单独应用韩氏戒毒仪治疗海洛因成瘾121例创造

目的：观察单独应用韩氏戒毒治疗仪（ＨＡＮＳ）治疗海洛因成瘾戒断症状的效果。方法：选择１８１例有明显戒断症状的海洛因成瘾者，其中１２１例行ＨＡＮＳ治疗，其余６０例为对照组。于入院次日开始进行ＨＡＮＳ治疗，每天４次，每次３０ｍｉｎ；３０天后每天２次，７天后每天１次，共１５天。穴位：合谷、劳宫、内关、外关、双侧足三里、三阴交。频率：２／１００Ｈｚ。强度：上肢１２￣１６ｍＡ，下肢１６￣２６ｍＡ。对照组不给     

Lifetime multiple substance use pattern among heroin users before entering methadone maintenance treatment clinic in Yunnan,China

Introduction and Aims. Multiple substance use leads to greater levels of psycho‐behavioural problems, unsafe sex, and therefore a high risk of contracting sexually transmitted diseases, and is also more difficult to treat. This study aims to determine pattern of lifetime multiple substance use among Chinese heroin users before entering methadone maintenance treatment clinic. Design and Methods. A survey to obtain retrospective longitudinal data on lifetime multiple substance use was conducted among 203 heroin users in two of the biggest methadone maintenance clinics in Kunming City, Yunnan province. Results. All participants used more than one substance in their lifetime. Most of them used four or more substance groups (range two to seven groups). The most common substance patterns in lifetime use were alcohol, tobacco, opiates and depressants. Approximately 80% of them had a history of simultaneous substance use (co‐use). The most common combination of co‐use pattern was heroin with depressant. Common reasons for co‐use were to get high, to experiment, to sleep and to increase the potency of other drugs. Determinants of co‐use were education, marital status and family relationship. Discussion and Conclusions. Multiple substance use is highly prevalent among Chinese heroin users. Depressants are the most common substances used in combination with heroin.[Li L, Sangthong R, Chongsuvivatwong V, McNeil E, Li J. Lifetime multiple substance use pattern among heroin users before entering methadone maintenance treatment clinic in Yunnan, China. Drug Alcohol Rev 2010]     

The global diversion of pharmaceutical drugs

Aims   This paper explores India's role in the world illicit opiate market, particularly its role as a producer. India, a major illicit opiate consumer, is also the sole licensed exporter of raw opium: this unique status may be enabling substantial diversion to the illicit market.
Methods   Participant observation and interviews were carried out at eight different sites. Information was also drawn from all standard secondary sources and the analysis of about 180 drug-related criminal proceedings reviewed by Indian High Courts and the Supreme Court from 1985 to 2001.
Findings   Diversion from licit opium production takes place on such a large scale that India may be the third largest illicit opium producer after Afghanistan and Burma. With the possible exceptions of 2005 and 2006, 200–300 tons of India's opium may be diverted yearly. After estimating India's opiate consumption on the basis of UN-reported prevalence estimates, we find that diversion from licit production might have satisfied a quarter to more than a third of India's illicit opiate demand to 2004.
Conclusions   India is not only among the world's largest consumer of illicit opiates but also one of the largest illicit opium producers. In contrast to all other illicit producers, India owes the latter distinction not to blatantly illicit cultivation but to diversion from licit cultivation. India's experience suggests the difficulty of preventing substantial leakage, even in a relatively well-governed nation.     

海洛因中毒性脑病—附5例临床分析

目的 报道和分析5例海洛因中毒性脑病患的临床资料，探讨该病的诊断及可能的发病机制。方法 详细询问病史，头颅MRI和其它辅助性检查以及治疗和转归分析。结果 治疗1个月后，4例患感觉运动功能基本恢复，精神症状不同程度减轻；2例遗留计算力、记忆力差；死亡1例，死因为出院后再次吸毒过量引起呼吸衰竭。结论 根据患明确的吸毒吸以及一系列神经精神症状和神经系统阳性体征、头颅MRI特征性改变，该病可有明确的诊断。其发病机制除与海洛因直接损害中枢神经系统有关外，还与黑市上出售的低纯度海洛因引起脱髓鞘病变有关。     

HUMAN ERYTHROCYTE BUT NOT BRAIN ACETYLCHOLINESTERASE HYDROLYSES HEROIN TO MORPHINE

1. In human blood, heroin is rapidly hydrolysed by sequential deacylation of two ester bonds to yield first 6-monoacetylmorphine (6-MAM), then morphine. 2. Serum butyrylcholinesterase (BuChE) hydrolyses heroin to 6-MAM with a catalytic efficiency of 4.5/min per mumol/L, but does not proceed to produce morphine. 3. In vitro, human erythrocyte acetylcholinesterase (AChE) hydrolyses heroin to 6-MAM, with a catalytic efficiency of 0.5/min per mumol/L under first-order kinetics. Moreover, erythrocyte AChE, but not BuChE is capable of further hydrolysing 6-MAM to morphine, albeit at a considerably slower rate. 4. Both hydrolysis steps by erythrocyte AChE were totally blocked by the selective AChE inhibitor BW284c51 but were not blocked by the BuChE-specific inhibitor, iso-OMPA (tetraisopropylpyrophosphoramide). 5. The brain synaptic form of AChE, which differs from the erythrocyte enzyme in its C-terminus, was incapable of hydrolysing heroin. 6. Heroin suppressed substrate hydrolysis by antibody-immobilized erythrocyte but not by brain AChE. 7. These findings reveal a new metabolic role for erythrocyte AChE, the biological function of which is as yet unexplained, and demonstrate distinct biochemical properties for the two AChE variants, which were previously considered catalytically indistinguishable.     

The dynamics of heroin use; implications for intervention

STUDY OBJECTIVE: To use a readily available dataset to detect periods of epidemic change and to examine the progression of heroin epidemics in different geographical areas. To consider the implications of epidemic change for strategies to tackle drug misuse. DESIGN: Comparison of trends in new treatment demand, observed incidence, and age specific population rates for treated heroin users in two geographical areas. PARTICIPANTS: Heroin users recorded to have sought treatment. MAIN RESULTS: The areas studied seem to show differences with respect to trends in new treatment demand, incidence of heroin use and distribution of age specific population rates; indicating that they may be at different epidemic stages. CONCLUSIONS: These analyses show how areas may differ with respect to epidemic progression of heroin use. It is essential that government strategies, and local responses to these, should be cognisant of these dynamics.     

海洛因依赖者的海马区磁共振氢质子波谱改变

目的探讨海洛因依赖者的海马区氢质子磁共振波谱(1H MRS)改变。方法对30例自愿戒毒的海洛因依赖者及20例正常对照组进行脑部常规MR I及海马区1H MRS检查,分析海洛因依赖者海马区1H MR I波谱的改变。结果常规MR I扫描,所有检查者海马区均未见异常信号1。H MRS发现海洛因依赖者双侧海马区NAA/Cr低于正常对照组,有显著性差异(P<0.05);Cho/Cr与正常对照组比较无显著性差异。结论1H MRS可以早期显示海洛因的毒性效应造成的海马区神经元功能受损,而此时可不出现形态学改变。     

盐酸二氢埃托啡与海洛因滥用死亡者的尸体形态学观察

本文报告60例药物滥用致死尸体形态学改变。对20例盐酸二氢埃托啡(DHE)与安痛定(anileridine)混用者(简称D +A组)、20例DHE单用者(简称D组)和20例海洛因(heroin)单用者(简称H组)进行尸体形态学研究 ,结果表明 :(1)以上三组均有尸斑显著、口鼻泡沫分泌物、唇甲青紫和注射部位有新旧不一的感染等尸体改变 ,但以D +A组和D组的改变更为显著 ,与H组比较具有显著性差异(P<0.01) ;(2)腓肠肌和咬肌僵硬隆起改变只出现于D +A组和D组 ,是DHE滥用的特征性尸体改变 ;(3)三组均未检见药物滥用所致的瞳孔缩小改变。     

海洛因成瘾大白鼠脑组织超微结构变化的研究

目的：模仿人类吸毒成瘾方式建立海洛因成瘾动物模型，研究其脑组织超微结构改变，为深入研究海洛因成瘾神经生物学、行为学、神经药理学、成瘾戒断治疗等奠定基础。方法：采用递增法人为建立海洛因成瘾动物模型，设对照组和实验组，取两组动物多部位脑组织于电镜下观察超微结构改变。结果：海洛因成瘾大白鼠脑内多部位神经元胞体、轴突、树突都出现变性、坏死、凋亡等超微病理结构改变。对照组电镜超微影像正常。结论：海洛因成瘾大鼠脑组织出现广泛性损害，以变性为主，神经元凋亡是海洛因成瘾致脑神经元死亡的主要形式。