Search

This study aims to investigate the effect of detoxification on acoustic features of Mandarin speech. Speech recordings were collected from 66 male abstinent heroin users with different durations of drug detoxification, specifically early abstinent users with a detoxification duration of less than 2 years, sustained abstinent users with 2 years of detoxification, and long-term abstinent users with a detoxification duration of more than 2 years. The results of the acoustic analyses showed that early abstinent users exhibited lower loudness, relative energies of F1, F2, and F3, higher H1–A3, and fewer loudness peaks per second, as well as a longer average duration of unvoiced segments, compared to the sustained and long-term abstinent users. The findings suggest that detoxification may lead to a rehabilitation process in the speech production of abstinent heroin users (e.g., less vocal hoarseness). This study not only provides valuable insights into the effect of detoxification on speech production but also provides a theoretical basis for the speech rehabilitation and detoxification treatment of heroin users. [ABSTRACT FROM AUTHOR]

Rationale: Opioid injection drug use (IDU) has been linked to a more severe pattern of use (e.g. tolerance, overdose risk) and shorter retention in treatment, which may undermine abstinence attempts. Objectives: This secondary data analysis of four human laboratory studies investigated whether current opioid IDU modulates subjective abuse liability responses to high-dose hydromorphone during intermediate-dose buprenorphine stabilization (designed to suppress withdrawal but allow surmountable agonist effects), and whether hydromorphone response magnitude predicts latency of return to opioid use during buprenorphine dose-tapering. Methods: Regular heroin users not currently seeking treatment (n = 54; 29 current injectors, 25 non-injectors) were stabilized on 8-mg/day sublingual buprenorphine and assessed for subjective responses (e.g. 'liking', craving) to hydromorphone 24-mg intramuscular challenge (administered 16-hr post-buprenorphine) under randomized, double-blinded, controlled conditions. A subgroup (n = 35) subsequently completed a standardized 3-week outpatient buprenorphine dose-taper, paired with opioid-abstinent contingent reinforcement, and were assessed for return to opioid use based on thrice-weekly urinalysis and self-report. Results: During buprenorphine stabilization, IDU reported lower 'liking' of buprenorphine and post-hydromorphone peak 'liking', 'good effect' and 'high' compared to non-IDU. Less hydromorphone peak increase-from-baseline in 'liking' (which correlated with less hydromorphone-induced craving suppression) predicted significantly faster return to opioid use during buprenorphine dose-tapering. Conclusions: In these buprenorphine-stabilized regular heroin users, IDU is associated with attenuated 'liking' response (more cross-tolerance) to buprenorphine and to high-dose hydromorphone challenge and, in turn, this cross-tolerance (but not IDU) predicts faster return to opioid use. Further research should examine mechanisms that link cross-tolerance to treatment response. [ABSTRACT FROM AUTHOR]

Opioid addiction is a global problem that has been exacerbated in the USA and Europe by the COVID-19 pandemic. The globus pallidus (GP) plays a prominent neurobiological role in the regulation of behaviour as an output station of the striato-pallidal system. GABAergic large projection neurons are the main neuronal type in the external (EGP) and internal (IGP) parts of the GP, where addiction-specific molecular and functional abnormalities occur. In these neurons, glutamate decarboxylase (GAD) with isoforms GAD 65 and 67 is a key enzyme in GABA synthesis, and experimental studies suggest GAD dysregulation in the GP of heroin addicts. Our study, which was performed on paraffin-embedded brains from the Magdeburg Brain Bank, aimed to investigate abnormalities in the GABAergic function of large GP neurons by densitometric evaluation of their GAD 65/67-immunostained thick dendrites. The study revealed a bilaterally decreased fibres density in the EGP paralleled by the increase in the IGP in 11 male heroin addicts versus 11 healthy controls (significant U-test P values). The analysis of confounding variables found no interference of age, brain volume, and duration of formalin fixation with the results. Our findings suggest a dysregulation of GABAergic activity in the GP of heroin addicts, which is consistent with experimental data from animal models and plays potentially a role in the disturbed function of basal ganglia circuit in opioid addiction. [ABSTRACT FROM AUTHOR]

Drug addiction can cause severe damage to the human brain, leading to significant problems in cognitive processing, such as irritability, speech distortions, and exaggeration of negative stimuli. Speech plays a fundamental role in social interaction, including both the production and perception. The ability to perceive communicative functions conveyed through speech is crucial for successful interpersonal communication and the maintaining good social relationships. However, due to the limited number of previous studies, it remains unclear whether the cognitive disorder caused by drug addiction affects the perception of communicative function conveyed in Mandarin speech. To address this question, we conducted a perception experiment involving sixty male participants, including 25 heroin addicts and 35 healthy controls. The experiment aimed to examine the perception of three communicative functions (i.e., statement, interrogative, and imperative) under three background noise conditions (i.e., no noise, SNR [Signal to Noise Ratio] = 10, and SNR = 0). Eight target sentences were first recorded by two native Mandarin speakers for each of the three communicative functions. Each half was then combined with Gaussian White Noise under two background noise conditions (i.e., SNR = 10 and SNR = 0). Finally, 48 speech stimuli were included in the experiment with four options provided for perceptual judgment. The results showed that, under the three noise conditions, the average perceptual accuracies of the three communicative functions were 80.66% and 38% for the control group and the heroin addicts, respectively. Significant differences were found in the perception of the three communicative functions between the control group and the heroin addicts under the three noise conditions, except for the recognition of imperative under strong noise condition (i.e., SNR = 0). Moreover, heroin addicts showed good accuracy (around 50%) in recognizing imperative and poor accuracy (i.e., lower than the chance level) in recognizing interrogative. This paper not only fills the research gap in the perception of communicative functions in Mandarin speech among drug addicts but also enhances the understanding of the effects of drugs on speech perception and provides a foundation for the speech rehabilitation of drug addicts. [ABSTRACT FROM AUTHOR]

The article discusses a neuroimaging study revealing heightened corticolimbic reactivity in heroin-addicted individuals to drug-related cues compared to healthy controls. The study explores two addiction theories, iRISA and incentive sensitization, suggesting that increased salience and motivational "wanting" for drugs contribute to limbic hyperreactivity. Topics include neural hyperreactivity patterns, cognitive regulation attempts, and implications for addiction treatment strategies.

This study investigates the impact of methadone maintenance treatment (MMT) on the brain glymphatic system (GS) in opioid addiction in China. A total of 51 male MMT patients, 48 demographically matched healthy controls (HCs), and 20 heroin dependents (HDs) were recruited for this study. The GS functioning was assessed using diffusion-tensor-imaging analysis along perivascular spaces (DTI-ALPS index) and the bilateral ALPS divergency (DivALPS). Group differences were analyzed utilizing ANOVA and two-sample t-tests. The relationship between DivALPS and relapse rate was explored using regression analysis. The DTI-ALPS index was significantly higher for the left-side brain than the right side in all three groups. There was a significant difference for the right side (p = 0.0098) between the groups. The MMT and HD groups showed significantly higher DTI-ALPS than the HC group (p = 0.018 and 0.016, respectively). The DivALPS varied significantly among the three groups (p = 0.04), with the HD group showing the lowest and the HC group the highest values. Significant negative relationships were found between relapse count, DivALPS (p < 0.0001, Exp(B) = 0.6047), and age (p < 0.0001, Exp(B) = 0.9142). The findings suggest that MMT may contribute to promoting brain GS recovery in heroin addicts, and modulation of the GS may serve as a potential biomarker for relapse risk, providing insights into novel therapeutic strategies. [ABSTRACT FROM AUTHOR]

We and others have observed reduced volumes of brain regions, including the nucleus accumbens, globus pallidus, hypothalamus, and habenula in opioid addiction. Notably, the insular cortex has been under increasing study in addiction, and a smaller anterior insula has been found in alcohol-addicted cases. Here, we have investigated whether similar effects occur in heroin addicts compared to healthy controls. Volumes of the anterior and posterior insula in heroin addicts (n = 14) and controls (n = 13) were assessed by morphometry of Nissl-myelin-stained serial whole-brain coronal sections. The mean relative volume of the anterior insular cortex was smaller than in non-addicted controls (3010 ± 614 *10–6 versus 3970 ± 1306 *10–6; p = 0.021). However, no significant differences in neuronal cell counts were observed. Therefore, the observed volume reduction appears to be a consequence of damaged connecting structures such as neuropil and glial cells. The findings were not confounded by age or duration of autolysis. Our results provide further evidence of structural deficits in key hubs of the addiction circuitry in heroin-dependent individuals and warrant further research in this area. [ABSTRACT FROM AUTHOR]

Background: Heroin-Assisted Treatment (HAT) is well evidenced internationally to improve health and social outcomes for people dependent on opioids who have not been helped by traditional treatment options. Despite this evidence base, England has been slow to implement HAT. The first service outside of a trial setting opened in 2019, providing twice-daily supervised injections of medical-grade heroin (diamorphine) to a select sample of high-risk heroin users in Middlesbrough. This paper explores their experiences, including the negotiation of the strict regularly controls required of a novel intervention in the UK context. Methods: We conducted in-depth interviews with service providers and users of the Middlesbrough HAT service between September and November 2021. Data from each group were thematically analysed and reported separately. This paper details the experiences of the twelve heroin dependent men and women accessing HAT. Results: Participants' accounts of HAT treatment evidenced a tension between the regulatory constraints and uncertainty of treatment provision, and the positive outcomes experienced through supportive service provision and an injectable treatment option. Limited confidence was held in treatment efficacy, longevity of funding, and personal capacity for treatment success. This was counteracted by a strong motivation to cease engagement with the illicit drug market. While attendance requirements placed restrictions on daily activities, participants also experienced benefits from strong, supportive bonds built with the service providers through their continued engagement. Conclusions: The Middlesbrough HAT programme provided benefits to a high-risk population of opioid dependent people who were unable or disinclined to participate in conventional opioid substitution treatments. The findings in this paper highlight the potential for service modifications to further enhance engagement. The closure of this programme in 2022 prohibits this opportunity for the Middlesbrough community, but holds potential to inform advocacy and innovation for future HAT interventions in England. [ABSTRACT FROM AUTHOR]

Background: Suicide is considered a fundamental problem in discussions on public and global health. Thus, the current study aimed to review the prevalence of and reasons for successful suicide attempts in heroin users. Methods: This study was conducted by systematically searching the electronic databases of PubMed, Scopus, Web of Science, and PsycINFO from 1960/1/1 to 2021/11/1 based on the PRISMA checklist and using MeSH keywords with no temporal or linguistic limitations. The primary and secondary impacts of suicide were identified, and all studies following an observational design (cohort, case-control, and cross-sectional studies) were included in the research. Data analysis was performed using Stata version 13. Finally, 17 studies were included in the work process for systematic review and meta-analysis. Findings: The results showed the most frequent reasons for suicide among the studied individuals were gender (being female), youngness, heroin overdose, multi-drug abuse, history of repeated suicide attempts, history of psychiatric disorder (especially depression), joblessness, homelessness, distorted family relationships, etc. Moreover, the results of synthesizing the studies revealed the prevalence of suicide attempts equaled the effect size (95% CI = 0.3 [0.23-0.37]) among these individuals, and the prevalence of successful suicides approached the effect size (95% CI = 0.03 [0.01-0.05]). Conclusion: The results of the present study showed the high prevalence of suicidal thoughts and suicide attempts among the heroin-abusing population. Furthermore, according to the findings, the prevalence of unsuccessful suicide attempts was ten times more than that of successful ones in the target population. [ABSTRACT FROM AUTHOR]

As societal attitudes toward narcotics have changed, harm reduction strategies have emerged which make it safer to inject intravenous drugs. Diamorphine (heroin) is commonly sold as its free base—better known as brown—which has extremely poor aqueous solubility. As such, it needs to be chemically modified (cooked) to enable administration. Needle exchange programmes commonly supply citric or ascorbic acids which facilitate intravenous administration by increasing heroin solubility. If heroin users mistakenly add too much acid, the low solution pH can cause damage to their veins and, after repeated injury, could result in the loss of that injection site. Currently, advice cards supplied with these exchange kits suggest that the acid should be measured in pinches, which could result in considerable error. This work employs Henderson–Hasselbalch models to analyse the risk of venous damage by placing solution pH within the context of the buffer capacity of the blood. These models also highlight the significant risk of heroin supersaturation and precipitation within the vein, an event that has the potential to cause further harm to the user. This perspective closes with a modified administration method which could be included as part of a wider harm reduction package. [ABSTRACT FROM AUTHOR]

The opioid epidemic resulted in an increase in identifications of fentanyl, fentanyl analogs, and heroin, among other opioids, in the toxicology and seized drug analysis fields over the past several years. The Dallas County Southwestern Institute of Forensic Sciences, comprised of the Toxicology Laboratory and Drug Analysis Laboratory, observed a rise in fentanyl‐positive analyses in both laboratories. Fentanyl positivity increased from 1.1% to 3.4% in the Toxicology Laboratory over the five years of this study, whereas 6‐monoacetylmorphine (6‐MAM) positivity remained relatively stable at approximately 2%. Similarly, in the Drug Analysis Laboratory, the fentanyl positivity rate changed from 0.03% to 0.60%, whereas heroin identification remained stable at approximately 8–9%. Based on data obtained from toxicology submissions, a typical fentanyl or heroin user was a white male in their late 30s. The average concentration of fentanyl in postmortem cases, antemortem cases, and 6‐MAM in postmortem specimens was 9.7 ng/ml, 5.5 ng/ml, and 68.4 ng/ml, respectively. Poly‐drug use was evident, with benzodiazepines being the most commonly co‐administered drug with fentanyl (49.4%). Multiple drugs were identified via analysis of clandestine tablets submitted to the Drug Analysis Laboratory, including fentanyl and/or heroin in combination with compounds such as cocaine, etizolam, and acetaminophen. The most frequently identified clandestine tablet was "M367," typically manufactured to contain acetaminophen and hydrocodone, but was found to contain fentanyl or heroin. The results from this study aid in the understanding of the current opioid trends in Dallas County and provides an opportunity for comparison to other populations and geographical regions. [ABSTRACT FROM AUTHOR]

Previous studies have explored effects of the conscious processing of emotional information on the interaction between emotion and executive control. However, the conscious processing of emotional information introduces "defensive responses," which might limit the emotional effect. To avoid the limitations, this study aimed to explore the effect of automatic emotional processing on response inhibition among heroin abstainers. Individuals experiencing heroin withdrawal symptoms are not entirely exempt from the influence of drugs, and it is challenging to find heroin addicts in practice. Therefore, similar to previous studies, we recruited heroin abstainers in this study. In Experiment 1, for the heroin abstainers group, 30 participants meeting the inclusion criteria were recruited from a compulsory isolated detoxification center, whereas 30 age‐ and education‐matched participants were recruited from the community as the control group. These participants completed the Go/No‐Go task by supraliminal emotional priming. In Experiment 2, the heroin abstainers group comprised 33 eligible participants and control group comprised 33 eligible participants. These participants completed the Go/No‐Go task by subliminal emotional priming. We compared the participants' rates of commission errors in the Go/No‐Go tasks. The rate of commission errors was lowest upon the activation of positive emotion. Moreover, under subliminal emotional priming, the rate of commission errors for the heroin abstainers group was significantly lower than that for the control group. However, regarding supraliminal emotional priming, there was no significant difference between the rates of commission errors for the two groups. These results suggest automatic positive emotional processing can enhance response inhibition among heroin abstainers. Moreover, under subliminal emotional priming, heroin abstainers had more enhanced response inhibition than the control groups. This study plays a significant role in understanding the effect of automatic emotional processing on response inhibition among drug addicts. This study also provides a theoretical basis for ensuring enhanced response inhibition among drug addicts. [ABSTRACT FROM AUTHOR]

Opioid addiction is a worldwide problem accentuated in the USA and European countries by the COVID-19 pandemic. The nucleus accumbens (NAc) plays an outstanding neurobiological role in opioid addiction as a part of the striatum and key component of brain reward system. The striatal GABAergic medium spiny projection neurons (MSNs) are the main neuronal type in the NAc where addiction-specific synaptic plasticity occurs. The activity of ribosomal DNA (rDNA) transcription is crucial for neural plasticity and molecular studies suggest its increase in the NAc of heroin addicts. Silver-stained argyrophilic nucleolar organizer region (AgNOR) areas visualised in neuronal nuclei in paraffin-embedded brain sections are reliable morphological estimators of rDNA transcription and thus surrogate markers for the activity of brain regions. Our study revealed increased AgNOR areas in MSNs of the left NAc in 11 heroin addicts versus 11 healthy controls from the Magdeburg Brain Bank (U-test P = 0.007). No differences were observed in another investigated part of the striatum, namely the head of caudate nucleus, which is located closely to the NAc. The results were not confounded by significant differences in the age, brain volume and time of formalin fixation existing between compared groups. Our findings suggest an increased NAc activity in heroin addicts, which is consistent with human and animal experimental data. [ABSTRACT FROM AUTHOR]

Away from hemorheological properties, the effect of heroin addiction on erythrocytes is poorly investigated. This study aimed to investigate the oxidative impacts of heroin administration on erythrocytes. Study subjects included chronic intravenous heroin addicts and control subjects. Hematological analysis and redox parameters were measured, including serum concentration of methemoglobin ([MethHb]), serum glutathione peroxidase-1 ([GPX-1]), serum glutathione peroxidase (GPX) activity, erythrocytic protein carbonyl content, and oxidized to reduced glutathione (GSSG/GSH) ratio. Hematological analysis revealed that addicts had a significantly higher red cell distribution width, consistent with the mild anisocytosis and poikilocytosis of erythrocytes. As compared to control subjects, significantly higher levels of serum [Met-Hb], [GPX-1], and GPX activity (p < 0.001) were reported among addicted subjects. A significant association between [MetHb] and GPX activity was observed with r = 0.764 (p < 0.001). Furthermore, significantly higher erythrocytic protein carbonyl contents and GSSG/GSH ratio were evident among heroin addicts (p < 0.005) that were significantly associated with r = 0.429 (p = 0.01). Results demonstrate preliminary evidence that heroin addiction is implicated in impaired redox status of erythrocytes. Considering the pharmacokinetics of heroin, erythrocytic antioxidant mechanisms, and turnover rate, further investigation is required to evaluate the extent and clinical outcomes, especially upon over-dose administration. [ABSTRACT FROM AUTHOR]

We aim in this research to show the global behavior of each equilibrium of a heroin epidemic model with distributed delays. We obtained that the global behavior of the considered system is completely governed by the value of the basic reproduction number ℜ 0 . For the case when ℜ 0 is less than one, we established the global stability of the drug-free equilibrium using the Lyapunov direct method. However, for ℜ 0 greater than one, the addiction persists and the drug equilibrium is globally asymptotically stable, which is shown also by the Lyapunov direct method. Moreover, we obtained that by controlling the density of occasional heroin users we can control the heroin epidemic spread, and this measure is more effective than the treatment measure. [ABSTRACT FROM AUTHOR]

Transcranial direct current stimulation (tDCS) has been demonstrated to modulate neural activity and related brain functions. In clinical studies, tDCS has been shown to reduce craving in various substance use disorders including cocaine, heroin and nicotine. Our previous report suggested that cathodal tDCS on the frontal-parietal-temporal (FPT) brain areas reduced cigarette consumption in moderate smokers. However, whether it is effective in smokers with history of drug use is unknown. This study investigated the effects of bilateral FPT areas cathodal tDCS on smokers with history of heroin use. 22 abstinent heroin users were recruited and randomly assigned to sham group and tDCS group. The sham group received 30 s tDCS treatment and tDCS group received normal tDCS (one trial of 20 min, 1 mA, cathodal electrodes were placed bilaterally on the FPT areas). The average of daily cigarettes consumption was recorded for the week before the tDCS and the following day after tDCS. In addition, pupil light reflex was measured right before and after tDCS treatment. One trial of tDCS stimulation significantly reduced daily cigarette consumption in smokers who had heroin use history. This reducing effect was also observed in heavy smokers. In addition, this effect on cigarette consumption lasted at least 48 h after the stimulation. Furthermore, it has been shown that opiates decrease pupillary size in humans, we found detectable changes of the dynamic pupil light reflex after bilateral tDCS stimulation. These findings suggest that FPT cathodal tDCS may be an effective approach to reduce cigarette craving in heroin users. • tDCS reduced daily cigarette consumption in smokers with heroin use history. • One session of tDCS reduced cigarette consumption for at least 48 h. • tDCS may be an effective approach to reduce cigarette craving in heroin users. [ABSTRACT FROM AUTHOR]

Neuroscientists have devoted efforts to explore potential brain recovery after prolonged abstinence in heroin users (HU). However, not much is known about whether frontostriatal circuits can recover after prolonged abstinence in HU. An eight-month longitudinal study was carried out for HU. Two MRI scans were obtained at baseline (HU1) and 8-month follow-up (HU2). The functional and structural connectivities of dorsal and ventral frontostriatal pathways were measured by resting-state functional connectivity (RSFC) and diffusion tensor imaging (DTI). Correlation analyses were employed to reveal the associations between neuroimaging and behavioral changes. Results suggested that relative to healthy controls (HCs), HU1 showed lower fractional anisotropy (FA) in the right dorsolateral prefrontal cortex (DLPFC)-to-caudate tracts and medial orbitofrontal cortex (mOFC)-to-nucleus accumbens (NAc) tracts as well as decreased RSFC in the left mOFC-NAc circuits. Longitudinal results revealed reduced craving and enhanced cognitive control in HU2 compared with HU1. After prolonged abstinence, HU2 showed increased FA values in the right DLPFC-caudate and mOFC-NAc tracts as well as increased RSFC strength in the bilateral mOFC-NAc circuits compared with HU1. In addition, changes in RSFC and FA values in the right mOFC-NAc circuit were negatively correlated with craving score changes. Similarly, negative correlations were also found between changes of RSFC in the bilateral DLPFC-caudate circuits and TMT-A scores. We provided scientific evidence for brain recovery of the dorsal and ventral frontostriatal circuits in HU after prolonged abstinence, and these circuits may be potential neuroimaging biomarkers for cognition and craving changes. • Reduced craving and improved cognition were observed in heroin users (HU) after 8-month of abstinence. • Increased RSFC and FA values of frontostriatal were demonstrated in HU after 8 months of abstinence. • ΔRSFC and ΔFA values in the dorsal and ventral circuit were associated with improved cognition and decreased craving. • Time line (baseline and eight-month follow-up) produced a significant main effect. [ABSTRACT FROM AUTHOR]

Objective. To explore the potential link between gut damage and proinflammatory cytokines in heroin-dependent patients. Methods. We retrospectively analyzed and compared partial blood counts and biomarkers of intestinal injury and their potential correlations in 38 male heroin abuse patients and 29 healthy male participants. In addition, we compared and assessed proinflammatory cytokines and immune cells in 10 heroin abuse patients and 10 healthy participants. Results. Neutrophil counts, platelets/lymphocytes (PLR), neutrophils/lymphocytes (NLR), gut injury biomarkers, and proinflammatory cytokines, CD19+B in patients compared with healthy subjects' cells increased significantly. The number of lymphocytes, CD3 CD4 T cells, and CD3 CD8 T cells decreased in patients compared to healthy individuals. When distinguishing between heroin addicts and healthy people, ROC/AUC analysis showed that a cutoff of 142.42 for PLR and 2.18 for NLR yielded a sensitivity of 65% and 85% and a specificity of 96.5% and 89.7%, respectively (p = 0.001 , p < 0.001). For predicting intestinal injury, ROC/AUC analysis showed that a cutoff of 135.7 for PLR and 0.15 for NLR yielded a sensitivity of 52% and 60% and a specificity of 82% and 86.4%, respectively (p = 0.003 , p = 0.009). Male heroin addicts are subject to intestinal injury and present with increased proinflammatory cytokine levels. Conclusion. NLR and PLR are possible indirect biomarkers for heroin dependence based on intestinal injury. [ABSTRACT FROM AUTHOR]

Background: Substance use has turned out to be one of the growing social problems of the present society cutting across all sorts of boundaries of the world with Kashmir Valley being no exception to this growing pathological phenomenon. Aims and Objectives: To find the prevalence and pattern of dermatological manifestations among substance users across Kashmir Valley. Materials and Methods: Cross-sectional study where patients of all age-groups, irrespective of gender, were enrolled in the three largest districts of Kashmir Valley over a span of 18 months. Results: Sample size was 710 with a male/female ratio of 12.4:1. The mean age of the cases was 25.2 ± 7.05 years. Heroin, one of the opioids, was the most common substance used (n = 515), followed by cannabis (n = 334). Pruritus was found to be the most common dermatological manifestation overall and statistically significant among heroin users. Stigmata of injection drug use (IDU) with the presence of track marks and sooting tattoos (93.1%), atrophic scars secondary to skin popping (30.7%), active skin ulcers (18.8%), and puffy hand syndrome (8.7%) were specifically seen among injection drug users. Oral involvement was seen in 48.5%, including periodontal disease, oral thrush, and stomatitis nicotinica. Hyperhidrosis was present in 30%, and hesitation cuts over arms in 16.3% of all substance users. Conclusion: Dermatological manifestations are quite prevalent among substance users in the population of Kashmir. Pruritus with temporal relation to substance use, stigmata of injectable drug use including track marks and sooting tattoos, atrophic scars at injection sites, active skin ulcers, and skin and soft tissue infections, and hyperhidrosis are among important dermatological clues for detecting substance use. Recognition of such cutaneous signs is important in these cases for more effective diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Compared with healthy controls, heroin users (HUs) show evidence of structural and functional brain alterations. However, little is known about the possibility of brain recovery after protracted heroin abstinence. The purpose of this study was to investigate whether brain recovery is possible after protracted abstinence in HUs. A total of 108 subjects with heroin addiction completed structural and functional scans, and 61 of those subjects completed 8‐month follow‐up scans. Resting‐state data and 3D‐T1 MR images were collected for all participants, first at baseline and again after 8 months. Cognitive function and craving were measured by the Trail Making Test‐A (TMT‐A) and Visual Analog Scale for Craving, respectively. The cortical thickness and resting‐state functional connectivity (RSFC) differences were then analyzed and compared between baseline and follow‐up, and correlations were obtained between neuroimaging and behavioral changes. HUs demonstrated improved cognition (shorter TMT‐A time) and reduced craving at the follow‐up (HU2) relative to baseline (HU1), and the cortical thickness in the bilateral superior frontal gyrus (SFG) was significantly greater at HU2 than at HU1. Additionally, the RSFC of the left SFG with the inferior frontal gyrus (IFG), insula, and nucleus accumbens and that of the right SFG with the IFG, insula and orbitofrontal cortex (OFC) were increased at HU2. The changes in TMT‐A time were negatively correlated with the RSFC changes between the left SFG and the bilateral IFG, the bilateral caudate, and the right insula. The changes in craving were negatively correlated with the RSFC changes between the left OFC and the bilateral SFG. Our results demonstrated that impaired frontal‐limbic neurocircuitry can be partially restored, which might enable improved cognition as well as reduced craving in substance‐abusing individuals. We provided novel scientific evidence for the partial recovery of brain circuits implicated in cognition and craving after protracted abstinence. Highlights: Improved cognition and reduced craving were observed in heroin users (HUs) after 8 months of abstinence.HUs demonstrated increased superior frontal gyrus (SFG) cortical thickness after 8 months of abstinence.Increased resting‐state functional connectivity within SFG circuits was correlated with improved cognition and reduced craving; Brain circuit recovery was detected as a result of protracted abstinence in HUs. [ABSTRACT FROM AUTHOR]

Pregabalin (PGL) is a gabapentinoid used to treat epilepsy, neuropathic pain and generalized anxiety disorder. PGL is also misused by heroin users as it enhances the effects of heroin. While it is thought those who misuse PGL take it in amounts greater than the recommended therapeutic dose, it is unknown whether there is a significant difference between the amounts of PGL used by heroin users compared to non-heroin users. This study hypothesized that the PGL concentrations in postmortem (PM) samples taken from heroin users positive for PGL would be higher than those in non-heroin users. Between 1 January 2016 and 31 December 2016, a routine drug screen and a specific screen for PGL were carried out on femoral-vein bloods from 3,750 PM Coroners' cases. Of the cases screened, 354 were heroin users, of which 264 cases were negative for gabapentinoids and therefore used as the control-heroin-user group. PGL was positive in 229 cases, of which 69 were heroin users and 160 were non-heroin users. On comparing the PGL concentrations, statistically higher concentrations were observed in the heroin users compared to non-heroin users (P  = 0.002). There was no correlation between the concentrations of PGL and morphine (from heroin) in the heroin users (P  = 0.95), and the amount of heroin (morphine) consumed was not dependant on whether PGL was consumed or not (P  = 0.98). The prevalence of anti-depressants, benzodiazepines, methadone and non-heroin-related opioids was seen to be significantly higher in heroin users that were positive for PGL than the control-heroin users (P  = < 0.001 for all drugs). This study suggests that heroin users are using greater amounts of PGL compared to non-heroin users; however, the magnitude of the difference in use may not be sufficient to conclude that heroin users are at substantially greater risk of PGL toxicity compared to non-heroin users. Results indicate that heroin users who take PGL are more likely to use multiple depressant drugs, hence increasing the risk of multi-drug toxicity and death in this population. [ABSTRACT FROM AUTHOR]

Background: Epidemiological data from Mexico have documented an increase in heroin use in the last decade. However, there is no comprehensive care strategy for heroin users, especially those who have been accused of a crime. The objective of this study was to describe the heroin and methadone use of intravenous heroin users of both sexes who have been in jail, to offer evidence for the formulation of health policy.Methods: This study used an ethnographic approach, with open-ended interviews carried out from 2014 to the present. Heroin users of both sexes attending a private methadone clinic in Mexico City were invited to participate. The sample was non-probabilistic. All interviews were audiotaped and transcribed, and narratives were analyzed using thematic analysis.Results: Participants in this study were 33 users of heroin, two of them women, who had been in prison. They ranged in age from 33 to 62 years, had used heroin for a period of 13-30 years, and were from three states: Michoacan, Oaxaca, and Mexico City. Three principal categories of analysis were structured: 1. Pilgrimage for help (dynamics of the drama of suffering, pain, and time through health care spaces); 2) methadone use as self-care; and 3) accessibility to methadone treatment. The impossibility of access to methadone treatment is a condition which motivates users in their journey. The dynamics of methadone use are interpreted as a form of self-care and care to avoid substance use. Reducing the psychological, physical, and harmful effects of the substance allows them to perform daily activities. The inability to access treatment leads to a significant effect on users who experience structural violence.Conclusion: Compassionate methadone treatment and holistic attention should be considered as a way to meet patients' needs and mitigate their suffering, based on public health policy that allows for human rights-based care. [ABSTRACT FROM AUTHOR]

The study was conducted to gain knowledge about the assessment of DNA damage in the population of heroin addicts and also to learn about the related health complications in drug abusers. A total of 103 samples of blood were collected from 65 heroin addicted subjects and 38 control subjects. For evaluation of DNA damage in the heroin addicted group, a comet assay technique was carried out. The results demonstrated that significant DNA damage 167.35±16.49 (P<0.05) was found in subjects who were addicted to heroin as compared to the control group having cells without any DNA damage 53.02±25.03. The population which were positive for human immunodeficiency virus infection had the highest total comet score values followed by asthma and hepatitis C virus. The total comet score increased significantly with age group. Significantly, the highest genotoxicity was concluded in the heroin addicted population. [ABSTRACT FROM AUTHOR]

Fly artifacts (FA) are bloodstains resulting from insect activity at a crime scene, usually by feeding on human blood. Whether these artifactual stains might be useful for forensic toxicological investigations in cases of absence of conventional and unconventional matrices, for example, in cases concealment of the body or of extensive putrefaction, has not yet been investigated. The purpose of this study is to understand if FA trace evidence permits toxicological analysis when traditional matrices are not available. To this aim, FA experimentally produced by Calliphora vomitoria feeding on human blood of a cocaine and heroin user were collected from absorptive and non‐absorptive material. FA material was analyzed by a new simple and fast LC‐MS/MS method. Results were evaluated in terms of presence of the drug and relative amount of the detected molecules. From a qualitative point of view, the analysis of FA revealed all the substances originally detected in post‐mortem blood in both cases. The ratios of cocaine/benzoylecgonine, codeine/morphine, and 6‐monoacetylmorphine/morphine recovered in FA from cotton‐textile materials and from non‐absorptive surfaces were consistent with data resulted from original post‐mortem blood. The preliminary study herein reported demonstrated that FA are extremely informative in case of cocaine and heroin users and merit further research in order to be applied in real caseworks. [ABSTRACT FROM AUTHOR]

Harm reduction approaches to heroin addiction treatment are safe and effective, particularly those using medication‐assisted therapy, yet they remain underutilized in the drug treatment field. This paper posits the need for a psychoanalytic formulation of harm reduction. It draws on object relations theory, to illustrate the ways in which harm reduction, as a philosophy and as a practice, maps onto the particular developmental and attachment themes of addiction. It explores heroin addiction and harm reduction at the intersection of the psyche and the social and calls upon psychoanalysis to challenge oppressive systems in the lives of heroin users. [ABSTRACT FROM AUTHOR]

Methadone eliminates heroin use, reduces death rates and criminality associated with heroin use, and improves patients' health and social productivity. This study included long-term addicts who completed a methadone therapy program as well as relapsed patients. Liver and renal markers important for methadone metabolism were analyzed. Renal markers included urea and creatinine, while hepatic markers included total bilirubin, AST, ALT, γGT, and LDH as nonspecific but significant parameters of liver metabolism. The study included 34 male and 6 female heroin-dependent patients undergoing a rehabilitation program with methadone maintenance treatment (MMT). During therapy, average values ​​of all parameters remained within the reference interval but individual parameters in some patients were very high. Significant differences for urea (0.00) and very high individual variations in all parameters, especially γGT and LDH, were found in patients who were in relapse. Age of the patients did not show a correlation with the presence of significant differences in serum biochemical parameters during therapy. Prolonged use of methadone therapy stabilizes high variations of liver and renal markers. MMT achieves a stabilization of serum indicators relevant for methadone metabolism that correlates with the duration of consumption and the type of opioid substance. The most important hepato-renal markers as indicators of therapy success are γGT, LDH, and creatinine. The validity of former enzymatic tests (AST, ALP, and ALT) should be seriously reconsidered in terms of MTT treatment success and monitoring the health of heroin addicts. [ABSTRACT FROM AUTHOR]

Dopaminergic pathways from the midbrain to striatum as well as cortex are involved in addiction. However, the alternations of these pathways and whether the recoveries of aberrant circuits would be detected after prolonged abstinence in heroin users are rarely known. The resting-state functional connectivity (RSFC) patterns of midbrain (i.e., the ventral tegmental area (VTA) and substantia nigra (SN)) were compared between 40 abstinent heroin users with opioid use disorder (HUs) and 35 healthy controls (HCs). Then, we tested the functional recovery hypothesis by both cross-sectional and longitudinal design. For cross-sectional design, HUs were separated into short-term abstainers (STs) (3–15 days) and long-term abstainers (LTs) (>15 days). With regard to longitudinal design, 22 subjects among HUs were followed up for 10 months. A sandwich estimator method was used to analyze the differences between baseline HUs and follow-up HUs. HUs showed lower RSFC between midbrain and several cortical areas (medial orbitofrontal cortex (mOFC) and anterior cingulate cortex) compared with HCs. Besides, lower RSFC of VTA-right nucleus accumbens circuit as well as right SN- caudate circuit was also found in HUs. The enhanced RSFC value of VTA-left mOFC circuit was observed in LTs, compared with STs. Additionally, longitudinal design also revealed the increased RSFC values of the midbrain with frontal cortex after 10 months prolonged abstinence. We revealed abnormal functional organizations of midbrain-striato and midbrain-cortical circuits in HUs. More importantly, partially recovery of these dysfunctions can be found after long-term abstinence. [ABSTRACT FROM AUTHOR]

The present study was undertaken to explore whether prodynorphin (PDYN) polymorphisms have an effect on the intensity of depressive symptoms and negative craving in heroin addicts in a sample of 100 heroin addicts and 108 controls. PDYN rs2281285, rs2225749 and rs910080 polymorphisms were analyzed by PCR-RFLP. Craving and the intensity of depressive symptoms were measured by the Substance Craving Scale and the Beck Depression Inventory-II, respectively. A significant association between depression severity and PDYN rs2281285 (P=0.026) and rs2225749 (P=0.038) polymorphisms was detected. PDYN rs2225749 variation showed a trend association with increased negative craving (P=0.066). We also examined the associations between heroin dependence and PDYN rs2281285, rs2225749 and rs910080 gene polymorphisms at the gene and haplotype levels. The AAA haplotype was more frequent in heroin addicts and shown to be significantly associated with increased risk for heroin dependence (OR, 8.922; 95% CI, 1.116-71.313; P<0.05). PDYN rs2281285 and rs2225749 variations affected the intensity of depressive symptoms, and PDYN rs2225749 polymorphism may contribute to the induction of negative craving in heroin addicts. Haplotype analysis revealed for the first time that addicts with the AAA haplotype of PDYN gene may be more prone to heroin dependence. [ABSTRACT FROM AUTHOR]

The Habenula is increasingly being investigated in addiction. Reduced volumes of other relevant brain regions in addiction, such as nucleus accumbens, globus pallidus and hypothalamus have been reported. Reduced volumes of the habenula as well as reduced neuronal cell count in the habenula have also been reported in mood disorders and an overlap between mood disorders and addiction is clinically widely recognized. Thus, our aim was to investigate possible volume and neuronal cell count differences in heroin addicts compared to healthy controls. Volumes of the medial (MHB) and lateral habenula (LHB) in heroin addicts (n = 12) and healthy controls (n = 12) were assessed by morphometry of 20 µm serial whole brain sections. Total brain volume was larger in the heroin group (mean 1466.6 ± 58.5 cm3 vs. mean 1331.5 ± 98.8 cm3), possibly because the heroin group was about 15 years younger (p = 0.001). Despite larger mean whole brain volume, the mean relative volume of the MHB was smaller than in healthy non-addicted controls (6.94 ± 2.38 × 10–6 vs.10.64 ± 3.22 × 10−6; p = 0.004). A similar finding was observed regarding relative volumes of the LHB (46.62 ± 10.90 × 10−6 vs. 63.05 ± 16.42 × 10−6p = 0.009). In parallel, neuronal cell numbers were reduced in the MHB of heroin-addicted subjects (395,966 ± 184,178 vs. 644,149 ± 131,140; p < 0.001). These findings were not significantly confounded by age and duration of autolysis. Our results provide further evidence for brain-structural deficits in heroin addiction. [ABSTRACT FROM AUTHOR]

Abstinence is one of the important measures for heroin addiction. However, it is unknown whether long-term abstinence (LA) would improve the coupling among three core brain networks (salience, default mode, and executive control) and decrease craving in treated heroin addicts. Forty-three heroin addicts with LA, 27 heroin addicts with short-term abstinence (SA), and 46 demographically matched healthy controls (HC) participated in the resting-state functional magnetic resonance imaging study. The authors compared the functional connectivity among the three groups and examined how the coupling among salience, default mode, and executive control networks related to duration of abstinence and craving before and after drug cue exposure among heroin addicts. Compared with the SA group, with a tendency toward the HC group, the LA group showed lower drug cue-induced craving, stronger connectivity between the dorsal anterior cingulate cortex (a key node of salience network) and left dorsolateral prefrontal cortex and right posterior parietal cortex (key nodes of executive control network), and stronger connectivity between the right dorsolateral prefrontal cortex and precuneus (a key node of default mode network). Meanwhile, the right dorsolateral prefrontal cortex-precuneus connectivity positively correlated with duration of abstinence. The LA and SA groups demonstrated lower connectivity between the left anterior insula (a key node of salience network) and dorsolateral prefrontal cortex and lower connectivity within the left dorsolateral prefrontal cortex, compared with the HC group. Our findings revealed that LA is associated with lower drug cue induced craving and improve the coupling among the three core brain networks in heroin addicts. [ABSTRACT FROM AUTHOR]

To document exposure to NPSs, clinical and forensic toxicologists have attempted to measure both parent compounds and their metabolites. Currently, more than 1000 molecules have been classified as New Psychoactive Substances (NPSs), and it is reported that, every year, this number increases with new classes of compounds and/or newer generations of NPS families [[1]]. Due to well-stocked and up-to-date libraries of the spectra, a combined method could identify up to around one thousand different compounds, and in urine samples from 296 patients with a history of opioid use disorder, about 80 different psychoactive substances and/or metabolites plus several prescription drugs were identified. [Extracted from the article]

Background: Impulsivity and sensitivity to reward situate at the marrow of pathology of substance use disorders (SUDs). This study examined the role of impulsivity and sensitivity to reward in dropout of addiction treatment in heroin addicts. Methods: The participants of this study were 216 heroin addicts. The participants were assigned to three different groups including abstinent group (n = 104), relapsed group (n = 45), and dropped out of treatment group (n = 67). The participants completed the semi-structured interview, Carver and White Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) questionnaires, and the Delay Discounting Task (DDT). Findings: The delay discounting (DD) and reward-seeking rates were high in relapse and dropout groups compared to the abstinence group and this difference was significant in P < 0.01 level. Conclusion: People with substance abuse disorders have impulsive behaviors and often prefer immediate reward related to substance use than long-term and greater rewards. [ABSTRACT FROM AUTHOR]

Introduction: Substance abuse refers to the harmful or hazardous use of any psychoactive substance including licit and illicit drugs, other than when medically indicated. According to a UN report, 1 million heroin addicts are registered in India, and unofficially, there are as many as 5 million. Among all the states Punjab stood third in substance abuse and also injectable drug use. The present study was thus conducted to assess the sociodemographic profile and pattern of substance abuse among patients attending a Drug de-addiction centre. Material and Methods: A record-based analysis from March 2015 to March 2019 was done. Substance dependence was diagnosed post detailed clinical interview by a consultant psychiatrist at the center using DSM -10. For the 966 registered patients admitted in the last four years, the record was checked for completeness of data and relevant information on socio-demographic profile, substance abused, duration of hospital stays, drop out and relapse rates was extracted. Results: Of the total admitted patients (n= 966) 100% addicts were of male gender and natives of Punjab. 514 (53.21%) were married followed by 434(44.93%) never married. Maximum patients 456(47.20%) were self-employed. Heroin was the most abused drug. The injecting route of drug abuse was used by most of the abusers i.e. 51.66%. Only 173 (17.90%) patients dropped out of the treatment followed by relapse in 192 (19.88%). Conclusion: In this paper we demonstrated the vulnerability of young population towards drug addiction. Easy accessibility of drugs, peer pressure and difficult family circumstances raises the fragility to restore for substance use. However, community-based studies are imperative in order to estimate how big is the problem at the bottom. [ABSTRACT FROM AUTHOR]

Methadone is a synthetic opioid used as maintenance treatment for patients addicted to heroin. Skin irritation is one of the adverse events caused by opioid use. 344 methadone maintenance treatment (MMT) patients were recruited with records and measurements on methadone dose, plasma methadone concentrations, and treatment emergent symptom scales (TESS). 15 patients reported with skin irritation. Five SNPs located within the NECTIN4 genetic region were genotyped. The NECTIN4 gene within the adherens junction interaction pathway was associated with methadone dose in pathway-based genome wide association analyses (P = 0.0008). Three highly-linked SNPs, rs11265549, rs3820097, and rs4656978, were significantly associated with methadone dose (P = 0.0003), plasma concentrations of R,S-methadone (P = 0.0004) and TNF-α (P = 0.010) in all 344 MMT patients, and with self-report skin irritation symptom scores (P = 0.010) in the 15 MMT patients who reported with skin irritation. To identify the possible roles of plasma level of Nectin-4 in the responses to MMT and opioid use, additional age- and gender-matched 51 controls and 83 methadone-free abstinent former heroin users were recruited. Plasma level of Nectin-4 was the highest in MMT patients among the three groups. The results suggest involvement of genetic variants on NECTIN4 in methadone dose. Plasma Nectin-4 level is likely an indicator for continued use of opioids. [ABSTRACT FROM AUTHOR]

This study uses National Surveys on Drug Use and Health data to characterize trends in heroin use, heroin use disorder, and heroin injection overall and by age, race, and geographic region. [ABSTRACT FROM AUTHOR]

Sudden deaths are mostly caused by substance abuse and overdose, whether they were used separately or combined with other substances having depressor effect on the central nervous system. Apart from the pathology associated with the central nervous system and the lungs, a large portion in sudden death occurrence in opiate abusers lies also in the pathology of cardiovascular system, especially the heart. A group of 42 long-term heroin addicts was observed (35 men and 7 women), aged 18-48 years, whose sudden death was related to heroin abuse, whether heroin taken intravenously (38 cases) or by sniffing (4 case). Myocardial tissue samples were processed with the modified Movat's staining procedure and analysed statistically. In the current study, standard histological examinations of the heart muscle in heroin addicts found cardiomyocyte hypertrophy and interstitial and/or perivascular fibrosis with statistical significance (p < 0.001) in comparison with the control group. In 24% (10 cases) of all examined cases, histological picture in the heart muscle matching the picture of the acquired cardiomyopathy was determined. We believe that in cases of repeated intoxication, even in the doses of heroin that are not inherently lethal, sudden changes in hemodynamics and disturbances in the rhythm of operation of such altered and more vulnerable heart muscle can affect the occurrence of sudden cause of death. [ABSTRACT FROM AUTHOR]

The dopamine D2 receptor encoded by DRD2 has been implicated in multiple psychiatric disorders, mediated at least in part by two intronic variants affecting mRNA splicing, rs1076560 and rs2283265, and a less frequent enhancer variant, rs12364283, which increases DRD2 mRNA expression. This study tests whether these functionally validated variants confer susceptibility toward heroin addiction in a Pakistani population. A total of 540 heroin addicts and 467 healthy controls were genotyped, basic allele and genotype tests were performed. Neither rs1076560 nor rs2283265 significantly associated with heroin addiction. The enhancer rs12364283 occurs more frequently in heroin‐dependent cases than controls (MAF 13% vs. 7%, respectively), revealing significant association with heroin addiction (p = 3.0E‐06, OR 2.1). This study identifies rs12364283 of DRD2 as a potential risk factor for heroin addiction in the Pakistani study population. This enhancer variant had been shown to increase DRD2 mRNA expression, a possible factor in increased vulnerability to heroin addiction. Further studies are needed to validate this association of rs12364283. [ABSTRACT FROM AUTHOR]

Introduction. Mexico northern border has high levels of heroin use. For more than 10 years, the country has implemented several harm reduction interventions to reduce the risks associated with drug use. New strategies such as Safe Consumption Sites (SCS) must be considered as a next step to service vulnerable populations and increase their health outcomes. Objective. This report seeks to measure and compare attitudes on a potential SCS intervention in Tijuana among police and people with lived experience (PLE) in heroin use in the city. Method. Two parallel studies on police practices and everyday experiences of heroin users in Tijuana were able to ask similar questions about attitudes toward SCS and its implementation in the city. They conducted quantitative interviews with 771 active police officers and 200 PLE while in rehabilitation services. Results. Both groups showed a high personal support for SCS of nearly 82% and a perceived implementation success around 80%. Officers reported 58.9% peer support for SCS while PLE 79%. Around 76% of both groups agreed that a SCS would help to improve their personal health. Finally, 86.2% of the officers would refer people to a SCS while 62.5% of PLE would use the service. Discussion and conclusions. The strong positive attitudes from police officers and PLE towards SCS in the city of Tijuana reported in both studies indicate the possibility of a successful implementation of a SCS. This intervention would represent an innovative way to protect PLE from police harassment and victimization, helping reduce HIV and HCV risk behaviors while improving community health. [ABSTRACT FROM AUTHOR]

Background: Methadone maintenance treatment, initially introduced in Vietnam for HIV harm reduction, has marked a significant switch in the country's drug policy - from addiction as a moral issue to addiction as a brain disease. After the some initial outstanding achievements, the programme is facing a high dropout rate that threatens both goals of HIV prevention and drug treatment. This sociological study, as part of an HIV intervention research project, explores the challenges and opportunities that individuals who use drugs are faced with in relation to addiction treatment.Methods: A qualitative study among drug users with and without methadone maintenance treatment experiences recruited by peer outreach workers. We conducted 58 in-depth interviews and 2 focus groups between 2016 and 2017.Results: The start of treatment brought about significant feelings of success as heroin use was no longer compulsive. However, being in treatment programmes is also challenging with respect to continuing the recovery process. Barriers to retention include a popular fear of methadone as another harmful drug, a feeling of dependence related to the current practices of methadone treatment programmes and a poor therapeutic relationship. In the face of such challenges, the two major motivations that keep patients in care come from the desire to completely break up with heroin and the pursuit of family happiness.Conclusion: The current practices of methadone programmes pose challenges to patients' recovery efforts from addiction and threaten treatment retention. Prompt interventions are needed to help Vietnam attain its objective of providing better care for larger vulnerable populations. [ABSTRACT FROM AUTHOR]

Deep brain stimulation (DBS) of the globus pallidus internus was recently proposed as a potential new treatment target for opioid addiction. DBS requires computer-assisted-3D planning to implant the stimulation electrode precisely. As volumes of brain regions may differ in addiction compared to healthy controls, our aim was to investigate possible volume differences in addicts compared to healthy controls. Volumes of the globus pallidus externus (PE) and internus (PI) in heroin addicts (n = 14) and healthy controls (n = 12) were assessed using morphometry of serial whole-brain sections. Total brain volume was larger in the heroin group (mean 1479 ± 62 cm3 vs. mean 1352 ± 103 cm3), as the heroin group was more than 10 years younger (p = 0.001). Despite larger mean whole brain volume, the mean relative volume of the PE and PI was smaller in addicted subjects compared to healthy controls (PE 0.658 ± 0.183 × 10−3 vs. 0.901 ± 0.284 × 10−3; ANOVA F(1, 24) = 6.945, p = 0.014, η2 = 0.224; PI 0.253 ± 0.095 × 10−3 vs. 0.345 ± 0.107 × 10−3; ANOVA F(1, 24) = 5.374, p = 0.029, η2 = 0.183). These findings were not significantly confounded by age, duration of autolysis, and fixation time. Our results provide further evidence for structural and not only functional deficits of the globus pallidus in addiction. In the context of previous studies, our findings support the idea of shared pathophysiological processes between comorbid depression and impulsivity in opioid addiction. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the mediating and moderating roles of resilience on the relationship between perceived stress and depression among heroin addicts. A total of 138 heroin addicts completed the measures of perceived stress, resilience, and depression. Correlation analysis indicated that perceived stress was positively associated with depression. Resilience was negatively correlated with perceived stress and depression. Mediation analysis revealed that resilience partially mediated the relationship between perceived stress and depression. However, resilience did not moderate the influence of perceived stress on depression. These findings might provide a better understanding of the mental health among heroin addicts. [ABSTRACT FROM AUTHOR]

Aims: To describe the polysubstance use patterns of heroin‐dependent patients and to understand the impact of polysubstance use patterns on relapse during the 5 years after completing compulsory rehabilitation programmes. Design In this secondary analysis, the baseline data of 503 heroin‐dependent patients were linked with their 5‐year follow‐up data from official records. Setting: Four compulsory rehabilitation centres in Shanghai, China. Participants: A total of 564 heroin‐dependent patients who were discharged from Shanghai compulsory rehabilitation facilities in 2007 and 2008 were recruited. Among these, 503 patients with available follow‐up records were included in this analysis. Measurements The baseline measurements included the Addiction Severity Index, the Temperament and Character Inventory and the Medical Outcomes Study Social Support Scale. Relapses after discharge from the compulsory rehabilitation centres were extracted monthly from the official electronic record system. Latent class analysis was used to identify different polysubstance use patterns. Associations between the identified latent classes and heroin use and the factors related to relapse during the 5‐year follow‐up were analysed with the Cox regression model. Findings Three latent classes were identified in this cohort: (1) alcohol polydrug users (APU; 13.7%), (2) low polydrug users (LPU; 76.5%) and (3) amphetamine‐type stimulant polydrug users (ASPU; 9.7%). During the 5‐year follow‐up, 298 heroin patients relapsed, and the three groups showed different relapse rates (ASPU 69.4 versus LPU 60.5 versus APU 44.9%, P = 0.02). The average durations of abstinence for the three groups differed (ASPU 31.27 ± 3.41 months versus LPU 36.77 ± 1.19 months versus APU 42.46 ± 2.81 months, P = 0.02). Multivariate Cox regression analyses found that the LPU [hazard ratio (HR) = 1.63, 1.06–2.51] and ASPU (HR = 2.10, 1.24–3.56) classes were positively associated with the risk of heroin relapse. Conclusion: Polydrug use patterns differ among heroin‐dependent patients in compulsory rehabilitation programmes in China. A history of polydrug use may predict heroin relapse risk among patients in those compulsory rehabilitation programmes. [ABSTRACT FROM AUTHOR]

During September 29-October 6, 2017, the County of San Diego Public Health Services (COSD) was notified of two patients with suspected wound botulism and a history of using black tar heroin. On October 9, COSD, which had reported an average of one wound botulism case per year during 2001-2016, sent a health alert through the California Health Alert Network, notifying Southern California providers of these two patients, including their signs and symptoms and black tar heroin exposure. In collaboration with the California Department of Public Health, COSD conducted an investigation to identify additional cases, determine risk factors for illness, estimate cost of medical care, and develop recommendations to prevent further illness. By April 18, 2018, nine (eight confirmed and one probable) patients with wound botulism were identified, all of whom were hospitalized; one of the nine died. All nine were persons who inject drugs; seven specifically reported using black tar heroin and six practiced subcutaneous injection known as skin popping. Clinically compatible signs and symptoms included muscle weakness, difficulty swallowing, blurred vision, drooping eyelids, slurred speech, difficulty breathing, loss of facial expression, or descending paralysis. All patients were treated with heptavalent botulism antitoxin (BAT). Wound botulism is likely underrecognized because of its rarity and the overlapping signs and symptoms with opioid intoxication, overdose, and other neurologic syndromes including Guillain-Barré syndrome, the Miller Fisher variant of Guillain-Barré syndrome, and myasthenia gravis. Prompt diagnosis, administration of BAT, and provision of supportive care can help stop the progression of paralysis and be lifesaving. [ABSTRACT FROM AUTHOR]

The recent rise in opioid-related overdose deaths stresses the importance of understanding how heroin use disorders persist and what interventions are best suited for treating these illnesses. Trends show that there are diverse pathways leading to heroin use disorder that span multiple generations, but little is known about how different generations utilize and respond to treatment. This study provides insight into treatment utilization for young, middle-aged, and older adults by examination of an unusually rich longitudinal dataset of substance use disorder clients in Maryland who were treated for heroin use. Results show that clear patterns of treatment readmission emerge across generations in treatment-naïve clients with regard to gender, ethnicity, employment, geographical region, and treatment type/intensity. In particular, Millennials comprise the majority of the clients receiving heroin use disorder treatment and are the largest contributor to these readmission patterns. Millennials are also given opioid maintenance therapy (OMT) more frequently than other generations, while exhibiting a strong avoidance to treatment. Generational differences in treatment decisions and outcomes over the course of a treatment career are important for understanding the nature of the current opioid epidemic, and can play an important role in directing heroin use disorder treatment efforts and improving models of care. [ABSTRACT FROM AUTHOR]

Abstract Evidence from various studies suggests that narcotics abuse may exert adverse immunomodulatory effects on immune responses. The aim of this research was to understand the effects of detoxification with methadone on the percentage of dendritic cells (DCs) and expression of its markers in heroin addicts. In this study, myeloid DCs (CD11c+) and plasmacytoid DCs (CD123+) were examined in two groups. These groups comprised of 20 healthy volunteers and 20 chronic heroin addicts, before and after detoxification with methadone. The percentages of myeloid DCs and plasmacytoid DCs were lower in addict subjects than in the control. The HLA-DR expression on DCs was significantly lower in addict subjects than in the control, whereas CD11c and CD123 expression in DCs subsets were increased in them. Most of these changes were modified after the methadone therapy. Dendritic cells are essential to the initiation of primary immune responses, therefore the disruption of their function can be one of the reasons for the increased prevalence of infections in heroin addicts. The methadone therapy can improve the imposed changes by heroin. Highlights • The percentages of myeloid DCs and plasmacytoid DCs were lower in heroin addicts than in the control. • The heroin can significantly increase expression of CD11c molecules on the surface of myeloid DCs of peripheral blood. • The HLA-DR is downregulated in dendritic cells of heroin addicts. • The methadone chloride can improve the imposed changes by heroin. [ABSTRACT FROM AUTHOR]

Introduction: Illicit drugs abuse is associated with several clinical life-threatening consequences that are primarily mediated by oxidative damage to multiple cellular components with a subsequent cellular dysfunction and death. Primarily, this study aimed to investigate oxidative stress to protein and lipid components of circulatory platelets among chronic heroin and hashish addicts. Methods: Platelet lysates were prepared from 20 chronic intravenously administrated heroin addicts and 20 chronic smoked hashish addicts. For comparative purposes, two control groups of 20 cigarette smokers and 20 nonsmokers were included in the study. Oxidative stress to platelet's proteins and lipids was investigated using carbonyl group contents assay and thiobarbituric acid reactive substances (TBARS) assay, respectively. Results: In comparison to control groups, carbonyl group contents and TBARS concentration were significantly higher among heroin addicts but not among hashish addicts. Both of these markers were significantly correlated to the duration of addiction but not to the daily administrated dose. While in regard of the timing of the latest administrated dose (TLAD), only carbonyl group contents were significantly correlated to the TLAD. Conclusions: Considering the contribution of drug's route of administration, drug's pharmacokinetics, and kinetics of circulatory platelet, we concluded that chronic heroin addiction is associated with significant levels of oxidative stress to platelet's proteins and lipids. Due to the high proteomic contents of platelets, protein's oxidative stress is more prominent compared to lipids. Chronic hashish smoking is not associated with significant levels of oxidative stress in platelet's proteins and lipids. [ABSTRACT FROM AUTHOR]