针灸对海洛因复吸大鼠脑组织多巴胺、5-羟色胺的影响

目的探讨针灸干预海洛因复吸的作用机制。方法采用间断性递增量肌肉注射海洛因的方法复制海洛因复吸大鼠模型,观察针灸对海洛因复吸大鼠条件性位置偏爱（conditional position preference,CPP）的行为学改变及脑组织多巴胺（dopamine,DA）、5-羟色胺（5-hydroxytryptamine,5-HT）含量变化的影响。结果针灸能防止海洛因复吸大鼠体质量的下降（P〈0.01）,显著延长海洛因复吸大鼠在暗箱的停留时间（P〈0.01）,显著降低海洛因复吸大鼠脑组织DA和5-HT含量（P〈0.01）。结论抑制脑组织DA、5-HT的释放,降低对海洛因用药行为有关环境的依赖行为,可能是针灸干预海洛因复吸的作用机制之一。     

海洛因依赖者环境线索诱发心理生理反应

目的：了解海洛因依赖者对吸毒相关环境线索诱发反应。方法：对来自自愿戒毒机构的36例刚完成生理脱毒（康复早期）的海洛因依赖者和劳教戒毒机构112例康复期满1年的海洛因依赖者观看吸毒相关视频同时给予海洛因模拟物及吸毒用具刺激,于暴露前后自评渴求程度、情绪以及戒断症状反应;用生物反馈仪自动记录暴露前后的生理反应。结果：环境线索暴露后海洛因依赖者心理渴求、害怕／焦虑、抑郁／悲伤、戒断症状、心率、皮肤导电和肌电增高（P〈0．05）,中性／放松／自然降低（P〈0．05）。自愿戒毒机构康复早期海洛因依赖者环境诱发心率增高,比康复期满一年以上者更明显（P〈0．05）,其余与康复期长短无显著关系。结论：海洛因依赖者戒断康复期的延长并不会使渴求和环境诱发心理生理反应减弱或消褪。     

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.     

Examination of the Phenomenology of the Ibogaine Treatment Experience: Role of Altered States of Consciousness and Psychedelic Experiences

Psychedelic drugs have historically been used for ritualistic purposes and to help individuals gain insight. Ibogaine, a naturally occurring psychoactive substance, has been reported to have anti-addictive properties that aid in the treatment of substance use disorders. An online survey obtained retrospective data from individuals who used ibogaine in the past. Individuals who used ibogaine tended to describe thematically similar experiences post-treatment. This study adds to the literature by using the 5d-ASC, a psychometrically sound measure of altered states of consciousness (ASCs), to examine the ASCs induced by ibogaine and discusses the demographic characteristics of those who seek ibogaine treatment (N = 27). The study also examined several aspects of ibogaine treatment experience, including reasons for seeking treatment, course of treatment, and treatment outcome. Results indicated a positive correlation between the various dimensions of the ASCs and the outcome (ability to make changes in one’s life, cravings, and how changed the person was as a result of ibogaine treatment). While this study is limited in generalizability due to high attrition and low sample size, it deepens the understanding of the phenomenological experience of ibogaine and explores the possible utility of ibogaine in the treatment of substance use disorders.     

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

Aims   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.
Design   Three waves of data came from a cohort of 1108 adults reporting a life-time history of heroin and/or cocaine use.
Setting   Low-income neighborhoods with high rates of drug use in Baltimore, Maryland.
Participants   Participants had weekly contact with drug users and were 18 years of age or older.
Measurements   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.
Conclusions   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.     

“Foam Cone” exuding from the mouth and nostrils following heroin overdose

A “foam cone” exuding the mouth and nostrils is a recognized consequence of anoxia following pulmonary edema. In this report, we illustrate and explain this phenomenon in victims of heroin overdose.     

Abuse liability of intravenous buprenorphine/naloxone and buprenorphine alone in buprenorphine‐maintained intravenous heroin abusers

Background Sublingual buprenorphine is an effective maintenance treatment for opioid dependence, yet intravenous buprenorphine misuse occurs. A buprenorphine/naloxone formulation was developed to mitigate this misuse risk. This randomized, double‐blind, cross‐over study was conducted to assess the intravenous abuse potential of buprenorphine/naloxone compared with buprenorphine in buprenorphine‐maintained injection drug users (IDUs). Methods Intravenous heroin users (n = 12) lived in the hospital for 8–9 weeks and were maintained on each of three different sublingual buprenorphine doses (2 mg, 8 mg, 24 mg). Under each maintenance dose, participants completed laboratory sessions during which the reinforcing and subjective effects of intravenous placebo, naloxone, heroin and low and high doses of buprenorphine and buprenorphine/naloxone were examined. Every participant received each test dose under the three buprenorphine maintenance dose conditions. Results Intravenous buprenorphine/naloxone was self‐administered less frequently than buprenorphine or heroin (P < 0.0005). Participants were most likely to self‐administer drug intravenously when maintained on the lowest sublingual buprenorphine dose. Subjective ratings of ‘drug liking’ and ‘desire to take the drug again’ were lower for buprenorphine/naloxone than for buprenorphine or heroin (P = 0.0001). Participants reported that they would pay significantly less money for buprenorphine/naloxone than for buprenorphine or heroin (P < 0.05). Seven adverse events were reported; most were mild and transient. Conclusions These data suggest that although the buprenorphine/naloxone combination has intravenous abuse potential, that potential is lower than it is for buprenorphine alone, particularly when participants received higher maintenance doses and lower buprenorphine/naloxone challenge doses. Buprenorphine/naloxone may be a reasonable option for managing the risk for buprenorphine misuse during opioid dependence treatment.     

Does opioid substitution treatment in prisons reduce injecting‐related HIV risk behaviours? A systematic review

Objectives To review systematically the evidence on opioid substitution treatment (OST) in prisons in reducing injecting‐related human immunodeficiency virus (HIV) risk behaviours. Methods Systematic review in accordance with guidelines of the Cochrane Collaboration. Electronic databases were searched to identify studies of prison‐based opioid substitution treatment programmes that included assessment of effects of prison OST on injecting drug use, sharing of needles and syringes and HIV incidence. Published data were used to calculate risk ratios for outcomes of interest. Risk ratios were not pooled due to the low number of studies and differences in study designs. Results Five studies were included in the review. Poor follow‐up rates were reported in two studies, and representativeness of the sample was uncertain in the remaining three studies. Compared to inmates in control conditions, for treated inmates the risk of injecting drug use was reduced by 55–75% and risk of needle and syringe sharing was reduced by 47–73%. No study reported a direct effect of prison OST on HIV incidence. Conclusions There may be a role for OST in preventing HIV transmission in prisons, but methodologically rigorous research addressing this question specifically is required. OST should be implemented in prisons as part of comprehensive HIV prevention programmes that also provide condoms and sterile injecting and tattooing equipment.     

Can a targeted GP-led clinic improve outcomes for street sex workers who use heroin?

Female street sex workers in the UK are often addicted to heroin, and sex work may be a result of the economic drive to fund this addiction. This study looks at outcomes of a primary care drugs treatment intervention for street sex workers who use heroin, using prescribed maintenance treatment with intensive health and psychosocial support. Thirty-four sex workers entered the study and 100% were retained in the study at 1 year. After 1 year, only 33% of participants were still sex workers. Quality of life had improved significantly and heroin use had reduced.