韩氏穴位神经刺激仪与丁丙诺啡联合应用应用治疗72例海洛因依赖者的临床观察

韩氏仪（HANS）可促进中枢神经系统释放内源性阿片肽，使阿片类依赖者的戒断症状得到缓解。本工作用盐酸丁丙诺啡（BuprenorphineHydrochloride，Bup）替代疗法对72例男性海洛因依赖者进行治疗，其中36例（联合组）从第4天开始联合应用HANS治疗，每天1次（30min）；另36例作为对照组（不加HANS仪）连续使用Bup7天。就脱瘾治疗的时间、丁丙诺啡及麻醉镇痛催眠药物的用量（第4～7天）进行了比较。结果显示：联合组的脱瘤时间（110±7．5h）显著少于对照组（127±5．6h）（P＜0．01）；治疗第4～7天联合组的丁丙诺啡用量（0．46±0．05mg）也显著低于对照组（0.96±0．12mg）（P＜0.01），氯氮平（Clozapine）用量也是联合组（88．2±14．1mg）显著低于对照组（120±13．6mg）（P＜0.05）。提示：丁丙诺啡联合HANS仪治疗，使脱瘾时间缩短，替代药物和对症处理的药物剂量减少，可能与HANS促使中枢神经系统“内源性阿片肽一阿片受体－体内生理稳态”这一生理机能迅速恢复有关。     

吸毒人群HBV、HCV感染状况及吸毒合并两种病毒感染对ALT异常的影响

目的 :为评估湛江市吸毒人群 HCV、HBV的感染状况 ,以及吸毒合并 HCV、HBV感染对血清 AL T异常的影响。方法 :收集 2 0 0 2 - 0 2～ 2 0 0 3- 0 3湛江市吸毒人群资料 ,并对调查对象进行血清 HCV、HBV和 AL T的检测。结果 :湛江市静脉吸毒人群的 HBs Ag阳性率、HCV感染率和 HBV感染率分别为 2 4 .6 1%、5 7.87%、6 7.32 % ,明显高于对照组(11.0 3%、0 .91%、5 1.96 % ) ,有显著性差异 ,非静脉吸毒组此 3项与对照组比较无显著性差异 ;HBV单项、HCV单项、HBV和 HCV混合项 ,这 3种组合感染的静脉吸毒者 ,他们血清中的 AL T异常率分别为 15 .6 9%、33.33%、4 5 .5 0 % ,这3种 AL T异常率分别与未感染 HBV、HCV的静脉吸毒者的 AL T异常率 (9.84 % )比较 ,前者无显著性差异 ,后两者有显著性差异。结论 :静脉吸毒是吸毒者感染 HBV、HCV的重要途径 ;HCV感染对静脉吸毒者血清 AL T的异常起重要作用     

海洛因依赖者脑灰质体积的VBM研究

目的探讨海洛因依赖对大脑灰质结构的作用,分析吸食海洛因总时间、吸食海洛因总量、每日吸食海洛因量等因素对脑灰质体积产生的影响。资料与方法采用MRI对17例海洛因依赖者和15名健康受试者行3D结构像扫描,所得数据用基于体素的形态学分析(voxel based morphometry,VBM)方法分析脑灰质体积,并比较两组之间的体积差异;分析脑灰质体积与吸食海洛因总时间、吸食海洛因总量、每日吸食海洛因量之间的相关关系。结果与健康被试者相比,海洛因依赖者右侧眶额回、中央前回、左侧岛叶、扣带回、枕叶舌回灰质体积减少(P<0.005);控制年龄、受教育程度、每日吸烟量后,脑灰质体积变化与使用海洛因总时间、海洛因总量、每日吸食海洛因量之间无显著相关关系。结论长期吸食海洛因导致脑灰质结构损害,主要涉及认知控制、情感、视觉控制等相关脑区。     

Isolated sternoclavicular joint arthritis in heroin addicts and/or HIV positive patients: Three cases

Summary The authors describe three patients in whom septic arthritis of the sternoclavicular joint (SCJ) occurred, drug addiction and human immunodeficiency virus (HIV) infection representing the predisposing conditions. Infectious arthritis is well known in intravenous drug users, but it is rare in HIV positive patients, who are prone to bacterial infections from usual or unusual microorganisms. In one case, staphylococcus aureus methicillin sensitive was responsible for septic arthritis. In another case, SCJ infection was associated with pneumonitis.     

A Placebo-Controlled Trial of Dextromethorphan as an Adjunct in Opioid-Dependent Patients Undergoing Methadone Maintenance Treatment

Background:

Low-dose dextromethorphan (DM) might have anti-inflammatory and neurotrophic effects mechanistically remote from an NMDA receptor. In a randomized, double-blind, controlled 12 week study, we investigated whether add-on dextromethorphan reduced cytokine levels and benefitted opioid-dependent patients undergoing methadone maintenance therapy (MMT).

Methods:

Patients were randomly assigned to a group: DM60 (60mg/day dextromethorphan; n = 65), DM120 (120mg/day dextromethorphan; n = 65), or placebo (n = 66). Primary outcomes were the methadone dose required, plasma morphine level, and retention in treatment. Plasma tumor necrosis factor (TNF)-α, C-reactive protein, interleukin (IL)-6, IL-8, transforming growth factor–β1, and brain-derived neurotrophic factor (BDNF) levels were examined during weeks 0, 1, 4, 8, and 12. Multiple linear regressions with generalized estimating equation methods were used to examine the therapeutic effect.

Results:

After 12 weeks, the DM60 group had significantly longer treatment retention and lower plasma morphine levels than did the placebo group. Plasma TNF-α was significantly decreased in the DM60 group compared to the placebo group. However, changes in plasma cytokine levels, BDNF levels, and the methadone dose required in the three groups were not significantly different.

Conclusions:

We provide evidence—decreased concomitant heroin use—of low-dose add-on DM’s efficacy for treating opioid-dependent patients undergoing MMT.     

Patterns of drug preference and use among people who inject drugs in Melbourne,Australia

Background: Understanding of substitution patterns in drug using careers is limited. Between 2009 and mid-2013, the purity-adjusted price of methamphetamine declined sharply in Melbourne in absolute terms and relative to the purity-adjusted price of heroin. We determine whether there were associated increases among people who inject drugs (PWID) in (1) use of methamphetamine and (2) citing methamphetamine as the drug of choice. Method: Responses to “drug of choice” and “most used drug” were obtained from baseline and follow-up interviews of the 688 PWID enrolled in the Melbourne Injecting Drug User Cohort Study between April 2008 and August 2013, categorised as heroin, methamphetamine, cannabis or other. Previous month heroin and methamphetamine use was reported at baseline by 82% and 41% of participants, respectively, and 51% had completed four or more interviews in this period. A Markov model that included marginal effects for methamphetamine purity-adjusted price was used to calculate (1) transitions between drug of choice and (2) conditional probabilities for most used drug. Parameters were determined by fitting multinomial logistic models to appropriate data subsets. Results: At baseline, the majority of participants reported heroin as both their preferred drug and the drug they used most. There were no significant increases in reports of methamphetamine as drug of choice, or as the most used drug. Conclusion: In a cohort of PWID who reported a range of drug behaviours, there was little evidence of drug substitution into methamphetamine, despite substantial declines in its purity-adjusted price.     

Transcranial direct current stimulation of the frontal-parietal-temporal area attenuates cue-induced craving for heroin

BackgroundTranscranial direct current stimulation (tDCS) is an effective approach to modulate brain region functions. We assessed if a single tDCS session over the bilateral frontal-parietal-temporal (FPT) areas would reduce cue induced craving in heroin addicts.MethodsTwenty non-treated, long-term heroin-addicted subjects were randomly assigned to receive either real tDCS (1.5 mA, cathodal over bilateral FPT for 20 min) or control tDCS stimulation (turning off the stimulation after 30 s). The participants received heroin cue exposure (containing both injection and inhalation procedures) before and after stimulation and rated their craving after each block of cue presentation.ResultsStimulation of the bilateral FPT with real tDCS for 20 min reduced craving scores significantly (68 ± 8.4 pre-stimulation vs. 43 ± 7.6 post-stimulation, p = 0.003), while the control stimulation group showed no significant changes. No side effects of tDCS were reported.ConclusionsOne session of tDCS over bilateral FPT area significantly reduced subjective craving score induced by heroin cues in heroin addicted subjects.     

High enhancer,downer, withdrawal helper: Multifunctional nonmedical benzodiazepine use among young adult opioid users in New York City

BackgroundBenzodiazepines are a widely prescribed psychoactive drug; in the U.S., both medical and nonmedical use of benzodiazepines has increased markedly in the past 15 years. Long-term use can lead to tolerance and dependence, and abrupt withdrawal can cause seizures or other life-threatening symptoms. Benzodiazepines are often used nonmedically in conjunction with other drugs, and with opioids in particular—a combination that can increase the risk for fatal and non-fatal overdose. This mixed-methods study examines nonmedical use of benzodiazepines among young adults in New York City and its relationship with opioid use.MethodsFor qualitative analysis, 46 90-minute semi-structured interviews were conducted with young adult opioid users (ages 18–32). Interviews were transcribed and coded for key themes. For quantitative analysis, 464 young adult opioid users (ages 18–29) were recruited using Respondent-Driven Sampling and completed structured interviews. Benzodiazepine use was assessed via a self-report questionnaire that included measures related to nonmedical benzodiazepine and opioid use.ResultsParticipants reported using benzodiazepines nonmedically for a wide variety of reasons, including: to increase the high of other drugs; to lessen withdrawal symptoms; and to come down from other drugs. Benzodiazepines were described as readily available and cheap. There was a high prevalence (93%) of nonmedical benzodiazepine use among nonmedical opioid users, with 57% reporting regular nonmedical use. In bivariate analyses, drug-related risk behaviours such as polysubstance use, drug binging, heroin injection and overdose were strongly associated with regular nonmedical benzodiazepine use. In multivariate analysis, growing up in a middle-income household (earning between $51,000 and $100,000 annually), lifetime overdose experience, having ever used cocaine regularly, having ever been prescribed benzodiazepines, recent drug binging, and encouraging fellow drug users to use benzodiazepines to cope with opioid withdrawal were consistently strong predictors of regular nonmedical benzodiazepine use.ConclusionNonmedical benzodiazepine use may be common among nonmedical opioid users due to its drug-related multi-functionality. Harm reduction messages should account for the multiple functions benzodiazepines serve in a drug-using context, and encourage drug users to tailor their endorsement of benzodiazepines to peers to include safer alternatives.