drug-experienced adults. Three waves of data came from a cohort of 1108 adults reporting a life-time history of heroin and/or cocaine use. Low-income neighborhoods with high rates of drug use in Baltimore, Maryland. Participants had weekly contact with drug users and were 18 years of age or older. Drug use data were self-report. Network drug use was assessed through a social network inventory. Close friends were individuals whom the participant reported seeing daily or rated as having the highest level of trust. Findings Structural equation modeling indicated significant bidirectional influences. The majority of change in network drug use over time was due to change in the composition of the network rather than change in friends' behavior. Drug use by close peers did not influence participant drug use beyond the total network. There is evidence of both social selection and social influence processes in the association between drug use and network drug use among drug-experienced adults.

The older adult road user : recommendations for driver assistance

NARCIS (Netherlands)

Wilschut, E.S.; Kroon, E.C.M.; Goede, M. de; Cremers, A.H.M.; Hoedemaeker, D.M.

2014-01-01

The number of older road users is getting increasingly larger in Europe. Therefore policy makers pay more attention to the abilities and limitations of this group of road users. Providing accessible and comfortable assistance and safety functions for mobility is a key challenge in the objective of

Persistence of drug use during imprisonment: relationship of drug type, recency of use and severity of dependence to use of heroin, cocaine and amphetamine in prison.

Science.gov (United States)

Strang, John; Gossop, Michael; Heuston, Joan; Green, John; Whiteley, Christopher; Maden, Anthony

2006-08-01

To investigate the persistence of use of heroin, cocaine and amphetamine drugs during imprisonment, and to identify factors associated with increased levels of persistence. The use of heroin, cocaine and amphetamine by current prison inmates has been examined and, in particular, the relationship between drug use within prison and the type of drug used prior to imprisonment, recency of use and severity of dependence. A randomly selected sample of 1009 adult male prisoners in 13 prisons in England and Wales during 1994/95; structured confidential interviews conducted by independent research staff. Enquiry about prior use of heroin, cocaine or amphetamine focused on three time-periods (ever, last year and last month pre-prison) and the use of these drugs during the first month of imprisonment. A total of 557 (55%) of the 1009 prisoners had used previously one of the three drugs selected for study: 58% had used heroin, 69% cocaine and 75% amphetamine. More than half (59%; 327/557) had used these drugs in the month before the current imprisonment. Drug use in prisons was most likely to occur among those who had used in the month prior to imprisonment. The persistence of heroin use in prison occurred more frequently (70%) than use of cocaine (20%) or amphetamine (15%). Of those using heroin pre-imprisonment, 67% considered they were dependent, compared to 15% and 22%, respectively, for cocaine and amphetamine users. Changes in the drug-taking behaviour of drug users after imprisonment vary according to the type of drug being taken. Prisoners were much more likely to continue to use heroin than either cocaine or amphetamines while in prison. Heroin was most likely to be used by those who had been using heroin during the immediate pre-imprisonment period, and particularly by the two-thirds of heroin users who considered themselves dependent. In view of the high prevalence of prior use of these drugs by individuals currently imprisoned, continuing attention is required to

Deuterodiacetylmorphine as a marker for use of illicit heroin by addicts in a heroin-assisted treatment program

NARCIS (Netherlands)

Klous, Marjolein G.; Rook, Elisabeth J.; Hillebrand, Michel J. X.; van den Brink, Wim; van Ree, Jan M.; Beijnen, Jos H.

2005-01-01

In preparation for a treatment program concerning the medical coprescription of heroin and methadone to treatment-resistant addicts in the Netherlands, we studied a novel strategy for monitoring co-use of illicit (nonprescribed) heroin. A deuterated analogue of heroin was added (1:20) to

Heroin and saccharin demand and preference in rats.

Science.gov (United States)

Schwartz, Lindsay P; Kim, Jung S; Silberberg, Alan; Kearns, David N

2017-09-01

Several recent studies have investigated the choice between heroin and a non-drug alternative reinforcer in rats. A common finding in these studies is that there are large individual differences in preference, with some rats preferring heroin and some preferring the non-drug alternative. The primary goal of the present study was to determine whether individual differences in how heroin or saccharin is valued, based on demand analysis, predicts choice. Rats lever-pressed for heroin infusions and saccharin reinforcers on fixed-ratio schedules. The essential value of each reinforcer was obtained from resulting demand curves. Rats were then trained on a mutually exclusive choice procedure where pressing one lever resulted in heroin and pressing another resulted in saccharin. After seven sessions of increased access to heroin or saccharin, rats were reexposed to the demand and choice procedures. Demand for heroin was more elastic than demand for saccharin (i.e., heroin had lower essential value than saccharin). When allowed to choose, most rats preferred saccharin. The essential value of heroin, but not saccharin, predicted preference. The essential value of both heroin and saccharin increased following a week of increased access to heroin, but similar saccharin exposure had no effect on essential value. Preference was unchanged after increased access to either reinforcer. Heroin-preferring rats differed from saccharin-preferring rats in how they valued heroin, but not saccharin. To the extent that choice models addiction-related behavior, these results suggest that overvaluation of opioids specifically, rather than undervaluation of non-drug alternatives, could identify susceptible individuals. Copyright © 2017 Elsevier B.V. All rights reserved.

Heroin Epidemic PSA (:60)

Centers for Disease Control (CDC) Podcasts

This 60 second public service announcement is based on the July 2015 CDC Vital Signs report. Heroin use and heroin-related overdose deaths are increasing. Most people are using it with other drugs, especially prescription opioid painkillers. Learn what can be done to prevent and treat the problem.

Everyday activities and social contacts among older deaf sign language users

DEFF Research Database (Denmark)

Werngren-Elgström, Monica; Brandt, Ase; Iwarsson, Susanne

2006-01-01

The purpose of this study was to describe the everyday activities and social contacts among older deaf sign language users, and to investigate relationships between these phenomena and the health and well-being within this group. The study population comprised deaf sign language users, 65 years...... or older, in Sweden. Data collection was based on interviews in sign language, including open-ended questions covering everyday activities and social contacts as well as self-rated instruments measuring aspects of health and subjective well-being. The results demonstrated that the group of participants...... aspects of health and subjective well-being and the frequency of social contacts with family/relatives or visiting the deaf club and meeting friends. It is concluded that the variety of activities at the deaf clubs are important for the subjective well-being of older deaf sign language users. Further...

Comportamentos de risco ao HIV em utilizadores de heroína em um distrito português: estudo qualitativo HIV risk behaviors in heroin users in a Portuguese district: a qualitative study

Directory of Open Access Journals (Sweden)

Vanessa Fabiane Machado Gomes Marsden

2009-12-01

Full Text Available OBJETIVO: Explorar relatos de utilizadores de heroína sobre seus comportamentos de risco para transmissão do vírus da imunodeficiência humana (HIV no distrito de Vila Real, Portugal, já que a heroína é a droga predominante no que se refere ao uso problemático de drogas em Portugal, e 48% de todas as notificações de infecção por HIV no país são associadas à dependência de drogas. MÉTODO: Utilizadores de heroína recebendo tratamento ambulatorial para dependência em clínica pública foram selecionados aleatoriamente e convidados a participar do estudo. A coleta de dados foi realizada através de entrevista qualitativa semiestruturada, desenvolvida para explorar os relatos dos participantes sobre seu comportamento de risco associado ao uso de heroína. RESULTADOS: Vinte e cinco entrevistas foram realizadas. A idade média foi de 32 anos, e 92% eram homens. Os participantes relataram um tempo médio de uso de heroína de 14,7 anos, e 64% deles mencionaram uso diário da droga. Dois terços relataram uso de heroína e 16% referiram uso intravenoso da droga nos 30 dias anteriores à entrevista. 75% referiram compartilhamento de seringas ou parafernália de injeção. Front-loading ou back-loading foram técnicas comuns e não reconhecidas como comportamento de risco. 84% referiram ter sido testados anteriormente para o HIV. CONCLUSÕES: O desenvolvimento de melhores programas de prevenção ao HIV para este grupo de risco é essencial através do uso de informações sobre movimentos demográficos e padrões de comportamento de utilizadores de heroína, abordando seus comportamentos de risco nas práticas sexuais e no compartilhamento de parafernália de injeção.OBJECTIVE: To explore heroin users' accounts of risk behavior in relation to the transmission of human immunodeficiency virus (HIV in the district of Vila Real, northern Portugal, since heroin is the predominant drug in problematic drug use in Portugal and 48% of the total

Psychiatric comorbidity and gender difference among treatment-seeking heroin abusers in Taiwan.

Science.gov (United States)

Chiang, Shu-Chuan; Chan, Hung-Yu; Chang, Yuan-Ying; Sun, Hsiao-Ju; Chen, Wei J; Chen, Chih-Ken

2007-02-01

The objectives of the present study were to estimate the psychiatric comorbidity of Taiwanese heroin users seeking treatment and to identify the gender differences in psychiatric comorbidity and drug use behavior. Subjects were interviewed using a structured questionnaire on drug use behavior and the Mini International Neuropsychiatric Interview for psychiatric disorders. Of the subjects, 58.5% of the male and 62.5% of the female subjects had at least one non-substance-use axis I psychiatric disorder or antisocial personality disorder. Compared to male subjects, female subjects were younger, were less educated, had higher rates of unemployment and had earlier onset of illicit drug use. Female subjects were 11-fold more likely than male subjects to exhibit suicidal behavior. Among heroin abusers in the present study, female subjects were more widely exposed to unfavorable social factors and had substantially higher incidence of suicidal behavior than male subjects. Drug treatment centers should be aware of these gender differences and pay particular attention to comorbid depressive disorders and suicidal behavior of female heroin abusers.

Acupuncture inhibits cue-induced heroin craving and brain activation.

Science.gov (United States)

Cai, Xinghui; Song, Xiaoge; Li, Chuanfu; Xu, Chunsheng; Li, Xiliang; Lu, Qi

2012-11-25

Previous research using functional MRI has shown that specific brain regions associated with drug dependence and cue-elicited heroin craving are activated by environmental cues. Craving is an important trigger of heroin relapse, and acupuncture may inhibit craving. In this study, we performed functional MRI in heroin addicts and control subjects. We compared differences in brain activation between the two groups during heroin cue exposure, heroin cue exposure plus acupuncture at the Zusanli point (ST36) without twirling of the needle, and heroin cue exposure plus acupuncture at the Zusanli point with twirling of the needle. Heroin cue exposure elicited significant activation in craving-related brain regions mainly in the frontal lobes and callosal gyri. Acupuncture without twirling did not significantly affect the range of brain activation induced by heroin cue exposure, but significantly changed the extent of the activation in the heroin addicts group. Acupuncture at the Zusanli point with twirling of the needle significantly decreased both the range and extent of activation induced by heroin cue exposure compared with heroin cue exposure plus acupuncture without twirling of the needle. These experimental findings indicate that presentation of heroin cues can induce activation in craving-related brain regions, which are involved in reward, learning and memory, cognition and emotion. Acupuncture at the Zusanli point can rapidly suppress the activation of specific brain regions related to craving, supporting its potential as an intervention for drug craving.

CDC Vital Signs-Heroin Epidemic

Centers for Disease Control (CDC) Podcasts

This podcast is based on the July 2015 CDC Vital Signs report. Heroin use and heroin-related overdose deaths are increasing. Most people are using it with other drugs, especially prescription opioid painkillers. Learn what can be done to prevent and treat the problem.

Heroin Epidemic PSA (:60)

Centers for Disease Control (CDC) Podcasts

2015-07-07

This 60 second public service announcement is based on the July 2015 CDC Vital Signs report. Heroin use and heroin-related overdose deaths are increasing. Most people are using it with other drugs, especially prescription opioid painkillers. Learn what can be done to prevent and treat the problem.  Created: 7/7/2015 by National Center for Injury Prevention and Control (NCIPC).   Date Released: 7/7/2015.

Differences in onset and abuse/dependence episodes between prescription opioids and heroin: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Directory of Open Access Journals (Sweden)

Mannelli P

2011-05-01

Full Text Available Li-Tzy Wu1, George E Woody2, Chongming Yang3, Paolo Mannelli1, Dan G Blazer11Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA; 2Department of Psychiatry, University of Pennsylvania School of Medicine, University of Pennsylvania and Treatment Research Institute, Philadelphia, PA, USA; 3Social Science Research Institute, Duke University, Durham, NC, USAObjectives: To examine patterns of onset and abuse/dependence episodes of prescription opioid (PO and heroin use disorders in a national sample of adults, and to explore differences by gender and substance abuse treatment status.Methods: Analyses of data from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093.Results: Of all respondents, 5% (n = 1815 reported a history of nonmedical PO use (NMPOU and 0.3% (n = 150 a history of heroin use. Abuse was more prevalent than dependence among NMPOUs (PO abuse, 29%; dependence, 7% and heroin users (heroin abuse, 63%; dependence, 28%. Heroin users reported a short mean interval from first use to onset of abuse (1.5 years or dependence (2.0 years, and a lengthy mean duration for the longest episode of abuse (66 months or dependence (59 months; the corresponding mean estimates for PO abuse and dependence among NMPOUs were 2.6 and 2.9 years, respectively, and 31 and 49 months, respectively. The mean number of years from first use to remission from the most recent episode was 6.9 years for PO abuse and 8.1 years for dependence; the mean number of years from first heroin use to remission from the most recent episode was 8.5 years for heroin abuse and 9.7 years for dependence. Most individuals with PO or heroin use disorders were remitted from the most recent episode. Treated individuals, whether their problem was heroin or POs, tended to have a longer mean duration of an episode than untreated individuals.Conclusion: Periodic remissions

Prevalence of antisocial personality disorder among Chinese individuals receiving treatment for heroin dependence: a meta-analysis

Science.gov (United States)

ZHONG, Baoliang; XIANG, Yutao; CAO, Xiaolan; LI, Yan; ZHU, Junhong; CHIU, Helen F. K.

2014-01-01

Background Studies from Western countries consistently report very high rates of comorbid Antisocial Personality Disorder (ASPD) among individuals with heroin addiction, but the reported proportion of Chinese individuals with heroin addiction who have co-morbid ASPD varies widely, possibly because Chinese clinicians do not consider personality issues when treating substance abuse problems. Aim Conduct a meta-analysis of studies that assessed the proportion of Chinese individuals with heroin dependence who have comorbid ASPD. Methods We searched for relevant studies in both Chinese databases (China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, Taiwan Electronic Periodical Services) and western databases (PubMed, EMBASE, and PsycInfo). Two authors independently retrieved the literature, identified studies that met pre-defined inclusion and exclusion criteria, assessed the quality of included studies, and extracted the data used in the analysis. Statistical analysis was performed using StatsDirect 3.0 and R software. Results The search yielded 15 eligible studies with a total of 3692 individuals with heroin dependence. Only 2 of the studies were rated as high-quality studies. All studies were conducted in rehabilitation centers or hospitals. The pooled lifetime prevalence of ASPD in these subjects was 30% (95%CI: 23%-38%), but the heterogeneity of results across studies was great (I2 =95%, p<0.001). Men had a higher prevalence than women (44% vs. 21%), and injection heroin users had higher prevalence than those who smoked heroin (44% vs. 27%). Studies that were methodologically stronger had higher reported prevalence of ASPD among heroin dependent individuals. Conclusions There are substantial methodological problems in the available literature about ASPD in Chinese individuals receiving treatment for heroin dependence, but we estimate that about one-third of them meet criteria for ASPD. Further work is needed to increase clinicians�

Managing the safe mobility of older road users: How to cope with their diversity?

DEFF Research Database (Denmark)

Haustein, Sonja; Marin-Lamellet, Claude

2014-01-01

Against the background of an ageing population, the management of older people's safe mobility is becoming an increasingly important issue. Mobility is vital for older people's quality of life and several examples of good practice that support older people's safe mobility already exist. However...... groups who are already users and improve their (safe) use of the preferred transport mode. However, they do not seem to succeed in increasing mobility options, e.g. by encouraging car-reliant users to cycle or use public transport or by helping older women to continue to drive. We advise that existing...... systems, a lack of programmes to increase perceived security, as well as a comprehensive scheme for older drivers who have to stop driving....

Acute progressive paraplegia in heroin-associated myelopathy.

Science.gov (United States)

Mahoney, Kyle W; Romba, Meghan; Gailloud, Philippe; Izbudak, Izlem; Saylor, Deanna

2018-05-01

As the opioid epidemic continues, understanding manifestations of abuse, including heroin-associated myelopathy remains essential. Here we describe a young man with a past medical history significant for polysubstance abuse who developed acute-onset, rapidly progressive myelopathy after resumption of intravenous heroin use. He had significant spinal cord involvement with findings suggestive of heroin-associated myelopathy. The salient features of this case include diffusion imaging of the spine and spinal angiography supporting a possible vasculopathy as the pathophysiologic mechanism underlying heroin-associated myelopathy. Additionally, CSF studies showed the transition from a neutrophilic pleocytosis to a lymphocytic pleocytosis suggesting an inflammatory component. Copyright © 2018 Elsevier Ltd. All rights reserved.

Temporal correlation between opiate seizures in East/Southeast Asia and B.C. heroin deaths: a transoceanic model of heroin death risk.

Science.gov (United States)

McLean, Mark E

2003-01-01

Because heroin supply changes cannot be measured directly, their impact on populations is poorly understood. British Columbia has experienced an injection drug use epidemic since the 1980s that resulted in 2,590 illicit drug deaths from 1990-1999. Since previous work indicates heroin seizures can correlate with supply and B.C. receives heroin only from Southeast Asia, this study examined B.C. heroin deaths against opiate seizures in East/Southeast Asia. Opiate seizures in East/Southeast Asia and data from two B.C. mortality datasets containing heroin deaths were examined. The Pearson correlation coefficient for seizures against each mortality dataset was determined. Opiate seizures, all illicit drug deaths and all opiate deaths concurrently increased twice and decreased twice from 1989-1999, and all reached new peak values in 1993. Three B.C. sub-regions exhibited illicit drug deaths rate trends concurrent with the three principal datasets studied. The Pearson correlation coefficient for opiate-induced deaths against opiate seizures from 1980-1999 was R=0.915 (popiate seizures from 1987-1999 was R=0.896 (popiate seizures in East/Southeast Asia were very strongly correlated with B.C. opiate and illicit drug deaths. The number of B.C. heroin-related deaths may be strongly linked to heroin supply. Enforcement services are not effective in preventing harm caused by heroin in B.C.; therefore, Canada should examine other methods to prevent harm. The case for harm reduction is strengthened by the ineffectiveness of enforcement and the unlikelihood of imminent eradication of heroin production in Southeast Asia.

Subtyping patients with heroin addiction at treatment entry: factor derived from the Self-Report Symptom Inventory (SCL-90).

Science.gov (United States)

Maremmani, Icro; Pani, Pier Paolo; Pacini, Matteo; Bizzarri, Jacopo V; Trogu, Emanuela; Maremmani, Angelo Gi; Gerra, Gilberto; Perugi, Giulio; Dell'Osso, Liliana

2010-04-13

Addiction is a relapsing chronic condition in which psychiatric phenomena play a crucial role. Psychopathological symptoms in patients with heroin addiction are generally considered to be part of the drug addict's personality, or else to be related to the presence of psychiatric comorbidity, raising doubts about whether patients with long-term abuse of opioids actually possess specific psychopathological dimensions. Using the Self-Report Symptom Inventory (SCL-90), we studied the psychopathological dimensions of 1,055 patients with heroin addiction (884 males and 171 females) aged between 16 and 59 years at the beginning of treatment, and their relationship to age, sex and duration of dependence. A total of 150 (14.2%) patients with heroin addiction showed depressive symptomatology characterised by feelings of worthlessness and being trapped or caught; 257 (24.4%) had somatisation symptoms, 205 (19.4%) interpersonal sensitivity and psychotic symptoms, 235 (22.3%) panic symptomatology, 208 (19.7%) violence and self-aggression. These dimensions were not correlated with sex or duration of dependence. Younger patients with heroin addiction were characterised by higher scores for violence-suicide, sensitivity and panic anxiety symptomatology. Older patients with heroin addiction showed higher scores for somatisation and worthlessness-being trapped symptomatology. This study supports the hypothesis that mood, anxiety and impulse-control dysregulation are the core of the clinical phenomenology of addiction and should be incorporated into its nosology.

Perceived Treatment Need and Latent Transitions in Heroin and Methamphetamine Polydrug Use among People who Inject Drugs in Tijuana, Mexico.

Science.gov (United States)

Meacham, Meredith C; Roesch, Scott C; Strathdee, Steffanie A; Gaines, Tommi L

2018-01-01

People who inject drugs (PWID) in Tijuana, Mexico, use heroin and/or methamphetamine. While polydrug use is associated with HIV risk behavior, less is known about the stability of polydrug use patterns over time and how polydrug use is related to perceived treatment need. Within a cohort of PWID in Tijuana (N = 735) we sought to (1) characterize subgroups of polydrug and polyroute use from baseline to six months; (2) determine the probabilities of transitioning between subgroups; and (3) examine whether self-reported need for help for drug use modified these transition probabilities. Latent transition analysis (LTA) identified four latent statuses: heroin-only injection (38% at both baseline and follow-up); co-injection of heroin with methamphetamine (3% baseline, 15% follow-up); injection of heroin and methamphetamine (37% baseline, 32% follow-up); and polydrug and polyroute users who injected heroin and both smoked and injected methamphetamine (22% baseline, 14% follow-up). Heroin-only injectors had the highest probability of remaining in the same latent status at follow-up. The majority reported great or urgent need for treatment (51%) and these PWID had greater odds of transitioning to a higher-risk status at follow-up, emphasizing the need for evidence-based drug treatment options for PWID.

Opioid analgesics and heroin: Examining drug misuse trends among a sample of drug treatment clients in Kentucky.

Science.gov (United States)

Victor, Grant A; Walker, Robert; Cole, Jennifer; Logan, T K

2017-08-01

In an effort to mitigate Kentucky's prescription drug misuse, legislative intervention efforts were introduced in 2012 and 2013 to better regulate pain clinics, prescribed use of opioid analgesics, and to expand the monitoring of opioid prescriptions. The focus of this paper is primarily on opioid analgesics and heroin and the relationship of use/misuse patterns of these drugs to state drug policy initiatives. A secondary data analysis of drug treatment clients (N=52,360) was conducted to project illicit drug use trends in Kentucky. This study describes temporal and geographic trends of self-reported illicit drug use among individuals in state-funded treatment in Kentucky between fiscal year 2010 and fiscal year 2013. Significant reductions in the prevalence of illicit opioid use, declined from fiscal year 2010 to fiscal year 2013 (p<.01, CI=-.298 to -.215). However, heroin use rates significantly increased over the years studied, suggesting there may be a transition from prescription opioids to heroin (p<.01, CI=.143 to .178). The analysis suggests these trends may continue. Findings suggest Kentucky's legislative efforts were effective in reducing illicit prescription opioid use, but heroin use has increased. One possible explanation for this relationship is that as prescription opioids became more difficult to obtain, users turned to heroin as a substitute. The finding of rising heroin use suggests a need for further policy initiatives to reduce heroin use, but the potential effectiveness of this policy remains unclear. Understanding trends may help to guide future policy efforts and pain management treatment strategies to where they might have their greatest impact. Copyright © 2017 Elsevier B.V. All rights reserved.

What You Need to Know About Drugs: Heroin

Science.gov (United States)

... You Need to Know About Drugs: Heroin Print en español Lo que necesitas saber sobre las drogas: La heroína What It Is: Heroin (say: HAIR-uh-win) comes from the opium poppy, a flower that grows in Asia, Mexico, and South America. Pure heroin is a white ...

Use of morphine and 6-monoacetylmorphine in blood for the evaluation of possible risk factors for sudden death in 192 heroin users.

Science.gov (United States)

Fugelstad, Anna; Ahlner, Johan; Brandt, Lena; Ceder, Gunnel; Eksborg, Staffan; Rajs, Jovan; Beck, Olof

2003-04-01

To detect risk factors for sudden death from heroin injection. Evaluation of data from forensic investigations of all fatal cases of suspected heroin death in a metropolitan area. Only cases with detectable morphine and 6-monoacetylmorphine (6-MAM) in blood were included in order to select heroin intoxication cases. Stockholm, Sweden. Autopsy investigation and toxicological analysis of blood and urine; and police reports. In two-thirds of the 192 cases, death occurred in public places, and mostly without any time delay. Blood concentrations of morphine ranged from 50 to 1200 ng/g, and of 6-MAM from 1 to 80 ng/g. Codeine was detected in 96% of the subjects. In the majority of cases the forensic investigation indicated polydrug use, the most common additional findings being alcohol and benzodiazepines. However, in one-quarter of the cases other drug combinations were found. Previous abstinence from heroin and use of alcohol were identified as risk factors. For 6-MAM there was also a correlation with the presence of THC and benzodiazepines. Despite a high frequency of heart abnormalities (e.g. myocarditis and focal myocardial fibrosis), these conditions did not correlate with morphine or 6-MAM blood concentrations. We confirm that alcohol intake and loss of tolerance are risk factors for death from heroin use, whereas no connection to heart pathology was observed. Further, prospective, studies should focus on other possible risk factors.

What caused the recent reduction in heroin supply in Australia?

Science.gov (United States)

Wodak, Alex

2008-08-01

Heroin availability and purity decreased and prices increased in Australia suddenly in early 2001. The heroin market in Australia has still not returned to the status quo ante after more than six years. Benefits of the heroin shortage, including a substantial reduction in drug overdose deaths and property crime, are generally considered to have outweighed adverse effects which included increased use of other drugs, especially stimulants, with a subsequent increase in aggression, violence and mental illness. Some commentators attributed the heroin shortage to a combination of factors, while an influential study highlighted the importance of supply control asserting that increased funding and improved effectiveness of domestic drug law enforcement produced critical heroin seizures which disrupted major syndicates, thereby producing the heroin shortage. Evidence to support a critical role for drug law enforcement in the heroin shortage is weak with some recent evidence contradicting key assertions used to support the supply control hypothesis. Although the most likely interpretation is still a combination of multiple factors, the most important factors appear to have been a substantial recent reduction in source opium cultivation and heroin production in Burma, but probably also increased heroin consumption en route through China and a switch from heroin to amphetamine production in Burma. This interpretation is consistent with the international experience of several recent decades in numerous countries where national heroin shortages have occurred rarely and generally only briefly, notwithstanding vigorous and very well resourced supply control efforts. The recent reduction in heroin supply in Australia, the most severe, longest lasting and best-documented heroin shortage in the world, cannot be confidently attributed, solely or largely, to improved domestic drug law enforcement. At best, domestic law enforcement may have made a small contribution compared to several

CDC Vital Signs-Heroin Epidemic

Centers for Disease Control (CDC) Podcasts

2015-07-07

This podcast is based on the July 2015 CDC Vital Signs report. Heroin use and heroin-related overdose deaths are increasing. Most people are using it with other drugs, especially prescription opioid painkillers. Learn what can be done to prevent and treat the problem.  Created: 7/7/2015 by National Center for Injury Prevention and Control (NCIPC).   Date Released: 7/7/2015.

Wheel running decreases the positive reinforcing effects of heroin.

Science.gov (United States)

Smith, Mark A; Pitts, Elizabeth G

2012-01-01

The purpose of this study was to examine the effects of voluntary wheel running on the positive reinforcing effects of heroin in rats with an established history of drug self-administration. Rats were assigned to sedentary (no wheel) and exercise (wheel) conditions and trained to self-administer cocaine under positive reinforcement contingencies. Rats acquiring cocaine self-administration were then tested with various doses of heroin during daily test sessions. Sedentary rats self-administered more heroin than exercising rats, and this effect was greatest at low and moderate doses of heroin. These data suggest that voluntary wheel running decreases the positive reinforcing effects of heroin.

The role of alcohol abuse in the etiology of heroin-related deaths. Evidence for pharmacokinetic interactions between heroin and alcohol.

Science.gov (United States)

Polettini, A; Groppi, A; Montagna, M

1999-01-01

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 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

ZNF804A variants confer risk for heroin addiction and affect decision making and gray matter volume in heroin abusers.

Science.gov (United States)

Sun, Yan; Zhao, Li-Yan; Wang, Gui-Bin; Yue, Wei-Hua; He, Yong; Shu, Ni; Lin, Qi-Xiang; Wang, Fan; Li, Jia-Li; Chen, Na; Wang, Hui-Min; Kosten, Thomas R; Feng, Jia-Jia; Wang, Jun; Tang, Yu-De; Liu, Shu-Xue; Deng, Gui-Fa; Diao, Gan-Huan; Tan, Yun-Long; Han, Hong-Bin; Lin, Lu; Shi, Jie

2016-05-01

Drug addiction shares common neurobiological pathways and risk genes with other psychiatric diseases, including psychosis. One of the commonly identified risk genes associated with broad psychosis has been ZNF804A. We sought to test whether psychosis risk variants in ZNF804A increase the risk of heroin addiction by modulating neurocognitive performance and gray matter volume (GMV) in heroin addiction. Using case-control genetic analysis, we compared the distribution of ZNF804A variants (genotype and haplotype) in 1035 heroin abusers and 2887 healthy subjects. We also compared neurocognitive performance (impulsivity, global cognitive ability and decision-making ability) in 224 subjects and GMV in 154 subjects based on the ZNF804A variants. We found significant differences in the distribution of ZNF804A intronic variants (rs1344706 and rs7597593) allele and haplotype frequencies between the heroin and control groups. Decision-making impairment was worse in heroin abusers who carried the ZNF804A risk allele and haplotype. Subjects who carried more risk alleles and haplotypes of ZNF804A had greater GMV in the bilateral insular cortex, right temporal cortex and superior parietal cortex. The interaction between heroin addiction and ZNF804A variants affected GMV in the left sensorimotor cortex. Our findings revealed several ZNF804A variants that were significantly associated with the risk of heroin addiction, and these variants affected decision making and GMV in heroin abusers compared with controls. The precise neural mechanisms that underlie these associations are unknown, which requires future investigations of the effects of ZNF804A on both dopamine neurotransmission and the relative increases in the volume of various brain areas. © 2015 Society for the Study of Addiction.

CDC Vital Signs: Today's Heroin Epidemic

Science.gov (United States)

... the MMWR Science Clips Today’s Heroin Epidemic More people at risk, multiple drugs abused Language: English (US) Español Recommend on Facebook Tweet Share Compartir On This Page Overview Problem Infographics What Can Be Done Issue Details Overview Heroin use has increased across the US among men and ...

Subtyping patients with heroin addiction at treatment entry: factor derived from the Self-Report Symptom Inventory (SCL-90

Directory of Open Access Journals (Sweden)

Maremmani Icro

2010-04-01

Full Text Available Abstract Background Addiction is a relapsing chronic condition in which psychiatric phenomena play a crucial role. Psychopathological symptoms in patients with heroin addiction are generally considered to be part of the drug addict's personality, or else to be related to the presence of psychiatric comorbidity, raising doubts about whether patients with long-term abuse of opioids actually possess specific psychopathological dimensions. Methods Using the Self-Report Symptom Inventory (SCL-90, we studied the psychopathological dimensions of 1,055 patients with heroin addiction (884 males and 171 females aged between 16 and 59 years at the beginning of treatment, and their relationship to age, sex and duration of dependence. Results A total of 150 (14.2% patients with heroin addiction showed depressive symptomatology characterised by feelings of worthlessness and being trapped or caught; 257 (24.4% had somatisation symptoms, 205 (19.4% interpersonal sensitivity and psychotic symptoms, 235 (22.3% panic symptomatology, 208 (19.7% violence and self-aggression. These dimensions were not correlated with sex or duration of dependence. Younger patients with heroin addiction were characterised by higher scores for violence-suicide, sensitivity and panic anxiety symptomatology. Older patients with heroin addiction showed higher scores for somatisation and worthlessness-being trapped symptomatology. Conclusions This study supports the hypothesis that mood, anxiety and impulse-control dysregulation are the core of the clinical phenomenology of addiction and should be incorporated into its nosology.

Understanding fatal older road user crash circumstances and risk factors.

Science.gov (United States)

Koppel, Sjaan; Bugeja, Lyndal; Smith, Daisy; Lamb, Ashne; Dwyer, Jeremy; Fitzharris, Michael; Newstead, Stuart; D'Elia, Angelo; Charlton, Judith

2018-02-28

This study used medicolegal data to investigate fatal older road user (ORU) crash circumstances and risk factors relating to four key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity. The Coroners Court of Victoria's Surveillance Database was searched to identify coronial records with at least one deceased ORU in the state of Victoria, Australia, for 2013-2014. Information relating to the ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed. The average rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI] 6.0-10.2), which was more than double the average rate of fatal middle-aged road user crashes (3.6, 95% CI 2.5-4.6). There was a significant relationship between age group and deceased road user type (χ 2 (15, N = 226) = 3.56, p road" (87.0%), on roads that were paved (94.2%), dry (74.2%), and had light traffic volume (38.3%). Road user error was identified by the police and/or coroner for the majority of fatal ORU crashes (57.9%), with a significant proportion of deceased ORU deemed to have "misjudged" (40.9%) or "failed to yield" (37.9%). Road user error was the most significant risk factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the Victorian road system to fully accommodate road user errors. Initiatives related to safer roads and roadsides, vehicles, and speed zones, as well as behavioral approaches, are key areas of priority for targeted activity to prevent fatal older road user crashes in the future.

Influence of treatment with inhalable heroin on pulmonary function

NARCIS (Netherlands)

Buster, M. C. A.; van den Brink, W.; van Brussel, G. H. A.; van Ree, J. M.

2011-01-01

This study aims to asses the influence of inhalable heroin on pulmonary function in chronic heroin-dependent patients treated with inhalable heroin. Among 32 patients (all cigarette smokers), a spirometric test was conducted at baseline and after an average period of 10 months of treatment with

Heroines & Superheroines

DEFF Research Database (Denmark)

Raahauge, Kirsten Marie

2010-01-01

Med udgangspunkt i billedkunstneren Ivar Tønsbergs værker, der under titlen Heroines & Superheroines udstilles ved Dronninglund Kunstcenter 6.6.-1.8.2010, diskuterer denne tekst til udstillingskataloget kvinder og magt, fremstillingsformer og ansigtsaflæsninger. Motivet for værkerne er kvindelige...

An Examination of the Behaviour of Young and Older Users of Facebook

OpenAIRE

Quinn, Darren; Chen, Liming; Mulvenna, Maurice D.

2011-01-01

Increased use in recent years of social networking applications such as Facebook has resulted in a rapid growth of user generated content. As a communication tool for social engagement, the online patterns and characteristics of individuals and user types can now be better understood by monitoring user behaviour, activity frequency and modality of use. The aim of this paper is to present an analysis of the behaviour and characteristics of young and older user groups in an online social networ...

Power mobility with collision avoidance for older adults: user, caregiver, and prescriber perspectives.

Science.gov (United States)

Wang, Rosalie H; Korotchenko, Alexandra; Hurd Clarke, Laura; Mortenson, W Ben; Mihailidis, Alex

2013-01-01

Collision avoidance technology has the capacity to facilitate safer mobility among older power mobility users with physical, sensory, and cognitive impairments, thus enabling independence for more users. Little is known about consumers' perceptions of collision avoidance. This article draws on interviews (29 users, 5 caregivers, and 10 prescribers) to examine views on design and utilization of this technology. Data analysis identified three themes: "useful situations or contexts," "technology design issues and real-life application," and "appropriateness of collision avoidance technology for a variety of users." Findings support ongoing development of collision avoidance for older adult users. The majority of participants supported the technology and felt that it might benefit current users and users with visual impairments, but might be unsuitable for people with significant cognitive impairments. Some participants voiced concerns regarding the risk for injury with power mobility use and some identified situations where collision avoidance might be beneficial (driving backward, avoiding dynamic obstacles, negotiating outdoor barriers, and learning power mobility use). Design issues include the need for context awareness, reliability, and user interface specifications. User desire to maintain driving autonomy supports development of collaboratively controlled systems. This research lays the groundwork for future development by illustrating consumer requirements for this technology.

DrugFacts: Heroin

Science.gov (United States)

... Alcohol Club Drugs Cocaine Fentanyl Hallucinogens Inhalants Heroin Marijuana MDMA (Ecstasy/Molly) Methamphetamine Opioids Over-the-Counter Medicines Prescription Medicines Steroids (Anabolic) Synthetic Cannabinoids (K2/Spice) Synthetic Cathinones (Bath Salts) Tobacco/ ...

Cost utility analysis of co-prescribed heroin compared with methadone maintenance treatment in heroin addicts in two randomised trials

NARCIS (Netherlands)

Dijkgraaf, Marcel G. W.; van der Zanden, Bart P.; de Borgie, Corianne A. J. M.; Blanken, Peter; van Ree, Jan M.; van den Brink, Wim

2005-01-01

Objective To determine the cost utility of medical co-prescription of heroin compared with methadone maintenance treatment for chronic, treatment resistant heroin addicts. Design Cost utility analysis of two pooled open label randomised controlled trials. Setting Methadone maintenance programmes in

Tips for Teens: The Truth about Heroin

Science.gov (United States)

... think, slows down reaction time, and slows down memory. This affects the way you act and make decisions. Heroin ... it enters the brain so rapidly. It particularly affects those regions of the brain ... fashion, and music, heroin use can have tragic consequences that extend ...

Hemodynamic, Thyroid and Immunomodulatory Effects of Heroin in Rats

Directory of Open Access Journals (Sweden)

Ismail M. Maulood

2016-05-01

Full Text Available Diacetylmorphine (heroin has many effects on the body system; it exerts effects on cardiovascular, immune and endocrine systems. The aim of the this study is to investigate the short-term effects of low and high doses of heroin on systolic blood pressure (SBP, thyroid hormones and monocyte chemoattractant protein-1 (MCP-1. The experimental rats were divided into three groups, each with six individuals and the treatments were continued for seven days. SBP significantly reduced by heroin administration in the second dose as compared with the control group. A marked decrease in the serum NO level was also noticed after first (low and second (high dose of administration as compared with control group. The present results also revealed that serum MCP-1 was statistically increased in the second dose of heroin group. Statistical analysis showed that both serum T3 and T4 levels were reduced significantly by heroin administration. In conclusions, for the first time, our findings suggested that diacetylmorphine could affect immune system through MCP-1 elevation. As well as heroin may affect cardiac and liver functions via increasing troponin-T and bilirubin levels.

Drug choice, spatial distribution, HIV risk, and HIV prevalence among injection drug users in St. Petersburg, Russia

Directory of Open Access Journals (Sweden)

Shaboltas Alla V

2009-07-01

Full Text Available Abstract Background The HIV epidemic in Russia has been driven by the unsafe injection of drugs, predominantly heroin and the ephedrine derived psychostimulants. Understanding differences in HIV risk behaviors among injectors associated with different substances has important implications for prevention programs. Methods We examined behaviors associated with HIV risk among 900 IDUs who inject heroin, psychostimulants, or multiple substances in 2002. Study participants completed screening questionnaires that provided data on sociodemographics, drug use, place of residence and injection- and sex-related HIV risk behaviors. HIV testing was performed and prevalence was modeled using general estimating equation (GEE analysis. Individuals were clustered by neighborhood and disaggregated into three drug use categories: Heroin Only Users, Stimulant Only Users, and Mixed Drug Users. Results Among Heroin Only Users, younger age, front/backloading of syringes, sharing cotton and cookers were all significant predictors of HIV infection. In contrast, sharing needles and rinse water were significant among the Stimulant Only Users. The Mixed Drug Use group was similar to the Heroin Only Users with age, front/back loading, and sharing cotton significantly associated with HIV infection. These differences became apparent only when neighborhood of residence was included in models run using GEE. Conclusion The type of drug injected was associated with distinct behavioral risks. Risks specific to Stimulant Only Users appeared related to direct syringe sharing. The risks specific to the other two groups are common to the process of sharing drugs in preparation to injecting. Across the board, IDUs could profit from prevention education that emphasizes both access to clean syringes and preparing and apportioning drug with these clean syringes. However, attention to neighborhood differences might improve the intervention impact for injectors who favor different drugs.

Characteristics and Behaviors of Older Male Anabolic Steroid Users.

Science.gov (United States)

Ip, Eric J; Trinh, Karen; Tenerowicz, Michael J; Pal, Jai; Lindfelt, Tristan A; Perry, Paul J

2015-10-01

To compare and contrast the characteristics of 2 groups of men ≥40 years old: reported anabolic-androgenic steroid (AAS) users and nonusers. Cross-sectional survey. Thirty-eight online fitness, weight lifting, bodybuilding, and steroid Web sites. A total of 67 male AAS users and 76 male nonusers ≥40 years old. Demographics, utilization of AAS and other performance-enhancing agents (PEAs), exercise patterns, history of illicit drugs and alcohol use, and psychiatric traits/diagnoses. The majority of AAS users ≥40 years old were caucasian (92.5%), heterosexual (97.0%), and classified themselves as recreational exercisers (79.1%). AAS users took more PEAs (11.5 ± 5.6 vs 4.6 ± 2.7; P aggressive alcohol use, and a higher incidence of substance dependence and anxiety disorders compared to nonusers. This information may help clinicians and researchers identify and develop appropriate intervention strategies for AAS abuse among older men. © The Author(s) 2014.

Older Cancer Patients’ User Experience of Online Health Information Tools: A Think Aloud Study

NARCIS (Netherlands)

Bolle, Sifra; Romijn, G.A.; Smets, E.M.A.; Loos, E.F.; Kunneman, M.; van Weert, J.

2016-01-01

Background: Health information is increasingly presented on the Internet. Several Web design guidelines for older Web users have been proposed; however, these guidelines are often not applied in website development. Furthermore, although we know that older individuals use the Internet to search for

Clinical significance of myoglobinuria and serum myoglobin in heroin-addicted patients

International Nuclear Information System (INIS)

Chen Xuehong; Zhong Ganping; Zhang Lan; Liu Jiangyan

2001-01-01

The authors study the relationship between myoglobinuria and acute rhabdomyolysis in heroin-addicted patients. The levels of myoglobin in serum and urine were determined by RIA in 106 heroin-addicted patients and 30 healthy volunteers who were selected as the controls. The levels of myoglobin in serum and urine increased significantly in heroin-addicted patients in 3 days after giving up heroin, and gradually decreased in 2 weeks but still higher than the levels of the controls (P 0.05). Urine myoglobin detection is a simple and effective method to find out acute rhabdomyolysis derived from heroin addiction early

Reaction time in relation to duration of heroin abuse

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Martinović-Mitrović Slađana

2011-01-01

Full Text Available Introduction. Consequences of heroin abuse include organic damage of cerebral structures. The level of impairments is in a direct and positive relation with the length of heroin abuse. Objective. The aim of this research was the evaluation of the reaction time with heroin addicts with different length of substance abuse. Methods. Research method: 90 examinees were divided into three groups with relation to the length of heroin abuse. Data collection included a questionnaire referring to socio-demographic and addictive characteristics. A specially designed programme was used for the evaluation of reaction time to audio/ visual signal. Results. In relation to the reaction time as overall model, the difference between examinees with different length of heroin abuse can be found on the marginal level of significance (F=1.69; df=12; p=0.07. In visual modality, with the increase of length of heroin abuse leads to a significant prolongation of simple (the first visual sign: F=3.29; df=2; p=0.04 and choice reaction time (the second visual sign: F=4.97; df=2; p=0.00; the third visual sign: F=3.08; df=2; p=0.05. Longer heroin consumption also leads to the prolongation of the simple (the first auditory task: F=3.41; df=2; p=0.04 and the complex auditory reaction time (the second auditory task: F=5.67; df=2; p=0.01; the third auditory task: F=6.42; df=2; p=0.00. Conclusion. Heroin abuse leads to the prolongation of both simple and choice reaction time in visual as well as auditory modality. The average daily dose of opiates was the most important predictor of the abovementioned cognitive dysfunction.

Prevalence and correlates of fentanyl-contaminated heroin exposure among young adults who use prescription opioids non-medically.

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Macmadu, Alexandria; Carroll, Jennifer J; Hadland, Scott E; Green, Traci C; Marshall, Brandon D L

2017-05-01

The rate of overdose deaths caused by fentanyl-contaminated heroin (FCH) use is increasing rapidly in the United States. We examined risk factors for exposure to FCH and experiences with FCH use among young adult non-medical prescription opioids (NMPO) users. We analyzed data from the Rhode Island Young Adult Prescription Drug Study (RAPiDS), which enrolled young adults aged 18 to 29 reporting prior 30day NMPO use between January 2015 and February 2016. Participants completed questionnaires ascertaining drug use patterns and risk behaviors, including FCH exposure. Logistic regression was used to assess factors associated with known or suspected FCH exposure. Of 199 participants, the median age was 25 (IQR: 22, 27), 130 (65.3%) were male, and 122 (61.3%) were of White, non-Hispanic race/ethnicity. In total, 22 (11%) reported known or suspected FCH exposure in the prior six months. Several drug use patterns and risk behaviors were associated with FCH exposure, including: regular heroin and cocaine use; diverted pharmaceutical fentanyl use in the prior six months; NMPO use to avoid withdrawal symptoms; longer duration of NMPO use; regular injection drug use; and prior overdose (all pfentanyl prior to last use, 59% reported that FCH provides a better high, and all recognized that fentanyl increases overdose risk. Exposure to fentanyl-contaminated heroin is an emerging trend among young adult NMPO users in Rhode Island. Overdose prevention programs addressing FCH use are urgently needed. Copyright © 2017 Elsevier Ltd. All rights reserved.

Neuroreceptor and its transporters imaging by PET and SPECT in heroin addiction

International Nuclear Information System (INIS)

Yuan Jie; Liu Xingdang; Han Mei

2013-01-01

Heroin abuse can cause prominent hazardous effects,including the collapse of social,economic status and health. The research of heroin addiction mechanism has got some progress, but the neurotransmitter and receptor mechanism are still not clear. This review discussed potential neurobiology mechanisms of heroin addiction, including opioid receptor, dopamine receptors and dopamine transporters in different brain areas when exposed to heroin and the application of PET and SPECT imaging of Neuroreceptor and its transporters in heroin addiction research. (authors)

Toxic spongiform leucoencephalopathy after inhaling heroin vapour

International Nuclear Information System (INIS)

Weber, W.; Henkes, H.; Kuehne, D.; Moeller, P.; Bade, K.

1998-01-01

This is a report of clinical, CT and MRI findings in a patient with toxic spongiform leucoencephalopathy after heroin ingestion. The disease is observed in drug addicts who inhale pre-heated heroin. The clinical onset, which usually occurs some days or even longer after the last heroin consumption, is characterized by a cerebellar syndrome. The cerebellar hemispheres, the cerebellar and cerebral peduncles and the pyramidal tract may be affected. Spongiform demyelination is the morphological substrate of the lesions, which are not contrast enhancing, hypodense on CT and hyperintense on T2-weighted MRI. The frequently perfect symmetry of the affection of functional systems points to a toxic and/or metabolic pathophysiological mechanism. (orig.)

Population pharmacokinetics of heroin and its major metabolites

NARCIS (Netherlands)

Rook, Elisabeth J.; Huitema, Alwin D. R.; van den Brink, Wim; van Ree, Jan M.; Beijnen, Jos H.

2006-01-01

BACKGROUND: In several European countries and in Canada, clinical trials are being conducted in which heroin-addicted patients are treated with pharmaceutically prepared heroin in order to reduce the destructive behaviour that is so often associated with this drug. OBJECTIVE: To develop an

Pharmacokinetics and pharmacokinetic variability of heroin and its metabolites: review of the literature

NARCIS (Netherlands)

Rook, Elisabeth J.; Huitema, Alwin D. R.; van den Brink, Wim; van Ree, Jan M.; Beijnen, Jos H.

2006-01-01

This article reviews the pharmacokinetics of heroin after intravenous, oral, intranasal, intramuscular and rectal application and after inhalation in humans, with a special focus on heroin maintenance therapy in heroin dependent patients. In heroin maintenance therapy high doses pharmaceutically

Matching of treatment-resistant heroin-dependent patients to medical prescription of heroin or oral methadone treatment: results from two randomized controlled trials

NARCIS (Netherlands)

Blanken, Peter; Hendriks, Vincent M.; Koeter, Maarten W. J.; van Ree, Jan M.; van den Brink, Wim

2005-01-01

AIMS: To investigate which baseline patient characteristics of treatment-resistant heroin addicts differentially predicted treatment response to medical heroin prescription compared to standard methadone maintenance treatment. DESIGN: Two open-label randomized controlled trials; pooled data.

[Severe candidiasis in heroin addicts].

Science.gov (United States)

Badillet, G; Puissant, A; Colliard, H

1984-01-01

Seven cases of severe candida infection in heroin addicts are reported. The principal features of this condition which arose in 1980, apparently due to a particular quality of heroin, are described, Candida albicans was the only pathogenic agent isolated from mainly scalp nodular and pustular lesions. These cutaneous lesions were associated in half the cases with ocular lesions, which sometimes had a poor prognosis despite active therapy. Osteo-articular complications were less common. Ketoconazole therapy alone gave good results in this series. The precise reasons for this dissemination of Candida albicans and for these localisations are still not clearly understood.

Toxic spongiform leucoencephalopathy after inhaling heroin vapour

Energy Technology Data Exchange (ETDEWEB)

Weber, W.; Henkes, H.; Kuehne, D. [Klinik fuer Allgemeine Roentgendiagnostik und Neuroradiologie, Alfried-Krupp-Krankenhaus, Alfried Krupp Strasse 21, D-45117, Essen (Germany); Moeller, P.; Bade, K. [Neurologische Klinik, Knappschafts-Krankenhaus, D-45657 Recklinghausen (Germany)

1998-06-02

This is a report of clinical, CT and MRI findings in a patient with toxic spongiform leucoencephalopathy after heroin ingestion. The disease is observed in drug addicts who inhale pre-heated heroin. The clinical onset, which usually occurs some days or even longer after the last heroin consumption, is characterized by a cerebellar syndrome. The cerebellar hemispheres, the cerebellar and cerebral peduncles and the pyramidal tract may be affected. Spongiform demyelination is the morphological substrate of the lesions, which are not contrast enhancing, hypodense on CT and hyperintense on T2-weighted MRI. The frequently perfect symmetry of the affection of functional systems points to a toxic and/or metabolic pathophysiological mechanism. (orig.) With 2 figs., 2 tabs., 26 refs.

Drug use trajectory patterns among older drug users

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Tyndall B

2011-05-01

Full Text Available Miriam Boeri, Thor Whalen, Benjamin Tyndall, Ellen BallardKennesaw State University, Department of Sociology and Criminal Justice, Kennesaw GA, USAAbstract: To better understand patterns of drug use trajectories over time, it is essential to have standard measures of change. Our goal here is to introduce measures we developed to quantify change in drug use behaviors. A secondary goal is to provide effective visualizations of these trajectories for applied use. We analyzed data from a sample of 92 older drug users (ages 45 to 65 to identify transition patterns in drug use trajectories across the life course. Data were collected for every year since birth using a mixed methods design. The community-drawn sample of active and former users were 40% female, 50% African American, and 60% reporting some college or greater. Their life histories provided retrospective longitudinal data on the diversity of paths taken throughout the life course and changes in drug use patterns that occurred over time. Bayesian analysis was used to model drug trajectories displayed by innovative computer graphics. The mathematical techniques and visualizations presented here provide the foundation for future models using Bayesian analysis. In this paper we introduce the concepts of transition counts, transition rates and relapse/remission rates, and we describe how these measures can help us better understand drug use trajectories. Depicted through these visual tools, measurements of discontinuous patterns provide a succinct view of individual drug use trajectories. The measures we use on drug use data will be further developed to incorporate contextual influences on the drug trajectory and build predictive models that inform rehabilitation efforts for drug users. Although the measures developed here were conceived to better examine drug use trajectories, the applications of these measures can be used with other longitudinal datasets.Keywords: drug use, trajectory patterns

Heroin: Statistics and Trends

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... Alcohol Club Drugs Cocaine Fentanyl Hallucinogens Inhalants Heroin Marijuana MDMA (Ecstasy/Molly) Methamphetamine Opioids Over-the-Counter Medicines Prescription Medicines Steroids (Anabolic) Synthetic Cannabinoids (K2/Spice) Synthetic Cathinones (Bath Salts) Tobacco/ ...

Effect of heroin-conditioned auditory stimuli on cerebral functional activity in rats

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Trusk, T.C.; Stein, E.A.

1988-08-01

Cerebral functional activity was measured as changes in distribution of the free fatty acid (1-14C)octanoate in autoradiograms obtained from rats during brief presentation of a tone previously paired to infusions of heroin or saline. Rats were trained in groups of three consisting of one heroin self-administering animal and two animals receiving yoked infusions of heroin or saline. Behavioral experiments in separate groups of rats demonstrated that these training parameters imparts secondary reinforcing properties to the tone for animals self-administering heroin while the tone remains behaviorally neutral in yoked-infusion animals. The optical densities of thirty-seven brain regions were normalized to a relative index for comparisons between groups. Previous pairing of the tone to heroin infusions irrespective of behavior (yoked-heroin vs. yoked-saline groups) produced functional activity changes in fifteen brain areas. In addition, nineteen regional differences in octanoate labeling density were evident when comparison was made between animals previously trained to self-administer heroin to those receiving yoked-heroin infusions, while twelve differences were noted when comparisons were made between the yoked vehicle and self administration group. These functional activity changes are presumed related to the secondary reinforcing capacity of the tone acquired by association with heroin, and may identify neural substrates involved in auditory signalled conditioning of positive reinforcement to opiates.

Effect of heroin-conditioned auditory stimuli on cerebral functional activity in rats

International Nuclear Information System (INIS)

Trusk, T.C.; Stein, E.A.

1988-01-01

Cerebral functional activity was measured as changes in distribution of the free fatty acid [1-14C]octanoate in autoradiograms obtained from rats during brief presentation of a tone previously paired to infusions of heroin or saline. Rats were trained in groups of three consisting of one heroin self-administering animal and two animals receiving yoked infusions of heroin or saline. Behavioral experiments in separate groups of rats demonstrated that these training parameters imparts secondary reinforcing properties to the tone for animals self-administering heroin while the tone remains behaviorally neutral in yoked-infusion animals. The optical densities of thirty-seven brain regions were normalized to a relative index for comparisons between groups. Previous pairing of the tone to heroin infusions irrespective of behavior (yoked-heroin vs. yoked-saline groups) produced functional activity changes in fifteen brain areas. In addition, nineteen regional differences in octanoate labeling density were evident when comparison was made between animals previously trained to self-administer heroin to those receiving yoked-heroin infusions, while twelve differences were noted when comparisons were made between the yoked vehicle and self administration group. These functional activity changes are presumed related to the secondary reinforcing capacity of the tone acquired by association with heroin, and may identify neural substrates involved in auditory signalled conditioning of positive reinforcement to opiates

Determinants of user acceptance of a specific social platform for older adults: An empirical examination of user interface characteristics and behavioral intention.

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Tsai-Hsuan Tsai

Full Text Available The use of the Internet and social applications has many benefits for the elderly, but numerous investigations have shown that the elderly do not perceive online social networks as a friendly social environment. Therefore, TreeIt, a social application specifically designed for the elderly, was developed for this study. In the TreeIt application, seven mechanisms promoting social interaction were designed to allow older adults to use social networking sites (SNSs to increase social connection, maintain the intensity of social connections and strengthen social experience. This study's main objective was to investigate how user interface design affects older people's intention and attitude related to using SNSs. Fourteen user interface evaluation heuristics proposed by Zhang et al. were adopted as the criteria to assess user interface usability and further grouped into three categories: system support, user interface design and navigation. The technology acceptance model was adopted to assess older people's intention and attitude related to using SNSs. One hundred and one elderly persons were enrolled in this study as subjects, and the results showed that all of the hypotheses proposed in this study were valid: system support and perceived usefulness had a significant effect on behavioral intention; user interface design and perceived ease of use were positively correlated with perceived usefulness; and navigation exerted an influence on perceived ease of use. The results of this study are valuable for the future development of social applications for the elderly.

Determinants of user acceptance of a specific social platform for older adults: An empirical examination of user interface characteristics and behavioral intention.

Science.gov (United States)

Tsai, Tsai-Hsuan; Chang, Hsien-Tsung; Chen, Yan-Jiun; Chang, Yung-Sheng

2017-01-01

The use of the Internet and social applications has many benefits for the elderly, but numerous investigations have shown that the elderly do not perceive online social networks as a friendly social environment. Therefore, TreeIt, a social application specifically designed for the elderly, was developed for this study. In the TreeIt application, seven mechanisms promoting social interaction were designed to allow older adults to use social networking sites (SNSs) to increase social connection, maintain the intensity of social connections and strengthen social experience. This study's main objective was to investigate how user interface design affects older people's intention and attitude related to using SNSs. Fourteen user interface evaluation heuristics proposed by Zhang et al. were adopted as the criteria to assess user interface usability and further grouped into three categories: system support, user interface design and navigation. The technology acceptance model was adopted to assess older people's intention and attitude related to using SNSs. One hundred and one elderly persons were enrolled in this study as subjects, and the results showed that all of the hypotheses proposed in this study were valid: system support and perceived usefulness had a significant effect on behavioral intention; user interface design and perceived ease of use were positively correlated with perceived usefulness; and navigation exerted an influence on perceived ease of use. The results of this study are valuable for the future development of social applications for the elderly.

Determinants of user acceptance of a specific social platform for older adults: An empirical examination of user interface characteristics and behavioral intention

Science.gov (United States)

Chang, Hsien-Tsung; Chen, Yan-Jiun; Chang, Yung-Sheng

2017-01-01

The use of the Internet and social applications has many benefits for the elderly, but numerous investigations have shown that the elderly do not perceive online social networks as a friendly social environment. Therefore, TreeIt, a social application specifically designed for the elderly, was developed for this study. In the TreeIt application, seven mechanisms promoting social interaction were designed to allow older adults to use social networking sites (SNSs) to increase social connection, maintain the intensity of social connections and strengthen social experience. This study’s main objective was to investigate how user interface design affects older people’s intention and attitude related to using SNSs. Fourteen user interface evaluation heuristics proposed by Zhang et al. were adopted as the criteria to assess user interface usability and further grouped into three categories: system support, user interface design and navigation. The technology acceptance model was adopted to assess older people’s intention and attitude related to using SNSs. One hundred and one elderly persons were enrolled in this study as subjects, and the results showed that all of the hypotheses proposed in this study were valid: system support and perceived usefulness had a significant effect on behavioral intention; user interface design and perceived ease of use were positively correlated with perceived usefulness; and navigation exerted an influence on perceived ease of use. The results of this study are valuable for the future development of social applications for the elderly. PMID:28837566

Comparing the impact of socio-demographic factors associated with traffic injury among older road users and the general population in Japan

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Nagata Takashi

2012-10-01

Full Text Available Abstract Background The increasing number of older road users represents a public health issue because older individuals are more susceptible to traffic injury and mortality than the general population. This study investigated the association between socio-demographic factors and traffic injury and traffic mortality for the general population and among older road users in Japan. Methods An ecological study was conducted using national data in Japan. Multivariate regression methods were applied to investigate the association of traffic injury and traffic mortality for the general population and among older road users with significant demographic, economic, road traffic, and medical/cultural factors. Results Income per capita, total road length, and alcohol consumption per person were significantly associated with traffic injury and traffic mortality both for the general population and among older road users in Japan. Income per capita and alcohol consumption per person were negatively associated with traffic mortality for both groups. Meanwhile, for both groups, income per capita was positively associated with traffic injury, while total road length and alcohol consumption per person were negatively associated with traffic injury. Conclusions The effects of socio-demographic factors on traffic injury and traffic mortality in Japan were similar for both the general population and older road users. The study results suggest that injury preventive measures designed for the general population will be beneficial also for older road users in Japan.

Using medico-legal data to investigate fatal older road user crash circumstances and risk factors.

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Koppel, Sjaan; Bugeja, Lyndal; Smith, Daisy; Lamb, Ashne; Dwyer, Jeremy; Fitzharris, Michael; Newstead, Stuart; D'Elia, Angelo; Charlton, Judith

2018-02-17

This study used medico-legal data to investigate fatal older road user (ORU, aged 65 years and older) crash circumstances and risk factors relating to 4 key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity. The Coroners' Court of Victoria's (CCOV) Surveillance Database was searched to identify and describe the frequency and rate per 100,000 population of fatal ORU crashes in the Australian state of Victoria for 2013-2014. Information relating to the deceased ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed. One hundred and thirty-eight unintentional fatal ORU crashes were identified in the CCOV Surveillance Database. Of these fatal ORU crashes, most involved older drivers (44%), followed by older pedestrians (32%), older passengers (17%), older pedal cyclists (4%), older motorcyclists (1%), and older mobility scooter users (1%). The average annual rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI], 6.0-10.2). In terms of the crash characteristics and circumstances, most fatal ORU crashes involved a counterpart (98%), of which the majority were passenger cars (50%) or fixed/stationary objects (25%), including trees (46%) or embankments (23%). In addition, most fatal ORU crashes occurred close to home (73%), on-road (87%), on roads that were paved (94%), on roads with light traffic volume (37%), and during low-risk conditions: between 12 p.m. and 6 p.m. (44%), on weekdays (80%), during daylight (75%), and under dry/clear conditions (81%). Road user (RU) error was identified by the police and/or the coroner for the majority of fatal crashes (55%), with a significant proportion of deceased ORUs deemed to have failed to yield (54%) or misjudged (41%). RU error was the most significant factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the

Older Cancer Patients’ User Experiences With Web-Based Health Information Tools : A Think Aloud Study

NARCIS (Netherlands)

Bolle, S.; Romijn, G.; Smets, E.M.A.; Loos, E.F.; Kunneman, M.; van Weert, J.C.M.

Background: Health information is increasingly presented on the Internet. Several Web design guidelines for older Web users have been proposed; however, these guidelines are often not applied in website development. Furthermore, although we know that older individuals use the Internet to search for

Older Cancer Patients' User Experiences With Web-Based Health Information Tools: A Think-Aloud Study

NARCIS (Netherlands)

Bolle, Sifra; Romijn, Geke; Smets, Ellen M. A.; Loos, Eugene F.; Kunneman, Marleen; van Weert, Julia C. M.

2016-01-01

Health information is increasingly presented on the Internet. Several Web design guidelines for older Web users have been proposed; however, these guidelines are often not applied in website development. Furthermore, although we know that older individuals use the Internet to search for health

Pathological and MRI study on experimental heroin-induced brain damage in rats

International Nuclear Information System (INIS)

Long Yu; Kong Xiangquan; Xu Haibo; Liu Dingxi; Yuan Ren; Yu Qun; Xiong Yin; Deng Xianbo

2005-01-01

Objective: To study the pathological characteristics of the heroin-induced brain damage in rats, and to assess the diagnostic value of MRI. Methods: A total of 40 adult Wistar rats were studied, 32 rats were used for injecting heroin as heroin group and 8 were used for injecting saline as control group. The heroin dependent rat model was established by administering heroin (ip) in the ascending dosage schedule (0.5 mg/kg), three times a day (at 8:00, 12:00, and 18:00). The control group was established by the same way by injection with saline. The withdrawal scores were evaluated with imp roved criterion in order to estimate the degree of addiction after administering naloxone. Based on the rat model of heroin dependence, the rat model of heroin-induced brain damage was established by the same way with increasing heroin dosage everyday. Two groups were examined by using MRI, light microscope, and electron microscope, respectively in different heroin accumulated dosage (918, 1580, 2686, 3064, 4336, and 4336 mg/kg withdrawal after 2 weeks). Results: There was statistically significant difference (t=9.737, P<0.01) of the withdrawal scores between the heroin dependent group and the saline group (23.0 ± 4.4 and 1.4 ± 0.5, respectively). It suggested that the heroin dependent rat model be established successfully. In different accumulated dosage ( from 1580 mg/kg to 4336 mg/kg), there were degeneration and death of nerve cells in cerebrum and cerebellum of heroin intoxicated rats, and it suggested that the rat model of heroin-induced brain damage was established successfully. The light microscope and electron microscope features of heroin-induced brain damage in rats included: (1) The nerve cells of cerebral cortex degenerated and died. According to the heroin accumulated dosage, there were statistically significant difference of the nerve cell deaths between 4336 mg/kg group and 1580 mg/kg group or control group (P=0.024 and P=0.032, respectively); (2) The main

Exploring heroin consumption

NARCIS (Netherlands)

Trautmann, Franz; Frijns, Tom

2013-01-01

In this report we explore some aspects of heroin consumption, using the data we collected through the face-to-face interviews and comparing our findings with data from other research and monitoring sources. We focus on Italy, the Netherlands and England, the three sample Member States where we have

Heroin and fentanyl overdoses in Kentucky: Epidemiology and surveillance.

Science.gov (United States)

Slavova, Svetla; Costich, Julia F; Bunn, Terry L; Luu, Huong; Singleton, Michael; Hargrove, Sarah L; Triplett, Jeremy S; Quesinberry, Dana; Ralston, William; Ingram, Van

2017-08-01

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; 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. Copyright © 2017 Elsevier B.V. All rights reserved.

The role of ethanol in heroin deaths.

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Levine, B; Green, D; Smialek, J E

1995-09-01

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.

Effects of heroin on rat prosocial behavior.

Science.gov (United States)

Tomek, Seven E; Stegmann, Gabriela M; Olive, M Foster

2018-05-04

Opioid use disorders are characterized in part by impairments in social functioning. Previous research indicates that laboratory rats, which are frequently used as animal models of addiction-related behaviors, are capable of prosocial behavior. For example, under normal conditions, when a 'free' rat is placed in the vicinity of rat trapped in a plastic restrainer, the rat will release or 'rescue' the other rat from confinement. The present study was conducted to determine the effects of heroin on prosocial behavior in rats. For 2 weeks, rats were given the opportunity to rescue their cagemate from confinement, and the occurrence of and latency to free the confined rat was recorded. After baseline rescuing behavior was established, rats were randomly selected to self-administer heroin (0.06 mg/kg/infusion i.v.) or sucrose pellets (orally) for 14 days. Next, rats were retested for rescuing behavior once daily for 3 days, during which they were provided with a choice between freeing the trapped cagemate and continuing to self-administer their respective reinforcer. Our results indicate that rats self-administering sucrose continued to rescue their cagemate, whereas heroin rats chose to self-administer heroin and not rescue their cagemate. These findings suggest that rats with a history of heroin self-administration show deficits in prosocial behavior, consistent with specific diagnostic criteria for opioid use disorder. Behavioral paradigms providing a choice between engaging in prosocial behavior and continuing drug use may be useful in modeling and investigating the neural basis of social functioning deficits in opioid addiction. © 2018 Society for the Study of Addiction.

The effects of piracetam on heroin-induced CPP and neuronal apoptosis in rats.

Science.gov (United States)

Xu, Peng; Li, Min; Bai, Yanping; Lu, Wei; Ling, Xiaomei; Li, Weidong

2015-05-01

Piracetam is a positive allosteric modulator of the AMPA receptor that has been used in the treatment of cognitive disorders for decades. Recent surveys and drug analyses have demonstrated that a heroin mixture adulterated with piracetam has spread rapidly in heroin addicts in China, but its addictive properties and the damage it causes to the central neural system are currently unknown. The effect of piracetam on the reward properties of heroin was assessed by conditioned place preference (CPP). Electron microscopy and radioimmunoassay were used to compare the effects of heroin mixed with equivalent piracetam (HP) and heroin alone on neuronal apoptosis and the levels of beta-endorphin (β-EP) in different brain subregions within the corticolimbic system, respectively. Piracetam significantly enhanced heroin-induced CPP expression while piracetam itself didn't induce CPP. Morphological observations showed that HP-treated rats had less neuronal apoptosis than heroin-treated group. Interestingly, HP normalized the levels of β-EP in the medial prefrontal cortex (mPFC) and core of the nucleus accumbens (AcbC) subregions, in where heroin-treated rats showed decreased levels of β-EP. These results indicate that piracetam potentiate the heroin-induced CPP and protect neurons from heroin-induced apoptosis. The protective role of HP might be related to the restoration of β-EP levels by piracetam. Our findings may provide a potential interpretation for the growing trend of HP abuse in addicts in China. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Inclusion of service robots in the daily lives of frail older users: A step-by-step definition procedure on users' requirements.

Science.gov (United States)

García-Soler, Álvaro; Facal, David; Díaz-Orueta, Unai; Pigini, Lucia; Blasi, Lorenzo; Qiu, Renxi

2018-01-01

The implications for the inclusion of robots in the daily lives of frail older adults, especially in relation to these population needs, have not been extensively studied. The "Multi-Role Shadow Robotic System for Independent Living" (SRS) project has developed a remotely-controlled, semi-autonomous robotic system to be used in domestic environments. The objective of this paper is to document the iterative procedure used to identify, select and prioritize user requirements. Seventy-four requirements were identified by means of focus groups, individual interviews and scenario-based interviews. The list of user requirements, ordered according to impact, number and transnational criteria, revealed a high number of requirements related to basic and instrumental activities of daily living, cognitive and social support and monitorization, and also involving privacy, safety and adaptation issues. Analysing and understanding older users' perceptions and needs when interacting with technological devices adds value to assistive technology and ensures that the systems address currently unmet needs. Copyright © 2017 Elsevier B.V. All rights reserved.

Neural correlates of the severity of cocaine, heroin, alcohol, MDMA and cannabis use in polysubstance abusers: a resting-PET brain metabolism study.

Directory of Open Access Journals (Sweden)

Laura Moreno-López

Full Text Available INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Medical prescription of heroin to treatment resistant heroin addicts: two randomised controlled trials

NARCIS (Netherlands)

van den Brink, Wim; Hendriks, Vincent M.; Blanken, Peter; Koeter, Maarten W. J.; van Zwieten, Barbara J.; van Ree, Jan M.

2003-01-01

OBJECTIVE: To determine whether supervised medical prescription of heroin can successfully treat addicts who do not sufficiently benefit from methadone maintenance treatment. DESIGN: Two open label randomised controlled trials. SETTING: Methadone maintenance programmes in six cities in the

Historiography taking issue : Analyzing an experiment with heroin abusers

NARCIS (Netherlands)

Dehue, T.

2004-01-01

This article discusses the predicament of historians becoming part of the history they are investigating and illustrates the issue in a particular case. The case is that of the randomized controlled trial (RCT)-more specifically, its use for testing the effects of providing heroin to severe heroin

Imaging of chest disease due to intravenous heroin abuse

International Nuclear Information System (INIS)

Lian Xuhui; Chen Zhong; Ye Wenqin

2002-01-01

Objective: To study the imaging findings of the chest disease due to intravenous heroin abuse. Methods: Twenty-five cases of clinically confirmed chest disease due to intravenous heroin abuse were retrospectively analyzed. 25 cases had conventional X-ray film, 6 cases had CT scanning, and 6 cases had echocardiography scanning. Results: On X-ray and CT, the following signs were found: lung making manifold (n = 5), small patchy shadow (n = 15), pneumatocele (n = 16), small cavity (n = 16), small node (n = 7), pleural effusion (n = 8 ), pneumothorax (n = 2), hydropneumothorax (n = 6), pulmonary edema (n = 2), megacardia (n = 11), multiple-shaped lesion (n = 20). On echocardiography, tricuspid vegetation (n = 4) and tricuspid insufficiency (n = 4) were found. Conclusion: The X-ray and CT manifestations of chest inflammation due to intravenous heroin abuse are multiple. The multiple small cavities and pneumatoceles sign are of some value in the diagnosis of lung inflammation due to intravenous heroin abuse among young patients

Transnational cocaine and heroin flow networks in western Europe: A comparison.

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Chandra, Siddharth; Joba, Johnathan

2015-08-01

A comparison of the properties of drug flow networks for cocaine and heroin in a group of 17 western European countries is provided with the aim of understanding the implications of their similarities and differences for drug policy. Drug flow data for the cocaine and heroin networks were analyzed using the UCINET software package. Country-level characteristics including hub and authority scores, core and periphery membership, and centrality, and network-level characteristics including network density, the results of a triad census, and the final fitness of the core-periphery structure of the network, were computed and compared between the two networks. The cocaine network contains fewer path redundancies and a smaller, more tightly knit core than the heroin network. Authorities, hubs and countries central to the cocaine network tend to have higher hub, authority, and centrality scores than those in the heroin network. The core-periphery and hub-authority structures of the cocaine and heroin networks reflect the west-to-east and east-to-west patterns of flow of cocaine and heroin respectively across Europe. The key nodes in the cocaine and heroin networks are generally distinct from one another. The analysis of drug flow networks can reveal important structural features of trafficking networks that can be useful for the allocation of scarce drug control resources. The identification of authorities, hubs, network cores, and network-central nodes can suggest foci for the allocation of these resources. In the case of Europe, while some countries are important to both cocaine and heroin networks, different sets of countries occupy positions of prominence in the two networks. The distinct nature of the cocaine and heroin networks also suggests that a one-size-fits-all supply- and interdiction-focused policy may not work as well as an approach that takes into account the particular characteristics of each network. Copyright © 2015 Elsevier B.V. All rights reserved.

Older marijuana users' marijuana risk perceptions: associations with marijuana use patterns and marijuana and other substance use disorders.

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Choi, Namkee G; DiNitto, Diana M; Marti, C Nathan

2017-12-10

Compared to their non-using age peers, older marijuana users are known to have lower marijuana risk perceptions. We examined associations of older marijuana users' risk perceptions with their marijuana use patterns and substance use disorders. Data are from 2013 to 2015 National Survey of Drug Use and Health (N = 24,057 respondents aged 50+ years). Bivariate logistic regression was used to compare risk perceptions among never users, former users, and past-year users aged 50+ years. Multivariable logistic regression was used to test associations between risk perception and marijuana use status and between risk perception and marijuana use patterns. Among the total sample, former (AOR = 0.30, 95% CI = 0.27-0.32) and past-year (AOR = 0.05, 95% CI = 0.04-0.06) marijuana users had significantly lower odds of moderate/great risk perception (as opposed to no/slight risk perception) than never users. Among past-year users, odds of moderate/great risk perception were lower among those who used marijuana more frequently (AOR = 0.14, 95% CI = 0.07-0.28 for 300+ days of use compared to 1-11 days of use) and who reported any medical marijuana use (AOR = 0.27, 95% CI = 0.14-0.51). However, those who had marijuana use disorder were 3.5 times more likely to report moderate/great risk perception (AOR = 3.50, 95% CI = 1.62-7.58). Those who had a college education, had higher incomes, and resided in states with medical marijuana laws also had lower risk perceptions. Public health education on scientific evidence about marijuana's benefits and harms and age-appropriate treatment for older adults with substance use problems are needed. Research on risk perception formation using longitudinal data among older adults is also needed.

Dopamine D4 receptor polymorphism modulates cue-elicited heroin craving in Chinese.

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Shao, Chunhong; Li, Yifeng; Jiang, Kaida; Zhang, Dandan; Xu, Yifeng; Lin, Ling; Wang, Qiuying; Zhao, Min; Jin, Li

2006-06-01

Subjective craving, which contributes to the continuation of drug use in active abuser and the occurrence of relapse in detoxified abusers, is considered to be a central phenomenon in addiction. Dopamine pathway has been implicated in the mechanism underlying the cue-elicited craving for a variety of addictive substances. The objective of this study was to test the hypothesis that heroin addicts carrying D4 dopamine receptor gene (DRD4) variable number tandem repeat (VNTR) long type allele would have higher craving after exposure to a heroin-related cue. Craving was induced by a series of exposure to neutral and heroin-related cue and were assessed in a cohort of Chinese heroin abusers (n=420) recruited from the Voluntary Drug Dependence Treatment Center at Shanghai. Significantly stronger cue-elicited heroin craving was found in individuals carrying DRD4 VNTR long type allele than the non-carriers (F=31.040, pcue-elicited craving in heroin dependence, indicating DRD4 VNTR represents one of potential genetic risk factors for cue-induced craving.

Reduction in cerebral perfusion after heroin administration: a resting state arterial spin labeling study.

Directory of Open Access Journals (Sweden)

Niklaus Denier

Full Text Available Heroin dependence is a chronic relapsing brain disorder, characterized by the compulsion to seek and use heroin. Heroin itself has a strong potential to produce subjective experiences characterized by intense euphoria, relaxation and release from craving. The neurofunctional foundations of these perceived effects are not well known. In this study, we have used pharmacological magnetic resonance imaging (phMRI in 15 heroin-dependent patients from a stable heroin-assisted treatment program to observe the steady state effects of heroin (60 min after administration. Patients were scanned in a cross-over and placebo controlled design. They received an injection of their regular dose of heroin or saline (placebo before or after the scan. As phMRI method, we used a pulsed arterial spin labeling (ASL sequence based on a flow-sensitive alternating inversion recovery (FAIR spin labeling scheme combined with a single-shot 3D GRASE (gradient-spin echo readout on a 3 Tesla scanner. Analysis was performed with Statistical Parametric Mapping (SPM 8, using a general linear model for whole brain comparison between the heroin and placebo conditions. We found that compared to placebo, heroin was associated with reduced perfusion in the left anterior cingulate cortex (ACC, the left medial prefrontal cortex (mPFC and in the insula (both hemispheres. Analysis of extracted perfusion values indicate strong effect sizes and no gender related differences. Reduced perfusion in these brain areas may indicate self- and emotional regulation effects of heroin in maintenance treatment.

Dental Disease Prevalence among Methamphetamine and Poly-drug Users in an Urban Setting: A Pilot Study

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Brown, Carolyn; Krishnan, Sumathi; Hursh, Kevin; Yu, Michelle; Johnson, Paul; Page, Kimberly; Shiboski, Caroline H.

2013-01-01

Background/Objectives Rampant tooth decay has been reported among methamphetamine users. We investigated the prevalence of dental disease and associated risk behaviors in methamphetamine users compared to heroin users. Methods This pilot project is a cross-sectional study of an on-going cohort of young adult injection-drug users (IDUs) in San Francisco. An oral health questionnaire was administered by a research-assistant, and two dentists performed clinical examinations to record the Decayed-Missing-Filled-Surfaces (DMFS) index, presence of residual roots, the Simplified Oral Hygiene Index, and salivary hypofunction. Results The prevalence of dental disease among 58 young adult IDUs was strikingly high compared to the U.S. general population, however, there was no difference in the level of dental disease between the methamphetamine and heroin users in this study. The mean DMFS and number of decayed surfaces exceeded 28 in both groups. Conclusions While no difference in dental disease between methamphetamine and heroin users was detected, we found a high prevalence of caries and caries-associated behaviors in this sample of young adult IDUs. Clinical Implications Given the high level of dental disease observed in this population of young adult IDUs, one next step may be to explore the feasibility and effectiveness of providing low-intensity preventative measures (e.g., distribution of chlorhexidine rinses, xylitol gum, application of fluoride varnishes) through outreach workers. PMID:22942146

Comparison of the middle-aged and older users' adoption of mobile health services in China.

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Deng, Zhaohua; Mo, Xiuting; Liu, Shan

2014-03-01

Given the increasing number of older people, China has become an aging society. A mobile health service is a type of health informatics that provides personalized healthcare advice to those who require it, especially the older people and the middle-aged. However, few studies consider the adoption of mobile health services with regard to older and middle-aged users. This paper explored a research model based on the value attitude behavior model, theory of planned behavior, and four aging characteristic constructs to investigate how older and middle-aged citizens adopted mobile health services. The hypothesized model was empirically tested using data collected from a survey of 424 residents older than 40 years in China. Structural equation modeling was used to estimate the significance of the path coefficients. The findings revealed that (1) perceived value, attitude, perceived behavior control, and resistance to change can be used to predict intention to use mobile health services for the middle-aged group; (2) perceived value, attitude, perceived behavior control, technology anxiety, and self-actualization need positively affected the behavior intention of older users; and (3) subjective norm and perceived physical condition showed no significant effects on the behavior intention to use mobile health services for the two groups. The theoretical and practical implications and contributions of this study are then discussed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Exploring the Relationship Between Online Social Network Site Usage and the Impact on Quality of Life for Older and Younger Users: An Interaction Analysis.

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Quinn, Darren; Chen, Liming; Mulvenna, Maurice D; Bond, Raymond

2016-09-29

Analyzing content generated by users of social network sites has been shown to be beneficial across a number of disciplines. Such analysis has revealed the precise behavior of users that details their distinct patterns of engagement. An issue is evident whereby without direct engagement with end users, the reasoning for anomalies can only be the subject of conjecture. Furthermore, the impact of engaging in social network sites on quality of life is an area which has received little attention. Of particular interest is the impact of online social networking on older users, which is a demographic that is specifically vulnerable to social isolation. A review of the literature reveals a lack of knowledge concerning the impact of these technologies on such users and even less is known regarding how this impact varies across different demographics. The objective of our study was to analyze user interactions and to survey the attitudes of social network users directly, capturing data in four key areas: (1) functional usage, (2) behavioral patterns, (3) technology, and (4) quality of life. An online survey was constructed, comprising 32 questions. Each question directly related to a research question. Respondents were recruited through a variety of methods including email campaigns, Facebook advertisements, and promotion from related organizations. In total, data was collected from 919 users containing 446 younger and 473 older users. In comparison to younger users, a greater proportion of older users (289/473, 61.1% older vs 218/446, 48.9% younger) (PFacebook had either a positive or huge impact on their quality of life. Furthermore, a greater percentage of older users strongly agreed that Facebook strengthened their relationship with other people (64/473, 13.5% older vs 40/446, 9.0%younger) (P=.02). In comparison to younger users, a greater proportion of older users had more positive emotions-classified as slightly better or very good-during their engagement with

Cue-Elicited Craving in Heroin Addicts at Different Abstinent Time: An fMRI Pilot Study

OpenAIRE

Lou, Mingwu; Wang, Erlei; Shen, Yunxia; Wang, Jiping

2012-01-01

Objective: We evaluated the effect of short-term and long-term heroin abstinence on brain responses to heroin-related cues using functional magnetic resonance imaging (fMRI). Methods: Eighteen male heroin addicts following short-term abstinence and 19 male heroin addicts following long-term abstinence underwent fMRI scanning while viewing heroin-related and neutral images. Cue-elicited craving and withdrawal symptoms in the subjects were measured. Results: Following short-term abstinence, gre...

From “Kickeando las malias” (Kicking the Withdrawals) to “Staying clean”: The Impact of Cultural Values on Cessation of Injection Drug Use in Aging Mexican-American Men

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Flores, David V.; Torres, Luis R.; Torres-Vigil, Isabel; Bordnick, Patrick S.; Ren, Yi; Torres, Melissa I. M.; DeLeon, Freddy; Pericot-Valverde, Irene; Lopez, Tenee

2013-01-01

Drug use among older adults is a growing concern, particularly for the burgeoning Hispanic population. Older adults seeking drug treatment will double over the next decade to almost 6 million. Cultural factors influence drug use, and more specifically, Hispanic cultural values influence heroin use. This study explored Mexican-American injection drug users' adherence to traditional Hispanic cultural values and their impact on cessation. Ethnographic interviews endorsed contextualized influences of values on heroin use. Cultural values functioned dichotomously, influencing both initiation and cessation. Understanding the impact of cultural values on substance abuse is critical given the changing demographics in American society. PMID:24779493

From "Kickeando las malias" (kicking the withdrawals) to "Staying clean": The impact of cultural values on cessation of injection drug use in aging Mexican-American men.

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Flores, David V; Torres, Luis R; Torres-Vigil, Isabel; Bordnick, Patrick S; Ren, Yi; Torres, Melissa I M; Deleon, Freddie; Pericot-Valverde, Irene; Lopez, Tenee

2014-06-01

Drug use among older adults is a growing concern, particularly for the burgeoning Hispanic population. Older adults seeking drug treatment will double over the next decade to almost 6 million. Cultural factors influence drug use, and more specifically, Hispanic cultural values influence heroin use. This study explored Mexican-American injection drug users' adherence to traditional Hispanic cultural values and their impact on cessation. Ethnographic interviews endorsed contextualized influences of values on heroin use. Cultural values functioned dichotomously, influencing both initiation and cessation. Understanding the impact of cultural values on substance abuse is critical given the changing demographics in American society.

Prevalence and Correlates of Heroin-Methamphetamine Co-Injection Among Persons Who Inject Drugs in San Diego, California, and Tijuana, Baja California, Mexico.

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Meacham, Meredith C; Strathdee, Steffanie A; Rangel, Gudelia; Armenta, Richard F; Gaines, Tommi L; Garfein, Richard S

2016-09-01

Although persons who inject drugs (PWID) in the western United States-Mexico border region are known to inject both heroin and methamphetamine, little is known about the prevalence and risks associated with co-injection of this depressant-stimulant combination (also known as "goofball" and "Mexican speedball"). Baseline data from parallel cohort studies of PWID conducted concurrently in San Diego, CA, and Tijuana, Mexico, were used to estimate the prevalence and identify correlates of heroin-methamphetamine co-injection. PWID older than 18 years of age who reported injecting illicit drugs in the past month (N = 1,311; 32.7% female) were recruited in San Diego (n = 576) and Tijuana (n = 735) and completed interviewer-administered questionnaires. Bivariate and multivariable logistic regression analyses were used to identify correlates of heroin-meth-amphetamine co-injection. The prevalence of co-injection in the past 6 months was 39.9% overall and was higher in Tijuana (55.8%) than in San Diego (19.8%). In multivariable analyses adjusting for study cohort, distributive syringe sharing, purchasing syringes prefilled with drugs, finding it hard to get new syringes, reporting great or urgent need for treatment, and younger age were independently associated with co-injection. Past-6-month overdose was significantly associated with higher odds of co-injection in San Diego than in Tijuana. These findings indicate that heroin-methamphetamine co-injection is more common in Tijuana than in San Diego, yet this practice was only associated with overdose in San Diego. Heroin-methamphetamine coinjection was also independently associated with HIV-associated injection risk behaviors. Overdose-prevention interventions should address co-injection of depressants and stimulants.

Buprenorphine from detox and beyond: preliminary evaluation of a pilot program to increase heroin dependent individuals' engagement in a full continuum of care.

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Donovan, Dennis M; Knox, Patricia C; Skytta, Jenny A F; Blayney, Jessica A; DiCenzo, Jessica

2013-04-01

Absence of successful transition to post-detoxification treatment leads to high rates of relapse among detoxified heroin users. The present study evaluated a pilot buprenorphine treatment program (BTP). Heroin dependent individuals were inducted onto buprenorphine/naloxone in detox, maintained while transitioning through an intensive inpatient program (IIP), and gradually tapered off medication over 5 months of outpatient (OP) treatment. Compared to programmatic indicators of treatment engagement in the year prior to BTP implementation, referrals from detox to IIP, entry into and completion of IIP and subsequent OP, and days in OP treatment increased substantially. BTP completers, compared to non-completers, viewed abstinence as more difficult and as requiring more assistance to achieve, were less likely to be current cocaine and alcohol users or to have relapsed during the course of treatment. Although preliminary and in need of replication, initial adjunctive use of buprenorphine in an abstinence-based continuum of care may improve post-detoxification treatment entry, engagement, and completion. Copyright © 2013 Elsevier Inc. All rights reserved.

Clonidine improved laboratory-measured decision-making performance in abstinent heroin addicts.

Directory of Open Access Journals (Sweden)

Xiao-Li Zhang

Full Text Available BACKGROUND: Impulsivity refers to a wide spectrum of actions characterized by quick and nonplanned reactions to external and internal stimuli, without taking into account the possible negative consequences for the individual or others, and decision-making is one of the biologically dissociated impulsive behaviors. Changes in impulsivity may be associated with norepinephrine. Various populations of drug addicts all performed impulsive decision making, which is a key risk factor in drug dependence and relapse. The present study investigated the effects of clonidine, which decreased norepinephrine release through presynaptic alpha-2 receptor activation, on the impaired decision-making performance in abstinent heroin addicts. METHODOLOGY/PRINCIPAL FINDINGS: Decision-making performance was assessed using the original version of Iowa Gambling Task (IGT. Both heroin addicts and normal controls were randomly assigned to three groups receiving clonidine, 0, 75 µg or 150 µg orally under double blind conditions. Psychiatric symptoms, including anxiety, depression and impulsivity, were rated on standardized scales. Heroin addicts reported higher scores on the Barratt Impulsiveness Scale and exhibited impaired decision-making on the IGT. A single high-dose of clonidine improved the decision-making performance in heroin addicts. CONCLUSIONS/SIGNIFICANCE: Our results suggest clonidine may have a potential therapeutic role in heroin addicts by improving the impaired impulsive decision-making. The current findings have important implications for behavioral and pharmacological interventions targeting decision-making in heroin addiction.

Demographic trends among older cannabis users in the United States, 2006–13

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Han, Benjamin H.; Sherman, Scott; Mauro, Pia M.; Martins, Silvia S.; Rotenberg, James; Palamar, Joseph J.

2017-01-01

Background and Aims The ageing US population is providing an unprecedented population of older adults who use recreational drugs. We aimed to estimate the trends in the prevalence of past-year use of cannabis, describe the patterns and attitudes and determine correlates of cannabis use by adults age 50 years and older. Design Secondary analysis of the National Survey on Drug Use and Health survey from 2006 to 2013, a cross-sectional survey given to a nationally representative probability sample of populations living in US households. Setting USA. Participants A total of 47 140 survey respondents aged ≥ 50 years. Measures Estimates and trends of past-year use of cannabis. Findings The prevalence of past-year cannabis use among adults aged ≥ 50 increased significantly from 2006/07 to 2012/13, with a 57.8% relative increase for adults aged 50–64 (linear trend P aged ≥ 65 (linear trend P = 0.002). When combining data from 2006 to 2013, 6.9% of older cannabis users met criteria for cannabis abuse or dependence, and the majority of the sample reported perceiving no risk or slight risk associated with monthly cannabis use (85.3%) or weekly use (79%). Past-year users were more likely to be younger, male, non-Hispanic, not have multiple chronic conditions and use tobacco, alcohol or other drugs compared with non-past-year cannabis users. Conclusions The prevalence of cannabis use has increased significantly in recent years among US adults aged ≥ 50 years. PMID:27767235

Heroin-Related Compartment Syndrome: An Increasing Problem for Acute Care Surgeons.

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Benns, Matthew; Miller, Keith; Harbrecht, Brian; Bozeman, Matthew; Nash, Nicholas

2017-09-01

Heroin use has been increasing in the United States with the rate of heroin overdose nearly quadrupling in the last 10 years. Heroin overdose can occasionally lead to compartment syndrome (CS) because of extended periods of immobility and pressure tissue injury. Heroin-related compartment syndrome (HRCS) has previously been described, but has been limited to isolated case reports. We sought to examine our experience with HRCS in the climate of rising rates of heroin use among the general population. Medical records of all patients undergoing operative decompression for a CS at our academic medical center over a six-year period (2010-2015) were examined. Patient demographics, operation performed, and etiology were recorded. Cases of HRCS were identified, and clinical outcomes examined. A total of 213 patients undergoing fasciotomy were identified. Twenty-two of these patients had HRCS. Heroin was the second most common etiology of CS after trauma. Only one case of HRCS presented during the first three years of the study period, with the remaining 95 per cent of cases occurring within the last three years. The most common single location for HRCSs was gluteal (31.8%); 36 per cent of HRCS patients needed dialysis and 27 per cent suffered complications such as tissue loss. The incidence of HRCS has increased dramatically over the past several years and is now the second most common etiology for CS in our patient population. Patients with HRCS may present with severe manifestations of CS and different body areas affected.

The influence of heroin abuse on glutathione-dependent enzymes in human brain.

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Gutowicz, Marzena; Kaźmierczak, Beata; Barańczyk-Kuźma, Anna

2011-01-01

Heroin is an illicit narcotic abused by millions of people worldwide. In our earlier studies we have shown that heroin intoxication changes the antioxidant status in human brain. In the present work we continued our studies by estimating the effect of heroin abuse on reduced glutathione (GSH) and enzymes related to this cofactor, such as glutathione S-transferase detoxifying electrophilics (GST) and organic peroxides (as Se-independent glutathione peroxidase-GSHPx), and Se-dependent glutathione peroxidase (Se-GSHPx) specific mainly for hydrogen peroxide. Studies were conducted on human brains obtained from autopsy of 9 heroin abusers and 8 controls. The level of GSH and the activity of glutathione-related enzymes were determined spectrophotometrically. The expression of GST pi on mRNA and protein level was studied by RT-PCR and Western blotting, respectively. The results indicated significant increase of GST and GSHPx activities, unchanged Se-GSHPx activity, and decreased level of GSH in frontal, temporal, parietal and occipital cortex, brain stem, hippocampus, and white matter of heroin abusers. GST pi expression was increased on both mRNA and protein levels, however the increase was lower in brain stem than in other regions. Heroin affects all regions of human brain, and especially brain stem. Its intoxication leads to an increase of organic rather then inorganic peroxides in various brain regions. Glutathione S-transferase plays an important role during heroin intoxication, however its protective effect is lower in brain stem than in brain cortex or hippocampus. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Temporal and social contexts of heroin-using populations. An illustration of the snowball sampling technique.

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Kaplan, C D; Korf, D; Sterk, C

1987-09-01

Snowball sampling is a method that has been used in the social sciences to study sensitive topics, rare traits, personal networks, and social relationships. The method involves the selection of samples utilizing "insider" knowledge and referral chains among subjects who possess common traits that are of research interest. It is especially useful in generating samples for which clinical sampling frames may be difficult to obtain or are biased in some way. In this paper, snowball samples of heroin users in two Dutch cities have been analyzed for the purpose of providing descriptions and limited inferences about the temporal and social contexts of their lifestyles. Two distinct heroin-using populations have been discovered who are distinguished by their life cycle stage. Significant contextual explanations have been found involving the passage from adolescent peer group to criminal occupation, the functioning of network "knots" and "outcroppings," and the frequency of social contact. It is suggested that the snowball sampling method may have utility in studying the temporal and social contexts of other populations of clinical interest.

Neuronal representation of individual heroin choices in the orbitofrontal cortex.

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Guillem, Karine; Brenot, Viridiana; Durand, Audrey; Ahmed, Serge H

2018-05-01

Drug addiction is a harmful preference for drug use over and at the expense of other non-drug-related activities. We previously identified in the rat orbitofrontal cortex (OFC) a mechanism that influences individual preferences between cocaine use and an alternative action rewarded by a non-drug reward (i.e. sweet water). Here, we sought to test the generality of this mechanism to a different addictive drug, heroin. OFC neuronal activity was recorded while rats responded for heroin or the alternative non-drug reward separately or while they chose between the two. First, we found that heroin-rewarded and sweet water-rewarded actions were encoded by two non-overlapping OFC neuronal populations and that the relative size of the heroin population represented individual drug choices. Second, OFC neurons encoding the preferred action-which was the non-drug action in the large majority of individuals-progressively fired more than non-preferred action-coding neurons 1 second after the onset of choice trials and around 1 second before the preferred action was actually chosen, suggesting a pre-choice neuronal competition for action selection. Together with a previous study on cocaine choice, the present study on heroin choice reveals important commonalities in how OFC neurons encode individual drug choices and preferences across different classes of drugs. It also reveals some drug-specific differences in OFC encoding activity. Notably, the proportion of neurons that non-selectively encode both the drug and the non-drug reward was higher when the drug was heroin (present study) than when it was cocaine (previous study). We will discuss the potential functional significance of these commonalities and differences in OFC neuronal activity across different drugs for understanding drug choice. © 2017 Society for the Study of Addiction.

Criminal outcomes and costs of treatment services for injecting and non-injecting heroin users: evidence from a national prospective cohort survey.

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Healey, Andrew; Knapp, Martin; Marsden, John; Gossop, Michael; Stewart, Duncan

2003-07-01

To assess the incremental cost-effectiveness of drug addiction treatment programmes provided in the UK by the National Health Service and not-for-profit agencies in terms of crime-related outcomes. All costs and crime-related outcomes were implicitly evaluated relative to a 'no treatment' alternative. Longitudinal observational data on a national sample of heroin addicts referred to addiction treatment services throughout England were re-analysed. Predictions from a Poisson random-effects model were used to estimate the incremental effectiveness and cost-effectiveness of treatment programmes. Interaction variables were used to assess whether the injecting of heroin on entry to treatment had an impact on cost-effectiveness. The findings rejected the null hypothesis that increasing time in treatment (and therefore treatment cost) has no mean crime prevention effect on clients referred for community-based methadone treatment, treatment delivered within specialist drug dependency units and residential rehabilitation programmes (P reduction in treatment cost-effectiveness across all treatment programmes for clients who reported injecting drugs at treatment intake. Whilst the analyses did not include an evaluation of the effect of treatment programmes on client health and quality of life and stopped short of providing a social weighting for the predicted reduction in crimes, they do offer a useful starting point for establishing the cost-effectiveness of treating heroin addiction. The onus is on public decision-makers to decide whether the predicted reductions in crime are worth the opportunity costs of investing extra resources in a major expansion of treatment services.

Responsible and controlled use: Older cannabis users and harm reduction.

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Lau, Nicholas; Sales, Paloma; Averill, Sheigla; Murphy, Fiona; Sato, Sye-Ok; Murphy, Sheigla

2015-08-01

Cannabis use is becoming more accepted in mainstream society. In this paper, we use Zinberg's classic theoretical framework of drug, set, and setting to elucidate how older adult cannabis users managed health, social and legal risks in a context of normalized cannabis use. We present selected findings from our qualitative study of Baby Boomer (born 1946-1964) cannabis users in the San Francisco Bay Area. Data collection consisted of a recorded, in-depth life history interview followed by a questionnaire and health survey. Qualitative interviews were analyzed to discover the factors of cannabis harm reduction from the users' perspectives. Interviewees made harm reduction choices based on preferred cannabis derivatives and routes of administration, as well as why, when, where, and with whom to use. Most interviewees minimized cannabis-related harms so they could maintain social functioning in their everyday lives. Responsible and controlled use was described as moderation of quantity and frequency of cannabis used, using in appropriate settings, and respect for non-users. Users contributed to the normalization of cannabis use through normification. Participants followed rituals or cultural practices, characterized by sanctions that helped define "normal" or "acceptable" cannabis use. Users contributed to cannabis normalization through their harm reduction methods. These cultural practices may prove to be more effective than formal legal prohibitions in reducing cannabis-related harms. Findings also suggest that users with access to a regulated market (medical cannabis dispensaries) were better equipped to practice harm reduction. More research is needed on both cannabis culture and alternative routes of administration as harm reduction methods. Copyright © 2015 Elsevier B.V. All rights reserved.

The entry of Colombian-sourced heroin into the US market: the relationship between competition, price, and purity.

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Rosenblum, Daniel; Unick, George Jay; Ciccarone, Daniel

2014-01-01

There have been large structural changes in the US heroin market over the past 20 years. Colombian-sourced heroin entered the market in the mid-1990s, followed by a large fall in the price per pure gram and the exit of Asian heroin. By the 2000s, Colombian-sourced heroin had become a monopoly on the east coast and Mexican-sourced heroin a monopoly on the west coast with competition between the two in the middle. We estimate the relationship between these changes in competitive market structure on retail-level heroin price and purity. We find that the entry of Colombian-sourced heroin is associated with less competition and a lower price per pure gram of heroin at the national level. However, there is wide variation in changes in market concentration across the US. Controlling for the national fall in the heroin price, more competition in a region or city is associated with a lower price per pure gram. Copyright © 2013 Elsevier B.V. All rights reserved.

Altered economic decision-making in abstinent heroin addicts: Evidence from the ultimatum game.

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Hou, Yu; Zhao, Liyan; Yao, Qi; Ding, Lixiang

2016-08-03

The development and persistence of drug addiction has been suggested to involve decision-making deficits. The Ultimatum Game is a widely used economic decision-making paradigm that illustrates the tension between financial self-interest and fairness motives. The behavior of responders in the Ultimatum Game has been associated with emotional reactions and cognitive control abilities, both of which are dysregulated in drug addicts. In this study, we investigated whether this economic decision-making process that involves considerations of social norms is affected by heroin addiction. Heroin addicts (n=17) and demographically matched healthy control subjects (n=18) were recruited to play the part of responders in the Ultimatum Game, during which they decided to accept or reject the monetary offers proposed by strangers. The offers were manipulated by varying the stake sizes and fairness scales. The rejection rates of all of the offer categories, response times, fairness judgments, and impulsivity were compared between heroin addicts and healthy controls. Compared with healthy subjects, the rejection rates of most unfair offers in the Ultimatum Game were significantly higher under low-offer-size conditions among heroin addicts. In contrast, the most unfair offers were more likely to be accepted by heroin addicts in the high-offer-size condition than by healthy subjects. The ratings of unfairness were equal in both conditions although the rejection rates were different. Heroin addicts had higher scores on BIS attentional/cognitive impulsivity and non-planning impulsivity, but not in motor impulsivity. Rejection rates to most unfair offers under low-offer-size conditions significantly correlated with score on BIS non-planning impulsivity and total score of impulsivity. Heroin addicts differentially responded under different stake-level conditions in the Ultimatum Game, with emotional impulses in low-offer-size conditions and selfish motives in the face of high monetary

Botulism in injecting drug users, Dublin, Ireland, November-December 2008.

LENUS (Irish Health Repository)

Ward, M

2009-01-08

In November and December 2008, six cases of suspect wound botulism were reported in heroin injecting drug users, all residents in Dublin, Ireland. Patients were aged between 23-42 years of age; four cases were male; one patient died shortly after admission. The patients presented to four different hospitals across the city. Botulism in injecting drug users in Ireland was last reported in 2002.

The pro-heroin effects of anti-opium laws in Asia.

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Westermeyer, J

1976-09-01

Over 25 years anti-opium laws were enacted by three Asian governments in countries where opium use was traditional. Within months, heroin use suddenly appeared; and within a decade, heroin addiction surpassed opium addiction. The laws led to (1) increased price of narcotic drugs, (2) a heroin "industry," (3) corruption of the law enforcement system, and (4) major health problems involving parenteral drug use. The Asian experience indicates that antinarcotic laws can be effective only with careful preparations: (1) changing society's attitude toward the traditional drug from ambivalence to opposition; (2) mobilizing resources to treat and rehabilitate all addicts within a short period of time; (3) developing the social will to incarcerate all "recidivist" addicts for a prolonged period; and (4) preventing narcotic production or importation.

Risk factors associated with injection initiation among drug users in Northern Thailand

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Suriyanon Vinai

2006-03-01

Full Text Available Abstract Background Circumstances surrounding injection initiation have not been well addressed in many developing country contexts. This study aimed to identify demographic factors, sexual behaviors and drug use characteristics related to injection initiation among drug users in northern Thailand. Methods A cross-sectional survey was conducted among 2,231 drug users admitted to the Northern Drug Treatment Center in Mae Rim, Chiang Mai, Thailand, between February 1, 1999 and December 31, 2000. A multiple logistic regression was employed to identify the independent effects from potential risk factors of transition into injection. Results After controlling for other covariates, being 20 years of age or older, single, ever receiving education, urban residence, and having a history of smoking or incarceration were significantly associated with higher likelihood of injection initiation. Multiple sex partners and an experience of sex abuse were associated with an increased risk of injection initiation. Comparing to those whose first drug was opium, individuals using heroin as their initiation drug had greater risk of injection initiation; conversely, those taking amphetamine as their first drug had less risk of injection initiation. Age of drug initiation was negatively associated with the risk of injection initiation: the older the age of drug initiation, the less the risk of injection initiation. Conclusion Injection initiation was related to several demographic factors, sexual behaviors and drug use characteristics. Understanding these factors will benefit the design of approaches to successfully prevent or delay transition into injection.

Responsible and controlled use: Older cannabis users and harm reduction

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Lau, Nicholas; Sales, Paloma; Averill, Sheigla; Murphy, Fiona; Sato, Sye-Ok; Murphy, Sheigla

2015-01-01

Background Cannabis use is becoming more accepted in mainstream society. In this paper, we use Zinberg’s classic theoretical framework of drug, set, and setting to elucidate how older adult cannabis users managed health, social and legal risks in a context of normalized cannabis use. Methods We present selected findings from our qualitative study of Baby Boomer (born 1946–1964) cannabis users in the San Francisco Bay Area. Data collection consisted of a recorded, in-depth life history interview followed by a questionnaire and health survey. Qualitative interviews were analyzed to discover the factors of cannabis harm reduction from the users’ perspectives. Results Interviewees made harm reduction choices based on preferred cannabis derivatives and routes of administration, as well as why, when, where, and with whom to use. Most interviewees minimized cannabis-related harms so they could maintain social functioning in their everyday lives. Responsible and controlled use was described as moderation of quantity and frequency of cannabis used, using in appropriate settings, and respect for non-users. Users contributed to the normalization of cannabis use through normification. Conclusion Participants followed rituals or cultural practices, characterized by sanctions that helped define “normal” or “acceptable” cannabis use. Users contributed to cannabis normalization through their harm reduction methods. These cultural practices may prove to be more effective than formal legal prohibitions in reducing cannabis-related harms. Findings also suggest that users with access to a regulated market (medical cannabis dispensaries) were better equipped to practice harm reduction. More research is needed on both cannabis culture and alternative routes of administration as harm reduction methods. PMID:25911027

Neurophysiological evidence for abnormal cognitive processing of drug cues in heroin dependence

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Franken, Ingmar H. A.; Stam, Cornelis J.; Hendriks, Vincent M.; van den Brink, Wim

2003-01-01

Rationale. Recent studies provide evidence for specific aspects of cue processing in addictive disorders. Objective. The present study employs event related potentials (ERPs) to investigate heroin related visual information processing Methods. Neutral and heroin related pictures were presented to 19

Ultrastructural Changes in the Liver of Intravenous Heroin Addicts

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Goran Ilić

2010-02-01

Full Text Available The ultrastructural research has a decisive role in gathering the knowledge on the liver’s response to the influence of some drugs. The aim of the study was to perform an ultrastructurai analysis of the liver in chronic intravenous heroin addicts.The study involved the autopsy conducted on 40 bodies of intravenous heroin addicts and 10 control autopsies. The liver tissue was fixed in glutaraldehyde and moulded with epon for investigation purposes of ultrastructural changes. The analysis was performed using the method of transmission electron microscopy.In the group of intravenous heroin addicts, the liver autopsy samples showed degenerative vesicular and fat changes, chronic active and persistent hepatitis, cirrhosis, reduction in the amount of glycogen in hepatocytes, as well as the Kupffer cell’s dominant hypertrophy. Various changes occur in organelles, plasma membrane of hepatocytes and biliary channels as well as in the nucleus.The most important ultrastructural findings include: hyperplasia and hypertrophy of the smooth endoplasmic reticulum, which is histologically proven vesicular degeneration of hepatocyte occurring as a result of the increased synthesis of enzymes of smooth endoplasmic reticulum due to chronic intravenous heroin intake, and the presence of continuous basal membrane followed by transformation of the sinusoids into capillaries (in the cases of chronic active hepatitis and cirrhosis which leads to a disorder of microcirculation and further progress of cirrhosis.

Fatal methadone and heroin overdoses : Time trends in England and Wales

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Neeleman, J; Farrell, M

Study objective-Although the total number of self poisonings in England and Wales has dropped by 32%, the number involving methadone and/or heroin rose by 900% in 1974-92. Because of concern about the role of methadone in this increase, the part played by methadone and heroin in poisoning deaths in

Evaluation of the reinforcing and subjective effects of heroin in combination with dextromethorphan and quinidine

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Vosburg, Suzanne K.; Sullivan, Maria A.; Comer, Sandra D.

2015-01-01

Objective Studies have suggested that the N-methyl-d-aspartate antagonist dextromethorphan may be useful in the treatment of opioid dependence. Design This double-blinded, placebo-controlled inpatient study evaluated the effects of 0, 30, and 60 mg of dextromethorphan and quinidine (DMQ) on the reinforcing and subjective effects of heroin in recently detoxified heroin abusers. Participants Nine heroin-dependent participants were admitted and then detoxified from heroin over the course of several days. Interventions Participants were subsequently stabilized on 0, 30, or 60 mg of DMQ. Each dose of DMQ was administered for two consecutive weeks, and the effects of heroin (0, 12.5, and 50 mg) were studied under each DMQ maintenance dose condition. DMQ and heroin dose were administered in random order both within and between participants. Results Planned comparisons revealed statistically significant increases in progressive ratio breakpoint values and positive subjective ratings as a function of heroin dose. There were no consistent changes in any of the responses as a function of DMQ maintenance dose, other than a modest reduction in craving. Conclusions In summary, results from this study suggest that maintenance on dextromethorphan in combination with quinidine has a limited role in the treatment of opioid dependence. PMID:22320027

Heroin impurity profiling: trends throughout a decade of experimenting.

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Dams, R; Benijts, T; Lambert, W E; Massart, D L; De Leenheer, A P

2001-12-01

Heroin is still one of the most frequently abused drugs of today. All over the world, law enforcement agencies try to eradicate the illicit production and trafficking of this potent and highly addictive narcotic. To this aim, important information is provided by physical and chemical toxicological analysis of confiscated samples, with special attention for the identification and the quantification of minor components, such as the impurities related to the origin and manufacturing. By combining these data complex characterisations, i.e. impurity profiles, chemical signatures or fingerprints, can be obtained and used for comparative analysis. This review focuses on heroin impurity profiling during the 1990s, proclaimed by the United Nations as the 'Decade for Eradicating Drug Abuse'. Special attention will be given to the new trends in analytical techniques as well as in data handling strategies, so called chemometrics, to produce these profiles. The latter can be used in comparative analysis of seized heroin samples for tactical (batch-to-batch comparison) and strategic (origin determination) intelligence purposes.

A Cluster of Fentanyl-Laced Heroin Deaths in 2015 in Melbourne, Australia.

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Rodda, Luke N; Pilgrim, Jennifer L; Di Rago, Matthew; Crump, Kerryn; Gerostamoulos, Dimitri; Drummer, Olaf H

2017-05-01

The prevalence of opioid use in therapeutic and recreational settings has steadily increased throughout the western world. The addition of fentanyl into heroin products can produce potentially dangerous consequences, even to opioid tolerant individuals who may be unaware of such additions. Following an observed spike of heroin-fentanyl related deaths in Melbourne, Australia, a study was undertaken to determine the prevalence of these cases. All reportable deaths occurring in Victoria during 2015 and submitted to the toxicology laboratory were analysed using LC-MS-MS to confirm the combination of the heroin marker 6-acetylmorphine and/or morphine, and fentanyl. Over 4,000 coronial cases in 2015 underwent toxicological analysis for these drugs, there were nine cases identified that involved fentanyl-laced heroin. There was no specific mention of fentanyl use in any of these cases. All occurred within 2 months and in two distinct locations. The first four deaths occurred within 3 days of each other, in neighboring suburbs. The ages ranged from 25 to 57 years with an average of 40 and median of 37 years, and consisted of eight males and one female. The average and median femoral blood concentration of fentanyl was 18 and 20 ng/mL (range: fentanyl, which supported the likelihood of fentanyl-laced heroin. This is the first reported case series of fatalities involving heroin and fentanyl outside of North America in published literature. These findings may help inform public health and prevention strategies serving to decrease the potential for such fatalities in the future. © Crown copyright 2017.

Cost-effectiveness of buprenorphine and naltrexone treatments for heroin dependence in Malaysia.

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Ruger, Jennifer Prah; Chawarski, Marek; Mazlan, Mahmud; Ng, Nora; Schottenfeld, Richard

2012-01-01

To aid public health policymaking, we studied the cost-effectiveness of buprenorphine, naltrexone, and placebo interventions for heroin dependence in Malaysia. We estimated the cost-effectiveness ratios of three treatments for heroin dependence. We used a microcosting methodology to determine fixed, variable, and societal costs of each intervention. Cost data were collected from investigators, staff, and project records on the number and type of resources used and unit costs; societal costs for participants' time were estimated using Malaysia's minimum wage. Costs were estimated from a provider and societal perspective and reported in 2004 US dollars. Muar, Malaysia. 126 patients enrolled in a randomized, double-blind, placebo-controlled clinical trial in Malaysia (2003-2005) receiving counseling and buprenorphine, naltrexone, or placebo for treatment of heroin dependence. Primary outcome measures included days in treatment, maximum consecutive days of heroin abstinence, days to first heroin use, and days to heroin relapse. Secondary outcome measures included treatment retention, injection drug use, illicit opiate use, AIDS Risk Inventory total score, and drug risk and sex risk subscores. Buprenorphine was more effective and more costly than naltrexone for all primary and most secondary outcomes. Incremental cost-effectiveness ratios were below $50 for primary outcomes, mostly below $350 for secondary outcomes. Naltrexone was dominated by placebo for all secondary outcomes at almost all endpoints. Incremental treatment costs were driven mainly by medication costs, especially the price of buprenorphine. Buprenorphine appears to be a cost-effective alternative to naltrexone that might enhance economic productivity and reduce drug use over a longer term.

Cost-effectiveness of buprenorphine and naltrexone treatments for heroin dependence in Malaysia.

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Jennifer Prah Ruger

Full Text Available To aid public health policymaking, we studied the cost-effectiveness of buprenorphine, naltrexone, and placebo interventions for heroin dependence in Malaysia.We estimated the cost-effectiveness ratios of three treatments for heroin dependence. We used a microcosting methodology to determine fixed, variable, and societal costs of each intervention. Cost data were collected from investigators, staff, and project records on the number and type of resources used and unit costs; societal costs for participants' time were estimated using Malaysia's minimum wage. Costs were estimated from a provider and societal perspective and reported in 2004 US dollars.Muar, Malaysia.126 patients enrolled in a randomized, double-blind, placebo-controlled clinical trial in Malaysia (2003-2005 receiving counseling and buprenorphine, naltrexone, or placebo for treatment of heroin dependence.Primary outcome measures included days in treatment, maximum consecutive days of heroin abstinence, days to first heroin use, and days to heroin relapse. Secondary outcome measures included treatment retention, injection drug use, illicit opiate use, AIDS Risk Inventory total score, and drug risk and sex risk subscores.Buprenorphine was more effective and more costly than naltrexone for all primary and most secondary outcomes. Incremental cost-effectiveness ratios were below $50 for primary outcomes, mostly below $350 for secondary outcomes. Naltrexone was dominated by placebo for all secondary outcomes at almost all endpoints. Incremental treatment costs were driven mainly by medication costs, especially the price of buprenorphine.Buprenorphine appears to be a cost-effective alternative to naltrexone that might enhance economic productivity and reduce drug use over a longer term.

Older adults' perspectives on the process of becoming users of assistive technology: a qualitative systematic review and meta-synthesis.

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Larsen, Stina Meyer; Mortensen, Rikke Falgreen; Kristensen, Hanne Kaae; Hounsgaard, Lise

2018-04-22

To identify, synthesize, and evaluate existing literature concerning the process of becoming a user of assistive technology (AT). A systematic review and meta-synthesis were carried out. Five bibliographic databases (MEDLINE via PubMed, CINAHL, Web of Science, PsycINFO and SocINDEX) were systematically searched up to 13 th of March 2017, using two sets of search terms: (i) elderly and synonyms and (ii) assistive technology and similar words, and combined with a qualitative research filter. Articles were screened, read and critically assessed. The meta-synthesis was guided by Ricoeur's theory of interpretation. Seventeen out of 4645 articles were included. Five phases emerged relating to the process of becoming a user of AT: phase A: Evaluating need, phase B: Acknowledging need, phase C: Incorporating the AT into daily life, phase D: Using the AT, and phase E: Future use. Three transitions, describing factors essential to moving from one phase to the next, were identified; from phase A-B: Valued activities are threatened, from phase B-C: Obtaining the AT and from phase C-D: Trust in the AT. No transition was identified from phase D-E. The meta-synthesis led to a deeper understanding of the process of older adults becoming users of AT, by exploring findings across the included articles. The identified phases and transitions in the systematic review serve as an analytical framework for understanding the process from the older adult's perspective. This review advocates for using a client-centred approach throughout the entire delivery process. Implications for rehabilitation The process of the older adult becoming a user of AT involves an individualized time factor, and this supports the practice of individualized follow-up. The process of becoming a user of AT is closely related to self-image; healthcare professionals should support not only the use of AT but also the older adult's emotional adjustment to a new self-image. The process is highly influenced by the older

Does Chinese culture influence psychosocial factors for heroin use among young adolescents in China? A cross-sectional study.

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Liu, Hongjie; Li, Jian; Lu, Zhouping; Liu, Wei; Zhang, Zhiyong

2010-09-21

Little empirical research has examined how cultural factors influence psychosocial factors for heroin drug use. The objectives of the study were to investigate the levels of individualism and collectivism among young adolescents and how cultural differences were associated with the constructs of the Theory of Planned Behavior and other psychosocial factors for heroin drug use. A cross-sectional study was conducted among young adolescents in an HIV and heroin-stricken area in China. The Individualism-Collectivism Interpersonal Assessment Inventory (ICIAI) was used to measure cultural norms and values in the context of three social groups: family members, close friends, and classmates. A total of 220 boys and 241 girls were recruited and participated in an interview. Compared to boys, girls reported higher levels of the three specific-relationship ICIAIs, as well as higher levels of perceived behavioral control for heroin use, perceived peer control, and communication with parent about heroin use, but a lower level of favorable attitude towards heroin use. The levels of descriptive and subjective norms of heroin use were low in both girls and boys. Among boys, family ICIAI was positively associated with perceived behavioral control, and friend ICIAI was positively associated with perceived peer control and communication with parent. Among girls, family ICIAI was positively associated with perceived behavioral control and communication with parents about heroin use, but negatively with favorable attitudes to heroin use; friend ICIAI was positively associated with perceived peer control, and classmate ICIAI was negatively associated with favorable attitudes toward heroin use. This study documents that collectivistic aspects of Chinese culture may influence psychosocial factors for heroin use, although the patterns are varied by gender. Findings provide an empirical basis for the development of culturally competent intervention programs for heroin use intervention and

Does Chinese culture influence psychosocial factors for heroin use among young adolescents in China? A cross-sectional study

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Liu Wei

2010-09-01

Full Text Available Abstract Background Little empirical research has examined how cultural factors influence psychosocial factors for heroin drug use. The objectives of the study were to investigate the levels of individualism and collectivism among young adolescents and how cultural differences were associated with the constructs of the Theory of Planned Behavior and other psychosocial factors for heroin drug use. Methods A cross-sectional study was conducted among young adolescents in an HIV and heroin-stricken area in China. The Individualism-Collectivism Interpersonal Assessment Inventory (ICIAI was used to measure cultural norms and values in the context of three social groups: family members, close friends, and classmates. Results A total of 220 boys and 241 girls were recruited and participated in an interview. Compared to boys, girls reported higher levels of the three specific-relationship ICIAIs, as well as higher levels of perceived behavioral control for heroin use, perceived peer control, and communication with parent about heroin use, but a lower level of favorable attitude towards heroin use. The levels of descriptive and subjective norms of heroin use were low in both girls and boys. Among boys, family ICIAI was positively associated with perceived behavioral control, and friend ICIAI was positively associated with perceived peer control and communication with parent. Among girls, family ICIAI was positively associated with perceived behavioral control and communication with parents about heroin use, but negatively with favorable attitudes to heroin use; friend ICIAI was positively associated with perceived peer control, and classmate ICIAI was negatively associated with favorable attitudes toward heroin use. Conclusions This study documents that collectivistic aspects of Chinese culture may influence psychosocial factors for heroin use, although the patterns are varied by gender. Findings provide an empirical basis for the development of

Cue-elicited craving in heroin addicts at different abstinent time: an fMRI pilot study.

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Lou, Mingwu; Wang, Erlei; Shen, Yunxia; Wang, Jiping

2012-05-01

We evaluated the effect of short-term and long-term heroin abstinence on brain responses to heroin-related cues using functional magnetic resonance imaging (fMRI). Eighteen male heroin addicts following short-term abstinence and 19 male heroin addicts following long-term abstinence underwent fMRI scanning while viewing heroin-related and neutral images. Cue-elicited craving and withdrawal symptoms in the subjects were measured. Following short-term abstinence, greater activation was found in response to heroin cues compared to neutral cues in bilateral temporal, occipital, posterior cingulate, anterior cingulate, thalamus, cerebellum, and left hippocampus. In contrast, activations in bilateral temporal and occipital and deactivations in bilateral frontal, bilateral parietal, left posterior cingulate, insula, thalamus, dorsal striatum, and bilateral cerebellum were observed following long-term abstinence. Direct comparisons between conditions showed greater brain reactivity in response to smoking cues following short-term abstinence. In addition, short-term abstinence had more serious withdrawal symptoms than the long-term. The present findings indicate that compared to short-term, long-term abstinence manifests less serious withdrawal symptoms and significantly decreases neural responses to heroin-related cues in brain regions subserving visual sensory processing, attention, memory, and action planning. These findings suggest that long-term abstinence can decrease the salience of conditioned cues, thereby reducing the risk of relapses. The study's limitations are noted.

A rapid solution-based method for determining the affinity of heroin hapten-induced antibodies to heroin, its metabolites, and other opioids.

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Torres, Oscar B; Duval, Alexander J; Sulima, Agnieszka; Antoline, Joshua F G; Jacobson, Arthur E; Rice, Kenner C; Alving, Carl R; Matyas, Gary R

2018-06-01

We describe for the first time a method that utilizes microscale thermophoresis (MST) technology to determine polyclonal antibody affinities to small molecules. Using a novel type of heterologous MST, we have accurately measured a solution-based binding affinity of serum antibodies to heroin which was previously impossible with other currently available methods. Moreover, this mismatch approach (i.e., using a cross-reactive hapten tracer) has never been reported in the literature. When compared with equilibrium dialysis combined with ultra-performance liquid chromatography/tandem mass spectrometry (ED-UPLC/MS/MS), this novel MST method yields similar binding affinity values for polyclonal antibodies to the major heroin metabolites 6-AM and morphine. Additionally, we herein report the method of synthesis of this novel cross-reactive hapten, MorHap-acetamide-a useful analog for the study of heroin hapten-antibody interactions. Using heterologous MST, we were able to determine the affinities, down to nanomolar accuracies, of polyclonal antibodies to various abused opioids. While optimizing this method, we further discovered that heroin is protected from serum esterase degradation by the presence of these antibodies in a concentration-dependent manner. Lastly, using affinity data for a number of structurally different opioids, we were able to dissect the moieties that are crucial to antibody binding. The novel MST method that is presented herein can be extended to the analysis of any ligand that is prone to degradation and can be applied not only to the development of vaccines to substances of abuse but also to the analysis of small molecule/protein interactions in the presence of serum. Graphical abstract Strategy for the determination of hapten-induced antibody affinities using Microscale thermophoresis.

Marijuana use among older adults in the U.S.A.: user characteristics, patterns of use, and implications for intervention.

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Dinitto, Diana M; Choi, Namkee G

2011-06-01

Epidemiological studies show that the number of older adults using marijuana is increasing. This study aimed to determine the correlates and patterns of marijuana use among older adults that might help health and social service providers better assist this group. Data are from the 2008 National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration in the U.S.A. The sample consisted of 5,325 adults aged 50 years and older. Of the sample, 2.8% were past-year marijuana users. Of them, 23% had used marijuana on at least half the days of the year. Past-year users were more likely to be younger (50-64 years old), black, and not married, and they had significantly higher psychological distress scores, but they did not rate their health as poorer than others in the sample, nor did they attribute many problems, including psychological problems, as being related to their marijuana use. Nevertheless, past-year users present a high-risk profile because, in addition to frequent marijuana use, they also are more likely to smoke cigarettes, engage in binge drinking, and use other illicit drugs. Health and social service providers should be alert to the small number of routine marijuana users among the younger members of the older adult population, especially those suffering significant psychological distress, so that these individuals can be encouraged to utilize services that will help alleviate this distress and promote a healthier lifestyle and increase general well being.

ROBIN, a Telepresence Robot to Support Older Users Monitoring and Social Inclusion: Development and Evaluation.

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Cortellessa, Gabriella; Fracasso, Francesca; Sorrentino, Alessandra; Orlandini, Andrea; Bernardi, Giulio; Coraci, Luca; De Benedictis, Riccardo; Cesta, Amedeo

2018-02-01

This article describes an enhanced telepresence robot named ROBIN, part of a telecare system derived from the GIRAFFPLUS project for supporting and monitoring older adults at home. ROBIN is integrated in a sensor-rich environment that aims to continuously monitor physical and psychological wellbeing of older persons living alone. The caregivers (formal/informal) can communicate through it with their assisted persons. Long-term trials in real houses highlighted several user requirements that inspired improvements on the robotic platform. The enhanced telepresence robot was assessed by users to test its suitability to support social interaction and provide motivational feedback on health-related aspects. Twenty-five users (n = 25) assessed the new multimodal interaction capabilities and new communication services. A psychophysiological approach was adopted to investigate aspects like engagement, usability, and affective impact, as well as the possible role of individual differences on the quality of human-robot interaction. ROBIN was overall judged usable, the interaction with/through it resulted pleasant and the required workload was limited, thus supporting the idea of using it as a central component for remote assistance and social participation. Open-minded users tended to have a more positive interaction with it. This work describes an enabling technology for remote assistance and social communication. It highlights the importance of being compliant with users' needs to develop solutions easy to use and able to foster their social connections. The role of personality appeared to be relevant for the interaction, underscoring a clear role of the service personalization.

Patterns of drug use among a sample of drug users and injecting drug users attending a General Practice in Iran

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Shakeshaft Anthony

2006-01-01

Full Text Available Abstract Aim This study aimed to examine drug use, drug treatment history and risk behaviour among a sample of Iranian drug users seeking treatment through a general practice clinic in Iran. Methods Review of medical records and an intake questionnaire at a large general practice in Marvdasht, Iran, with a special interest in drug dependence treatment. Records from a random sample of injecting drug users (IDU, non-injecting drug users (DU and non-drug using patients were examined. Results 292 records were reviewed (34% IDU, 31% DU and 35% non-drug users. Eighty-three percent were males; all females were non-drug users. The mean age of the sample was 30 years. Of the IDU sample, 67% reported sharing a needle or syringe, 19% of these had done so in prison. Of those who had ever used drugs, being 'tired' of drug use was the most common reason for seeking help (34%. Mean age of first drug use was 20 years. The first drugs most commonly used were opium (72%, heroin (13% and hashish/ other cannabinoids (13%. Three quarters reported having previously attempted to cease their drug use. IDU were more likely than DU to report having ever been imprisoned (41% vs 7% and 41% to have used drugs in prison. Conclusion This study has shown that there is a need for general practice clinics in Iran to treat drug users including those who inject and that a substantial proportion of those who inject have shared needles and syringes, placing them at risk of BBVI such as HIV and hepatitis C. The expansion of services for drug users in Iran such as needle and syringe programs and pharmacotherapies are likely to be effective in reducing the harms associated with opium use and heroin injection.

Five-Factor Model personality profiles of drug users

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Crum Rosa M

2008-04-01

Full Text Available Abstract Background Personality traits are considered risk factors for drug use, and, in turn, the psychoactive substances impact individuals' traits. Furthermore, there is increasing interest in developing treatment approaches that match an individual's personality profile. To advance our knowledge of the role of individual differences in drug use, the present study compares the personality profile of tobacco, marijuana, cocaine, and heroin users and non-users using the wide spectrum Five-Factor Model (FFM of personality in a diverse community sample. Method Participants (N = 1,102; mean age = 57 were part of the Epidemiologic Catchment Area (ECA program in Baltimore, MD, USA. The sample was drawn from a community with a wide range of socio-economic conditions. Personality traits were assessed with the Revised NEO Personality Inventory (NEO-PI-R, and psychoactive substance use was assessed with systematic interview. Results Compared to never smokers, current cigarette smokers score lower on Conscientiousness and higher on Neuroticism. Similar, but more extreme, is the profile of cocaine/heroin users, which score very high on Neuroticism, especially Vulnerability, and very low on Conscientiousness, particularly Competence, Achievement-Striving, and Deliberation. By contrast, marijuana users score high on Openness to Experience, average on Neuroticism, but low on Agreeableness and Conscientiousness. Conclusion In addition to confirming high levels of negative affect and impulsive traits, this study highlights the links between drug use and low Conscientiousness. These links provide insight into the etiology of drug use and have implications for public health interventions.

[Expectations and user experiences of older Roma women with health services in primary care].

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Ramos-Morcillo, Antonio Jesús; Ruzafa-Martínez, María; Fernández-Salazar, Serafín; Del-Pino-Casado, Rafael

2015-04-01

To know the expectations and user experiences of older Roma women with health services in primary care (PC). Phenomenological qualitative study. Using focus groups (4-9 women/group) and semistructured interviews. Audio recorded from March to November 2011. Performed in Úbeda and Linares (Spain). Roma women over 50years. A purposive sample stratified by age and area of residence was carried out. Woman were recruited through community leaders. Process of qualitative content analysis: coding, triangulation, obtain and verify results. Supported whit the software Nvivo 8. Three focus groups and four interviews were conducted, including 23 women. The expectations for the PC are focus exclusively on their physician, being invisible other professionals. They look for a relationship with their physician based on trust. In their user experience with the PC coexist three types of user: who goes to their appointments, demands attention only in acute disease and does not attend appointments and reviews. There are socio-cultural factors related to accessibility. Older Roma women set their expectations and experiences with health service in PC around the binomial disease/physician. Expect attention based on trust and a high instrumentalization. A speech with signs of change directed towards a more active and demanding participation in PC services is observed. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Effects of Methadone Maintenance Treatment on Decision-Making Processes in Heroin-Abusers: A Cognitive Modeling Analysis

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Arash Khodadadi

2010-05-01

Full Text Available A B S T R A C TIntroduction: Although decision-making processes have become a principal target of study among addiction researchers, few researches are published according to effects of different treatment methods on the cognitive processes underlying decision making up to now. Utilizing cognitive modeling method, in this paper we examine the effects of Methadone maintenance treatment (MMT on cognitive processes underlying decision-making disorders in heroin-abusers. Methods: For this purpose, for the first time, we use the balloon analog risk task (BART to assess the decision-making ability of heroin-abusers before and after treatment and compare it to the non heroin-dependent subjects. Results: Results demonstrate that heroin-abusers show more risky behavior than other groups. But, there is no difference between the performance of heroin-abusers after 6 months of MMT and control group. Modeling subjects’ behavior in BART reveals that poor performance in heroin-abusers is due to reward-dependency and insensitivity to evaluation. Discussion: Results show that 6 months of MMT decreases reward-dependency and increases sensitivity to evaluation.

NAOMI: The trials and tribulations of implementing a heroin assisted treatment study in North America

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Laliberté Nancy

2009-01-01

Full Text Available Abstract Background Opioid addiction is a chronic, relapsing disease and remains a major public health challenge. Despite important expansions of access to conventional treatments, there are still significant proportions of affected individuals who remain outside the reach of the current treatment system and who contribute disproportionately to health care and criminal justice costs as well as to public disorder associated with drug addiction. The NAOMI study is a Phase III randomized clinical trial comparing injectable heroin maintenance to oral methadone. The study has ethics board approval at its Montréal and Vancouver sites, as well as from the University of Toronto, the New York Academy of Medicine and Johns Hopkins University. The main objective of the NAOMI Study is to determine whether the closely supervised provision of injectable, pharmaceutical-grade opioid agonist is more effective than methadone alone in recruiting, retaining, and benefiting chronic, opioid-dependent, injection drug users who are resistant to current standard treatment options. Methods The case study submitted chronicles the challenges of getting a heroin assisted treatment trial up and running in North America. It describes: a brief background on opioid addiction; current standard therapies for opioid addiction; why there is/was a need for a heroin assisted treatment trial; a description of heroin assisted treatment; the beginnings of creating the NAOMI study in North America; what is the NAOMI study; the science and politics of the NAOMI study; getting NAOMI started in Canada; various requirements and restrictions in getting the study up and running; recruitment into the study; working with the media; a status report on the study; and a brief conclusion from the authors' perspectives. Results and conclusion As this is a case study, there are no specific results or main findings listed. The case study focuses on: the background of the study; what it took to get

Opium and heroin alter biochemical parameters of human's serum.

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Kouros, Divsalar; Tahereh, Haghpanah; Mohammadreza, Afarinesh; Minoo, Mahmoudi Zarandi

2010-05-01

Iran is a significant consumer of opium, and, generally, of opioids, in the world. Addiction is one of the important issues of the 21st century and is an imperative issue in Iran. Long-term consumption of opioids affects homeostasis. To determine the effects of opium and heroin consumption on serum biochemical parameters. In a cross-sectional study, subjects who had consumed heroin (n = 35) or opium (n = 42) for more than two years and 35 nonaddict volunteers as the control group were compared in regard to various biochemical parameters such as fasting blood sugar (FBS), Na(+), K(+), Ca(2+), blood urea nitrogen (BUN), uric acid (UA), triglyceride (TG), cholesterol, creatinine, and total protein. Chromatography was used to confirm opioid consumption, and the concentration of biochemical parameters was determined by laboratory diagnostic tests on serum. No significant differences were found in Na(+), Ca(2+), BUN, UA, TG, creatinine, and total protein concentrations among the three groups. FBS, K(+), and UA levels were significantly lower in opium addicts compared to the control group. Serum Ca(2+) concentration of heroin addicts showed a significant decrease compared to that of the control group. Both addict groups showed a significant decrease in serum cholesterol levels. Chronic use of opium and heroin can change serum FBS, K(+), Ca(2+), UA, and cholesterol. This study, one of few on the effects of opium on serum biochemical parameters in human subjects, has the potential to contribute to the investigation of new approaches for further basic studies.

Evaluation of morphological changes of the liver caused by heroin abuse in forensic practice

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Ilić Goran

2010-01-01

Full Text Available Background/Aim. A study of morphological lesions in the liver of heroin addicts enables a precise overview of the type and degree of the liver damages caused by intravenous (iv heroin abuse, additive effects of viral infections and alcohol consumption, as well as whether the expressiveness of these lesions depends on the duration of the time period of heroin application. The aim of the study was to investigate histopathological, ultrastructural and morphometric features of the liver of heroin addicts in forensic samples of the liver. Methods. The study involved the autopsy conducted on 40 bodies of iv heroin addicts and 10 control autopsies. The investigated group consisted of liver samples of 36 male subjects and 4 female subjects aged 35-40 years and the control group of 8 male and 2 female cadaveric bodies aged 15-35 years. The liver tissue samples were prepared for light microscopy. Sections of the tissue paraffin blocks 5 μ thick were stained using classical Hematoxylin and Eosin method (H&E, as well as PAS Van Gieson, Gomori, and Congo Red techniques. For investigation purposes of ultrastructural changes, liver tissue was fixed in glutaraldehyde and molded with epon. The analysis was performed using the method of transmission electron microscopy. Morphometric investigation of the liver sinusoidal macrophages was performed by using the M42 test system. Results. In the investigated group of iv heroin addicts, the liver autopsy samples showed degenerative vesicular and fat changes, chronic hepatitis, cirrhosis, sedimentation of pathologic protein amyloidosis, dysplastic changes, reduction in the amount of glycogen in hepatocytes, as well as the change in the number of Kupfer and endothelial cells. The established changes correlated with the duration of iv heroin abuse, whereas sinusoidal macrophages were activated in cases with active hepatitis, and no significant change in their number was found in hepatocytes with alcohol-related fatty

Trajectories of Heroin Addiction: Growth Mixture Modeling Results Based on a 33-Year Follow-Up Study

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Hser, Yih-Ing; Huang, David; Chou, Chih-Ping; Anglin, M. Douglas

2007-01-01

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…

Bilateral avascular necrosis of the femoral head due to the use of heroin: A case report.

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Ozkunt, Okan; Sarıyılmaz, Kerim; Sungur, Mustafa; Ilen, Ferhat; Dikici, Fatih

2015-01-01

Femoral head avascular necrosis is caused by disruption of the blood supply of the femoral head, which finally results in hip dysfunction. Non traumatic osteonecrosis may related with corticosteroid use, alcohol abuse, SLE, hemoglobinopathies or exposure to cytotoxic agents. But avascular necrosis of the femoral head (ANFH) due to heroin use is a rare condition. We report a patient with bilateral ANFH due to heroin use treated by simultaneous bilateral hip arthroplasty. 37 year-old male patient presented with bilateral hip pain that had been occurring for four years. The patient had no history of smoking, excessive drinking, using corticosteroid and the other drugs or trauma but used heroin for 10 years. In clinic and radiologic examination indicated advanced degenerative changes on both hip due to femoral head avascular necrosis. The patient was treated with simultaneous bilateral total hip arthroplasty. After 6 months postoperatively the active hip range of motion was painless. Avascular femoral head necrosis caused by the using of heroin is rare. Ultimately, osteonecrosis of the femoral head occurs through one final common pathway, which is decreased blood flow to the femoral head that leads bone ischemia and death. But it is still unknown that heroin's systemic effects. Intravenous drug use more as a serious problem for today. There is a need for comprehensive studies to demonstrate effects of heroin on bone and vascularity metabolism. Heroin use will be important problem for population. That's why is crucial to understand the effect of heroin. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Frequency and correlates of comorbid psychiatric illness in patients with heroin use disorder admitted to Stikland Opioid Detoxification Unit, South Africa

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Lisa Dannatt

2014-08-01

Full Text Available Background. There is a lack of studies addressing the frequency and correlates of comorbidities among heroin users admitted for treatment in South Africa (SA. Objective. To assess the frequency and correlates of psychiatric comorbidity among patients with heroin use disorder admitted to the Opioid Detoxification Unit at Stikland Hospital in the Western Cape, SA. Method. Participants (N=141 were assessed for psychiatric illness (Mini International Neuropsychiatric Interview, comorbid substance use disorders (World Health Organization’s Alcohol Smoking Substance Involvement Screening Tool, and legal and social problems (Maudsley Addiction Profile. Demographic, personal, psychiatric and substance-use history, in addition to mental state examination on admission, were collected from the case notes. Results. The largest group of patients (n=56, 40% had not been abstinent from heroin use since drug debut, and most had been arrested for drug-related activities (n=117, 83% and had family conflicts related to use (n=135, 96%. Nicotine was the most common comorbid substance of dependence (n=137, 97% and methamphetamine was the most common comorbid substance abused (n=73, 52%. The most common comorbid psychiatric illness was previous substance-induced psychosis (n=42, 30% and current major depressive disorder (n=37, 26%. Current major depressive disorder was significantly associated with females (p=0.03, intravenous drug use (p=0.03, alcohol use (p=0.02, and a higher number of previous rehabilitation attempts (p=0.008. Conclusion. Patients with heroin use disorders present with high rates of psychiatric comorbidities, which underscores the need for substance treatment services with the capacity to diagnose and manage these comorbidities.

Asthma associated with the use of cocaine, heroin, and marijuana: A review of the evidence.

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Self, Timothy H; Shah, Samarth P; March, Katherine L; Sands, Christopher W

2017-09-01

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.

Policy makers ignoring science and scientists ignoring policy: the medical ethical challenges of heroin treatment

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Small Dan

2006-05-01

Full Text Available Abstract A decade of research in Switzerland, The Netherlands, Germany, and Spain now constitutes a massive body of work supporting the use of heroin treatment for the most difficult patients addicted to opiates. These trials concur on this method's safety and efficacy and are now serving as a prelude to the institution of heroin treatment in clinical practice throughout Europe. While the different sampling and research protocols for heroin treatment in these studies were important to the academic claims about specific results and conclusions that could be drawn from each study, the overall outcomes were quite clear – and uniformly positive. They all find that the use of prescribed pharmaceutical heroin does exactly what it is intended to do: it reaches a treatment refractory group of addicts by engaging them in a positive healthcare relationship with a physician, it reduces their criminal activity, improves their health status, and increases their social tenure through more stable housing, employment, and contact with family. The Canadian trial (NAOMI, now underway for over a year, but not yet completed, now faces a dilemma about what to do with its patients who have successfully completed 12 months of heroin and must be withdrawn from heroin and transferred to other treatments in accordance with the research protocol approved by Government of Canada, federal granting body and host institutions. The problem is that the principal criterion for acceptance to NAOMI was their history of repeated failure in these very same treatment programs to which they will now be referred. The existence of the results from abroad (some of which were not yet available when NAOMI was designed and initiated now raises a very important question for Canada: is it ethical to continue to prohibit the medical use of heroin treatment that has already been shown to be feasible and effective in numerous medical studies throughout the world? And while this is being worked

Effective brain network analysis with resting-state EEG data: a comparison between heroin abstinent and non-addicted subjects

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Hu, Bin; Dong, Qunxi; Hao, Yanrong; Zhao, Qinglin; Shen, Jian; Zheng, Fang

2017-08-01

Objective. Neuro-electrophysiological tools have been widely used in heroin addiction studies. Previous studies indicated that chronic heroin abuse would result in abnormal functional organization of the brain, while few heroin addiction studies have applied the effective connectivity tool to analyze the brain functional system (BFS) alterations induced by heroin abuse. The present study aims to identify the abnormality of resting-state heroin abstinent BFS using source decomposition and effective connectivity tools. Approach. The resting-state electroencephalograph (EEG) signals were acquired from 15 male heroin abstinent (HA) subjects and 14 male non-addicted (NA) controls. Multivariate autoregressive models combined independent component analysis (MVARICA) was applied for blind source decomposition. Generalized partial directed coherence (GPDC) was applied for effective brain connectivity analysis. Effective brain networks of both HA and NA groups were constructed. The two groups of effective cortical networks were compared by the bootstrap method. Abnormal causal interactions between decomposed source regions were estimated in the 1-45 Hz frequency domain. Main results. This work suggested: (a) there were clear effective network alterations in heroin abstinent subject groups; (b) the parietal region was a dominant hub of the abnormally weaker causal pathways, and the left occipital region was a dominant hub of the abnormally stronger causal pathways. Significance. These findings provide direct evidence that chronic heroin abuse induces brain functional abnormalities. The potential value of combining effective connectivity analysis and brain source decomposition methods in exploring brain alterations of heroin addicts is also implied.

Do painkillers serve as "hillbilly heroin" for rural adults with high levels of psychosocial stress?

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Black, Pamela; Hendy, Helen M

2017-07-05

Nonmedical use of painkillers has increased in recent years, with some authors suggesting that painkillers serve as "hillbilly heroin": a drug chosen by rural adults to cope with psychosocial stresses in their lives. The present study compared rural and urban adults for their reported use of 5 drugs during the past year (painkillers, marijuana, cocaine, methamphetamine, heroin) and for associations between these 5 drugs and their reported psychosocial stressors. This study conducted secondary analyses of anonymous survey data provided by the 2014 National Survey on Drug Use and Health with responses from 8,699 rural and 18,481 urban adults. The survey included demographics (gender, age, race, education, marital status, family income), reports of whether participants had used each of 5 illicit drugs during the past year, and measures of psychological distress and social functioning problems. Controlling for demographics, rural adults showed no greater prevalence of painkiller use than urban adults, but rural adults were more likely than urban adults to use methamphetamine and less likely to use marijuana, cocaine, and heroin. Controlling for demographics, rural adults showed no associations between psychological or social stressors and the use of painkillers, but such stressors were significantly associated with the use of marijuana, methamphetamine, and heroin. Urban adults showed significant associations of psychological and social stressors with the use of painkillers, as well as with the use of marijuana, cocaine, and heroin. Results suggest that painkillers are unlikely to serve as "hillbilly heroin" for rural adults, but they may serve as "big-city heroin" for urban adults.

Pioglitazone attenuates the opioid withdrawal and vulnerability to relapse to heroin seeking in rodents.

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de Guglielmo, Giordano; Kallupi, Marsida; Scuppa, Giulia; Demopulos, Gregory; Gaitanaris, George; Ciccocioppo, Roberto

2017-01-01

Relapse to opioids is often driven by the avoidance of the aversive states of opioid withdrawal. We recently demonstrated that activation of peroxisome proliferator-activated receptor gamma (PPARγ) by pioglitazone reduces the motivation for heroin and attenuates its rewarding properties. However, the role of PPARγ in withdrawal and other forms of relapse to heroin is unknown. To further address this issue, we investigated the role of PPARγ on the development and expression of morphine withdrawal in mice and the effect of pioglitazone on several forms of heroin relapse in rats. We induced physical dependence to morphine in mice by injecting morphine twice daily for 6 days. Withdrawal syndrome was precipitated on day 6 with an injection of naloxone. In addition, different groups of rats were trained to self-administer heroin and, after the extinction, the relapse was elicited by cues, priming, or stress. The effect of different doses of pioglitazone was tested on these different paradigms. Data show that chronic and acute administration of pioglitazone attenuates morphine withdrawal symptoms, and these effects are mediated by activation of PPARγ receptors. Activation of PPARγ by pioglitazone also abolishes yohimbine-induced reinstatement of heroin seeking and reduces heroin-induced reinstatement, while it does not affect cue-induced relapse. These findings provide new insights on the role of PPARγ on opioid dependence and suggest that pioglitazone may be useful for the treatment of opioid withdrawal in opioid-addicted individuals.

Eye Movement Evidence of Attentional Bias for Substance-Related Cues in Heroin Dependents on Methadone Maintenance Therapy.

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Zhao, Hui; Yang, Bo; Zhu, Qian; Zhang, Guangqun; Xiao, Yuqin; Guo, Xiao; Huang, Xiu; Zhang, Zhuo

2017-03-21

Attentional biases toward substance-related stimuli might play a contributing role in addictive behaviors. This study investigated the selective attention to substance-related stimuli in heroin dependents receiving methadone maintenance therapy. Thirty outpatients receiving methadone maintenance treatment for heroin dependence and 38 healthy controls completed a visual probe task with concurrent eye movement monitoring. The results showed that the heroin group reacted faster to probes associated with substance-related pictures than neutral pictures, and they directed more initial fixations and maintained longer initial fixation durations toward substance-related pictures than neutral pictures. However, attentional bias was not correlated with addiction severity in the heroin group. These findings suggest that attentional bias towards substance-related cues occurs in heroin dependents, although this bias might not be associated with the severity of drug-using behavior.

Haloperidol differentially affects reinforcement and motivational processes in rats running an alley for intravenous heroin.

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McFarland, K; Ettenberg, A

1995-12-01

The role of drug-paired environmental stimuli in opiate self-administration was investigated by exposing animals to discrete cues that were predictive of the availability or unavailability of heroin reinforcement. Rats were trained to traverse a straight arm runway for a reinforcement consisting of a single 0.1 mg/kg intravenous infusion of heroin delivered upon entrance to the goal box. On each trial, one of two discriminative olfactory stimuli (orange and almond) was used: one which signaled the availability of heroin in the goal box (S+), and one which signaled its absence (S-). The effect of dopamine (DA) receptor antagonism on reinforcement and motivational processes was investigated by pretreating subjects with 0.0, 0.15 or 0.30 mg/kg of the DA receptor antagonist drug, haloperidol. Haloperidol had no effect on operant runway performance (i.e. goal time) in any condition. However, 24 h later, on the first post-treatment trial, those haloperidol animals that received heroin in the goal box on the previous trial (i.e. the S+ condition) ran reliably more slowly than subjects that received vehicle on the previous S+ trial. These results suggest that haloperidol does not affect the motivational properties of stimuli which predict the availability of heroin, while it does diminish the reinforcing effects of actually receiving heroin.

The Leeds Evaluation of Efficacy of Detoxification Study (LEEDS project: An open-label pragmatic randomised control trial comparing the efficacy of differing therapeutic agents for primary care detoxification from either street heroin or methadone [ISRCTN07752728

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Sheard Laura

2004-04-01

Full Text Available Abstract Background Heroin is a synthetic opioid with an extensive illicit market leading to large numbers of people becoming addicted. Heroin users often present to community treatment services requesting detoxification and in the UK various agents are used to control symptoms of withdrawal. Dissatisfaction with methadone detoxification 8 has lead to the use of clonidine, lofexidine, buprenorphine and dihydrocodeine; however, there remains limited evaluative research. In Leeds, a city of 700,000 people in the North of England, dihydrocodeine is the detoxification agent of choice. Sublingual buprenorphine, however, is being introduced. The comparative value of these two drugs for helping people successfully and comfortably withdraw from heroin has never been compared in a randomised trial. Additionally, there is a paucity of research evaluating interventions among drug users in the primary care setting. This study seeks to address this by randomising drug users presenting in primary care to receive either dihydrocodeine or buprenorphine. Methods/design The Leeds Evaluation of Efficacy of Detoxification Study (LEEDS project is a pragmatic randomised trial which will compare the open use of buprenorphine with dihydrocodeine for illicit opiate detoxification, in the UK primary care setting. The LEEDS project will involve consenting adults and will be run in specialist general practice surgeries throughout Leeds. The primary outcome will be the results of a urine opiate screening at the end of the detoxification regimen. Adverse effects and limited data to three and six months will be acquired.

Characterization and Management of Patients with Heroin versus Nonheroin Opioid Overdoses: Experience at an Academic Medical Center.

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Morizio, Kate M; Baum, Regan A; Dugan, Adam; Martin, Julia E; Bailey, Abby M

2017-07-01

To characterize the differences between patients who had heroin and nonheroin opioid overdoses and to determine whether there were any significant differences in their management with regard to the naloxone use. Retrospective cohort study. Large academic medical center. A total of 923 patients admitted to the medical center who were identified for overdose by heroin or other opiate-related narcotics between January 2010 and September 2015; 480 patients experienced a nonheroin opioid overdose event, and 443 patients experienced a heroin overdose event. Patients presenting with heroin overdose tended to be younger and male, with higher rates of hepatitis C virus (HCV) infection compared with those presenting with nonheroin opioid overdose (pevent, history of injection drug use, and history of prescription opioid abuse compared with the nonheroin group (pevent with the same drug. The proportion of patients presenting with a heroin overdose steadily increased from 2010-2015; the number of patients presenting to the emergency department with nonheroin opioid overdoses steadily decreased. As rates of heroin overdose increased each year, the incidence of HCV infection increased dramatically. This study indicates that the incidence of heroin overdoses has significantly increased over the last several years, and the rates of HCV infection 4-fold since the start of the study period. Patients admitted for nonheroin opioid overdose were more likely to be admitted to the hospital and intensive care unit compared with those admitted for heroin overdose. The rise in overdose events only further illustrates a gap in our understanding of the cycle of addiction, drug abuse, and overdose events. © 2017 Pharmacotherapy Publications, Inc.

Analysis of diacetylmorphine, caffeine, and degradation products after volatilization of pharmaceutical heroin for inhalation

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Klous, Marjolein G.; Lee, WeiChing; Hillebrand, Michel J. X.; van den Brink, Wim; van Ree, Jan M.; Beijnen, Jos H.

2006-01-01

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.

Eating disorders and food addiction in men with heroin use disorder: a controlled study.

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Canan, Fatih; Karaca, Servet; Sogucak, Suna; Gecici, Omer; Kuloglu, Murat

2017-06-01

We aimed to determine the prevalence estimates of binge eating disorder, bulimia nervosa, anorexia nervosa, and food addiction in men with heroin use disorder and a matched sample of control participants. A group of 100 men with heroin use disorder, consecutively admitted to a detoxification and therapy unit, were screened for DSM-5 eating disorders, along with a group of 100 male controls of similar age, education, and body mass index. The Yale Food Addiction Scale (YFAS), the Barratt Impulsivity Scale-version 11, and the Eating Attitudes Test were used for data collection. Patients were also evaluated for various aspects of heroin use disorder (e.g., craving) using the Addiction Profile Index. Binge eating disorder that met DSM-5 criteria was more prevalent in patients with heroin use disorder (21%) than in control subjects (8%) (odds ratio 3.1, 95% confidence interval 1.3-7.3; p disorder (28%) than among control participants (12%) (odds ratio 2.9, 95% confidence interval 1.4-6.1; p eating disorder and food addiction are highly frequent in men with heroin use disorder. Screening for binge eating disorder and food addiction in patients with substance use disorder is important, as interventions may improve treatment outcome in this patient group.

Telling our stories: heroin-assisted treatment and SNAP activism in the Downtown Eastside of Vancouver.

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Boyd, Susan; Murray, Dave; MacPherson, Donald

2017-05-18

This article highlights the experiences of a peer-run group, SALOME/NAOMI Association of Patients (SNAP), that meets weekly in the Downtown Eastside of Vancouver, British Columbia, Canada. SNAP is a unique independent peer- run drug user group that formed in 2011 following Canada's first heroin-assisted treatment trial (HAT), North America Opiate Medication Initiative (NAOMI). SNAP's members are now made up of former research participants who participated in two heroin-assisted trials in Vancouver. This article highlights SNAP members' experiences as research subjects in Canada's second clinical trial conducted in Vancouver, Study to Assess Longer-term Opioid Medication Effectiveness (SALOME), that began recruitment of research participants in 2011. This paper draws on one brainstorming session, three focus groups, and field notes, with the SALOME/NAOMI Association of Patients (SNAP) in late 2013 about their experiences as research subjects in Canada's second clinical trial, SALOME in the DTES of Vancouver, and fieldwork from a 6-year period (March 2011 to February 2017) with SNAP members. SNAP's research draws on research principles developed by drug user groups and critical methodological frameworks on community-based research for social justice. The results illuminate how participating in the SALOME clinical trial impacted the lives of SNAP members. In addition, the findings reveal how SNAP member's advocacy for HAT impacts the group in positive ways. Seven major themes emerged from the analysis of the brainstorming and focus groups: life prior to SALOME, the clinic setting and routine, stability, 6-month transition, support, exiting the trial and ethics, and collective action, including their participation in a constitutional challenge in the Supreme Court of BC to continue receiving HAT once the SALOME trial ended. HAT benefits SNAP members. They argue that permanent HAT programs should be established in Canada because they are an effective harm reduction

CORRELATIONS BETWEEN AWARENESS OF ILLNESS (INSIGHT AND HISTORY OF ADDICTION IN HEROIN-ADDICTED PATIENTS

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Angelo Giovanni Icro eMaremmani

2012-07-01

Full Text Available In a group of 1066 heroin addicts, who were seeking treatment for opioid agonist treatment, we looked for differences in historical, demographic and clinical characteristics, between patients with different levels of awareness of illness (insight. The results showed that, in the cohort studied, a majority of subjects lacked insight into their heroin-use behaviour. Compared with the impaired-insight group, those who possessed insight into their illness showed significantly greater awareness of past social, somatic and psychopathological impairments, and had a greater number of past treatment-seeking events for heroin addiction. In contrast with other psychiatric illnesses, the presence of awareness appears to be related to the passing of time and to the worsening of the illness. Methodologies to improve the insight of patients should, therefore, be targeted more directly on patients early in their history of heroin dependence, because the risk of lack of insight is greatest during this period.

Expression of brain-derived neurotrophic factors, neurotrophin-3, and neurotrophin-4 in the nucleus accumbens during heroin dependency and withdrawal.

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Li, Yixin; Xia, Baijuan; Li, Rongrong; Yin, Dan; Wang, Yanlin; Liang, Wenmei

2017-08-02

Neurotrophins, brain-derived neurotrophic factors (BDNF), neurotrophin-3 (NT-3), and neurotrophin-4 (NT-4), have been implicated in the modulation of heroin dependency. This study was designed to explore the expression alterations of BDNF, NT-3, and NT-4 in the context of heroin dependence and withdrawal in the rat nucleus accumbens (NAc). Heroin dependence was induced by a progressive intraperitoneal treatment of heroin. The results showed that the expression levels of BDNF and NT-4 were significantly decreased in the NAc of rats with heroin addiction in comparison with the control group, whereas there was a significant increase in BDNF and NT-4 expressions in the groups of rats with both naloxone-induced and spontaneous withdrawal. Moreover, NT-3 expression was markedly increased in the NAc of rats with heroin addiction and spontaneous withdrawal in comparison with the control group, but decreased in the NAc of rats with naloxone-induced withdrawal. These results indicated that chronic administration of heroin results in the alterations of BDNF, NT-3, and NT-4 expressions in the rat NAc. BDNF, NT-3, and NT-4 may play a critical role in the development of heroin dependency and withdrawal.

Dysfunctional Default Mode Network in Methadone Treated Patients Who Have a Higher Heroin Relapse Risk.

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Li, Wei; Li, Qiang; Wang, Defeng; Xiao, Wei; Liu, Kai; Shi, Lin; Zhu, Jia; Li, Yongbin; Yan, Xuejiao; Chen, Jiajie; Ye, Jianjun; Li, Zhe; Wang, Yarong; Wang, Wei

2015-10-15

The purpose of this study was to identify whether heroin relapse is associated with changes in the functional connectivity of the default mode network (DMN) during methadone maintenance treatment (MMT). Resting-state functional magnetic resonance imaging (fMRI) data of chronic heroin relapsers (HR) (12 males, 1 female, age: 36.1 ± 6.9 years) and abstainers (HA) (11males, 2 female; age: 42.1 ± 8.1 years) were investigated with an independent component analysis to address the functional connectivity of their DMN. Group comparison was then performed between the relapsers and abstainers. Our study found that the left inferior temporal gyrus and the right superior occipital gyrus associated with DMN showed decreased functional connectivity in HR when compared with HA, while the left precuneus and the right middle cingulum had increased functional connectivity. Mean intensity signal, extracted from left inferior temporal gyrus of HR patients, showed a significant negative correlation corresponding to the degree of heroin relapse. These findings suggest that altered functional connectivity of DMN may contribute to the potential neurobiological mechanism(s) of heroin relapse and have a predictive value concerning heroin relapse under MMT.

Regional homogeneity changes between heroin relapse and non-relapse patients under methadone maintenance treatment: a resting-state fMRI study.

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Chang, Haifeng; Li, Wei; Li, Qiang; Chen, Jiajie; Zhu, Jia; Ye, Jianjun; Liu, Jierong; Li, Zhe; Li, Yongbin; Shi, Ming; Wang, Yarong; Wang, Wei

2016-08-18

Methadone maintenance treatment (MMT) is recognized as one of the most effective treatments for heroin addiction but its effect is dimmed by the high incidence of heroin relapse. However, underlying neurobiology mechanism of heroin relapse under MMT is still largely unknown. Here, we took advantage of a resting-state fMRI technique by analysis of regional homogeneity (ReHo), and tried to explore the difference of brain function between heroin relapsers and non-relapsers in MMT. Forty MMT patients were included and received a 12-month follow-up. All patients were given baseline resting-state fMRI scans by using a 3.0 T GE Signa Excite HD whole-body MRI system. Monthly self-report and urine test were used to assess heroin relapse or non-relapse. Subjective craving was measured with visual analog scale. The correlation between ReHo and the degree of heroin relapse was analyzed. Compared with the non-relapsers, ReHo values were increased in the bilateral medial orbitofrontal cortex, right caudate, and right cerebellum of the heroin relapsers while those in the left parahippocampal gyrus, left middle temporal gyrus, right lingual gyrus, and precuneus were decreased in heroin relapsers. Importantly, altered ReHo in the right caudate were positively correlated with heroin relapse rates or subjective craving response. Using the resting-state fMRI technique by analysis of ReHo, we provided the first resting-state fMRI evidence that right caudate may serve as a potential biomarker for heroin relapse prediction and also as a promising target for reducing relapse risk.

Older Cancer Patients' User Experiences With Web-Based Health Information Tools: A Think-Aloud Study.

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Bolle, Sifra; Romijn, Geke; Smets, Ellen M A; Loos, Eugene F; Kunneman, Marleen; van Weert, Julia C M

2016-07-25

Health information is increasingly presented on the Internet. Several Web design guidelines for older Web users have been proposed; however, these guidelines are often not applied in website development. Furthermore, although we know that older individuals use the Internet to search for health information, we lack knowledge on how they use and evaluate Web-based health information. This study evaluates user experiences with existing Web-based health information tools among older (≥ 65 years) cancer patients and survivors and their partners. The aim was to gain insight into usability issues and the perceived usefulness of cancer-related Web-based health information tools. We conducted video-recorded think-aloud observations for 7 Web-based health information tools, specifically 3 websites providing cancer-related information, 3 Web-based question prompt lists (QPLs), and 1 values clarification tool, with colorectal cancer patients or survivors (n=15) and their partners (n=8) (median age: 73; interquartile range 70-79). Participants were asked to think aloud while performing search, evaluation, and application tasks using the Web-based health information tools. Overall, participants perceived Web-based health information tools as highly useful and indicated a willingness to use such tools. However, they experienced problems in terms of usability and perceived usefulness due to difficulties in using navigational elements, shortcomings in the layout, a lack of instructions on how to use the tools, difficulties with comprehensibility, and a large amount of variety in terms of the preferred amount of information. Although participants frequently commented that it was easy for them to find requested information, we observed that the large majority of the participants were not able to find it. Overall, older cancer patients appreciate and are able to use cancer information websites. However, this study shows the importance of maintaining awareness of age-related problems

Older Cancer Patients’ User Experiences With Web-Based Health Information Tools: A Think-Aloud Study

Science.gov (United States)

Romijn, Geke; Smets, Ellen M A; Loos, Eugene F; Kunneman, Marleen; van Weert, Julia C M

2016-01-01

Background Health information is increasingly presented on the Internet. Several Web design guidelines for older Web users have been proposed; however, these guidelines are often not applied in website development. Furthermore, although we know that older individuals use the Internet to search for health information, we lack knowledge on how they use and evaluate Web-based health information. Objective This study evaluates user experiences with existing Web-based health information tools among older (≥ 65 years) cancer patients and survivors and their partners. The aim was to gain insight into usability issues and the perceived usefulness of cancer-related Web-based health information tools. Methods We conducted video-recorded think-aloud observations for 7 Web-based health information tools, specifically 3 websites providing cancer-related information, 3 Web-based question prompt lists (QPLs), and 1 values clarification tool, with colorectal cancer patients or survivors (n=15) and their partners (n=8) (median age: 73; interquartile range 70-79). Participants were asked to think aloud while performing search, evaluation, and application tasks using the Web-based health information tools. Results Overall, participants perceived Web-based health information tools as highly useful and indicated a willingness to use such tools. However, they experienced problems in terms of usability and perceived usefulness due to difficulties in using navigational elements, shortcomings in the layout, a lack of instructions on how to use the tools, difficulties with comprehensibility, and a large amount of variety in terms of the preferred amount of information. Although participants frequently commented that it was easy for them to find requested information, we observed that the large majority of the participants were not able to find it. Conclusions Overall, older cancer patients appreciate and are able to use cancer information websites. However, this study shows the importance

Attitudes and knowledge about naloxone and overdose prevention among detained drug users in Ningbo, China

Directory of Open Access Journals (Sweden)

Liu Yu

2012-02-01

Full Text Available Abstract Background To date there has been limited research on both the prevalence of overdose and drug user knowledge about overdose prevention and response methods in China. In addition, there has been no effort to integrate naloxone information and distribution into pre-release services for drug users detained in isolated compulsory detoxification facilities in China. Methods The authors conducted a survey of 279 heroin users in isolated compulsory detoxification centers in Ningbo, China in an attempt to evaluate the possibility of conducting prelease peer naloxone programs in Ningbo isolated compulsory detoxification centers. Respondents' demographic background, history of heroin overdoses, and attitudes/knowledge about overdose prevention and response were collected. Results While drug users in Ningbo's compulsory detoxification centers have limited understandings of how to effectively respond to overdoses, they expressed concern about the possibility of overdose, interest in participating in overdose prevention and response programs, and a willingness to help their peers. In general, there was no significant difference in history and attitudes/knowledge of overdose between male and female participants. Conclusion Based on the findings of this research, our survey provides preliminary evidence that detained drug users have considerable interest in overdose prevention and response information and willingness to help peers. However, drug users in Ningbo isolated compulsory detoxification centers currently have limited understandings of effective ways of helping to prevent overdose deaths.

Cost-Effectiveness of Buprenorphine and Naltrexone Treatments for Heroin Dependence in Malaysia

OpenAIRE

Ruger, Jennifer Prah; Chawarski, Marek; Mazlan, Mahmud; Ng, Nora; Schottenfeld, Richard

2012-01-01

Aims To aid public health policymaking, we studied the cost-effectiveness of buprenorphine, naltrexone, and placebo interventions for heroin dependence in Malaysia. Design We estimated the cost-effectiveness ratios of three treatments for heroin dependence. We used a microcosting methodology to determine fixed, variable, and societal costs of each intervention. Cost data were collected from investigators, staff, and project records on the number and type of resources used and unit costs; soci...

The Impact of Hydrochloride Heroin on Mental Flexibility, Abstract Reasoning, Impulsivity, and Attention

Directory of Open Access Journals (Sweden)

Zahra Alam Mehrjerdi

2011-04-01

Full Text Available Introduction: Drug addiction could lead to severe impairments in executive and neurocognitive functions but study on the impact of hydrochloride heroin on executive functions has remained in infancy in Iran. The aim of this study was to examine the relationship between addiction to hydrochloride heroin and executive functioning in several cognitive domains including mental flexibility, abstract reasoning, impulsivity, and attention. Methods: A total of 60 cases of young male addicts aged 18 to 21 were recruited from outpatient addiction clinics in Karaj city and were matched with 60 non-drug using controls. A test battery including the Wisconsin Card Sorting Test (WCST, Porteus Maze Test (PMQS, Serial Seven Subtraction Test (SSST, and Color Trails Test (CTT were administered respectively. Results: The patient group showed more problems in impulse control compared with the control group, while mental flexibility, abstract reasoning and attention were not affected. Discussion: The findings indicated that addiction to hydrochloride heroin had a negative effect on impulse control. This issue could reflect the role of impaired inhibitory control on drug-seeking behaviors and relapse. Special treatment programs must be tailored to control impulsivity among addicts to hydrochloride heroin during treatment.

Pharmacokinetics and pharmacodynamics of high doses of pharmaceutically prepared heroin, by intravenous or by inhalation route in opioid-dependent patients

NARCIS (Netherlands)

Rook, Elisabeth J.; van Ree, Jan M.; van den Brink, Wim; Hillebrand, Michel J. X.; Huitema, Alwin D. R.; Hendriks, Vincent M.; Beijnen, Jos H.

2006-01-01

A pharmacokinetic-pharmacodynamic study was performed in opioid-dependent patients in the Netherlands, who were currently treated with high doses of pharmaceutically prepared heroin on medical prescription. Besides intravenous heroin, heroin was prescribed for inhalation by "chasing the dragon"

Outcome of heroin-dependent adolescents presenting for opiate substitution treatment.

LENUS (Irish Health Repository)

Smyth, Bobby P

2012-01-01

Because the outcome of methadone and buprenorphine substitution treatment in adolescents is unclear, we completed a retrospective cohort study of 100 consecutive heroin-dependent adolescents who sought these treatments over an 8-year recruitment period. The participants\\' average age was 16.6 years, and 54 were female. Half of the patient group remained in treatment for over 1 year. Among those still in treatment at 12 months, 39% demonstrated abstinence from heroin. The final route of departure from the treatment program was via planned detox for 22%, dropout for 32%, and imprisonment for 8%. The remaining 39% were transferred elsewhere for ongoing opiate substitution treatment after a median period of 23 months of treatment. Males were more likely to exit via imprisonment (p < .05), but other outcomes were not predicted by gender. There were no deaths during treatment among these 100 patients who had a cumulative period of 129 person years at risk. Our findings suggest that this treatment delivers reductions in heroin use and that one fifth of patients will exit treatment following detox completion within a 1- to 2-year time frame.

Geospatial Analysis of Drug Poisoning Deaths Involving Heroin in the USA, 2000-2014.

Science.gov (United States)

Stewart, Kathleen; Cao, Yanjia; Hsu, Margaret H; Artigiani, Eleanor; Wish, Eric

2017-08-01

We investigate the geographic patterns of drug poisoning deaths involving heroin by county for the USA from 2000 to 2014. The county-level patterns of mortality are examined with respect to age-adjusted rates of death for different classes of urbanization and racial and ethnic groups, while rates based on raw counts of drug poisoning deaths involving heroin are estimated for different age groups and by gender. To account for possible underestimations in these rates due to small areas or small numbers, spatial empirical Baye's estimation techniques have been used to smooth the rates of death and alleviate underestimation when analyzing spatial patterns for these different groups. The geographic pattern of poisoning deaths involving heroin has shifted from the west coast of the USA in the year 2000 to New England, the Mid-Atlantic region, and the Great Lakes and central Ohio Valley by 2014. The evolution over space and time of clusters of drug poisoning deaths involving heroin is confirmed through the SaTScan analysis. For this period, White males were found to be the most impacted population group overall; however, Blacks and Hispanics are highly impacted in counties where significant populations of these two groups reside. Our results show that while 35-54-year-olds were the most highly impacted age group by county from 2000 to 2010, by 2014, the trend had changed with an increasing number of counties experiencing higher death rates for individuals 25-34 years. The percentage of counties across the USA classified as large metro with deaths involving heroin is estimated to have decreased from approximately 73% in 2010 to just fewer than 56% in 2014, with a shift to small metro and non-metro counties. Understanding the geographic variations in impact on different population groups in the USA has become particularly necessary in light of the extreme increase in the use and misuse of street drugs including heroin and the subsequent rise in opioid-related deaths in the

Regional homogeneity changes between heroin relapse and non-relapse patients under methadone maintenance treatment: a resting-state fMRI study

OpenAIRE

Chang, Haifeng; Li, Wei; Li, Qiang; Chen, Jiajie; Zhu, Jia; Ye, Jianjun; Liu, Jierong; Li, Zhe; Li, Yongbin; Shi, Ming; Wang, Yarong; Wang, Wei

2016-01-01

Background Methadone maintenance treatment (MMT) is recognized as one of the most effective treatments for heroin addiction but its effect is dimmed by the high incidence of heroin relapse. However, underlying neurobiology mechanism of heroin relapse under MMT is still largely unknown. Here, we took advantage of a resting-state fMRI technique by analysis of regional homogeneity (ReHo), and tried to explore the difference of brain function between heroin relapsers and non-relapsers in MMT. Met...

Variants of opioid system genes are associated with non-dependent opioid use and heroin dependence

NARCIS (Netherlands)

Randesi, Matthew; van den Brink, Wim; Levran, Orna; Blanken, Peter; Butelman, Eduardo R; Yuferov, Vadim; da Rosa, Joel Correa; Ott, Jurg; van Ree, Jan M; Kreek, Mary Jeanne

2016-01-01

BACKGROUND: Heroin addiction is a chronic, relapsing brain disease. Genetic factors are involved in the development of drug addiction. The aim of this study was to determine whether specific variants in genes of the opioid system are associated with non-dependent opioid use and heroin dependence.

Variants of opioid system genes are associated with non-dependent opioid use and heroin dependence

NARCIS (Netherlands)

Randesi, Matthew; van den Brink, Wim; Levran, Orna; Blanken, Peter; Butelman, Eduardo R.; Yuferov, Vadim; da Rosa, Joel Correa; Ott, Jurg; van Ree, Jan M.; Kreek, Mary Jeanne

2016-01-01

Heroin addiction is a chronic, relapsing brain disease. Genetic factors are involved in the development of drug addiction. The aim of this study was to determine whether specific variants in genes of the opioid system are associated with non-dependent opioid use and heroin dependence. Genetic

Corticotropin-releasing factor (CRF) and α 2 adrenergic receptors mediate heroin withdrawal-potentiated startle in rats.

Science.gov (United States)

Park, Paula E; Vendruscolo, Leandro F; Schlosburg, Joel E; Edwards, Scott; Schulteis, Gery; Koob, George F

2013-09-01

Anxiety is one of the early symptoms of opioid withdrawal and contributes to continued drug use and relapse. The acoustic startle response (ASR) is a component of anxiety that has been shown to increase during opioid withdrawal in both humans and animals. We investigated the role of corticotropin-releasing factor (CRF) and norepinephrine (NE), two key mediators of the brain stress system, on acute heroin withdrawal-potentiated ASR. Rats injected with heroin (2 mg/kg s.c.) displayed an increased ASR when tested 4 h after heroin treatment. A similar increase in ASR was found in rats 10-20 h into withdrawal from extended access (12 h) to i.v. heroin self-administration, a model that captures several aspects of heroin addiction in humans. Both the α 2 adrenergic receptor agonist clonidine (10 μg/kg s.c.) and CRF1 receptor antagonist N,N-bis(2-methoxyethyl)-3-(4-methoxy-2-methylphenyl)-2,5-dimethyl-pyrazolo[1,5-a] pyrimidin-7-amine (MPZP; 20 mg/kg s.c.) blocked heroin withdrawal-potentiated startle. To investigate the relationship between CRF1 and α 2 adrenergic receptors in the potentiation of the ASR, we tested the effect of MPZP on yohimbine (1.25 mg/kg s.c.)-potentiated startle and clonidine on CRF (2 μg i.c.v.)-potentiated startle. Clonidine blocked CRF-potentiated startle, whereas MPZP partially attenuated but did not reverse yohimbine-potentiated startle, suggesting that CRF may drive NE release to potentiate startle. These results suggest that CRF1 and α 2 receptors play an important role in the heightened anxiety-like behaviour observed during acute withdrawal from heroin, possibly via CRF inducing the release of NE in stress-related brain regions.

Exploring representations and experiences of case-management users: towards difficulties and solutions to leading qualitative interviews with older people with complex living conditions.

Science.gov (United States)

Balard, Frédéric; Corre, Stéphanie Pin Le; Trouvé, Hélène; Saint-Jean, Olivier; Somme, Dominique

2013-01-01

By matching needs to resource services, case management could be a useful tool for improving the care of older people with complex living conditions. Collecting and analysing the users' experiences represents a good way to evaluate the effectiveness and efficiency of a case-management service. However, in the literature, fieldwork is very rarely considered and the users included in qualitative research seem to be the most accessible. This study was undertaken to describe the challenges of conducting qualitative research with older people with complex living conditions in order to understand their experiences with case-management services. Reflective analysis was applied to describe the process of recruiting and interviewing older people with complex living conditions in private homes, describing the protocol with respect to fieldwork chronology. The practical difficulties inherent in this type of study are addressed, particularly in terms of defining a sample, the procedure for contacting the users and conducting the interview. The users are people who suffer from a loss of autonomy because of cognitive impairment, severe disease and/or psychiatric or social problems. Notably, most of them refuse care and assistance. Reflective analysis of our protocol showed that the methodology and difficulties encountered constituted the first phase of data analysis. Understanding the experience of users of case management to analyse the outcomes of case-management services requires a clear methodology for the fieldwork.

Activity Monitors as Support for Older Persons' Physical Activity in Daily Life: Qualitative Study of the Users' Experiences.

Science.gov (United States)

Ehn, Maria; Eriksson, Lennie Carlén; Åkerberg, Nina; Johansson, Ann-Christin

2018-02-01

Falls are a major threat to the health and independence of seniors. Regular physical activity (PA) can prevent 40% of all fall injuries. The challenge is to motivate and support seniors to be physically active. Persuasive systems can constitute valuable support for persons aiming at establishing and maintaining healthy habits. However, these systems need to support effective behavior change techniques (BCTs) for increasing older adults' PA and meet the senior users' requirements and preferences. Therefore, involving users as codesigners of new systems can be fruitful. Prestudies of the user's experience with similar solutions can facilitate future user-centered design of novel persuasive systems. The aim of this study was to investigate how seniors experience using activity monitors (AMs) as support for PA in daily life. The addressed research questions are as follows: (1) What are the overall experiences of senior persons, of different age and balance function, in using wearable AMs in daily life?; (2) Which aspects did the users perceive relevant to make the measurements as meaningful and useful in the long-term perspective?; and (3) What needs and requirements did the users perceive as more relevant for the activity monitors to be useful in a long-term perspective? This qualitative interview study included 8 community-dwelling older adults (median age: 83 years). The participants' experiences in using two commercial AMs together with tablet-based apps for 9 days were investigated. Activity diaries during the usage and interviews after the usage were exploited to gather user experience. Comments in diaries were summarized, and interviews were analyzed by inductive content analysis. The users (n=8) perceived that, by using the AMs, their awareness of own PA had increased. However, the AMs' impact on the users' motivation for PA and activity behavior varied between participants. The diaries showed that self-estimated physical effort varied between participants and

Drug users in contact with general practice.

Science.gov (United States)

Robertson, J R

1985-01-05

A group of heroin users who are in contact with a general practice in north west Edinburgh are described. The study group was younger and included more women than previous studies. These people used a large variety of drugs and mainly purchased them locally. Frequent and often prolonged abstinent periods occurred with no prescribed opiate treatment. The group had experienced a high rate of drug related medical disorders. All these points raise the possibility that opiate users who are known to general practitioners may be a distinctly different population from those who attend drug dependency clinics. The frequency of remission and the prevalence of polydrug use have profound implications for planning and evaluating an effective medical response.

Disrupted Topological Organization in Whole-Brain Functional Networks of Heroin-Dependent Individuals: A Resting-State fMRI Study

OpenAIRE

Jiang, Guihua; Wen, Xue; Qiu, Yingwei; Zhang, Ruibin; Wang, Junjing; Li, Meng; Ma, Xiaofen; Tian, Junzhang; Huang, Ruiwang

2013-01-01

Neuroimaging studies have shown that heroin addiction is related to abnormalities in widespread local regions and in the functional connectivity of the brain. However, little is known about whether heroin addiction changes the topological organization of whole-brain functional networks. Seventeen heroin-dependent individuals (HDIs) and 15 age-, gender-matched normal controls (NCs) were enrolled, and the resting-state functional magnetic resonance images (RS-fMRI) were acquired from these subj...

A surface plasmon resonance-based immunosensors for sensitive detection of heroin

International Nuclear Information System (INIS)

Wu Zhongcheng; Wang Lianchao; Ge Yu; Yu Chengduan; Fang Tingjian; Chen Wenge

2000-01-01

A simple technique for sensitive detection of heroine based on surface-plasmon resonance has been theoretically and experimentally investigated. The experiment was realized by using an anti-MO monoclonal antibody and a morphine (MO)-bovine serum albumin (MO-BSA) conjugate (antigen). The reason for using MO-BSA in the detection of heroine was also discussed. MO-BSA was immobilized on a gold thin film of SPR sensor chip by physical adsorption. The configuration of the device is allowed to be further miniaturized, which is required for the construction of a portable SPR device in the application of in-situ analysis

Multivitamin Use and Serum Vitamin B12 Concentrations in Older-Adult Metformin Users in REGARDS, 2003-2007.

Science.gov (United States)

Kancherla, Vijaya; Garn, Joshua V; Zakai, Neil A; Williamson, Rebecca S; Cashion, Winn T; Odewole, Oluwaseun; Judd, Suzanne E; Oakley, Godfrey P

2016-01-01

Metformin, an insulin-sensitizing drug, is a first line treatment for type 2 diabetes. Long-term use of metformin has been associated with subsequent reductions in vitamin B12 concentrations. The objective of our study was to determine whether metformin use is associated with lower serum vitamin B12 concentrations in older adults, and whether concurrent use of multivitamins modifies this association. We examined 2,510 participants aged 50 years and over, participating in the national population-based Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study. Multivariable linear and logistic regression models were used to assess associations between multivitamin use and serum vitamin B12 concentrations. We estimated adjusted odds ratios (aOR)s and confidence intervals (CI)s. Results were stratified by three metformin/diabetes sub-groups: 1) participants with diabetes who were metformin users; 2) participants with diabetes who were not metformin users; and 3) participants without diabetes. We found that diabetic metformin users had significantly lower geometric mean serum B12 concentrations (409 pmol/L) than the group with diabetes not taking metformin (485 pmol/L; PL; P = 0.02). The geometric mean serum B12 concentrations were greater for multivitamin users (509 pmol/L) compared to those who did not use multivitamins (376 pmol/L; pvitamin B12 concentrations that were 50% (or 161 pmol/L) higher, compared to those not using multivitamins. Among metformin users, multivitamin use was associated with lower prevalence of combined low and borderline vitamin B12 concentrations (aOR = 0.14; 95% CI = 0.04, 0.54) compared to those not using multivitamins. In conclusion, metformin use was associated with lower geometric mean serum vitamin B12 concentrations among diabetic older adults compared to their counterparts. Concurrent multivitamin use may potentially protect against low or borderline vitamin B12 concentrations in long-term metformin users. Additional

Study of trace impurities in heroin by neutron activation analysis

International Nuclear Information System (INIS)

Zhang, Z.Y.; Yang, J.H.; Ouyang, H.; Li, Z.J.; Chai, Z.F.; Zhu, J.; Xi'an JiaoTong Univ., Shaanxi; Zhao, J.Z.; Yu, Z.S.; Wang, J.

2004-01-01

Sixty-two heroin samples were analyzed for their contents of 15 trace elements (Au, Ba, Br, Ca, Ce, Co, Cr, Fe, La, Na, Sb, Sc, Sm, Th, and Zn) by neutron activation analysis (NAA). Large variations of elemental concentrations between samples were found to possess statistical significance. Of all the elements calcium was the most abundant element, followed by zinc and sodium. The concentrations of Au, Ce, Co, La, Sb, Sc, Sm, and Th in all the samples were below 1 μg x g -1 . Classification of these heroin samples was achieved by the application of hierarchical cluster analysis. The results show that NAA can provide useful information on the origin of the illicit drugs. (author)

Cunts, Dicks, and Postfeminist Politics: Torture-Porn, the Horror Heroine, and Hostel II

DEFF Research Database (Denmark)

Schubart, Rikke

2009-01-01

about the new horror heroine in contemporary horror and the torture porn aesthetics, espcially in Hostel II......about the new horror heroine in contemporary horror and the torture porn aesthetics, espcially in Hostel II...

Pathways to age of onset of heroin use: a structural model approach exploring the relationship of the COMT gene, impulsivity and childhood trauma.

Science.gov (United States)

Li, Ting; Du, Jiang; Yu, Shunying; Jiang, Haifeng; Fu, Yingmei; Wang, Dongxiang; Sun, Haiming; Chen, Hanhui; Zhao, Min

2012-01-01

The interaction of the association of dopamine genes, impulsivity and childhood trauma with substance abuse remains unclear. To clarify the impacts and the interactions of the Catechol -O-methyltransferase (COMT) gene, impulsivity and childhood trauma on the age of onset of heroin use among heroin dependent patients in China. 202 male and 248 female inpatients who meet DSM-IV criteria of heroin dependence were enrolled. Impulsivity and childhood trauma were measured using BIS-11 (Barratt Impulsiveness Scale-11) and ETISR-SF (Early Trauma Inventory Self Report-Short Form). The single nucleotide polymorphism (SNP) rs737866 on the COMT gene-which has previously been associated with heroin abuse, was genotyped using a DNA sequence detection system. Structural equations model was used to assess the interaction paths between these factors and the age of onset of heroin use. Chi-square test indicated the individuals with TT allele have earlier age of onset of heroin use than those with CT or CC allele. In the correlation analysis, the severity of childhood trauma was positively correlated to impulsive score, but both of them were negatively related to the age of onset of heroin use. In structure equation model, both the COMT gene and childhood trauma had impacts on the age of onset of heroin use directly or via impulsive personality. Our findings indicated that the COMT gene, impulsive personality traits and childhood trauma experience were interacted to impact the age of onset of heroin use, which play a critical role in the development of heroin dependence. The impact of environmental factor was greater than the COMT gene in the development of heroin dependence.

Aberrant default-mode functional and structural connectivity in heroin-dependent individuals.

Directory of Open Access Journals (Sweden)

Xiaofen Ma

Full Text Available Little is known about connectivity within the default mode network (DMN in heroin-dependent individuals (HDIs. In the current study, diffusion-tensor imaging (DTI and resting-state functional MRI (rs-fMRI were combined to investigate both structural and functional connectivity within the DMN in HDIs.Fourteen HDIs and 14 controls participated in the study. Structural (path length, tracts count, (fractional anisotropy FA and (mean diffusivity MD derived from DTI tractographyand functional (temporal correlation coefficient derived from rs-fMRI DMN connectivity changes were examined in HDIs. Pearson correlation analysis was performed to compare the structural/functional indices and duration of heroin use/Iowa gambling task(IGT performance in HDIs.HDIs had lower FA and higher MD in the tract connecting the posterior cingulate cortex/precuneus (PCC/PCUN to right parahippocampal gyrus (PHG, compared to the controls. HDIs also had decreased FA and track count in the tract connecting the PCC/PCUN and medial prefrontal cortex (MPFC, as well as decreased functional connectivity between the PCC/PCUN and bilateral PHG and MPFC, compared to controls. FA values for the tract connecting PCC/PCUN to the right PHG and connecting PCC/PCUN to the MPFC were negatively correlated to the duration of heroin use. The temporal correlation coefficients between the PCC/PCUN and the MPFC, and the FA values for the tract connecting the PCC/PCUN to the MPFC were positively correlated to IGT performance in HDIs.Structural and functional connectivity within the DMN are both disturbed in HDIs. This disturbance progresses as duration of heroin use increases and is related to deficits in decision making in HDIs.

Multivariate analysis of dopaminergic gene variants as risk factors of heroin dependence.

Directory of Open Access Journals (Sweden)

Andrea Vereczkei

Full Text Available BACKGROUND: Heroin dependence is a debilitating psychiatric disorder with complex inheritance. Since the dopaminergic system has a key role in rewarding mechanism of the brain, which is directly or indirectly targeted by most drugs of abuse, we focus on the effects and interactions among dopaminergic gene variants. OBJECTIVE: To study the potential association between allelic variants of dopamine D2 receptor (DRD2, ANKK1 (ankyrin repeat and kinase domain containing 1, dopamine D4 receptor (DRD4, catechol-O-methyl transferase (COMT and dopamine transporter (SLC6A3 genes and heroin dependence in Hungarian patients. METHODS: 303 heroin dependent subjects and 555 healthy controls were genotyped for 7 single nucleotide polymorphisms (SNPs rs4680 of the COMT gene; rs1079597 and rs1800498 of the DRD2 gene; rs1800497 of the ANKK1 gene; rs1800955, rs936462 and rs747302 of the DRD4 gene. Four variable number of tandem repeats (VNTRs were also genotyped: 120 bp duplication and 48 bp VNTR in exon 3 of DRD4 and 40 bp VNTR and intron 8 VNTR of SLC6A3. We also perform a multivariate analysis of associations using Bayesian networks in Bayesian multilevel analysis (BN-BMLA. FINDINGS AND CONCLUSIONS: In single marker analysis the TaqIA (rs1800497 and TaqIB (rs1079597 variants were associated with heroin dependence. Moreover, -521 C/T SNP (rs1800955 of the DRD4 gene showed nominal association with a possible protective effect of the C allele. After applying the Bonferroni correction TaqIB was still significant suggesting that the minor (A allele of the TaqIB SNP is a risk component in the genetic background of heroin dependence. The findings of the additional multiple marker analysis are consistent with the results of the single marker analysis, but this method was able to reveal an indirect effect of a promoter polymorphism (rs936462 of the DRD4 gene and this effect is mediated through the -521 C/T (rs1800955 polymorphism in the promoter.

Impaired emotion recognition is linked to alexithymia in heroin addicts

Directory of Open Access Journals (Sweden)

Giuseppe Craparo

2016-04-01

Full Text Available Several investigations document altered emotion processing in opiate addiction. Nevertheless, the origin of this phenomenon remains unclear. Here we examined the role of alexithymia in the ability (i.e., number of errors—accuracy and reaction times—RTs of thirty-one heroin addicts and thirty-one healthy controls to detect several affective expressions. Results show generally lower accuracy and higher RTs in the recognition of facial expressions of emotions for patients, compared to controls. The hierarchical multivariate regression analysis shows that alexithymia might be responsible of the between groups difference with respect to the RTs in emotion detection. Overall, we provide new insights in the clinical interpretation of affective deficits in heroin addicts suggesting a role of alexithymia in their ability to recognize emotions.

Dierexperimenteel onderzoek naar de effecten van inhalatoire blootstelling aan pyrolysaat van verontreinigde hard-drugs, heroine en cocaine

NARCIS (Netherlands)

van Velsen FL; Beekhof PK; de Jong Y; Marra M; Dormans JAMA

1985-01-01

Het dierexperimenteel onderzoek is uitgevoerd met monsters van hard- drugs. die zijn aangetroffen bij een recent slachtoffer van de "heroine"-leuko-encephalopathie. De resultaten van een dagelijkse blootstelling van ratten gedurende 4 weken aan heroine of cocaine heeft niet geleid tot

Prevalence of antisocial personality disorder among Chinese individuals receiving treatment for heroin dependence: a meta-analysis.

Science.gov (United States)

Zhong, Baoliang; Xiang, Yutao; Cao, Xiaolan; Li, Yan; Zhu, Junhong; Chiu, Helen F K

2014-10-01

Studies from Western countries consistently report very high rates of comorbid Antisocial Personality Disorder (ASPD) among individuals with heroin addiction, but the reported proportion of Chinese individuals with heroin addiction who have co-morbid ASPD varies widely, possibly because Chinese clinicians do not consider personality issues when treating substance abuse problems. Conduct a meta-analysis of studies that assessed the proportion of Chinese individuals with heroin dependence who have comorbid ASPD. We searched for relevant studies in both Chinese databases (China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, Taiwan Electronic Periodical Services) and western databases (PubMed, EMBASE, and PsycInfo). Two authors independently retrieved the literature, identified studies that met pre-defined inclusion and exclusion criteria, assessed the quality of included studies, and extracted the data used in the analysis. Statistical analysis was performed using StatsDirect 3.0 and R software. The search yielded 15 eligible studies with a total of 3692 individuals with heroin dependence. Only 2 of the studies were rated as high-quality studies. All studies were conducted in rehabilitation centers or hospitals. The pooled lifetime prevalence of ASPD in these subjects was 30% (95%CI: 23%-38%), but the heterogeneity of results across studies was great (I(2) =95%, ptreatment for heroin dependence, but we estimate that about one-third of them meet criteria for ASPD. Further work is needed to increase clinicians' awareness of this issue; to compare the pathogenesis, treatment responsiveness and recidivism of those with and without ASPD; and to develop and test targeted interventions for this difficult-to-treat subgroup of individuals with heroin dependence.

User-centered Development of Video telephony for Servicing Mainly Older Users: Review and Evaluation of an Approach Applied for 10 Years

Directory of Open Access Journals (Sweden)

Seppo Väyrynen

2006-01-01

Full Text Available A research and development (R&D approach has been applied to video telephony (VT in northern Finland since 1994 by broad consortia. The focus has been on the considerable involvement of ergonomics within the engineering and implementation of VT. This multidisciplinary participatory ergonomic R&D approach (PERDA is described briefly, in general and through two cases. The user-centeredness should be discernible in this sociotechnical systemic entity. A consortium—comprising mainly manufacturers, individual and organizational users of technological products, and R&D organizations—serves as a natural context for product development. VT has been considered to have much potential for enhancing (multimedia interaction and effective multimodal communication, thereby facilitating many activities of everyday life and work. An assessment of the VT system, called HomeHelper, involved older citizens, as clients or customers, and the staff of social, health, and other services.

Assessing cue-induced brain response as a function of abstinence duration in heroin-dependent individuals: an event-related fMRI study.

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Qiang Li

Full Text Available The brain activity induced by heroin-related cues may play a role in the maintenance of heroin dependence. Whether the reinforcement or processing biases construct an everlasting feature of heroin addiction remains to be resolved. We used an event-related fMRI paradigm to measure brain activation in response to heroin cue-related pictures versus neutral pictures as the control condition in heroin-dependent patients undergoing short-term and long-term abstinence. The self-reported craving scores were significantly increased after cue exposure in the short-term abstinent patients (t = 3.000, P = 0.008, but no increase was found in the long-term abstinent patients (t = 1.510, P = 0.149. However, no significant differences in cue-induced craving changes were found between the two groups (t = 1.193, P = 0.850. Comparing between the long-term abstinence and short-term abstinence groups, significant decreases in brain activation were detected in the bilateral anterior cingulated cortex, left medial prefrontal cortex, caudate, middle occipital gyrus, inferior parietal lobule and right precuneus. Among all of the heroin dependent patients, the abstinence duration was negatively correlated with brain activation in the left medial prefrontal cortex and left inferior parietal lobule. These findings suggest that long-term abstinence may be useful for heroin-dependent patients to diminish their saliency value of heroin-related cues and possibly lower the relapse vulnerability to some extent.

A pilot assessment of relapse prevention for heroin addicts in a Chinese rehabilitation center.

Science.gov (United States)

Min, Zhao; Xu, Li; Chen, Hanhui; Ding, Xu; Yi, Zhang; Mingyuang, Zhang

2011-05-01

To conduct a pilot assessment of relapse prevention (RP) group therapy for heroin-dependent patients in a drug rehabilitation center in China. A randomized case-control study was conducted to assess the efficacy of RP delivered over a 2-month period to male heroin addicts (n = 50, RP group) in the Shanghai Labor Drug Rehabilitation Center (LDRC) compared with an equal number of participants (n = 50, labor rehabilitation (LR) group) in the LDRC program receiving standard-of-care treatment. Outcomes were assessed by the Beck Depression Inventory (BDI), the Self-Rating Anxiety Scale (SAS), the Self-Efficacy Scale (SE), and the Self-Esteem Scale (SES) after completion of RP, and by the Addiction Severity Index (ASI) and abstinence rates of heroin use at 3-month follow-up post release from the LDRC for both groups. Significant improvements in scores on SAS, SE, and SES were found in the RP group after completion of the 2-month RP group therapy compared with the LR group (SAS 7.85 ± 6.20 vs 1.07 ± 5.42, SE 3.88 ± 3.60 vs .08 ± 2.89, and SES 3.83 ± 3.31 vs .78 ± 2.55). At 3-month follow-up, the RP group participants had more improvements on ASI scores in most domains and had higher abstinence rates than that in the LR group (37.2% vs 16.7%). An RP component can be effective in increasing abstinence rates among post-program heroin-dependent individuals and may help reduce anxiety and improve self-esteem and self-efficacy during and following treatment. This study suggests RP as a potentially effective component of treatment for heroin addicts.

Supply-side response to declining heroin purity: fentanyl overdose episode in New Jersey.

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Hempstead, Katherine; Yildirim, Emel O

2014-06-01

The inelastic price demand observations characteristic of illegal drug markets have led to the conclusion that the burden of a negative supply shock would be completely reflected to consumers. This paper argues that the increasing availability of prescription opioids may threaten heroin sellers' profit margin and force them to find alternative methods to compensate buyers in the event of a supply shock. We investigate the 2006 fentanyl overdose episode in New Jersey and argue that the introduction of non-pharmaceutical fentanyl, its spatial distribution, and the timing of overdose deaths may have been related to trends in heroin purity. Using medical examiner data, as well as data from the Drug Enforcement Administration, Office of Diversion Control on retail sales of prescription opioids in a negative binomial specification, we show that month-to-month fluctuations in heroin purity have a significant effect on fentanyl-related overdoses, particularly in those areas where prescription opioids are highly available. Copyright © 2013 John Wiley & Sons, Ltd.

Brain-derived neurotrophic factor (BDNF) and oxidative stress in heroin-dependent male patients undergoing methadone maintenance treatment.

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Tsai, Meng-Chang; Huang, Tiao-Lai

2017-03-01

Brain-derived neurotrophic factor (BDNF) and oxidative stress may play a role in patients with heroin dependence. The aim of this study was to investigate the serum levels and activities of BDNF and oxidative stress markers, such as superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), thiobarbituric acid reactive substances (TBARS), protein carbonyl content (PCC), and 8-hydroxy 2'-deoxyguanosine (8-OHdG), in heroin-dependent patients undergoing methadone maintenance treatment (MMT). 60 heroin-dependent male MMT patients and 30 healthy males were recruited for this study. The serum BDNF and oxidative stress markers of these subjects were measured with assay kits. Analyses of covariance (ANCOVAs) with age and body mass index adjustments indicated that the serum levels of BDNF in the MMT patients were significantly higher than those in the healthy controls (F=5.169; p=0.026). However, there were no significant differences between the heroin-dependent patients and the healthy controls in the serum levels or activities of oxidative stress markers (p>0.05). In conclusion, our results suggest that MMT increases BDNF levels in heroin-dependent patients, and that patients undergoing MMT might be in a balanced state of reduced oxidation. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months.

LENUS (Irish Health Repository)

Smyth, Bobby P

2018-05-04

Opioid dependence is a major health concern across the world and does also occur in adolescents. While opioid substitution treatment (OST) has been thoroughly evaluated in adult populations, very few studies have examined its use in adolescents. There are concerns that OST is underutilised in adolescents with heroin dependence. We sought to measure changes in drug use among adolescents receiving OST and also to examine treatment attrition during the first 12 months of this treatment.

Computed Tomography Following Body Stuffing Heroin

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Sean P. Nordt

2015-12-01

Full Text Available A 37-year-old male presented to the emergency department (ED in police custody for “medical clearance” before being taken to jail. The patient was approached by police officers for suspicion of selling illicit drugs. When approached by police he ran away and was witnessed to swallow several small plastic baggies suspected to contain heroin. He was apprehended and brought to the ED. On arrival, he was asymptomatic with a blood pressure 144/83mmHg, heart rate 67bpm, respiratory rate of 19bpm, oxygen saturation of 99% on room air and afebrile. A Glasgow coma score was 15 and he was alert and oriented to person, place and time. Patient had a negative review of systems. On physical examination pupils were 4mm and reactive to light, lungs clear to auscultation and had normal respiratory rate with normal cardiovascular exam. Abdomen was soft, non-tender and non-distended with present bowel sounds. The patient admitted to ingesting approximately 20 packets of heroin to avoid being charged with possession. The patient declined activated charcoal and whole bowel irrigation (WBI with polyethylene glycol-electrolyte solution (PEG-ELS. The patient declined a urine toxicology immunoassay screen. A computed tomography (CT of his abdomen with contrast was obtained and read as normal except for a cluster of foreign bodies within the distal stomach likely contained within a plastic bag.

Long-term mortality and causes of death among hospitalized Swedish drug users.

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Fugelstad, Anna; Annell, Anders; Ågren, Gunnar

2014-06-01

To study long-term mortality and causes of death in a cohort of drug users in relation to main type of drug use and HIV-status. A total of 1640 hospitalized drug users in Stockholm was followed up from 1985 to the end of 2007. The mortality was compared with the general Swedish population and hazard ratios (HR) for the main risk indicators were calculated. The causes of death were studied, using information from death certificates. 630 persons died during the observation period. The Standard Mortality Ratio (SMR) was 16.1 (males 13.8, females 18.5). The crude mortality rate was 2.0 % (males 2.2% and females 1.5%). The mortality rate was higher in heroin users than among amphetamine users, HR 1.96, controlled for age and other risk factors. The mortality rate among individuals infected with the human immunodeficiency virus (HIV) was high (4.9 %), HR 2.64, compared with HIV-negative individuals. Most of the deaths were from other causes than acquired immune deficiency syndrome. One-third of deaths (227) were caused by heroin intoxication. The number of deaths from HIV-related causes decreased after 1996, when highly active anti-retroviral therapy was introduced. In all, there were 92 HIV-related deaths. Deaths from natural causes increased during the observation period. The SMR was highest for cardiovascular and gastrointestinal diseases. The results indicate a correlation between amphetamine use and death from cerebral haemorrhage. A high proportion of natural deaths were alcohol-related. The death rate among illicit drug users was persistently high. Alcohol consumption was a contributing factor to premature death. © 2014 the Nordic Societies of Public Health.

A recommended procedure for establishing the source level relationships between heroin case samples of unknown origins

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Kar-Weng Chan

2014-06-01

Full Text Available A recent concern of how to reliably establish the source level relationships of heroin case samples is addressed in this paper. Twenty-two trafficking heroin case samples of unknown origins seized from two major regions (Kuala Lumpur and Penang in Malaysia were studied. A procedure containing six major steps was followed to analyze and classify these samples. Subsequently, with the aid of statistical control samples, reliability of the clustering result was assessed. The final outcome reveals that the samples seized from the two regions in 2013 had highly likely originated from two different sources. Hence, the six-step procedure is sufficient for any chemist who attempts to assess the relative source level relationships of heroin samples.

Effects of cortisol administration on craving in heroin addicts

NARCIS (Netherlands)

Walter, M.; Bentz, D.; Schicktanz, N.; Milnik, A.; Aerni, A.; Gerhards, C.; Schwegler, K.; Vogel, M.; Blum, J.; Schmid, O.; Roozendaal, B.; Lang, U.E.; Borgwardt, S.; Quervain, D. de

2015-01-01

Heroin dependence is a severe and chronically relapsing substance use disorder with limited treatment options. Stress is known to increase craving and drug-taking behavior, but it is not known whether the stress hormone cortisol mediates these stress effects or whether cortisol may rather reduce

Phylogeny and biogeography of 91 species of heroine cichlids (Teleostei: Cichlidae) based on sequences of the cytochrome b gene.

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Pérez, Gustavo A Concheiro; Rícan, Oldrich; Ortí, Guillermo; Bermingham, Eldredge; Doadrio, Ignacio; Zardoya, Rafael

2007-04-01

Heroini constitute the second largest tribe of Neotropical cichlids and show their greatest diversity in Mesoamerica. Although heroine species are morphologically and ecologically very diverse, they were all historically assigned to one single genus, Cichlasoma that was never formally revised from a phylogenetic point of view. Here, we present the most comprehensive molecular phylogeny of the tribe Heroini to date, based on the complete DNA sequence of the mitochondrial gene cytochrome b, and the analysis of 204 individuals representing 91 species. Phylogenetic analyses did not support the monophyly of heroines because the genus Pterophyllum was placed as the sister group of all remaining heroines plus cichlasomatines. However, the recovered relative position of Pterophyllum was without strong statistical support. Within the remaining heroines, Hyspelecara and Hoplarchus are recovered with low support in a basal position with respect to a clade that includes Heros, Uaru, Mesonauta, and Symphysodon, and the circumamazonian (CAM) heroines. The first clade is restricted to South America. The largest clade of heroines, the CAM heroines, include more than 85% of the species within the tribe. This clade is mostly Mesoamerican, but also contains four species found in the Greater Antilles (Nandopsis), and three genera found in South America (the 'Heros' festae group, Australoheros, and Caquetaia). Up to eight major lineages can be recovered within the CAM heroines, but the phylogenetic relationships among them remain unresolved. Two large suprageneric groups can be distinguished, the amphilophines and the herichthyines. The amphilophines include Amphilophus, Archocentrus, Hypsophrys, Neetroplus, Parachromis, Petenia, and five additional unnamed genera (the 'Heros' istlanus group, the 'Amphilophus' calobrensis group, the 'Heros' urophthalmus group, the 'Heros' wesseli group, and the 'Heros' sieboldii group). The herichthyines include the crown-group herichthyines

Study Of The Effect Of Heroin Used In Iran, On Spermatogenesis Changes And Their Development In Balb/C Mice

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Fazelipour S

2005-05-01

Full Text Available Background: Heroin is one of the opiates which is used, as the most addictive drugs, in Iran. Considering the damaging effects of these drugs on the health of opiate addicts, investigation on the effects of heroin used in Iran, on male genital indicators including daily sperm production and its development, which has an essential role in fertility, seems to be necessary. Materials and Methods: A total of 70 Bulb/c mature male mice, were divided into 5 groups of control, [intact (n=10, sham I (n=10 sham II (n=10] and experimental groups [I (n=20, II (n=20], and 50 days after addiction to heroin (50 mg/kg via intra peritoneal injection (IP, 6 mice from each groups were selected and after euthenizing, the testes and epididymes were removed. The rate of daily sperm production (DSP, epididymic sperm preservation (ESP and the rate of sperm motility were measured accurately. Results: In the study of the effect of heroin on daily sperm production and sperm preservation between the control and experimental groups, no significant differences were observed. The effect of heroin on sperm motility between control and experimental groups, the difference were significant (P<0/05. Conclusions: In this survey, it was indicated that, the heroin used in Iran, causes a decrease in healthy sperms of mice their motility, and consequently can affect on genital indicators.

Neuropsychological functioning in buprenorphine maintained patients versus abstinent heroin abusers on naltrexone hydrochloride therapy.

Science.gov (United States)

Messinis, Lambros; Lyros, Epameinondas; Andrian, Virginia; Katsakiori, Paraskevi; Panagis, George; Georgiou, Vasileios; Papathanasopoulos, Panagiotis

2009-10-01

Methadone and buprenorphine are among the most widely employed pharmacological treatments currently available for opioid addiction. Cognitive effects of buprenorphine in abstinent heroin abusers are nevertheless far from being understood. Neuropsychological performance of 18 buprenorphine-maintained patients (BMP) was evaluated relative to that of 32 currently abstinent heroin abusers on naltrexone hydrochloride therapy (FHAN), and 34 non-drug dependent controls. The three groups were demographically balanced. Clinical groups reported histories of similar patterns of drug use and had increased periods of abstinence from any illicit substance use including heroin. The BMP group performed poorer than controls on the RAVLT (encoding and delayed recall of verbal information), CTT (conceptual flexibility, executive functions) and the RBANS figure copy (visual perception) and delayed recall of visual information. There were no significant differences in any of the cognitive measures between the BMP and FHAN groups or between the FHAN group and controls. Furthermore, the non-differing percentage of abnormal cases between the two patient groups led us to infer that treatment with either BPM or FHAN is not accompanied by qualitative differences in the cognitive profiles of these patients. Overall, results suggest that treatment with naltrexone in abstinent heroin abusers may result in less impairment of cognitive functions compared to treatment with buprenorphine. These findings are relevant for improved prognosis and treatment strategies in opioid dependence.

Heroin-induced leukoencephalopathy: characterization using MRI, diffusion-weighted imaging, and MR spectroscopy

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Offiah, C. [Department of Neuroradiology, St Bartholomew' s and the London Hospitals NHS Trust, London (United Kingdom); Hall, E. [Department of Neuroradiology, St Bartholomew' s and the London Hospitals NHS Trust, London (United Kingdom)], E-mail: curtis.offiah@bartsandthelondon.nhs.uk

2008-02-15

Aim: To describe the magnetic resonance imaging (MRI) characteristics of heroin-induced leukoencephalopathy or 'chasing the dragon syndrome' and, in particular, the diffusion-weighted imaging (DWI) and MR spectroscopy (MRS) features. Material and methods: Six patients with a clinical or histopathological diagnosis of heroin-induced leukoencephalopathy were identified and MRI examinations, including DWI and single-voxel MRS, reviewed. Results: Cerebellar white matter was involved in all six cases demonstrating similar symmetrical distribution with sparing of the dentate nuclei. Brain stem signal change was evident in five of the six patients imaged. Supratentorial brain parenchymal involvement, as well as brain stem involvement, correlated anatomically with corticospinal tract distribution. None of the areas of signal abnormality were restricted on DWI. Of those patients subjected to MRS, the areas of parenchymal damage demonstrated reduced N-acetylaspartate, reduced choline, and elevated lactate. Conclusion: Heroin-induced leukoencephalopathy results in characteristic and highly specific signal abnormalities on MRI, which can greatly aid diagnosis. DWI and MRS findings can be explained by known reported neuropathological descriptions in this condition and can be used to support a proposed mechanism for the benefit of current recommended drug treatment regimes.

MRI features of patients with heroin spongiform leukoencephalopathy of different clinical stages

International Nuclear Information System (INIS)

Shi Zhu; Pan Suyue; Zhou Liang; Dong Zhao; Lu Bingxun

2007-01-01

Objective: To investigate radiological features of patients with heroin spongiform leukoencephalopathy (HSLE) of different clinical stages and discuss the evolutional characteristics of the disease. Methods: Thirty two patients with HSLE underwent precontrast MRI and postcontrast MRI. The history of addiction, clinical presentations, and brain MRI were analyzed and summarized according to the patient's clinical staging. There are 6 cases in I stage, 21 cases in II stage, 5 cases in III stage. Results: All patients had history of heroin vapor inhalation. Most of the cases developed subacute cerebellar impairment in earlier period. Brain MRI revealed symmetrical lesion within bilateral cerebellum in all patients. Splenium of the corpus callosum, posterior limb of the internal capsule, deep white matter of the occipital and parietal lobes, were gradually involved with progressive deterioration of HSLE. The brain stem and deep white matter of the frontal and temporal lobes were involved in some cases. Conclusions: The history of heated heroin vapor inhalation was the prerequisite for the diagnosis of HSLE. Brain MRI presented the characteristic lesion and its evolution of HSLE. Brain MRI was very important for accurate diagnosis and helpful to judge the clinical stages according to the involved brain region. (authors)

Parallel increases in sister chromatid exchanges at base level and with UV treatment in human opiate users

International Nuclear Information System (INIS)

Shafer, D.A.; Falek, A.; Madden, J.J.; Tadayon, F.; Pline, M.; Kuehnle, J.C.; Mendelson, J.

1983-01-01

The SCE base level frequency and SCE levels induced by far-UV (254 nm) treatment of cells in early G 1 and early S phases of the cell cycle were significantly higher in leukocytes from heroin addicts as compared to controls. The increased SCE levels in addicts was greatest at base level and smallest after UV irradiation of cells in S phase. These results corrobate and extend our previous findings of increased chromosome damage and reduced DNA-repair synthesis in heroin users. Since opiates do not directly damage DNA, the elevated cytogenetic effects associated with opiate use probably arise from secondary promotional effects related to opiate-mediated alterations in leukocyte metabolism. (orig.)

Disrupted topological organization in whole-brain functional networks of heroin-dependent individuals: a resting-state FMRI study.

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Guihua Jiang

Full Text Available Neuroimaging studies have shown that heroin addiction is related to abnormalities in widespread local regions and in the functional connectivity of the brain. However, little is known about whether heroin addiction changes the topological organization of whole-brain functional networks. Seventeen heroin-dependent individuals (HDIs and 15 age-, gender-matched normal controls (NCs were enrolled, and the resting-state functional magnetic resonance images (RS-fMRI were acquired from these subjects. We constructed the brain functional networks of HDIs and NCs, and compared the between-group differences in network topological properties using graph theory method. We found that the HDIs showed decreases in the normalized clustering coefficient and in small-worldness compared to the NCs. Furthermore, the HDIs exhibited significantly decreased nodal centralities primarily in regions of cognitive control network, including the bilateral middle cingulate gyrus, left middle frontal gyrus, and right precuneus, but significantly increased nodal centralities primarily in the left hippocampus. The between-group differences in nodal centralities were not corrected by multiple comparisons suggesting these should be considered as an exploratory analysis. Moreover, nodal centralities in the left hippocampus were positively correlated with the duration of heroin addiction. Overall, our results indicated that disruptions occur in the whole-brain functional networks of HDIs, findings which may be helpful in further understanding the mechanisms underlying heroin addiction.

Disrupted topological organization in whole-brain functional networks of heroin-dependent individuals: a resting-state FMRI study.

Science.gov (United States)

Jiang, Guihua; Wen, Xue; Qiu, Yingwei; Zhang, Ruibin; Wang, Junjing; Li, Meng; Ma, Xiaofen; Tian, Junzhang; Huang, Ruiwang

2013-01-01

Neuroimaging studies have shown that heroin addiction is related to abnormalities in widespread local regions and in the functional connectivity of the brain. However, little is known about whether heroin addiction changes the topological organization of whole-brain functional networks. Seventeen heroin-dependent individuals (HDIs) and 15 age-, gender-matched normal controls (NCs) were enrolled, and the resting-state functional magnetic resonance images (RS-fMRI) were acquired from these subjects. We constructed the brain functional networks of HDIs and NCs, and compared the between-group differences in network topological properties using graph theory method. We found that the HDIs showed decreases in the normalized clustering coefficient and in small-worldness compared to the NCs. Furthermore, the HDIs exhibited significantly decreased nodal centralities primarily in regions of cognitive control network, including the bilateral middle cingulate gyrus, left middle frontal gyrus, and right precuneus, but significantly increased nodal centralities primarily in the left hippocampus. The between-group differences in nodal centralities were not corrected by multiple comparisons suggesting these should be considered as an exploratory analysis. Moreover, nodal centralities in the left hippocampus were positively correlated with the duration of heroin addiction. Overall, our results indicated that disruptions occur in the whole-brain functional networks of HDIs, findings which may be helpful in further understanding the mechanisms underlying heroin addiction.

Electroacupuncture Suppresses Discrete Cue-Evoked Heroin-Seeking and Fos Protein Expression in the Nucleus Accumbens Core in Rats

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Sheng Liu

2012-01-01

Full Text Available Relapse to drug seeking was studied using a rodent model of reinstatement induced by exposure to drug-related cues. Here, we used intravenous drug self-administration procedures in rats to further investigate the beneficial effects of electroacupuncture (EA on heroin-seeking behavior in a reinstatement model of relapse. We trained Sprague-Dawley rats to nose-poke for i.v. heroin either daily for 4 h or 25 infusions for 14 consecutive days. Then the rats were abstinent from heroin for two weeks. 2 Hz EA stimulation was conducted once daily for 14 days during heroin abstinence. We tested these animals for contextual and discrete cue-induced reinstatement of active responses. We also applied immunohistochemistry to detect Fos-positive nuclei in the nucleus accumbens (NACc core and shell after reinstatement test. We found that active responses elicited by both contextual cues and discrete cues were high in the rats trained with heroin than in saline controls. EA treatment significantly reduced active responses elicited by discrete cues. EA stimulation attenuated Fos expression in the core but not the shell of the NACc. Altogether, these results highlight the therapeutic benefit of EA in preventing relapse to drug addiction.

Impulsivity, Sensation Seeking, and Risk-Taking Behaviors among HIV-Positive and HIV-Negative Heroin Dependent Persons

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Koosha Paydary

2016-01-01

Full Text Available Objective. The aim of this study was to compare impulsivity and risky decision making among HIV-positive and negative heroin dependent persons. Methods. We compared different dimensions of impulsivity and risky decision making in two groups of 60 HIV-positive and 60 HIV-negative male heroin dependent persons. Each group was comprised of equal numbers of current (treatment seeker and former (abstinent heroin addicts. Data collection tools included Balloon Analogue Risk Task (BART, Iowa Gambling Task (IGT, Barratt Impulsiveness Scale (BIS, and Zuckerman Sensation Seeking Scale (SSS. Results. In SSS, comprised of four subscales including thrill and adventure seeking (TAS, experience seeking (ES, disinhibition (DIS, and boredom susceptibility (BS, there was a borderline difference in DIS (P=0.08 as HIV-positive group scored higher than HIV-negative group. Also, ES and total score were significantly higher among HIV-positive patients. In BART, HIV-positive subjects scored higher in risk taking than HIV-negative subjects as reflected in higher Average Number of puffs in Successful Balloons (ANSB. In BIS, HIV-positive group scored significantly higher in cognitive impulsivity (CI (P=0.03 and nonplanning impulsivity (NPI (P=0.05 in comparison to HIV-negative group. Also, current heroin addicts scored significantly higher in NPI compared to former addict HIV-negative participants (P=0.015. IGT did not show any significant difference between groups. Conclusion. Higher levels of impulsivity and risk taking behaviors among HIV-positive heroin addicts will increase serious concerns regarding HIV transmission from this group to other opiate dependents and healthy people.

Impulsivity, Sensation Seeking, and Risk-Taking Behaviors among HIV-Positive and HIV-Negative Heroin Dependent Persons

Science.gov (United States)

Paydary, Koosha; Mahin Torabi, Somayeh; SeyedAlinaghi, SeyedAhmad; Noori, Mehri; Noroozi, Alireza; Ameri, Sara; Ekhtiari, Hamed

2016-01-01

Objective. The aim of this study was to compare impulsivity and risky decision making among HIV-positive and negative heroin dependent persons. Methods. We compared different dimensions of impulsivity and risky decision making in two groups of 60 HIV-positive and 60 HIV-negative male heroin dependent persons. Each group was comprised of equal numbers of current (treatment seeker) and former (abstinent) heroin addicts. Data collection tools included Balloon Analogue Risk Task (BART), Iowa Gambling Task (IGT), Barratt Impulsiveness Scale (BIS), and Zuckerman Sensation Seeking Scale (SSS). Results. In SSS, comprised of four subscales including thrill and adventure seeking (TAS), experience seeking (ES), disinhibition (DIS), and boredom susceptibility (BS), there was a borderline difference in DIS (P = 0.08) as HIV-positive group scored higher than HIV-negative group. Also, ES and total score were significantly higher among HIV-positive patients. In BART, HIV-positive subjects scored higher in risk taking than HIV-negative subjects as reflected in higher Average Number of puffs in Successful Balloons (ANSB). In BIS, HIV-positive group scored significantly higher in cognitive impulsivity (CI) (P = 0.03) and nonplanning impulsivity (NPI) (P = 0.05) in comparison to HIV-negative group. Also, current heroin addicts scored significantly higher in NPI compared to former addict HIV-negative participants (P = 0.015). IGT did not show any significant difference between groups. Conclusion. Higher levels of impulsivity and risk taking behaviors among HIV-positive heroin addicts will increase serious concerns regarding HIV transmission from this group to other opiate dependents and healthy people. PMID:27051528

Validation and User Evaluation of a Sensor-Based Method for Detecting Mobility-Related Activities in Older Adults.

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Hilde A E Geraedts

Full Text Available Regular physical activity is essential for older adults to stay healthy and independent. However, daily physical activity is generally low among older adults and mainly consists of activities such as standing and shuffling around indoors. Accurate measurement of this low-energy expenditure daily physical activity is crucial for stimulation of activity. The objective of this study was to assess the validity of a necklace-worn sensor-based method for detecting time-on-legs and daily life mobility related postures in older adults. In addition user opinion about the practical use of the sensor was evaluated. Twenty frail and non-frail older adults performed a standardized and free movement protocol in their own home. Results of the sensor-based method were compared to video observation. Sensitivity, specificity and overall agreement of sensor outcomes compared to video observation were calculated. Mobility was assessed based on time-on-legs. Further assessment included the categories standing, sitting, walking and lying. Time-on-legs based sensitivity, specificity and percentage agreement were good to excellent and comparable to laboratory outcomes in other studies. Category-based sensitivity, specificity and overall agreement were moderate to excellent. The necklace-worn sensor is considered an acceptable valid instrument for assessing home-based physical activity based upon time-on-legs in frail and non-frail older adults, but category-based assessment of gait and postures could be further developed.

Heroin assisted treatment and research networks

DEFF Research Database (Denmark)

Houborg, Esben; Munksgaard, Rasmus

2015-01-01

Purpose – The purpose of this paper is to map research communities related to heroin-assisted treatment (HAT) and the scientific network they are part of to determine their structure and content. Design/methodology/approach – Co-authorship as the basis for conducting social network analysis....... In total, 11 research communities were constructed with different scientific content. HAT research communities are closely connected to medical, psychiatric, and epidemiological research and very loosely connected to social research. Originality/value – The first mapping of the collaborative network HAT...... researchers using social network methodology...

User Experience, Actual Use, and Effectiveness of an Information Communication Technology-Supported Home Exercise Program for Pre-Frail Older Adults

NARCIS (Netherlands)

Dekker-van Weering, Marit; Jansen-Kosterink, Stephanie; Frazer, Sanne; Vollenbroek-Hutten, Miriam

2017-01-01

Objective: The main objective of this study was to investigate the use and user experience of an Information Communication Technology-supported home exercise program when offered for independent use to pre-frail older adults. Our secondary aim was to explore whether the program improved quality of

Authors’ reply: Response to “Older cancer patients’ user experiences with web-based health information tools: A think-aloud study"

NARCIS (Netherlands)

Bolle, S.; Romijn, G.; Smets, E.M.A; Loos, E.F.; Kunneman, M.; van Weert, J.C.M.

2016-01-01

We greatly appreciate the thoughtful comments of Gokani and colleagues [1] in response to our article “Older Cancer Patients’ User Experiences With Web-Based Health Information Tools: A Think-Aloud Study” [2]. We are happy to elaborate on the points for which they request further clarification.

The presence of some humoral immunologic indicators and clinical manifestations in cryoglobulin positive heroin addicts without evidence of hepatitis virus infection

Directory of Open Access Journals (Sweden)

Simonovska Natasha

2015-01-01

Full Text Available Introduction. Cryoglobulins are single or mixed immunoglobulins that are subject to reversible precipitation at low temperatures. Objective. The aims of this paper were: 1. Comparison of cryoglobulin positive (CP, cryoglobulin negative (CN heroin addicts and the control group (CG in terms of serum immunoglobulins IgG, IgA and IgM and complement components C3 and C4; 2. Comparison of CP and CN heroin addicts in terms of rheumatoid factor (RF and circulating immune complexes (CIC; 3. Assessment of clinical manifestations in CP heroin addicts. Methods. This is a comparative study of cases (outpatients treated at the University Clinic of Toxicology in Skopje over 3.5 years, from January 2009 to June 2012. In this study 140 heroin addicts without HbsAg were examined, seronegative for HCV and HIV infections. They were divided into 2 groups: 70 CP and 70 CN heroin addicts. A previously designed self-administered questionnaire was used as a data source on participants. All heroin addicts underwent the following analyses: urea and creatinine in serum; creatinine in urine; proteinuria; 24-hour proteinuria; IgM, IgG, IgA, C3, C4 ; RF; CIC; creatinine clearance; ECG; toxicological analyses for opioids in a urine sample; cryoglobulins. In addition to these 2 groups, IgG, IgA, IgM, C3 and C4 were also examined in 70 healthy subjects (CG. Results. The study showed that there was no statistically significant difference between CP, CN heroin addicts and CG regarding the concentration of IgA, IgG, IgM, C3 and C4, and between CP and CN regarding the concentration of CIC. There was significant difference between CP and CN regarding the concentration of RF. The following conditions were significantly more frequently manifested in CP than in CN heroin addicts: arthralgia, Raynaud’s phenomenon, respiratory difficulties, neurological disorders, manifested skin changes, hematuria, 24-hour proteinuria levels, and decreased renal clearance. Conclusion. There were no

Disrupted coupling of large-scale networks is associated with relapse behaviour in heroin-dependent men

Science.gov (United States)

Li, Qiang; Liu, Jierong; Wang, Wei; Wang, Yarong; Li, Wei; Chen, Jiajie; Zhu, Jia; Yan, Xuejiao; Li, Yongbin; Li, Zhe; Ye, Jianjun; Wang, Wei

2018-01-01

Background It is unknown whether impaired coupling among 3 core large-scale brain networks (salience [SN], default mode [DMN] and executive control networks [ECN]) is associated with relapse behaviour in treated heroin-dependent patients. Methods We conducted a prospective resting-state functional MRI study comparing the functional connectivity strength among healthy controls and heroin-dependent men who had either relapsed or were in early remission. Men were considered to be either relapsed or in early remission based on urine drug screens during a 3-month follow-up period. We also examined how the coupling of large-scale networks correlated with relapse behaviour among heroin-dependent men. Results We included 20 controls and 50 heroin-dependent men (26 relapsed and 24 early remission) in our analyses. The relapsed men showed greater connectivity than the early remission and control groups between the dorsal anterior cingulate cortex (key node of the SN) and the dorsomedial prefrontal cortex (included in the DMN). The relapsed men and controls showed lower connectivity than the early remission group between the left dorsolateral prefrontal cortex (key node of the left ECN) and the dorsomedial prefrontal cortex. The percentage of positive urine drug screens positively correlated with the coupling between the dorsal anterior cingulate cortex and dorsomedial prefrontal cortex, but negatively correlated with the coupling between the left dorsolateral prefrontal cortex and dorsomedial prefrontal cortex. Limitations We examined deficits in only 3 core networks leading to relapse behaviour. Other networks may also contribute to relapse. Conclusion Greater coupling between the SN and DMN and lower coupling between the left ECN and DMN is associated with relapse behaviour. These findings may shed light on the development of new treatments for heroin addiction. PMID:29252165

Older Adults' Knowledge of Internet Hazards

Science.gov (United States)

Grimes, Galen A.; Hough, Michelle G.; Mazur, Elizabeth; Signorella, Margaret L.

2010-01-01

Older adults are less likely to be using computers and less knowledgeable about Internet security than are younger users. The two groups do not differ on trust of Internet information. The younger group shows no age or gender differences. Within the older group, computer users are more trusting of Internet information, and along with those with…

The Personality Features of Heroin Addicts and Psychological Rehabilitation%海洛因依赖者人格特征及心理康复

Institute of Scientific and Technical Information of China (English)

刘显玲; 严明娟; 周宗敏

2003-01-01

Objective To analyze the personality features of heroin addicts and their need for psychological rehabilitationto improve personal integrity. Methods The mental health of 35 heroin addicts and 32 normal subjects were assessed by SCL- 90,Social Support Rating Scale and EPQ. Conclusion Heroin addicts have severe personality problems, which warrant long- term psychological rehabilitation after detoxification.

The cutting of cocaine and heroin: A critical review.

Science.gov (United States)

Broséus, Julian; Gentile, Natacha; Esseiva, Pierre

2016-05-01

The illicit drug cutting represents a complex problem that requires the sharing of knowledge from addiction studies, toxicology, criminology and criminalistics. Therefore, cutting is not well known by the forensic community. Thus, this review aims at deciphering the different aspects of cutting, by gathering information mainly from criminology and criminalistics. It tackles essentially specificities of cocaine and heroin cutting. The article presents the detected cutting agents (adulterants and diluents), their evolution in time and space and the analytical methodology implemented by forensic laboratories. Furthermore, it discusses when, in the history of the illicit drug, cutting may take place. Moreover, researches studying how much cutting occurs in the country of destination are analysed. Lastly, the reasons for cutting are addressed. According to the literature, adulterants are added during production of the illicit drug or at a relatively high level of its distribution chain (e.g. before the product arrives in the country of destination or just after its importation in the latter). Their addition seems hardly justified by the only desire to increase profits or to harm consumers' health. Instead, adulteration would be performed to enhance or to mimic the illicit drug effects or to facilitate administration of the drug. Nowadays, caffeine, diltiazem, hydroxyzine, levamisole, lidocaïne and phenacetin are frequently detected in cocaine specimens, while paracetamol and caffeine are almost exclusively identified in heroin specimens. This may reveal differences in the respective structures of production and/or distribution of cocaine and heroin. As the relevant information about cutting is spread across different scientific fields, a close collaboration should be set up to collect essential and unified data to improve knowledge and provide information for monitoring, control and harm reduction purposes. More research, on several areas of investigation, should be

Trends in Deaths Involving Heroin and Synthetic Opioids Excluding Methadone, and Law Enforcement Drug Product Reports, by Census Region - United States, 2006-2015.

Science.gov (United States)

O'Donnell, Julie K; Gladden, R Matthew; Seth, Puja

2017-09-01

Opioid overdose deaths quadrupled from 8,050 in 1999 to 33,091 in 2015 and accounted for 63% of drug overdose deaths in the United States in 2015. During 2010-2015, heroin overdose deaths quadrupled from 3,036 to 12,989 (1). Sharp increases in the supply of heroin and illicitly manufactured fentanyl (IMF) are likely contributing to increased deaths (2-6). CDC examined trends in unintentional and undetermined deaths involving heroin or synthetic opioids excluding methadone (i.e., synthetic opioids)* by the four U.S. Census regions during 2006-2015. Drug exhibits (i.e., drug products) obtained by law enforcement and reported to the Drug Enforcement Administration's (DEA's) National Forensic Laboratory Information System (NFLIS) that tested positive for heroin or fentanyl (i.e., drug reports) also were examined. All U.S. Census regions experienced substantial increases in deaths involving heroin from 2006 to 2015. Since 2010, the South and West experienced increases in heroin drug reports, whereas the Northeast and Midwest experienced steady increases during 2006-2015. † In the Northeast, Midwest, and South, deaths involving synthetic opioids and fentanyl drug reports increased considerably after 2013. These broad changes in the U.S. illicit drug market highlight the urgent need to track illicit drugs and enhance public health interventions targeting persons using or at high risk for using heroin or IMF.

Postmortem Toxicology Findings of Acetyl Fentanyl, Fentanyl, and Morphine in Heroin Fatalities in Tampa, Florida

OpenAIRE

Pearson, Julia; Poklis, Justin; Poklis, Alphonse; Wolf, Carl; Mainland, Mary; Hair, Laura; Devers, Kelly; Chrostowski, Leszek; Arbefeville, Elise; Merves, Michele

2015-01-01

In the last two years, an epidemic of 40 fatal heroin overdose cases has occurred in the Tampa area of Florida. Of these cases, 14 involved fentanyl and acetyl fentanyl. Victim demographics, case histories, toxicology findings, and causes and manners of death for all 40 deaths are presented. In 26 deaths in which acetyl fentanyl or fentanyl were not involved, free and total peripheral blood morphine concentrations were consistent with fatal heroin intoxications, averaging 0.16 mg/L and 0.35 m...

Heroin-related Deaths from the Hennepin County Medical Examiner's Office from 2004 Through 2015.

Science.gov (United States)

Love, Sara A; Lelinski, Jessica; Kloss, Julie; Middleton, Owen; Apple, Fred S

2018-01-01

Over the past two decades, prescription and illicit opioid use has led to changes in public health policy to address the increasing number of opioid-related deaths. The purpose of this study was to review cases from Hennepin County Medical Examiner's Office between 2004 through 2015 where heroin was listed as a significant contributor or as the cause of death. We identified 322 heroin-related deaths, which were predominantly male (255; 79%). 6-Monoacetylmorphine (6-MAM) median (range) concentrations were as follows: blood (n = 7), 0.010 (0.006-0.078) mg/L; urine (n = 30), 0.359 (0.009-1.75) mg/L; and vitreous humor (n = 31), 0.034 (0.004-0.24) mg/L. Free morphine was measurable in 273 cases and the percent free morphine (range), when grouped by COD, was opioid (n = 124), 28% (2.2%-92%), and mixed drug toxicity (n = 135), 35.3% (1.5%-100%); (p 26%, was useful in establishing heroin-related deaths. © 2017 American Academy of Forensic Sciences.

Intravenous heroin use in Haiphong, Vietnam: Need for comprehensive care including methamphetamine use-related interventions.

Science.gov (United States)

Michel, Laurent; Des Jarlais, Don C; Duong Thi, Huong; Khuat Thi Hai, Oanh; Pham Minh, Khuê; Peries, Marianne; Vallo, Roselyne; Nham Thi Tuyet, Thanh; Hoang Thi, Giang; Le Sao, Mai; Feelemyer, Jonathan; Vu Hai, Vinh; Moles, Jean-Pierre; Laureillard, Didier; Nagot, Nicolas

2017-10-01

The aim of this study was to describe patterns among people who inject drugs (PWID), risk-related behaviours and access to methadone treatment, in order to design a large-scale intervention aiming to end the HIV epidemic in Haiphong, Vietnam. A respondent-driven sampling (RDS) survey was first conducted to identify profiles of drug use and HIV risk-related behaviour among PWID. A sample of PWID was then included in a one-year cohort study to describe access to methadone treatment and associated factors. Among the 603 patients enrolled in the RDS survey, 10% were female, all were injecting heroin and 24% were using methamphetamine, including 3 (0.5%) through injection. Different profiles of risk-related behaviours were identified, including one entailing high-risk sexual behaviour (n=37) and another involving drug-related high-risk practices (n=22). High-risk sexual activity was related to binge drinking and methamphetamine use. Among subjects with low sexual risk, sexual intercourse with a main partner with unknown serostatus was often unprotected. Among the 250 PWID included in the cohort, 55.2% initiated methadone treatment during the follow-up (versus 4.4% at RDS); methamphetamine use significantly increased. The factors associated with not being treated with methadone after 52 weeks were fewer injections per month and being a methamphetamine user at RDS. Heroin is still the main drug injected in Haiphong. Methamphetamine use is increasing markedly and is associated with delay in methadone initiation. Drug-related risks are low but sexual risk behaviours are still present. Comprehensive approaches are needed in the short term. Copyright © 2017 Elsevier B.V. All rights reserved.

Changes in Expression of Dopamine, Its Receptor, and Transporter in Nucleus Accumbens of Heroin-Addicted Rats with Brain-Derived Neurotrophic Factor (BDNF) Overexpression.

Science.gov (United States)

Li, Yixin; Xia, Baijuan; Li, Rongrong; Yin, Dan; Liang, Wenmei

2017-06-09

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.

Trends in drug overdose deaths in England and Wales 1993-98: methadone does not kill more people than heroin.

Science.gov (United States)

Hickman, Matthew; Madden, Peter; Henry, John; Baker, Allan; Wallace, Chris; Wakefield, Jon; Stimson, Gerry; Elliott, Paul

2003-04-01

To test the hypothesis that methadone is responsible for a greater increase in overdose deaths than heroin, and causes proportionally more overdose deaths than heroin at weekends. Multivariate analysis of 3961 death certificates mentioning heroin, morphine and/or methadone held on the Office for National Statistics drug-related poisoning mortality database from 1993 to 1998 in England and Wales. Percentage increase in deaths by year by drug, odds ratio (OR) of dying at the weekend from methadone-related overdose compared to dying from heroin/morphine overdose. From 1993 to 1998, annual opiate overdose deaths increased from 378 to 909. There was a 24.7% (95% confidence interval (CI) 22-28%) yearly increase in heroin deaths compared to 9.4% (95% CI 6-13%) for methadone only. This difference was significant (P < 0.001 by test of interaction) after adjustment for sex, age group, polydrug use, area of residence and underlying cause of death. The largest number of deaths occurred on Saturday (673). The OR of death from methadone overdose on Saturday and Sunday was 1.48 (95% CI 1.29-1.71) for methadone-only deaths compared to dying from heroin/morphine at the weekend after adjustment for other covariates, but the OR was not significant (1.09, 95% CI 0.95-1.25) if the weekend was defined as Friday and Saturday. There was no evidence that the threefold increase in deaths over time was due to methadone. There was equivocal support only for the hypothesis that there was an excess of deaths from methadone at weekends. Increased interventions to prevent overdose among injectors in England and Wales are long overdue.

The relation between social desirability and different measures of heroin craving

NARCIS (Netherlands)

Marissen, Marlies A. E.; Franken, Ingmar H. A.; Blanken, Peter; Hendriks, Vincent M.; van den Brink, Wim

2005-01-01

A low association between self-reported craving and physiological measures of craving is often found. Social desirability might influence this relation between subjective and physiological reactivity. Subjects were seventy-six in-patient abstinent heroin abusers. Social desirability, general craving

Association between VNTR polymorphism in promoter region of prodynorphin (PDYN) gene and heroin dependence.

Science.gov (United States)

Saify, Khyber; Saadat, Iraj; Saadat, Mostafa

2014-11-30

Within the core promoter region of prodynorphin (PDYN), a 68-bp sequence was found to occur as a polymorphism element, either singular or as tandemly repeated two, three or four times. We report the sequence of a novel allele (5-repeats). Our study revealed the existence of an ancestral nucleotide (A) at 29th position of the VNTR in human. In total, 442 heroin addicts and 799 controls were included in this study. The present findings revealed a male-limited association between VNTR polymorphism and heroin dependence risk. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

A study of 1H-MR spectroscopy in the prefrontal cortex and amygdala of heroine abusers

International Nuclear Information System (INIS)

Yang Lanying; Wang Yarong; Li Qiang; Xiong Xiaoshuang; Wang Wei; Zhao Wei; Bai Yunliang

2009-01-01

Objective: To explore the characteristic findings of 1 H-MR spectroscopy ( 1 H-MRS) in the prefrontal cortex and amygdala of patients with heroine dependence (HD), and the relationship to total cumulative dose of inhaled heroine. Methods: Fourteen male HD patients and 12 healthy controls (HC) underwent 1 H-MRS at the prefrontal cortex and amygdala regions. The total cumulative in haled heroin dose was (852±341) g in HD. Ratios of N-acetylaspartate/creatine(NAA/Cr) and choline/creatine (Cho/Cr) were respectively measured in the prefrontal cortex and bilateral amygdale regions. The student's t test and the linear correlation were employed for statistical analysis. Results: Compared to HC group, HD patients had a significant lower ratio of NAA/Cr in the prefrontal cortex (1.44±0.46 vs 1.50±0.75, t=1.77, P< 0.05), left amygdala region (1.32±0.08 vs 1.42±0.08, t=3.41, P<0.05), and right amygdala region (1.34±0.09 vs 1.44±0.10, t=2.63, P<0.05), the HD patients had a significant increased ratio of Cho/Cr in the prefrontal cortex (0.92±0.06 vs 0.86±0.08, t=2.31, P<0.05), left amygdala region (1.20±0.12 vs 1.07±0.04, t=3.60, P<0.05) and right amygdala region(1.26±0.15 vs 1.12±0.11, t=2.60, P<0.05). There was a negative linear correlation between the total cumulative inhaled heroine dose and the ratio of NAA/Cr in the prefrontal cortex (r=-0.9159, P<0.01), left amygdala region( r= -0.8756, P<0.01), and right amygdala region (r=-0.9399, P<0.01) respectively. Conclusions: The study indicates that neuronal damage and glial proliferation may occur in the prefrontal cortex and amygdala region, which suggests the abnormalities of executive function and emotion in patients with HD. A relationship exists between the heroin-induced metabolic abnormality and the total cumulative dose of inhaled heroine. (authors)

User Requirements for Technology to Assist Aging in Place: Qualitative Study of Older People and Their Informal Support Networks.

Science.gov (United States)

Elers, Phoebe; Hunter, Inga; Whiddett, Dick; Lockhart, Caroline; Guesgen, Hans; Singh, Amardeep

2018-06-06

Informal support is essential for enabling many older people to age in place. However, there is limited research examining the information needs of older adults' informal support networks and how these could be met through home monitoring and information and communication technologies. The purpose of this study was to investigate how technologies that connect older adults to their informal and formal support networks could assist aging in place and enhance older adults' health and well-being. Semistructured interviews were conducted with 10 older adults and a total of 31 members of their self-identified informal support networks. They were asked questions about their information needs and how technology could support the older adults to age in place. The interviews were transcribed and thematically analyzed. The analysis identified three overarching themes: (1) the social enablers theme, which outlined how timing, informal support networks, and safety concerns assist the older adults' uptake of technology, (2) the technology concerns theme, which outlined concerns about cost, usability, information security and privacy, and technology superseding face-to-face contact, and (3) the information desired theme, which outlined what information should be collected and transferred and who should make decisions about this. Older adults and their informal support networks may be receptive to technology that monitors older adults within the home if it enables aging in place for longer. However, cost, privacy, security, and usability barriers would need to be considered and the system should be individualizable to older adults' changing needs. The user requirements identified from this study and described in this paper have informed the development of a technology that is currently being prototyped. ©Phoebe Elers, Inga Hunter, Dick Whiddett, Caroline Lockhart, Hans Guesgen, Amardeep Singh. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 06.06.2018.

A Review on Hematological Factors in Opioid-Dependent People (Opium and Heroin) after the Withdrawal Period

OpenAIRE

Haghpanah, Tahereh; Afarinesh, Mohammadreza; Divsalar, Kouros

2010-01-01

Background: Long-term use of opioids has acute effects on homeostasis of the body. Discovering the impacts of opioids on hematological parameters of narcotics withdrawal and dependents blood may be helpful in recognizing the homeostasis condition of their body for the useful treatment. Methods: In this study a cross-sectional method was applied. The abusers of opium and heroin for more than two consecutive years were considered as opium and heroin dependent groups, respectively. The dependent...

Development of mechanical hypersensitivity in rats during heroin and ethanol dependence: alleviation by CRF₁ receptor antagonism.

Science.gov (United States)

Edwards, Scott; Vendruscolo, Leandro F; Schlosburg, Joel E; Misra, Kaushik K; Wee, Sunmee; Park, Paula E; Schulteis, Gery; Koob, George F

2012-02-01

Animal models of drug dependence have described both reductions in brain reward processes and potentiation of stress-like (or anti-reward) mechanisms, including a recruitment of corticotropin-releasing factor (CRF) signaling. Accordingly, chronic exposure to opiates often leads to the development of mechanical hypersensitivity. We measured paw withdrawal thresholds (PWTs) in male Wistar rats allowed limited (short access group: ShA) or extended (long access group: LgA) access to heroin or cocaine self-administration, or in rats made dependent on ethanol via ethanol vapor exposure (ethanol-dependent group). In heroin self-administering animals, after transition to LgA conditions, thresholds were reduced to around 50% of levels observed at baseline, and were also significantly lower than thresholds measured in animals remaining on the ShA schedule. In contrast, thresholds in animals self-administering cocaine under either ShA (1 h) or LgA (6 h) conditions were unaltered. Similar to heroin LgA rats, ethanol-dependent rats also developed mechanical hypersensitivity after eight weeks of ethanol vapor exposure compared to non-dependent animals. Systemic administration of the CRF1R antagonist MPZP significantly alleviated the hypersensitivity observed in rats dependent on heroin or ethanol. The emergence of mechanical hypersensitivity with heroin and ethanol dependence may thus represent one critical drug-associated negative emotional state driving dependence on these substances. These results also suggest a recruitment of CRF-regulated nociceptive pathways associated with escalation of intake and dependence. A greater understanding of relationships between chronic drug exposure and pain-related states may provide insight into mechanisms underlying the transition to drug addiction, as well as reveal new treatment opportunities. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'. Copyright © 2011 Elsevier Ltd. All rights reserved.

Attitudes of older mobile phone users towards mobile phones

OpenAIRE

Vicente, P.; Lopes, I.

2016-01-01

Research on mobile technology adoption has focused predominantly on young adults, and little attention has been paid to older people. But with rapidly aging populations in most developed countries, and evidence from many studies that older adults are as capable of adopting and using mobile technology as everybody else, the academic, business and technology industry worlds are devoting more attention to this group. Research has already demonstrated that older people differ from young people in...

海洛因静脉吸毒者共用针具行为检出率及危险因素%Needle-sharing behavior among intravenous heroin users:prevalence and risk factors

Institute of Scientific and Technical Information of China (English)

张现国; 高艳杰; 张宝华; 方强; 范强; 钟宝亮; 禚传君

2015-01-01

Objective To investigate the prevalence and risk factors of needle-sharing behavior among intravenous drug users (IDUs).Methods Data regarding socio-demographics,drug abuse characteristics and HIV related health literacy of 474 heroin IDUs were collected.Antisocial personality disorder of IDUs was diagnosed through Mini international neuropsychiatric interview.Results The prevalence of needle sharing among IDUs was 53.8％.Needle-sharing behavior of IDUs was significantly associated with male gender,marital status of being single and separated/divorced,local dwelling,an early age of first drug abuse and antisocial personality disorder (OR =1.11 ～ 6.69,P＜0.05).Conclusion Heroin IDUs have high prevalence of needle sharing.A comprehensive social,behavior and psychology based intervention is needed to effectively prevent HIV infection in IDUs.%目的 探讨海洛因静脉吸毒者共用针具行为的检出率及危险因素.方法 调查474例海洛因静脉吸毒者(IDUs)的社会人口学特征、吸毒特征和HIV知识知晓情况,并用简明国际神经精神访谈诊断IDUs的反社会人格障碍.结果 海洛因IDUs共用针具行为检出率为53.8％,IDUs共用针具吸毒的危险因素为男性、未婚、离异或丧偶、本地户籍、开始吸毒年龄小和反社会人格障碍(OR=1.11～6.69,P＜0.05).结论 海洛因IDUs共用针具行为检出率高,有必要采取综合性的社会-行为-心理干预才能有效预防IDUs感染HIV.

Know thy eHealth user: Development of biopsychosocial personas from a study of older adults with heart failure.

Science.gov (United States)

Holden, Richard J; Kulanthaivel, Anand; Purkayastha, Saptarshi; Goggins, Kathryn M; Kripalani, Sunil

2017-12-01

Personas are a canonical user-centered design method increasingly used in health informatics research. Personas-empirically-derived user archetypes-can be used by eHealth designers to gain a robust understanding of their target end users such as patients. To develop biopsychosocial personas of older patients with heart failure using quantitative analysis of survey data. Data were collected using standardized surveys and medical record abstraction from 32 older adults with heart failure recently hospitalized for acute heart failure exacerbation. Hierarchical cluster analysis was performed on a final dataset of n=30. Nonparametric analyses were used to identify differences between clusters on 30 clustering variables and seven outcome variables. Six clusters were produced, ranging in size from two to eight patients per cluster. Clusters differed significantly on these biopsychosocial domains and subdomains: demographics (age, sex); medical status (comorbid diabetes); functional status (exhaustion, household work ability, hygiene care ability, physical ability); psychological status (depression, health literacy, numeracy); technology (Internet availability); healthcare system (visit by home healthcare, trust in providers); social context (informal caregiver support, cohabitation, marital status); and economic context (employment status). Tabular and narrative persona descriptions provide an easy reference guide for informatics designers. Personas development using approaches such as clustering of structured survey data is an important tool for health informatics professionals. We describe insights from our study of patients with heart failure, then recommend a generic ten-step personas development process. Methods strengths and limitations of the study and of personas development generally are discussed. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparison of MRI, CT, TCD and SPECT in patients with spongiform leukoencephalopathy after inhaling heroin vapor

International Nuclear Information System (INIS)

Wang Qun; Lu Bingxun; Yuan Huijuan

2002-01-01

Objective: To compare the characteristics of MRI, CT, single photon emission computed tomography (SPECT) and transcranial Doppler sonography (TCD) in patients with spongiform leukoencephalopathy after inhaling heroin vapor. Methods: Seventeen patients were investigated. MRI or CT was scanned in 17 patients, SPECT in 9 patients' and TCD in 11 patients. Results: MRI or CT: Brain MRI and CT revealed extensive symmetric white matter involvement of bilateral cerebral and cerebellar hemispheres and the brainstem. The lesions, which showed no contrast enhancement, were hypodense on CT and hypointense on T 1 -weighted and hyperintense on T 2 -weighted MRI. SPECT: The regional cerebral blood flows (rCBF) of white matter involvement on bilateral cerebral and cerebellar hemispheres was reduced obviously. The rCBF of temporal lobes, parietal lobes, occipital lobes, cerebellar hemispheres, and basal ganglion was reduced in varying degrees. TCD: The systolic peak became sharpened, and end-diastolic flow velocity and mean flow velocity were reduced obviously and pulsatile index was increased markedly in patients with spongiform leukoencephalopathy after inhaling heroin vapor. Conclusion: The characteristic manifestations of MRI and CT imaging may be regarded as the main foundation of diagnosing spongiform leukoencephalopathy after inhaling heroin vapor; SPECT and TCD can help comprehend the changes of hemodynamics of cerebral vessels and the degree of cerebral ischemia in patients with spongiform leukoencephalopathy after inhaling heroin vapor

User participation is a family matter: A multiple case study of the experiences of older, hospitalised people and their relatives.

Science.gov (United States)

Nyborg, Ingrid; Danbolt, Lars J; Kirkevold, Marit

2017-12-01

The purpose of this multiple case study was to compare and contrast older people's and their relatives' experiences of participation in decision-making processes regarding the planning of everyday life after discharge from hospital. Internationally, patient involvement in health services is established to benefit patient health and to improve quality of the services. The literature shows that at hospital discharge, older people would benefit from better communication and more active participation of relatives in the discharge planning. Little research has been carried out on the experiences of patients and relatives as a family in this context, and even less has investigated their participation. This study used a qualitative design with a comparative multicase approach. Participants were recruited from two hospitals in Norway using a purposive sampling strategy. Semi-structured interviews were conducted with five patients and with six of their relatives. Three patterns of experiences were identified: contradicting experiences; consistent experiences of nonpreferred participation; similar, but separate experiences of user participation. User participation in the planning of everyday life following discharge appeared to be random and limited for both patients and their relatives, and conflicting for the families as a whole. The decision-making processes seemed to be limited to the hospital context and did not include the broader context of everyday life following discharge. The results underscore the importance of taking a family perspective when caring for older people. Family meetings might be a useful tool to ensure systematic assessment and integration of the perspectives of both older people and their family in the planning of follow-up care. © 2017 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

Impaired cytokine production and suppressed lymphocyte proliferation activity in HCV-infected cocaine and heroin ("speedball") users.

Science.gov (United States)

Ríos-Olivares, Eddy; Vilá, Luis M; Reyes, Juan C; Rodríguez, José W; Colón, J Héctor M; Pagán, Nat O; Marrero, Amalia; Ríos-Orraca, Zilka M; Boukli, Nawal M; Shapshak, Paul; Robles, Rafaela R

2006-12-01

HCV-infected "speedball" users (n = 30) were selected from an original cohort of 400 intravenous drug users for cytokine analysis. Cytokine concentrations (TNF-alpha, IL-1beta, IL-6, IFN-gamma, IL-2, IL-4, IL-10 and IL-12) were determined in plasma and peripheral blood mononuclear cells (PBMC) cultures derived ex vivo from these patients. In addition, lymphocyte proliferation was measured in 49 HCV-positive "speedball" users. TNF-alpha, IL-6, IFN-gamma, IL-2, IL-4, IL-10, IL-12 cytokines and not IL-1beta were significantly increased in plasma from HCV-positive "speedball" users compared with healthy controls. Except for IL-10, all other cytokines measured were augmented in phytohemagglutinin-stimulated PBMC cultures from HCV-positive "speedball" users. Likewise, overproduction of cytokines TNF-alpha, IL-1beta, IL-6 and IFN-gamma, was consistently detected when PBMC cultures from HCV-positive "speedball" users were stimulated with a biological response modifier. However, HCV-infected "speedball" users showed significant reduction in lymphoproliferative activity. Compared with healthy subjects, there was a consistent overproduction of both TH1 and TH2 type cytokines in the plasma and PBMC's of HCV-infected "speedball" users. Furthermore, there was a persistent reduction of lymphoproliferative activity in this group. These immunologic abnormalities, coupled with the range of response between the two TH-types in HCV-infected "speedball" users, suggest impairment in the regulatory mechanism of the TH1-TH2 system.

Trends in substance use admissions among older adults.

Science.gov (United States)

Chhatre, Sumedha; Cook, Ratna; Mallik, Eshita; Jayadevappa, Ravishankar

2017-08-22

Substance abuse is a growing, but mostly silent, epidemic among older adults. We sought to analyze the trends in admissions for substance abuse treatment among older adults (aged 55 and older). Treatment Episode Data Set - Admissions (TEDS-A) for period between 2000 and 2012 was used. The trends in admission for primary substances, demographic attributes, characteristics of substance abused and type of admission were analyzed. While total number of substance abuse treatment admissions between 2000 and 2012 changed slightly, proportion attributable to older adults increased from 3.4% to 7.0%. Substantial changes in the demographic, substance use pattern, and treatment characteristics for the older adult admissions were noted. Majority of the admissions were for alcohol as the primary substance. However there was a decreasing trend in this proportion (77% to 64%). The proportion of admissions for following primary substances showed increase: cocaine/crack, marijuana/hashish, heroin, non-prescription methadone, and other opiates and synthetics. Also, admissions for older adults increased between 2000 and 2012 for African Americans (21% to 28%), females (20% to 24%), high school graduates (63% to 75%), homeless (15% to 19%), unemployed (77% to 84%), and those with psychiatric problems (17% to 32%).The proportion of admissions with prior history of substance abuse treatment increased from 39% to 46% and there was an increase in the admissions where more than one problem substance was reported. Ambulatory setting continued to be the most frequent treatment setting, and individual (including self-referral) was the most common referral source. The use of medication assisted therapy remained low over the years (7% - 9%). The changing demographic and substance use pattern of older adults implies that a wide array of psychological, social, and physiological needs will arise. Integrated, multidisciplinary and tailored policies for prevention and treatment are necessary to

Exchanging expertise and constructing boundaries: The development of a transnational knowledge network around heroin-assisted treatment.

Science.gov (United States)

Duke, Karen

2016-05-01

Over the last 20 years, supervised injectable and inhalable heroin prescribing has been developed, tested and in some cases introduced as a second line treatment for limited groups of entrenched heroin users in a number of European countries and Canada. Based on documentary analyses and eleven key informant interviews, this paper investigates the growth of 'expertise' and the sharing of knowledge between scientific stakeholders from different countries involved in researching and developing this area of treatment. Drawing on Stone's concept of the 'knowledge network' (Stone, 2013) and Gieryn's theory of 'boundary-work' (Gieryn, 1983), the analysis demonstrates the collective power of this group of scientists in producing a particular form of knowledge and expertise which has accrued and been exchanged over time. It also illustrates the ways in which this type of science has gained credibility and authority and become legitimised, reinforced and reproduced by those who employ it in both scientific and political debates. Boundaries were constructed by the knowledge network between different types of professions/disciplines, different forms of science and between the production of science and its consumption by non-scientists. The uniformity of the knowledge network in terms of their professional and disciplinary backgrounds, methodological expertise and ideological perspectives has meant that alternative forms of knowledge and perspectives have been neglected. This limits the nature and scope of the scientific evidence on which to base policy and practice decisions impacting on the work of policy makers and practitioners as well as the experiences of those in treatment who are most affected by this research and policy development. Copyright © 2015 Elsevier B.V. All rights reserved.

Drug-related cue induced craving and the correlation between the activation in nucleus accumbens and drug craving: a fMRI study on heroin addicts

International Nuclear Information System (INIS)

Wang Yarong; Yang Lanying; Li Qiang; Yang Weichuan; Du Pang; Wang Wei

2010-01-01

Objective: To explore the neural mechanism underlying the craving of heroin addicts induced by picture-cue and the correlation between the brain activation degree in nucleus accumbens (NAc)/ the ventral striatum and the scores of patients self-report craving. Methods: Twelve active heroin addicts and 12 matched healthy controls underwent fMRI scan while viewing drug-related pictures and neutral pictures presented in a block design paradigm after anatomical scanning in GE 3.0 T scanner. The fMRI data were analyzed with SPM 5. The change of craving scores was tested by Wilcoxon signed rank test. The Pearson correlation between the activation of NAc/the ventral striatum and the heroin craving score was tested by SPSS 13.0. Results: The craving scores of heroin addicts ranged from 0 to 3.70 (median 0.15) before exposed to drug cue and 0 to 5.10 (median 3.25) after viewing drug-related pictures and showed statistical significance (Z=-2.666, P<0.05). There were 16 activated brain areas when heroin dependent patients exposed to visual drug-related cue vs. neutral visual stimuli. The activation brain regions belonged to two parts, one was limbic system (amygdale, hippocampus, putamen, anterior cingulate cortex and caudate), another was brain cortex (middle frontal cortex, inferior frontal cortex, precentral gyrus, middle temporal cortex, inferior temporal cortex, fusiform gyrus, precuneus and middle occipital gyrus). The MR signal activation magnitude of heroin addicts ranged from 0.19 to 3.50. The result displayed a significant positive correlation between the cue-induced fMRI activation in NAc/the ventral striatum and heroin craving severity (r=0.829, P<0.05). Conclusion: Heroin shared the same neural circuitry in part with other drugs of abuse for cue-induced craving, including brain reward circuitry, visualspatial attention circuit and working memory region. In addition, the dysfunction of NAc/the ventral striatum may attribute to heroin-related cue induced craving

The Beautiful and Dangerous: A New Depiction of Heroines in North American Television Drama Series

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Irena Sever Globan

2016-06-01

Full Text Available Television drama series are nowadays one of the most common television formats in the entertainment program genre. On the one hand, heroes and heroines of these series mirror social and cultural realities and changes, whereas on the other, they offer imitation models and shape ideas about, among other things, what being male and female means. While in the first three decades of their existence television series predominantly showed stereotypical male-female relationships through active heroes and passive housewives, in the last two decades we have witnessed changes which question the stereotypical depiction of gender roles. Television started presenting new main heroines that are equally courageous, independent, intelligent and violent as their male partners although they continue to perpetuate the stereotypical depiction in terms of physical attractiveness and sex appeal. This primarily refers to the protagonists of North American series such as Buffy, Nikita, Xena, Alias, Revenge, Rogue, etc. This paper discusses the characteristics of these new heroines in the leading roles and their potential to redefine the female character.

Prescription Opioid Abuse, Prescription Opioid Addiction, and Heroin Abuse among Adolescents in a Recovery High School: A Pilot Study

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Vosburg, Suzanne K.; Eaton, Thomas A.; Sokolowska, Marta; Osgood, Eric D.; Ashworth, Judy B.; Trudeau, Jeremiah J.; Muffett-Lipinski, Michelle; Katz, Nathaniel P.

2016-01-01

The progression from prescription opioid (RXO) abuse to RXO addiction is not well understood in adolescents, nor is the progression from RXO addiction to heroin abuse. The purpose of this pilot study was to characterize the development of RXO drug abuse, RXO drug addiction, and heroin abuse in a small cohort of adolescents recovering from opioid…

Was an increase in cocaine use among injecting drug users in New South Wales, Australia, accompanied by an increase in violent crime?

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Conroy Elizabeth

2005-04-01

Full Text Available Abstract Background A sharp reduction in heroin supply in Australia in 2001 was followed by a large but transient increase in cocaine use among injecting drug users (IDU in Sydney. This paper assesses whether the increase in cocaine use among IDU was accompanied by increased rates of violent crime as occurred in the United States in the 1980s. Specifically, the paper aims to examine the impact of increased cocaine use among Sydney IDU upon police incidents of robbery with a weapon, assault and homicide. Methods Data on cocaine use among IDU was obtained from the Illicit Drug Reporting System (IDRS. Monthly NSW Police incident data on arrests for cocaine possession/use, robbery offences, homicides, and assaults, were obtained from the Bureau of Crime Statistics and Research. Time series analysis was conducted on the police data series where possible. Semi-structured interviews were conducted with representatives from law enforcement and health agencies about the impacts of cocaine use on crime and policing. Results There was a significant increase in cocaine use and cocaine possession offences in the months immediately following the reduction in heroin supply. There was also a significant increase in incidents of robbery where weapons were involved. There were no increases in offences involving firearms, homicides or reported assaults. Conclusion The increased use of cocaine among injecting drug users following the heroin shortage led to increases in violent crime. Other States and territories that also experienced a heroin shortage but did not show any increases in cocaine use did not report any increase in violent crimes. The violent crimes committed did not involve guns, most likely because of its stringent gun laws, in contrast to the experience of American cities that have experienced high rates of cocaine use and violent crime.

Pilot study of a social network intervention for heroin users in opiate substitution treatment: study protocol for a randomized controlled trial.

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Day, Edward; Copello, Alex; Seddon, Jennifer L; Christie, Marilyn; Bamber, Deborah; Powell, Charlotte; George, Sanju; Ball, Andrew; Frew, Emma; Freemantle, Nicholas

2013-08-19

Research indicates that 3% of people receiving opiate substitution treatment (OST) in the UK manage to achieve abstinence from all prescribed and illicit drugs within 3 years of commencing treatment, and there is concern that treatment services have become skilled at engaging people but not at helping them to enter a stage of recovery and drug abstinence. The National Treatment Agency for Substance Misuse recommends the involvement of families and wider social networks in supporting drug users' psychological treatment, and this pilot randomized controlled trial aims to evaluate the impact of a social network-focused intervention for patients receiving OST. In this two-site, early phase, randomized controlled trial, a total of 120 patients receiving OST will be recruited and randomized to receive one of three treatments: 1) Brief Social Behavior and Network Therapy (B-SBNT), 2) Personal Goal Setting (PGS) or 3) treatment as usual. Randomization will take place following baseline assessment. Participants allocated to receive B-SBNT or PGS will continue to receive the same treatment that is routinely provided by drug treatment services, plus four additional sessions of either intervention. Outcomes will be assessed at baseline, 3 and 12 months. The primary outcome will be assessment of illicit heroin use, measured by both urinary analysis and self-report. Secondary outcomes involve assessment of dependence, psychological symptoms, social satisfaction, motivation to change, quality of life and therapeutic engagement. Family members (n = 120) of patients involved in the trial will also be assessed to measure the level of symptoms, coping and the impact of the addiction problem on the family member at baseline, 3 and 12 months. This study will provide experimental data regarding the feasibility and efficacy of implementing a social network intervention within routine drug treatment services in the UK National Health Service. The study will explore the impact of the

Spongiform leucoencephalopathy following intravenous heroin abuse: Radiological and histopathological findings

International Nuclear Information System (INIS)

Robertson, A.S.; Jain, S.; O'Neil, R.A.

2001-01-01

A case of spongiform leucoencephalopathy in a known intravenous heroin abuser is presented. To our knowledge, this is the only case of heroin-related spongiform leucoencephalopathy reported in Australia. The relationship to intravenous rather than inhaled heroin is particularly unusual with only one other possible case documented in the literature. The imaging and histopathological findings are described. Neurological examination revealed disorientation in time and place, memory loss and cognitive impairment but no focal signs. Biochemical and haematological profiles were normal. Viral serology was positive for hepatitis C but negative for hepatitis B and human immunodeficiency virus (HIV). Cerebral CT revealed diffuse symmetrical hypodensity of the cerebral white matter. The ventricles and subarachnoid spaces were of normal size. Magnetic resonance imaging showed diffuse symmetrical signal abnormality in the cerebral white matter. These changes were hyperintense on proton density, T2-weighted, modified T2-weighted (FLAIR) and diffusion-weighted images. T1 -weighted scans showed corresponding hypointensity. There was no enhancement after intravenous gadolinium. Cerebral spinal fluid (CSF) specimens were negative for a variety of virological, immunological and bacteriological markers. No viral or bacterial growth was demonstrated. Oligoclonal bands for multiple sclerosis and Protein 134 for Wilson's disease were negative. Right frontal brain biopsy showed spongiform white matter and degenerative change with prominent fibrous gliosis. In severely affected areas, loss of normal myelin staining and axonal loss were present, accompanied by scattered foamy macrophages. Loss of oligodendroglial nuclei was also present. There was no evidence of inflammation or progressive multifocal leucoencephalopathy. No bacteria or virus particles were seen on electron microscopic examination of the brain tissue. Following the biopsy, the patient discharged himself from hospital and the

Characteristics of New-Onset and Chronic Sleep Medication Users Among Older Adults: A Retrospective Study of a US Medigap Plan Population using Propensity Score Matching.

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Musich, Shirley; Wang, Shaohung S; Slindee, Luke B; Saphire, Lynn; Wicker, Ellen

2018-05-01

Prescription sleep medications are often utilized to manage sleep problems among older adults even though these drugs are associated with multiple risks. The aim was to determine the prevalence and characteristics of new-onset compared to chronic sleep medication users and to examine factors associated with the conversion from new to chronic use. A secondary objective was to investigate the impact of sleep medications on health outcomes of injurious falls and patterns of healthcare utilization and expenditures. A 25% random sample of adults ≥ 65 years with 3-year continuous AARP ® Medicare Supplement medical and AARP ® MedicareRx drug plan enrollment was utilized to identify new-onset and chronic sleep medication users. Prescription sleep medication drugs were defined using National Drug Codes (NDCs); falls or hip fractures were identified from diagnosis codes. New users had no sleep medication use in 2014, but initiated medication use in 2015; chronic users had at least one sleep medication prescription in 2014 and in 2015; both groups had follow-up through 2016. Characteristics associated with new users, new users who converted to chronic use, and chronic users were determined using multivariate logistic regression. Prevalence of falls, healthcare utilization and expenditures were regression adjusted. Among eligible insureds, 3 and 9% were identified as new-onset and chronic sleep medication users, respectively. New-onset sleep medication prescriptions were often associated with an inpatient hospitalization. The strongest characteristics associated with new users, those who converted to chronic use, and chronic users were sleep disorders, depression and opioid use. About 50% of new users had > 30 days' supply; 25% converted to chronic use with ≥ 90 days' supply. The prevalence of falls for new-onset users increased by 70% compared to a 22% increase among chronic users. New-onset and chronic sleep medication users were characterized by sleep

Methadone dose increase and abstinence reinforcement for treatment of continued heroin use during methadone maintenance.

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Preston, K L; Umbricht, A; Epstein, D H

2000-04-01

Although methadone maintenance is an effective therapy for heroin dependence, some patients continue to use heroin and may benefit from therapeutic modifications. This study evaluated a behavioral intervention, a pharmacological intervention, and a combination of both interventions. Throughout the study all patients received daily methadone hydrochloride maintenance (initially 50 mg/d orally) and weekly counseling. Following baseline treatment patients who continued to use heroin were randomly assigned to 1 of 4 interventions: (1) contingent vouchers for opiate-negative urine specimens (n = 29 patients); (2) methadone hydrochloride dose increase to 70 mg/d (n = 31 patients); (3) combined contingent vouchers and methadone dose increase (n = 32 patients); and (4) neither intervention (comparison standard; n = 28 patients). Methadone dose increases were double blind. Vouchers had monetary value and were exchangeable for goods and services. Groups not receiving contingent vouchers received matching vouchers independent of urine test results. Primary outcome measure was opiate-negative urine specimens (thrice weekly urinalysis). Contingent vouchers and a methadone dose increase each significantly increased the percentage of opiate-negative urine specimens during intervention. Contingent vouchers, with or without a methadone dose increase, increased the duration of sustained abstinence as assessed by urine screenings. Methadone dose increase, with or without contingent vouchers, reduced self-reported frequency of use and self-reported craving. In patients enrolled in a methadone-maintainence program who continued to use heroin, abstinence reinforcement and a methadone dose increase were each effective in reducing use. When combined, they did not dramatically enhance each other's effects on any 1 outcome measure, but they did seem to have complementary benefits.

Modeling the structure and operation of drug supply chains: The case of cocaine and heroin in Italy and Slovenia.

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Caulkins, Jonathan P; Disley, Emma; Tzvetkova, Marina; Pardal, Mafalda; Shah, Hemali; Zhang, Xiaoke

2016-05-01

Multiple layers of dealers connect international drug traffickers to users. The fundamental activity of these dealers is buying from higher-level dealers and re-selling in smaller quantities at the next lower market level. Each instance of this can be viewed as completing a drug dealing "cycle". This paper introduces an approach for combining isolated accounts of such cycles into a coherent model of the structure, span, and profitability of the various layers of the domestic supply chain for illegal drugs. The approach is illustrated by synthesizing data from interviews with 116 incarcerated dealers to elucidate the structure and operation of distribution networks for cocaine and heroin in Italy and Slovenia. Inmates' descriptions of cycles in the Italian cocaine market suggest fairly orderly networks, with reasonably well-defined market levels. The Italian heroin market appears to have more "level-jumpers" who skip a market level by making a larger number of sales per cycle, with each sale being of a considerably smaller weight. Slovenian data are sparser, but broadly consistent. Incorporating prices allows calculation of how much of the revenue from retail sales is retained by dealers at each market level. In the Italian cocaine market, both retail sellers and the international supply chain outside of Italy each appear to receive about 30-40% of what users spend, with the remaining 30% going to higher-level dealers operating in Italy (roughly 10% to those at the multi-kilo level and 20% to lower level wholesale dealers). Factoring in cycle frequencies permits rough estimation of the number of organizations at each market level per billion euros in retail sales, and of annual net revenues for organizations at each level. These analyses provide an approach to gaining insight into the structure and operation of the supply chain for illegal drugs. They also illustrate the value of two new graphical tools for describing illicit drug supply chains and hint at possible

Effect of electro-acupuncture intervention on cognition attention bias in heroin addiction abstinence-a dot-probe-based event-related potential study.

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Jiang, Ying-Ping; Liu, Hao; Xu, Ping; Wang, Yan; Lu, Guang-Hua

2011-04-01

To study the changes of cognitive attention-related brain function in the heroin addicts before and after electro-acupuncture (EA) intervention for exploring the concerned neuro-mechanism of addictive relapse and the central action role of EA intervention. Adopting event-related potential (ERP) technique, the ERP at 64 electrode spots in 10 heroin addicts (test group) were recorded before and after EA intervention with dot-probe experimental form during implementing cognitive task on positive emotional clue (PEC), negative emotional clues (NEC), and heroin-related clue (HRC). The P200 amplitude components on the selected observation points (Fz, Cz, and Pz) were analyzed and compared with those obtained from 10 healthy subjects as the control. Before EA, the ERP of attention on HRC in the test group was higher than that on PEC and NEC (Pattention on HRC at Cz and Pz was significantly lowered (P PEC > HRC, but in the control group, it showed PEC > HRC at all three observation points and PEC > NEC at Pz. Heroin addicts show attention bias to HRC, which could be significantly reduced by EA intervention, illustrating that EA could effectively inhibit the attention bias to heroin and so might have potential for lowering the relapse rate.

CO 2 laser photoacoustic spectra and vibrational modes of heroin ...

Indian Academy of Sciences (India)

Heroin, morphine and narcotine are very large molecules having 50, 40 and 53 atoms respectively. Moderately high resolution photoacoustic (PA) spectra have been recorded in 9.6 m and 10.6 m regions of CO2 laser. It is very difficult to assign the modes of vibrations for PA bands by comparison with conventional low ...

海洛因依赖与人格障碍的共病研究%Comorbidity of Heroin Dependence and Personality Disorders

Institute of Scientific and Technical Information of China (English)

吴强; 郭月锋; 连卓

2017-01-01

目的:评估海洛因依赖者中人格障碍的发生率,探讨海洛因依赖者的人格障碍共病情况.方法:采用美国精神障碍诊断与统计手册第4版人格障碍临床定式访谈量表(SCID-Ⅱ)对120例海洛因依赖者和120名健康对照者进行人格障碍的评估.结果:海洛因依赖患者中人格障碍的共病率是79.2％,且73.3％的患者同时符合两种或以上的人格障碍.患者中最常见的人格障碍是边缘型、反社会型、偏执型、强迫型,男性海洛因依赖者中反社会型人格障碍的发生率显著高于女性(x2=11.98,P＜0.01).结论:海洛因依赖者中人格障碍的共病现象非常普遍.%Objectiye:To evaluate the prevalence rate of personality disorders in heroin dependence patients,and explore the comorbidity of heroin dependence and personality disorders.Methods:The SCID-Ⅱ was used to assess the personality disorders in 120 heroin dependence patients and 120 matched normal controls.Results:The comorbidity rate of personality disorder in the heroin dependence patients was 79.2％,in which 73.3％ were fulfilled at least two personality disorders.Boardline、antisocial、paranoid and compulsive personality disorder were most common.The prevalence rate of antisocial personality disorder in male heroin dependence patients was signficantly higher than that in female heroin dependence (x2 =11.98,P ＜ 0.01).Conclusion:The comorbidity of personality disorders is much common in heroin dependence patients.

The effects of chronic consumption of heroin on basal and vagal electrical-stimulated gastric acid and pepsin secretion in rat.

Science.gov (United States)

Rafsanjani, Fatemeh N; Maghouli, Fatemeh; Vahedian, Jalal; Esmaeili, Farzaneh

2004-10-01

Addiction to opium and heroin is not only an important social and individual problem in the world but it also affects the human physiology and multiple systems. The aim of this study is to determine the effects of chronic heroin consumption on basal and vagus electrical-stimulated total gastric acid and pepsin secretion in rats. The study was carried out in the Department of Physiology, Kerman University of Medical Sciences, Iran from August 2002 to June 2003. Both male and female rats weighing 200-250 g were used. Rats received daily doses of heroin intraperitoneally starting from 0.2 mg/kg to 0.1 mg/kg/day up to the maintenance level of 0.7 mg/kg and continued until day 12. After anesthesia, tracheotomy and laparotomy, gastric effluents were collected by washout technique with a 15 minutes interval. The total titrable acid was measured by manual titrator, and the total pepsin content was measured by Anson's method. Vagal electrical stimulation was used to stimulate the secretion of acid and pepsin. Heroin results in a significant decrease in total basal acid and pepsin secretions (4.10 +/- 0.18 mmol/15 minutes versus 2.40 +/- 0.16 mmol/15 minutes for acid, pacid and pepsin secretions in vagotomized condition. Heroin also causes a significant decrease in vagal-electrically stimulated acid and pepsin secretions (14.70 +/- 0.54 mmol/15 minutes versus 4.30 +/- 0.21 mmol/15 minutes for acid, pacid and pepsin secretion, but not in vagotomized condition. Heroin may decrease acid secretion by inhibiting vagal release of acetylcholine within the gastric wall. Other probable mechanisms include: presynaptic inhibition of acetylcholine release or depressing the vagal center, inhibition of pentagastrin induced acid secretion, inhibitory effects via central mechanisms, probably mediated by the opiate receptors. Further studies are needed to recognize the actual mechanism.

Progressive white matter microstructure damage in male chronic heroin dependent individuals: a DTI and TBSS study.

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Yingwei Qiu

Full Text Available BACKGROUND: To investigate the WM microstructure deficits in heroin dependent individuals (HDIs with different length of heroin dependence, and to investigate whether these WM deficits can be related to the duration of heroin use and to decision-making deficits in HDIs. METHODOLOGY/PRINCIPAL FINDINGS: Thirty-six HDIs [including eighteen sHDIs (duration of heroin dependent is less than 10 years and eighteen lHDIs (duration of dependent is between 10:20 years] and sixteen healthy controls participated in this study. Whole brain voxel-wise analysis of fractional anisotropy (FA, mean diffusivity (MD, axial diffusivity (Da and radial diffusivity (Dr were performed by tract-based spatial statistics (TBSS to localize abnormal WM regions among groups. TBSS demonstrated that sHDIs had significantly lower FA than controls in right orbito-frontal WM, bilateral temporal WM and right parietal WM. The lHDIs had significantly lower FA throughout the brain compared with the controls and sHDIs. The lHDIs had significantly lower Da than controls in bilateral inferior frontaloccipital fasciculus, bilateral splenium of corpus callosum, left inferior longitudinal fasciculus, and had significantly higher Dr than controls in bilateral uncinatus fasciculus, bilateral inferior frontaloccipital fasciculus and bilateral cortical spinal fasciculus. Volume-of-interest (VOI analyses detect the changes of diffusivity indices in the regions with FA abnormalities revealed by control vs sHDIs. In most VOIs, FA reductions were caused by the increase in Dr as well as the decrease in Da. Correlation analysis was used to assess the relationship between FA and behavioral measures in HDIs and controls available. Significantly positively correlations were found between the FA values in the right orbital-frontal WM, right parietal WM and IGT performance. CONCLUSIONS: The extent and severity of WM integrity deficits in HDIs was associated with the length of heroin dependent. Furthermore

Cytokines, Chaperones and Neuroinflammatory Responses in Heroin-Related Death: What Can We Learn from Different Patterns of Cellular Expression?

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Vittorio Fineschi

2013-09-01

Full Text Available Heroin (3,6-diacetylmorphine has various effects on the central nervous system with several neuropathological alterations including hypoxic-ischemic brain damage from respiratory depressing effects and neuroinflammatory response. Both of these mechanisms induce the release of cytokines, chemokines and other inflammatory mediators by the activation of many cell types such as leucocytes and endothelial and glial cells, especially microglia, the predominant immunocompetent cell type within the central nervous system. The aim of this study is to clarify the correlation between intravenous heroin administration in heroin related death and the neuroinflammatory response. We selected 45 cases among autopsies executed for heroin-related death (358 total cases; immunohistochemical studies and Western blotting analyses were used to investigate the expression of brain markers such as tumor necrosis factor-α, oxygen-regulated protein 150, (interleukins IL-1β, IL-6, IL-8, IL-10, IL-15, cyclooxygenase-2, heat shock protein 70, and CD68 (MAC387. Findings demonstrated that morphine induces inflammatory response and cytokine release. In particular, oxygen-regulated protein 150, cyclooxygenase-2, heat shock protein 70, IL-6 and IL-15 cytokines were over-expressed with different patterns of cellular expression.

Comparison of self-administration behavior and responsiveness to drug-paired cues in rats running an alley for intravenous heroin and cocaine.

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Su, Zu-In; Wenzel, Jennifer; Baird, Rebeccah; Ettenberg, Aaron

2011-04-01

Evidence suggests that responsiveness to a drug-paired cue is predicted by the reinforcing magnitude of the drug during prior self-administration. It remains unclear, however, if this principle holds true when comparisons are made across drug reinforcers. The current study was therefore devised to test the hypothesis that differences in the animals' responsiveness to a cocaine- or heroin-paired cue presented during extinction would reflect differences in the patterns of prior cocaine and heroin runway self-administration. Rats ran a straight alley for single intravenous injections of either heroin (0.1 mg/kg/inj) or cocaine (1.0 mg/kg/inj) each paired with a distinct olfactory cue. Animals experienced 15 trials with each drug reinforcer in a counterbalanced manner. Start latencies, run times, and retreat behaviors (a form of approach-avoidance conflict) provided behavioral indices of the subjects' motivation to seek the reinforcer on each trial. Responsiveness to each drug-paired cue was assessed after 7, 14, or 21 days of non-reinforced extinction trials. Other animals underwent conditioned place preference (CPP) testing to ensure that the two drug reinforcers were capable of producing drug-cue associations. While both drugs produced comparable CPPs, heroin served as a stronger incentive stimulus in the runway as evidenced by faster start and run times and fewer retreats. In contrast, cocaine- but not heroin-paired cues produced increases in drug-seeking behavior during subsequent extinction trials. The subjects' responsiveness to drug-paired cues during extinction was not predicted by differences in the motivation to seek heroin versus cocaine during prior drug self-administration.

The Digital Divide and urban older adults.

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Cresci, M Kay; Yarandi, Hossein N; Morrell, Roger W

2010-01-01

Computers and the Internet offer older adults opportunities and resources for independent living. However, many urban older adults do not use computers. This study examined the demographic, health, and social activities of urban older adults to determine variables that might predict the use and nonuse of computers in this population. A secondary data analysis was performed using the 2001 Detroit City-Wide Needs Assessment of Older Adults (n = 1410) data set. Logistic regression was used to explore potential differences in predictor variables between computer users and nonusers. Overall, computer users were younger (27%), had a higher level of education, were more likely to be employed, had an annual income greater than $20,000, and were healthier and more active than nonusers. They also were more likely to have memberships in community organizations and do volunteer work. Preferred computer activities included conducting Internet searches, playing games, writing, and communicating with family members and friends. The results suggest significant differences in demographic and health-related characteristics between computer users and nonusers among urban older adults. Although about a quarter of participants in this study used computers, the Digital Divide continues to exist in urban settings for scores of others.

Effectiveness and Cost-effectiveness of Opportunistic Screening and Stepped-care Interventions for Older Alcohol Users in Primary Care.

Science.gov (United States)

Coulton, Simon; Bland, Martin; Crosby, Helen; Dale, Veronica; Drummond, Colin; Godfrey, Christine; Kaner, Eileen; Sweetman, Jennifer; McGovern, Ruth; Newbury-Birch, Dorothy; Parrott, Steve; Tober, Gillian; Watson, Judith; Wu, Qi

2017-11-01

To compare the clinical effectiveness and cost-effectiveness of a stepped-care intervention versus a minimal intervention for the treatment of older hazardous alcohol users in primary care. Multi-centre, pragmatic RCT, set in Primary Care in UK. Patients aged ≥ 55 years scoring ≥ 8 on the Alcohol Use Disorders Identification Test were allocated either to 5-min of brief advice or to 'Stepped Care': an initial 20-min of behavioural change counselling, with Step 2 being three sessions of Motivational Enhancement Therapy and Step 3 referral to local alcohol services (progression between each Step being determined by outcomes 1 month after each Step). Outcome measures included average drinks per day, AUDIT-C, alcohol-related problems using the Drinking Problems Index, health-related quality of life using the Short Form 12, costs measured from a NHS/Personal Social Care perspective and estimated health gains in quality adjusted life-years measured assessed EQ-5D. Both groups reduced alcohol consumption at 12 months but the difference between groups was small and not significant. No significant differences were observed between the groups on secondary outcomes. In economic terms stepped care was less costly and more effective than the minimal intervention. Stepped care does not confer an advantage over a minimal intervention in terms of reduction in alcohol use for older hazardous alcohol users in primary care. However, stepped care has a greater probability of being more cost-effective. Current controlled trials ISRCTN52557360. A stepped care approach was compared with brief intervention for older at-risk drinkers attending primary care. While consumption reduced in both groups over 12 months there was no significant difference between the groups. An economic analysis indicated the stepped care which had a greater probability of being more cost-effective than brief intervention. © The Author 2017. Medical Council on Alcohol and Oxford University Press. All rights

BULLOUS DEGENERATION OF THE LEFT LOWER LOBE IN A HEROIN-ADDICT

NARCIS (Netherlands)

SMEENK, FWJM; SERLIE, J; VANDERJAGT, EJ; POSTMUS, PE

1990-01-01

A 34 yr old heroin addict was referred because of chest pain caused by air-trapping in a bulla in the left lower lobe. There was a marked difference between the functional residual capacity measured by body-plethysmography and helium dilution. A slow wash-in and wash-out were demonstrated by

Decline in Herpes Simplex Virus Type 2 Among Non-Injecting Heroin and Cocaine Users in New York City, 2005 to 2014: Prospects for Avoiding a Resurgence of Human Immunodeficiency Virus.

Science.gov (United States)

Des Jarlais, Don C; Arasteh, Kamyar; Feelemyer, Jonathan; McKnight, Courtney; Tross, Susan; Perlman, David C; Campbell, Aimee N C; Hagan, Holly; Cooper, Hannah L F

2017-02-01

Herpes simplex virus type 2 (HSV-2) infection increases both susceptibility to and transmissibility of human immunodeficiency virus (HIV), and HSV-2 and HIV are often strongly associated in HIV epidemics. We assessed trends in HSV-2 prevalence among non-injecting drug users (NIDUs) when HIV prevalence declined from 16% to 8% among NIDUs in New York City. Subjects were current non-injecting users of heroin and/or cocaine and who had never injected illicit drugs. Three thousand one hundred fifty-seven NIDU subjects were recruited between 2005 and 2014 among persons entering Mount Sinai Beth Israel substance use treatment programs. Structured interviews, HIV, and HSV-2 testing were administered. Change over time was assessed by comparing 2005 to 2010 with 2011 to 2014 periods. Herpes simplex virus type 2 incidence was estimated among persons who participated in multiple years. Herpes simplex virus type 2 prevalence was strongly associated with HIV prevalence (odds ratio, 3.9; 95% confidence interval, 2.9-5.1) from 2005 to 2014. Herpes simplex virus type 2 prevalence declined from 60% to 56% (P = 0.01). The percentage of NIDUs with neither HSV-2 nor HIV infection increased from 37% to 43%, (P < 0.001); the percentage with HSV-2/HIV coinfection declined from 13% to 6% (P < 0.001). Estimated HSV-2 incidence was 1 to 2/100 person-years at risk. There were parallel declines in HIV and HSV-2 among NIDUs in New York City from 2005 to 2014. The increase in the percentage of NIDUs with neither HSV-2 nor HIV infection, the decrease in the percentage with HSV-2/HIV coinfection, and the low to moderate HSV-2 incidence suggest some population-level protection against resurgence of HIV. Prevention efforts should be strengthened to end the combined HIV/HSV-2 epidemic among NIDUs in New York City.

Reinterpreting ethnic patterns among white and African American men who inject heroin: a social science of medicine approach.

Science.gov (United States)

Bourgois, Philippe; Martinez, Alexis; Kral, Alex; Edlin, Brian R; Schonberg, Jeff; Ciccarone, Dan

2006-10-01

Street-based heroin injectors represent an especially vulnerable population group subject to negative health outcomes and social stigma. Effective clinical treatment and public health intervention for this population requires an understanding of their cultural environment and experiences. Social science theory and methods offer tools to understand the reasons for economic and ethnic disparities that cause individual suffering and stress at the institutional level. We used a cross-methodological approach that incorporated quantitative, clinical, and ethnographic data collected by two contemporaneous long-term San Francisco studies, one epidemiological and one ethnographic, to explore the impact of ethnicity on street-based heroin-injecting men 45 years of age or older who were self-identified as either African American or white. We triangulated our ethnographic findings by statistically examining 14 relevant epidemiological variables stratified by median age and ethnicity. We observed significant differences in social practices between self-identified African Americans and whites in our ethnographic social network sample with respect to patterns of (1) drug consumption; (2) income generation; (3) social and institutional relationships; and (4) personal health and hygiene. African Americans and whites tended to experience different structural relationships to their shared condition of addiction and poverty. Specifically, this generation of San Francisco injectors grew up as the children of poor rural to urban immigrants in an era (the late 1960s through 1970s) when industrial jobs disappeared and heroin became fashionable. This was also when violent segregated inner city youth gangs proliferated and the federal government initiated its "War on Drugs." African Americans had earlier and more negative contact with law enforcement but maintained long-term ties with their extended families. Most of the whites were expelled from their families when they began engaging in

DYNAMICS OF OPIOID SUBSTITUTION TREATMENTIN DIFFERENT INITIAL SUBSTANCE USER OPIOID DEPENDENT PATIENTS.

Science.gov (United States)

Todadze, Kh; Mosia, S

2016-05-01

Injecting drug user size estimation studies carried out in 2009, 2012 and 2015 revealed growing trends of drug abuse in Georgia:estimated number of people who inject drugs (PWID) have been increased from 40000 and 45000 to 50000. Since Soviet period the most popular injective narcotics have been opioids: home-made opium, heroine, buprenorphine and home-made desomorphine ("Krokodile") replacing each other on the black market. Self-made desomorphine typically contains big amounts of different toxic substances and causes significant somatic disorders, especially skin, bone, blood infections, liver and kidney failure; is highly addictive, associates with frequent injections that enhance injecting-related harm, including the risk of HIV transmission, in comparison with typical opioids. The aim of the study was to determine the effectiveness of opioid substitution treatment (OST) on depression and anxiety in opioid dependent clients with history of different opioid substance use. 104 opioid drug users undergoing OST with intensive psychological counseling have been divided in 5 groups according to the principal opioid drug that was abused during past 6 months before starting treatment: heroine, desomorphine, illicit methadone injectors, illicit buprenorphine injectors, and multiple drug abusers consuming opioids as primary drugs. Level of depression (Beck Depression Inventory), anxiety (Spielberger Anxiety Inventory) as well as clinical symptoms, risky behavior, quality of life (WHO), and other data were measured before starting and after 3, 9, 15, 21 months of treatment. The illegal use of psychotropic-narcotics was checked through random urine-testing 1-2 times per patient per month. In all five groups remarkable decrease of depression and anxiety was observed in comparison with the starting data. Before inclusion desomorphine and poly-drug users had the highest scores of depression and anxiety while buprenorphine users manifested the lowest rate. Improvement of

Syndrome surveillance of fentanyl-laced heroin outbreaks: Utilization of EMS, Medical Examiner and Poison Center databases.

Science.gov (United States)

Moore, P Quincy; Weber, Joseph; Cina, Steven; Aks, Steven

2017-11-01

Describe surveillance data from three existing surveillance systems during an unexpected fentanyl outbreak in a large metropolitan area. We performed a retrospective analysis of three data sets: Chicago Fire Department EMS, Cook County Medical Examiner, and Illinois Poison Center. Each included data from January 1, 2015 through December 31, 2015. EMS data included all EMS responses in Chicago, Illinois, for suspected opioid overdose in which naloxone was administered and EMS personnel documented other criteria indicative of opioid overdose. Medical Examiner data included all deaths in Cook County, Illinois, related to heroin, fentanyl or both. Illinois Poison Center data included all calls in Chicago, Illinois, related to fentanyl, heroin, and other prescription opioids. Descriptive statistics using Microsoft Excel® were used to analyze the data and create figures. We identified a spike in opioid-related EMS responses during an 11-day period from September 30-October 10, 2015. Medical Examiner data showed an increase in both fentanyl and mixed fentanyl/heroin related deaths during the months of September and October, 2015 (375% and 550% above the median, respectively.) Illinois Poison Center data showed no significant increase in heroin, fentanyl, or other opioid-related calls during September and October 2015. Our data suggests that EMS data is an effective real-time surveillance mechanism for changes in the rate of opioid overdoses. Medical Examiner's data was found to be valuable for confirmation of EMS surveillance data and identification of specific intoxicants. Poison Center data did not correlate with EMS or Medical Examiner data. Copyright © 2017 Elsevier Inc. All rights reserved.

'Chasing the Dragon' - imaging of heroin inhalation leukoencephalopathy

Energy Technology Data Exchange (ETDEWEB)

Hagel, J. [Vancouver General Hospital, Dept. of Radiology, Vancouver, British Columbia (Canada)]. E-mail: jeff_hagel@hotmail.com; Andrews, G. [UBC Hospital, Dept. of Radiology, Vancouver, British Columbia (Canada); Vertinsky, T. [Vancouver General Hospital, Dept. of Radiology, Vancouver, British Columbia (Canada); Heran, M.K.S. [Vancouver General Hospital, Div. of Neuroradiology, Vancouver, British Columbia (Canada); Keogh, C. [BC Cancer Agency, Dept. of Radiology, Vancouver, British Columbia (Canada)

2005-10-15

'Chasing the dragon' refers to the inhalation of heroin pyrolysate vapors produced when the freebase form of heroin is heated. Inhalation of these vapors can result in a rare toxic spongiform leukoencephalopathy. The patients may progress through 3 defined clinical stages, with one-quarter reaching the terminal stage, which invariably leads to death. Imaging and, in particular, magnetic resonance imaging (MRI) demonstrates white matter findings that are felt to be specific for this entity and essential in its early diagnosis. We present the typical imaging findings in a pictorial essay format, using images taken from 9 patients who presented within an 18-month period at UBC-affiliated hospitals. These findings include low computed tomography (CT) attenuation and high T2 MRI signal most commonly in the posterior cerebral and cerebellar white matter, cerebellar peduncles, splenium of the corpus callosum, and posterior limb of the internal capsules. In addition, there is often selective, symmetric involvement of the corticospinal tract, the medial lemniscus, and the tractus solitarius. We also present the variable diffusion-weighted imaging arid apparent diffusion coefficient findings from 4 of our patients, which to our knowledge, have not been described in the literature. (author)

Heroin addicts have higher discount rates for delayed rewards than non-drug-using controls.

Science.gov (United States)

Kirby, K N; Petry, N M; Bickel, W K

1999-03-01

Fifty-six heroin addicts and 60 age-matched controls were offered choices between monetary rewards ($11-$80) available immediately and larger rewards ($25-$85) available after delays ranging from 1 week to 6 months. Participants had a 1-in-6 chance of winning a reward that they chose on one randomly selected trial. Delay-discounting rates were estimated from the pattern of participants' choices. The discounting model of impulsiveness (Ainslie, 1975) implies that delay-discounting rates are positively correlated with impulsiveness. On average, heroin addicts' discount rates were twice those of controls (p = .004), and discount rates were positively correlated with impulsivity as measured by self-report questionnaires (p discounting rate as a measure of impulsiveness, a characteristic associated with substance abuse.

Hero/Heroine Modeling for Puerto Rican Adolescents: A Preventive Mental Health Intervention.

Science.gov (United States)

Malgady, Robert G.; And Others

1990-01-01

Developed hero/heroine intervention based on adult Puerto Rican role models to foster ethnic identity, self-concept, and adaptive coping behavior. Screened 90 Puerto Rican eighth and ninth graders for presenting behavior problems in school and randomly assigned them to intervention or control groups. After 19 sessions, intervention significantly…

Chronic THC during adolescence increases the vulnerability to stress-induced relapse to heroin seeking in adult rats.

Science.gov (United States)

Stopponi, Serena; Soverchia, Laura; Ubaldi, Massimo; Cippitelli, Andrea; Serpelloni, Giovanni; Ciccocioppo, Roberto

2014-07-01

Cannabis derivatives are among the most widely used illicit substances among young people. The addictive potential of delta-9-tetrahydrocannabinol (THC), the major active ingredient of cannabis is well documented in scientific literature. However, the consequence of THC exposure during adolescence on occurrence of addiction for other drugs of abuse later in life is still controversial. To explore this aspect of THC pharmacology, in the present study, we treated adolescent rats from postnatal day (PND) 35 to PND-46 with increasing daily doses of THC (2.5-10mg/kg). One week after intoxication, the rats were tested for anxiety-like behavior in the elevated plus maze (EPM) test. One month later (starting from PND 75), rats were trained to operantly self-administer heroin intravenously. Finally, following extinction phase, reinstatement of lever pressing elicited by the pharmacological stressor, yohimbine (1.25mg/kg) was evaluated. Data revealed that in comparison to controls, animals treated with chronic THC during adolescence showed a higher level of anxiety-like behavior. When tested for heroin (20μg per infusion) self-administration, no significant differences were observed in both the acquisition of operant responding and heroin intake at baseline. Noteworthy, following the extinction phase, administration of yohimbine elicited a significantly higher level of heroin seeking in rats previously exposed to THC. Altogether these findings demonstrate that chronic exposure to THC during adolescence is responsible for heightened anxiety and increased vulnerability to drug relapse in adulthood. Copyright © 2013 Elsevier B.V. and ECNP. All rights reserved.

Gene transcripts selectively down-regulated in the shell of the nucleus accumbens long after heroin self-administration are up-regulated in the core independent of response contingency.

Science.gov (United States)

Jacobs, Edwin H; de Vries, Taco J; Smit, August B; Schoffelmeer, Anton N M

2004-01-01

Long-term drug-induced alterations in neurotransmission within the nucleus accumbens (NAc) shell and core may underlie relapse to drug-seeking behavior and drug-taking upon re-exposure to drugs and drug-associated stimuli (cues) during abstinence. Using an open screening strategy, we recently identified 25 gene transcripts, encoding for proteins involved in neuronal functioning and structure that are down-regulated in rat NAc shell after contingent (active), but not after non-contingent (passive), heroin administration. Studying the expression of the same transcripts in the NAc core by means of quantitative PCR, we now demonstrate that most of these transcripts are up-regulated in that NAc subregion long (3 weeks) after heroin self-administration in rats. A similar up-regulation in gene expression was also apparent in the NAc core of animals with a history of non-contingent heroin administration (yoked controls). These data indicate that heroin self-administration differentially regulates genes in the NAc core as compared with the shell. Moreover, whereas cognitive processes involved in active drug self-administration (e.g., instrumental learning) seems to direct gene expression in the NAc shell, neuroplasticity in the NAc core may be due to the pharmacological effects of heroin (including Pavlovian conditioning), as expressed in rats upon contingent as well as non-contingent administration of heroin.

Ethical Concerns in Usability Testing Involving Older Adults

DEFF Research Database (Denmark)

Møller, Margrethe Hansen

Based on experience from the research project “User Manuals for Older Adults”, this paper discusses whether there are special ethical concerns with older adults as test persons in a usability test involving the think-aloud method. In this context, older adults are defined as individuals with normal...

Validation and optimization of a chromatographic method for the quantitative and qualitative determination of cocaine and heroin through liquid chromatography of high resolution

International Nuclear Information System (INIS)

Montero Aguilar, A.L.

1997-01-01

A (HPLC) chromatographic method was optimized in this work, for the determination of cocaine and heroin in seizures, through the application of the factorial and the simplex design. It applied the developed methodology in the determination of the content of cocaine and of heroin in nine different samples. The application of this methodology in abuse drugs seizures samples, turned out analytically satisfactory for the time of analysis and the veracity of the results. It also complements efficiently the qualitative analysis of cocaine and heroin, that the Laboratory of Physical and Chemical Investigations of the Department of Forensic Sciences of the Agency of Judicial Investigation carries out. (S. Grainger) [es

Heroin addict with gangrene of the extremities, rhabdomyolysis and severe hyperkalemia

Directory of Open Access Journals (Sweden)

Radovanović Milan R.

2012-01-01

Full Text Available Introduction. Long-time consumption of narcotics leads to altered mental status of the addict. It is also connected to damages of different organic systems and it often leads to appearance of multiple organ failure. Excessive narcotics consumption or abuse in a long time period can lead to various consequences, such as atraumatic rhabdomyolysis, acute renal failure and electrolytic disorders. Rhabdomyolysis is characterized by injury of skeletal muscle with subsequent release of intracellular contents, such as myoglobin, potassium and creatine phosphokinase. In heroin addicts, rhabdomyolysis is a consequence of the development of a compartment syndrome due to immobilization of patients in the state of unconsciousness and prolonged compression of extremities, direct heroin toxicity or extremities ischemia caused by intraluminal occlusion of blood vessels after intraarterial injection of heroin. Severe hyperkalemia and the development of acute renal failure require urgent therapeutic measures, which imply the application of either conventional treatment or a form of dialysis. Case report. We presented a male patient, aged 50, hospitalized in the Emergency Center Kragujevac due to altered mental status (Glasgow Coma Score 11, partial respiratory insufficiency (pO2 7.5 kPa, pCO2 4.3 kPa, SpO2 89 %, weakness of lower extremities and atypical electrocardiographic changes. Laboratory analyses, carried out immediately after the patient’s admission to the Emergency Center, registered the following disturbances: high hyperkalemia level (K+ 9.9 mmol/L, increased levels of urea (30.1 mmol/L, creatinine (400 μmol/L, creatine phosphokinase - CK (120350 IU/L, CK-MB (2500 IU/L and myoglobin (57000 μg/L, with normal levels of troponin I (< 0.01 μg/L, as well as signs of anemia (Hgb 92 g/L, Er 3.61 x 1012/L, infection (C-reactive proteine 184 μg/mL, Le 16.1 x 109/L and acidosis (base excess - 18.4 mmol/L, pH 7.26. Initial examination of the patient revealed

Reinterpreting ethnic patterns among white and African American men who inject heroin: a social science of medicine approach.

Directory of Open Access Journals (Sweden)

Philippe Bourgois

2006-10-01

Full Text Available Street-based heroin injectors represent an especially vulnerable population group subject to negative health outcomes and social stigma. Effective clinical treatment and public health intervention for this population requires an understanding of their cultural environment and experiences. Social science theory and methods offer tools to understand the reasons for economic and ethnic disparities that cause individual suffering and stress at the institutional level.We used a cross-methodological approach that incorporated quantitative, clinical, and ethnographic data collected by two contemporaneous long-term San Francisco studies, one epidemiological and one ethnographic, to explore the impact of ethnicity on street-based heroin-injecting men 45 years of age or older who were self-identified as either African American or white. We triangulated our ethnographic findings by statistically examining 14 relevant epidemiological variables stratified by median age and ethnicity. We observed significant differences in social practices between self-identified African Americans and whites in our ethnographic social network sample with respect to patterns of (1 drug consumption; (2 income generation; (3 social and institutional relationships; and (4 personal health and hygiene. African Americans and whites tended to experience different structural relationships to their shared condition of addiction and poverty. Specifically, this generation of San Francisco injectors grew up as the children of poor rural to urban immigrants in an era (the late 1960s through 1970s when industrial jobs disappeared and heroin became fashionable. This was also when violent segregated inner city youth gangs proliferated and the federal government initiated its "War on Drugs." African Americans had earlier and more negative contact with law enforcement but maintained long-term ties with their extended families. Most of the whites were expelled from their families when they began

Associations between alcohol, heroin, and cocaine use and high risk sexual behaviors among detoxification patients.

Science.gov (United States)

Raj, Anita; Saitz, Richard; Cheng, Debbie M; Winter, Michael; Samet, Jeffrey H

2007-01-01

The purpose of this study was to assess associations between substance use (alcohol to intoxication, heroin, and cocaine) and sexual activity, high risk sexual behaviors, and STD among detoxification inpatients (n = 470). Participants were surveyed on past 30 day substance use, past 6 month sexual behaviors, and STD in the past 6 months and/or over 24 months of follow-up. Logistic regression models adjusted for demographics found that cocaine use was significantly associated with being sexually active (OR(adj) = 2.3, 95% CI = 1.1-4.8) and selling sex (OR(adj) = 2.6, 95% CI = 1.3-5.3). Alcohol and heroin were not significantly associated with sexual activity, high risk sexual behaviors or STD in this sample.

Augmented production of proinflammatory cytokines and accelerated allotransplantation reactions in heroin-treated mice

Czech Academy of Sciences Publication Activity Database

Holáň, Vladimír; Zajícová, Alena; Krulová, Magdalena; Blahoutová, V.; Wilczek, H.

2003-01-01

Roč. 132, č. 1 (2003), s. 40-45 ISSN 0009-9104 R&D Projects: GA MZd NF6824; GA MZd NJ6632 Institutional research plan: CEZ:MSM 113100003 Keywords : heroin * naltrexone * skin allografts Subject RIV: EC - Immunology Impact factor: 2.347, year: 2003

Mortality among young injection drug users in San Francisco: a 10-year follow-up of the UFO study.

Science.gov (United States)

Evans, Jennifer L; Tsui, Judith I; Hahn, Judith A; Davidson, Peter J; Lum, Paula J; Page, Kimberly

2012-02-15

This study examined associations between mortality and demographic and risk characteristics among young injection drug users in San Francisco, California, and compared the mortality rate with that of the population. A total of 644 young (UFO ("U Find Out") Study, from November 1997 to December 2007. Using the National Death Index, the authors identified 38 deaths over 4,167 person-years of follow-up, yielding a mortality rate of 9.1 (95% confidence interval: 6.6, 12.5) per 1,000 person-years. This mortality rate was 10 times that of the general population. The leading causes of death were overdose (57.9%), self-inflicted injury (13.2%), trauma/accidents (10.5%), and injection drug user-related medical conditions (13.1%). Mortality incidence was significantly higher among those who reported injecting heroin most days in the past month (adjusted hazard ratio = 5.8, 95% confidence interval: 1.4, 24.3). The leading cause of death in this group was overdose, and primary use of heroin was the only significant risk factor for death observed in the study. These findings highlight the continued need for public health interventions that address the risk of overdose in this population in order to reduce premature deaths.

On-the-road driving performance and driving-related skills in older untreated insomnia patients and chronic users of hypnotics.

Science.gov (United States)

Leufkens, T R M; Ramaekers, J G; de Weerd, A W; Riedel, W J; Vermeeren, A

2014-07-01

Many older adults report sleep problems and use of hypnotics. Several studies have shown that hypnotics can have acute adverse effects on driving the next morning. It is unclear however whether driving of chronic hypnotic users is impaired. Therapeutic effects on insomnia and development of tolerance may reduce the residual effects on driving. The present study aimed to compare actual driving performance and driving-related skills of chronic hypnotic users to good sleepers. To determine whether insomnia itself affects driving performance, driving and driving-related skills were compared between insomnia patients who do not or infrequently use hypnotics and good sleepers. Twenty-two frequent users of hypnotics (using hypnotics ≥ 4 nights per week for more than 3 months), 20 infrequent users (using hypnotics ≤ 3 nights per week), and 21 healthy, age-matched controls participated in this study. On the night before testing, all subjects were hospitalized for an 8-h sleep recorded by polysomnography. Frequent hypnotic users used their regular medication at bedtime (2330 hours), while infrequent users and controls received no medication. Cognitive performance (word learning, digit span, tracking, divided attention, vigilance, and inhibitory control) was assessed 8.5 h and driving performance between 10 and 11 h after bedtime and dosing. Polysomnographic recordings did not significantly differ between the groups, but the insomnia patients, treated or untreated, still reported subjective sleep complaints. Results show no differences in driving performance and driving-related skills between both groups of insomnia patients and controls. Driving performance in chronic users of hypnotics and untreated insomnia patients is not impaired. For chronic users, this may be due to prescription of relatively safe drugs and low doses. For untreated insomniacs, this corroborates previous findings showing an absence of neuropsychological deficits in this group of patients.

Analysis of variations in the glutamate receptor, N-methyl D-aspartate 2A (GRIN2A gene reveals their relative importance as genetic susceptibility factors for heroin addiction.

Directory of Open Access Journals (Sweden)

Bin Zhao

Full Text Available The glutamate receptor, N-methyl D-aspartate 2A (GRIN2A gene that encodes the 2A subunit of the N-methyl D-aspartate (NMDA receptor was recently shown to be involved in the development of opiate addiction. Genetic polymorphisms in GRIN2A have a plausible role in modulating the risk of heroin addiction. An association of GRIN2A single-nucleotide polymorphisms (SNPs with heroin addiction was found earlier in African Americans. To identify markers that contribute to the genetic susceptibility to heroin addiction, we examined the potential association between heroin addiction and forty polymorphisms of the GRIN2A gene using the MassARRAY system and GeneScan in this study. The frequency of the (GT26 repeats (rs3219790 in the heroin addiction group was significantly higher than that in the control group (χ(2 = 5.360, P = 0.021. The allele frequencies of three polymorphisms (rs1102972, rs1650420, and rs3104703 in intron 3 were strongly associated with heroin addiction (P<0.001, 0.0002, and <0.001, after Bonferroni correction. Three additional SNPs from the same intron (rs1071502, rs6497730, and rs1070487 had nominally significant P values for association (P<0.05, but did not pass the threshold value. Haplotype analysis revealed that the G-C-T-C-C-T-A (block 6 and T-T (block 10 haplotypes of the GRIN2A gene displayed a protective effect (P = <0.001 and 0.003. These findings point to a role for GRIN2A polymorphisms in heroin addiction among the Han Chinese from Shaanxi province, and may be informative for future genetic or neurobiological studies on heroin addiction.

Susan And Lucy: Two Outstanding Heroines Of Alan Ayckbourn / Susan ve Lucy: Alan Ayckbourn’un İki Sıradışı Kadın-Kahramanı

OpenAIRE

Parlak, Erdinç

2012-01-01

Alan Ayckbourn (1939-     ) has an important place among the twentieth century British playwrights. The playwright handles some present-day social problems such as insensitiveness, lack of communication, lack of love, collision, alienation, moral degeneration especially around his heroines. Susan, the protagonist of Woman in Mind, and Lucy, the little heroine in Invisible Friends, are among the outstanding heroines of the playwright. The life experiences of Susan and Lucy reflected from the s...

Investigation of Internal Tensions of Wives of Men Who Addicted to Heroin

Directory of Open Access Journals (Sweden)

S. Mahdizadeh

2013-08-01

Full Text Available Background: Addiction is one of the social bad phenomenon and because of family is the most vulnerable of social institution against to the adverse effects of addiction and due to head of family with drug addicts cannot perform his role as husband and father, important role of women in such families is double. Due to this group of women are the most vulnerable community groups and are at risk of serious damage to the system of family, present study describes the structure and nature of psychological problems who addict to heroin and deep understanding of the overall psychological problems. Methods: In this research was used from qualitative approaches (phenomenology. Sampling method is based on object and has been continued until data saturation. Participants were the wives of men who have been addicted to heroin .The women refer to Eynolhayat club - treatment center of addiction- in Khoy city during this research. Results: The extracted interviews were analyzed. Concepts of internal stresses associated with six subconcepts that were identified are as follow: shy, uncertain future, frustration, guard less, concern and confusion. Conclusion: This study suggests that the wives of men who addicted to heroin experience a range of psychological problems in various aspects of their life. They need psychological support and use from counseling of psychologists when faced with psychological problems. Because the women have an important role in shaping the family system, the practitioners with adequate knowledge of their spouse problems in relation to addiction husbands must support them. We can use from findings of this study to educate and raise awareness level of some organization (especially the anti-drug organization and the nature of addiction to rise possibility comply with human psychosis problems and better support from them.

The association of 5-HTR2A-1438A/G, COMTVal158Met, MAOA-LPR, DATVNTR and 5-HTTVNTR gene polymorphisms and antisocial personality disorder in male heroin-dependent Chinese subjects.

Science.gov (United States)

Yang, Mei; Kavi, Vasish; Wang, Wenfu; Wu, Zhimei; Hao, Wei

2012-03-30

To explore the association between the 5-HTR2A-1438A/G, COMTVal158Met, MAOA-LPR, DATVNTR and 5-HTTVNTR polymorphisms with comorbidity of antisocial personality disorder in male heroin-dependent patients. In case control study, we compared the polymorphic distributions of 5-HTR2A-1438A/G, COMTVal158Met, MAOA-LPR, DATVNTR and 5-HTTVNTR in 588 male heroin-dependent patients (including 311 patients with antisocial personality disorder and 277 patients without antisocial personality disorder) and 194 normal males by genotypes, alleles, and interaction between genes. Between male heroin-dependent patients with antisocial personality disorder and normal males, and between male heroin-dependent patients with and without antisocial personality disorder, the distributions of 5-HTTVNTR polymorphic genotypes and alleles were in statistical significance. Individuals carrying 10R allele were in higher risk of the comorbidity of antisocial personality disorder and heroin dependence. By MDR analyses, the interaction between 5-HTTVNTR and DATVNTR was close to statistical significance in predicting the risk of antisocial personality disorder in male heroin dependent patients. In male heroin dependent patients, individuals carrying 5-HTTVNTR 10R allele or/and DATVNTR 9R allele were in higher risks of co-occurring antisocial personality disorder, while individuals with 5-HTTVNTR 12R/12R and DATVNTR 10R/10R genotypes together were in lower risks of antisocial personality disorder. 5-HTTVNTR, and the interaction between 5-HTTVNTR and DATVNTR may be associated with the comorbidity of antisocial personality disorder in male heroin-dependent patients. Copyright © 2011 Elsevier Inc. All rights reserved.

Decision-making in stimulant and opiate addicts in protracted abstinence: evidence from computational modeling with pure users.

Science.gov (United States)

Ahn, Woo-Young; Vasilev, Georgi; Lee, Sung-Ha; Busemeyer, Jerome R; Kruschke, John K; Bechara, Antoine; Vassileva, Jasmin

2014-01-01

Substance dependent individuals (SDI) often exhibit decision-making deficits; however, it remains unclear whether the nature of the underlying decision-making processes is the same in users of different classes of drugs and whether these deficits persist after discontinuation of drug use. We used computational modeling to address these questions in a unique sample of relatively "pure" amphetamine-dependent (N = 38) and heroin-dependent individuals (N = 43) who were currently in protracted abstinence, and in 48 healthy controls (HC). A Bayesian model comparison technique, a simulation method, and parameter recovery tests were used to compare three cognitive models: (1) Prospect Valence Learning with decay reinforcement learning rule (PVL-DecayRI), (2) PVL with delta learning rule (PVL-Delta), and (3) Value-Plus-Perseverance (VPP) model based on Win-Stay-Lose-Switch (WSLS) strategy. The model comparison results indicated that the VPP model, a hybrid model of reinforcement learning (RL) and a heuristic strategy of perseverance had the best post-hoc model fit, but the two PVL models showed better simulation and parameter recovery performance. Computational modeling results suggested that overall all three groups relied more on RL than on a WSLS strategy. Heroin users displayed reduced loss aversion relative to HC across all three models, which suggests that their decision-making deficits are longstanding (or pre-existing) and may be driven by reduced sensitivity to loss. In contrast, amphetamine users showed comparable cognitive functions to HC with the VPP model, whereas the second best-fitting model with relatively good simulation performance (PVL-DecayRI) revealed increased reward sensitivity relative to HC. These results suggest that some decision-making deficits persist in protracted abstinence and may be mediated by different mechanisms in opiate and stimulant users.

Decision-making in stimulant and opiate addicts in protracted abstinence: evidence from computational modeling with pure users

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Woo-Young eAhn

2014-08-01

Full Text Available Substance dependent individuals (SDI often exhibit decision-making deficits; however, it remains unclear whether the nature of the underlying decision-making processes is the same in users of different classes of drugs and whether these deficits persist after discontinuation of drug use. We used computational modeling to address these questions in a unique sample of relatively pure amphetamine-dependent (N=38 and heroin-dependent individuals (N=43 who were currently in protracted abstinence, and in 48 healthy controls. A Bayesian model comparison technique, a simulation method, and parameter recovery tests were used to compare three cognitive models: (1 Prospect Valence Learning with decay reinforcement learning rule (PVL-DecayRI, (2 PVL with delta learning rule (PVL-Delta, and (3 Value-Plus-Perseverance (VPP models based on Win-Stay-Lose-Switch (WSLS strategy. The model comparison results indicated that the VPP model, a hybrid model of reinforcement learning (RL and a heuristic strategy of perseverance had the best post hoc model fit, but the two PVL models showed better simulation performance. Computational modeling results suggested that overall all three groups relied more on RL than on a WSLS strategy. Heroin users displayed reduced loss aversion relative to healthy controls across all three models, which suggests that their decision-making deficits are longstanding (or pre-existing and may be driven by reduced sensitivity to loss. In contrast, amphetamine users showed comparable cognitive functions to healthy controls with the VPP model, whereas the second best-fitting model with relatively good simulation performance (PVL-DecayRI revealed increased reward sensitivity relative to healthy controls. These results suggest that some decision-making deficits persist in protracted abstinence and may be mediated by different mechanisms in opiate and stimulant users.

Drug use among HIV+ adults aged 50 and older: findings from the GOLD II study.

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Ompad, Danielle C; Giobazolia, Tatiana T; Barton, Staci C; Halkitis, Sophia N; Boone, Cheriko A; Halkitis, Perry N; Kapadia, Farzana; Urbina, Antonio

2016-11-01

Understanding the nexus of aging, HIV, and substance use is key to providing appropriate services and support for their aging, HIV seropositive patients. The proportion of PLWHA aged 50 and older is growing due to a variety of factors like decreases in mortality due to highly active retroviral therapy and non-negligible HIV incidence. We describe prevalence of alcohol, tobacco, and other drug use and participation in substance use treatment and 12-step programs among 95 HIV-positive patients aged 50 and older engaged in care. Most (73.7%) smoked cigarettes in their lifetime and 46.3% were current smokers. Most were at medium (81.1%) or high risk (13.7%) for an alcohol use disorder. With respect to illicit drug use, 48.4% had used marijuana, cocaine, crack, methamphetamines, heroin, and/or prescription opiates without a prescription in the last 12 months; 23.2% met criteria for drug dependence. Marijuana was the most commonly reported illicit drug (32.6%) followed by cocaine and crack (10.5% each), heroin and prescription opiates (7.4% each), and methamphetamines (6.3%). Among those who had not used drugs in the past 12 months, 36.7% had been in a substance use treatment program and 26.5% had participated in a 12-step program in their lifetime; 8.2% were currently in treatment and 16.3% were currently participating in a 12-step program. Among those who had used an illicit drug in the past 12 months, 37.0% had never been in treatment, 34.8% had been in treatment in their lifetime, and 28.3% were currently in treatment. With respect to 12-step programs, 27.3% of those meeting dependence criteria had never participated, 45.5% had participated in their lifetimes, and 27.3% were currently participating. Our findings suggest that older adults in HIV care settings could benefit from Screening, Brief Intervention, and Referral to Treatment interventions and/or integrated services for substance abuse and medical treatment.

Psychological barriers to Internet usage among older adults in the UK.

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Adams, Nichola; Stubbs, David; Woods, Valerie

2005-03-01

The Internet is an important tool in assisting the older population to lead independent and social lives. However, the majority of Internet users are under 55. This study investigated the following psychological barriers to Internet use by older adults: perceived usefulness, perceived ease of use, Internet efficacy, perceived complexity of navigation and perceived complexity of terminology. Twenty-three subjects (aged 55 - 75 years) were interviewed in the UK. The influences of age, computer and Internet experience, and training on these psychological barriers were explored. The results showed that the majority of the older adults who had a positive perception of usefulness, ease of use, and efficacy of the Internet or e-mail, used the Internet or e-mail more often. In addition, it was found that computer or Internet experience increased perceptions of ease of use and efficacy of the Internet and reduced perceived complexity of navigation. There was no difference between the two age groups (55 - 65 and 66 - 75 years) in these psychological barriers. It was concluded that increased marketing of the Internet (aimed at the older user), more simple and uniformly designed Internet pages, more user-friendly online help and error message terminology, and increased provision of training for the older user would assist uptake of the World Wide Web.

Harm reduction as a complex adaptive system: A dynamic framework for analyzing Tanzanian policies concerning heroin use.

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Ratliff, Eric A; Kaduri, Pamela; Masao, Frank; Mbwambo, Jessie K K; McCurdy, Sheryl A

2016-04-01

Contrary to popular belief, policies on drug use are not always based on scientific evidence or composed in a rational manner. Rather, decisions concerning drug policies reflect the negotiation of actors' ambitions, values, and facts as they organize in different ways around the perceived problems associated with illicit drug use. Drug policy is thus best represented as a complex adaptive system (CAS) that is dynamic, self-organizing, and coevolving. In this analysis, we use a CAS framework to examine how harm reduction emerged around heroin trafficking and use in Tanzania over the past thirty years (1985-present). This account is an organizational ethnography based on of the observant participation of the authors as actors within this system. We review the dynamic history and self-organizing nature of harm reduction, noting how interactions among system actors and components have coevolved with patterns of heroin us, policing, and treatment activities over time. Using a CAS framework, we describe harm reduction as a complex process where ambitions, values, facts, and technologies interact in the Tanzanian sociopolitical environment. We review the dynamic history and self-organizing nature of heroin policies, noting how the interactions within and between competing prohibitionist and harm reduction policies have changed with patterns of heroin use, policing, and treatment activities over time. Actors learn from their experiences to organize with other actors, align their values and facts, and implement new policies. Using a CAS approach provides researchers and policy actors a better understanding of patterns and intricacies in drug policy. This knowledge of how the system works can help improve the policy process through adaptive action to introduce new actors, different ideas, and avenues for communication into the system. Copyright © 2015 Elsevier B.V. All rights reserved.

Older Motorcyclists in Ireland

LENUS (Irish Health Repository)

Fitzpatrick, D

2017-06-01

Older motorcyclists are under-recognised as vulnerable road users. Using Irish data from the Central Statistics Office, the Road Safety Authority and the Healthcare Pricing Office, we explored the trend of ageing riders and factors in older motorcyclist collisions and injuries. In 2005, 17 motorcyclists ≥55 were injured compared to 31 in 2012. Motorcyclists aged between 30 and 49 years and ≥50 have longer lengths of stay compared to riders <30. The percentage of motorcycles with an engine capacity of ≥750cc increased from 39.6% in 2007 to 46.7% in 2015. Older motorcyclists are less likely to be fatally injured in single vehicle collisions. Older motorcyclists are generally safer than younger riders but the proportion of older motorcyclist injury is rising. Irish road safety strategies and trauma services need to incorporate these findings into planning and development of preventive and treatment approaches

Lesions of cholinergic pedunculopontine tegmental nucleus neurons fail to affect cocaine or heroin self-administration or conditioned place preference in rats.

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Stephan Steidl

Full Text Available 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.

Identifications of Opium and Heroin Body Packing by Medical Imaging in the Poisoned and Non-poisoned Drug Smuggler

International Nuclear Information System (INIS)

Balali-Mood, M.; Zare, G.

2007-01-01

Opium and heroin body packing is a social and health problem in Mashhad since the city is in the vicinity of Afghanistan border. We aimed to compare abdominal X-ray (AXR) and computed tomography (CT) scan for diagnosis. All body packers referred to the center between 2003 and 2006 were hospitalized. Defecation of packets was considered as the gold standard for diagnosis. AXR and CT scan results were classified into 3 groups (highly suggestive, suggestive, and false positive) and compared with each other, using Chi-Square test. A total of 56 body packers (54 M and 2 F) aged 32.1 ± 11.3 years were studied. A mean of 44.4 ± 35.1 opium and 52.0 ± 20.0 heroin packets weighed 8-15 g were retrieved from 46 and 10 patients, respectively. Mean period of hospitalization was 4.7 ± 2.7 and 4.1 ± 0.6 days for opium and heroin packers, respectively. Urine morphine test was positive in 82 percent of the patients. Nine patients underwent surgical operation and death occurred in only 3 opium packers. AXR and CT scan results were significantly different (p less than 0.001) in terms of highly suggestive (16 and 40), suggestive (36 and 1) and false negative (4 and 0), respectively. However, sensitivity of AXR and CT scan in diagnosis of body packing was determined as 92 percent and 100 percent, respectively. Although AXR is a simple and more available technique for the diagnosis of opium and heroin body packing, CT scan revealed more significant sensitive diagnostic tool and should be employed as the confirmatory method.(author)

An evaluation of a heroin overdose prevention and education campaign.

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Horyniak, Danielle; Higgs, Peter; Lewis, Jennifer; Winter, Rebecca; Dietze, Paul; Aitken, Campbell

2010-01-01

Following detection of an upward trend in the frequency of fatal heroin overdoses in Victoria between 2001 and 2003, Victoria's Department of Human Services planned a campaign aimed at increasing injecting drug users' (IDU) awareness of overdose risks and prevention strategies. Stickers, wallet cards and posters featuring five key messages were distributed via needle and syringe programs (NSP) and other drug and alcohol services between November 2005 and April 2006. An evaluation of the campaign was commissioned to be conducted in late 2006. The evaluation consisted of analysis of three independent data sets--quantitative data collected from IDU during the campaign period (n = 855 at baseline; and a range of 146-656 at follow up); qualitative interviews with IDU who were NSP clients during the campaign period (n = 16) and qualitative interviews with NSP staff and other key stakeholders (n = 9). While key experts felt that the campaign messages had engendered lasting impact for at least some IDU, these positive impressions were not borne out by the NSP client data, with less than one quarter of all campaign messages being mentioned by a significantly higher proportion of clients during the post-campaign period compared with baseline. Key experts perceived the greatest weakness of the campaign to be the delay between issue identification and the introduction of campaign materials. While IDU are generally responsive to health promotion campaigns, future initiatives in this domain should be designed and implemented rapidly and in ways that are sufficiently flexible to cope with shifts in drug markets which could influence the reception of key messages.

Heroin and cocaine abusers have higher discount rates for delayed rewards than alcoholics or non-drug-using controls.

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Kirby, Kris N; Petry, Nancy M

2004-04-01

To test a prediction of the discounting model of impulsiveness that discount rates would be positively associated with addiction. The delay-discount rate refers to the rate of reduction in the present value of a future reward as the delay to that reward increases. We estimated participants' discount rates on the basis of their pattern of choices between smaller immediate rewards ($11-80) and larger, delayed rewards ($25-85; at delays from 1 week to 6 months) in a questionnaire format. Participants had a one-in-six chance of winning a reward that they chose on one randomly selected trial. Heroin (n = 27), cocaine (n = 41) and alcohol (n = 33) abusers and non-drug-using controls (n = 44) were recruited from advertisements. They were tested in a drug abuse research clinic at a medical school. On average, the cocaine and heroin groups had higher rates than controls (both P rates for heroin abusers (P = 0.03), but not for cocaine or alcohol abusers (both P > 0.50). These data suggest that discount rates vary with the preferred drug of abuse, and that high discount rates should be considered in the development of substance abuse prevention and treatment efforts.

Beyond WhatsApp: Older people and smartphones

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Andrea Rosales

2016-06-01

Full Text Available This paper analyzes how older people, living in Spain, use smartphones and smartphone applications. Using a mixed methods approach, we compare quantitative results obtained by tracking mobile app usage amongst different generational samples with qualitative, focus-group discussions with active smartphone users. A sample of Spanish smartphone users were tracked during one month in the winter of 2014 (238 individuals, aged 20 to 76 years-old. This was followed by three focus group sessions conducted in the spring of 2015, with 24 individuals aged 55 to 81. As we learned, WhatsApp is currently the most popular application used by people of all ages, including older adults. Smartphones increasingly are playing a central role in the life of older participants, although the frequency of app access is negatively correlated with age. On the other hand, as our data indicates, older adults also use a number of different types of apps that are distinct from that of younger users. Older participants access personal information manager apps (calendar, address book and notes more often than other age groups. And comparatively, older participants use the smartphone less often in stable locations (home, office, relatives’ home with Wifi than somewhere else and with mobile data. As we argue, differences in age seem to reflect the evolution in personal interests and communication patterns that change as we grow older. Our study captures new trends in smartphone usage amongst this cohort. It also indicates how a combination of methods may help to assess the validity of the log and qualitative data. We highlight the relevance of conducting careful generational studies in smartphone use and some of the potentials and limitations of making predictive studies of ICT use as we change throughout the life course. Finally, we assert the value of the inclusion of older representatives within research, which ultimately may influence public decisions and the design of new

Fentanyl and heroin contained in seized illicit drugs and overdose-related deaths in British Columbia, Canada: An observational analysis.

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Baldwin, Nicholas; Gray, Roger; Goel, Anirudh; Wood, Evan; Buxton, Jane A; Rieb, Launette Marie

2018-04-01

Due to the alarming rise in opioid-related overdose deaths, a public health emergency was declared in British Columbia (BC). In this study, we examined the relationship between illicit fentanyl and heroin found in seized drugs and illicit overdose deaths in BC. An observational cross-sectional survey was conducted using BC data from Health Canada's Drug Analysis Service, which analyzes drug samples seized by law enforcement agencies, and non-intentional illicit overdoses from the BC Coroner's Service, from 2000 to 2016. Initial scatter plots and subsequent multivariate regression analysis were performed to describe the potential relationship between seized illicit fentanyl samples and overdose deaths and to determine if this differed from seized heroin and overdose deaths. Fentanyl samples were analyzed for other drug content. Fentanyl is increasingly being found combined with other opioid and non-opioid illicit drugs. Strong positive relationships were found between the number of seized fentanyl samples and total overdose deaths (R2 = 0.97) as well as between seized fentanyl and fentanyl-detected overdose deaths (R2 = 0.99). A positive association was found between the number of seized heroin samples and total overdose deaths (R2 = 0.78). This research contributes to the expanding body of evidence implicating illicit fentanyl use (often combined with heroin or other substances) in overdose deaths in BC. Policy makers and healthcare providers are urged to implement drug treatment and harm reduction strategies for people at risk of overdose associated with current trends in illicit opioid use. Copyright © 2018 Elsevier B.V. All rights reserved.

Biased and less sensitive: A gamified approach to delay discounting in heroin addiction.

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Scherbaum, Stefan; Haber, Paul; Morley, Kirsten; Underhill, Dylan; Moustafa, Ahmed A

2018-03-01

People with addiction will continue to use drugs despite adverse long-term consequences. We hypothesized (a) that this deficit persists during substitution treatment, and (b) that this deficit might be related not only to a desire for immediate gratification, but also to a lower sensitivity for optimal decision making. We investigated how individuals with a history of heroin addiction perform (compared to healthy controls) in a virtual reality delay discounting task. This novel task adds to established measures of delay discounting an assessment of the optimality of decisions, especially in how far decisions are influenced by a general choice bias and/or a reduced sensitivity to the relative value of the two alternative rewards. We used this measure of optimality to apply diffusion model analysis to the behavioral data to analyze the interaction between decision optimality and reaction time. The addiction group consisted of 25 patients with a history of heroin dependency currently participating in a methadone maintenance program; the control group consisted of 25 healthy participants with no history of substance abuse, who were recruited from the Western Sydney community. The patient group demonstrated greater levels of delay discounting compared to the control group, which is broadly in line with previous observations. Diffusion model analysis yielded a reduced sensitivity for the optimality of a decision in the patient group compared to the control group. This reduced sensitivity was reflected in lower rates of information accumulation and higher decision criteria. Increased discounting in individuals with heroin addiction is related not only to a generally increased bias to immediate gratification, but also to reduced sensitivity for the optimality of a decision. This finding is in line with other findings about the sensitivity of addicts in distinguishing optimal from nonoptimal choice options.

THE ROLE OF DEXTROMETHORPHAN IN EIGHT FATAL OVERDOSES: IS IT SOLELY A CUTTING SUBSTANCE FOR HEROIN OR COULD IT BE SOMETHING MORE?

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Francesca Indorato

2015-04-01

Full Text Available The Authors evaluate the role of dextromethorphan as heroin adulterant. From December 2010 through April 2013, in our Laboratory of Forensic Toxicology of University of Catania, eight fatal overdose of heroin cut with dextromethorphan were observed. Our first case (December 2010 was the earliest report in Italy. For these reasons we focused our interest on this cutting substance, studying its pharmacological interaction with the depressive morphine action on central nervous system.

Reception of nutrition information by adult and older adult users of Primary Healthcare: Occurrence, associated factors, and sources of information

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Ivana Loraine LINDEMANN

Full Text Available ABSTRACT Objective: To investigate reception of nutrition information (outcome, associated factors, and types of sources. Methods: This cross-sectional study, conducted in 2013, included 1,246 adult and older adult users of the Primary Healthcare network of Pelotas, Rio Grande do Sul, Brazil. The sample was characterized by reception of nutrition information, its sources, and demographic, socioeconomic, health, knowledge, and life habit variables. Prevalence ratios and their respective 95% confidence intervals investigated associations between reception of nutrition information and independent variables. Results: More than one-third of the sample (37.6% received nutrition information (95%CI=34.9-40.3. Older adults, individuals with positive self-perceived diet, those who received health information, and those who were physically active were more likely to receive nutrition information, and normal weight individuals were less likely. The outcome differed by income strata, being highest in the highest quintile. There was a linear trend for education level and for following the Ten Steps to Healthy Eating: the outcome was more likely in individuals with at least higher education and those who followed at least four steps. The most cited sources of nutrition information were television shows (56.2%, other (46.2%, physician (41.2%, Internet (25.1%, and family members (20.9%, which did not differ by sex. Conclusion: Primary healthcare users received little nutrition information, and television could be a useful tool for the institutions responsible for the sector to disseminate the official nutritional recommendations.

Acute heroin intoxication in a baby chronically exposed to cocaine and heroin: a case report

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Pichini Simona

2011-07-01

Full Text Available Abstract Introduction Acute intoxication with drugs of abuse in children is often only the tip of the iceberg, actually hiding chronic exposure. Analysis using non-conventional matrices such as hair can provide long-term information about exposure to recreational drugs. Case presentation We report the case of a one-month-old Caucasian boy admitted to our pediatric emergency unit with respiratory distress and neurological abnormalities. A routine urine test was positive for opiates, suggesting an acute opiate ingestion. No other drugs of misuse, such as cocaine, cannabis, amphetamines or derivatives, were detected in the baby's urine. Subsequently, hair samples from the baby and the parents were collected to evaluate the possibility of chronic exposure to drug misuse by segmental analysis. Opiates and cocaine metabolites were detected in hair samples from the baby boy and his parents. Conclusions In light of these and previous results, we recommend hair analysis in babies and children from risky environments to detect exposure to heroin and other drug misuse, which could provide the basis for specific social and health interventions.

Sexual dysfunction improved in heroin-dependent men after methadone maintenance treatment in Tianjin, China.

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Minying Zhang

Full Text Available OBJECTIVE: To investigate whether methadone maintenance treatment (MMT is correlated with sexual dysfunction in heroin-dependent men and to determine the prevalence and risk factors of sexual dysfunction among men on MMT. METHODS: The study included a retrospective survey and a cross-sectional survey which contained interviews of 293 men who are currently engaged in MMT. The results of the two surveys were compared. For a subset of 43 participants, radioimmunoassay was additionally conducted using retrospective and prospective blood samples to test the levels of plasma testosterone and luteinizing hormone. Other study evaluations were the International Index of Erectile Function (IIEF-15, and Self-rating Depression Scale. RESULTS: Sexual dysfunction in all five IIEF-15 domains (erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction was strongly associated with long-term use of heroin. A decrease in the severity of sexual dysfunction was associated with MMT initiation. Erectile dysfunction, lack of sexual desire, inability to orgasm, and lack of intercourse satisfaction were significantly correlated with increasing age of the participants. Methadone dose and duration of methadone treatment were not found to be associated with sexual dysfunction. The level of plasma testosterone significantly declined during methadone treatment, but results from multivariate analysis indicated low levels of testosterone were not the main cause of sexual dysfunction. No correlation between reported depression status and sexual function was found. CONCLUSIONS: While high levels of sexual dysfunction were reported by heroin-dependent men in our study before and after MMT initiation, MMT appears to be correlated with improved sexual function in the population of the study.

Electroencephalographic power and coherence analyses suggest altered brain function in abstinent male heroin-dependent patients

NARCIS (Netherlands)

Franken, Ingmar H. A.; Stam, Cornelis J.; Hendriks, Vincent M.; van den Brink, Wim

2004-01-01

Previous studies have shown that drug abuse is associated with altered brain function. However, studies of heroin abuse-related brain dysfunctions are scarce. Electroencephalographic ( EEG) power and coherence analyses are two important tools for examining the effects of drugs on brain function. In

Heroin and methadone prescriptions from a London drug clinic over the first 15 years of operation (1968-1983): old records examined.

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Strang, John; Sheridan, Janie

2006-01-01

We charted changes in the prescriptions issued to opiate addicts in treatment at a London clinic over the first 15 years of operation of one of the new National Health Service (NHS) drug clinics established in 1968. Having located the original handwritten ledger records of prescriptions issued by the drug addict treatment clinic, an SPSS data file was created of the prescriptions given to each of the clinic patients each month over the period 1968-1983 to permit examination of changes over this 15-year period in the drugs prescribed (e.g., heroin, methadone), the form (e.g., injectable or oral), the daily doses, and the extent of multiple items for single patients (e.g., both injectable ampule and oral forms). For each month, a list was available of all current patients detailing which drug(s) they had received during that month, in what form(s) and what dose(s). These items were the basic units of study. We report changes over the 15-year period for which the data were available. For the first 5 years, more than half of the prescriptions were for heroin (diamorphine hydrochloride), with the remainder of the prescriptions mostly comprising oral methadone. After 1973, methadone ampules for injection were increasingly commonly prescribed and thereafter remained at about a quarter of the prescriptions for the remaining 10 years for which data are available, whereas heroin prescriptions declined over the mid-1970s to only 20%. From 1973 onward, oral methadone was increasingly prescribed, rising from approximately one third of prescriptions in the early 1970s to more than two thirds by the early 1980s. Individual patients often received more than one drug or form of drug: From 1969 onward, oral methadone was commonly prescribed as a supplement to heroin prescriptions. This same practice was widespread with prescriptions for methadone ampules prescribed as a supplement to heroin prescriptions. Daily doses of heroin were at a mean of from 160 to 540 mg, in contrast with

Internet Use Among Older Adults: Association With Health Needs, Psychological Capital, and Social Capital

Science.gov (United States)

2013-01-01

Background Previous studies have identified socioeconomic status and health status as predictors of older adults’ computer and Internet use, but researchers have not examined the relationships between older adults’ health needs and psychological capital (emotional well-being and self-efficacy) and social capital (social integration/ties and support networks) to different types of Internet use. Objective This study examined (1) whether older adults’ health conditions and psychological and social capital differentiate Internet users from nonusers, and (2) whether the Internet users differed in their types of Internet use on the basis of their health conditions and psychological and social capital. Methods Data for this study came from the National Health and Aging Trends Study, which is based on a nationally representative sample of US Medicare beneficiaries aged 65 years and older. The sample for this study were those who resided in the community in their own or others’ homes (N=6680). Binary logistic regression analysis was used to compare health needs, psychological capital, and social capital among (1) any type of Internet users and nonusers, (2) Internet users who engaged in health-related tasks and Internet users who did not, (3) Internet users who engaged in shopping/banking tasks and Internet users who did not, and (4) Internet users only used the Internet for email/texting and all other Internet users. Results Depressive and anxiety symptoms, measures of psychological capital, were negatively associated with Internet use among older adults (odds ratio [OR] 0.83, 95% CI 0.70-0.98, P=.03 and OR 0.79, 95% CI 0.65-0.97, P=.03, respectively), whereas most measures of social capital were positively associated with Internet use. Having more chronic medical conditions and engaging in formal volunteering increased the odds of Internet use for health-related tasks by 1.15 (95% CI 1.08-1.23, PInternet use for shopping/banking activities (OR 0.75, 95% CI 0

Internet use among older adults: association with health needs, psychological capital, and social capital.

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Choi, Namkee G; Dinitto, Diana M

2013-05-16

Previous studies have identified socioeconomic status and health status as predictors of older adults' computer and Internet use, but researchers have not examined the relationships between older adults' health needs and psychological capital (emotional well-being and self-efficacy) and social capital (social integration/ties and support networks) to different types of Internet use. This study examined (1) whether older adults' health conditions and psychological and social capital differentiate Internet users from nonusers, and (2) whether the Internet users differed in their types of Internet use on the basis of their health conditions and psychological and social capital. Data for this study came from the National Health and Aging Trends Study, which is based on a nationally representative sample of US Medicare beneficiaries aged 65 years and older. The sample for this study were those who resided in the community in their own or others' homes (N=6680). Binary logistic regression analysis was used to compare health needs, psychological capital, and social capital among (1) any type of Internet users and nonusers, (2) Internet users who engaged in health-related tasks and Internet users who did not, (3) Internet users who engaged in shopping/banking tasks and Internet users who did not, and (4) Internet users only used the Internet for email/texting and all other Internet users. Depressive and anxiety symptoms, measures of psychological capital, were negatively associated with Internet use among older adults (odds ratio [OR] 0.83, 95% CI 0.70-0.98, P=.03 and OR 0.79, 95% CI 0.65-0.97, P=.03, respectively), whereas most measures of social capital were positively associated with Internet use. Having more chronic medical conditions and engaging in formal volunteering increased the odds of Internet use for health-related tasks by 1.15 (95% CI 1.08-1.23, PInternet use for shopping/banking activities (OR 0.75, 95% CI 0.62-0.91, P=.01). Anxiety symptoms increased the

Satisfying Product Features of a Fall Prevention Smartphone App and Potential Users' Willingness to Pay: Web-Based Survey Among Older Adults.

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Rasche, Peter; Mertens, Alexander; Brandl, Christopher; Liu, Shan; Buecking, Benjamin; Bliemel, Christopher; Horst, Klemens; Weber, Christian David; Lichte, Philipp; Knobe, Matthias

2018-03-27

Prohibiting falls and fall-related injuries is a major challenge for health care systems worldwide, as a substantial proportion of falls occur in older adults who are previously known to be either frail or at high risk for falls. Hence, preventive measures are needed to educate and minimize the risk for falls rather than just minimize older adults' fall risk. Health apps have the potential to address this problem, as they enable users to self-assess their individual fall risk. The objective of this study was to identify product features of a fall prevention smartphone app, which increase or decrease users' satisfaction. In addition, willingness to pay (WTP) was assessed to explore how much revenue such an app could generate. A total of 96 participants completed an open self-selected Web-based survey. Participants answered various questions regarding health status, subjective and objective fall risk, and technical readiness. Seventeen predefined product features of a fall prevention smartphone app were evaluated twice: first, according to a functional (product feature is implemented in the app), and subsequently by a dysfunctional (product feature is not implemented in the app) question. On the basis of the combination of answers from these 2 questions, the product feature was assigned to a certain category (must-be, attractive, one-dimensional, indifferent, or questionable product feature). This method is widely used in user-oriented product development and captures users' expectations of a product and how their satisfaction is influenced by the availability of individual product features. Five product features were identified to increase users' acceptance, including (1) a checklist of typical tripping hazards, (2) an emergency guideline in case of a fall, (3) description of exercises and integrated workout plans that decrease the risk of falling, (4) inclusion of a continuous workout program, and (5) cost coverage by health insurer. Participants' WTP was assessed

Pavlovian conditioned approach, extinction, and spontaneous recovery to an audiovisual cue paired with an intravenous heroin infusion.

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Peters, Jamie; De Vries, Taco J

2014-01-01

Novel stimuli paired with exposure to addictive drugs can elicit approach through Pavlovian learning. While such approach behavior, or sign tracking, has been documented for cocaine and alcohol, it has not been shown to occur with opiate drugs like heroin. Most Pavlovian conditioned approach paradigms use an operandum as the sign, so that sign tracking can be easily automated. We were interested in assessing whether approach behavior occurs to an audiovisual cue paired with an intravenous heroin infusion. If so, would this behavior exhibit characteristics of other Pavlovian conditioned behaviors, such as extinction and spontaneous recovery? Rats were repeatedly exposed to an audiovisual cue, similar to that used in standard self-administration models, along with an intravenous heroin infusion. Sign tracking was measured in an automated fashion by analyzing motion pixels within the cue zone during each cue presentation. We were able to observe significant sign tracking after only five pairings of the conditioned stimulus (CS) with the unconditioned stimulus (US). This behavior rapidly extinguished over 2 days, but exhibited pronounced spontaneous recovery 3 weeks later. We conclude that sign tracking measured by these methods exhibits all the characteristics of a classically conditioned behavior. This model can be used to examine the Pavlovian component of drug memories, alone, or in combination with self-administration methods.

Patrones de consumo de heroína en una cárcel de la frontera norte de México: barreras de acceso a tratamiento Heroin consumption patterns in a northern Mexican border prison: obstacles to treatment access

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Patricia Cravioto

2003-06-01

Full Text Available OBJETIVO: Describir la prevalencia del consumo de heroína, los patrones de inicio, el alto consumo y la dependencia a esta sustancia e identificar barreras que impidan a los adictos acudir a tratamiento. MATERIAL Y MÉTODOS: El estudio se realizó en la cárcel de Ciudad Juárez, Chihuahua, México, entre abril y junio de 2000; los participantes se obtuvieron a través de un muestreo aleatorio simple, partiendo del censo del penal. Se identificaron las barreras al tratamiento, estimadas mediante un modelo de regresión logística. RESULTADOS: La prevalencia de consumo de heroína en los últimos seis meses fue de 26.4%; de 25.3% para usuarios fuertes; 95% fueron dependientes. El promedio de la edad de inicio del consumo fue a los 21 años. El modelo multivariado mostró que baja escolaridad, abstinencia, sobredosis, enfermedades crónicas y tiempo de exposición son barreras que impiden solicitar tratamiento. CONCLUSIONES: Las implicaciones de los resultados se discuten en función de aplicarlos para implantar programas de tratamiento en las cárceles.OBJECTIVE: To assess the prevalence of heroin use, patterns of initiation, intense use, and drug-dependency; also, to assess barriers to drug treatment access. MATERIAL AND METHODS: The study was conducted in the Ciudad Juarez, Chihuahua prison. Subjects were selected using simple random sampling from census of prison inmates. Barriers to drug treatment were identified and analyzed using a logistic regression model. RESULTS: The prevalence of heroin use for the last six months was 26.4%; 25.3% were intense heroin users; and 95% showed dependence. The mean age of initiation was 21 years. A multivariate model showed that the significant barriers to drug treatment access were: low education, withdrawal, overdosing, presence of chronic diseases, and duration of heroin use. CONCLUSIONS: Study findings should serve to devise potential applications to establish treatment programs in prisons.

User Experience, Actual Use, and Effectiveness of an Information Communication Technology-Supported Home Exercise Program for Pre-Frail Older Adults

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Marit Dekker-van Weering

2017-11-01

Full Text Available ObjectiveThe main objective of this study was to investigate the use and user experience of an Information Communication Technology-supported home exercise program when offered for independent use to pre-frail older adults. Our secondary aim was to explore whether the program improved quality of life and health status compared to a control group.MethodsA cohort multiple randomized controlled trail is being performed. Physically pre-frail older adults (65–75 years living independently at home were included and randomly assigned to a control group or an intervention group. The intervention group received a home exercise program (strength, balance, and flexibility exercises for a minimal duration of 12 weeks. The control group received usual care. Primary outcomes were: use of the intervention (frequency and duration, adherence to a 3-day exercise protocol and user experience [System Usability Scale (SUS; rating 1–10]. Secondary outcomes were quality of life measured with the SF12 (Physical Component Scale and Mental Component Scale and health status (EQ-5D, assessed before the study starts and after 12 weeks of exercising.ResultsThirty-seven independently living older adults participated in the study. Sixteen participants were allocated to the intervention group and 21 to the control group. The average score on the SUS was 84.2 (±13.3, almost reaching an excellent score. Participants rated the intervention with an 8.5. Eighty percent of the participants finished the 12 week exercise protocol. The adherence to the 3-day exercise protocol was 68%. Participants in the intervention group trained on average 2.2 times (±1.3 each week. The mean duration of login for each exercise session was 24 min. The Mental Component Scale of the SF12 was significantly higher in the intervention group compared to the control group. A trend was seen in the change over time in the health status between groups.ConclusionsThis study provides evidence that a

User Experience, Actual Use, and Effectiveness of an Information Communication Technology-Supported Home Exercise Program for Pre-Frail Older Adults.

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Dekker-van Weering, Marit; Jansen-Kosterink, Stephanie; Frazer, Sanne; Vollenbroek-Hutten, Miriam

2017-01-01

The main objective of this study was to investigate the use and user experience of an Information Communication Technology-supported home exercise program when offered for independent use to pre-frail older adults. Our secondary aim was to explore whether the program improved quality of life and health status compared to a control group. A cohort multiple randomized controlled trail is being performed. Physically pre-frail older adults (65-75 years) living independently at home were included and randomly assigned to a control group or an intervention group. The intervention group received a home exercise program (strength, balance, and flexibility exercises) for a minimal duration of 12 weeks. The control group received usual care. Primary outcomes were: use of the intervention (frequency and duration), adherence to a 3-day exercise protocol and user experience [System Usability Scale (SUS); rating 1-10]. Secondary outcomes were quality of life measured with the SF12 (Physical Component Scale and Mental Component Scale) and health status (EQ-5D), assessed before the study starts and after 12 weeks of exercising. Thirty-seven independently living older adults participated in the study. Sixteen participants were allocated to the intervention group and 21 to the control group. The average score on the SUS was 84.2 (±13.3), almost reaching an excellent score. Participants rated the intervention with an 8.5. Eighty percent of the participants finished the 12 week exercise protocol. The adherence to the 3-day exercise protocol was 68%. Participants in the intervention group trained on average 2.2 times (±1.3) each week. The mean duration of login for each exercise session was 24 min. The Mental Component Scale of the SF12 was significantly higher in the intervention group compared to the control group. A trend was seen in the change over time in the health status between groups. This study provides evidence that a home-based exercise program is easy to use and

'Defeating the dragon' - can we afford not to treat patients with heroin dependence?

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Lize Weich

2010-10-01

Full Text Available A worrying increase in heroin use disorders has been noted in South Africa over recent years. Despite this, very limited treatment options exist in the state sector. This article provides a brief overview of the local extent of the problem and its implications, and discusses treatment options. It briefly investigates international treatment implementation strategies and makes suggestions for local policy.

Depression in the barrio: An analysis of the risk and protective nature of cultural values among Mexican American substance users.

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Villarreal, Yolanda R; Torres, Luis R; Stotts, Angela L; Ren, Yi; Sampson, Mcclain; Klawans, Michelle R; Bordnick, Patrick S

2017-06-07

Understanding the effect of cultural values on depression and how social networks influence these relationships may be important in the treatment of substance-using, Mexican American populations. Latino cultural values, familismo, personalismo, fatalismo, and machismo, may be associated with depression among Latinos. The current study identified the association of traditional Latino values on depressive symptomatology among a sample of Mexican American heroin injectors. A cross-sectional research design and field-intensive outreach methodology were utilized to recruit 227 Mexican American men. Participants were categorized into depressed and nondepressed groups. Relations among cultural values and depression were examined using logistic regression. Findings indicate that drug-using men with higher familismo and fatalismo scores are protected against depressive symptomatology. Relations between familismo and depression seem to be moderated by having a drug use network. In addition, findings reveal that age is inversely related to depressive symptomatology. Young Mexican American heroin users who do not ascribe to traditional Latino values may be highly associated with depression and therefore more vulnerable to riskier drug use behaviors. Moreover, drug-using social networks may affect the protective nature of certain cultural values. Further research is needed to identify whether culturally tailored treatments can cultivate these values while simultaneously undermining the effect of substance-using social networks in order to reduce depression symptoms among this group of high-risk substance users.

Personality characters of heroin addict%海洛因依赖者的人格特征

Institute of Scientific and Technical Information of China (English)

卢秀琼

2005-01-01

BACKGROUND: Heroin addict induces severe physical and mental health problem himself/herself and to family members.OBJECTIVE: To analyze personality characters of heroin addict so as to propose corresponding treating measures and improve operative efficiency of detoxification.DESIGN: Sampling investigation.SETTING: Xiamen Xianyue Hospital.PARTICIPANTS: Totally 38 male heroin addicts received withdrawal treatment voluntarily and were selected in the investigation in Xiamen Xianyue Hospital from October 1995 to May 1997. Fifty cases were selected as normal control from the staffs and family members of two units in Xiamen.METHODS:"Minnesota multiphasic personality inventory (MMPI)" [including 10 clinical scales, hypochondriasis (Hs), depression (D), hysteria (Hy), morbid personality (Pd), masculinization/feminization (Mf), paranoia (Pa), psychasthenia (Pt), schizophrenia (Sc), hypomania (Ma) and social interior (Si)] was used for the test of heroin addicts in 3 days after admitted and the tested results were compared with MMPI results in normal control MAIN OUTCOME MEASURES: Comparison of primary scales in MMPI in heroin addicts and normal people.RESULTS: The data of 38 heroin addicts and 50 cases in normal control were all in result analysis, without dropped out case. Compared with normal control, the scales of Hs, Pd, Pa, Pt, Sc and Ma were higher remarkably in heroin addict group (14.44±1.68, 8.91±3.90; 22.89±1.75, 18.31±4.18;14.42±1.56, 12.23±3.15; 26.86±1.79, 17.32±5.12; 33.00±2.63, 22.71±3.72;21.25±1.23, 17.65±4.28), and Mf scale was lower remarkably (23.08±1.69,27.60±3.42).CONCLUSION: Heroin addicts present obviously physical discomfort and tendency of hypochondriasis, paranoid personality character and tendency of individual attack and appear obvious personality character of abnormality and psychological changes

A case report: Pavlovian conditioning as a risk factor of heroin 'overdose' death

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Bácskai Erika

2005-07-01

Full Text Available 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.

Leisure activities among older Germans - a qualitative study.

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Boggatz, Thomas

2013-05-01

Leisure activities contribute to well-being and health in old age. Community nurses should consequently promote such activities among older persons. To do so they need an understanding of older persons' interest in leisure activities. Social contacts, volunteering and pursuit of hobbies and interests constitute the main aspects of leisure. This study aimed to determine the attitudes of older Germans to these aspects to identify user types of leisure time facilities. A qualitative study was conducted within a community-based project in an industrial town in West Germany. Data were collected with semi-structured guideline interviews and evaluated with qualitative content analysis according to Mayring. With regard to social contacts attitudes ranged from limited need for contacts to being a reliable member in an older persons' club. Social engagement is only found among the latter. Pursuit of hobbies and interest ranged from being a minimal user of leisure time facilities to refined expectations. Inflexible group structures may prevent potential users from participation despite having a programme in accordance with target group needs. Attitudes to leisure activities can be described as a combination of two dimensions: the degree of social involvement and the desired refinement of hobbies and interest. Community nurses who organise social afternoons need to assess these attitudes and should steer social dynamics of in a way that facilitates access for newcomers. © 2012 Blackwell Publishing Ltd.

How to find non-dependent opiate users: a comparison of sampling methods in a field study of opium and heroin users

NARCIS (Netherlands)

Korf, D.J.; van Ginkel, P.; Benschop, A.

2010-01-01

Background/aim The first aim is to better understand the potentials and limitations of different sampling methods for reaching a specific, rarely studied population of drug users and for persuading them to take part in a multidisciplinary study. The second is to determine the extent to which these

The alterations of immunological reactivity in heroin addicts and their normalization in patients maintained on methadone

Czech Academy of Sciences Publication Activity Database

Zajícová, Alena; Wilczek, H.; Holáň, Vladimír

2004-01-01

Roč. 50, - (2004), s. 24-28 ISSN 0015-5500 R&D Projects: GA MZd NF6824; GA MZd NJ6632 Institutional research plan: CEZ:AV0Z5052915 Keywords : heroin, cytokines, proliferation Subject RIV: EC - Immunology Impact factor: 0.507, year: 2004

Older adults' motivated choice for technological innovation: Evidence for benefit-driven selectivity

NARCIS (Netherlands)

Melenhorst, Anne-Sophie; Rogers, Wendy A.; Bouwhuis, Don G.

2006-01-01

This study examined older adults' motivation to adopt technological innovation. Sixty-eight older e-mail users and nonusers discussed the use of e-mail and of traditional communication methods in 18 focus groups. The results show older adults' benefit-driven approach to new communication technology.

Older adults motivated choice for technological innovation: evidence for benefit-driven selectivity

NARCIS (Netherlands)

Melenhorst, A.S.; Rogers, W.A.; Bouwhuis, D.G.

2006-01-01

This study examined older adults' motivation to adopt technological innovation. Sixty-eight older e-mail users and nonusers discussed the use of e-mail and of traditional communication methods in 18 focus groups. The results show older adults' benefit-driven approach to new communication technology.

From Heroes and Heroines to Hermaphrodites: Emasculation or Emancipation of School Leaders and Leadership?

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Sugrue, Ciaran

2009-01-01

In the fast paced, fluid contemporary world, and in a headlong rush to invent the future, there is a tendency to jettison aspects of the past as flotsam and jetsam, unworthy of a place in steerage into the future. This paper argues that is some respects the ordinary heroes and heroines who enact school leaderships, and from their practice…

Four-wheeled walker related injuries in older adults in the Netherlands.

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van Riel, K M M; Hartholt, K A; Panneman, M J M; Patka, P; van Beeck, E F; van der Cammen, T J M

2014-02-01

With ageing populations worldwide, mobility devices are used more than ever. In the current literature there is no consensus whether the available mobility devices safely improve the mobility of their users. Also, evidence is lacking concerning the risks and types of injuries sustained while using a four-wheeled walker. To assess injury risks and injury patterns in older adults (≥65 years) who presented at Emergency Departments (ED) in the Netherlands with an injury due to using a four-wheeled walker. In this study, the Dutch Injury Surveillance System was used to obtain a national representative sample of annual ED visits in the Netherlands in the adult population (≥65 years) sustaining an injury while using a four-wheeled walker. The numbers of four-wheeled walker users in the Netherlands were obtained from the national insurance board. The numbers of ED visits were divided by the numbers of four-wheeled walker users to calculate age- and sex-specific injury risks. Annually 1869 older adults visited an ED after sustaining an injury while using a four-wheeled walker. Falls were the main cause of injury (96%). The injury risk was 3.1 per 100 users of four-wheeled walkers. Women (3.5 per 100 users) had a higher risk than men (2.0 per 100 users). Injury risk was the highest in women aged 85 years and older (6.2 per 100 users). The majority of injuries were fractures (60%) with hip fracture (25%) being the most common injury. Nearly half of all four-wheeled walker related injuries required hospitalisation, mostly due to hip fractures. Healthcare costs per injury were approximately €12 000. This study presents evidence that older adults experiencing a fall while using a four-wheeled walker are at high risk to suffer severe injuries.

A single-nucleotide polymorphism of GRIN1 in heroin and methamphetamine addicts at a rehabilitation sanatorium in Markazi province, Iran

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Ahmad Hamta

2017-03-01

Full Text Available Introduction: Using addictive drugs can change the amount of neurotransmitters, especially dopamine and glutamate. Glutamate has been known to trigger the relapse and tendency toward addictive drugs. The glutamate receptor ionotropic NMDA type subunit 1 (GRIN1 contains the single- nucleotide polymorphism C1001G (rs11146020 and encodes N-methyl-D-aspartic acid (NDMA receptor subunit 1 (NR1. The present study was conducted to investigate the relationship between the rs11146020 polymorphism in GRIN1 and addiction to heroin and methamphetamine. Methods: The present case-control study recruited 90 male heroin and methamphetamine addicts treated with methadone and 100 healthy men. Genomic DNA was extracted from peripheral blood using Iraizol kits. Four pairs of specific primers were designed using AlleleID 7.5, and the T-ARMS PCR was optimized. Results: The genotype distribution of GG, GC and CC was respectively found to be 66%, 31% and 3% in the control group and 58%, 31% and 11% in the patient group. The statistical analysis suggested no significant differences between these two groups. Conclusion: No significant relationships were observed between the C1001G polymorphism in GRIN1 and addiction to heroin and methamphetamine.

Feasibility study of an attention training application for older adults.

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Hill, Nikki L; Mogle, Jacqueline; Colancecco, Elise; Dick, Robert; Hannan, John; Lin, Feng Vankee

2015-09-01

Technology-based attention training has demonstrated promise in its potential to improve cognitive functioning in older people. Developing mobile applications, with older users specifically in mind, may support future dissemination of these interventions and integration into daily life. The purpose of this pilot study was to test the feasibility of an Attention Training Application (ATA) for community-dwelling older adults using mobile technology. A descriptive, mixed-methods design was used to capture older adults' feedback on the usability and acceptability of the ATA. A convenience sample of older adults (n = 9) from two independent living facilities participated in a 2-hour training and practice session with the ATA. Participants were given personally tailored instructions for using the mobile device and the ATA specifically. Following a practice session, participants provided ratings on multiple components of the ATA and completed an audio-recorded, semi-structured interview to provide detailed descriptions of their experience and perceptions. An iterative process of content analysis was used to characterise the open-ended responses. Participants rated the ATA favourably overall on several 0-10 scales including likeability [8.5 (1.6)], interest [8.8 (2.3)] and satisfaction [8.2 (1.9)]. The qualitative analyses revealed several issues relevant to the feasibility of the ATA among older people including the importance of the technological background of the user, limiting negative feedback, challenges with the touch screen interface, personal preferences for challenge, extending the practice period and the difficulty of the dual-task condition. The use of the ATA is feasible in the older adult population. Future development should specifically consider personal characteristics as well as preferences to maximise usability and acceptability among older people. Older adults enjoyed the ATA. This opens doors to user-friendly technological interventions that may be

Post-Vietnam heroin use and injection by returning US veterans: clues to preventing injection today

Czech Academy of Sciences Publication Activity Database

Robins, L. N.; Slobodyan, Sergey

2003-01-01

Roč. 98, č. 8 (2003), s. 1053-1060 ISSN 0965-2140 Institutional research plan: CEZ:AV0Z7085904 Keywords : heroin * injection * Vietnam Subject RIV: AN - Psychology Impact factor: 3.241, year: 2003 http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=10316019&site=ehost-live

Co-occurring Attention Deficit Hyperactivity Disorder symptoms in adults affected by heroin dependence: Patients characteristics and treatment needs.

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Lugoboni, Fabio; Levin, Frances Rudnick; Pieri, Maria Chiara; Manfredini, Matteo; Zamboni, Lorenzo; Somaini, Lorenzo; Gerra, Gilberto; Gruppo InterSert Collaborazione Scientifica Gics

2017-04-01

Attention Deficit Hyperactivity Disorder (ADHD) is a risk for substance use disorders. The aim of this study was to investigate the association between adult ADHD symptoms, opioid use disorder, life dysfunction and co-occurring psychiatric symptoms. 1057 heroin dependent patients on opioid substitution treatment participated in the survey. All patients were screened for adult ADHD symptoms using the Adult ADHD Self-Report Scale (ASRS-v1.1). 19.4% of the patients screened positive for concurrent adult ADHD symptoms status and heroin dependence. Education level was lower among patients with ADHD symptoms, but not significant with respect to non-ADHD patients. Patients with greater ADHD symptoms severity were less likely to be employed. A positive association was observed between ADHD symptoms status and psychiatric symptoms. Patients with ADHD symptoms status were more likely to be smokers. Patients on methadone had a higher rate of ADHD symptoms status compared to buprenorphine. Those individuals prescribed psychoactive drugs were more likely to have ADHD symptoms. In conclusion, high rate of ADHD symptoms was found among heroin dependent patients, particularly those affected by the most severe form of addiction. These individuals had higher rates of unemployment, other co-morbid mental health conditions, heavy tobacco smoking. Additional psychopharmacological interventions targeting ADHD symptoms, other than opioid substitution, is a public health need. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

CE-MS analysis of heroin and its basic impurities using a charged polymer-protected gold nanoparticle-coated capillary.

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Zhang, Zhengxiang; Yan, Bo; Liu, Kelin; Liao, Yiping; Liu, Huwei

2009-01-01

The first application of charged polymer-protected gold nanoparticles (Au NPs) as semi-permanent capillary coating in CE-MS was presented. Poly(diallyldimethylammonium chloride) (PDDA) was the only reducing and stabilizing agent for Au NPs preparation. Stable and repeatable coating with good tolerance to 0.1 M HCl, methanol, and ACN was obtained via a simple rinsing procedure. Au NPs enhanced the coating stability toward flushing by methanol, improved the run-to-run and capillary-to-capillary repeatabilities, and improved the separation efficiency of heroin and its basic impurities for tracing geographical origins of illicit samples. Baseline resolution of eight heroin-related alkaloids was achieved on the PDDA-protected Au NPs-coated capillary under the optimum conditions: 120 mM ammonium acetate (pH 5.2) with addition of 13% methanol, separation temperature 20 degrees C, applied voltage -20 kV, and capillary effective length 60.0 cm. CE-MS analysis with run-to-run RSDs (n=5) of migration time in the range of 0.43-0.62% and RSDs (n=5) of peak area in the range of 1.49-4.68% was obtained. The established CE-MS method would offer sensitive detection and confident identification of heroin and related compounds and provide an alternative to LC-MS and GC-MS for illicit drug control.

Stroke And Substance Abuse

OpenAIRE

A Chitsaz

2017-01-01

Introduction: stroke in recreational substance users can be an indirect complication, like endocarditis and cardio embolism in parenteral drug users. With some drug like cocaine, stroke appear to be the result of a direct effect. In young subjects without other risk factors provide persuasive evidence for causality . OPIATES: Heroine is the most abused opiate drug, which is administered by injection, by snorting or by smoking. Stroke affects heroin users by diverse mechanisms,. Injec...

The Force Awakens: The Individualistic and Contemporary Heroine

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Payal Doctor

2017-12-01

Full Text Available Star Wars Episode VII: The Force Awakens is not the hero’s journey as George Lucas previously conceptualized it. Instead, the story line of The Force Awakens leads me to believe that it creates a new iteration of the hero myth. It follows the contemporary heroine’s journey while conforming to the essential construct of the hero monomyth. First, the contemporary heroine’s journey focuses primarily on the greater good and secondarily on her own personal journey, which is the converse of the traditional hero’s journey. Second, the contemporary heroine’s self is awakened and called to adventure in a different way than the traditional hero. Third, the traditional hero receives guidance on his journey, while the contemporary heroine pushes ahead alone, striving to save her society from despair.

Mast cell mediator tryptase levels after inhalation or intravenous administration of high doses pharmaceutically prepared heroin

NARCIS (Netherlands)

Rook, E. J.; van Zanten, A. P.; van den Brink, W.; van Ree, J. M.; Beijnen, J. H.

2006-01-01

BACKGROUND: Opioids like morphine and heroin induce mast cell degranulation in vitro. The release of mast cell mediators like histamine and tryptase may lead to allergic symptoms. In this study it was investigated whether mast cell mediator release also occurs in vivo in addicted patients who

Serotonergic dysfunction in addiction: effects of alcohol, cigarette smoking and heroin on platelet 5-HT content.

Science.gov (United States)

Schmidt, L G; Dufeu, P; Heinz, A; Kuhn, S; Rommelspacher, H

1997-10-10

The impact of ethanol, cigarette smoking and heroin on serotonin function was evaluated, first in alcoholics during chronic ethanol intoxication and in opiate addicts after long-term heroin consumption, and secondly in both patient groups after detoxification treatment (i.e. a short-term abstinence of 8 days). Our results showed that the 5-hydroxytryptamine (5-HT) content in platelets was: (1) increased in the subgroup of anti-social alcoholics; (2) transiently and differently altered in alcoholics compared to opiate addicts; and (3) lowered in drinking alcoholics and normal in alcoholics who were drinking as well as smoking (that may occur via MAO-B inhibition by smoke). The findings indicate that alterations of the peripheral and possibly the central serotonin system may occur as predisposing factors for alcoholism in individuals with anti-social traits; they may also have some impact on the progression of alcoholism due to its lowered function during chronic ethanol intoxication that is substantially modified by smoking.

Adherence and Persistence Among Statin Users Aged 65 Years and Over: A Systematic Review and Meta-analysis.

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Ofori-Asenso, Richard; Jakhu, Avtar; Zomer, Ella; Curtis, Andrea J; Korhonen, Maarit Jaana; Nelson, Mark; Gambhir, Manoj; Tonkin, Andrew; Liew, Danny; Zoungas, Sophia

2018-05-09

Older people (aged ≥ 65 years) have distinctive challenges with medication adherence. However, adherence and persistence patterns among older statin users have not been comprehensively reviewed. As part of a broader systematic review, we searched Medline, Embase, PsycINFO, CINAHL, Database of Abstracts of Reviews of Effects, CENTRAL, and the National Health Service Economic Evaluation Database through December 2016 for English articles reporting adherence and/or persistence among older statin users. Data were analyzed via descriptive methods and meta-analysis using random-effect modeling. Data from more than 3 million older statin users in 82 studies conducted in over 40 countries were analyzed. At 1-year follow-up, 59.7% (primary prevention 47.9%; secondary prevention 62.3%) of users were adherent (medication possession ratio [MPR] or proportion of days covered [PDC] ≥ 80%). For both primary and secondary prevention subjects, 1-year adherence was worse among individuals aged more than 75 years than those aged 65-75 years. At 3 and ≥10 years, 55.3% and 28.4% of users were adherent, respectively. The proportion of users persistent at 1-year was 76.7% (primary prevention 76.0%; secondary prevention 82.6%). Additionally, 68.1% and 61.2% of users were persistent at 2 and 4 years, respectively. Among new statin users, 48.2% were nonadherent and 23.9% discontinued within the first year. The proportion of statin users who were adherent based on self-report was 85.5%. There is poor short and long term adherence and persistence among older statin users. Strategies to improve adherence and reduce discontinuation are needed if the intended cardiovascular benefits of statin treatment are to be realized.

Stroke And Substance Abuse

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A Chitsaz

2017-02-01

Full Text Available Introduction: stroke in recreational substance users can be an indirect complication, like endocarditis and cardio embolism in parenteral drug users. With some drug like cocaine, stroke appear to be the result of a direct effect. In young subjects without other risk factors provide persuasive evidence for causality . OPIATES: Heroine is the most abused opiate drug, which is administered by injection, by snorting or by smoking. Stroke affects heroin users by diverse mechanisms,. Injectors are at risk of infections endocarditis, which carries risk for both ischemic and hemorrhagic stroke. Cerebral or subarachnoid hemorrhage usually occurs after rupture of a septic (mycotic aneurysm. Heroine users can are also at risk for hemorrhagic stroke secondary to liver failure with deranged clotting and to heroin nephropathy with uremia or malignant hypertension. In some heroin users the drug it self is directly causal due to vasculitis, hypersensitivity and immunologic changes. Embolization of foreign material to brain due to mixed of heroine with quinine can cause cerebral embolism. AMPHETAMINE AND other psychostimulants: In abuser of amphetamine hemorrhagic stroke can occur, oral, intravenous, nasal, and inhalational routes of administration have been reported. Most were chronic user, but in several patients, stroke followed a first exposure. Some of amphetamine induced intracranial hemorrhages are secondary to acute hypertension, some to cerebral vacuities, and some to a combination of two. Decongestants and diet pills: Phenylpropanolamine (PPA, an amphetamine – like drug, in decongestants and diet pills, induce acute hypertension, sever headache, psychiatric symptoms, seizures and hemorrhagic stroke. Ephedrine and pseudo ephedrine are present in decongestants and bronchodilators and induce headache, tachyarrhythmia, hypertensive emergency, and hemorrhagic and occlusive stroke. Ecstasy, 3,4 Methylenedioxymethamphetamin (MDMA with amphetamine like can

Overdose prevention for injection drug users: lessons learned from naloxone training and distribution programs in New York City.

Science.gov (United States)

Piper, Tinka Markham; Rudenstine, Sasha; Stancliff, Sharon; Sherman, Susan; Nandi, Vijay; Clear, Allan; Galea, Sandro

2007-01-25

Fatal heroin overdose is a significant cause of mortality for injection drug users (IDUs). Many of these deaths are preventable because opiate overdoses can be quickly and safely reversed through the injection of Naloxone [brand name Narcan], a prescription drug used to revive persons who have overdosed on heroin or other opioids. Currently, in several cities in the United States, drug users are being trained in naloxone administration and given naloxone for immediate and successful reversals of opiate overdoses. There has been very little formal description of the challenges faced in the development and implementation of large-scale IDU naloxone administration training and distribution programs and the lessons learned during this process. During a one year period, over 1,000 participants were trained in SKOOP (Skills and Knowledge on Opiate Prevention) and received a prescription for naloxone by a medical doctor on site at a syringe exchange program (SEP) in New York City. Participants in SKOOP were over the age of 18, current participants of SEPs, and current or former drug users. We present details about program design and lessons learned during the development and implementation of SKOOP. Lessons learned described in the manuscript are collectively articulated by the evaluators and implementers of the project. There were six primary challenges and lessons learned in developing, implementing, and evaluating SKOOP. These include a) political climate surrounding naloxone distribution; b) extant prescription drug laws; c) initial low levels of recruitment into the program; d) development of participant appropriate training methodology; e) challenges in the design of a suitable formal evaluation; and f) evolution of program response to naloxone. Other naloxone distribution programs may anticipate similar challenges to SKOOP and we identify mechanisms to address them. Strategies include being flexible in program planning and implementation, developing evaluation

The digital health divide: evaluating online health information access and use among older adults.

Science.gov (United States)

Hall, Amanda K; Bernhardt, Jay M; Dodd, Virginia; Vollrath, Morgan W

2015-04-01

Innovations in health information technology (HIT) provide opportunities to reduce health care spending, improve quality of care, and improve health outcomes for older adults. However, concerns relating to older adults' limited access and use of HIT, including use of the Internet for health information, fuel the digital health divide debate. This study evaluated the potential digital health divide in relation to characteristic and belief differences between older adult users and nonusers of online health information sources. A cross-sectional survey design was conducted using a random sample of older adults. A total of 225 older adults (age range = 50-92 years, M = 68.9 years, SD = 10.4) participated in the study. Seventy-six percent of all respondents had Internet access. Users and nonusers of online health information differed significantly on age (M = 66.29 vs. M = 71.13), education, and previous experience with the health care system. Users and nonusers of online health information also differed significantly on Internet and technology access, however, a large percentage of nonusers had Internet access (56.3%), desktop computers (55.9%), and laptop computers or netbooks (43.2%). Users of online health information had higher mean scores on the Computer Self-Efficacy Measure than nonusers, t(159) = -7.29, p information. Findings suggest strategies for reducing this divide and implications for health education programs to promote HIT use among older adults. © 2014 Society for Public Health Education.

Injection and Non-Injection Drug Use and Infectious Disease in Baltimore City: Differences by Race

Science.gov (United States)

Keen, Larry; Khan, Maria; Clifford, Lisa; Harrell, Paul T.; Latimer, William W.

2014-01-01

Purpose The current study examines differences in the prevalence of biologically-confirmed hepatitis C virus (HCV), HIV, and coinfection between Black and White adult cocaine/heroin users across three drug use subgroups identified in previous research (Harrell et al, 2012): non-injection smoking crack/nasal heroin users, heroin injectors, and polydrug injectors. Results 59% of the 482 participants in the study were male. Significant race differences emerged between drug use subgroup memberships. Non-injection smoking crack/nasal heroin users were predominantly Black (75%), while heroin injectors and polydrug injectors were predominantly White (69% and 72%, respectively). Polydrug injectors accounted for nearly three quarters of the HCV positive diagnoses in Whites. Though HIV disease status, stratified by race, did not differ significantly between drug use subgroups, the non-injection smoking crack/nasal heroin subgroup contained over half of the HIV positive diagnoses in the sample and was predominantly Black. Despite much lower rates of injection, Blacks (8%) had a higher prevalence of coinfection than Whites (3%; X2 (2) = 6.18, p = .015). Conclusions The current findings are consistent with trends in recent HIV transmission statistics where sexual activity has overtaken injection drug use as a HIV risk factor. The current findings also provide further support to the notion of injection drug use as an exceedingly high-risk behavior for HCV and coinfection, specifically those who are polysubstance injectors. PMID:24837755

A Case Report of Acute Esotropia in a Young Woman following Heroin Withdrawal

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Bethel Shiferaw

2015-01-01

Full Text Available Introduction. Esotropia is a form of strabismus that can give the affected individual a “cross-eyed” appearance. Acute onset of esotropia is an uncommon form; in the vast majority of cases, no underlying neurological etiology is found. Case Presentation. A 22-year-old female with a long history of opiate abuse presented with acute onset of diplopia. She noted her eyes were crossing and started seeing double. She stopped using heroin 11 days prior to presentation. There was large inward deviation of her left eye. Convergence was difficult and accompanied by horizontal nystagmus. Diplopia resolved by covering each eye. Further investigations including imaging studies were normal. Discussion. Acute onset esotropia is rare and must be investigated right away to exclude central nervous system pathologies, where no opiates use is reported. Diplopia in the form of acute esotropia may manifest in up to 30% of individuals undergoing heroin withdrawal. Evaluating acute esotropia requires detailed information of medical history with an emphasis on drug use. Conclusion. Acute onset esotropia with double vision can be caused by abrupt withdrawal of opiates. This case should serve to raise awareness among health care professionals, to avoid costly and unnecessary diagnostic evaluations and interventions.

Action coordination and resource allocation against user profiles

DEFF Research Database (Denmark)

Valente, Pedro Ricardo da Nova

Ageing is a natural evolution among all living things, part of the life cycle, well known by everyone. World-wide population is being older, as a result of all social-financial aspects, leaving modern societies with less active citizens and increasing older population, which demands more focus...... into welfare politics. Having this reality in mind, influenced by the natural evolution of human care dependency over time, technologies can fit in this gap, as not replacing care staff shortage, but helping them to have more time for Human interactive activities. This thesis research is one attempt towards...... approach design, we studied user behaviours when engaging in daily-life activities, in a nursing home environment, relating users with activity definition, and following System context-awareness challenges. Two system approaches were deployed, one focus on understanding users behaviours (action), based...

Drug problems in contemporary China: a profile of Chinese drug users in a metropolitan area.

Science.gov (United States)

Huang, Kaicheng; Zhang, Lening; Liu, Jianhong

2011-03-01

Drug problems are reemerging in China since the nation implemented economic reform and an "open door" policy in the early 1980s. This is causing both national and international concern. However, knowledge and understanding of the Chinese drug problem is fairly limited because of the nation's unique social and political history. In response to this shortage of information, our study presents a profile of Chinese drug users. Data were collected from a survey of drug users attending mandatory treatment centres in a large city in 2009. We present a demographic profile of the drug users, describe their patterns of drug use, their access to drugs and their history of drug treatment. Chinese drug users, like those from the U.S., are likely to be unemployed and have a low level of education. However, they are more likely than those in the U.S. to use heroin, Bingdu (methamphetamine) and Maguo (a derivative of methamphetamine), and they pay less for their drugs. This profile of drug users is informative and valuable for drug prevention, intervention, and treatment in the Chinese setting because knowing and understanding the drug population is essential for effective control. Copyright © 2010 Elsevier B.V. All rights reserved.

Assisting the older driver : intersection design and in-car devices to improve the safety of the older driver. Proefschrift Rijksuniversiteit Groningen RUG, Groningen.

NARCIS (Netherlands)

Davidse, R.J.

2007-01-01

In this thesis, the main focus was on assistive devices that may improve and prolong the safe mobility of older drivers. Older drivers form a group of road users that is getting more and more attention in road safety research and policy. An important reason for this growing interest is the increase

[Application of hair analysis of selected psychoactive substances for medico-legal purposes. Part II. Cases of complex fatal poisonings: interactions of heroine - cocaine - amphetamines].

Science.gov (United States)

Rojek, Sebastian; Kłys, Małgorzata; Rzepecka-Woźniak, Ewa; Konopka, Tomasz

2010-01-01

The study represents an attempt at employing segmental hair analysis in complex poisonings with xenobiotic mixtures of heroine - cocaine - amphetamines in the context of the cause of death as a consequence of complex interaction mechanisms which occurred prior to death. Two cases of complex poisonings: heroine - cocaine and heroine - cocaine - amphetamines were analyzed and documented with macro- and microscopic examinations and complex toxicological examinations, including the analysis of classic biological material, i.e. samples of selective blood, and alternative material, i.e. hair samples. Determinations of opioids, cocaine and its metabolite and amphetamines in the hair biological matrix were performed using high performance liquid chromatography--atmospheric pressure chemical ionization--tandem mass spectrometry (HPLC-APCI-MS-MS). Segmental hair analysis of the investigated cases indicated a prolonged intake of similar psychoactive substances and a developed adaptation of the addicted to interaction mechanisms, which, however, led gradually to multiorgan anatomopathological changes, and in consequence to death.

Patrones de consumo de heroína en una muestra de consumidores de Medellín - Colombia Patterns of heroin use in a sample of consumers in Medellín - Colombia

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Guillermo Alonso Castaño Pérez

2012-09-01

una realidad emergente en Colombia. Es necesario ahondar en estudios cuanti-cualitativos que nos permitan conocer y comprender más este fenómeno con el fin de disminuir su impacto en la salud pública.INTRODUCTION: In Colombia, there are no specific studies on the prevalence of heroin use. This paper reviews the patterns of substance use in a consumer group in the city of Medellín and its metropolitan area, showing that consumption is becoming a threat to public health due to the particular forms of consumption, among which risk practices are included. OBJECTIVE: To evaluate the use of heroin in the city of Medellín and its metropolitan area. METHODS: The study took a mixed approach using multiple-case study to cover each of the variables and categories proposed; 42 heroin users of treatment centers in the city of Medellín and its metropolitan area were accessed between July and September 2008, using the "snowball", technique. Information was collected by a structured, face to face interview, asking about the type of heroin consumed, routes of administration, frequency of consumption, equipment used, consumption practices and rituals that accompany these practices. Quantitative data were analyzed using the EPI-Info statistical package 2,000 and Atlas ti qualitative, version 5.5, for Windows. RESULTS: Consumers were predominantly male, single, aged between 18 and 23 years, childless and many had not completed college. Most respondents were in the middle socioeconomic stratum, had a family history of psychoactive substance use and had started heroin use between 15 and 17 years. There are special forms to name heroine, consumers, and rituals to consume the substance. The article gives details of the heroin consumed, the paraphernalia and associated practices. CONCLUSIONS: The use of heroin is an emerging reality in Colombia. Qualitative-quantitative studies are necessary to allow us to acknowledge and understand more about this phenomenon in order to decrease the

Kappa opioid receptor antagonism and chronic antidepressant treatment have beneficial activities on social interactions and grooming deficits during heroin abstinence.

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Lalanne, L; Ayranci, G; Filliol, D; Gavériaux-Ruff, C; Befort, K; Kieffer, B L; Lutz, P-E

2017-07-01

Addiction is a chronic brain disorder that progressively invades all aspects of personal life. Accordingly, addiction to opiates severely impairs interpersonal relationships, and the resulting social isolation strongly contributes to the severity and chronicity of the disease. Uncovering new therapeutic strategies that address this aspect of addiction is therefore of great clinical relevance. We recently established a mouse model of heroin addiction in which, following chronic heroin exposure, 'abstinent' mice progressively develop a strong and long-lasting social avoidance phenotype. Here, we explored and compared the efficacy of two pharmacological interventions in this mouse model. Because clinical studies indicate some efficacy of antidepressants on emotional dysfunction associated with addiction, we first used a chronic 4-week treatment with the serotonergic antidepressant fluoxetine, as a reference. In addition, considering prodepressant effects recently associated with kappa opioid receptor signaling, we also investigated the kappa opioid receptor antagonist norbinaltorphimine (norBNI). Finally, we assessed whether fluoxetine and norBNI could reverse abstinence-induced social avoidance after it has established. Altogether, our results show that two interspaced norBNI administrations are sufficient both to prevent and to reverse social impairment in heroin abstinent animals. Therefore, kappa opioid receptor antagonism may represent a useful approach to alleviate social dysfunction in addicted individuals. © 2016 Society for the Study of Addiction.

Homeless drug users' awareness and risk perception of peer "Take Home Naloxone" use – a qualitative study

Science.gov (United States)

Wright, Nat; Oldham, Nicola; Francis, Katharine; Jones, Lesley

2006-01-01

Background Peer use of take home naloxone has the potential to reduce drug related deaths. There appears to be a paucity of research amongst homeless drug users on the topic. This study explores the acceptability and potential risk of peer use of naloxone amongst homeless drug users. From the findings the most feasible model for future treatment provision is suggested. Methods In depth face-to-face interviews conducted in one primary care centre and two voluntary organisation centres providing services to homeless drug users in a large UK cosmopolitan city. Interviews recorded, transcribed and analysed thematically by framework techniques. Results Homeless people recognise signs of a heroin overdose and many are prepared to take responsibility to give naloxone, providing prior training and support is provided. Previous reports of the theoretical potential for abuse and malicious use may have been overplayed. Conclusion There is insufficient evidence to recommend providing "over the counter" take home naloxone" to UK homeless injecting drug users. However a programme of peer use of take home naloxone amongst homeless drug users could be feasible providing prior training is provided. Peer education within a health promotion framework will optimise success as current professionally led health promotion initiatives are failing to have a positive impact amongst homeless drug users. PMID:17014725

Homeless drug users' awareness and risk perception of peer "Take Home Naloxone" use – a qualitative study

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Oldham Nicola

2006-10-01

Full Text Available Abstract Background Peer use of take home naloxone has the potential to reduce drug related deaths. There appears to be a paucity of research amongst homeless drug users on the topic. This study explores the acceptability and potential risk of peer use of naloxone amongst homeless drug users. From the findings the most feasible model for future treatment provision is suggested. Methods In depth face-to-face interviews conducted in one primary care centre and two voluntary organisation centres providing services to homeless drug users in a large UK cosmopolitan city. Interviews recorded, transcribed and analysed thematically by framework techniques. Results Homeless people recognise signs of a heroin overdose and many are prepared to take responsibility to give naloxone, providing prior training and support is provided. Previous reports of the theoretical potential for abuse and malicious use may have been overplayed. Conclusion There is insufficient evidence to recommend providing "over the counter" take home naloxone" to UK homeless injecting drug users. However a programme of peer use of take home naloxone amongst homeless drug users could be feasible providing prior training is provided. Peer education within a health promotion framework will optimise success as current professionally led health promotion initiatives are failing to have a positive impact amongst homeless drug users.

The phenomenological experience of dementia and user interface development

DEFF Research Database (Denmark)

Peterson, Carrie Beth; Mitseva, Anelia; Mihovska, Albena D.

2009-01-01

This study follows the project ISISEMD through a phenomenological approach of investigating the experience of the Human Computer Interaction (HCI) for someone with dementia. The aim is to accentuate the Assistive Technology (AT) from the end user perspective. It proposes that older adults and those...... with dementia should no longer be an overlooked population, and how the HCI community can learn from their experiences to develop methods and design interfaces which truly benefit these individuals. Guidelines from previous research are incorporated along with eclectic, user-centered strategies as the interface...... designers for ISISEMD develop an appropriate and effective modality. The paper outlines the interconnected difficulties associated with the characteristics of older adults with mild dementia, which are important to be considered when introducing AT to that group of end users. It further presents clear...

Pavlovian conditioned approach, extinction, and spontaneous recovery to an audiovisual cue paired with an intravenous heroin infusion

NARCIS (Netherlands)

Peters, J.; de Vries, T.J.

2014-01-01

Rationale: Novel stimuli paired with exposure to addictive drugs can elicit approach through Pavlovian learning. While such approach behavior, or sign tracking, has been documented for cocaine and alcohol, it has not been shown to occur with opiate drugs like heroin. Most Pavlovian conditioned

Correlates of illicit methadone use in New York City: A cross-sectional study

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Frye Victoria

2008-10-01

Full Text Available Abstract Background Despite growing concern about illicit methadone use in the US and other countries, there is little data about the prevalence and correlates of methadone use in large urban areas. We assessed the prevalence and examined correlates of lifetime and recent illicit methadone use in New York City (NYC. Methods 1,415 heroin, crack, and cocaine users aged 15–40 years were recruited in NYC between 2000 and 2004 to complete interviewer-administered questionnaires. Results In multivariable logistic regression, non-injection drug users who used illicit methadone were more likely to be heroin dependent, less than daily methamphetamine users and to have a heroin using sex partner in the last two months. Injection drug users who used illicit methadone were more likely to use heroin daily, share injection paraphernalia and less likely to have been in a detoxification program and to have not used marijuana in the last six months. Conclusion The results overall suggest that illicit (or street methadone use is likely not a primary drug of choice, but is instead more common in concert with other illicit drug use.

Physical and Leisure Activity in Older Community-Dwelling Canadians Who Use Wheelchairs: A Population Study

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Krista L. Best

2011-01-01

Full Text Available Background. Physical and leisure activities are proven health promotion modalities and have not been examined in older wheelchair users. Main Objectives. Examine physical and leisure activity in older wheelchair users and explore associations between wheelchair use and participation in physical and leisure activity, and wheelchair use, physical and leisure activity, and perceived health. Methods. 8301 Canadians ≥60 years of age were selected from the Canadian Community Health Survey. Sociodemographic, health-related, mobility-related, and physical and leisure activity variables were analysed using logistic regression to determine, the likelihood of participation in physical and leisure activity, and whether participation in physical and leisure activities mediates the relationship between wheelchair use and perceived health. Results. 8.3% and 41.3% older wheelchair users were physically and leisurely active. Wheelchair use was a risk factor for reduced participation in physical (OR=44.71 and leisure activity (OR=10.83. Wheelchair use was a risk factor for poor perceived health (OR=10.56 and physical and leisure activity negatively mediated the relationship between wheelchair user and perceived health. Conclusion. There is a need for the development of suitable physical and leisure activity interventions for older wheelchair users. Participation in such interventions may have associations with health benefits.

Physical and leisure activity in older community-dwelling canadians who use wheelchairs: a population study.

Science.gov (United States)

Best, Krista L; Miller, William C

2011-04-13

Background. Physical and leisure activities are proven health promotion modalities and have not been examined in older wheelchair users. Main Objectives. Examine physical and leisure activity in older wheelchair users and explore associations between wheelchair use and participation in physical and leisure activity, and wheelchair use, physical and leisure activity, and perceived health. Methods. 8301 Canadians ≥60 years of age were selected from the Canadian Community Health Survey. Sociodemographic, health-related, mobility-related, and physical and leisure activity variables were analysed using logistic regression to determine, the likelihood of participation in physical and leisure activity, and whether participation in physical and leisure activities mediates the relationship between wheelchair use and perceived health. Results. 8.3% and 41.3% older wheelchair users were physically and leisurely active. Wheelchair use was a risk factor for reduced participation in physical (OR = 44.71) and leisure activity (OR = 10.83). Wheelchair use was a risk factor for poor perceived health (OR = 10.56) and physical and leisure activity negatively mediated the relationship between wheelchair user and perceived health. Conclusion. There is a need for the development of suitable physical and leisure activity interventions for older wheelchair users. Participation in such interventions may have associations with health benefits.

Human-Centered Design Study: Enhancing the Usability of a Mobile Phone App in an Integrated Falls Risk Detection System for Use by Older Adult Users.

Science.gov (United States)

Harte, Richard; Quinlan, Leo R; Glynn, Liam; Rodríguez-Molinero, Alejandro; Baker, Paul Ma; Scharf, Thomas; ÓLaighin, Gearóid

2017-05-30

according to the NASA Task Load Index (NASA-TLX). From our observation of older adults' interactions with smartphone interfaces, there were some recurring themes. Clear and relevant feedback as the user attempts to complete a task is critical. Feedback should include pop-ups, sound tones, color or texture changes, or icon changes to indicate that a function has been completed successfully, such as for the connection sequence. For text feedback, clear and unambiguous language should be used so as not to create anxiety, particularly when it comes to saving data. Warning tones or symbols, such as caution symbols or shrill tones, should only be used if absolutely necessary. Our HCD methodology, designed and implemented based on the principles of the International Standard Organizaton (ISO) 9241-210 standard, produced a functional app interface within a short production cycle, which is now suitable for use by older adults in long term clinical trials. ©Richard Harte, Leo R Quinlan, Liam Glynn, Alejandro Rodríguez-Molinero, Paul MA Baker, Thomas Scharf, Gearóid ÓLaighin. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 30.05.2017.

Adulterants and diluents in heroin, amphetamine, and cocaine found on the illicit drug market in Aarhus, Denmark

DEFF Research Database (Denmark)

Andreasen, Mette Findal; Lindholst, Christian; Kaa, Elisabet

2009-01-01

of adulterants and diluents present in the drugs. Results are compared with a similar study conducted ten years earlier. The concentrations of the active substances in illicit heroin, amphetamine, and cocaine samples have decreased significantly over a 10-year period. This finding shows that the "cutting...

Young-Elderly Travellers as Potential Users and Actual Users of Internet with Mobile Devices During Trips

OpenAIRE

Eriksson , Niklas; Fabricius , Susanna

2015-01-01

Part 2: Adoption; International audience; The population is rapidly ageing in countries such as Finland. However, little research has been conducted to better understand older travellers’ use of Internet and mobile devices. This qualitative study aims at exploring young-elderly (aged 60–75) travellers as potential users and actual users of the Internet with mobile device during trips. The results identify a range of possible drivers and barriers for the use of Internet with mobile devices and...

Game preferences and personality of older adult users

NARCIS (Netherlands)

de Vette, Anna Frederiek Alberdien; Tabak, Monique; Vollenbroek-Hutten, Miriam Marie Rosé; Hermens, Hermanus J.

2015-01-01

To improve engagement needed for long-term adherence to telemedicine services for elderly users, we need methods to design effective and tailored gamification. This study explores the relation between personality (based on the Five Factor Model) and game preference (based on the Five Domains of Play

Web-Based, Pictograph-Formatted Discharge Instructions for Low-Literacy Older Adults After Hip Replacement Surgery: Findings of End-User Evaluation of the Website.

Science.gov (United States)

Choi, Jeungok; Jacelon, Cynthia S; Kalmakis, Karen A

The purpose of this study was to develop web-based, pictograph-formatted discharge instructions and evaluate the website with intended users to maximize the relevance and clarity of the website. A descriptive study. Low-literacy text and 45 sets of pictographs were implemented in web-based instructions. The content, design, function, and navigation of the website were reviewed by 15 low-literate older adults following hip replacement surgery. Participants observed that the simple line drawings with clear background were well suited to web pages and helped to convey the points made. They also suggested changes such as adding an additional alphabetical index menu to enhance easy navigation and removing hypertext links to avoid distraction. Web-based, pictograph-formatted discharge instructions were well received by low-literate older adults, who perceived the website easy to use and understand. A pictograph-formatted approach may provide effective strategies to promote understanding of lengthy, complex action-based discharge instructions in rehabilitation facilities.

[Anesthetic Care of Patient With Heroin Addiction: A Case Report].

Science.gov (United States)

Lee, Wen-Yi; Kuo, Shu-Yu

2018-04-01

The use of illegal drugs in Taiwan is on the rise. Drug addicts often have complex physical, psychological, and social problems. In addition, they often avoid disclosing their illicit drug use by deceit, concealment, or under-reporting. Building and maintaining relationships of trust with drug-addict patients has become a critical issue in achieving better care quality. In this case report, we report on an anesthesia care process for a heroin addict who was admitted for open reduction and internal fixation surgery for the femur and patella fractures after a car accident. During the six-hour perioperative care period, starting from 11pm on November 30th to 5am on December 1st, 2015, the patient was not willing to disclose his illicit drug use before the surgery. However, the nurse anesthetist noticed signs and symptoms of drug use. The nurse empathized with the patient's worries, provided him with a safe communication environment, and gained trust from the patient in a timely manner, which then enabled the patient to fully disclose his illicit drug use with the nurse anesthetist. The anesthesia-care strategy was then modified according to client's condition. The nurse anesthetist played an important role of bridging communications between the patient and medical care staffs and of modifying the care strategies in a timely manner. During the care period, the blood-borne disease contamination was successfully prevented, the client received uneventful pain management, there was a lack of withdrawal symptoms, and the staffs and patient safety was maintained. The literature on the anesthetic care of heroin patients undergoing surgery is relatively limited in Taiwan. The findings in the current case report add information on providing anesthetic care to patients with drug addiction. Publishing additional case reports, research, and clinical recommendations is essential for improving care quality for this vulnerable population.

Syncope and QT prolongation among patients treated with methadone for heroin dependence in the city of Copenhagen

DEFF Research Database (Denmark)

Fanoe, Søren; Hvidt, C; Ege, P

2007-01-01

were collected in a population of adult heroin addicts treated with methadone or buprenorphine on a daily basis. Of the patients at the Drug Addiction Service in the municipal of Copenhagen, 450 ( 52%) were included. The QT interval was estimated from 12 lead ECGs. All participants were interviewed...

Validity of the EQ-5D as a generic health outcome instrument in a heroin-dependent population

NARCIS (Netherlands)

van der Zanden, Bart P.; Dijkgraaf, Marcel G. W.; Blanken, Peter; de Borgie, Corianne A. J. M.; van Ree, Jan M.; van den Brink, Wim

2006-01-01

OBJECTIVE: To evaluate the validity of the EuroQol (EQ-5D) in a population of chronic, treatment-resistant heroin-dependent patients. METHODS: The EQ-5D is studied relative to the Maudsley Addiction Profile (MAP), the Symptom Checklist (SCL-90) and the European Addiction Severity Index (EuropASI)

A behavioral typology of opioid overdose risk behaviors among recent veterans in New York City.

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Alex S Bennett

Full Text Available To identify meaningful classes of opioid-using military veterans in terms of self-reported opioid overdose risk behaviors.The study recruited a sample of 218 military veterans in the NYC area who were discharged from active duty service after September 11, 2001 and reported past-month opioid use. Survey data including measures of mental health, social stressors, substance use, and opioid-related overdose risk behaviors were analyzed using Latent Class Analysis (LCA.A five group solution had excellent fit scores and interpretability. Factor analysis confirmed the existence of two major dimensions of variation: non-adherence and heroin use. The five groups included lower-risk prescription opioid users, non-adherent prescription opioid users and heroin users. The non-adherent prescription opioid users and heroin user classes were both further subdivided into "occasional" and "regular" use categories. In addition to endorsing a greater number of overdose risk behaviors, users in the regular use classes were more likely to screen positive for alcohol and substance use disorders, reported greater self-medicating opioid use to relieve anxiety, reported greater problems with physical pain, were more likely to have had mental health, alcohol and drug treatment, and were less likely to be employed or in school. Heroin users also were less likely to report stable housing.Findings indicate that opioid overdose risk classes are grounded in contextual factors related to experiences of psychological, physiological, and social adjustment pain and distress which should be addressed in tailored interventions targeting opioid users' unique constellations of risk behaviors and comorbid conditions.

Proteomic Analysis of Saliva in HIV-positive Heroin Addicts Reveals Proteins Correlated with Cognition

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Dominy, Stephen; Brown, Joseph N.; Ryder, Mark I.; Gritsenko, Marina A.; Jacobs, Jon M.; Smith, Richard D.

2014-04-01

The prevalence of HIV-associated neurocognitive disorders (HAND) remains high despite effective antiretroviral therapies. Multiple etiologies have been proposed over the last few 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+) and 11 -negative (HIV-) heroin addicts. In the HIV+ group, 58 proteins were identified that show significant correlations with cognitive scores and that implicate disruption of protein quality control pathways by HIV. Notably, no proteins from the HIV- heroin addict cohort showed significant correlations with cognitive scores. 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.

Elevated Hair Cortisol Levels among Heroin Addicts on Current Methadone Maintenance Compared to Controls.

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Jin Yang

Full Text Available Whether methadone maintenance treatment (MMT can improve the basal function of the hypothalamic-pituitary-adrenal (HPA axis, which is suppressed by long-term heroin consumption, is a matter of debate. The stress state and depression and anxiety symptoms may affect the basal activity of the HPA axis in MMT patients. However, the effect of psychological factors on HPA activity was not simultaneously controlled in previous studies. This study investigated differences in HPA basal activity between MMT patients and controls using psychological variables as covariates. The participants included 52 MMT patients and 41 age-matched, non-heroin-dependent controls. Psychological states were self-reported with the Perceived Stress Scale, Self-Rating Depression Scale and Self-Rating Anxiety Scale. The hair cortisol level was adopted as a biomarker of HPA basal activity and was determined with liquid chromatography tandem mass spectrometry. The results revealed that MMT patients had significantly higher hair cortisol levels than the controls (p0.05 when the perceived stress, depression and anxiety scores were used as covariates. We concluded that patients with long-term MMT showed higher basal activity of the HPA axis. The high chronic stress state and increase in depression and anxiety symptoms may mask the suppression effect of methadone on the HPA activity.

Engaging older people with participatory design

NARCIS (Netherlands)

Iacono, I.; Marti, P.

2014-01-01

We present a design case focusing on participatory design (PD) with older people. We experimented with PD techniques to foster engagement with participants in development of a graphical user interface (GUI) for controlling a robotic system in a smart home environment. The tenet of our approach is

Association between statin use and physical function among community-dwelling older Japanese adults.

Science.gov (United States)

Kawai, Hisashi; Ihara, Kazushige; Kera, Takeshi; Hirano, Hirohiko; Fujiwara, Yoshinori; Tanaka, Masashi; Kojima, Motonaga; Obuchi, Shuichi

2018-04-01

Statin-associated muscle symptoms (SAMS) are the muscle-related side-effects of statins, but the association between statin use and physical function among community-dwelling older adults is unclear. The objective of the present study was to examine the association between statin use and physical function among community-dwelling older Japanese adults by considering the risk factors of statin-associated muscle symptoms. The participants were 1022 community-dwelling older adults aged 65-88 years, who participated in comprehensive health checkups from 2013 to 2015. Statin use in the participants (381 men and 559 women) was verified by using data from their medicine notebooks. The differences between statin use (users and non-users) and physical functions (grip strength, knee extension torque, normal and maximum gait speed, Timed Up & Go test, one-legged stance, quadriceps muscle thickness and echo intensity) were analyzed using the t-test. Multiple regression analyses were also carried out to examine the association between statin use and physical function. A total of 93 men (24.4%) and 154 women (27.5%) were statin users. Grip strength, normal gait speed and one-legged stance declined significantly in statin users compared with the non-users. In multiple regression analysis while controlling for the risk factors of statin-associated muscle symptoms, including age, sex, body mass index and number of medicines, no independent association, between statin use and the reduction of physical functions, was observed. Statin use was not associated with the decline of physical function in community-dwelling older Japanese adults. Geriatr Gerontol Int 2018; 18: 623-630. © 2017 Japan Geriatrics Society.

Transportation use in community-dwelling older adults: association with participation and leisure activities.

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Dahan-Oliel, Noémi; Mazer, Barbara; Gélinas, Isabelle; Dobbs, Bonnie; Lefebvre, Hélène

2010-12-01

This article presents a study that compared participation by elderly individuals living in the community according to primary transportation mode used, and estimated the association between transportation, personal factors, and environmental factors. Participants included 90 adults aged 65 and older (M=76.3 years; SD=7.7). They were classified according to their primary transportation mode: driver, passenger, public transport user, walk, or adapted transport/taxi user. Participation was measured with the Craig Handicap Assessment and Reporting Technique (CHART) and the Nottingham Leisure Questionnaire (NLQ). Overall, results indicated that drivers, public transport users, and walkers had higher participation levels compared to passengers and adapted transport/taxi users. This study suggests that clinicians should consider older adults' use of transportation in an attempt to encourage and maximize their participation.

Perceptions and Use of Technology to Support Older Adults with Multimorbidity.

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Murphy, Emma; Doyle, Julie; Hannigan, Caoimhe; Smith, Suzanne; Kuiper, Janneke; Jacobs, An; Hoogerwerf, Evert-Jan; Desideri, Lorenzo; Fiordelmondo, Valentina; Maluccelli, Lorenza; Brady, Anne-Marie; Dinsmore, John

2017-01-01

Digital technologies hold great potential to improve and advance home based integrated care for older people living with multiple chronic health conditions. In this paper, we present the results of a user requirement study for a planned digital integrated care system, based on the experiences and needs of key stakeholders. We present rich, multi-stakeholder, qualitative data on the perceptions and use of technology among older people with multiple chronic health conditions and their key support actors. We have outlined our future work for the design of the system, which will involve continuous stakeholder engagement through a user-centred co-design method.

High anxiety is a predisposing endophenotype for loss of control over cocaine, but not heroin, self-administration in rats

DEFF Research Database (Denmark)

Dilleen, Ruth; Pelloux, Yann; Mar, Adam C

2012-01-01

RATIONALE: Although high anxiety is commonly associated with drug addiction, its causal role in this disorder is unclear. OBJECTIVES: In light of strong evidence for dissociable neural mechanisms underlying heroin and cocaine addiction, the present study investigated whether high anxiety predicts...

The current status of opioid maintenance treatment in France: a survey of physicians, patients, and out-of-treatment opioid users

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Benyamina A

2014-09-01

Full Text Available Amine Benyamina National Institute for Medical Research (INSERM U-669, Hôpital Universitaire Paul Brousse, 94804 Villejuif, France Aim: Project Access France was a national survey designed to provide real-world observations on the status of opioid dependence treatment in France. Methods: The views of physicians (n=100, patients (n=130, and out-of-treatment opioid users (n=33 were collected via interviews and questionnaires. Results: Physicians reported being moderately satisfied with treatment programs in their area (rating 6.9 out of 10. Most physicians (82% reported being concerned about misuse and diversion of medication-assisted treatment (MAT medications and 50% identified psychosocial/behavioral counseling as the key change that would most improve patient care. Among patients, the mean number of previous MAT episodes was low (1.5; 78% reported that it was easy to access a doctor to undergo MAT; 14% reported regularly or sometimes using heroin; misuse and diversion were reported in 15% and 39% of patients, respectively; and 57% of patients were not receiving psychosocial help. Out-of-treatment opioid users reported using drugs on a regular basis (42% regularly used heroin and cited 'not wanting to give up drugs completely' as the most frequent reason for staying out of MAT. Conclusion: This survey highlights a number of positive features of the open-access, GP-based treatment model for opioid dependence in France. Challenges remain with regard to continued misuse/diversion of MAT medications and limited patient access to psychosocial support. Keywords: opioid maintenance treatment, medication-assisted treatment, buprenorphine, methadone, buprenorphine–naloxone, France

1HMR spectroscopy and diffusion tensor technology in heroin-induced brain damage

International Nuclear Information System (INIS)

Li Min; Liu Shuyong; Geng Daoying

2008-01-01

Objective: To study the values of 1 HMRS and DTI technology for detecting brain damage in heroin-dependent patients. Methods: The routine MRI, 1 HMRS and DTI were performed in 7 heroin abusers and 8 healthy volunteers without the history of drug abuse. The regions of interest (ROI) were selected in the gray matter and white matter of prefrontal lobe in 1HMRS exam, and the ratio of NAA/ Cr, Cho/Cr and Cho/NAA were measured respectively. For the DTI, six ROIs were selected, and the values of fractional anisotropy (FA) and ADC were calculated respectively. The independent samples t test was used for the statistics. Results: No abnormality was found in the routine MRI. The ratio of NAA/Cr decreased in the prefrontal lobe, the values were 1.40 + 0. 16 in gray matter and 1.72 + 0.41 in white matter of the drug group, 1.57±0.09 and 2.08±0.21 in the control group on 1 HMRS examiation. The difference between the two groups had statistical significance (t = 2. 183, 2.190, P -4 , (7.54±0.22) x 10 -4 , (7.72±0.30) x 10 -4 , and (7.50±0.26) x 10 -4 , (7.15±0.20) x 10 -4 , (7.19±0.39) x 10 -4 mm 2 /s in control group respectively. The difference between the two groups had statistical significance (t=3.477, 3.507, 2.895, P 1 HMRS and DTI. (authors)

Hypnosis for pain management in the older adult.

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Cuellar, Norma G

2005-09-01

Pain is a physical, emotional and psychologic phenomenon that is often ignored in older adults causing depression and poor quality of life. Older adults report the use of complementary and alternative medicine in some form with 80% of these users reporting improvement in their health conditions. Although physical pain in the older adult is usually managed with pharmacologic interventions, methods that may reduce the use of prescription drugs may decrease adverse effects that can compromise the physiologic state of the older adult. Hypnosis has continued to gain acceptance within mainstream medicine as an appropriate treatment and can be integrated safely with conventional medicine as an effective treatment for a variety of conditions in the older adult. It is an intervention that can be used for relaxation and pain control, especially when conventional pharmacologic regimens have failed. The purpose of this article is to review the concepts related to pain in older adults; the use of complementary and alternative medicine in the older adult; hypnosis and the older adult (i.e., background, definition, benefits, research, mechanism of action, hypnotizability, and the process); and the implications of using hypnosis for pain management in the older adult.

Older Adults' Use of Online and Offline Sources of Health Information and Constructs of Reliance and Self-Efficacy for Medical Decision Making.

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Hall, Amanda K; Bernhardt, Jay M; Dodd, Virginia

2015-01-01

We know little about older adults' use of online and offline health information sources for medical decision making despite increasing numbers of older adults who report using the Internet for health information to aid in patient-provider communication and medical decision making. Therefore we investigated older adult users and nonusers of online and offline sources of health information and factors related to medical decision making. Survey research was conducted using random digit dialing of Florida residents' landline telephones. The Decision Self-Efficacy Scale and the Reliance Scale were used to measure relationships between users and nonusers of online health information. Study respondents were 225 older adults (age range = 50-92 years, M = 68.9, SD = 10.4), which included users (n = 105) and nonusers (n = 119) of online health information. Users and nonusers differed in frequency and types of health sources sought. Users of online health information preferred a self-reliant approach and nonusers of online health information preferred a physician-reliant approach to involvement in medical decisions on the Reliance Scale. This study found significant differences between older adult users and nonusers of online and offline sources of health information and examined factors related to online health information engagement for medical decision making.

The effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care (AESOPS – A randomised control trial protocol

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Morton Veronica

2008-06-01

Full Text Available Abstract Background There is a wealth of evidence regarding the detrimental impact of excessive alcohol consumption. In older populations excessive alcohol consumption is associated with increased risk of coronary heart disease, hypertension, stroke and a range of cancers. Alcohol consumption is also associated with an increased risk of falls, early onset of dementia and other cognitive deficits. Physiological changes that occur as part of the ageing process mean that older people experience alcohol related problems at lower consumption levels. There is a strong evidence base for the effectiveness of brief psychosocial interventions in reducing alcohol consumption in populations identified opportunistically in primary care settings. Stepped care interventions involve the delivery of more intensive interventions only to those in the population who fail to respond to less intensive interventions and provide a potentially resource efficient means of meeting the needs of this population. Methods/design The study design is a pragmatic prospective multi-centre two arm randomised controlled trial. The primary hypothesis is that stepped care interventions for older hazardous alcohol users reduce alcohol consumption compared with a minimal intervention at 12 months post randomisation. Potential participants are identified using the AUDIT questionnaire. Eligible and consenting participants are randomised with equal probability to either a minimal intervention or a three step treatment approach. The step treatment approach incorporates as step 1 behavioural change counselling, step 2 three sessions of motivational enhancement therapy and step 3 referral to specialist services. The primary outcome is measured using average standard drinks per day and secondary outcome measures include the Drinking Problems Index, health related quality of life and health utility. The study incorporates a comprehensive economic analysis to assess the relative cost

Wheeled-mobility correlates of life-space and social participation in adult manual wheelchair users aged 50 and older.

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Sakakibara, Brodie M; Routhier, François; Miller, William C

2017-08-01

To characterize the life-space mobility and social participation of manual wheelchair users using objective measures of wheeled mobility. Individuals (n = 49) were included in this cross-sectional study if they were aged 50 or older, community-dwelling and used their wheelchair on a daily basis for the past 6 months. Life-space mobility and social participation were measured using the life-space assessment and late-life disability instrument. The wheeled mobility variables (distance travelled, occupancy time, number of bouts) were captured using a custom-built data logger. After controlling for age and sex, multivariate regression analyses revealed that the wheeled mobility variables accounted for 24% of the life-space variance. The number of bouts variable, however, did not account for any appreciable variance above and beyond the occupancy time and distance travelled. Occupancy time and number of bouts were significant predictors of social participation and accounted for 23% of the variance after controlling for age and sex. Occupancy time and distance travelled are statistically significant predictors of life-space mobility. Lower occupancy time may be an indicative of travel to more distant life-spaces, whereas the distance travelled is likely a better reflection of mobility within each life-space. Occupancy time and number of bouts are significant predictors of participation frequency. Implications for rehabilitation Component measures of wheelchair mobility, such as distance travelled, occupancy time and number of bouts, are important predictors of life-space mobility and social participation in adult manual wheelchair users. Lower occupancy time is an indication of travel to more distant life-spaces, whereas distance travelled is likely a better reflection of mobility within each life-space. That lower occupancy time and greater number of bouts are associated with more frequent participation raises accessibility and safety issues for manual wheelchair

Designing for an imagined user: Provision for thermal comfort in energy-efficient extra-care housing

International Nuclear Information System (INIS)

Lewis, Alan

2015-01-01

Regarded as one solution to the problem of how to enable older people to retain their independence, extra-care housing, where each resident has their own self-contained dwelling and access to communal facilities and to care, has received extensive funding in recent years. Implicit in the concept of specialist housing is the notion of ‘special’ occupants, imagined older people. Adopting a socio-technical approach, this paper considers how ideas about ageing inform those aspects of extra-care-housing-design that relate to thermal comfort. The paper draws on semi-structured interviews with 13 people involved in the design, development and management of UK-based extra-care housing. Participants characterised imagined occupants as vulnerable to cold, at risk from fuel poverty and liable to be burned by hot surfaces or fall from high windows. These user representations were reportedly inscribed into the design of extra-care housing schemes through the inclusion of building features such as communal heating, under-floor heating, restricted window opening and heated corridors. The utilisation of stereotypical user representations of older people raises questions, given that older people's thermal comfort needs can be highly diverse. The paper explores the implications for energy demand. -- Highlights: •Explores the factors that condition energy demand in older people's housing. •Considers how user representations are scripted into building design. •Older occupants characterised as vulnerable to cold and having low incomes. •These user representations affect selection of thermal technologies. •Priority given to keeping occupants warm, leading to possible risk of overheating

Self-administration of cocaine, cannabis and heroin in the human laboratory: benefits and pitfalls

OpenAIRE

Haney, Margaret

2008-01-01

The objective of this review is to describe self-administration procedures for modeling addiction to cocaine, cannabis and heroin in the human laboratory, the benefits and pitfalls of the approach, and the methodological issues unique to each drug. In addition, the predictive validity of the model for testing treatment medications will be addressed. The results show that all three drugs of abuse are reliably and robustly self-administered by non-treatment-seeking research volunteers. In terms...

Effect of Sirtuin-1 on Synaptic Plasticity in Nucleus Accumbens in a Rat Model of Heroin Addiction.

Science.gov (United States)

Xia, Baijuan; Li, Yixin; Li, Rongrong; Yin, Dan; Chen, Xingqiang; Li, Jie; Liang, Wenmei

2018-06-05

BACKGROUND Synaptic plasticity plays an important role in the process of addiction. This study investigated the relationship between synaptic plasticity and changes in addictive behavior and examined the expression of synaptic plasticity-associated proteins and genes in the nucleus accumbens (NAc) region in different rat models. MATERIAL AND METHODS Heroin addiction, SIRT1-overexpression, and SIRT1-silenced rat models were established. Polymerase chain reaction gene chip technology, immunohistochemistry, Western blotting, and transmission electron microscopy were used to detect changes in synaptic plasticity-related gene and protein expression, and changes in the ultrastructure of synapses, in the NAc. RESULTS Naloxone withdrawal symptoms appeared in the SIRT1-overexpression group. In the SIRT1-silenced group the symptoms were reduced. Immunohistochemistry and Western blotting results showed that FOXO1 expression decreased in the heroin addiction (HA) group but increased in the SIRT1-silenced group (paddiction. SIRT1 overexpression can increase behavioral sensitization in the NAc of rats, and SIRT1 silencing might ease withdrawal symptoms and reduce conditioned place preferences.

Report on the first government-funded opioid substitution programme for heroin users in the Western Cape Province, South Africa.

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Michie, Graeme; Hoosain, Shuaib; Macharia, Muiruri; Weich, Lize

2017-05-24

Although pharmacological opioid substitution treatment (OST) is a well-established treatment modality for heroin addiction, it is a relatively recent introduction in low- and middle-income countries. To report on a pilot OST programme initiated in 2013 that was the only public-funded programme in South Africa (SA) at the time. Participants were offered standard care only (n=68) or, for the OST group (n=67), standard care plus Suboxone (Reckitt Benckiser), a synthetic partial opioid agonist, in a 12-week clinician-monitored programme. Clinical records of 135 participants in the rehabilitation programme at Sultan Bahu Rehabilitation Centre in Mitchell's Plain, Cape Town, SA, from 1 January to 31 December 2014 were reviewed. Data collected included demographics and duration in treatment (retention) as well as number of urine samples provided, positive tests or self-reported use events and dates of first positive/negative tests. Significantly more participants in the OST group (65.7%) than controls (44.1%) completed the treatment (p=0.019). Among the non-completers, retention was higher in the OST group than in the standard care group (48.2 v. 30.1 days; p=0.001). The groups did not differ in respect of number of missed appointments and time to first positive test. However, the proportion of participants testing positive was higher in the OST group (80.6%) than in the standard care group (61.8%), although the former were tested nearly three times (18.3 v. 6.6 times) more. Consequently, the positive rate (proportion of positive tests) was substantially lower in the OST group (16.8%) than in the standard care group (23.3%). The results demonstrate modest success of this pilot OST programme in terms of completion and retention and should argue for a move to increase availability of and accessibility to OSTs for the management of opioid use disorder.

Increases in Doublecortin Immunoreactivity in the Dentate Gyrus following Extinction of Heroin-Seeking Behavior

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Megan P. Hicks

2012-01-01

Full Text Available Adult-generated neurons in the dentate gyrus (DG of the hippocampus play a role in various forms of learning and memory. However, adult born neurons in the DG, while still at an immature stage, exhibit unique electrophysiological properties and are also functionally implicated in learning and memory processes. We investigated the effects of extinction of drug-seeking behavior on the formation of immature neurons in the DG as assessed by quantification of doublecortin (DCX immunoreactivity. Rats were allowed to self-administer heroin (0.03 mg/kg/infusion for 12 days and then subjected either to 10 days of extinction training or forced abstinence. We also examined extinction responding patterns following heroin self-administration in glial fibrillary acidic protein thymidine kinase (GFAP-tk transgenic mice, which have been previously demonstrated to show reduced formation of immature and mature neurons in the DG following treatment with ganciclovir (GCV. We found that extinction training increased DCX immunoreactivity in the dorsal DG as compared with animals undergoing forced abstinence, and that GCV-treated GFAP-tk mice displayed impaired extinction learning as compared to saline-treated mice. Our results suggest that extinction of drug-seeking behavior increases the formation of immature neurons in the DG and that these neurons may play a functional role in extinction learning.

Overdose prevention for injection drug users: Lessons learned from naloxone training and distribution programs in New York City

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Nandi Vijay

2007-01-01

Full Text Available Abstract Background Fatal heroin overdose is a significant cause of mortality for injection drug users (IDUs. Many of these deaths are preventable because opiate overdoses can be quickly and safely reversed through the injection of Naloxone [brand name Narcan], a prescription drug used to revive persons who have overdosed on heroin or other opioids. Currently, in several cities in the United States, drug users are being trained in naloxone administration and given naloxone for immediate and successful reversals of opiate overdoses. There has been very little formal description of the challenges faced in the development and implementation of large-scale IDU naloxone administration training and distribution programs and the lessons learned during this process. Methods During a one year period, over 1,000 participants were trained in SKOOP (Skills and Knowledge on Opiate Prevention and received a prescription for naloxone by a medical doctor on site at a syringe exchange program (SEP in New York City. Participants in SKOOP were over the age of 18, current participants of SEPs, and current or former drug users. We present details about program design and lessons learned during the development and implementation of SKOOP. Lessons learned described in the manuscript are collectively articulated by the evaluators and implementers of the project. Results There were six primary challenges and lessons learned in developing, implementing, and evaluating SKOOP. These include a political climate surrounding naloxone distribution; b extant prescription drug laws; c initial low levels of recruitment into the program; d development of participant appropriate training methodology; e challenges in the design of a suitable formal evaluation; and f evolution of program response to naloxone. Conclusion Other naloxone distribution programs may anticipate similar challenges to SKOOP and we identify mechanisms to address them. Strategies include being flexible in

An Analysis of the Heroine of North and South---Margaret Hale as an Independent Woman

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Ping Wang

2017-11-01

Full Text Available Mrs. Gaskell is a very important woman writer in the 19th century in Britain, and she is famous for her social novels, in which she highlights complicated social conflicts. North and South is usually considered as the turning point of Mrs. Gaskell’s literary creation, in which she suggests for the first time that there should be a hope of a reconciliation between the working class and the bourgeoisie. Also, the author vividly depicted an independent woman with a sharp mind and a deliberate manner in the book, that is, Margaret Hale. She seems to be very special when compared with the women around her and very attractive to men for her peculiar thoughts as well as her beautiful looks. This thesis mainly analyzes the attractive heroine of the novel in three aspects: her independent character, her independent action and her independent thoughts. What’s more, the thesis aims to shed light on the characteristics a “New Woman” should be endowed with. The heroine, to some extent, is the author Mrs. Gaskell herself, rejecting inferiority to men and defending the rights to express themselves freely. All in all, this thesis tries to enlighten people on woman’s position in today’s society by deriving some inspirations from the literary work.

The safety of meperidine prescribing in older adults: A longitudinal population-based study.

Science.gov (United States)

Friesen, Kevin J; Falk, Jamie; Bugden, Shawn

2016-05-11

Meperidine (pethidine) is an opioid analgesic that offers little advantage relative to other opioids and several disadvantages including limited potency, short duration of action, and the production of a neurotoxic metabolite (normeperidine) with a long half-life. Older adults are more sensitive to meperidine's side effects and may have diminished renal function which leads to the accumulation of normeperidine. The Institute for Safe Medication Practices has suggested avoiding meperidine in older adults, limiting its dose (≤600 mg/day) and duration of use (≤48 h). The objective of this study was to determine the level of meperidine use in older adults and assess the dosage and duration of meperidine with reference to these safety recommendations. A longitudinal study using administrative healthcare data was conducted to examine meperidine utilization and levels of high dose and extended duration prescribing among persons ≥65 years of age between April 1, 2001, and March 31, 2014 in Manitoba, Canada. The number of meperidine prescriptions, users, duration of treatment, defined daily doses (DDD) dispensed and number of prescribers were determined over the study period. In the Manitoba older adult population there was a marked decline in meperidine users and prescriptions from 2001 to 2014. There was an average use of 26.4 (95 % CI 24.0-28.8) DDDs of meperidine per user per year. While only 3.7 % of the prescriptions exceeded the 600 mg maximum daily dose, 96.7 % of prescriptions exceeded the recommended 2 days of therapy. For the remaining users of meperidine, the amount of meperidine used per person rose from 18.98 to 56.14 DDDs/user/year over the study period. The number of prescribers of meperidine declined throughout the study, but low DDD prescribers declined more quickly than high DDD prescribers. While meperidine use has declined, the remaining use appears to be decreasing in safety, with more meperidine prescribed per user. This seems to be driven by