Factors for Employment: A Case-Control Study of Fully Employed and Unemployed Heroin Users

The purpose of this article is to characterize fully employed users of heroin, compare them with their unemployed counterparts, and identify demographic, human, and social capital and drug misuse factors that are differentially associated with full employment. A nested case-control research design was used to identify 122 fully employed users (cases) and 466 unemployed users (controls) from a larger study of African American, Hispanic, and non-Hispanic White men and women who were active heroin injectors and sniffers and recruited from the streets of Miami–Dade County, Florida, between July 1997 and February 2000. Multivariate logistic regression techniques were used to analyze data from the Modified AIDS Risk Behavior Questionnaire. Findings indicated that employed users were more likely to possess human capital and social capital and less likely to use crack cocaine than unemployed users. Intervention to increase and sustain the employability of persons who misuse heroin is essential. Protocols that enhance human capital and social capital and reduce the misuse of drugs will benefit programs that seek to improve the employment status of persons who misuse heroin. The study's limitations are noted.     

Prevalence and Correlates of Former Injection Drug Use Among Young Noninjecting Heroin Users in Chicago

Noninjecting heroin users (NIHU) that were 16–30 years old were street recruited in Chicago between 2002 and 2005 to examine factors associated with having ever injected. Participants completed computerized self-administered interviews and provided specimens for HIV and hepatitis serotesting. Of 689 NIHU, 51.2% were non-Hispanic Black, 64.4% were male, and the median age was 25 years. Former injection was reported by 17.9%; of those, 66.7% injected <10 times. Multivariable analysis identified individual and social factors that place young NIHU at increased risk of injection. Targeted interventions are necessary to prevent transitions to injection and reduce transmission of HIV and viral hepatitis infections. The study's limitations are noted.     

Development of a Risk Reduction Intervention to Reduce Bacterial and Viral Infections for Injection Drug Users

Bacterial infections are widespread problems among drug injectors, requiring novel preventive intervention. As part of a NIDA-funded study, we developed an intervention based on the Information-Motivation-Behavioral Skills model, past research, injection hygiene protocols, and data collected from focus groups with 32 injectors in Denver in 2009. Qualitative responses from focus groups indicated that most participants had experienced skin abscesses and believed that bacterial infections were commonly a result of drug cut, injecting intramuscularly, and reusing needles. Access to injection supplies and experiencing withdrawal were the most frequently reported barriers to utilizing risk reduction. Implications for intervention development are discussed.     

Mortality Risk for Cocaine Abusers in Relation to Heroin Use: A Follow-Up Study

Cohort study on 471 subjects resident in the metropolitan area of Bologna who had visited a public treatment center for problems due to the abuse of cocaine from January 1, 1988 to December 31, 2009. Two user typologies were created: cocaine users (no heroin) and heroin and cocaine users. Crude mortality rates and standardized mortality ratios were calculated. We performed a regression analysis using the Poisson method. The study results show a higher mortality risk for those injecting substances and for subjects who took both heroin and cocaine. They appear to have different characteristics from their counterparts who do not use heroin. Future studies should be oriented to this aspect.     

METODO,A Prospective Observational Study to Assess the Efficacy and Tolerability of Methadone in Heroin-Addicted Patients Undergoing a Methadone Maintenance Treatment: Preliminary Results at Baseline Evaluation

METODO (methadone efficacy therapy optimization dosage on-going) is a prospective observational study to assess the efficacy and tolerability of methadone in 500 heroin-addicted patients taking a methadone maintenance treatment, enrolled through 2010 to 2011 in five Italian sites, observed over 2 years. The Opiate Dosage Adequacy Scale has been used for the evaluation of the “adequacy” of the methadone dosage and to stratify patients in adequate and not adequate groups. The treatment efficacy has been evaluated in correlation to the dosage adequacy during the visits. Moreover, patients have been evaluated according to the retention rate and duration of retention in treatment and a series of questionnaires.     

Cocaine Addiction:

Analysis of the behavior of cocaine in the human brain with Positron Emission Tomography reveals that it is not only its affinity for the dopamine transporter that gives it its unique properties but also its fast pharmacokinetics. Its very fast uptake and clearance from the brain contrasts with that of methylphenidate, another drug that inhibits the DA transporter. Methylphenidate clears from the brain at a much slower rate and is less addictive than cocaine. We postulate that periodic and frequent stimulation of the dopaminergic system secondary to chronic use of cocaine favors activation of a circuit that involves the orbitofrontal cortex, cingulate gyrus, thalamus and striatum. This circuit is abnormal in cocaine abusers and we postulate that its activation by cocaine perpetuates the compulsive administration of the drug and is perceived by the cocaine abuser as a intense desire resulting in the loss of control over the drive to take more cocaine.     

The Expansion of Methadone Prescribing in Ontario, 1996–1998

Various Ontario agencies have co-operated to increase the availability of methadone maintenance treatment (MMT) across Ontario. It is expected that increased availability of MMT will lead to a reduction in some of the harms of opioid use, such as HIV infection acquired through needle use. This initiative is consistent with Canada's Drug Strategy and with MMT policy changes at the federal level and is responsive to concerns of methadone patient advocates and treatment providers. When the Methadone Program at The College of Physicians and Surgeons of Ontario was established in mid-1996, there were 975 patients in MMT across Ontario. At the end of 1998 - two and a half years later - there were over 4000. This expansion is attributed to policy changes at the provincial level which were facilitated by the development of MMT guidelines compatible with both harm reduction-based and abstinence-based treatment approaches and the development of a MMT training program and supporting reference materials.     

Attitudes to a Proposal for Controlled Availability of Heroin in Australia: Is it Time for a Trial?

As part of a wide-ranging investigation of the feasibility of providing heroin to dependent users, the views of key interest groups were sought. Sixty-six percent of Canberra residents and 31%, 71% and 76% of samples of police, service providers and drug users/ex-users, respectively, supported the notion of a trial of controlled heroin provision. Although the Canberra community was more supportive of a trial than the general public in Sydney or Queanbeyan, there was more support for controlled availability in all three communities than had been found in previous surveys for decriminalisation or legalisation. This suggests that options where strict social control on drug use is maintained are viewed more favourably by the general public than options where this control is perceived to be minimal or absent. These results are discussed in light of the groups' views of and experiences with illicit drug use.     

海洛因诱导条件性位置偏爱大鼠颞叶联络皮层遥测脑电的分析

目的：分析海洛因诱导条件性位置偏爱(conditioned place preference,CPP)大鼠颞叶联络皮层(temporal association cortex,TeA)脑电变化与觅药行为产生的关系。方法：运用大鼠脑立体定位技术对TeA区进行电极埋藏,通 过CPP视频系统结合脑电无线遥测技术,分别实时记录手术对照组(n=10)、海洛因诱导CPP组(n=20)大鼠TeA区黑、白 箱停留状态、黑-白箱穿梭和白-黑箱穿梭时脑电变化,分析其各脑电波百分比差异。结果：与手术对照组比较,海洛 因诱导CPP组大鼠在黑、白箱停留状态,左、右侧TeA区θ波百分比显著增加(P<0.05,P<0.01);大鼠黑-白箱、白-黑箱 穿梭时,海洛因诱导CPP组左、右侧TeA区δ波百分比显著减少(P<0.01),β波百分比显著增加(P<0.01),尤其表现为β2 波显著增加(P<0.05,P<0.01)。与海洛因诱导CPP组大鼠黑箱停留状态比较,黑-白箱穿梭时右侧TeA区θ波百分比显著 减少,β波百分比显著增加,尤其以β2波增加明显(P<0.01);与海洛因诱导CPP组大鼠白箱停留状态比较,白-黑箱穿 梭时右侧TeA区θ波百分比显著减少(P<0.01),但β波差异无统计学意义(P>0.05)。结论：海洛因诱导CPP大鼠右侧TeA 区快波(β,β2)频率增加,伴有θ波频率的相应减少,可能与海洛因诱导CPP大鼠觅药行为产生有关。     

Recurrent and Massive Life Threatening Epistaxis due to Nasal Heroin Usage

Epistaxis, active bleeding from the nose, is a common ear nose and throat emergency, and can be severe or even fatal. We report a severe life threatening recurrent massive nasal bleeding caused by intranasal heroin use that has not hitherto been reported in the English literature. A 24-year-old male who took heroin several times nasally presented with massive nasal bleeding. A blood transfusion and an operation to halt nasal bleeding were required. The patient did not experience a bleeding attack 2 months following cessation of nasal heroin use.