Analytical studies on illicit heroin

The recovery of heroin in fumes was investigated. In the Netherlands the common mode of heroin smoking is the chasing the dragon procedure: heroin is heated on an aluminium foil by a lighter and the fumes are inhaled. The efficiency of the volatilization of heroin using this procedure was studied under laboratory conditions using thin layer chromatography, gas chromatography and high pressure liquid chromatography. A considerable influence of the form (salt or base) of the heroin was found as well as strong influences of other substances that may be present in illicit heroin samples as diluents. The danger of the inhalation of fumes containing unknown pyrolysis products is mentioned and a hypothesis is given for the phenomenon of heroin-leucoencephalopathy that was observed in heroin smokers in Amsterdam in 1981. The types of heroin encountered in the Netherlands are discussed with regard to their suitability for smoking.     

海洛因烟雾吸入致海绵状白质脑病的CT、MRI表现

目的 探讨海洛因烟雾吸入所致的海绵状脑病的CT、MRI征象,提高对该病的认识和诊断水平。方法 对4例加热吸食海洛因烟雾的患者进行颅脑CT或MR平扫和增强,MRI常规行SE序列平扫、增强,以及液体衰减反转恢复序列（FLAIR）、磁共振波谱（MRS）检查。结果 2例CT扫描的病例表现为双侧小脑半球、脑干、内囊后肢、大脑脚 、胼胝体压部、大脑后部脑白质对称性低密度灶,无强化。2例MRI检查的病例也表现为相应区域长T1、长T2信号,无强化。FLAIR像呈高信号,小脑病变较大脑明显,顶枕叶病变较额叶显著,MRS显示脑白质变性,乳酸升高。结论 该病的CT及MRI表现较具特征性,结合病史,可作出诊断。     

Stability of bupivacaine hydrochloride with diamorphine hydrochloride in an epidural infusion

The stability of diamorphine (0.02 mg/ml as the hydrochloride) in 250 ml bupivacaine hydrochloride (0.15% wt/vol infusion) was studied by high pressure liquid chromatography at temperatures in the range 7 to 45°C. Diamorphine hydrochloride was degraded by approximately 0.13% per day at 7°C. No bupivacaine hydrochloride degradation was detectable during the study. The storage life of the combination at 7°C, based on the lower 95% confidence limit of the time to 5% diamorphine hydrochloride degradation, was 14 days. The stability at 25°C was adequate to allow transport and administration over 24 h at ambient temperature. Stability was also maintained for at least 24 h at 32 and 45°C. Infusion of the mixture with an ambulatory infusion pump which uses a standard polyvinyl chloride infusion bag is therefore possible. A study of its compatibility with different infusion pump medication reservoirs was not undertaken. The drugs were also stable on frozen storage at –18°C for up to 6 months.     

Clinical observation on improvement of heroin withdrawal syndrome by acupuncture plus methadone

目的:观察针刺在美沙酮疗法改善海洛因戒断综合征中的作用.方法:将60例海洛因依赖者分为治疗组和对照组,治疗组给予针刺和美沙酮治疗,对照组给予美沙酮治疗.结果:治疗组戒断症状积分比对照组低(P＜0.05).治疗组戒断症状改善明显优于对照组(P＜0.05).结论:针刺配合美沙酮较为明显地改善戒断症状.     

Opioid Dependence and Methadone Maintenance Treatment during Pregnancy

The use of methadone maintenance treatment for the care of opioid-dependent individuals is well established. However, pregnant women who either are currently abusing opioids or are maintained on methadone present particular challenges to the obstetrician. As the outcomes of methadone-maintained pregnancies are consistently better than those of untreated opioid abusers, the recognition of dependence and the provision of appropriate prenatal and post-natal care are vital to the future health of both the baby and its mother. The literature is reviewed to provide an introduction to the abuse of heroin and its treatment with methadone. An overview of the medical management of the pregnant methadone-maintained woman is given, including care of the infant undergoing neonatal abstinence sydrome.     

Double-blind injectable hydromorphone versus diacetylmorphine for the treatment of opioid dependence: A pilot study

Using data from the North American Opioid Maintenance Initiative study, a Phase III randomized and parallel arm trial, this pilot study is aimed at testing if treatment response with injectable hydromorphone differs compared to diacetylmorphine in the treatment of long-term opioid addiction. A total of 140 long-term, treatment-refractory opioid-dependent individuals received either injectable diacetylmorphine (n = 115) or hydromorphone (n = 25), in a double-blind fashion, over 12 months. At the end of the study, none of the participants in the hydromorphone group thought they were definitely receiving this drug. Retention rates at 12 months with diacetylmorphine (87.8%; 95% confidence interval [CI] = 80.5%–92.7%) and hydromorphone (88.0%; 95% CI = 68.7%–96.1%) were virtually identical. The use of illicit heroin in the prior month declined from a mean of 26.6 and 26.3 days at baseline to 5.3 and 5.2 days at 12 month in the diacetylmorphine and hydromorphone groups, respectively. There were no differences between diacetylmorphine and hydromorphone in the adjusted mean scores of the European Addiction Severity Index. There were no differences in the safety profile of the medications. Hydromorphone may be similarly safe and effective as diacetylmorphine as opioid-agonist substitution treatment; future studies are required to confirm it. Further study will also be required to show that open-label hydromorphone can also successfully attract patients into care and retain them.