心理干预对海洛因依赖者戒毒康复期焦虑状态的影响

目的 分析海洛因依赖者戒毒康复期的焦虑症状，提高脱毒治疗的依从性。方法 将100例海洛因依赖者随机分两组（实验组和对照组），每组50例，对照组进行戒断治疗及一般护理；实验组采用戒断治疗、系统的抗焦虑治疗护理基础上，由主管护士对其进行情绪、认知、睡眠等心理干预。运用焦虑自评量表（SAS），于干预前后评价所有入选的海洛因依赖者。结果 干预前两组对比焦虑状况差异无显著性（P〉0．05），而干预后两组对比焦虑状况差异有显著性（P〈0．05）；实验组干预前后焦虑状况差异有显著性（P〈0．05）；对照组干预前后焦虑的发生差异无显著性。结论 心理干预可减轻海洛因依赖者戒毒康复期的焦虑症状，提高脱毒治疗依从性。     

Explaining the Geographical Variation of HIV Among Injection Drug Users in the United States

Distinct physical and chemical types of street heroin exist worldwide, but their impact on behavior and disease acquisition is not well understood or documented. This article presents a hypothesis to explain the unequal diffusion of HIV among injection drug users in the United States by examining the distribution and use of one type of heroin—“Mexican black tar.” Drawing on ethnographic, clinical, epidemiological, and laboratory data, we suggest that the chemical properties of black tar heroin promote the following safer injection practices: (1) the rinsing of syringes with water to prevent clogging; (2) the heating of cookers to promote dissolution; and (3) a rapid transition from venous injection to subcutaneous or intramuscular injections.     

A Comparison of Mental Health Hospital Admissions in a Cohort of Heroin Users Prior to and After Rapid Opiate Detoxification and Oral Naltrexone Maintenance

Mental health (MH) hospital admissions were investigated in a cohort (N = 1184) of heroin dependent persons using linked health records. All MH in-patient admissions were extracted 36 months before to 36 months after commencing rapid opioid detoxification (ROD) and oral naltrexone. Results show that the incidence rate ratio (IRR) of drug-related and other MH admissions peaked in the 3 months immediately prior to treatment. All categories subsequently declined to baseline levels by 36 months following treatment. The authors conclude that treatment for heroin dependence reduces risk of MH admissions.     

A Fatal Case of Spongiform Leukoencephalopathy Linked to “Chasing the Dragon”

Abstract

Background:?“Chasing the dragon” involves placing heroin on aluminum foil, heating it from below with a flame, and inhaling the pyrolysate through a straw. It has rarely been associated with the development of a progressive spongiform leukoencephalopathy. Case Report:?A 43‐year‐old woman presented with 2 weeks of bizarre behavior, forgetfulness, and slowed speech and movements. Serum, cerebrospinal fluid, and head computed tomography (CT) scan were normal. The patient progressed to coma and expired during week 4 of hospital admission. The family confirmed that she “chased the dragon.” Cause of death at post mortem examination was spongiform leukoencephalopathy. Conclusion:?The diagnosis of heroin pyrolysate‐induced spongiform leukoencephalopathy should be considered in a patient with a history of “chasing the dragon” and neurobehavioral changes, including confusion, apathy, cerebellar signs, and motor restlessness.     

Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose

Aims   Traditionally, the opiate antagonist naloxone has been administered parenterally; however, intranasal (i.n.) administration has the potential to reduce the risk of needlestick injury. This is important when working with populations known to have a high prevalence of blood-borne viruses. Preliminary research suggests that i.n. administration might be effective, but suboptimal naloxone solutions were used. This study compared the effectiveness of concentrated (2 mg/ml) i.n. naloxone to intramuscular (i.m.) naloxone for suspected opiate overdose.
Methods   This randomized controlled trial included patients treated for suspected opiate overdose in the pre-hospital setting. Patients received 2 mg of either i.n. or i.m. naloxone. The primary outcome was the proportion of patients who responded within 10 minutes of naloxone treatment. Secondary outcomes included time to adequate response and requirement for supplementary naloxone. Data were analysed using multivariate statistical techniques.
Results   A total of 172 patients were enrolled into the study. Median age was 29 years and 74% were male. Rates of response within 10 minutes were similar: i.n. naloxone (60/83, 72.3%) compared with i.m. naloxone (69/89, 77.5%) [difference: −5.2%, 95% confidence interval (CI) −18.2 to 7.7]. No difference was observed in mean response time (i.n.: 8.0, i.m.: 7.9 minutes; difference 0.1, 95% CI −1.3 to 1.5). Supplementary naloxone was administered to fewer patients who received i.m. naloxone (i.n.: 18.1%; i.m.: 4.5%) (difference: 13.6%, 95% CI 4.2–22.9).
Conclusions   Concentrated intranasal naloxone reversed heroin overdose successfully in 82% of patients. Time to adequate response was the same for both routes, suggesting that the i.n. route of administration is of similar effectiveness to the i.m. route as a first-line treatment for heroin overdose.     

Drug-related deaths with evidences of body packing: Two case reports and medico-legal issues

Body packing is a general term used to indicate the internal transportation of drug packages, mainly cocaine, heroin, amphetamines, and methamphetamine, within the gastrointestinal tract. We described two cases of accidental drug intoxication, observed over the last year period, with evidence of intracorporeal drug concealment. The first case concerned a body packer transporting 69 drug packages of heroin adulterated with piracetam. The second body packer transported 16 drug packages of cocaine adulterated with levamisole. For both cases, forensic examination and toxicological analysis of drug packages and biological samples were carried out. Authors also wants to highlight the main medico-legal issues that commonly arise in cases of suspected or ascertained body packers.     

中药瑞康欣胶囊的质量和在戒毒中的疗效观察

目的:评价复方中药瑞康欣颗粒戒毒的临床疗效。方法:比较2774例海洛因依赖者在我院进行西药和中西医结合治疗的治疗情况和疗效。结果:中西医结合治疗组较西药治疗组美沙酮、可乐宁、曲马多等西药的用量减少,但平均住院天数延长,稽延性症状的评分降低程度具有显著性差异。结论:复方瑞康欣中药方剂对海洛因依赖者的戒断症状治疗效果肯定;能减少美沙酮等药物的用量;浓缩中药颗粒具有质控性好、方便实用的特点。     

海洛因依赖脱毒后复吸与未复吸两者生活质量关系研究

目的：了解海洛因依赖患者脱毒后复吸与未复吸者生活质量及相关心理因素。方法：将符合诊断标准的60例患者编为戒毒组；用SCL-90、简易应对方式问卷、GQOLI-74和NEO人格问卷等对其测查；戒毒组按追踪结果分为未复吸和复吸组，并与正常组作对照，用SPSS11．0对数据作统计分析。结果：复吸组日用毒品量、日用毒品频度等均值显著高于未复吸组，前次戒毒操守时间未复吸组均值显著高于复吸组；戒毒组与正常对照组的心理症状及应对方式各因子均值有显著差异，其心理症状与应对方式显著相关；复吸组与未复吸组生活质量因子除物质生活外，躯体功能、心理功能、社会功能和生活质量总水平均值有显著差异；未复吸组个性中自律性对其生活质量有显著影响，复吸组的信任、刺激追求、责任心、坦诚和开放性对其生活质量有显著影响；未复吸组和复吸组生活质量及其正性情感、认知功能、自尊、社会支持、人际交往能力、心理功能、社会功能等也在多气质组问存在显著差异；心理症状与躯体功能、心理功能、社会功能、生活质量总水平有显著负相关。结论：吸食海洛因成瘾可造成吸毒者的心理症状恶化和应对方式不良及生活质量下降，个性差异会使其生活质量水平各显不同；生活质量与心理健康水平互有影响。