Narcotic-induced hypogonadism during therapy for heroin addiction

Many patients receiving sustained-action narcotics during therapy for heroin addiction have symptoms of fatigue, depression, diminished libido, and impaired sexual function. They are rarely, however, evaluated for narcotic-induced hypogonadism, or treated with sex-hormone replacement. Studies are reviewed examining the influence of narcotic administration on sex-hormone levels. These document frequent, sometimes profound, deficiencies in many men and women treated with narcotics. We have documented improved quality of life during sex-hormone replacement therapy in patients with narcotic-induced hypogonadism, most of whom were receiving their narcotics for control of chronic pain. These studies suggest that similar hormone replacement therapy may assist patients receiving narcotics for treatment of heroin addiction.     

Pseudoepidemics of heroin addiction

Smooth unimodal skewed distributions, sometimes referred to as “epidemic-like” curves, are often used as evidence of time to time changes in incidence. Data on year of onset from groups of treated heroin addicts are generally alleged to reflect incidence, and this distribution is used to evaluate effectiveness and predict future needs.This paper describes the development of simple demographic models which demonstrate the production of epidemic-like curves without changes in incidence, ascertainment or duration of disorder. These graphic models are relevant to other non-infectious disorders where there is continuing exposure to the etiologic agents and where intervals between onset and ascertainment are not uniformly distributed.     

Pharmacological treatments for heroin and cocaine addiction

AIMS: To provide an overview of the pharmacological options for the treatment of heroin- and cocaine-dependent patients based on known biochemical pathways to addiction and the chronic disease model as a starting point for treatment planning. RESULTS: Recent pre-clinical and clinical studies indicate that different brain structures and different neurotransmitters are involved in different stages of the addiction process. In addition, clinical experience shows that heroin and cocaine addiction can best be conceptualised and treated as a chronic, relapsing disorder with the following treatment goals: crisis intervention, cure or recovery (detoxification, relapse prevention) and care or partial remission (stabilization and harm reduction). The various high-quality studies, systematic literature reviews and formal meta-analyses clearly demonstrate that today many proven effective interventions are available for crisis intervention, detoxification, stabilization and harm reduction for heroin-dependent patients. Interventions directed at relapse prevention are still problematic and only effective in a minority of motivated patients in stable living conditions and adequate social support. In contrast, no proven effective pharmacological interventions are available for the treatment of cocaine-dependent patients, maybe with the exception of some patient groups that seem to benefit from treatment with disulfiram or amantadine. Treatment innovations are primarily based on experimental animal studies. Newly developed cannabinoid receptor antagonists and cortisol synthesis inhibitors show great promise. CONCLUSION: Heroin addiction is a chronic relapsing disease that is difficult to cure, but stabilization and harm reduction can greatly increase the life time expectancy and the quality of life of the patient, his direct environment and society as a whole. Currently, no proven effective pharmacological interventions are available for cocaine addiction, and treatment has to rely on existing cognitive behaviour therapies combined with contingency management strategies.     

A multiple baseline analysis of treatment for heroin addiction

The effects and side effects of behavioral treatment for heroin abuse was assessed in a multiple baseline across behaviors design. Self-reported urges to take heroin, urine drug screens, assertiveness in rejecting efforts of drug pushers, and financial status were measured throughout the study. After baseline measures were taken on all responses, covert sensitization was begun, which decresed drugs urges and was associated with abstinence from drug use and positive change in assertiveness. However, extended baseline estimates of financial status indicated the client's liabilities were reliably increasing. Behavioral contracting was then implemented successfully influencing work behavior and paying back debts. Daily follow-up measures of drug use were assessed over a three month period, with no change in drug urges or use. A six month follow-up indicated no changes in drug urges or use, and the client was financially independent and employed in a responsible job. The results indicate the independence of reducing drug use and increasing some pro-social behaviors, and support the necessity of programs designed to decrease maladaptive while increasing adaptive behavior.     

Ketamine psychotherapy for heroin addiction: immediate effects and two-year follow-up

Seventy detoxified heroin-addicted patients were randomly assigned to one of two groups receiving ketamine psychotherapy (KPT) involving two different doses of ketamine. The patients of the experimental group received existentially oriented psychotherapy in combination with a hallucinogenic (“psychedelic”) dose of ketamine (2.0 mg/kg im). The patients of the control group received the same psychotherapy combined with a low, non-hallucinogenic (non-psychedelic), dose of ketamine (0.2 mg/kg im). Both the psychotherapist and patient were blind to the dose of ketamine. The therapy included preparation for the ketamine session, the ketamine session itself, and the post session psychotherapy aimed to help patients to integrate insights from their ketamine session into everyday life. The results of this double blind randomized clinical trial of KPT for heroin addiction showed that high dose (2.0 mg/kg) KPT elicits a full psychedelic experience in heroin addicts as assessed quantitatively by the Hallucinogen Rating Scale. On the other hand, low dose KPT (0.2 mg/kg) elicits “sub-psychedelic” experiences and functions as ketamine-facilitated guided imagery. High dose KPT produced a significantly greater rate of abstinence in heroin addicts within the first two years of follow-up, a greater and longer-lasting reduction in craving for heroin, as well as greater positive change in nonverbal unconscious emotional attitudes than did low dose KPT.     

Naltrexone treatment of heroin addiction: one-year follow-up

Pre-treatment characteristics and post-treatment outcome measures were compared for 40 patients who began naltrexone maintenance and 77 who did not after a 6-month period of temporary maintenance on L-alpha-acetylmethadol (methadyl acetate LAAM). Patients who chose to begin naltrexone were younger, had fewer incarcerations and fewer months incarcerated prior to LAAM treatment, had fewer opiate-free months following previous treatments, and were more likely to be of Caucasian ethnicity. One year later, significantly more patients who had received any naltrexone than those who had not were no longer in any treatment program and were opiate-free. We found no significant correlations between total duration of naltrexone-treatment and post-treatment outcome variables such as heroin use, arrests, incarcerations or enrollment in a treatment program.     

Substitution therapy for amphetamine users

At the commencement of the third millenium, the illicit use of amphetamines continues to be a growing problem in many countries around the world, yet treatment responses remain in need of further development. This is particularly true with regards to pharmacotherapy for amphetamine dependence. In this Harm Reduction Digest four authors who bring together considerable research and clinical experience in this area describe the nature of amphetamine-related problems and consider the role of amphetamine agonists in substitution therapy for amphetamine dependence. This is a timely paper which should be of interest to clinicians, researchers and regulators.     

非依赖性药物治疗海洛因成瘾的临床研究(附700例报道)

目的 为研究非依赖药物治疗海洛因成瘾，采用卡马西平和泰必利，按一定比例混匀配制成胶囊（以下称胶囊）治疗戒毒者的戒断症状。方法 用于临床前，委托贵阳医学院药理教研室进行了动物药理和毒理试验。结果 该胶囊能消除在小鼠对吗啡和海洛因依赖的戒断症状；大小鼠对胶囊无依赖性；急性和长期毒性试验表明无毒性作用。单用该胶囊治疗７００例自愿戒毒者，疗程７～１５天，随方３个月，采取自身对照法，比较戒毒者治疗前后的症状     

"Markers" for the MacAndrew and the Cavior heroin addiction MMPI scales

The MacAndrew and Cavior scales were not shown to measure "a general addictive propensity."     

The economic costs of heroin addiction in the United States

This study documents the costs of heroin addiction in the United States, both to the addict and society at large. Using a cost-of-illness approach, costs were estimated in four broad areas: medical care, lost productivity, crime, and social welfare. We estimate that the cost of heroin addiction in the United States was US$21.9 billion in 1996. Of these costs, productivity losses accounted for approximately US$11.5 billion (53%), criminal activities US$5.2 billion (24%), medical care US$5.0 billion (23%), and social welfare US$0.1 billion (0.5%). The large economic burden resulting from heroin addiction highlights the importance of investment in prevention and treatment.     

Life change, disease, perception and heroin addiction.

This is a pilot study of heroin addicts using recently developed tests which measure life change, perception of life change and perception of disease. The data indicate that heroin addicts maintain very high levels of life change while having normal or augmented perception of the impact of life change and of the seriousness of their disease. It is postulated that treatment techniques aimed at increasing understanding and insight may be countertherapeutic for these patients in that it gives them additional methods of manipulating others and tends to perpetuate the addiction life reducing life change in a setting of tight behavioral control where behavioral substitutes to heroin use are offered.     

Clonidine and opiate receptor antagonists in the treatment of heroin addiction

Good results in detoxification methods have been reached using both together clonidine and opiate receptors antagonists. One hundred fifty-two heroin-abusing patients were studied evaluating withdrawal symptoms after therapy with (a) clonidine only, (b) clonidine and naltrexone, (c) clonidine and naloxone, and (d) placebos. Treatment results, emotional and behavioral changes, and involvement in psychosocial programs were evaluated after a 6-month follow-up. Although opiate antagonists were able to induce slight and transient withdrawal signs and symptoms, there was, in the group of patients treated with clonidine and naltrexone together, a low percentage of catabolites in urine and an improvement in mood and family relationships. Furthermore, the patients that underwent longer naltrexone treatment showed a stronger involvement in psychosocial programs, and even their relatives demonstrated more interest in the recovery program. A decrease in the difficulties of accepting an opiate antagonists treatment and a different evaluation of withdrawal syndrome were the results of an early use of naltrexone.     

海洛因成瘾的防治及神经机理研究——香山科学会议第105次学术讨论会纪要

１９９８年１０月６日－９日,在北京香山举行了香山科学会议第１０５次学术讨论会。会议的主题为“海洛因成瘾的神经机理及其防治”。韩济生院士、秦伯益院士、池志强院士担任本次会议的执行主席。来自北京医科大学神经科学研究所、中国军事医学科学院毒物药物研究所、中...