Menstrual cycle length during methadone maintenance

AIMS: While the menstrual disruption of heroin has been demonstrated, there are few published data concerning methadone maintenance and menstrual function. This study was conducted to evaluate whether cycle length was more regular during methadone maintenance. SETTINGS: An out-patient research treatment program in Baltimore, Maryland, USA. PARTICIPANTS: A total of 191 heroin and cocaine-using women from two clinical trials, lasting 25-29 weeks; each woman was maintained on 70-100 mg of methadone. MEASUREMENTS: Start/end dates of each menses were collected. DESIGN: Menstrual patterns were classified as regular, irregular, transient amenorrhea, persistent amenorrhea or cycle restart. Repeated-measures regression modeling determined correlates of cycle length and predictors of long cycles (> 40 days) and short cycles (< 20 days). Bleeding episodes were defined as 1 or more bleeding days, bound by at least 2 non-bleeding days. Correlates/predictors examined were body mass index, drug use, methadone dose and race. FINDINGS: In the 133 women for whom menstrual patterns could be determined, cycle-length irregularity was common: irregular, 62 (46.7%); regular, 37 (27.8%); cycle restart, 16 (12%); persistent amenorrhea, 11 (8.3%); transient amenorrhea, seven (5.3%). Each additional week on methadone maintenance was associated with decreased risk of long (OR = 0.96, P < 0.01 and short (OR = 0.92, P < 0.01) cycles. Of 27 women with secondary amenorrhea pre-study, 16 (59%) restarted menses. Positivity for opioids or cocaine was not significantly associated with short or long cycles. CONCLUSIONS: Cycle length begins to normalize during methadone maintenance. Menses resumption may occur. Methadone maintenance, despite interfering with menstrual function in an absolute sense, may interfere less than illicit heroin abuse.     

Differential involvement of the prelimbic cortex and striatum in conditioned heroin and sucrose seeking following long-term extinction

Relapse to drug taking is triggered by stimuli previously associated with consumption of drugs of misuse (cues) and involves brain systems controlling motivated behaviour towards natural reinforcers. In this study, we aimed to identify and compare neuronal pathways in corticostriatal systems that control conditioned heroin or natural reward (sucrose) seeking. To that end, rats were trained to self-administer heroin or sucrose in association with an identical compound cue. After more than 3 weeks of abstinence during extinction training, cue exposure robustly reinstated heroin and sucrose seeking, but induced distinct and even opposing changes in the expression of the neuronal activation marker zif268 in the prelimbic cortex and striatal complex, respectively. Because in the prelimbic area zif268 expression was enhanced during cue-induced heroin seeking but unaffected during sucrose seeking, a pharmacological intervention was aimed at this prefrontal region. Injection of a GABA agonist mixture within the prelimbic area enhanced conditioned heroin seeking, but had no effect on conditioned sucrose seeking. Our findings suggest a differential role of the prelimbic area and the striatum in the persistence of heroin vs. sucrose seeking following long-term extinction.     

Changes in patterns of drug use among injecting drug users following changes in the availability of heroin in New South Wales, Australia

The aim of this study was to examine changes in drug use patterns among groups of injecting drug users (IDU) who remained in the drug market during a period of reduced heroin availability in NSW, Australia. Cross-sectional data collected from regular IDU interviewed as part of the NSW Illicit Drug Reporting System (IDRS) between 1996 - 2003 were analysed. Drug use patterns, reported drug availability and price were assessed. There was a marked decrease in the frequency of heroin use during the period of reduced availability in 2001, with some increase in 2002 and 2003. Heroin availability and frequency of use have not returned to levels reported prior to 2001; however; even at the peak of the reduction in supply, users continued to access heroin. There was a significant shift among IDU from heroin to cocaine during 2001, which subsequently reversed. The availability of cocaine has fluctuated in recent years, but the price has remained stable. The price of heroin appeared to be more responsive to market fluctuations, and co-varied with heroin availability. IDU used cocaine when heroin was less available; however, patterns of cocaine use were not maintained. The frequency of heroin use remained lower, which may be indicative of a less consistent supply, increased price or increased numbers of IDU entering treatment. The reduced supply of heroin in 2001 highlighted the adaptable nature of IDU patterns of use, indicative of the need for a commensurate treatment response. It also highlighted the importance of the ongoing monitoring of drug trends in Australia. [Roxburgh A, Degenhardt L, Breen C. Changes in patterns of drug use among injecting drug users following changes in the availability of heroin in New South Wales, Australia. Drug Alcohol Rev 2004;23:287-294]     

Concomitant drugs of misuse and drug using behaviours associated with fatal opiate-related poisonings in Sheffield,UK, 1997-2000

Aims To examine the degree of involvement of concomitant drugs of misuse and other previously identified behavioural risk factors in acute accidental opiate‐related poisoning fatalities in Sheffield, 1997–2000. Design Retrospective analysis of coroners’ records. Setting Sheffield, UK. Participants All those who died from an acute accidental opiate‐related poisoning in Sheffield between 1 January 1997 and 31 December 2000. Measurements Coronial data were collated under the headings: demographic characteristics, circumstances of death and toxicological findings. Findings Ninety‐four deaths occurred over the study period. The majority of cases were regular users of illicit drugs. Approximately 20% of deaths were preceded by a period of abstinence from drug use, with imprisonment and hospitalization as the most common reasons. Sixty‐one per cent of cases had concomitant drugs of misuse detected from toxicology most commonly benzodiazepines and/or alcohol. These were, however, found in relatively small concentrations and opiate blood concentrations were no lower in deaths where multiple substances were involved. Despite evidence to suggest that smoking is the preferred route of heroin administration in this region, the vast majority of cases involved injecting. Conclusions Administration of an opiate via intravenous injection was the most consistent factor associated with these deaths over the period of this study. Co‐administration of other central nervous system depressants, at least in lower quantities appear to be a feature rather than a risk factor per se in such fatalities.     

Learning the Language of Abstinence in Addiction Treatment: Some Similarities Between Relapse-Prevention with Disulfiram,Naltrexone, and Other Pharmacological Antagonists and Intensive “Immersion” Methods of Foreign Language Teaching

Relapse-prevention (RP) is an educational process. Learning to abstain from alcohol or opiates after years of dependence involves selectively suppressing old, maladaptive habits of thought and behavior and establishing new, adaptive ones. This process resembles foreign language (FL) learning. Effective FL teaching techniques are relevant to RP. Immersion, the most effective FL teaching method, discourages students from using their first language ab initio, requiring them to use the FL instead, however inexpertly. It resembles exposure and response-prevention for phobic or compulsive disorders. Supervised disulfiram aids RP by discouraging alcoholics from responding to real-life drinking cues in the language of excessive drinking, requiring them, ab initio, to practice new, alcohol-free responses. Supervised or depot naltrexone acts similarly in opiate dependence. We discuss the concept of antagonist-assisted abstinence.     

Gamma-vinyl GABA (GVG) blocks expression of the conditioned place preference response to heroin in rats

We examined the effect of gamma-vinyl GABA (GVG) on the expression of the conditioned place preference response to intraperitoneally (i.p.) administered heroin in rats. Heroin, but not vehicle, produced a significant conditioned place preference response. Pretreatment of animals with 300 mg/kg of GVG significantly attenuated the expression of the heroin-induced conditioned place preference response. These results are the first to suggest that systemic GVG may provide an effective alternative to methadone maintenance in the treatment of heroin addiction, since it is without abuse potential and can be used for treatment outside an institutional setting.     

海洛因依赖大鼠空肠5-羟色胺免疫反应细胞免疫组织化学及形态计量研究

目的:探讨海洛因依赖对大鼠空肠5-羟色胺免疫反应(5-HT-IR)细胞的影响.方法:应用免疫组织化学SABC法、图像分析法及形态计量法,研究海洛因依赖期间大鼠空肠5-HT-IR细胞的免疫组织化学反应、平均灰度值及细胞数量的变化.结果:海洛因依赖组大鼠空肠5-HT-IR细胞的免疫反应较空白组及盐水对照组明显增强,免疫染色加深,以24 d最显著;图像分析表明,海洛因依赖组大鼠空肠5-HT-IR细胞平均灰度值显著降低(P＜0.05),以24 d最低;海洛因依赖组大鼠空肠5-HT-IR细胞数量明显增多(P＜0.05).结论:海洛因依赖大鼠空肠5-HT-IR细胞通过增加细胞数量和增强细胞分泌能力,参与了海洛因依赖期间机体的调节过程.     

海洛因依赖脱毒后的康复治疗及回归社会

为降低复吸率,本研究对急性脱毒后的戒毒者采用康复治疗及回归社会帮教方法,在康复期进行认知及行为治疗,矫正其不良认知及行为。回归社会后予以继续教育,指定专人帮教,医院负责辅导帮教小组,定期跟踪检测尿液中吗啡类物质,组织康复者之家活动。结果使复吸率降至８７％。提示：在药物急性脱毒治疗后进行心理康复,有助于降低戒毒者复吸率,而回归社会的社区管理是降低复吸率的必要措施     

海洛因依赖者脑血流动力学的变化

本文应用经颅多普勒超声（ＴＣＤ）检测９０例海洛因依赖者的脑血流动力学的变化。结果表明观察组脑底动脉收缩期峰值血流速度明显高于正常对照组,差异非常显著（Ｐ＜０．０１）;大脑中动脉、前动脉、后动脉,椎基底动脉收缩期峰值血流速度改变与海洛因滥用时间呈正相关,不同滥用期之间差异有显著性（Ｐ＜０．０５）。结果提示：滥用海洛因导致脑血管功能障碍     

86例海洛因滥用者静脉注射毒品的原因分析

目的··：了解药物滥用者从烫吸发展到静脉注射的原因及静脉注射对滥用者个人造成的影响。方法··：对８６例海洛因静脉注射者进行调查和资料分析。结果··：采用静脉注射滥用海洛因的原因分别为好奇、享受、对毒品的渴求、寻求欣快感和毒资匮乏等。此种滥用方法已给滥用者造成全身感染和局部的损害。结论··：要注意消除滥用者脱毒期的心理障碍,脱毒后要开展心理治疗,生活和职业训练,进行正确的人生观教育。