改良丁丙诺啡法戒毒临床观察

目的：了解改良丁丙诺啡方法对海洛因依赖者戒毒的疗效。方法：对海洛因信赖者戒毒治疗的病人９０例分为２组,Ａ组以氯氮平、氯羟安定治疗;Ｂ组以氯氮平、氯羟安定联用丁丙诺啡治疗。比较两组的疗效、戒断症状及药物副作用的差异。结果：两种治疗方案对海洛因信赖者戒毒治疗均有效,但改良丁丙诺啡组患者戒断症状轻,用药量较小,两组间有显著性差异。结论：改良丁丙诺啡组对戒断症状的控制优于单独使用氯氮平和氯羟安定组,治疗安     

东莨菪碱和氯丙嗪联合戒毒的疗效分析

目的：探索对海洛因依赖者较理想的戒毒方法。方法：采用东莨菪碱和小剂量氯丙嗪联合静脉滴注对海洛因依赖者40例进行戒毒治疗,与单用美沙酮脱瘾60例比较。结果：东莨菪三和氯丙嗪联合对海洛因依赖者戒毒控制症状好,安全、副作用小。结论：东莨菪碱和氯丙嗪联合对海洛因依赖者戒毒有一种值得推广戒毒治疗方法。     

美沙酮与丁丙诺啡治疗海洛因依赖临床疗效观察

应用美沙酮、丁丙诺啡替代递减疗法治疗100例海洛因依赖患者。采用随机开放临床试验，分两组对照观察。结果显示：美沙酮控制戒断症状疗效显著，作用时间长，经济方便，患者易接受，安全性更高。     

海洛因依赖者脱瘾治疗中丁丙诺啡与美沙酮的比较研究

美沙酮(methadone)系目前世界上广泛用于阿片类药物依赖脱瘾(detoxification)治疗的经典药物。治疗方案有10天和21天替代递减法等多种。21天递减法有替代递减顺利、戒断症状较轻、给药方便、易于接受等优点,但脱瘾时间相对较长。丁丙诺啡(buprenorphine)理论上可用于阿片类药物依赖的替代治疗和脱瘾。并能抑制海洛因依赖者使用海洛因和有强化作用。目前美     

盐酸丁丙诺啡治疗海洛因依赖临床观察

85例海洛因依赖采用盐酸丁内诺啡注射液递减法戒毒的临床效果表明，60例完成治疗过程，效果良好，25例脱试。平均住院19.5天，盐酸丁丙诺啡人均用量9.45mg。9天内快速递减后，戒断症状控制好，副作用小，使用方便。     

丁丙诺啡与美沙酮对鸦片依赖者的维持治疗

丁丙诺啡与美沙酮对鸦片依赖者的维持治疗【英】／ＫｏｓｔｅｎＴＲＪＮｅｒｖＭｅｎｔＤｉｓ－１９９３，１８１（６）；－３５８～３６４丁丙诺啡已替代美沙酮维持治疗鸦片依赖者。但是门诊病人维持治疗的最小剂量尚未确定。每日２～３ｍｇ舌下含服进行脱瘾的研究，显示...     

多巴胺2受体基因TaqIA多态性与美沙酮维持治疗海洛因依赖患者心理症状相关性研究

目的研究昆明市美沙酮维持治疗A门诊接受美沙酮维持治疗的汉族海洛因依赖者多巴胺D2受体基因TaqIA多态性与接受美沙酮维持治疗海洛因依赖患者心理症状的相关性,探讨影响病人治疗效果的遗传因素。方法对81例接受美沙酮维持治疗的海洛因依赖者实施SCL-90测试,应用聚合酶链式反应-限制性片段长度多态性（PCR-RFLP）技术,检测多巴胺D2受体基因TaqIA基因多态,比较不同基因型与SCL-90各因子的关系。结果 A1＋组（A1/A1,A1/A2）与A1-组（A2/A2）SCL-90各因子分无显著性差异。结论D2受体基因TaqIA多态性与美沙酮维持治疗海洛因依赖患者心理症状可能不存在相关性。     

戒毒失败原因分析

戒毒失败原因分析王金爱张小燕我院自１９８０年起对海洛因依赖者以４种方法进行脱瘾治疗：①冬眠治疗辅以鸦片酊；②美沙酮；③美沙酮辅以可乐定；④美沙酮辅以络啡哂定。各组随机选择１００例进行分析，均系自愿住院者。男２７８例，女１２２例。年龄１７～４５岁，平均...     

戒除美沙酮时的器质性心境综合征

临床研究发现美沙酮(methadone)对戒断海洛因有效,但患者也易对美沙酮产生依赖。本文报道停止美沙酮维持治疗时,出现的戒断症状类型及这些症状与戒毒成败的关系。方法:受试者系海洛因成瘾而接受美沙酮维持治疗者。要求符合下列标准:①已接受固定剂量美沙酮3个月;②这3个月未用违禁药;③参加全日制工作或学习;③没有从事与求药有关的活动;⑤定期复查;⑥当时无情感障碍;⑦没有服任何抗精神病药物。符合上述标准的24例病人同意参加美沙酮解毒治疗,包括每周用量表评定鸦片戒断症状、体征及心境状态。解毒治疗前美沙酮平均剂     

丁丙诺啡替代海洛因脱毒治疗50例临床报告

丁丙诺啡是兼具对Ｍ受体和Ｋ受体的激动作用和拮抗特性的阿片类化合物。它的激动活性可用来替代海洛因脱毒治疗，其拮抗活性决定了它的依赖性，但比纯激动剂明显较轻，是具有应用价值的戒毒药物［１］。现将我们近期用丁丙诺啡治疗５０例脱瘾病例报告如下。１资料与方法１...     

美沙芬对美沙酮治疗海洛因戒断症状的协同作用研究

目的：研究美沙芬在美沙酮治疗海洛因戒断症状中的作用。方法：采用随机单盲对照试验设计,试验组25例采用美沙芬与美沙酮合并用药,对照组25例仅用美沙酮,结果：逐日比较两组病人戒断症状,无显著差别。结论：美沙芬对美沙酮有协同作用,可以减少脱毒治疗时美沙酮的用量。     

参与美沙酮维持治疗的海洛因成瘾者自我报告的抑郁症状严重程度：一项横断面调查

背景：美沙酮维持治疗(methadone maintenance treatment, MMT)是一种公认的有效降低毒瘾的措施。美沙酮维持治疗可以减少海洛因成瘾戒断症状,并因此可以提供心理和社会支持,对吸毒者的康复至关重要。
　　目标：比较目前正在接受MMT的海洛因成瘾者和没有接受MMT的海洛因成瘾者之间的抑郁症状严重程度。
　　方法：本研究运用了Beck-13(13-item version of the Beck Depression Inventory, BDI-13)抑郁自评量表和人口学历史资料调查表,对中国三个城市9个美沙酮治疗中心的929例正在接受MMT的海洛因成瘾患者（平均已接受9个月MMT治疗）和已经在中心注册参加MMT治疗但尚未开始的238例海洛因成瘾患者进行评估。
　　结果：与正在接受MMT的成瘾者中有68%(628/929)报告抑郁症状相比,79%(188/238)的未治疗成瘾者报告有抑郁症状(X2=11.69,p<0.001)。未经治疗组的BDI评分中位数（四分位区间）是10.4(7.9-11.4),而MMT 组BDI评分中位数是8.0(5.7-11.6),两者有显著差异(Z=2.75, p=0.006)。在MMT组内,自我报告的抑郁症状严重程度与参加MMT时间呈负相关(rs=-0.24,Z=2.88, p=0.004)。多元线性回归分析发现,在控制所有人口学变量后,治疗组的抑郁症状严重程度仍然轻于非治疗组。在控制MMT疗效后,自我报告家庭关系较差(β=0.118,t=6.56, p<0.001)以及离异(β=0.120,t=3.73, p<0.001)的海洛因成瘾患者抑郁症状较严重。
　　结论：中度至重度抑郁症状常见于海洛因成瘾患者。MMT治疗与海洛因成瘾患者抑郁症状较轻相关,但需要采用前瞻性随机对照试验来确定MMT是否确实改善了海洛因成瘾患者的抑郁症状。与家庭成员的关系较差也与海洛因成瘾患者的抑郁症状有关,这表明对海洛因成瘾患者的治疗需要纳入一些方法来帮助海洛因成瘾患者修复由于他们成瘾造成的社会关系割裂。     

Differential regional effects of methadone maintenance compared to heroin dependence on mu-opioid receptor desensitization in rat brain

Methadone maintenance therapy has been the mainstay of treatment for heroin addiction since the 1970s. Recent studies indicate that methadone is of greater relative intrinsic efficacy than the active metabolites of heroin at mu-opioid receptors and that the extent of mu-opioid receptor desensitization is dependent upon agonist efficacy. Regional differences have been found for mu-opioid receptor desensitization with chronic heroin self-administration, and a similar paradigm was employed to compare regional differences between the effects of heroin and methadone. Rats were trained to self-administer heroin i.v., and the dose available was increased incrementally to a terminal value of 6 mg/kg for each infusion. Half of these rats were allowed to continue to self-administer heroin, while dependence was maintained in the others by hourly infusions of 3 mg/kg of methadone. A separate group of animals was kept on a low dose of heroin. Activation of G-proteins by the high efficacy agonist DAMGO was decreased to a greater extent in animals treated chronically with methadone compared with those allowed to self-administer heroin in amygdala, periaqueductal gray, and subicular nucleus. Activation of G-proteins by the partial agonist endomorphin was decreased in striatum, thalamus, and amygdala in rats from all drug treatment groups, but to a greater extent in the striatum in methadone treated rats compared with the heroin groups. Elucidating the mechanisms by which methadone induces differential desensitization of mu-opioid receptors across brain regions compared with heroin could provide insights to improve the pharmacotherapy of heroin addiction.     

曲唑酮治疗海洛因戒断症状临床研究

目的：观察曲唑酮对海洛因依赖稽延性戒断症状的疗效。方法：采用双盲对照法，用曲唑酮或安慰剂分别治疗海洛因依赖临床脱毒后存在的稽延性戒断症状的患者。结果：曲唑酮较安慰剂能明显减轻患者的稽延性戒断症状、情绪障碍及对毒品的心理渴求，且无严重不良反应。结论：曲唑酮对海洛因依赖稽延性戒断症状有效。     

Iatrogenic addiction of pethidine: clinical feature and experience of detoxification]

Narcotic analgesic pethidine is widely applied in clinical practice to relieve pain caused by cancer or severe surgical conditions. Iatrogenic addiction following long term medication of narcotic analgesics have been noticed but rarely documented. In this presentation, the authors studied the clinical feature of pethidine dependency as well as experiences of residential detoxification in analysing 34 cases collected in the National Drug Dependence Treatment Center in previous two years. Manifestation of pethidine addiction are much alike to heroin and all abstinent syndromes can be relieved either by methadone or clonidine within 3 weeks except psychological craving throughout the detoxification period. In conclusion, the authors hold that iatrogenic narcotic addiction of this kind is curable as long as the addicts are highly and conscientiously motivated together with rehabilitation measures after detoxification.     

Methadone intoxication in a child: toxic encephalopathy?

Methadone is used in the treatment of opioid addiction. Acute intoxication can lead to severe consequences and can even be lethal. In several case reports and small series, a presumably toxic leukoencephalopathy is described resulting from inhalation of heroin. We present the case of a 3-year-old boy who ingested methadone accidentally. In a coma with acute obstructive hydrocephalus owing to massive cerebellar edema and supratentorial lesions, he was successfully treated with methylprednisolone and cerebrospinal fluid external drainage. To our knowledge, this is the first report of an encephalopathy associated with synthetic opioid intoxication.     

Effects of cortisol administration on craving in heroin addicts

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 craving, for example, by interfering with addiction memory. The aim of the present study was to determine the effects of cortisol administration on craving in heroin-dependent patients and to determine whether the effects depend on the daily dose of heroin consumption. We used a double-blind, placebo-controlled, cross-over study in 29 heroin-dependent patients in a stable heroin-assisted treatment setting. A single oral dose of 20 mg of cortisol or placebo was administered 105 min before the daily heroin administration. The primary outcome measure was cortisol-induced change in craving. Secondary measures included anxiety, anger and withdrawal symptoms. For the visual analog scale for craving, we found a significant interaction (P=0.0027) between study medication and heroin-dose group (that is, daily low, medium or high dose of heroin). Cortisol administration reduced craving in patients receiving a low dose of heroin (before heroin administration: P=0.0019; after heroin administration: P=0.0074), but not in patients receiving a medium or high dose of heroin. In a picture-rating task with drug-related pictures, cortisol administration did not affect the ratings for the picture-characteristic craving in all the three heroin-dose groups. Cortisol also did not significantly affect secondary outcome measures. In conclusion, a single administration of cortisol leads to reduced craving in low-dose heroin addicts. The present findings might have important clinical implications with regard to understanding stress effects and regarding treatment of addiction.     

Predicting Outcome in Public Addiction Services Using Data Collected During Routinely Assessment Procedures

The study examined the ability of several baseline variables to predict retention and treatment outcome in a cohort study that included 137 participants with heroin and cocaine addiction attending a public addiction service in Italy. Predictors included past drug use, intravenous use, initial urine drug screen results, cocaine and heroin craving and self-reported psychiatric symptoms. Severe depression and, in a lesser extent, anxiety symptoms, predicted lower retention. Only intravenous use was a significant predictor of cocaine use in the whole sample. Positive urine for cocaine and intravenous use predicted worse outcome among heroin addicts. Three Symptoms Checklist-90 (SCL-90) scales scores were associated with lower cocaine and heroin use. Multiple logistic regression showed that cocaine positivity and more structured psychosocial treatment predicted successful outcome. Results highlight the prognostic value of carefully assessing patterns of cocaine use and co-use, routes of administration and psychiatric symptoms at the beginning of treatment, especially in heroin addicts.