The ACT heroin trial: intellectual, practical and political challenges

An array of intellectual, practical and political challenges will be faced both if the Australian Capital Territory "heroin trial" does or does not eventuate. The intellectual challenges include the development of new methodologies and analytical tools for some of the outcome measures; the further development of a research process which involves all the relevant disciplines and interest groups; and capitalizing on an unprecedented opportunity to investigate the pharmacokinetics of heroin. The practicalities of setting up a trial also present a number of challenges, as does incorporating a health development approach. Political challenges include getting a sensible decision made about the trial, avoiding capture of the debate by supporters or opponents of drug law reform and avoiding unrealistic expectations. The major challenge if the trial does not go ahead is to implement other well-considered proposals which can be carefully evaluated.     

Heroin in the United Kingdom: different forms, different origins, and the relationship to different routes of administration

Heroin exists in the United Kingdom in several different forms, which vary not only in their country of origin and purity, but also in their suitability for use by either injecting or by 'chasing the dragon'. The availability of these different forms of heroin has varied considerably over time. A review of the characteristics and availability of these various forms of heroin in recent years is presented, accompanied by consideration of their probable intended use by injection or by 'chasing the dragon'. Samples of black market heroin in the salt form are usually used by injection, whereas the base form is usually taken by 'chasing the dragon'. The heroin yield to the drug user from samples of heroin taken by 'chasing the dragon' varies according to its base or salt format and according to the presence of other drugs in the sample. Heroin samples from different countries of production mostly conform to either base or salt form. Novel approaches at the macro level to prevention and control of heroin-related problems through influence upon this complex heroin market-place should now be considered.     

海洛因依赖者住院脱毒过程中的不良事件及其相关因素分析

目的:了解海洛因依赖者住院脱毒过程中出现的不良事件及其相关因素。方法:采用回顾性的方法,对630例海洛因依赖者在住院脱毒过程中出现的各种不良事件进行调查,并对相关因素进行分析。结果:不良事件的总发生率为17.6％。Logistic回归分析显示,整组不良事件患者的危险因素不明确。按不良事件的严重程度归类分组分析,其危险因素依次为:美沙酮最高剂量,血常规异常,合用抗精神病药物的种类以及目前吸食方式。结论:海洛因依赖者住院脱毒过程中不良事件较常见,它的发生既有患者自身的原因,又有医源性因素,值得重视。     

Acetylcholine Transmission in Nucleus Accumbens and VTA on Heroin- Seeking Elicited by Contextual and Conditioned Cues

The involvement of cholinergic transmission in heroin self - administration and the reinstatement of heroin - seeking was examined in rats trained to nose - poke for intravenous heroin. Systemic treatment with physostigmine modestly reduced the acquisition and rate of heroin self-administration. Following 10 -14 days of self-administration, rats were left in the home environment for 14 days. Withdrawn animals were evaluated for context-induced nosepokes during the first hour after being returned to the self-administration apparatus. One hr later a conditioned stimulus （ house light, light in the nose-poke hole, sound of the infusion pump） was presented to initiate cue-induced reinstatement.     

海洛因对大鼠黄嘌呤氧化酶和血尿酸的影响

目的:检测黄嘌呤氧化酶(xanthineoxidase ,XOD)和血浆尿酸含量,研究海洛因给药对嘌呤核苷酸分解代谢的影响。方法:建立海洛因给药、停药大鼠模型,测定尿酸及XOD含量。结果:给药组尿酸及XOD含量高于对照组。与给药组比较,两个停药组尿酸含量、血浆和肝XOD含量降低;停药8d组脑顶叶XOD含量降低,脑干XOD含量略有下降趋势。但两个停药组脑干XOD含量仍高于对照组。结论:海洛因通过增加XOD的含量,使嘌呤核苷酸分解代谢增强,且脑中这一作用消除较慢。     

海洛因依赖性人格概念的建构及其与心理健康的关系

目的:了解海洛因依赖性人格的概念结构,建立海洛因依赖性人格量表。方法:对10 5名海洛因戒除者的海洛因依赖性人格问卷的测试数据进行验证性因素分析。结果:(1)海洛因依赖性人格由海洛因渴求感和戒除效能感两个维度构成,二维模型对样本数据的拟合度较好;(2 )海洛因渴求感α=0 .86 6 ,戒断效能感α=0 . 92 3,所有项目与所属因素因子分的相关系数在0. 6 81- 0 . 876之间,P <0 .0 0 1,两个分量表的相关系数r =- 0 4 4 2 ,P <0 . 0 0 1;(3)海洛因渴求感和戒除效能感与自尊、孤独、抑郁的相关系数的绝对值在0 . 2 2 1- 0. 5 11之间,达到显著性水平;回归分析的结果显示,戒断效能感可解释自尊、孤独和抑郁14 . 4 %、10 . 8%和2 6 . 2 %的变异。结论:海洛因依赖性人格的概念的构想合理,其量表具有良好的项目区分度、内部一致性信度和效度。     

对男性海洛因依赖者康复训练效果的随访

目的:探索社区康复训练与劳动教养相结合的康复模式对男性海洛因依赖者的治疗效果。方法:以湖南省新开铺劳教大队的50名劳教吸毒人员为对照,对戒毒中心的50名劳教吸毒人员进行为期至少4个月的康复训练。康复训练以海洛因依赖者的需求、所处的康复阶段及接受能力为中心,包括强化戒毒治疗动机、减少吸毒造成的危害、复吸预防等各种技能训练。用成瘾严重度指数和应付方式问卷评估康复训练的疗效,并随访两组在解教后1 a的康复情况。结果:康复训练后海洛因依赖者幻想、退避、自责等不成熟型应付方式分值下降(P<0.01),求助的分值增加(P<0.01)。解教后1 a康复组与劳动教养组的戒断率差异无显著性,但康复训练组在海洛因滥用严重程度、违法犯罪行为和精神健康方面损害显著低于劳动教养组(P<0.05)。结论:劳动教养和社区康复训练都是对吸毒者有效的康复措施,康复训练的作用更大。     

我国部分地区非法成瘾物质使用第三次流行病学调查 第二部分:非法成瘾物质使用种类及方法

目的 :作为第三次全国非法成瘾物质使用流行病学调查报告的第二部分 ,本文报告我国 2 0 0 0年 6个吸毒高发区非法成瘾物质使用种类和方法。方法 :整群抽样 ,采用自行设计的调查表 ,以挨户、线索和机构调查相结合的方式调查了 5 374 7例 15a及 15a以上社区人群 (男 2 812 6 ,占 5 2 3% ,女 2 5 6 2 1,占 4 7 7% )的非法成瘾物质使用情况。结果 :使用者最近一个月非法使用的成瘾物质中 ,97 18%为海洛因 ,2 4 5 %为阿片 ,其它种类罕见 ;采用烫吸和静脉注射者所占比例分别为 6 8 4 2 %和2 2 98% ;75 99%的使用者使用频度在 7- 2 7次 周之间。结论 :目前我国非法使用的成瘾物质仍以阿片类为主 ,其中海洛因占首位 ,阿片次之 ;使用途径仍以烫吸为主 ,静脉注射其次。对其它非法成瘾物质使用流行病学调查仍有待深入     

43例海洛因依赖者并发带状疱疹和HIV感染分析

目的 :了解海洛因依赖者中并发带状疱疹和感染HIV之间的关系。方法 :对收治的戒毒人员中并发带状疱疹的患者进行抗 -HIV抗体检测。结果 :海洛因依赖者中并发带状疱疹的 4 3例患者抗 -HIV抗体均为阳性。结论 :在今后的戒毒治疗中 ,如遇感染带状疱疹的患者 ,应高度怀疑为HIV感染者或进入艾滋病发病期的病人 ,在诊断治疗、护理、隔离和防护工作中应予以高度重视。