Sample records for methadone heroin cocaine

  1. Heroin use during methadone maintenance treatment: the importance of methadone dose and cocaine use.

    PubMed Central

    Hartel, D M; Schoenbaum, E E; Selwyn, P A; Kline, J; Davenny, K; Klein, R S; Friedland, G H

    1995-01-01

    OBJECTIVES. The purpose of this study was to examine factors associated with heroin use during methadone maintenance treatment. METHODS. Logistic regression statistical models were used to examine data obtained in a cross-sectional sample of 652 methadone patients. RESULTS. Heroin use during the 3 months prior to interview was shown to be greatest among (1) patients maintained on methadone dosages of less than 70 mg/day (adjusted odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.3, 3.4) and (2) patients who used cocaine during treatment (adjusted OR = 5.9, 95% CI = 3.8, 9.1). These results were independent of treatment duration, treatment compliance, alcohol use, and socioeconomic factors. Cocaine users were more likely than nonusers of cocaine to use heroin at all methadone dosage levels. CONCLUSIONS. This study confirms and extends past research showing high-dose methadone maintenance to be important to heroin abstinence. Further investigation of the independent association between heroin use and cocaine use is needed. PMID:7832267

  2. The impact of cocaine and heroin on the placental transfer of methadone

    PubMed Central

    Malek, Antoine; Obrist, Cristina; Wenzinger, Silvana; von Mandach, Ursula

    2009-01-01

    Background Methadone is the therapeutic agent of choice for the treatment of opiate addiction in pregnancy. The co-consumption (heroin, cocaine) which may influence the effects of methadone is frequent. Therefore, the impact of cocaine and heroin on the placental transfer of methadone and the placental tissue was investigated under in vitro conditions. Methods Placentae (n = 24) were ex-vivo perfused with medium (m) (control, n = 6), m plus methadone (n = 6), m plus methadone and cocaine (n = 6) or m plus methadone and heroin (n = 6). Placental functionality parameters like antipyrine permeability, glucose consumption, lactate production, hormone production (hCG and leptin), microparticles release and the expression of P-glycoprotein were analysed. Results Methadone accumulated in placental tissue. Methadone alone decreased the transfer of antipyrine from 0.60 +/- 0.07 to 0.50 +/- 0.06 (fetal/maternal ratio, mean +/- SD, P < 0.01), whereas the combination with cocaine or heroin increased it (0.56 +/- 0.08 to 0.68 +/- 0.13, P = 0.03 and 0.58 +/- 0.21 to 0.71 +/- 0.24; P = 0.18). Microparticles (MPs) released from syncytiotrophoblast into maternal circuit increased by 30% after cocaine or heroin (P < 0.05) and the expression of P-glycoprotein in the tissue increased by ? 49% after any drug (P < 0.05). All other measured parameters did not show any significant effect when methadone was combined with cocaine or heroine. Conclusion The combination of cocaine or heroin with methadone increase antipyrine permeability. Changes of MPs resemble findings seen in oxidative stress of syncytiotrophoblast. PMID:19519880

  3. Methadone Treatment Induces Attenuation of Cerebrovascular Deficits Associated with the Prolonged Abuse of Cocaine and Heroin

    Microsoft Academic Search

    Ronald I Herning; Warren E Better; Kimberly Tate; Annie Umbricht; Kenzie L Preston; Jean L Cadet

    2003-01-01

    Opiate replacement therapy has been useful in reducing heroin use and in keeping patients in treatment programs. However, neuropsychological and neurophysiological effects of this treatment regimen have not been evaluated systematically. To determine whether methadone treatment reduces the magnitude of cerebral blood flow alternations in polysubstance (heroin and cocaine) abusers, we compared blood flow parameters in control subjects (n=26), polysubstance

  4. Promoting Abstinence from Cocaine and Heroin with a Methadone Dose Increase and a Novel Contingency

    PubMed Central

    Schmittner, John; Umbricht, Annie; Schroeder, Jennifer R.; Moolchan, Eric T.; Preston, Kenzie L.

    2010-01-01

    To test whether a combination of contingency management and methadone dose increase would promote abstinence from heroin and cocaine, we conducted a randomized controlled trial using a 2 X 3 (Dose X Contingency) factorial design in which dose assignment was double-blind. Participants were 252 heroin- and cocaine-abusing outpatients on methadone maintenance. They were randomly assigned to methadone dose (70 or 100 mg/day, double blind) and voucher condition (noncontingent, contingent on cocaine-negative urines, or “split”). The “split” contingency was a novel contingency that reinforced abstinence from either drug while doubly reinforcing simultaneous abstinence from both: the total value of incentives was “split” between drugs to contain costs. The main outcome measures were percentages of urine specimens negative for heroin, cocaine, and both simultaneously; these were monitored during a 5-week baseline of standard treatment (to determine study eligibility), a 12-week intervention, and a 10-week maintenance phase (to examine intervention effects in return-to-baseline conditions). DSM-IV criteria for ongoing drug dependence were assessed at study exit. Urine-screen results showed that the methadone dose increase reduced heroin use but not cocaine use. The Split 100mg group was the only group to achieve a longer duration of simultaneous negatives than its same-dose Noncontingent control group. The frequency of DSM-IV opiate and cocaine dependence diagnoses decreased in the active intervention groups. For a split contingency to promote simultaneous abstinence from cocaine and heroin, a relatively high dose of methadone appears necessary but not sufficient; an increase in overall incentive amount may also be required. PMID:19101098

  5. Methadone Anonymous: A 12-Step Program for Methadone Maintained Heroin Addicts.

    PubMed

    Gilman, Stephen M.; Galanter, Marc; Dermatis, Helen

    2001-12-01

    Methadone Anonymous (MA) is a new 12-step fellowship developed for methadone maintained heroin addicts. A total of 53 MA members completed a survey assessing factors related to methadone maintenance treatment program (MMTP) entry, drug use, MA participation, beliefs concerning effectiveness of MMTP and MA, and level of social cohesiveness. Length of time in MA was associated with a decreased use of alcohol, cocaine, and marijuana. Clients rated components of MA to be significantly more helpful to recovery than MMTP treatment components. Affiliation to five MA members known best by the respondents was significantly greater than affiliation to non-MA members. Length of time in MA was positively associated with MA affiliation. Social affiliation and endorsement of 12-step principles were positively correlated. These findings suggest that MA participation has benefits not available in professionally driven MMTP, and should be further studied. PMID:12466684

  6. Concurrent heroin use among methadone maintenance clients in China

    Microsoft Academic Search

    Li Li; Chunqing Lin; Dai Wan; Linglin Zhang; Wenhong Lai

    BackgroundThe study examined concurrent illicit heroin use among methadone maintenance clients in China and its association with clients' demographic characteristics, treatment experience, and personal social network.

  7. Randomized Trial of Prize-Based Reinforcement Density for Simultaneous Abstinence from Cocaine and Heroin

    ERIC Educational Resources Information Center

    Ghitza, Udi E.; Epstein, David H.; Schmittner, John; Vahabzadeh, Massoud; Lin, Jia-Ling; Preston, Kenzie L.

    2007-01-01

    To examine the effect of reinforcer density in prize-based abstinence reinforcement, heroin/cocaine users (N = 116) in methadone maintenance (100 mg/day) were randomly assigned to a noncontingent control group (NonC) or to 1 of 3 groups that earned prize draws for abstinence: manual drawing with standard prize density (MS) or computerized drawing…

  8. Effect of methadone maintenance treatment on heroin craving, a literature review.

    PubMed

    Fareed, Ayman; Vayalapalli, Sreedevi; Stout, Steven; Casarella, Jennifer; Drexler, Karen; Bailey, Stephen P

    2011-01-01

    Despite agreement that methadone maintenance treatment (MMT) is an effective and safe option for treatment of heroin dependence, there have been controversies about its effect on heroin craving. A systematic literature review of the PubMed database was used to find studies eligible for inclusion in the study. The authors present the results of 16 articles that met all inclusion criteria. Overall, 7 studies reported that methadone could reduce heroin craving, 4 studies reported that patients in MMT are still at risk of having heroin craving, 1 study reported that methadone could increase heroin craving, and 4 studies reported that methadone has a neutral effect on heroin craving. One may speculate from these data that methadone may help with heroin craving, but patients in MMT may still be at risk of cue-induced heroin cravings. Methadone provides a helpful tool for reducing some components of craving and risk of relapse for patient receiving MMT. PMID:21218308

  9. Concurrent heroin use among methadone maintenance clients in China

    PubMed Central

    Li, Li; Lin, Chunqing; Wan, Dai; Zhang, Linglin; Lai, Wenhong

    2011-01-01

    Background The study examined concurrent illicit heroin use among methadone maintenance clients in China and its association with clients’ demographic characteristics, treatment experience, and personal social network. Methods Face-to-face surveys were conducted with 178 clients randomly recruited from six methadone maintenance treatment (MMT) clinics in Sichuan, China. Concurrent heroin use was measured based on self-report of heroin use during the past 30 days and a confirmatory urine morphine test. The participants’ demographic characteristics and treatment factors were measured and examined. The drug use status of their family members and friends was also assessed. Results A total of 80 participants (44.9%) who either reported illicit heroin use in the past 30 days or had a positive urine test were defined as using heroin concurrently. Having drug-using friends was significantly associated with increased concurrent heroin use. Longer length of treatment (2 years or longer) was associated with increased concurrent heroin use. Among those who had both drug-using family members and friends, more women (71.4%) than men (50.0%) used heroin. For those who had no drug-using family members or friends, more men (34.8%) than women (20.8%) used heroin. Discussion Study findings indicate an urgent need to address concurrent illicit heroin use among MMT clients. Further examination of the influence of social networks on concurrent drug abuse behavior is encouraged. Results also highlight the importance of understanding gender differences in treatment seeking and behavioral changes, which is crucial to the development of gender-specific treatment strategies. PMID:22100548

  10. DISCIPLINING ADDICTIONS: THE BIO-POLITICS OF METHADONE AND HEROIN IN THE UNITED STATES

    Microsoft Academic Search

    PHILIPPE BOURGOIS

    2000-01-01

    Biomedical understanding of methadone as a magic-bullet pharmacological block to the euphoric effects of heroin is inconsistent with epidemiological and clinical data. An ethnographic perspective on the ways street-based heroin addicts experience methadone reveals the quagmire of power relations that shape drug treatment in the United States. The phenomenon of the methadone clinic is an unhappy compromise between competing discourses:

  11. Unfavorable attitudes toward receiving methadone maintenance therapy and associated factors among the inmates using intravenous heroin

    Microsoft Academic Search

    Cheng-Fang Yen; Jih-Jin Tsai; Peng-Wei Wang; Yi-Chun Yeh; Shu-Chun Liu; Shu-Hui Wang; Chao-Ching Wang

    2011-01-01

    The aims of this study were to examine unfavorable attitudes toward receiving methadone maintenance therapy (MMT) and associated factors among inmates using intravenous heroin in Taiwan. A total of 315 inmates using intravenous heroin were recruited. Their unfavorable attitudes toward receiving MMT after discharge from prison were evaluated using the Client Attitudes Toward Methadone Programs Scale. The associations of unfavorable

  12. Disciplining Addictions: The Bio-politics of Methadone and Heroin in the United States

    Microsoft Academic Search

    Philippe Bourgois

    2000-01-01

    Biomedical understanding of methadone as a magic-bullet pharmacologicalblock to the euphoric effects of heroin is inconsistent with epidemiologicaland clinical data. An ethnographic perspective on the ways street-basedheroin addicts experience methadone reveals the quagmire of powerrelations that shape drug treatment in the United States. The phenomenonof the methadone clinic is an unhappy compromise between competingdiscourses: A criminalizing morality versus a medicalizing

  13. Daily Temporal Patterns of Heroin and Cocaine Use and Craving: Relationship with Business Hours Regardless of Actual Employment Status

    PubMed Central

    Phillips, Karran A.; Epstein, David H.; Preston, Kenzie L.

    2013-01-01

    Real-time monitoring of behavior using Ecological Momentary Assessment (EMA) has provided detailed data about daily temporal patterns of craving and use in cigarette smokers. We have collected similar data from a sample of cocaine and heroin users. Here we analyzed it in the context of its relationship with a societal construct of daily temporal organization: 9-to-5 business hours. In a 28-week prospective study, 112 methadone-maintained polydrug-abusing individuals initiated an electronic-diary entry and provided data each time they used cocaine, heroin, or both during weeks 4 to 28. EMA data were collected for 10,781 person-days and included: 663 cocaine-craving events, 710 cocaine-use events, 288 heroin-craving events, 66 heroin-use events, 630 craving-both-drugs events, and 282 use-of-both-drugs events. At baseline, 34% of the participants reported full-time employment in the preceding 3-year period. Most participants’ current employment status fluctuated throughout the study. In a generalized linear mixed model (SAS Proc Glimmix), cocaine use varied by time of day relative to business hours (p<0.0001) and there was a significant interaction between Day of the Week and Time Relative to Business Hours (p<0.002) regardless of current work status. Cocaine craving also varied by time of day relative to business hours (p<0.0001), however, there was no significant interaction between Day of the Week and Time Relative to Business Hours (p=.57). Heroin craving and use were mostly reported during business hours, but data were sparse. Cocaine craving is most frequent during business hours while cocaine use is more frequent after business hours. Cocaine use during business hours, but not craving, seems suppressed on most weekdays, but not weekends, suggesting that societal conventions reflected in business hours influence drug-use patterns even in individuals whose daily schedules are not necessarily dictated by employment during conventional business hours. PMID:23770647

  14. Use of Street Methadone in Italian Heroin Addicts Presenting for Opioid Agonist Treatment

    Microsoft Academic Search

    Icro Maremmani; Matteo Pacini; Pier Paolo Pani; Dina Popovic; Anna Romano; Angelo G. I. Maremmani; Joseph Deltito; Giulio Perugi

    2009-01-01

    It is commonly assumed that people who are addicted to certain substances would abuse any substance. This position has never been supported by validly collected and analyzed research data. In this study, the authors examine the use of street methadone by heroin addicts seeking their first agonist opioid treatment in a clinical setting. Fifty-four heroin addicts who resorted to street

  15. Nutritional effects of marijuana, heroin, cocaine, and nicotine.

    PubMed

    Mohs, M E; Watson, R R; Leonard-Green, T

    1990-09-01

    Use of addictive drugs, such as cocaine, marijuana, and nicotine, affects food and liquid intake behavior, taste preference, and body weight. Changes in specific nutrient status and metabolism can also develop; heroin addiction can cause hyperkalemia and morphine use can result in calcium inhibition. Nutrition-related physiological aspects, such as impaired gastrin release, hypercholesterolemia, hypothermia, and hyperthermia, are also seen with morphine use. Nutrition-related conditions can affect sensitivity to and dependence on drugs and their effects. Diabetes decreases sensitivity to and dependence on morphine, protein deprivation produces preferential fat utilization with low cocaine use, and vitamin D deficiency decelerates morphine dependency. During use and/or withdrawal from nicotine, heroin, marijuana, and cocaine, major changes in food selection and intake occur, which result in weight gain or loss. Detailed human studies are needed to investigate the effects of drug use on the broad spectrum of nutrients and to determine the role of nutrition during drug withdrawal. PMID:2204648

  16. Randomized Trial of Prize-Based Reinforcement Density for Simultaneous Abstinence From Cocaine and Heroin

    PubMed Central

    Ghitza, Udi E.; Epstein, David H.; Schmittner, John; Vahabzadeh, Massoud; Lin, Jia-Ling; Preston, Kenzie L.

    2007-01-01

    To examine the effect of reinforcer density in prize-based abstinence reinforcement, heroin/cocaine users (N = 116) in methadone maintenance (100 mg/day) were randomly assigned to a noncontingent control group (NonC) or to 1 of 3 groups that earned prize draws for abstinence: manual drawing with standard prize density (MS) or computerized drawing with standard (CS) or high (CH) density. Probabilities (prizes/draw) were standard (50%) and high (78%); prize density was double blind. Mean prize values were CH, $286; CS, $167; MS, $139; and NonC, $171. Outcomes were % opioid/cocaine-negative urines during the 12-week intervention and then 8 weeks postintervention as well as diagnosis of dependence up to 6 months poststudy. CH had significantly more negative specimens than did NonC during intervention and had more than all groups during postintervention treatment: Mean % negative (95% confidence interval) during postintervention treatment adjusted for baseline drug use and dropout were CH, 55% (14%–90%); CS, 7% (1%–27%); MS, 4% (1%–12%); and NonC, 3% (1%–10%). Current cocaine dependence diagnoses after treatment were significantly lower in contingent compared with noncontingent groups. Computerized drawing with higher-density prizes enhanced reduction of cocaine use; abstinence reinforcement had long-term therapeutic benefits. PMID:17907858

  17. Aggressive responding of male heroin addicts under methadone treatment: psychometric and neuroendocrine correlates

    Microsoft Academic Search

    Gilberto Gerra; Amir Zaimovic; Maria Augusta Raggi; Francesca Giusti; Roberto Delsignore; Simone Bertacca; Francesca Brambilla

    2001-01-01

    Objective measures of experimentally-induced aggressiveness were evaluated in 20 methadone-treated heroin addicts, in comparison to 20 normal healthy male subjects. All the subjects were submitted to preliminary DSM IV interviews, Buss Durkee Hostility Inventory (BDHI) and Minnesota Multiphasic Personality Inventory (MMPI II). During a laboratory task, the point subtraction aggression paradigm (PSAP), subjects earned monetary reinforcers with repeated button presses,

  18. Unfavorable attitudes toward receiving methadone maintenance therapy and associated factors among the inmates using intravenous heroin.

    PubMed

    Yen, Cheng-Fang; Tsai, Jih-Jin; Wang, Peng-Wei; Yeh, Yi-Chun; Liu, Shu-Chun; Wang, Shu-Hui; Wang, Chao-Ching

    2011-01-01

    The aims of this study were to examine unfavorable attitudes toward receiving methadone maintenance therapy (MMT) and associated factors among inmates using intravenous heroin in Taiwan. A total of 315 inmates using intravenous heroin were recruited. Their unfavorable attitudes toward receiving MMT after discharge from prison were evaluated using the Client Attitudes Toward Methadone Programs Scale. The associations of unfavorable attitudes toward receiving MMT with sociodemographic and drug-using characteristics, human immunodeficiency virus serostatus, perceived family support, and depression were examined using multiple regression analysis. The results of this study showed that the mean score of unfavorable attitudes toward receiving MMT, determined on the Client Attitudes Toward Methadone Programs Scale, was 9.918 (standard deviation=2.277, range=5-20). Heroin-using inmates who were young, started using heroin earlier, perceived many advantages and few disadvantages of heroin use, had never received MMT, and had severe depression, had unfavorable attitudes toward receiving MMT. Based on the results of this study, we suggest that inmates who have the factors associated with unfavorable attitudes toward receiving MMT should receive intervention and motivational interviewing to improve their attitudes toward MMT and to increase their opportunity to receive MMT after discharge from prison. PMID:21329889

  19. Buprenorphine versus methadone in the treatment of opioid-dependent cocaine users

    Microsoft Academic Search

    Eric C. Strain; Maxine L. Stitzer; Ira A. Liebson; George E. Bigelow

    1994-01-01

    This study compared the efficacy of buprenorphine to methadone for decreasing cocaine use in patients with combined opioid and cocaine use. Participants (n=51) were enrolled in a 26-week treatment program and randomly assigned to either buprenorphine or methadone. Dosing was double-blind and double-dummy. Patients were stabilized on either 8 mg sublingual buprenorphine or 50 mg oral methadone, with dose increases

  20. QTc Prolongation in Veterans With Heroin Dependence on Methadone Maintenance Treatment

    PubMed Central

    Hassamal, Sameer; Fernandez, Antony; Moradi Rekabdarkolaee, Hossein; Pandurangi, Ananda

    2015-01-01

    Background: QTc prolongation and Torsade de Ppointes have been reported in patients on methadone maintenance. Objectives: In this study, QTc was compared before and after the veteran (n = 49) was on a stable dosage of methadone for 8.72 ± 4.50 years to treat heroin dependence. Risk factors were correlated with the QTc once the veteran was on a stable dose of methadone. Differences in the clinical risk factors in subgroups of veterans with below and above mean QTc change was compared. Patients and Methods: ECG data was obtained from a 12-lead electrocardiogram (pre-methadone and on methadone) on 49 veterans. Data and risk factors were retrospectively collected from the medical records. Results: The mean QTc at baseline (pre-methadone) was 426 ± 34 msec and after being on methadone for an average of 8.72 ± 4.50 years was significantly higher at 450 ± 35 msec. No significant relationships were found between QTc prolongation and risk factors except for calcium. The methadone dosage was significantly higher in veterans with a QTc change above the mean change of ? 24 msec (88.48 ± 27.20 mg v.s 68.96 ± 19.84 mg). None of the veterans experienced cardiac arrhythmias. Conclusions: The low complexity of medical co-morbidities may explain the lack of a significant correlation between any risk factor with the QTc except calcium and methadone dosage. The absence of TdP may be explained by the low prevalence of QTc values > 500 msec as well as the retrospective design of the study. During long-term methadone treatment, there was a slight increase in the QTc interval but we did not find evidence of increased cardiac toxicity as a reason for treatment termination.

  1. The comparative toxicology and major organ pathology of fatal methadone and heroin toxicity cases.

    PubMed

    Darke, Shane; Duflou, Johan; Torok, Michelle

    2010-01-01

    In order to determine the comparative toxicology and systemic disease of cases of death due to methadone and heroin toxicity, 1193 coronial cases of opioid overdose that occurred in New South Wales, Australia between 1 January 1998 and 31 December 2007 were inspected. These comprised 193 cases in which cause of death involved methadone toxicity (METH) and 1000 cases in which cause of death involved heroin toxicity in the absence of methadone (HER). METH cases were significantly more likely to have benzodiazepines (63.7% vs. 32.2%), and less likely to have alcohol (23.6% vs. 42.7%) detected. METH cases were significantly more likely to be diagnosed with pre-existing systemic pathology (94.3% vs. 79.9%), and multiple organ system pathology (68.8% vs. 41.4%). Specifically, METH cases were more likely to have cardiac (58.9% vs. 34.5%), pulmonary (53.6% vs. 30.9%), hepatic (80.7% vs. 62.8%) and renal (25.0% vs. 9.5%) disease. Given the notable differences in toxicology and disease patterns, great caution appears warranted in prescribing benzodiazepines to methadone users, and regular physical examinations of methadone treatment patients would appear clinically warranted. PMID:19720472

  2. Effect of Reinforcement Probability and Prize Size on Cocaine and Heroin Abstinence in Prize-Based Contingency Management

    PubMed Central

    Ghitza, Udi E; Epstein, David H; Schmittner, John; Vahabzadeh, Massoud; Lin, Jia-Ling; Preston, Kenzie L

    2008-01-01

    Although treatment outcome in prize-based contingency management has been shown to depend on reinforcement schedule, the optimal schedule is still unknown. Therefore, we conducted a retrospective analysis of data from a randomized clinical trial (Ghitza et al., 2007) to determine the effects of the probability of winning a prize (low vs. high) and the size of the prize won (small, large, or jumbo) on likelihood of abstinence until the next urine-collection day for heroin and cocaine users (N ?=? 116) in methadone maintenance. Higher probability of winning, but not the size of individual prizes, was associated with a greater percentage of cocaine-negative, but not opiate-negative, urines. PMID:19192858

  3. [The Rorschach's test for heroin addicts treated by methadone: from reality to imaginary].

    PubMed

    Deslandes, C; Gourarier, L; Sanchez, M; Lowenstein, W

    2000-10-01

    The aim of this study was to analyze the role of the imaginary and its link with reality among 30 subjects treated by methadone. The Rorschach test was proposed to 30 heroin addicts treated by methadone, over an average 7 months. The formal answers (used preferentially in the 30 results, though often inappropriately) and socializing landmarks involving considerable individual investment, we were able to identify two ways of working within the same protocol. The first relies most on conformity and adaptation and tries to put the imaginary aside. The second is a more projective, unorganized approach evidencing the influence of the imaginary. This specific imaginary activity could not be assimilated with the traditional "lack of fantasy" observed in heroin addicts. It would be interesting to examine the course of this approach over a longer period. PMID:11104948

  4. Do methadone and buprenorphine have the same impact on psychopathological symptoms of heroin addicts?

    Microsoft Academic Search

    Giovanni Icro Angelo Maremmani; Luca Rovai; Pier Paolo Pani; Matteo Pacini; Francesco Lamanna; Fabio Rugani; Elisa Schiavi; Liliana Dell’Osso; Icro Maremmani

    2011-01-01

    Background  The idea that the impact of opioid agonist treatment is influenced by the psychopathological profile of heroin addicts has\\u000a not yet been investigated, and is based on the concept of a specific therapeutic action displayed by opioid agents on psychopathological\\u000a symptoms. In the present report we compared the effects of buprenorphine and methadone on the psychopathological symptoms\\u000a of 213 patients

  5. Illicit Heroin and Methamphetamine Use among Methadone Maintenance Treatment Patients in Dehong Prefecture of Yunnan Province, China

    PubMed Central

    Duan, Song; Ye, Runhua; Yang, Yuecheng; Wang, Jibao; Tang, Renhai; Gao, Meiyang; He, Na

    2015-01-01

    Objective Methadone maintenance treatment (MMT) was introduced to China in 2004 to reduce the harm of injecting drug users (IDUs). However, little is known about continued drug use, especially methamphetamine (MAMP), among MMT patients. Methods A survey was conducted among patients attending five major MMT clinics in Dehong Prefecture in 2014 to investigate the heroin and MAMP use and their associated risk factors. Participants were administered with face-to-face interviews, and urine tests for morphine and MAMP. Results A total of 2,121 were eligible and participated in the study. Among them, 220 (10.4%) were only positive for morphine, 12.9% were only positive for MAMP, and 196 (9.2%) were positive for both morphine and MAMP. Compared with neither use of heroin nor MAMP during MMT, heroin use (not using MAMP) was associated with ethnicity, shorter duration of MMT, lower dose of methadone, and having had no more than two sex partners in the past year; MAMP use (not using heroin) was associated with ethnicity, longer duration of MMT, higher dose of methadone and being aged <30 years (vs. ?50 years); use of both heroin and MAMP was associated with being Dai minority (vs. Han), a marital status of divorced or widowed, having used drugs for ?10 years and shorter duration of MMT. Conclusion These findings indicate the complexity in the treatment of heroin users and underscore the importance in prescribing appropriate methadone dosages in order to reduce both heroin and MAMP use. PMID:26196394

  6. Latent classes of heroin and cocaine users predict unique HIV/HCV risk factors

    PubMed Central

    Harrell, PT; Mancha, B; Petras, H; Trenz, R; Latimer, WW

    2011-01-01

    Background Patterns of heroin and cocaine use vary and may be associated with unique risk factors for bloodborne infections. Methods Latent class analysis identified sub-populations of 552 heroin and cocaine users in Baltimore, Maryland. Using latent class regression, these classes were analyzed for associations with demographic characteristics, risky behaviors, Hepatitis C, and HIV. Results Three classes were found: Crack / Nasal-Heroin users (43.5%), Polysubstance users (34.8%), and Heroin Injectors (21.8%). Compared to Polysubstance users, Crack / Nasal-Heroin users were almost 7 times more likely to identify as Black (OR = 6.97, 95% CI = 4.35-11.2). Sharing needles was over 2.5 times more likely among Polysubstance users than among Heroin Injectors (OR = 2.66, 95% CI = 1.49-4.75). Crack/Nasal-Heroin users were 2.5 times more likely than Polysubstance users to exchange drugs for sex (OR = 2.50, 95% CI = 1.22-5.13). Crack/Nasal-Heroin users were less likely than Heroin Injectors to have Hepatitis C (OR = 0.10, 95% CI = 0.06-0.18), but no significant differences were found for HIV. Conclusions Subpopulations of cocaine and heroin users differed in demographic classifications, HIV-risk behaviors, and Hepatitis C infection. All subpopulations included substantial numbers of HIV-positive individuals. Findings provide further evidence that non-injection drug users face significant infectious disease risk. PMID:22030276

  7. Social defeat stress in rats: Escalation of cocaine and “speedball” binge self-administration, but not heroin

    PubMed Central

    Cruz, Fabio C.; Quadros, Isabel M.; Hogenelst, Koen; Planeta, Cleopatra S.; Miczek, Klaus A.

    2013-01-01

    Rationale Exposure to intermittent episodes of social defeat stress can increase drug seeking and leads to intense drug taking in rats. Objectives This study investigated the consequences of repeated, intermittent social defeat stress on patterns of drug self-administration in rats with access to heroin, cocaine, or a heroin-cocaine combination (“speedball”). Methods Male Long-Evans rats were either handled (controls) or subjected to 25 min social defeat stress episodes on days 1, 4, 7 and 10 during confrontations with an aggressive resident. Ten days following the last defeat, rats were assessed for locomotor cross-sensitization in response to heroin or cocaine. Animals were then prepared with intrajugular catheters for drug self-administration. Separate groups of controls and defeated rats were examined for self-administration of heroin (Experiment 1), a heroin-cocaine combination (Experiment 2), or cocaine (Experiment 3). Drug self-administration patterns were evaluated using fixed or progressive ratio schedules (FR, PR respectively) of reinforcement during limited access sessions or a 24-h unlimited access binge. Results Rats with a history of intermittent social defeat stress showed sensitized locomotor behavior when challenged with heroin or cocaine relative to controls. During the 24-h binge session, defeated rats escalated cocaine taking behavior (ca. 110 mg/kg vs. 66 mg/kg in controls), persisted in self-administering cocaine or the heroin-cocaine mixture for more hours, and showed a tendency for increased heroin-cocaine intake, but no effects on heroin taking. Conclusions A history of social defeat stress seems to preferentially promote escalated intake of cocaine but not heroin, unless a heroin-cocaine combination is available. PMID:21197616

  8. Hepatitis C Infection in Non-Treatment-Seeking Heroin Users: The Burden of Cocaine Injection

    PubMed Central

    Roux, P.; Fugon, L.; Jones, J.D.; Comer, S.D.

    2014-01-01

    Background and Objectives In heroin dependent individuals, the HIV epidemic has been controlled in countries where access to opioid maintenance treatment (OMT) and needle exchange programs (NEP) have been implemented. However, despite similar routes of contamination for both viruses, the prevalence of hepatitis C (HCV) infection remains high in drug users. The objective of this analysis was to identify the prevalence of HCV and the correlates of being HCV-positive in a sample of out-of-treatment heroin-dependent individuals. Methods Data were collected from five inpatient studies (n = 120 participants) conducted at the New York State Psychiatric Institute. A logistic regression was used to identify correlates of being HCV-positive at baseline. Results Among the 120 heroin-dependent volunteers, 42 were HCV-positive. Participants who had heavier alcohol use, a longer duration of heroin use, or who reported using heroin by injection were more likely to be HCV-positive. Interestingly, participants who had injected cocaine during the previous month had a ninefold greater risk of being HCV-positive compared to non-cocaine users and those who used cocaine by a non-injecting route. Conclusions and Scientific Significance These findings confirm the risk of being HCV-infected through intravenous drug use, especially with cocaine use. These results underscore the importance of rethinking interventions to prevent HCV infection with combined strategies using pharmacological approaches for cocaine dependence and tailored prevention for cocaine users. PMID:24131170

  9. Brain Disintegration in Heroin Addicts: The Natural Course of the Disease and the Effects of Methadone Treatment

    Microsoft Academic Search

    Anna G. Polunina; Dmitry M. Davydov; Alexander A. Kozlov

    Summary The present review aims to clear up the issue of the neurological processes underlying the personality changes induced by chronic opioid use. The effects of methadone treatment on brain functions have been analyzed, too. Brain dis- integration becomes evident very soon after an onset of chronic heroin abuse and continues throughout the period of drug consumption. A considerable proportion

  10. Changes in dopamine transporter binding in nucleus accumbens following chronic self-administration cocaine: heroin combinations.

    PubMed

    Pattison, Lindsey P; McIntosh, Scot; Sexton, Tammy; Childers, Steven R; Hemby, Scott E

    2014-10-01

    Concurrent use of cocaine and heroin (speedball) has been shown to exert synergistic effects on dopamine neurotransmission in the nucleus accumbens (NAc), as observed by significant increases in extracellular dopamine levels and compensatory elevations in the maximal reuptake rate of dopamine. The present studies were undertaken to determine whether chronic self-administration of cocaine, heroin or a combination of cocaine:heroin led to compensatory changes in the abundance and/or affinity of high- and low-affinity DAT binding sites. Saturation binding of the cocaine analog [(125) I] 3?-(4-iodophenyl)tropan-2?-carboxylic acid methyl ester ([(125) I]RTI-55) in rat NAc membranes resulted in binding curves that were best fit to two-site binding models, allowing calculation of dissociation constant (Kd ) and binding density (Bmax ) values corresponding to high- and low-affinity DAT binding sites. Scatchard analysis of the saturation binding curves clearly demonstrate the presence of high- and low- affinity binding sites in the NAc, with low-affinity sites comprising 85 to 94% of the binding sites. DAT binding analyses revealed that self-administration of cocaine and a cocaine:heroin combination increased the affinity of the low-affinity site for the cocaine congener RTI-55 compared to saline. These results indicate that the alterations observed following chronic speedball self-administration are likely due to the cocaine component alone; thus further studies are necessary to elaborate upon the synergistic effect of cocaine:heroin combinations on the dopamine system in the NAc. PMID:24916769

  11. Quantitative determination of amphetamines, cocaine, and opiates in human hair by gas chromatography\\/mass spectrometry

    Microsoft Academic Search

    L Skender; V Kara?i?; I Br?i?; A Bagari?

    2002-01-01

    Hair of young subjects (N=36) suspected for drug abuse was analysed for morphine, codeine, heroin, 6-acetylmorphine, cocaine, methadone, amphetamine, methamphetamine, 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA), and 3,4-methylenedioxyethylamphetamine (MDEA). The analysis of morphine, codeine, heroin, 6-acetylmorphine, cocaine, and methadone in hair included incubation in methanol, solid-phase extraction, derivatisation by the mixture of propionic acid anhydride and pyridine, and gas chromatography\\/mass spectrometry (GC\\/MS).

  12. Predictors of the Severity of Depressive Symptoms Among Intravenous Heroin Users Receiving Methadone Maintenance Treatment in Taiwan: An 18Month Follow-Up Study

    Microsoft Academic Search

    Peng-Wei Wang; Hung-Chi Wu; Chia-Nan Yen; Yi-Chun Yeh; Kuan-Sheng Chung; Hsun-Cheng Chang; Cheng-Fang Yen

    2012-01-01

    This 18-month follow-up study examined the predictors of the severity of depressive symptoms among intravenous heroin users receiving methadone maintenance treatment (MMT) in Taiwan. The severity of depressive symptoms in 368 intravenous heroin users receiving MMT in southern Taiwan was assessed using the Center for Epidemiological Studies Depression scale at baseline and at 3, 6, 9, 12, 15, and 18

  13. Randomized Trial of Contingent Prizes versus Vouchers in Cocaine-Using Methadone Patients

    ERIC Educational Resources Information Center

    Petry, Nancy M.; Alessi, Sheila M.; Hanson, Tressa; Sierra, Sean

    2007-01-01

    Contingency management (CM) interventions frequently utilize vouchers as reinforcers, but a prize-based system is also efficacious. This study compared these approaches. Seventy-four cocaine-dependent methadone outpatients were randomly assigned to standard treatment (ST), ST plus a maximum of $585 in contingent vouchers, or ST plus an expected…

  14. Simultaneous analysis of buprenorphine, methadone, cocaine, opiates and nicotine metabolites in sweat by liquid chromatography tandem mass spectrometry

    PubMed Central

    Concheiro, Marta; Shakleya, Diaa M.

    2013-01-01

    A liquid chromatography tandem mass spectrometry method for buprenorphine (BUP), norbuprenorphine (NBUP), methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), cocaine, benzoylecgonine, ecgonine methyl ester (EME), morphine, codeine, 6-acetylmorphine, heroin, 6-acetylcodeine, cotinine, and trans-3?-hydroxycotinine quantification in sweat was developed and comprehensively validated. Sweat patches were mixed with 6 mL acetate buffer at pH 4.5, and supernatant extracted with Strata-XC-cartridges. Reverse-phase separation was achieved with a gradient mobile phase of 0.1% formic acid and acetonitrile in 15 min. Quantification was achieved by multiple reaction monitoring of two transitions per compound. The assay was a linear 1–1,000 ng/patch, except EME 5–1,000 ng/patch. Intra-, inter-day and total imprecision were <10.1%CV, analytical recovery 87.2–107.7%, extraction efficiency 35.3– 160.9%, and process efficiency 25.5–91.7%. Ion suppression was detected for EME (?63.3%) and EDDP (?60.4%), and enhancement for NBUP (42.6%). Deuterated internal standards compensated for these effects. No carryover was detected, and all analytes were stable for 24 h at 22 °C, 72 h at 4 °C, and after three freeze/thaw cycles. The method was applied to weekly sweat patches from an opioid-dependent BUP-maintained pregnant woman; 75.0% of sweat patches were positive for BUP, 93.8% for cocaine, 37.5% for opiates, 6.3% for methadone and all for tobacco biomarkers. This method permits a fast and simultaneous quantification of 14 drugs and metabolites in sweat patches, with good selectivity and sensitivity. PMID:21125263

  15. Comparative epidemiology of initial drug opportunities and transitions to first use: marijuana, cocaine, hallucinogens and heroin

    Microsoft Academic Search

    M. L Van Etten; J. C Anthony

    1999-01-01

    The earliest stages of involvement with illicit drugs have been understudied. In a recent report, we examined initial opportunities to try marijuana and transitions from first opportunity to first use of that drug. This report extends that work by investigating early involvement with cocaine, heroin, and hallucinogens as well. We examine sex and race–ethnicity differences in estimates of having a

  16. Plasma level monitoring of the major metabolites of diacetylmorphine (heroin) by the "chasing the dragon" route in severe heroin addicts.

    PubMed

    Dubois, N; Demaret, I; Ansseau, M; Rozet, E; Hubert, Ph; Charlier, C

    2013-01-01

    The objective of the present study was to verify if severe physical health problems frequently encountered in heroin addicts and the concomitant use of alcohol and legal or illegal drugs other than heroin influenced the pharmacokinetics of the major metabolites of heroin. We conducted a 90 minutes follow-up of the plasma concentrations of the pharmaceutical heroin, named diacetylmorphine (DAM), in patients recruited in a DAM assisted treatment centre. TADAM (Traitement Assisté par DiAcétylMorphine) aimed to compare the efficacy of heroin-assisted treatment (HAT) compared with methadone maintenance treatment (MMT) for heroin users considered as treatment resistant patients and who have severe physical and mental health problems. Eleven patients were recruited. Blood samples were collected at baseline and 15, 45 and 90 minutes after DAM administration. All patients received DAM by the "chasing the dragon" route. Plasma samples were analyzed by a previously described ultra-high pressure liquid chromatography coupled to tandem mass spectrometry (UHPLC/MS-MS) method. A principal component analysis (PCA) was performed and 8 metabolite concentrations ratios were calculated to evaluate the influence of various factors (DAM dose, patient pathologies, concomitant use of medications, methadone, street heroin, alcohol and cocaine) on heroin metabolite pharmacokinetics. It seemed to be not affected by the DAM dose, patient pathologies and the concomitant use of medications, methadone, street heroin and alcohol. Cocaine use was the only parameter which showed differences in heroin pharmacokinetics. PMID:24579243

  17. Self-Administered Heroin and Cocaine Combinations in the Rat: Additive Reinforcing Effects—Supra-Additive Effects on Nucleus Accumbens Extracellular Dopamine

    PubMed Central

    Smith, James E; Co, Conchita; Coller, Michael D; Hemby, Scott E; Martin, Thomas J

    2013-01-01

    The concurrent use of cocaine and opiate combinations (speedball) has increased since the 1970s and now represents a growing subset of intravenous drug abusers. An isobolographic analysis was applied to the ascending limb of the dose–effect curves for rat self-administration of cocaine, heroin, and their combination to determine the nature of the interaction. The addition of heroin to cocaine shifted the dose–effect curve for self-administration to the left, and the modulation in reinforcing efficacy of the combination of cocaine and heroin was found to be additive. A second experiment used microdialysis to determine the effects of this drug combination on nucleus accumbens (NAc) extracellular levels of dopamine ([DA]e) in rats self-administering low doses of cocaine, heroin, or cocaine/ heroin combinations. These doses of cocaine and cocaine/heroin combinations significantly increased NAc [DA]e, while heroin alone did not. The ratio of the % baseline of [DA]e (or the dialysate concentrations of DA) to cocaine in the dialysate was higher during self-administration of cocaine/heroin combinations than with cocaine alone. These data indicate that although the interaction between cocaine and heroin in maintaining self-administration is additive, a potentiation of NAc dopaminergic neurotransmission is present, suggesting that NAc [DA]e may not be a direct measure of reinforcing efficacy and/or it is not central to the mediation of the self-administration of this drug combination. PMID:15956989

  18. Distinctive Profiles of Gene Expression in the Human Nucleus Accumbens Associated with Cocaine and Heroin Abuse

    PubMed Central

    Albertson, Dawn N; Schmidt, Carl J; Kapatos, Gregory; Bannon, Michael J

    2008-01-01

    Drug abuse is thought to induce long-term cellular and behavioral adaptations as a result of alterations in gene expression. Understanding the molecular consequences of addiction may contribute to the development of better treatment strategies. This study utilized highthroughput Affymetrix microarrays to identify gene expression changes in the post-mortem nucleus accumbens of chronic heroin abusers. These data were analyzed independently and in relation to our previously reported data involving human cocaine abusers, in order to determine which expression changes were drug specific and which may be common to the phenomenon of addiction. A significant decrease in the expression of numerous genes encoding proteins involved in presynaptic release of neurotransmitter was seen in heroin abusers, a finding not seen in the cocaine-abusing cohort. Conversely, the striking decrease in myelin-related genes observed in cocaine abusers was not evident in our cohort of heroin subjects. Overall, little overlap in gene expression profiles was seen between the two drug-abusing cohorts: out of the approximately 39 000 transcripts investigated, the abundance of only 25 was significantly changed in both cocaine and heroin abusers, with nearly one-half of these being altered in opposite directions. These data suggest that the profiles of nucleus accumbens gene expression associated with chronic heroin or cocaine abuse are largely unique, despite what are thought to be common effects of these drugs on dopamine neurotransmission in this brain region. A re-examination of our current assumptions about the commonality of molecular mechanisms associated with substance abuse seems warranted. PMID:16710320

  19. High-throughput simultaneous analysis of buprenorphine, methadone, cocaine, opiates, nicotine, and metabolites in oral fluid by liquid chromatography tandem mass spectrometry

    PubMed Central

    Concheiro, Marta; Gray, Teresa R.; Shakleya, Diaa M.

    2011-01-01

    A method for simultaneous determination of buprenorphine (BUP), norbuprenorphine (NBUP), methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), cocaine, benzoylecgonine (BE), ecgonine methyl ester (EME), anhydroecgonine methyl ester (AEME), morphine, codeine, 6-acetylmorphine (6AM), heroin, 6-acetylcodeine (6AC), nicotine, cotinine, and trans-3?-hydroxycotinine (OH-cotinine) by liquid chromatography tandem mass spectrometry in oral fluid (OF) was developed and extensively validated. Acetonitrile (800 ?L) and OF (250 ?L) were added to a 96-well Isolute-PPT+protein precipitation plate. Reverse-phase separation was achieved in 16 min and quantification was performed by multiple reaction monitoring. The assay was linear from 0.5 or 1 to 500 ?g/L. Intraday, interday, and total imprecision were less than 13% (n=20), analytical recovery was 92–114% (n= 20), extraction efficiencies were more than 77% (n=5), and process efficiencies were more than 45% (n=5). Although ion suppression was detected for EME, cocaine, morphine, 6AC, and heroin (less than 56%) and enhancement was detected for BE and nicotine (less than 316%), deuterated internal standards compensated for these effects. The method was sensitive (limit of detection 0.2–0.8 ?g/L) and specific (no interferences) except that 3-hydroxy-4-methoxyamphetamine interfered with AEME. No carryover was detected, and all analytes were stable for 24 h at 22 °C, for 72 h at 4 °C, and after three freeze–thaw cycles, except cocaine, 6AC, and heroin (22–97% loss). The method was applied to 41 OF specimens collected throughout pregnancy with a Salivette® OF collection device from an opioid-dependent BUP-maintained pregnant woman. BUP ranged from 0 to 7,400 ?g/L, NBUP from 0 to 71 ?g/L, methadone from 0 to 3 ?g/L, nicotine from 32 to 5,020 ?g/L, cotinine from 125 to 508 ?g/L, OH-cotinine from 11 to 51 ?g/L, cocaine from 0 to 419 ?g/L, BE from 0 to 351 ?g/L, EME from 0 to 286 ?g/L, AEME from 0 to 7 ?g/L, morphine from 0 to 22 ?g/L, codeine from 0 to 1 ?g/L, 6AM from 0 to 4 ?g/L, and heroin from 0 to 2 ?g/L. All specimens tested negative for EDDP and 6AC. This method permits a fast and simultaneous quantification of 16 drugs and metabolites in OF, with good selectivity and sensitivity. PMID:20652688

  20. Self-administration of cocaine, cannabis and heroin in the human laboratory: benefits and pitfalls.

    PubMed

    Haney, Margaret

    2009-01-01

    The objective of this review is to describe self-administration procedures for modeling addiction to cocaine, cannabis and heroin in the human laboratory, the benefits and pitfalls of the approach, and the methodological issues unique to each drug. In addition, the predictive validity of the model for testing treatment medications will be addressed. The results show that all three drugs of abuse are reliably and robustly self-administered by non-treatment-seeking research volunteers. In terms of pharmacotherapies, cocaine use is extraordinarily difficult to disrupt either in the laboratory or in the clinic. A range of medications has been shown to significantly decrease cocaine's subjective effects and craving without decreasing either cocaine self-administration or cocaine abuse by patients. These negative data combined with recent positive findings with modafinil suggest that self-administration procedures are an important intermediary step between pre-clinical and clinical studies. In terms of cannabis, a recent study suggests that medications that improve sleep and mood during cannabis withdrawal decrease the resumption of marijuana self-administration in abstinent volunteers. Clinical data on patients seeking treatment for their marijuana use are needed to validate these laboratory findings. Finally, in contrast to cannabis or cocaine dependence, there are three efficacious Food and Drug Administration-approved medications to treat opioid dependence, all of which decrease both heroin self-administration and subjective effects in the human laboratory. In summary, self-administration procedures provide meaningful behavioral data in a small number of individuals. These studies contribute to our understanding of the variables maintaining cocaine, marijuana and heroin intake, and are important in guiding the development of more effective drug treatment programs. PMID:18855806

  1. Field ion spectrometry: a new technology for cocaine and heroin detection

    NASA Astrophysics Data System (ADS)

    Carnahan, Byron L.; Day, Stephen; Kouznetsov, Viktor; Tarassov, Alexandre

    1997-02-01

    Field ion spectrometry, also known as transverse field compensation ion mobility spectrometry, is a new technique for trace gas analysis that can be applied to the detection of cocaine and heroin. Its principle is based on filtering ion species according to the functional dependence of their mobilities with electric field strength. Field ion spectrometry eliminates the gating electrodes needed in conventional IMS to pulse ions into the spectrometer; instead, ions are injected in to the spectrometer and reach the detector continuously, resulting in improved sensitivity. The technique enables analyses that are difficult with conventional constant field strength ion mobility spectrometers. We have shown that a filed ion spectrometer can selectively detect the vapors from cocaine and heroin emitted from both their base and hydrochloride forms. The estimated volumetric limits of detection are in the low pptv range, based on testing with standardized drug vapor generation systems. The spectrometer can detect cocaine base in the vapor phase, at concentrations well below its estimated 100 pptv vapor pressure equivalent at 20 degrees C. This paper describes the underlying principles of field ion spectrometry in relation to narcotic drug detection, and recent results obtained for cocaine and heroin. The work has been sponsored in part by the United States Advanced Research Projects Agency under contract DAAB10-95C-0004, for the DOD Counterdrug Technology Development Program.

  2. Topiramate for Cocaine Dependence during Methadone Maintenance Treatment: A Randomized Controlled Trial

    PubMed Central

    Umbricht, Annie; DeFulio, Anthony; Winstanley, Erin L.; Andrew Tompkins, D.; Peirce, Jessica; Mintzer, Miriam Z.; Strain, Eric C.; Bigelow, George E.

    2015-01-01

    Background Dual dependence on opiate and cocaine occurs in about 60% of patients admitted to methadone maintenance and negatively impacts prognosis (Kosten et al., 2003). Topiramate (TOP) is an antiepileptic drug that may have utility in the treatment of cocaine dependence because it enhances the GABAergic system, antagonizes the glutamatergic system, and has been identified by NIDA as one of only a few medications providing a “positive signal” warranting further clinical investigation. (Vocci and Ling, 2005). Method In this double-blind controlled clinical trial, cocaine dependent methadone maintenance patients (N=171) were randomly assigned to one of four groups. Under a factorial design, participants received either TOP or placebo, and monetary voucher incentives that were either contingent (CM) or non-contingent (Non-CM) on drug abstinence. TOP participants were inducted onto TOP over 7 weeks, stabilized for 8 weeks at 300 mg daily then tapered over 3 weeks. Voucher incentives were supplied for 12 weeks, starting during the fourth week of TOP induction. Primary outcome measures were cocaine abstinence (Y/N) as measured by thrice weekly urinalysis and analyzed using Generalized Estimating Equations (GEE) and treatment retention. All analyses were intent to treat and included the 12-week evaluation phase of combined TOP/P treatment and voucher intervention period. Results There was no significant difference in cocaine abstinence between the TOP vs P conditions nor between the CM vs Non-CM conditions. There was no significant TOP/CM interaction. Retention was not significantly different between the groups. Conclusion Topiramate is not efficacious for increasing cocaine abstinence in methadone patients. PMID:24814607

  3. Referring heroin users from compulsory detoxification centers to community methadone maintenance treatment: a comparison of three models

    PubMed Central

    2013-01-01

    Background Both compulsory detoxification treatment and community-based methadone maintenance treatment (MMT) exist for heroin addicts in China. We aim to examine the effectiveness of three intervention models for referring heroin addicts released from compulsory detoxification centers to community methadone maintenance treatment (MMT) clinics in Dehong prefecture, Yunnan province, China. Methods Using a quasi-experimental study design, three different referral models were assigned to four detoxification centers. Heroin addicts were enrolled based on their fulfillment to eligibility criteria and provision of informed consent. Two months prior to their release, information on demographic characteristics, history of heroin use, and prior participation in intervention programs was collected via a survey, and blood samples were obtained for HIV testing. All subjects were followed for six months after release from detoxification centers. Multi-level logistic regression analysis was used to examine factors predicting successful referrals to MMT clinics. Results Of the 226 participants who were released and followed, 9.7% were successfully referred to MMT(16.2% of HIV-positive participants and 7.0% of HIV-negative participants). A higher proportion of successful referrals was observed among participants who received both referral cards and MMT treatment while still in detoxification centers (25.8%) as compared to those who received both referral cards and police-assisted MMT enrollment (5.4%) and those who received referral cards only (0%). Furthermore, those who received referral cards and MMT treatment while still in detoxification had increased odds of successful referral to an MMT clinic (adjusted OR?=?1.2, CI?=?1.1-1.3). Having participated in an MMT program prior to detention (OR?=?1.5, CI?=?1.3-1.6) was the only baseline covariate associated with increased odds of successful referral. Conclusion Findings suggest that providing MMT within detoxification centers promotes successful referral of heroin addicts to community-based MMT upon their release. PMID:23938171

  4. Pilot Cluster-Randomised Trial of Adjunctive Motivational Interviewing to Reduce Crack Cocaine Use in Clients on Methadone Maintenance

    Microsoft Academic Search

    Luke Mitcheson; Jim McCambridge; Suzanne Byrne

    2007-01-01

    This pilot trial explored the effectiveness of an adjunctive single session of motivational interviewing (MI) to reduce crack cocaine use in a methadone maintenance treatment population. Twenty-nine participants were cluster randomised by clinician to MI or a crack information control condition as part of treatment as usual. The intervention had a modest impact on one crack cocaine measure but was

  5. Effects of ibogaine on responding maintained by food, cocaine and heroin reinforcement in rats

    Microsoft Academic Search

    Steven I. Dworkin; Suzanne Gleeson; D. Meloni; T. R. Koves; T. J. Martin

    1995-01-01

    The effects of ibogaine (40 and 80 mg\\/kg, IP), an indole alkaloid proposed for the treatment of drug abuse, were determined in three different groups of rats responding under an FR10 schedule of food, cocaine or heroin reinforcement. Ibogaine (80 mg\\/kg, IP) given 60 min before the start of the session resulted in a 97% decrease in the number of

  6. Cocaine use among heroin users in Spain: the diffusion of crack and cocaine smoking. Spanish Group for the Study on the Route of Administration of Drugs

    PubMed Central

    Barrio, G.; De la Fuente, L.; Royuela, L.; Diaz, A.; Rodriguez-Artalej..., F.

    1998-01-01

    STUDY OBJECTIVE: To describe the prevalence and patterns of use of crack and cocaine hydrochloride among heroin users in Spain. To explore if the expansion of heroin smoking is accompanied by a similar phenomenon for cocaine. DESIGN: Cross sectional study in 1995. Face to face interviews using a structured questionnaire. SETTING: Three cities with different prevalences of heroin use by smoking: high (Seville), intermediate (Madrid), and low (Barcelona). PARTICIPANTS: 909 heroin users, 452 in treatment and 457 out of treatment. MAIN RESULTS: Last month prevalence of crack use was 62.3% in Seville, 19.4% in Madrid, and 7.7% in Barcelona. Most users in Madrid (86.5%) and Barcelona (100%) generally prepared their own crack, usually with ammonia as alkali; in Seville most users (69.7%) bought preprocessed crack. The proportion of users who began taking cocaine (crack or cocaine hydrochloride) by smoking has increased progressively since the seventies, rising to 74.1% in Seville, 61.5% in Madrid, and 28% in Barcelona in 1992-1995, with the earliest increase in Seville. The factors associated with crack use were: residence in Seville (odds ratio (OR) = 16.3), cocaine hydrochloride use mainly by smoking (OR = 5.0), by sniffing (OR = 2.7) or by injecting (OR = 2.5), heroin use mainly by smoking (OR = 2.8) and weekly use of cannabis (OR = 1.9). CONCLUSIONS: In Spain smoking cocaine may be progressively diffusing from the south west to the north east, similar to what has happened with smoking heroin, but beginning later in time. The factors associated with smoking cocaine are basically ecological or cultural in nature (characteristics of the available drugs and the main route of heroin administration in each city).   PMID:9616422

  7. Rooming-in compared with standard care for newborns of mothers using methadone or heroin

    PubMed Central

    Abrahams, Ronald R.; Kelly, S. Ann; Payne, Sarah; Thiessen, Paul N.; Mackintosh, Jessica; Janssen, Patricia A.

    2007-01-01

    OBJECTIVE To evaluate the effect of rooming-in (rather than standard nursery care) on the incidence and severity of neonatal abstinence syndrome among opioid-exposed newborns and on the proportion of mothers who retain custody of their babies at hospital discharge. DESIGN Retrospective cohort study. SETTING Lower mainland in southwestern British Columbia. PARTICIPANTS We selected 32 women in the city of Vancouver known to have used heroin or methadone during pregnancy between October 2001 and December 2002. Comparison groups were a historical cohort of 38 women in Vancouver and a concurrent cohort of 36 women cared for in a neighbouring community hospital. MAIN OUTCOME MEASURES Need for treatment with morphine, number of days of treatment with morphine, and whether babies were discharged in the custody of their mothers. RESULTS Rooming-in was associated with a significant decrease in need for treatment of neonatal abstinence syndrome compared with the historical cohort (adjusted relative risk [RR] 0.40, 95% confidence interval [CI] 0.20 to 0.78) and the concurrent cohort (adjusted RR 0.39, 95% CI 0.20 to 0.75). Rooming-in was also associated with shorter newborn length of stay in hospital compared with both comparison groups. Newborns who roomed in at BC Women’s Hospital were significantly more likely to be discharged in the custody of their mothers than babies in the historical cohort (RR 2.23, 95% CI 1.43 to 3.98) or the concurrent cohort (RR 1.52, 95% CI 1.15 to 2.53) were. CONCLUSION Rooming-in might ease opioid-exposed newborns’ transition to extrauterine life and promote more effective mothering. PMID:17934036

  8. HCV infection is independently associated with depression among methadone maintenance treatment heroin users in China

    PubMed Central

    Wang, Zhen; Du, Jiang; Zhao, Min; Page, Kimberly; Xiao, Zeping; Mandel, Jeffrey S.

    2015-01-01

    Background Depression and hepatitis C virus (HCV) infection are two common conditions among heroin users in methadone maintenance treatment (MMT). However, the comorbid relationship between depression and HCV infection among MMT patients is not well understood. Methods 115 MMT patients were recruited from the Yangpu MMT Clinic in Shanghai. Demographic characteristics, drug use and HCV- related information were collected via a structured interview. The Beck Depression Inventory (BDI-II) and the Perceived Stress Scale (PSS) were administered to evaluate participants’ symptoms of depression and stress severity. HCV antibody (anti-HCV) test results were collected from patients’ MMT clinical medical records. Results 58.2% of participants were anti-HCV positive, and 41.3% scored moderate-to-severe for symptoms of depression (BDI-II scores>19). The prevalence of depressive symptoms (BDI-II score >19) was greater in HCV positive than HCV negative participants (51.6% vs 27.7%, respectively; p=0.02). There was no significant difference in the perceived stress level by anti-HCV status; overall the perceived stress level score was 15.9±5.7. In logistic regression analysis, positive anti-HCV status (OR=3.75, 95%CI=1.42–9.90), and greater perceived stress (OR=1.23, 95%CI=1.11–1.36) were independently associated with depression, after controlling for gender, age, duration of drug use and the awareness of HCV infection. Conclusion Depression and HCV infection are common and co-occurring among MMT patients in Shanghai. HCV infection itself appears to be associated with depressive symptoms regardless of whether the individual is aware of his HCV infection status. This finding indicated that it is important to consider the impact of depressive symptoms on injection risk behaviors and HCV transmission when planning intervention program in MMT clinic. PMID:23857926

  9. Treatment-like steady-state methadone in rats interferes with incubation of cocaine sensitization and associated alterations in gene expression?

    PubMed Central

    Leri, Francesco; Zhou, Yan; Carmichael, Brendan; Cummins, Erin; Kreek, Mary Jeanne

    2013-01-01

    In a previous study, steady-state methadone treatment was found to prevent associative cocaine learning, as well as related decreases in mRNA expression of preprohypocretin/preproorexin (ppHcrt) in the lateral hypothalamus (LH) and dopamine D2 receptor (DR2) in the caudate-putamen (CP), and increases in mu-opioid receptor in the ventral striatum of rats. To investigate whether the same regimen of methadone exposure could prevent the incubation of cocaine sensitization and related alterations in gene expression, male Sprague–Dawley rats received 45 mg/kg/day steadydose “binge” cocaine administration (IP) for 14 days followed by mini-pumps releasing 30 mg/kg/day methadone (SC). After 14 days of methadone, and a subsequent 10-day drug-free period, all rats were tested for sensitization (cocaine test dose: 15 mg/kg) and brain tissue was collected to quantify mRNA expression. Rats exposed to cocaine displayed cocaine-induced stereotypy at test, as well as enhanced ppHcrt mRNA in the LH and reduced DR2 mRNA in the CP. Importantly, these alterations were significantly reduced in rats treated with methadone following cocaine. These results suggest that steady-state methadone can interfere with the incubation of neuroadaptations underlying changes in behavioral responses to cocaine and cocaine-associated stimuli, and that these effects can be observed even after withdrawal from methadone. PMID:21745729

  10. Use of methylene blue as a simulant for the physical properties of cocaine HCl and heroin HCl

    NASA Astrophysics Data System (ADS)

    Patrick, Julie C.; Orzechowska, Grazyna E.; Poziomek, Edward J.

    1997-02-01

    Technological challenges in the development and testing of illicit narcotics include assuring safety of researchers and operations personnel from drug exposure, assessing the efficiency of sampling and sample handling, checking for artifacts introduced by field procedures, and maintaining quality control/quality assurance. The dye methylene blue was chosen as a simulant for cocaine HCl and heroin HCl. The similarities include the presence of fused ring systems, molecular weights over 300 g/mol, and melting points between 200 and 300 degrees C. A significant difference is that methylene blue has a much lower solubility in water than cocaine HCl and heroin HCl. Experiments have been conducted to successfully increase the solubility of the simulant to match those of cocaine HCl and heroin HCl by adding solidum methyl sulfate.

  11. Neighborhood Socioeconomic Status, Personal Network Attributes, and Use of Heroin and Cocaine

    PubMed Central

    Williams, Chyvette T.; Latkin, Carl A.

    2007-01-01

    Background Drug abuse is a significant public health problem because of its association with numerous negative health and social consequences. Examining the social context of drug use represents a burgeoning avenue of research in drug abuse. This study investigates the effects of neighborhood disadvantage and network factors on current heroin and cocaine use among a predominantly African-American adult sample residing in Baltimore City. Methods This study employs a cross-sectional, multilevel design using data from two sources: the SHIELD Study, a network-oriented HIV intervention in Baltimore City and the 1990 US Decennial Census. The sample consisted of 1305 adults from 249 neighborhoods (census block groups) across Baltimore City. Multilevel logistic regression analysis was performed to examine personal network and neighborhood effects on current heroin and cocaine use. Results Neighborhood poverty was significantly associated with current heroin and cocaine use (OR=1.51, CI: 1.06, 2.15). Social support (OR=0.80, CI: 0.69, 0.92) and having ties to employed persons (OR=0.47, CI: 0.24, 0.92) were protective of current drug use, but did not buffer negative effects of neighborhood poverty in the face of negative drug influences in the network (OR=8.62, CI: 5.81, 12.79). Conclusions The contexts of neighborhoods and networks represent key determinants in understanding the social epidemiology of drug abuse. Network attributes have strong influences on drug use and neighborhood poverty may increase odds of use. Further research is warranted to determine other aspects of neighborhood environments that may put individuals at risk for drug use and abuse. PMID:17543712

  12. Heroin

    MedlinePLUS

    ... is a white or brown powder or a black, sticky goo. It's made from morphine, a natural substance in the seedpod of the Asian poppy plant. It can be mixed with water and injected with a needle. Heroin can also ...

  13. Heroin

    MedlinePLUS

    ... 384KB) Online Only Featured Publications Drugs, Brains, and Behavior: The Science of Addiction Marijuana: Facts Parents Need to Know Marijuana: Facts for Teens Heroin ?Research Reports This series of reports simplifies the ...

  14. Heroin

    MedlinePLUS

    ... dependence America’s Addiction to Opioids: Heroin and Prescription Drug Abuse (Testimony to Congress, May 2014) Prescription Opioid and ... addiction (Archives) Other Resources MEDLINEplus Health Information on Drug Abuse - National Library of Medicine, NIH www.abovetheinfluence.com - ...

  15. An enumeration method of determining the prevalence of users and operatives of cocaine and heroin in Central Harlem

    Microsoft Academic Search

    W. Rees Davis; Bruce D. Johnson; Doris Randolph; Hilary James Liberty

    2003-01-01

    Introduction: The investigators estimated the number and characteristics of crack, powder cocaine and heroin users and distributors (“operatives”) in Central Harlem. Methods: Central Harlem was divided into 45 primary sampling units (PSUs) with 2 years of drug allegation data from the New York Police Department (NYPD) organized in three strata, those having high, middle or low levels of allegations. In

  16. Characterizing longitudinal health state transitions among heroin, cocaine, and methamphetamine users

    PubMed Central

    Nosyk, B; Li, L; Evans, E; Huang, D; Min, J; Kerr, T; Brecht, ML; Hser, YI

    2014-01-01

    Aims Characterize longitudinal patterns of drug use careers and identify determinants of drug use frequency across cohorts of primary heroin, methamphetamine (MA) and cocaine users. Design Pooled analysis of prospective cohort studies. Settings Illicit drug users recruited from community, criminal justice and drug treatment settings in California, USA. Participants We used longitudinal data on from five observational cohort studies featuring primary users of heroin (N=629), cocaine (N=694) and methamphetamine (N=474). The mean duration of follow-up was 20.9 years. Measurements Monthly longitudinal data was arranged according to five health states (incarceration, drug treatment, abstinence, non-daily and daily use). We fitted proportional hazards (PH) frailty models to determine independent differences in successive episode durations. We then executed multi-state Markov (MSM) models to estimate probabilities of transitioning between health states, and the determinants of these transitions. Findings Across primary drug use types, PH frailty models demonstrated durations of daily use diminished in successive episodes over time. MSM models revealed primary stimulant users had more erratic longitudinal patterns of drug use, transitioning more rapidly between periods of treatment, abstinence, non-daily and daily use. MA users exhibited relatively longer durations of high-frequency use. Criminal engagement had a destabilizing effect on health state durations across drug types. Longer incarceration histories were associated with delayed transitions towards cessation. Conclusions PH frailty and MSM modeling techniques provided complementary information on longitudinal patterns of drug abuse. This information can inform clinical practice and policy, and otherwise be used in health economic simulation models, designed to inform resource allocation decisions. PMID:24837584

  17. Comparing injection and non-injection routes of administration for heroin, methamphetamine, and cocaine users in the United States.

    PubMed

    Novak, Scott P; Kral, Alex H

    2011-01-01

    Research examining the demographic and substance use characteristics of illicit drug use in the United States has typically failed to consider differences in routes of administration or has exclusively focused on a single route of administration?injection drug use. Data from National Survey on Drug Use and Health were used to compare past-year injection drug users and non-injection drug users' routes of administration of those who use the three drugs most commonly injected in the United States: heroin, methamphetamine, and cocaine. Injection drug users were more likely than those using drugs via other routes to be older (aged 35 and older), unemployed, possess less than a high school education, and reside in rural areas. IDUs also exhibited higher rates of abuse/dependence, perceived need for substance abuse treatment, and co-occurring physical and psychological problems. Fewer differences between IDUs and non-IDUs were observed for heroin users compared with methamphetamine or cocaine users. PMID:21745047

  18. Methodology for the Randomised Injecting Opioid Treatment Trial (RIOTT): evaluating injectable methadone and injectable heroin treatment versus optimised oral methadone treatment in the UK

    Microsoft Academic Search

    Nicholas Lintzeris; John Strang; Nicola Metrebian; Sarah Byford; Christopher Hallam; Sally Lee; Deborah Zador

    2006-01-01

    Whilst unsupervised injectable methadone and diamorphine treatment has been part of the British treatment system for decades, the numbers receiving injectable opioid treatment (IOT) has been steadily diminishing in recent years. In contrast, there has been a recent expansion of supervised injectable diamorphine programs under trial conditions in a number of European and North American cities, although the evidence regarding

  19. Acquisition of cocaine and heroin self-administration in rats developmentally exposed to lead

    E-print Network

    Rocha, Angelica

    2005-08-29

    an enhanced vulnerability to reach the criterion for cocaine self-administration. Clinical relevance of developmental exposure to lead and the attendant vulnerability to self-administer drugs of abuse is discussed....

  20. Randomized Trial Comparing Two Treatment Strategies Using Prize-Based Reinforcement of Abstinence in Cocaine and Opiate Users

    PubMed Central

    Preston, Kenzie L; Ghitza, Udi E; Schmittner, John P; Schroeder, Jennifer R; Epstein, David H

    2008-01-01

    We compared two strategies of prize-based contingency management (CM) in methadone-maintained outpatients. Urine was tested thrice weekly for 5 weeks pre-CM, 12 weeks CM, and 8 weeks post-CM. Participants were randomly assigned to a cocaine contingency (four prize draws for each cocaine-negative urine, N ?=? 29) or an opiate-cocaine contingency (one draw for each urine negative for opiates or cocaine, four draws if negative for both, N ?=? 38). There were no group differences in cocaine abstinence during CM or post-CM and no differences in opiate abstinence during CM. Opiate abstinence was greater in the opiate-cocaine group post-CM, and heroin craving was reduced in this group during and post-CM. Draws earned per cocaine-negative urine (four vs. one) did not affect cocaine use. PMID:19192859

  1. Heroin and cocaine craving and use during treatment: Measurement validation and potential relationships

    Microsoft Academic Search

    Adrienne J. Heinz; David H. Epstein; Jennifer R. Schroeder; Edward G. Singleton; Stephen J. Heishman; Kenzie L. Preston

    2006-01-01

    Although commonly assessed with unidimensional scales, craving has been suggested to be multifaceted and to have a complex relationship with drug use and relapse. This study assessed the consistency and predictive validity of unidimensional and multidimensional craving scales. At the beginning of a 12-week outpatient treatment trial, opiate users (n = 101) and cocaine users (n = 72) completed unidimensional

  2. Risks for HIV infection among users and sellers of crack, powder cocaine and heroin in central Harlem: Implications for interventions

    PubMed Central

    DAVIS, W. REES; JOHNSON, B. D.; RANDOLPH, D.; LIBERTY, H. J.

    2007-01-01

    This article investigates behaviours that may be associated HIV infection among users and sellers of crack, powder cocaine and heroin in central Harlem. Chain referral sampling and other strategies were combined to acquire a sample of 637 (Users = 546; Sellers = 91) who provided urine specimens that were tested for the presence of drugs and HIV. Nearly a quarter (23.9%) of all respondents were HIV positive. Drug injectors were more than 2.5 times more likely to have HIV infections than other respondents (OR = 2.66; 95% CI 1.66–4.26). Those involved in frauds/cons were almost as likely to be HIV positive (OR = 2.58; 95% CI 1.64–4.06). Those with a marital status of being separated, divorced or widowed were twice as likely to be HIV infected (OR 2.16; 95% CI 1.43–3.25). Respondents currently having multiple partner sex (OR = 1.66; 95% CI 1.1–2.51) or who were female (OR = 1.66; 95% CI 1.12–2.45) were more than 1.5 times more likely to be HIV positive. Thus, controlling for lifetime drug injection and current multiple partner sex, other factors, such as participating in frauds/cons, as well as relationship status and being female, were also associated with HIV infection. PMID:16338774

  3. Cocaine. Specialized Information Service.

    ERIC Educational Resources Information Center

    Do It Now Foundation, Phoenix, AZ.

    This compilation of journal articles on cocaine includes a report describing cocaine as the recreational drug of the middle class, statistics from the United States Department of Health on health consequences of cocaine use, an article on "speedballing" (use of cocaine and heroin in combination), and a discussion of the various ways cocaine is…

  4. Cocaine

    MedlinePLUS

    ... High ( November 2014 ) Dr. Antonello Bonci Q & A: Lighting Up the Brain To Shut Down Cocaine Seeking ( ... the Cocaine High Dr. Antonello Bonci Q & A: Lighting Up the Brain To Shut Down Cocaine Seeking ...

  5. Sustained release d-amphetamine reduces cocaine but not 'speedball'-seeking in buprenorphine-maintained volunteers: a test of dual-agonist pharmacotherapy for cocaine/heroin polydrug abusers.

    PubMed

    Greenwald, Mark K; Lundahl, Leslie H; Steinmiller, Caren L

    2010-12-01

    The aim of this study was to determine whether oral sustained release d-amphetamine (SR-AMP) reduces cocaine and opioid/cocaine combination ('speedball'-like) seeking in volunteers with current opioid dependence and cocaine dependence. Following outpatient buprenorphine (BUP) 8?mg/day stabilization without SR-AMP, eight participants completed a 3-week in-patient study with continued BUP 8?mg/day maintenance and double-blind ascending SR-AMP weekly doses of 0, 30, and 60?mg/day, respectively. After 3 days (Saturday-Monday) stabilization at each SR-AMP weekly dose (0, 15, or 30?mg administered at 0700 and 1225 each day), on Tuesday-Friday mornings (0900-1200 hours), participants sampled four drug combinations in randomized, counterbalanced order under double-blind, double-dummy (intranasal cocaine and intramuscular hydromorphone) conditions: cocaine (COC 100?mg+saline); hydromorphone (COC 4?mg+HYD 24?mg); 'speedball' (COC 100?mg+HYD 24?mg); and placebo (COC 4?mg+saline). Subjective and physiological effects of these drug combinations were measured. From 1230 to 1530 hours, participants could respond on a choice, 12-trial progressive ratio schedule to earn drug units (1/12th of total morning dose) or money units (US$2). SR-AMP significantly reduced COC, but not HYD or speedball, choices and breakpoints. SR-AMP also significantly reduced COC subjective (eg, abuse-related) effects and did not potentiate COC-induced cardiovascular responses. This study shows the ability of SR-AMP to attenuate COC self-administration, as well as its selectivity, in cocaine/heroin polydrug abusers. Further research is warranted to ascertain whether SR-AMP combined with BUP could be a useful dual-agonist pharmacotherapy. PMID:20881947

  6. Methadone Induced Sensorineural Hearing Loss

    PubMed Central

    Saifan, Chadi; Barakat, Iskandar; El-Sayegh, Suzanne

    2013-01-01

    Background. Sudden sensorineural hearing loss (SSHL) caused by opiate abuse or overuse has been well documented in the medical literature. Most documented case reports have involved either heroin or hydrocodone/acetaminophen. Recently, case reposts of methadone induced SSHL have been published. Case Report. We present the case of a 31-year-old man who developed SSHL after a methadone overdose induced stupor. He was subsequently restarted on methadone at his regular dose. On follow-up audiometry exams, he displayed persistent moderately severe sensorineural hearing loss bilaterally. Discussion. This case is notable because unlike all but one previously reported case, the patient—who was restated on methadone—did not make a complete recovery. Conclusion. Methadone overuse in rare cases causes SSHL. PMID:23983704

  7. A morphine/heroin vaccine with new hapten design attenuates behavioral effects in rats.

    PubMed

    Li, Qian-Qian; Luo, Yi-Xiao; Sun, Cheng-Yu; Xue, Yan-Xue; Zhu, Wei-Li; Shi, Hai-Shui; Zhai, Hai-Feng; Shi, Jie; Lu, Lin

    2011-12-01

    Heroin use has seriously threatened public heath in many countries, but the existing therapies continue to have many limitations. Recently, immunotherapy has shown efficacy in some clinical studies, including vaccines against nicotine and cocaine, but no opioid vaccines have been introduced in clinical studies. The development of a novel opioid antigen designed specifically for the prevention of heroin addiction is necessary. A morphine-keyhole limpet hemocyanin conjugate was prepared and administered subcutaneously in rats. Antibody titers in plasma were measured using an enzyme-linked immunosorbent assay (ELISA). Competitive ELISA was used to assess the selectivity of the antibodies. Dopamine concentrations in the nucleus accumbens in rats after vaccine administration were determined by high-performance liquid chromatography with electrochemical detection. The effects of the vaccine on the heroin-primed restatement of self-administration and locomotor sensitization were evaluated. A novel hapten, 6-glutarylmorphine, was produced, and the vaccine generated a high antibody titer response. This vaccine displayed specificity for both morphine and heroin, but the anti-morphine antibodies could not recognize dissimilar therapeutic opioid compounds, such as buprenorphine, methadone, naloxone, naltrexone, codeine, and nalorphine. The morphine antibody significantly decreased morphine-induced locomotor activity in rats after immunization. Importantly, rats immunized with this vaccine did not exhibit heroin-primed reinstatement of heroin seeking when antibody levels were sufficiently high. The vaccine reduced dopamine levels in the nucleus accumbens after morphine administration, which is consistent with its behavioral effects. These results suggest that immunization with a novel vaccine is an effective means of inducing a morphine-specific antibody response that is able to attenuate the behavioral and psychoactive effects of heroin. PMID:21951213

  8. Elevated Norepinephrine may be a Unifying Etiological Factor in the Abuse of a Broad Range of Substances: Alcohol, Nicotine, Marijuana, Heroin, Cocaine, and Caffeine

    PubMed Central

    Fitzgerald, Paul J.

    2013-01-01

    A wide range of commonly abused drugs have effects on the noradrenergic neurotransmitter system, including alterations during acute intoxication and chronic use of these drugs. It is not established, however, that individual differences in noradrenergic signaling, which may be present prior to use of drugs, predispose certain persons to substance abuse. This paper puts forth the novel hypothesis that elevated noradrenergic signaling, which may be raised largely due to genetics but also due to environmental factors, is an etiological factor in the abuse of a wide range of substances, including alcohol, nicotine, marijuana, heroin, cocaine, and caffeine. Data are reviewed for each of these drugs comprising their interaction with norepinephrine during acute intoxication, long-term use, subsequent withdrawal, and stress-induced relapse. In general, the data suggest that these drugs acutely boost noradrenergic signaling, whereas long-term use also affects this neurotransmitter system, possibly suppressing it. During acute withdrawal after chronic drug use, noradrenergic signaling tends to be elevated, consistent with the observation that norepinephrine lowering drugs such as clonidine reduce withdrawal symptoms. Since psychological stress can promote relapse of drug seeking in susceptible individuals and stress produces elevated norepinephrine release, this suggests that these drugs may be suppressing noradrenergic signaling during chronic use or instead elevating it only in reward circuits of the brain. If elevated noradrenergic signaling is an etiological factor in the abuse of a broad range of substances, then chronic use of pharmacological agents that reduce noradrenergic signaling, such as clonidine, guanfacine, lofexidine, propranolol, or prazosin, may help prevent or treat drug abuse in general. PMID:24151426

  9. The impact of law enforcement activity on a heroin market.

    PubMed

    Weatherburn, D; Lind, B

    1997-05-01

    It may be argued that seizing large quantities of heroin being imported into the country should decrease its supply and hence increase its price, resulting in a reduction in the quantity of the drug being purchased or consumed. To date, however, there has been no empirical evidence that heroin seizures in Australia have any effect on the price of heroin at street level. This article describes a 2-year research study during which the price and purity of street-level heroin were regularly monitored. It was found that heroin seizures had no effect on the price, purity or perceived availability of heroin at street level. It was further found that admissions to methadone treatment were not affected by the price or perceived availability of heroin or by local arrests for heroin use/possession, nor was any relationship found between these arrests and the price of street-level heroin. Nevertheless, two-thirds of those who sought entry to local methadone programmes indicated the price as a reason for stopping using heroin. This paper argues that supply-side law enforcement should only be used as a strategy for maintaining high heroin prices if the demand for heroin can be shown to be price-elastic and, further, that the costs of such a strategy need to be weighted against the benefits. PMID:9219378

  10. Clinical efficacy of buprenorphine: comparisons to methadone and placebo

    Microsoft Academic Search

    Walter Ling; Donald R Wesson

    2003-01-01

    Buprenorphine has been studied extensively since 1978 when it was initially proposed as an alternative to methadone for treatment of opioid dependence. Early work by Jasinski, Mello, Mendelson and their colleagues demonstrated buprenorphine's low physical abuse potential and its ability to substitute for heroin and reduce heroin self-administration in opiate-dependent humans. The subsequent early clinical studies suggested that, in clinical

  11. Comparative toxicology of intentional and accidental heroin overdose.

    PubMed

    Darke, Shane; Duflou, Johan; Torok, Michelle

    2010-07-01

    The demographic and toxicological characteristics of deliberate (SUI, n = 50) and accidental (ACC, n = 927) fatal heroin overdose cases were examined. SUI cases were more likely to be female, had lower body mass indices, were more likely to be enrolled in treatment and less likely to have hepatic pathology. The median blood morphine concentration of SUI cases was significantly higher than that of ACC cases (0.70 vs. 0.40 mg/L, p < 0.001). Blood morphine concentrations of >1 mg/L were seen among 38.0% of SUI cases compared to 13.9% of ACC cases. Being a member of the SUI group remained a significant independent predictor of higher morphine concentrations after controlling for the effects of potential confounders (p < 0.001), other significant predictors being the absence of alcohol (p < 0.001), the presence of methadone (p < 0.05), and the presence of cocaine (p < 0.05). The current data are consistent with the view that suicide forms a small, but distinct, category of heroin overdose cases, rather than overdose being a parasuicidal phenomenon per se. PMID:20384920

  12. Heroin overdose

    MedlinePLUS

    ... olds in the United States use opiates (heroin/opium). If a user becomes dependent, then they are ... it naturally occurs in the seedpods of Asian (opium) poppy plants. Street names for heroin include "junk," " ...

  13. A 50-Year-Old Woman Addicted to Heroin

    PubMed Central

    O’Brien, Charles P.

    2011-01-01

    Heroin addiction is a complicated medical and psychiatric issue, with well-established as well as newer modes of treatment. The case of Ms W, a 50-year-old woman with a long history of opiate addiction who has been treated successfully with methadone for 9 years and who now would like to consider newer alternatives, illustrates the complex issues of heroin addiction. The treatment of heroin addiction as a chronic disease is reviewed, including social, medical, and cultural issues and pharmacologic treatment with methadone and the more experimental medication options of buprenorphine and naltrexone. PMID:18594026

  14. Extended Heroin Access Increases Heroin Choices Over a Potent Nondrug Alternative

    PubMed Central

    Lenoir, Magalie; Cantin, Lauriane; Vanhille, Nathalie; Serre, Fuschia; Ahmed, Serge H

    2013-01-01

    Epidemiological research shows that the proportion of drug users who become addicted to heroin is higher than to cocaine. Here we tested whether this difference could be due to a difference in the addiction liability between the two drugs. Addiction liability was assessed under a discrete-trials choice procedure by measuring the proportion of rats that prefer the drug over a potent alternative reward (ie, water sweetened with saccharin). Previous research on choice between self-administration of i.v. cocaine or sweet water showed that the proportion of cocaine-preferring rats remains relatively low and invariable (ie, 15%), even after extended drug access and regardless of past drug consumption (ie, total drug use before choice testing). By contrast, the present study shows that under similar choice conditions, the proportion of heroin-preferring rats considerably increases with extended heroin access (6–9?h per day for several weeks) and with past heroin consumption, from 11 to 51% at the highest past drug consumption level. At this level, the proportion of drug-preferring rats was about three times higher with heroin than with cocaine (51% vs 15%). This increase in the rate of heroin preference after extended heroin access persisted even after recovery from acute heroin withdrawal. Overall, these findings show that choice procedures are uniquely sensitive to different drugs and suggest that heroin is more addictive than cocaine. This higher addiction liability may contribute to explain why more drug users become addicted to heroin than to cocaine in epidemiological studies. PMID:23322185

  15. Relationship between plasma concentrations of the l-enantiomer of methadone and response to methadone maintenance treatment.

    PubMed

    Meini, Milo; Moncini, Marco; Daini, Laura; Giarratana, Tania; Scaramelli, Daniela; Chericoni, Silvio; Stefanelli, Fabio; Rucci, Paola

    2015-08-01

    This study evaluated the relationship between the plasma concentration of l-methadone and response to methadone in real-world patients, in order to identify a minimum plasma concentration above which methadone treatment is effective. Ninety-four patients with opioid dependence under maintenance methadone treatment were consecutively recruited. Response was defined as negative urine analyses in the three weeks prior to the blood sampling. The percentage of participants with a plasma l-methadone concentration between 100 and 250ng/ml was 54.2% among those with a methadone dosage ?60mg/day. Plasma l-methadone concentrations were significantly higher in patients with negative urine analyses compared with those with positive urine analyses (median 93 vs. 77ng/ml, Mann-Whitney test, P<0.05). Above plasma l-methadone concentrations of 200ng/ml no heroin use was reported and urine analyses were negative. Moreover, above concentrations of 250ng/ml craving was absent. Examination of demographic correlates of treatment outcome indicated that older age, a stable job and being married were protective against the use of heroin. Mean plasma l-methadone concentration was significantly lower in patients who used cannabis compared with those who did not use cannabis, after adjusting for methadone dosage. In conclusion our results identify specific cut-offs for plasma l-methadone concentrations about which therapeutic response is observed and provide new evidence that therapeutic response is associated with patient?s demographic characteristics. This underscores the need to monitor plasma methadone concentrations as part of Drug Addiction Services routine practice, in order to provide an objective framework for changing the methadone dosage. PMID:25891369

  16. Optimum Methadone Compliance Testing

    PubMed Central

    2006-01-01

    Executive Summary Objective The objective of this analysis was to determine the diagnostic utility of oral fluid testing collected with the Intercept oral fluid collection device. Clinical Need: Target Population and Condition Opioids (opiates or narcotics) are a class of drugs derived from the opium poppy plant that typically relieve pain and produce a euphoric feeling. Methadone is a long-acting synthetic opioid used to treat opioid dependence and chronic pain. It prevents symptoms of opioid withdrawal, reduces opioid cravings and blocks the euphoric effects of short-acting opioids such as heroin and morphine. Opioid dependence is associated with harms including an increased risk of exposure to Human Immunodeficiency Virus and Hepatitis C as well as other health, social and psychological crises. The goal of methadone treatment is harm reduction. Treatment with methadone for opioid dependence is often a long-term therapy. The Ontario College of Physicians and Surgeons estimates that there are currently 250 physicians qualified to prescribe methadone, and 15,500 people in methadone maintenance programs across Ontario. Drug testing is a clinical tool whose purpose is to provide objective meaningful information, which will reinforce positive behavioral changes in patients and guide further treatment needs. Such information includes knowledge of whether the patient is taking their methadone as prescribed and reducing or abstaining from using opioid and other drugs of abuse use. The results of drug testing can be used with behavior modification techniques (contingency management techniques) where positive reinforcements such as increased methadone take-home privileges, sustained employment or parole are granted for drug screens negative for opioid use, and negative reinforcement including loss of these privileges for drug screens positive for opioid used. Body fluids including blood, oral fluid, often referred to as saliva, and urine may contain metabolites and the parent drug of both methadone and drugs of abuse and provide a means for drug testing. Compared with blood which has a widow of detection of several hours, urine has a wider window of detection, approximately 1 to 3 days, and is therefore considered more useful than blood for drug testing. Because of this, and the fact that obtaining a urine specimen is relatively easy, urine drug screening is considered the criterion measure (gold standard) for methadone maintenance monitoring. However, 2 main concerns exist with urine specimens: the possibility of sample tampering by the patient and the necessity for observed urine collection. Urine specimens may be tampered with in 3 ways: dilution, adulteration (contamination) with chemicals, and substitution (patient submits another persons urine specimen). To circumvent sample tampering the supervised collection of urine specimens is a common and recommended practice. However, it has been suggested that this practice may have negative effects including humiliation experienced by patient and staff, and may discourage patients from staying in treatment. Supervised urine specimen collection may also present an operational problem as staff must be available to provide same-sex supervision. Oral fluid testing has been proposed as a replacement for urine because it can be collected easily under direct supervision without infringement of privacy and reduces the likelihood of sample tampering. Generally, the results of oral fluid drug testing are similar to urine drug testing but there are some differences, such as lower concentrations of substances in oral fluid than urine, and some drugs remain detectable for longer periods of time in urine than oral fluid. The Technology Being Reviewed The Intercept Oral Specimen Collection Device (Ora-Sure Technologies, Bethlehem, PA) consists of an absorbent pad mounted on a plastic stick. The pad is coated with common salts. The absorbent pad is inserted into the mouth and placed between the cheek and gums for 3 minutes on average. The pad absorbs the oral fluid. After 3 minutes (range 2min-5

  17. Cerebral vasculitis associated with cocaine abuse

    Microsoft Academic Search

    B. R. Kaye; M. Fainstat

    1987-01-01

    A case of cerebral vasculitis in a previously healthy 22-year-old man with a history of cocaine abuse is described. Cerebral angiograms showed evidence of vasculitis. A search for possible causes other than cocaine produced no results. The authors include cocaine with methamphetamines, heroin, and ephedrine as illicit drugs that can cause cerebral vasculitis.

  18. Heroin and Pregnancy

    MedlinePLUS

    ... It's been added to your dashboard . Heroin and pregnancy Heroin (also called smack or junk) is a ... liver disease Coma Can heroin cause problems in pregnancy? Yes. Using heroin during pregnancy can be dangerous, ...

  19. Prescription opioid abuse in patients presenting for methadone maintenance treatment

    Microsoft Academic Search

    Bruna Brands; Joan Blake; Beth Sproule; Douglas Gourlay; Usoa Busto

    2004-01-01

    To characterize prescription opioid dependent patients in a methadone maintenance treatment (MMT) program, a detailed retrospective chart review of new admissions (1997–1999, n=178, mean age=34.5±0.7 years, 65% male) was conducted. At admission most patients (83%) had been using prescription opioids (±heroin). Four groups were identified: 24% had used prescription opioids only; 24% used prescription opioids initially and heroin later; 35%

  20. Interaction of counseling rapport and topics discussed in sessions with methadone treatment clients.

    PubMed

    Joe, George W; Simpson, D Dwayne; Rowan-Szal, Grace A

    2009-01-01

    Therapeutic rapport between counselors and clients in drug user treatment has been shown to be an important predictor of follow-up outcomes. This naturalistic study investigated the relationship of counseling rapport to drug-related topics discussed in counseling sessions in a sample of 330 clients and nine counselors. These voluntary clients had been admitted to a private, for-profit outpatient methadone treatment in Texas between September 1995 and August 1997 and received no-fee services for a year for participation in this study. The data were gathered using forms in the TCU community treatment assessments (www.ibr.tcu.edu) that measured intake information, counseling session topics, and counselor evaluation of the client. A majority were males, Hispanic, had a pending legal status and the average age was 39. Co-occurring drug dependence for these heroin users included cocaine (38%) and alcohol (31%). The results supported the hypothesis that higher rapport would be associated with addressing clients in a more "supportive approach" that emphasized relapse prevention and strengths-building while lower rapport would be associated with a punitive counseling style that stressed program rules and compliance. The influences of client background, counselor differences, and during-treatment positive urines were also examined. Although counselors differed in their general manner of dealing with clients, each also showed flexibility determined in part by client behavior (such as continued cocaine use). The findings indicate that focusing on constructive solutions is the preferred counseling approach. PMID:19137479

  1. Urine testing in methadone maintenance treatment: applications and limitations

    Microsoft Academic Search

    Avram Goldstein; Byron W. Brown

    2003-01-01

    We consider here the applications and limitations of urine testing schedules used in methadone maintenance treatment programs. We show that for patients attending clinic daily, any practical testing schedule will only reliably detect those who are using heroin or other illicit drugs very frequently (e.g., daily). For patients with take-home privileges no testing schedule can effectively detect either skipped doses

  2. Neurobiology of Addictive Behaviors and Its Relationship to Methadone Maintenance

    Microsoft Academic Search

    BARRY STIMMEL; MARY JEANNE KREEK

    2000-01-01

    Scientific information about the neurobiology of addictive behaviors provides an increasingly important rationale to support op ioid agonist pharmacotherapy, primarily methadone maintenance treatment, for long-term heroin addiction. In late 1963 and 1964, the first research was performed at The Rockefeller Institute for Medical Research by Dole, Nyswander, and Kreek in an attempt to develop a new pharmacotherapy for opiate addiction.

  3. HIV risks, gender, and cocaine use among opiate users

    Microsoft Academic Search

    George W. Joe; D. Dwayne Simpson

    1995-01-01

    HIV risks involving injection and sex behaviors were analyzed in relation to cocaine use and gender among 487 opiate-dependent clients in methadone treatment. Those who also used cocaine were at greater risk than non-cocaine users on HIV risky injection variables. Females were at more risk than males on the HIV risky sex behaviors involving unprotected sex in exchange for money

  4. Anticholinergic poisoning with adulterated intranasal cocaine

    Microsoft Academic Search

    Alan L Weiner; Marc J Bayer; Charles A McKay; Margaret DeMeo; Elizabeth Starr

    1998-01-01

    In recent years, emergency physicians have encountered a growing number of patients who present with anticholinergic toxicity after using adulterated heroin. Anticholinergic poisoning caused by adulterated cocaine is far less common. This report describes the case of a 39-year-old man who arrived in the emergency department several hours after the nasal insufflation of cocaine. Classic symptoms of anticholinergic toxicity were

  5. Heroin. Specialized Information Service.

    ERIC Educational Resources Information Center

    Do It Now Foundation, Phoenix, AZ.

    The document presents a collection of articles about heroin. Article 1 provides general information on heroin identification, drug dependence, effects of abuse, cost, source of supply, and penalties for illegal heroin use. Article 2 gives statistical information on heroin-related deaths in the District of Columbia between 1971 and 1982. Article 3…

  6. [The history of heroin].

    PubMed

    Hosztafi, S

    2001-08-01

    The discovery of heroin and the development of heroin abuse are introduced. Heroin, the hydrochloride of diacetylmorphine, was discovered by acetylation of morphine. Heroin, in pharmacological studies, proved to be more effective than morphine or codeine. The Bayer Company started the production of heroin in 1898 on a commercial scale. The first clinical results were so promising that heroin was considered a wonder drug. Indeed, heroin was more effective than codeine in respiratory diseases. It has turned out, however, that repeated administration of heroin results in the development of tolerance and the patients become heroin-addicts soon. In the early 1910s morphine addicts "discovered" the euphorising properties of heroin and this effect was enhanced by intravenous administration. Heroin became a narcotic drug and its abuse began to spread quickly. Restrictions on its production, use and distribution were regulated by international treties. The total ban on heroin production was also proposed. As a result of the strict regulations the production and cosumption of heroin showed a significant decrease after 1931. At the same time the underworld recognized the shortage of heroin and started the illicit production and trafficking. The quantity of heroin seized by law enforcement agencies in the past decades rose gradually. As an indicator of the worldwide heroin market, the quantity of confiscated heroin underwent a tenfold increase since 1970. The paper surveys the most important heroin-producing and trafficking countries. Heroin, prepared in clandestine ("kitchen" or "jungle") laboratories, is diluted ("cut") by every member of the illegal heroin distributing chain, i.e. smugglers, traffickers, dealers and vendors. PMID:11862675

  7. HIV transmission and the cost-effectiveness of methadone maintenance.

    PubMed Central

    Zaric, G S; Barnett, P G; Brandeau, M L

    2000-01-01

    OBJECTIVES: This study determined the cost-effectiveness of expanding methadone maintenance treatment for heroin addiction, particularly its effect on the HIV epidemic. METHODS: We developed a dynamic epidemic model to study the effects of increased methadone maintenance capacity on health care costs and survival, measured as quality-adjusted life-years (QALYs). We considered communities with HIV prevalence among injection drug users of 5% and 40%. RESULTS: Additional methadone maintenance capacity costs $8200 per QALY gained in the high-prevalence community and $10,900 per QALY gained in the low-prevalence community. More than half of the benefits are gained by individuals who do not inject drugs. Even if the benefits realized by treated and untreated injection drug users are ignored, methadone maintenance expansion costs between $14,100 and $15,200 per QALY gained. Additional capacity remains cost-effective even if it is twice as expensive and half as effective as current methadone maintenance slots. CONCLUSIONS: Expansion of methadone maintenance is cost-effective on the basis of commonly accepted criteria for medical interventions. Barriers to methadone maintenance deny injection drug users access to a cost-effective intervention that generates significant health benefits for the general population. PMID:10897189

  8. Synaptic plasticity mediating cocaine relapse requires matrix metalloproteinases

    PubMed Central

    Smith, Alexander C. W.; Kupchik, Yonatan M.; Scofield, Michael D.; Gipson, Cassandra D.; Wiggins, Armina; Kalivas, Peter W.

    2014-01-01

    Summary Relapse to cocaine use necessitates remodeling excitatory synapses in the nucleus accumbens, and synaptic reorganization requires matrix metalloproteinase (MMP) degradation of the extracellular matrix proteins. We found enduring increases in MMP-2 activity in rats after withdrawal from self-administered cocaine and transient increases in MMP-9 during cue-induced cocaine relapse. Cue-induced heroin and nicotine relapse increased MMP activity, and increased MMP activity was required for both cocaine relapse and relapse-associated synaptic plasticity. PMID:25326689

  9. Changes to the daily pattern of methadone-related deaths in England and Wales, 1993-2003.

    PubMed

    Morgan, O W; Johnson, H; Rooney, C; Seagroatt, V; Griffiths, C

    2006-12-01

    Previous studies suggest that fatal poisoning deaths involving methadone occur more frequently on the weekends. We assessed changes in the daily pattern of mortality because of methadone poisoning following a review of drug misuse services in 1996 and publication of revised clinical guidelines in 1999. We also compared this to the daily pattern of deaths involving heroin/morphine. The Office for National Statistics provided data on all deaths in England and Wales between 1993 and 2003 for which methadone and heroin/morphine were mentioned on the coroner's certificate of death registration after inquest, with or without alcohol or other drugs. There were 3098 deaths involving methadone. The death rate increased up to 1997 and then declined. Initially, there was a marked excess of deaths occurring on Saturdays. The rate of decline was greatest for deaths occurring on Saturdays. As a result, the Saturday peak disappeared (P = 0.006). There were 6328 deaths involving heroin/morphine. No change in the daily pattern of heroin/morphine deaths was observed during the study period. Although the marked change in the epidemiology of methadone deaths coincided with recommendations for service redevelopment and clinical management of methadone treatment, the contribution of improved prescribing practice or treatment services is unclear. PMID:17060353

  10. Pharmacogenomics study in a Taiwan methadone maintenance cohort

    PubMed Central

    Wang, Sheng-Chang; Tsou, Hsiao-Hui; Ho, Ing-Kang; Lin, Keh-Ming; Liu, Yu-Li

    2014-01-01

    Pharmacogenomics is research to study the drug treatment responses in subgroups of patients according to their genetic variants or genetic expression information. Methadone maintenance treatment, which is usually prescribed for patients with heroin dependence, was launched in Taiwan by the government in 2006. In this study, 366 patients who had taken methadone continually in the previous 7 days were examined. Data from administration of the Treatment Outcomes Profile (TOP), Severity of Dependence Scale (SDS), Clinical Opioid Withdrawal Scale (COWS), and Treatment Emergent Symptoms Scale (TESS) were obtained from patients' report records. Genes encoding the liver cytochrome P-450 (CYP) enzymes that are involved with the metabolism of methadone (CYP2B6, 3A4 and 2C19) were selected and genotyped in this cohort. We found that the SNPs on CYP2B6 were associated with plasma S-methadone concentration; SNPs on CYP3A4 were associated with withdrawal symptoms and side effects; and SNPs on CYP2C19 were associated with methadone dose. SNPs in the genes encoding the morphine phase II metabolic enzyme, UGT2B7, were associated with withdrawal symptom scores. In pharmacodynamic genes, the SNPs on OPRM1 were associated with insomnia and change in libido side effects. We conclude that SNP markers may be useful for future methadone dosage adjustment and to reduce adverse reactions. PMID:25278738

  11. Youth, Heroin, Crack: A Review of Recent British Trends

    ERIC Educational Resources Information Center

    Seddon, Toby

    2008-01-01

    Purpose: The purpose of this paper is to review the research evidence on recent British trends in the use of heroin and/or crack-cocaine by young people in order to appraise the scale and nature of the contemporary health problem they pose. Design/methodology/approach: The approach consists of a narrative review of the main current data sources on…

  12. Randomized Trial Comparing Two Treatment Strategies Using Prize-Based Reinforcement of Abstinence in Cocaine and Opiate Users

    ERIC Educational Resources Information Center

    Preston, Kenzie L.; Ghitza, Udi E.; Schmittner, John P.; Schroeder, Jennifer R.; Epstein, David H.

    2008-01-01

    We compared two strategies of prize-based contingency management (CM) in methadone-maintained outpatients. Urine was tested thrice weekly for 5 weeks pre-CM, 12 weeks CM, and 8 weeks post-CM. Participants were randomly assigned to a cocaine contingency (four prize draws for each cocaine-negative urine, N = 29) or an opiate-cocaine contingency (one…

  13. Effects of urine testing frequency on outcome in a methadone take-home contingency program

    Microsoft Academic Search

    Mary Ann Chutuape; Kenneth Silverman; Maxine L Stitzer

    2001-01-01

    We examined the effects of urine testing frequency on treatment outcome in a contingent methadone take-home program. Study patients who submitted<80% opiate and\\/or cocaine positive urines during a 5-week baseline received 60 mg methadone throughout the study, submitted urine samples on Monday, Wednesday, and Friday, and were randomized into one of three take-home incentive conditions. Study patients could receive three

  14. Correlates of methadone client retention: A prospective cohort study in Guizhou province, China

    PubMed Central

    Liu, Enwu; Liang, Tao; Shen, Limei; Zhong, Huan; Wang, Bing; Wu, Zunyou; Detels, Roger

    2010-01-01

    Background Methadone client retention levels and treatment doses of patients vary widely in methadone clinics across China. Because methadone clinics have been available in China only recently, this study explored the relationship between methadone dosage and client retention in methadone maintenance programmes in Guizhou province. Methods The study used a prospective cohort study design. Injecting and non-injecting heroin-using clients who had been treated for no more than two and half months in one of eight methadone maintenance treatment clinics in Guizhou province were recruited into the cohort, beginning on 3 June 2006 and followed up until 1 June 2007. A total of 1003 participants were enrolled. Face-to-face interviews were conducted to collect baseline information, and clients’ daily doses were recorded. Results The 14-month retention rate was 56.2%. Controlling for other covariates in the multivariate Cox model, a higher methadone dose was found to predict higher client retention. Retention was also associated with intention to remain in treatment for life and the clinic attended. Conclusion Clients need to receive an adequate methadone dose to assure continued retention. Patients who expect to be treated for life have higher retention rates than patients who anticipate only short-term treatment. Key factors associated with successful clinics in China need to be elucidated. PMID:18951777

  15. Determining what heroin means to heroin addicts.

    PubMed

    Tokar, J T; Brunse, A J; Stefflre, V J; Sodergren, J A; Napior, D A

    1975-02-01

    For purposes of treatment, description, typological and psychological instrumentation, agreement judgements were obtained from 20 heroin addicts and 51 normal controls on data matrices constructed from sentences obtained from the heroin addicts. Correlations demonstrate controls are similar to one another and qualitatively different from addicts. Multidimensional scaling techniques and perspective summary maps demonstrate these differences and provide the technology for developing a typology of addicts for future studies. Heroin addicts have an inability to tolerate frustration, a depressive core, a negative sense of identity and a sense of futility and isolation. Heroin addicts deviate from normals at well beyond the p less than .001 level of significance in using heroin to handle problems that normals handle in other ways. For treatment of the addict, the drug must be withdrawn and new ways of coping with old needs must be taught. This matrix qualitatively demonstrates and pinpoints the deficiencies and excesses of the addict which need treatment. The epidemiology of drug use relating narcotics, delinquency, and social policy has been well documented (Chein, 1964). One major problem posed by narcotic addition is the problem of getting people to stay off drugs (withdrawal). Another major problem is the alleviation of the human misery that motivates drug use (rehabilitation). (Jaffee, 1970, Chein, 1964). In addition to the above, a problem of recent importance has been the key question of whether or not the Vietnam addicts differ basically from addicts socialized in the drug culture in the united States. (Walsh, 1971). Numerous investigators have discussed personality and addiction (Chein, 1964; Eddy, 1965, Jaffee, 1970) usually from the vantage point of the investigators. This study attempted to describe the personalities of heroin addicts from the vantage point of the addicts using instruments borrowed from descriptive semantics. (Goodenough, 1967; Stefflre, Reich, Wendell, 1967). The purpose of the pilot study was to: 1) determine where heroin positioned in the conceptual frames of reference of heroin addicts and non-addicted control subjects, 2) to establish a classification procedure for determining subtypes of heroin addicts, and 3) to demonstrate the usefulness of a linguistically based instrument in application in clinical psychiatry. PMID:1116419

  16. Cocaine-induced cocaine craving

    Microsoft Academic Search

    Jerome H. Jaffe; Nicola G. Cascella; Karen M. Kumor; Michael A. Sherer

    1989-01-01

    In nine experienced users of cocaine, we examined the urge to use cocaine or other drugs following a 40 mg dose of intravenous (IV) cocaine with and without oral pretreatment with 2.5 mg bromocriptine. The urge to use cocaine was assessed with a questionnaire constructed to assess both “wanting” and “craving” for cocaine or other drugs. Fifteen minutes after the

  17. Heroin crystal nephropathy

    PubMed Central

    Bautista, Josef Edrik Keith; Merhi, Basma; Gregory, Oliver; Hu, Susie; Henriksen, Kammi; Gohh, Reginald

    2015-01-01

    In this paper we present an interesting case of acute kidney injury and severe metabolic alkalosis in a patient with a history of heavy heroin abuse. Urine microscopy showed numerous broomstick-like crystals. These crystals are also identified in light and electron microscopy. We hypothesize that heroin crystalizes in an alkaline pH, resulting in tubular obstruction and acute kidney injury. Management is mainly supportive as there is no known specific therapy for this condition. This paper highlights the utility of urine microscopy in diagnosing the etiology of acute kidney injury and proposes a novel disease called heroin crystal nephropathy. PMID:26034599

  18. Heroin crystal nephropathy.

    PubMed

    Bautista, Josef Edrik Keith; Merhi, Basma; Gregory, Oliver; Hu, Susie; Henriksen, Kammi; Gohh, Reginald

    2015-06-01

    In this paper we present an interesting case of acute kidney injury and severe metabolic alkalosis in a patient with a history of heavy heroin abuse. Urine microscopy showed numerous broomstick-like crystals. These crystals are also identified in light and electron microscopy. We hypothesize that heroin crystalizes in an alkaline pH, resulting in tubular obstruction and acute kidney injury. Management is mainly supportive as there is no known specific therapy for this condition. This paper highlights the utility of urine microscopy in diagnosing the etiology of acute kidney injury and proposes a novel disease called heroin crystal nephropathy. PMID:26034599

  19. Gender Differences Among Older Heroin Users

    PubMed Central

    HAMILTON, ALISON B.; GRELLA, CHRISTINE E.

    2009-01-01

    Objectives This purpose of this study was to explore the following question: Are there gender differences among older individuals with a history of heroin addiction with regard to social and family relationships and health problems? Methods Eight gender-specific focus groups were conducted with 38 (19 women, 19 men) older (50+ years) individuals with long-term histories of heroin dependence. Four groups were conducted in a methadone maintenance (MM) clinic and four groups were derived from the Los Angeles community. Results Modest gender differences were observed, but mainly in the focus-group dynamics. Women typically described the impact of their addiction on their families, while men typically described their surprise at still being alive. Hepatitis C was the primary health concern in all groups; mental health issues were also discussed. Discussion Remarkable gender differences were not apparent in the qualitative experiences of these participants. Instead, we found overriding similarities related to the interactive effects of drug use and aging. Longitudinal studies of this population as they age and interact with the health-care system and other social systems will help to untangle the complicated relationship between aging, drug addiction, gender, and health. PMID:19418342

  20. Risk behaviour for HIV transmission in attenders on methadone maintenance.

    PubMed

    Williams, H; Mullan, E; O'Connor, J J; Kinsella, A

    1990-05-01

    Sixty-nine opiate addicts on methadone maintenance programmes at the Drug Treatment Centre were interviewed, all meet DSM. 3 criteria for opioid dependency. Most were young, poorly educated, unemployed and had involvement with both police and prison. Drug abuse started at a young age, all had injected drugs, heroin being the most widely abused opiate. Forty-eight (70%) were HIV (Human Immunodeficiency Virus) positive. Since diagnosis these individuals had made significant changes in their injecting practices and sexual behaviour. However, despite this positive change, there remained a high level of at risk behaviour for further HIV transmission. PMID:2397983

  1. Direct injection determination of benzoylecgonine, heroin, 6-monoacetylmorphine and morphine in serum by MLC

    Microsoft Academic Search

    Maria-Elisa Capella-Peiró; Devasish Bose; Mayte Gil-Agustí; Josep Esteve-Romero; Samuel Carda-Broch

    2005-01-01

    A simple and sensitive direct injection chromatographic procedure is developed for the determination of heroin, two of its metabolites (morphine and 6-monoacetylmorphine (6-MAM)), and benzoylecgonine (a metabolite of cocaine) in serum samples. The proper resolution of the four substances is obtained with a chemometrics approach, where the retention is modelled as a first step using the retention factors obtained in

  2. Screening for drugs of abuse. I: Opiates, amphetamines and cocaine.

    PubMed

    Braithwaite, R A; Jarvie, D R; Minty, P S; Simpson, D; Widdop, B

    1995-03-01

    (1) In order to provide an efficient and reliable service for drugs of abuse screening in urine, the laboratory should analyse 20-30 samples per week, and the staff should include a scientist with special expertise in the subject. (2) Turnaround times should be between 2-3 days of sample collection. To achieve this aim it may be necessary to make special arrangements for the delivery of samples to the laboratory. Results should preferably be transmitted by electronic mail or facsimile with the necessary precautions for security and confidentiality: hardcopy reports may also be required. (3) Good communications between the requesting clinician and the laboratory are essential. An advisory service should be provided by the laboratory and clinicians should be encouraged to discuss requests and results with laboratory staff. It is important that the laboratory inform doctors of the range of substances detected and the sensitivity and specificity of laboratory assays. (4) Assays should be performed according to the manufacturer's protocols, or by modified methods that have been rigorously validated. Quality control samples should be included in each analytical run and participation in an external quality assessment scheme, e.g. UKNEQAS, is essential to provide independent confirmation and confidence that results compare with those from other laboratories. Other requirements include adequate training and supervision of staff, and careful recording of samples and results. (5) Drugs to be tested will depend on the drug 'scene' in the area but should include those drugs regularly prescribed for maintenance therapy (e.g. methadone, dihydrocodeine, benzodiazepines), and drugs frequently misused (e.g. heroin, buprenorphine, amphetamines, cocaine). (6) Positive results obtained by preliminary screening methods e.g. EMIT, should be confirmed by another analytical technique, e.g. TLC, GC or GC-MS. If there are potentially serious or legal implications, and in employment and preemployment testing, confirmation of positive results is mandatory. In some cases, e.g. checking for methadone or benzodiazepine compliance, it may be considered unnecessary to confirm positive results although possible spiking of samples cannot be excluded without checking for the presence of metabolites by a chromatographic procedure. PMID:7785941

  3. Safety and tolerability of slow-release oral morphine versus methadone in the treatment of opioid dependence.

    PubMed

    Hämmig, Robert; Köhler, Wilfried; Bonorden-Kleij, Karin; Weber, Bernd; Lebentrau, Karin; Berthel, Toni; Babic-Hohnjec, Lucija; Vollmert, Christian; Höpner, Doris; Gholami, Najibulah; Verthein, Uwe; Haasen, Christian; Reimer, Jens; Ruckes, Christian

    2014-10-01

    Opioid substitution treatment (OST) for opioid dependence may be limited by adverse events (AEs). Increasing the range of therapeutic options optimizes outcomes and facilitates patient management. An international, multi-center, two-phase study investigated the efficacy and safety of slow-release oral morphine (SROM) versus methadone in patients receiving methadone therapy for opioid dependence. In phase 1 (two way cross-over, 11 weeks each period) patients were randomized to SROM or methadone oral solution. In phase 2 (25 weeks), patients continued treatment with SROM (group A) or switched from methadone to SROM (group B). In total, 211 out of 276 completed phase 1 and 198 entered phase 2 (n=95 group A, n=103 group B). Treatment with both SROM and methadone was well tolerated. However, the mean QTc-interval associated with methadone was significantly longer than that under SROM. Higher treatment satisfaction, fewer cravings for heroin, and lower mental stress were reported with SROM. This study adds a significant further weight of evidence that SROM is an effective and well tolerated long-term maintenance treatment for opioid dependence with a beneficial risk profile compared to methadone regarding cardiac effects and supports its clinical utility. PMID:25064422

  4. The effects of gabapentin on methadone based addiction treatment: a randomized controlled trial.

    PubMed

    Moghadam, Mohsen Saber; Alavinia, Mohammad

    2013-09-01

    Gabapentin is a potentially useful drug in alleviating the hyperexcitatory painful states in the control of opiate dependence in acute detoxification and the stabilization phase. This study aim was to evaluate the effectiveness of gabapentin adds-on methadone therapy on lowering the methadone. This randomized double blind controlled clinical trial conducted at an outpatient rehabilitation clinic. Sixty patients using opium, opium extract and heroin were randomly assigned to two groups (34 in treatment group and 26 in control group); one group was prescribed combination of methadone (40-120 mg) and gabapentin (300 mg) as group A, and the other group was given methadone (40-120) and placebo as group B. The subjects were followed up for three weeks after intervention. There were 60 outpatients including 51 males with the mean age of 40.9±9.2. Daily dose and cumulative dose of methadone during the treatment was found to be significantly higher in group B (73.8±19.5 mg daily vs. 58.9±11 mg daily and cumulatively 1550.7±409.7 mg vs. 238.3±238.2 mg, p= 0.001). When the patients were stratified based on the kind of abused drug, the methadone dose was seen to be significantly reduced in the opium addicted patients in the group A. Group A showed more withdrawal symptoms whereas the most common complain of group B was sedation particularly during the first three days. The results showed that gabapentin is an effective adds-on therapy when is added to methadone. This drug leads to relief of withdrawal symptoms and lower methadone consumption. PMID:24035957

  5. Is antisocial personality disorder associated with increased HIV risk behaviors in cocaine users?

    Microsoft Academic Search

    Wilson M. Compton; Linda B. Cottler; Audrey M. Shillington; Rumi K. Price

    1995-01-01

    Previous reports have shown antisocial personality disorder (ASPD) to be strongly associated with injection equipment sharing and increased rates of human immunodeficiency virus (HIV) infection in a sample of heroin injectors. Another report has shown ASPD to be associated with injection drug use, needle sharing, sexual promiscuity, and prostitution in a sample of methadone maintenance clients. The current study extends

  6. Rates of Fetal Polydrug Exposures in Methadone-Maintained Pregnancies from a High-Risk Population

    PubMed Central

    Delano, Kaitlyn; Gareri, Joey; Koren, Gideon

    2013-01-01

    Methadone maintenance treatment (MMT) is the standard of care during pregnancy for opioid-dependency, showing efficacy in improving prenatal care and reducing risk of relapse. By design, however, MMT is only intended to prevent withdrawal thus facilitating cognitive behavioural interventions. In order to maximize the benefits of MMT, it is essential that methadone is both properly prescribed and that additional addiction treatment is concurrently administered. This study aims to determine the effectiveness of MMT engagement in high-risk pregnant women in reducing polydrug use by objective laboratory examination of neonatal meconium. Patients and Methods Over a 29-month period, the Motherisk Laboratory at the Hospital for Sick Children in Toronto analyzed meconium samples as per request by social services and hospitals for drugs of abuse. Results Of the 904 meconium samples received, 273 were tested for methadone with 164 positive and 109 negative for methadone. Almost half of the methadone positive samples (46.34%) were also positive for at least one other opioid compound, which did not differ statistically from the methadone-negative control samples (46.79%; Chi square test, p=0.94). No differences were found between the methadone positive and negative groups in rates of concurrent amphetamines, cocaine, cannabis, and alcohol use indicating a similar risk of polydrug use between pregnant women taking or not taking methadone in this population. Discussion The high rates of additional opioid and other drug use in the MMT group, suggest that MMT is failing this population of patients. It is possible that methadone doses during pregnancy are not appropriately adjusted for changes in pharmacokinetic parameters (e.g. blood volume, renal function) during the second and third trimesters. This may result in sub-therapeutic dosing creating withdrawal symptoms leading to additional substance use. Alternatively, these results may be demonstrating a substantial lack in delivery of addiction support services in this vulnerable population. PMID:24312668

  7. Heroin on trial: systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction†.

    PubMed

    Strang, John; Groshkova, Teodora; Uchtenhagen, Ambros; van den Brink, Wim; Haasen, Christian; Schechter, Martin T; Lintzeris, Nick; Bell, James; Pirona, Alessandro; Oviedo-Joekes, Eugenia; Simon, Roland; Metrebian, Nicola

    2015-07-01

    BackgroundSupervised injectable heroin (SIH) treatment has emerged over the past 15 years as an intensive treatment for entrenched heroin users who have not responded to standard treatments such as oral methadone maintenance treatment (MMT) or residential rehabilitation.AimsTo synthesise published findings for treatment with SIH for refractory heroin-dependence through systematic review and meta-analysis, and to examine the political and scientific response to these findings.MethodRandomised controlled trials (RCTs) of SIH treatment were identified through database searching, and random effects pooled efficacy was estimated for SIH treatment. Methodological quality was assessed according to criteria set out by the Cochrane Collaboration.ResultsSix RCTs met the inclusion criteria for analysis. Across the trials, SIH treatment improved treatment outcome, i.e. greater reduction in the use of illicit 'street' heroin in patients receiving SIH treatment compared with control groups (most often receiving MMT).ConclusionsSIH is found to be an effective way of treating heroin dependence refractory to standard treatment. SIH may be less safe than MMT and therefore requires more clinical attention to manage greater safety issues. This intensive intervention is for a patient population previously considered unresponsive to treatment. Inclusion of this low-volume, high-intensity treatment can now improve the impact of comprehensive healthcare provision. PMID:26135571

  8. Validation of an automated solid-phase extraction method for the analysis of 23 opioids, cocaine, and metabolites in urine with ultra-performance liquid chromatography-tandem mass spectrometry.

    PubMed

    Ramírez Fernández, María del Mar; Van Durme, Filip; Wille, Sarah M R; di Fazio, Vincent; Kummer, Natalie; Samyn, Nele

    2014-06-01

    The aim of this work was to automate a sample preparation procedure extracting morphine, hydromorphone, oxymorphone, norcodeine, codeine, dihydrocodeine, oxycodone, 6-monoacetyl-morphine, hydrocodone, ethylmorphine, benzoylecgonine, cocaine, cocaethylene, tramadol, meperidine, pentazocine, fentanyl, norfentanyl, buprenorphine, norbuprenorphine, propoxyphene, methadone and 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine from urine samples. Samples were extracted by solid-phase extraction (SPE) with cation exchange cartridges using a TECAN Freedom Evo 100 base robotic system, including a hydrolysis step previous extraction when required. Block modules were carefully selected in order to use the same consumable material as in manual procedures to reduce cost and/or manual sample transfers. Moreover, the present configuration included pressure monitoring pipetting increasing pipetting accuracy and detecting sampling errors. The compounds were then separated in a chromatographic run of 9 min using a BEH Phenyl analytical column on a ultra-performance liquid chromatography-tandem mass spectrometry system. Optimization of the SPE was performed with different wash conditions and elution solvents. Intra- and inter-day relative standard deviations (RSDs) were within ±15% and bias was within ±15% for most of the compounds. Recovery was >69% (RSD < 11%) and matrix effects ranged from 1 to 26% when compensated with the internal standard. The limits of quantification ranged from 3 to 25 ng/mL depending on the compound. No cross-contamination in the automated SPE system was observed. The extracted samples were stable for 72 h in the autosampler (4°C). This method was applied to authentic samples (from forensic and toxicology cases) and to proficiency testing schemes containing cocaine, heroin, buprenorphine and methadone, offering fast and reliable results. Automation resulted in improved precision and accuracy, and a minimum operator intervention, leading to safer sample handling and less time-consuming procedures. PMID:24790061

  9. A reduction in blood morphine concentrations amongst heroin overdose fatalities associated with a sustained reduction in street heroin purity.

    PubMed

    Darke, Shane; Duflou, Johan; Torok, Michelle

    2010-05-20

    To determine the effects of a sudden and sustained reduction in heroin purity on the toxicology of heroin overdose, 959 consecutive heroin overdose cases autopsied at the NSW Department of Forensic Medicine (1/1/1998-31/12/2006) were analysed. There was a significant reduction in blood morphine concentration across the study period (beta=-0.07), declining from a median of 0.50mg/L in the years 1998-2000 prior to 0.40mg/L in the period 2001-2006. There was no significant change in the proportion of alcohol positive cases, but the proportion of benzodiazepine positive cases increased across time (OR 1.11), as did methadone positive cases (OR 1.12). The decline in blood morphine concentrations remained significant after controlling for these factors (beta=-0.07). In determining toxic and lethal morphine concentrations, the fact that the toxicology of overdose is responsive to changes in the opioid street market needs to be borne in mind. PMID:20163925

  10. "Every 'never' I ever said came true": transitions from opioid pills to heroin injecting.

    PubMed

    Mars, Sarah G; Bourgois, Philippe; Karandinos, George; Montero, Fernando; Ciccarone, Daniel

    2014-03-01

    This qualitative study documents the pathways to injecting heroin by users in Philadelphia and San Francisco before and during a pharmaceutical opioid pill epidemic. Data was collected through in-depth, semi-structured interviews (conducted between 2010 and 2012) that were, conducted against a background of longer-term participant-observation, ethnographic studies of street-based drug users and dealers in Philadelphia (2007-12) and San Francisco (1994-2007, 2012). Philadelphia and San Francisco were selected for their contrasting political economies, immigration patterns and source type of heroin. In Philadelphia the ethnographers found heroin injectors, usually white users, who had started their opiate using careers with prescription opioids rather than transitioning from other drugs. In both Philadelphia and San Francisco, most of the young heroin injectors interviewed began, their drug-use trajectories with opioid pills--usually Percocet (oxycodone and acetaminophen), generic short acting oxycodone or, OxyContin (long-acting oxycodone)--before transitioning to heroin, usually by nasal inhalation (sniffing) or smoking at first, followed by injecting. While most of the Philadelphia users were born in the city or its suburbs and had started using both opioid pills and heroin there, many of the San Francisco users had initiated their pill and sometimes heroin use elsewhere and had migrated to the city from around the country. Nevertheless, patterns of transition of younger injectors were similar in both cities suggesting an evolving national pattern. In contrast, older users in both Philadelphia and San Francisco were more likely to have graduated to heroin injection from non-opiate drugs such as cannabis, methamphetamine and cocaine. Pharmaceutical opioid initiates typically reported switching to heroin for reasons of cost and ease-of-access to supply after becoming physically and emotionally dependent on opioid pills. Many expressed surprise and dismay at their progression to sniffing and subsequently to injecting heroin. Historically and structurally these users found themselves caught at the intersection of two major developments in the opiate supply: (1) an over 500% increase in opiate pill prescription from 1997 to 2005 resulting in easy access to diverted supplies of less stigmatized opiates than heroin and (2) a heroin supply glut, following the US entry of Colombian-sourced, heroin in the early 1990s, that decreased cost and increased purity at the retail level. A nationwide up-cycle of heroin use may be occurring among young inner city, suburban and rural youth fueled by widespread prescription opioid pill use. PMID:24238956

  11. Effects of buprenorphine and methadone in methadone-maintained subjects

    Microsoft Academic Search

    S. L. Walsh; H. L. June; K. J. Schuh; K. L. Preston; G. E. Bigelow; M. L. Stitzer

    1995-01-01

    Buprenorphine, a partial mu opioid agonist, is an experimental medication under development for the treatment of opioid dependence as an alternative to methadone maintenance. The present study examined the relationship between level of opioid physical dependence and response to buprenorphine administration as part of a program to develop procedures for transferring patients from methadone to buprenorphine treatment. This laboratory study

  12. Methadone treatment at forty.

    PubMed

    Marion, Ira J

    2005-12-01

    In the view of a clinician who has been providing methadone therapy since its inception 40 years ago, the status of the treatment today reflects the culmination of two trends: an increase in understanding, skills, and standards on the one hand, and a deterioration of patients' health on the other. A retreat of stigma, greater physician interest, and the evolution of standards are beginning to move the treatment toward the mainstream. PMID:18552743

  13. Cocaine and kidney injury: a kaleidoscope of pathology

    PubMed Central

    Goel, Narender; Pullman, James M.; Coco, Maria

    2014-01-01

    Cocaine is abused worldwide as a recreational drug. It is a potent activator of the sympathetic nervous system leading to intense vasoconstriction, endothelial dysfunction, oxidative stress, platelet activation and decrease in prostaglandins E2 and prostacyclin. Cocaine can lead to widespread systemic adverse effects such as stroke, myocardial infarction, arterial dissection, vascular thrombosis and rhabdomyolysis. In human and rat kidneys, cocaine has been associated with glomerular, tubular, vascular and interstitial injury. It is not uncommon to diagnose cocaine-related acute kidney injury (AKI), malignant hypertension and chronic kidney disease. Cocaine abuse can lead to AKI by rhabdomyolysis, vasculitis, infarction, thrombotic microangiopathy and malignant hypertension. It is reported that 50–60% of people who use both cocaine and heroin are at increased risk of HIV, hepatitis and additional risk factors that can cause kidney diseases. While acute interstitial nephritis (AIN) is a known cause of AKI, an association of AIN with cocaine is unusual and seldom reported. We describe a patient with diabetes mellitus, hypertension and chronic hepatitis C, who presented with AKI. Urine toxicology was positive for cocaine and a kidney biopsy was consistent with AIN. Illicit drugs such as cocaine or contaminants may have caused AIN in this case and should be considered in the differential diagnosis of causes of AKI in a patient with substance abuse. We review the many ways that cocaine adversely impacts on kidney function. PMID:25859366

  14. Illicit use of methadone and buprenorphine among adolescents and young adults in Sweden

    PubMed Central

    2013-01-01

    Background Illicit use of methadone and buprenorphine has been described as a growing problem in Sweden in recent years, and has been associated with an increased drug-related mortality. Critics claim that the substances have become popular among adolescents and that they function as a gateway to heroin use. The aim of this study is to investigate, firstly, the extent to which illicit use of methadone and buprenorphine occurs among adolescents and young adults in Sweden, and secondly, at what stage in a user’s drug career these substances tend to appear. Methods The study is based on surveys and structured interviews on drug use among various populations of young people, in addition to qualitative interviews with 86 informants who, in their professional capacity, encounter adolescents or young adults who are using illicit drugs. Results Illicit use of methadone and buprenorphine is rare among young people in Sweden. According to high school surveys, less than 0.1% have tried these substances. Among young drug users in general, few have tried the substances, and there is nothing to indicate that they act as gateway drugs. Among adolescents and young adults with severe drug problems, however, the illicit use of methadone and buprenorphine is more common (54% in a compulsory care sample). These substances normally enter the drug career late, and few use them as their main drug of choice. Other prescription drugs, like benzodiazepines and tramadol, are used by adolescents to a far greater extent. Diversion and illicit use of methadone and buprenorphine is not seen as a serious problem by the professionals interviewed. A general view is that the substances are mainly used by people with a heroin or polydrug addiction, often for “self-medication” purposes. However, several informants express concern that methadone and buprenorphine may cause fatalities among young drug users without an opioid tolerance. Conclusions Illicit use of methadone and buprenorphine among young drug users is not a widespread problem in Sweden. Harm-reduction measures should target drug users with more severe problems, among whom illicit use of methadone and buprenorphine is more common and pose a medical risk. Illicit use of other prescription drugs, which are less controlled and more widely used by young people, is an important issue for further research. PMID:24139199

  15. Absence of neurocognitive impairment in a large Chinese sample of HCV-infected injection drug users receiving methadone treatment

    PubMed Central

    Gupta, Saurabh; Iudicello, Jennifer E.; Shi, Chuan; Letendre, Scott; Knight, Adam; Li, Jianhua; Riggs, Patricia K.; Franklin, Donald R.; Duarte, Nichole; Jin, Hua; Atkinson, J. Hampton; Yu, Xin; Wu, Zunyou; Grant, Igor; Heaton, Robert K.

    2014-01-01

    Background Prior research has demonstrated neuropsychological (NP) impairment in persons with histories of injection drug use (IDU), hepatitis C virus (HCV) infection, and methadone maintenance treatment (MMT), individually, but little is known about the NP effects of these three risk factors in combination. This issue is particularly important in China, which is addressing its highly HCV-comorbid IDU epidemic with widespread government sponsored MMT, especially in light of recent evidence suggesting that methadone may be neuroprotective in some circumstances. Methods We administered a comprehensive NP test battery to 195 Chinese heroin IDU individuals taking MMT (IDU+ group), the majority of whom were also HCV+ (87%; n = 169), and compared their NP performance to that of 198 demographically comparable, non-IDU Chinese controls (IDU? group). All participants in both groups tested negative for HIV infection, which is also a common comorbidity in the Chinese IDU population. Results The IDU+ group did not have an increased rate of global NP impairment, or perform significantly worse on any individual NP test measure. Within the IDU+ group, liver disease characteristics and reported details of heroin use were not significantly associated with NP performance. Conclusion Failure to detect NP impairment in IDU+ subjects with or without HCV infection was surprising, particularly considering the previously demonstrated sensitivity of our NP battery to neurocognitive disorders associated with HIV infection in China. One possible explanation, which should be explored in future research, is the potential neuroprotective effect of methadone in the context of HCV infection and/or heroin withdrawal. PMID:24508003

  16. Comparison of patient self-reports and urinalysis results obtained under naturalistic methadone treatment conditions

    Microsoft Academic Search

    Stephen T Chermack; John Roll; Mark Reilly; Leonard Davis; Usha Kilaru; John Grabowski

    2000-01-01

    This study examined under naturalistic assessment conditions the validity of self-reported opiate and cocaine use among 175 veterans enrolled in methadone treatment, and factors related to self-report validity, such as stage in treatment and drug of abuse. Veterans were interviewed by clinical staff about past 30-day drug use with the addiction severity index (ASI), and urinalysis results were obtained for

  17. Mapping-enhanced drug abuse counseling: Urinalysis results in the first year of methadone treatment

    Microsoft Academic Search

    Sandra M. Dees; Donald F. Dansereau; D. Dwayne Simpson

    1997-01-01

    Urinalysis (UA) tests for opiates and cocaine were obtained over a 12-month period for a total of 155 long-term clients who participated in treatment in one of three urban methadone centers. At admission, clients were randomly assigned to “node-link mapping” (n = 82) or “standard” (n = 73) counseling treatment. Node-link mapping is a strategy for visually representing interrelationships between

  18. Intimate partner violence among individuals in methadone maintenance treatment

    PubMed Central

    de Dios, Marcel A.; Anderson, Bradley J.; Caviness, Celeste M.; Stein, Michael

    2013-01-01

    Background Intimate partner violence (IPV) is a highly prevalent and concerning problem among methadone maintenance populations, and previous studies have shown a relationship between a history of IPV and increased substance use and affective disturbances. Methods The current study examined 1) the association between recent IPV victimization and alcohol and cocaine use and 2) the relationship between recent IPV victimization and depression in a sample of smokers (n=203) in methadone maintenance treatment (MMT). Participants in this study completed a battery of assessments that included standard questionnaires of trauma, alcohol and substance use, and depression. Parallel logistic and linear regression models were used to estimate the adjusted association of IPV victimization and depressive symptoms and evaluate the adjusted association of victimization with recent substance use. Results Participants recently victimized by partners were shown to have significantly higher mean CES-D scores (b = 0.54, 95%CI 0.07; 1.02, p < .05) and were found to have a 6 times greater likelihood of cocaine use (OR = 6.65, 95%CI 1.61; 27.46, p < .01) after controlling for age, gender, education, opiate use and ethnicity. Conclusions These findings support the notion that IPV victimization can potentially increase depression and other substance use among MMT patients, which can have a deleterious impact on treatment. PMID:24821357

  19. Concentrations of cocaine and benzoylecgonine in femoral blood from cocaine-related deaths compared with venous blood from impaired drivers.

    PubMed

    Jones, Alan Wayne; Holmgren, Anita

    2014-01-01

    The concentrations of cocaine and its major metabolite benzoylecgonine (BZE) were determined in femoral blood from 132 cocaine-related deaths and compared with venous blood from 988 apprehended drivers. Cocaine and BZE were determined by solid-phase extraction and isotope dilution gas chromatography-mass spectrometry with limits of quantitation of 0.02 mg/L for both substances. Significantly more men (95-98%) than women (2-5%) abused cocaine, although their mean age was about the same (29-30 years). Mean age (±SD) of cocaine-related deaths was 29 ± 7 years, which was not significantly different from 30 ± 8 years in traffic cases (P > 0.05). The median concentration of cocaine in blood in 61 fatalities was 0.10 mg/L compared with 0.06 mg/L in traffic cases (P < 0.001). In drug intoxication deaths, the median concentration of cocaine was 0.13 mg/L (N = 25), which was not significantly different from 0.09 mg/L (N = 36) in other causes of death. Cocaine-related deaths mostly involved mixed drug intoxications including co-ingestion of heroin, cannabis, amphetamines as well as legal drugs, such as benzodiazepines and/or ethanol. The concentrations of cocaine in blood from living and deceased persons overlapped, which makes it infeasible to predict toxicity from the analytical toxicology results alone. PMID:24327622

  20. Onsite QTc interval screening for patients in methadone maintenance treatment.

    PubMed

    Fareed, Ayman; Vayalapalli, Sreedevi; Byrd-Sellers, Johnita; Casarella, Jennifer; Drexler, Karen; Amar, Richard; Smith-Cox, Jocelyn; Lutchman, Tamara Shaw

    2010-01-01

    To improve the electrocardiogram screening process and early detection of patients at high risk for cardiac arrhythmias, the authors created a model in their clinic where they provided an onsite electrocardiogram screening that might be feasible and practical. The authors then performed a retrospective chart review to access the efficacy and feasibility of their new onsite procedure in identifying methadone maintained patients at high risk for cardiac arrhythmias. Records from all patients who are currently or had previously been maintained on methadone in the methadone maintenance program at the Atlanta VA Medical Center between 2002 and 2009 were evaluated. Of the 140 patients treated at the clinic between 2002 and 2009, 85 were excluded from the study because they had been treated as guests (had been in treatment in other clinics but received methadone dosing temporarily from our clinic), were treated in the clinic for less than 6 months, or dropped out of treatment. Thus, 55 patient charts were selected for review. Most patients (95%) received baseline and annual electrocardiogram screening. The average baseline QTc was (417 +/- 30) and most recent QTc (442 +/- 25). This QTc prolongation from baseline showed statistical significance (P < .0001). Sixty-seven percent of patients had statistically significant QTc prolongation from baseline but was less than 450 ms (mean: 428 +/- 16, P = .008). Twenty-seven percent of patients had statistically significant QTc prolongation from baseline of more 450 ms but was less than 500 ms (mean: 460 +/- 8, P < .0001). Six percent of patients had statistically significant QTc prolongation from baseline of more 500 ms (mean: 503 +/- 1.15, P = .027). Recent cocaine use was the only individual variable that showed statistically significant correlation with QTc prolongation (F = 6.98, P = .01). The authors demonstrated in this study that providing an onsite electrocardiogram screening with a focus on patient education and limiting the referral to specialty care for patients at high risk for cardiac arrhythmias could be practical and feasible. PMID:20390695

  1. Cocaine intoxication

    MedlinePLUS

    Blood chemistries and liver function tests such as CHEM-20 Cardiac enzymes (to look for evidence of heart damage ... Perrone J, Hoffman RS. Cocaine, amphetamines, caffeine, and ... eds. Emergency Medicine: A Comprehensive Study Guide . 6th ed. ...

  2. Characteristics and consequences of heroin use among older adults in the United States: a review of the literature, treatment implications, and recommendations for further research

    PubMed Central

    Hunsaker, Amanda; Albert, Steven M.; Cornelius, Jack R.; Reynolds, Charles F.

    2010-01-01

    This review reports on the results of a comprehensive literature search of studies examining the physical and mental health characteristics of older adults in the United States who use heroin. Multiple databases were searched for papers meeting the inclusion criteria of heroin users who were age 50 years or older. A total of 14 articles covering 9 different studies met the review inclusion criteria. All of the studies were convenience samples, and seven of the nine studies (77.8%) were entirely drawn from substance abuse treatment programs, primarily methadone maintenance programs. Findings from the qualitative studies suggest that the marginalization of older heroin users was a predominant experience that impacted intent to seek treatment as well as treatment retention. While articles reported high levels of physical and psychological/psychiatric comorbidities with substance misuse, research on heroin use and methadone treatment among older adults is scant and the quantitative findings are inconsistent. The articles reviewed in this study demonstrate that the needs of this population will be significant, yet the development of appropriate interventions and treatment for older adult heroin users will be contingent on empirical research that adequately describes mental and physical health problems. PMID:21237575

  3. Orthoptic status before and immediately after heroin detoxification

    PubMed Central

    Firth, A Y; Pulling, S; Carr, M P; Beaini, A Y

    2004-01-01

    Aim: To determine whether changes in orthoptic status take place during withdrawal from heroin and/or methadone. Method: A prospective study of patients, using a repeated measures design, attending a 5 day naltrexone compressed opiate detoxification programme. Results: 83 patients were seen before detoxification (mean age 27.1 (SD 4.6) years) and 69 after detoxification. The horizontal angle of deviation became less exo/more eso at distance (p<0.001) but no significant change was found at near (p?=?0.069). Stereoacuity, visual acuity, and convergence were found to be reduced in the immediate post-detoxification period. Prism fusion range, refractive error, subjective accommodation, and objective accommodation at 33 cm did not reduce but a small decrease was found in objective accommodation at 20 cm. Conclusions: The eso trend found in these patients may be responsible for the development of acute concomitant esotropia in some patients undergoing heroin detoxification. However, the mechanism for this trend does not appear to be caused by divergence insufficiency or sixth nerve palsy. PMID:15317713

  4. Evidence-based drug treatment practice and the child welfare system: the example of methadone.

    PubMed

    Lundgren, Lena M; Schilling, Robert F; Peloquin, Susan D

    2005-01-01

    This article examined the extent to which methadone maintenance (MM) is considered a treatment alternative for drug-dependent parents, as reflected in the social work and child welfare literature and in child welfare policies. Findings were derived from a review of 15 social work journals published from 1996 through 2002 and from a review of child welfare policies in 27 states in regard to treatment recommendations for substance-abusing parents. These reviews found that 23 articles focused on child welfare-substance abuse issues; no article specifically discussed MM as a treatment option for heroin-using parents; and of the 27 states, only three included methadone as a treatment option in their child welfare policy recommendations. Practice and policy recommendations are discussed. PMID:15688680

  5. Types of self-reported psychopathology in Dutch and American heroin addicts.

    PubMed

    Steer, R A; Platt, J J; Hendriks, V M; Metzger, D S

    1989-12-01

    One-hundred Dutch and 100 American heroin addicts receiving methadone were administered the Symptom Check List-90 (SCL-90), and a Modal Profile Analysis was performed to determine whether or not the mean profiles of the nine SCL-90 subscales were comparable for these two White male samples. Three profile-shape components correctly classified over 85% of both groups and reflected (1) Anxious-depressed, (2) Hostile and (3) Paranoid syndromes. The relationships of the SCL-90 profiles to selected psychosocial characteristics were also studied. For example, marijuana use was associated with the Paranoid shape component in both samples. The implications of these SCL-90 profiles for identifying common aspects of self-reported psychopathology in both Dutch and American heroin addicts were discussed. PMID:2605992

  6. A Randomized Trial of Methadone Initiation Prior to Release from Incarceration

    PubMed Central

    McKenzie, Michelle; Zaller, Nickolas; Dickman, Samuel L.; Green, Traci C.; Parihk, Amisha; Friedmann, Peter D.; Rich, Josiah D.

    2012-01-01

    Individuals who use heroin and illicit opioids are at high risk for infection with human immunodeficiency virus (HIV) and other blood-borne pathogens, as well as incarceration. The purpose of the randomized trial reported here is to compare outcomes between participants who initiated methadone maintenance treatment (MMT) prior to release from incarceration, with those who were referred to treatment at the time of release. Participants who initiated MMT prior to release were significantly more likely to enter treatment postrelease (P < .001) and for participants who did enter treatment, those who received MMT prerelease did so within fewer days (P = .03). They also reported less heroin use (P = .008), other opiate use (P = .09), and injection drug use (P = .06) at 6 months. Initiating MMT in the weeks prior to release from incarceration is a feasible and effective way to improve MMT access postrelease and to decrease relapse to opioid use. PMID:22263710

  7. Fatal cocaine interactions: a review of cocaine-related deaths in Bexar County, Texas.

    PubMed

    Molina, D Kimberley; Hargrove, Veronica M

    2011-03-01

    Although cocaine is a widely abused illicit substance that is known to cause death, deaths due to its use appear to occur in a minority of those who use it. This report was designed to review drug-related deaths due to cocaine, and the concomitant use of other drugs/medications. A retrospective review of drug deaths at the Bexar County Medical Examiner's Office in San Antonio, Texas, was undertaken for cases where cocaine was one of the drugs implicated in causing death. Analysis was performed comparing the concentrations of cocaine and benzoylecgonine present and the absence or presence of other drugs. The data obtained showed that cocaine was toxic over a large range with deaths occurring at concentrations ranging from 0.01 to 78 mg/L. Analyses also indicated an increased lethality when cocaine is used in combination with ethanol, heroin, opiates, and antidepressant/antipsychotic medications, which is consistent with previous reports and research. Antihistamine data showed that there may be relationship between increased toxicity and co-ingestion, although more research is necessary. PMID:21394957

  8. Impairment of acquisition of intravenous cocaine self-administration by RNA-interference of dopamine D1-receptors in the nucleus accumbens shell.

    PubMed

    Pisanu, Augusta; Lecca, Daniele; Valentini, Valentina; Bahi, Amine; Dreyer, Jean-Luc; Cacciapaglia, Fabio; Scifo, Andrea; Piras, Giovanna; Cadoni, Cristina; Di Chiara, Gaetano

    2015-02-01

    Microdialysis during i.v. drug self-administration (SA) have implicated nucleus accumbens (NAc) shell DA in cocaine and heroin reinforcement. However, this correlative evidence has not been yet substantiated by experimental evidence obtained by studying the effect of selective manipulation of NAc shell DA transmission on cocaine and heroin SA. In order to investigate this issue, DA D1a receptor (D1aR) expression was impaired in the NAc shell and core by locally infusing lentiviral vectors (LV) expressing specific D1aR-siRNAs (LV-siRNAs). Control rats were infused in the same areas with LV expressing GFP. Fifteen days later, rats were trained to acquire i.v. cocaine or heroin self-administration (SA). At the end of behavioral experiments, in order to evaluate the effect of LV-siRNA on D1aR expression, rats were challenged with amphetamine and the brains were processed for immunohistochemical detection of c-Fos and D1aR. Control rats acquired i.v. cocaine and heroin SA. Infusion of LV-siRNAs in the medial NAc shell reduced D1aR density and the number of c-Fos positive nuclei in the NAc shell, while sparing the core, and prevented the acquisition of cocaine, but not heroin SA. In turn, LV-siRNAs infusion in the core reduced D1aR density and the number of c-Fos positive nuclei in the same area, while sparing the shell, and failed to affect acquisition of cocaine. The differential effect of LV impairment of NAc shell D1aR on cocaine and heroin SA indicates that NAc shell DA acting on D1aR specifically mediates cocaine reinforcement. PMID:25446574

  9. [The message from heroin overdoses].

    PubMed

    Pap, Ágota; Heged?s, Katalin

    2015-03-01

    Drug use can be defined as a kind of self destruction, and it is directly linked to attitudes toward death and suicide occurring in a significant number of users of different narcotics. The aim of the authors was to look for the background of this relationship between drug and death and examine the origin, development, and motives behind heroin overdose based on an analysis of previous studies. It seems clear that pure heroin overdose increased gradually over the years. The fear of the police is the inhibitory factor of the overdose prevention and notification of emergency health care service. Signs of suicide could be the own home as the chosen location for heroin overdose and the presence of partners ("moment of death companion"). Interventions should include simple techniques such as first aid, naloxone administration, resuscitation, prevention of relapse of prisoners and social network extension involving maintenance programs. PMID:25702255

  10. Patterns of pre-treatment drug abuse, drug treatment history and characteristics of addicts in methadone maintenance treatment in Iran

    PubMed Central

    2012-01-01

    Background Opiates are the main drugs of abuse, and Methadone Maintenance Treatment (MMT) is the most widely administered drug addiction treatment program in Iran. Our study aimed to investigate patterns of pre-treatment drug abuse, addiction treatment history and characteristics of patients in MMT in Tehran. Methods We applied a stratified cluster random sampling technique and conducted a cross-sectional survey utilizing a standard patient characteristic and addiction history form with patients (n?=?810) in MMT. The Chi-square test and t-test served for statistical analyses. Results A clear majority of the participants were men (96%), more than 60% of whom were between 25 and 44?years of age, educated (89% had more than elementary education), and employed (>70%). The most commonly reported main drugs of abuse prior to MMT entry were opium (69%) and crystalline heroin (24%). The patients’ lifetime drug experience included opium (92%), crystalline heroin (28%), cannabis (16%), amphetamines (15%), and other drugs (33%). Crystalline heroin abusers were younger than opium users, had begun abusing drugs earlier, and reported a shorter history of opiate addiction. Conclusion Opium and crystalline heroin were the main drugs of abuse. A high rate of addiction using more dangerous opiate drugs such as crystalline heroin calls for more preventive efforts, especially among young men. PMID:22676557

  11. Patterns in Admission Delays to Outpatient Methadone Treatment in the United States

    PubMed Central

    Gryczynski, Jan; Schwartz, Robert P.; Salkever, David S.; Mitchell, Shannon Gwin; Jaffe, Jerome H.

    2011-01-01

    Waiting lists for methadone treatment have existed in many U.S. communities, but little is known nationally about what patient and service system factors are related to admission delays that stem from program capacity shortfalls. Using a combination of national data sources, this study examined patterns in capacity-related admission delays to outpatient methadone treatment in 40 U.S. metropolitan areas (n=28,920). Patient characteristics associated with admission delays included racial/ethnic minority status, lower education, criminal justice referral, prior treatment experience, secondary cocaine or alcohol use, and co-occurring psychiatric problems. Injection drug users experienced fewer delays, as did self-pay patients and referrals from healthcare and addiction treatment providers. Higher community-level utilization of methadone treatment was associated with delay, whereas delays were less common in communities with higher utilization of alternative modalities. These findings highlight potential disparities in timely admission to outpatient methadone treatment. Implications for improving treatment access and service system monitoring are discussed. PMID:21821378

  12. Buprenorphine Outpatient Outcomes Project: can Suboxone be a viable outpatient option for heroin addiction?

    PubMed Central

    Sittambalam, Charmian D.; Vij, Radhika; Ferguson, Robert P.

    2014-01-01

    Background Opioid dependence treatment traditionally involves methadone clinics, for which dispensing schedules can be cumbersome. Buprenorphine, a partial agonist of the mu receptor and antagonist of the kappa receptor, is a potential outpatient alternative to methadone. Funded by a grant from the State of Maryland's Community Health Resources Commission (CHRC), the Buprenorphine Outpatient Outcomes Project (BOOP) evaluates the outcome of Suboxone (buprenorphine/naloxone) treatment on abstinence from heroin use, rates of emergency room visits and hospitalizations, legal issues, and quality of life. Methods Active heroin users were recruited between June 2007 and June 2010 and induction therapy with Suboxone was instituted during hospitalization. Once discharged, patients were followed as outpatients for maintenance treatment and counseling. Data were collected from electronic medical records, Maryland state legal records, and SF-36® Health Surveys regarding several parameters and patients were categorized according to duration of treatment with Suboxone into one of three groups: <1 month, 1–3 months, and >3 months. Results A total of 220 participants were included in the study. The age range of participants was 18–67 years with most being African American males. Eighty-three (38%) remained in the study for at least 1 month, with 37 of the 83 (45%) remaining in treatment for >3 months. Ten of the 37 (27%) never relapsed after their longest period of abstinence from heroin. During the first year after initiating treatment with Suboxone, hospitalization and emergency room visit rates for all 220 participants decreased by 45 and 23%, respectively, as compared to the year prior to starting treatment. The number of legal charges for drug possession decreased from 70 to 62. Anecdotally, the quality of life seemed to improve in those who were treated with Suboxone for longer periods of time and received regular counseling. Conclusion Overall, Suboxone is an effective treatment method for heroin addiction and is a viable outpatient therapy option. Individualized treatment plans and counseling must be implemented for maximum benefits to be seen. Retention of patients for a long duration of therapy was difficult, but for those who did remain, benefits were seen in overall health, abstinence from heroin use, cognition, and quality of life. PMID:24765257

  13. Outcome of heroin-dependent adolescents presenting for opiate substitution treatment.

    PubMed

    Smyth, Bobby P; Fagan, John; Kernan, Kathy

    2012-01-01

    Because the outcome of methadone and buprenorphine substitution treatment in adolescents is unclear, we completed a retrospective cohort study of 100 consecutive heroin-dependent adolescents who sought these treatments over an 8-year recruitment period. The participants' average age was 16.6 years, and 54 were female. Half of the patient group remained in treatment for over 1 year. Among those still in treatment at 12 months, 39% demonstrated abstinence from heroin. The final route of departure from the treatment program was via planned detox for 22%, dropout for 32%, and imprisonment for 8%. The remaining 39% were transferred elsewhere for ongoing opiate substitution treatment after a median period of 23 months of treatment. Males were more likely to exit via imprisonment (p < .05), but other outcomes were not predicted by gender. There were no deaths during treatment among these 100 patients who had a cumulative period of 129 person years at risk. Our findings suggest that this treatment delivers reductions in heroin use and that one fifth of patients will exit treatment following detox completion within a 1- to 2-year time frame. PMID:21940134

  14. Cognitive Control in Opioid Dependence and Methadone Maintenance Treatment

    PubMed Central

    Liao, Ding-Lieh; Huang, Cheng-Yi; Hu, Sien; Fang, Su-Chen; Wu, Chi-Shin; Chen, Wei-Ti; Lee, Tony Szu-Hsien; Chen, Pau-Chung; Li, Chiang-shan R.

    2014-01-01

    Background Substance misuse is associated with cognitive dysfunction. We used a stop signal task to examine deficits in cognitive control in individuals with opioid dependence (OD). We examined how response inhibition and post-error slowing are compromised and whether methadone maintenance treatment (MMT), abstinence duration, and psychiatric comorbidity are related to these measures in individuals with OD. Methods Two-hundred-and-sixty-four men with OD who were incarcerated at a detention center and abstinent for up to 2 months (n?=?108) or at a correctional facility and abstinent for approximately 6 months (n?=?156), 65 OD men under MMT at a psychiatric clinic, and 64 age and education matched healthy control (HC) participants were assessed. We computed the stop signal reaction time (SSRT) to index the capacity of response inhibition and post-error slowing (PES) to represent error-related behavioral adjustment, as in our previous work. We examined group effects with analyses of variance and covariance analyses, followed by planned comparisons. Specifically, we compared OD and HC participants to examine the effects of opioid dependence and MMT and compared OD sub-groups to examine the effects of abstinence duration and psychiatric comorbidity. Results The SSRT was significantly prolonged in OD but not MMT individuals, as compared to HC. The extent of post-error slowing diminished in OD and MMT, as compared to HC (trend; p?=?0.061), and there was no difference between the OD and MMT groups. Individuals in longer abstinence were no less impaired in these measures. Furthermore, these results remained when psychiatric comorbidities including misuse of other substances were accounted for. Conclusions Methadone treatment appears to be associated with relatively intact cognitive control in opioid dependent individuals. MMT may facilitate public health by augmenting cognitive control and thereby mitigating risky behaviors in heroin addicts. PMID:24727743

  15. High dose versus moderate dose methadone maintenance: is there a better outcome?

    PubMed

    Fareed, Ayman; Casarella, Jennifer; Roberts, Mary; Sleboda, Mary; Amar, Richard; Vayalapalli, Shreedevi; Drexler, Karen

    2009-10-01

    Methadone dosing has been an issue of controversy among clinicians for a long time. Few recent studies reported that doses above 100 mg daily seem promising in better control of illicit opiate use for some patients, but more research is needed to support that notion. A retrospective chart review for patients maintained on methadone at Atlanta Veterans Affairs Medical Center was conducted. Patients were categorized into two groups: patients on a methadone dose of 60 to 100 mg daily (n = 34) and patients on a methadone dose greater than 100 mg daily (n = 25). Those charts were compared for urine drug screens for opiates and cocaine (first four from admission and most recent four screens), retention or drop out from the program, and Addiction Severity Index (ASI) composite score at admission and most recent score. The results of the first and last four urine drug screens for opiates showed that the moderate dose group was positive 23% and 17%, respectively. However, the high dose group was positive 14% and 8%, respectively. These results showed statistical significance (Chi-Square = 8.04, df = 3 and p =.03). ASI scores for drugs did not show statistically significant improvement for the moderate dose group (p =.19) but showed statistically significant improvement for the high dose group (p =.0002) when the result of the first and last ASI scores among each group were compared. The ASI scores for family problems showed statistically significant improvement for the moderate dose group (p =.03). High doses of methadone greater than 100 mg daily may provide a better outcome for illicit opiate use among some patients who would not respond to moderate doses. PMID:20155609

  16. Impact of South American heroin on the US heroin market 1993–2004

    PubMed Central

    Ciccarone, Daniel; Unick, George J; Kraus, Allison

    2008-01-01

    Background The past two decades have seen an increase in heroin-related morbidity and mortality in the United States. We report on trends in US heroin retail price and purity, including the effect of entry of Colombian-sourced heroin on the US heroin market. Methods The average standardized price ($/mg-pure) and purity (% by weight) of heroin from 1993 to 2004 was from obtained from US Drug Enforcement Agency retail purchase data for 20 metropolitan statistical areas. Univariate statistics, robust Ordinary Least Squares regression and mixed fixed and random effect growth curve models were used to predict the price and purity data in each metropolitan statistical area over time. Results Over the 12 study years, heroin price decreased 62%. The median percentage of all heroin samples that are of South American origin increased an absolute 7% per year. Multivariate models suggest percent South American heroin is a significant predictor of lower heroin price and higher purity adjusting for time and demographics. Conclusion These analyses reveal trends to historically low-cost heroin in many US cities. These changes correspond to the entrance into and rapid domination of the US heroin market by Colombian-sourced heroin. The implications of these changes are discussed. PMID:19201184

  17. Heroin in brown, black and white: Structural factors and medical consequences in the US heroin market

    PubMed Central

    Ciccarone, Daniel

    2009-01-01

    Background Heroin coming into the United States historically comes from three widely dispersed geographical regions: Southwest Asia, Southeast Asia and Mexico. A fourth source of US-bound heroin, from Colombia, originated in the early 1990s. The fact that the four heroin sources produce differing morphologies and qualities of heroin has not been critically examined. In addition, it is not well established how the contemporary competing dynamics of interdiction, or restriction of heroin flows across international boundaries, and neoliberal, e.g., global expansion of free trade, policies are affecting heroin markets. This paper will highlight changes in the US heroin market, including source trends, the political economy of the now dominant source and the resultant effects on the heroin risk environment by US region. Methods Using a structural and historical framework this paper examines two decades of secondary data sources, including government and drug control agency documents, on heroin flows together with published work on the political and economic dynamics in Latin America. Results Co-occurring neoliberal economic reforms may have contributed to paradoxical effects of US/Colombian interdiction efforts. Since entering the US market, heroin from Colombia has been distributed at a much higher quality and lower retail price. An increasingly exclusive market has developed with Mexican and Colombian heroin gaining market share and displacing Asian heroin. These trends have had dramatic effects on the risk environment for heroin consumers. An intriguing factor is that different global sources of heroin produce substantially different products. Plausible associations exist between heroin source/form and drug use behaviours and harms. For example, cold water-soluble powdered heroin (sources: Asia, Colombia) may be associated with higher HIV prevalence in the US, while low-solubility “black tar” heroin (BTH; source: Mexico) is historically used in areas with reduced HIV prevalence. BTH is associated with soft tissue infections caused by Clostridium bacteria. Conclusion Source and type of heroin are structural factors in the risk environment of heroin users: source dictates distribution and type predicts practice. How specific types of heroin are used and with what risk is therefore distributed geographically. Continued flux in the heroin market and its effects on the risk environment for drug users deserves further attention. PMID:18945606

  18. Pharmacokinetics and Pharmacogenetics of Methadone: Clinical Relevance

    Microsoft Academic Search

    Chin B. Eap; Jean-Jacques Déglon; Pierre Baumann

    Summary Recent data on the pharmacokinetics and pharmacogenetics of methadone, taking into account its enantiomers, have been collected. In particular, it has been demonstrated that isozymes belonging to the cytochrome P450 superfamily play a major role in the metabolism of methadone. During the past ten years, a large amount of information has been collected on this enzymatic system. In particular

  19. Dose escalation and dose preference in extended-access heroin self-administration in Lewis and Fischer rats

    PubMed Central

    Picetti, Roberto; Caccavo, Jilda A.; Ho, Ann; Kreek, Mary Jeanne

    2012-01-01

    Rationale A genetic component may be involved in different stages of the progression of drug addiction. Heroin users escalate unit doses and frequency of self-administration events over time. Rats that self-administer drugs of abuse over extended sessions escalate the amount of drug infused over days. Objectives Using a recently developed model of extended-access self-administration allowing for subject-controlled dose-escalation of the unit dose, thus potentially escalating the unit dose and number of infusions, we compared for the first time two genetically different inbred rat strains, Fischer and Lewis. Methods Extended (18h/day) self-administration lasted for 14 days. Rats had access to two active levers associated with two different unit doses of heroin. If a rat showed preference for the higher unit dose, then the available doses were escalated in the following session. Four heroin unit doses were available (20, 50, 125, 250 ?g/kg/infusion). Results Fischer rats did not escalate the unit dose of heroin self-administered; daily amount of heroin administered remained low, with a mean daily intake of 1.27±0.22 mg/kg/session. In marked contrast, Lewis rats escalated the total daily amount of heroin self-administered from 3.94±0.82 mg/kg on the day 1 to 8.95±2.2 mg/kg on day 14; almost half of the subjects preferred a higher heroin dose than Fischer rats. Conclusion These data are consistent with the hypothesis that Lewis rats are prone to opiate taking and escalation, and are in agreement with our previous data obtained with cocaine. PMID:21894484

  20. Motivational Profiles of Clients Seeking Methadone Maintenance Therapy in China

    PubMed Central

    Li, Li; Ding, Yingying; Lai, Wenhong; Lin, Chunqing; Luo, Wei

    2011-01-01

    Objective This study applied a stage-of-change model to examine the motivational profiles of clients seeking methadone maintenance therapy (MMT) in China. Methods Face-to-face interviews were conducted with a total of 179 clients from six MMT clinics. The University of Rhode Island Change Assessment (URICA) scale was used to measure the participants’ motivation and readiness to change. Cluster analysis was performed to classify the sample into subgroups with respect to their change dimensions. Results The study sample was allocated into five distinct clusters: uninvolved, denial, pre-participation, ambivalent, and participation. Participants who were classified in the denial cluster were older than those in the pre-participation and participation clusters. A higher level of motivation to change was positively associated with continued heroin use and more severe drug problems. Discussion It would be beneficial to evaluate motivational profiles of individual clients in the treatment planning process and provide tailored interventions for sustained treatment retention and outcomes. PMID:21571447

  1. Heroin addiction, ethics and philosophy of medicine.

    PubMed Central

    ten Have, H; Sporken, P

    1985-01-01

    This article discusses various ethical and philosophical aspects of heroin addiction. It arose as a result of the plan by the Amsterdam city council to supply free heroin to drug addicts. The objective of treatment of heroin addicts is ambivalent because what is in fact a socio-cultural problem is transformed into a medical problem. The characteristics of this treatment are made explicit through a philosophical analysis which sees the medical intervention as part of a strategy aimed at achieving social normalisation. The reason why such a social control function is practised by physicians is discussed, as well as the reason why heroin users in particular are the object of such a process. In this paper, heroin addiction is considered primarily as a cultural problem. The consequences of this for treatment and ethics form the conclusion. PMID:4078854

  2. NAOMI: The trials and tribulations of implementing a heroin assisted treatment study in North America

    PubMed Central

    Gartry, Candice C; Oviedo-Joekes, Eugenia; Laliberté, Nancy; Schechter, Martin T

    2009-01-01

    Background Opioid addiction is a chronic, relapsing disease and remains a major public health challenge. Despite important expansions of access to conventional treatments, there are still significant proportions of affected individuals who remain outside the reach of the current treatment system and who contribute disproportionately to health care and criminal justice costs as well as to public disorder associated with drug addiction. The NAOMI study is a Phase III randomized clinical trial comparing injectable heroin maintenance to oral methadone. The study has ethics board approval at its Montréal and Vancouver sites, as well as from the University of Toronto, the New York Academy of Medicine and Johns Hopkins University. The main objective of the NAOMI Study is to determine whether the closely supervised provision of injectable, pharmaceutical-grade opioid agonist is more effective than methadone alone in recruiting, retaining, and benefiting chronic, opioid-dependent, injection drug users who are resistant to current standard treatment options. Methods The case study submitted chronicles the challenges of getting a heroin assisted treatment trial up and running in North America. It describes: a brief background on opioid addiction; current standard therapies for opioid addiction; why there is/was a need for a heroin assisted treatment trial; a description of heroin assisted treatment; the beginnings of creating the NAOMI study in North America; what is the NAOMI study; the science and politics of the NAOMI study; getting NAOMI started in Canada; various requirements and restrictions in getting the study up and running; recruitment into the study; working with the media; a status report on the study; and a brief conclusion from the authors' perspectives. Results and conclusion As this is a case study, there are no specific results or main findings listed. The case study focuses on: the background of the study; what it took to get the study started in Canada; the unique requirements and conditions of getting a site, and the study, approved; working with the media; recruitment into the study; a brief status report on the study; and a brief conclusion from the authors' perspectives. Trail Registration ClinicalTrials.gov registration number: NCT00175357 PMID:19159475

  3. Polysubstance Use and Heroin Relapse among Adolescents following Residential Treatment

    ERIC Educational Resources Information Center

    Branson, Christopher E.; Clemmey, Philip; Harrell, Paul; Subramaniam, Geetha; Fishman, Marc

    2012-01-01

    This study examined posttreatment patterns of polysubstance use and heroin relapse in a sample of 43 adolescents (ages 14-20) entering short-term residential treatment for primary heroin use. At 12-month follow-up, youths that achieved heroin abstinence (N = 19) were significantly less likely than youths that relapsed to heroin (N = 24) to endorse…

  4. Cocaine and Pregnancy

    MedlinePLUS

    ... led to the suggestion that sperm could deliver cocaine directly to the egg, causing developmental problems. However, no birth defects have been identified as a direct result of paternal exposure to cocaine. The safest approach is for a man to ...

  5. Differences in methylphenidate abuse rates among methadone maintenance treatment patients in two clinics.

    PubMed

    Peles, Einat; Schreiber, Shaul; Linzy, Shirley; Domani, Yoav; Adelson, Miriam

    2015-07-01

    Methylphenidate, an amphetamine-like prescription medication for attention deficit hyperactivity disorder (ADHD) was suspected as being abused among methadone maintenance treatment (MMT) patients. We tested its presence in the routine urine monitoring of all patients in both Tel Aviv and Las Vegas MMT clinics. Data on demographic and addiction history, ADHD (Wender Utah Rating Scale), cognitive impairment (Mini Mental State Exam), and lifetime DSM-IV-TR psychiatric diagnosis from admission were retrieved, and retention following 6months. None of the 190 patients in Las Vegas tested positive for methylphenidate, while 14.7% (45/306) did in Tel Aviv. Abusers were less educated (p=0.01), had higher ADHD scores (p=0.02), lower cognitive scores (p=0.05), and a higher benzodiazepine (BDZ) abuse rate (p<0.0005), with no difference in age, gender, duration in MMT, cannabis, opiates, and cocaine abuse and infectious disease. Of the methylphenidate abuse 42.2% have take-home methadone dose privileges. Not like opiate use, being methylphenidate positive did not relate to 6-months retention. Compared to Tel Aviv, Las Vegas patients were more educated, with lower BDZ, and cocaine abuse. The greater abuse of methylphenidate among ADHD subjects might indicate their using it as self-medication, raising a possible indication for its prescription for that subgroup of MMT patients. The high rate of methylphenidate abuse in Israel needs future study. PMID:25605438

  6. CDC Vital Signs: Today's Heroin Epidemic

    MedlinePLUS

    ... Food and Drug Administration approved MAT options (methadone, buprenorphine, and naltrexone) in patients addicted to prescription opioid ... for Opioid Addiction: Facts for Families and Friends Buprenorphine Treatment Locator Mental Health Treatment Locator The White ...

  7. A study on photodegradation of methadone, EDDP, and other drugs of abuse in hair exposed to controlled UVB radiation.

    PubMed

    Favretto, Donata; Tucci, Marianna; Monaldi, Alice; Ferrara, Santo Davide; Miolo, Giorgia

    2014-06-01

    The drug content of hair may be affected by washing, chemical or thermal treatments, the use of cosmetics, or exposure to the environment. Knowledge concerning the effect of natural or artificial light on drug content in hair can be helpful to the forensic toxicologist, in particular when investigating drug concentrations above or below pre-determined cut-offs. The photodegradation of methadone and its metabolite, 2-ethyl-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) was studied in authentic positive hair samples by comparing drug concentrations determined by liquid chromatrography-high resolution mass spectrometry before and after exposure to UVB light (in vivo study). The same approach was applied in order to investigate the light sensitivity of opiates (6-monoacetylmorphine and morphine) and cocainics (cocaine and benzoylecgonine) in true positive hair. The yields of photodegradation were calculated for each drug class in eight different positive hair samples irradiated by UVB at 300?J/cm(2) obtaining averages, ranges and standard deviations. In parallel, the photostability of all the compounds as 10(-5) -10(-4) ?M standard solutions in methanol were examined by means of UVB light irradiation in the range 0-100?J/cm(2) followed by UV/Vis spectroscopic analysis and direct infusion electrospray ionization-high resolution mass spectrometry (in vitro study). In hair, methadone was shown to be significantly affected by light (photodegradation of 55% on average), while its metabolite EDDP proved to be more photostable (17%). 6-monoacetylmorphine, morphine, benzoylecgonine, and cocaine were more photostable than methadone in vivo (on average, 21%, 17%, 20%, and 11% of degradation, respectively). When irradiated in standard solutions, the target molecules exhibited a larger photodegradation than in vivo with the exception of cocaine (photodegradation for methadone up to 70%, 6-monoacetylmorphine and morphine up to 90%, benzoylecgonine up to 67%, cocaine up to 15%). Some factors possibly affecting the yields of photodegradation in hair and partially explaining the differences observed between the in vivo and the in vitro studies were also investigated, such as the colour of hair (the role of melanin) and the integrity of the keratin matrix. PMID:24817052

  8. Neutral heroin impurities from tetrahydrobenzylisoquinoline alkaloids.

    PubMed

    Toske, Steven G; Cooper, Samuel D; Morello, David R; Hays, Patrick A; Casale, John F; Casale, Ellen

    2006-03-01

    Laudanosine, reticuline, codamine, and laudanine are members of the tetrahydrobenzylisoquinoline family of natural products. These alkaloids are present in the opium poppy, Papaver somniferum, and are subsequently found as impurities in clandestinely processed morphine. Morphine is then synthesized to heroin using hot acetic anhydride. During the course of this study, it was determined that these four tetrahydrobenzylisoquinolines undergo degradation to a series of 18 neutral impurities when subjected to hot acetic anhydride. Based on the degradation pathway, these new impurities were categorized into two sets of impurities called the C1-acetates compounds and the stilbene compounds. Synthesis, isolation, and structural elucidation information is provided for the tetrahydrobenzylisoquinoline alkaloids, and the new neutral impurities have been studied. Several hundred authentic heroin samples were analyzed using an established heroin signature program method. This methodology features the detection of trace neutral impurities present in heroin samples. It was determined that all 18 new impurities were detected in various quantities in four different types of heroin samples. Analytical results featuring these new impurities are reported for South American-, Southwest Asian-, Mexican-, and Southeast Asian-type heroin samples. These new impurities, coupled with other established forensic markers, enhance the ability to classify illicit heroin samples. PMID:16566764

  9. Variation in use of Buprenorphine and Methadone Treatment by Racial, Ethnic and Income Characteristics of Residential Social Areas in New York City

    PubMed Central

    Hansen, Helena B.; Siegel, Carole E.; Case, Brady G.; Bertollo, David N.; DiRocco, Danae; Galanter, Marc

    2013-01-01

    National data indicate that patients treated with buprenorphine for opiate use disorders are more likely to be White, highly educated, and to have greater incomes than those receiving methadone, but patterns of buprenorphine dissemination across demographic areas have not been documented in major metropolitan areas where poverty, minority populations and injection heroin use are concentrated. Rates of buprenorphine and methadone treatment are compared among areas of New York City defined by their income and ethnic/racial composition. Residential social areas (hereinafter called social areas) were defined as aggregations of ZIP codes with similar race/ethnicity and income characteristics, and were formed based on clustering techniques. Treatment rates were obtained for each New York City ZIP code: buprenorphine treatment rates were based on the annual number of buprenorphine prescriptions written, and the methadone treatment rate on the number of methadone clinic visits for persons in each ZIP code. Treatment rates were correlated univariately with ethnicity and income characteristics of ZIP codes. Social area treatment rates were compared using individual ANOVA models for each rate. Buprenorphine and methadone treatment rates were significantly correlated with the ethnicity and income characteristics of ZIP codes, and treatment rates differed significantly across the social areas. Buprenorphine treatment rates were highest in the social area with the highest income and lowest percentage of Black and Hispanic residents. Conversely, the methadone treatment rate was highest in the social area with the highest percentage of low income and Hispanic residents. The uneven dissemination of 0pioid maintenance treatment in New York City may be reflective of the limited public health impact of buprenorphine in ethnic minority and low income areas. Specific policy and educational interventions to providers are needed to promote the use of buprenorphine for opiate use disorders in diverse populations. PMID:23702611

  10. The role of corticosterone in food deprivation-induced reinstatement of cocaine seeking in the rat

    Microsoft Academic Search

    Uri Shalev; Michela Marinelli; Michael H. Baumann; Pier-Vincenzo Piazza; Yavin Shaham

    2003-01-01

    Rational and objectives.  \\u000a Acute 1-day food deprivation stress reinstates heroin seeking in rats, but the generality of this effect to other drugs, and\\u000a its underlying mechanisms, are largely unknown. Here we studied whether food deprivation would reinstate cocaine seeking and\\u000a whether the stress hormone, corticosterone, is involved in this effect.\\u000a \\u000a \\u000a \\u000a Methods.  \\u000a Rats were trained to press a lever for cocaine

  11. Heroin

    MedlinePLUS

    ... Prescription Stimulant Medications (Amphetamines) Salvia Spice Tobacco, Nicotine, & E-Cigarettes Brain and Addiction HIV/AIDS and Drug Use + ... Prescription Stimulant Medications (Amphetamines) Salvia Spice Tobacco, Nicotine, & E-Cigarettes Brain and Addiction HIV/AIDS and Drug Use ...

  12. Examine the Relationship between Mindfulness and Drug Craving in Addicts Undergoing Methadone Maintenance Treatment

    PubMed Central

    ARDAME, Ali; BASSAKNEJAD, Soodabe; ZARGARD, Yadollah; ROKNI, Parisa; SAYYAH, Mehdi

    2014-01-01

    Abstract Background The aim of this study was examination the relationship between mindfulness and drug craving in addicts undergoing methadone maintenance treatment. Methods The subjects of this research were 80 addicts undergoing methadone maintenance treatment selected through available sampling from four addiction treatment center in Ahvaz from March 2012 to September 2012. Two questionnaires to examine the variables of this study were the five facets mindfulness questionnaire (FFMQ) and hero-in craving questionnaire (HCQ). The data were analyzed using SPSS version 16. Results The Pearson correlational results indicated significant reverse relation between mindfulness factors and craving sub scales (P<0.05). Besides, the regression results indicated that four factors of mindfulness such as observation, describing, acting with awareness and non-reactivity to inner experience can totally predict 48 percent of craving variance (P<0.01 ). Conclusion There is a reverse relation between mindfulness and craving. Therefore we advise the researchers in addiction fields that in line with various studies that indicated effectiveness of mindfulness based interventions in improving various psychological problems, be researcher in effectiveness of this intervention in addiction fields. Moreover, we advise the addiction therapists to use mindfulness based interventions and technics in order to reduction of emotional and cognitive problems co morbidities with addiction such as craving that is one of potential factors affecting survival and relapse to drug abuse. PMID:25988095

  13. Treatment of Heroin Dependence: Effectiveness, Costs, and Benefits of Methadone Maintenance

    ERIC Educational Resources Information Center

    Schilling, Robert; Dornig, Katrina; Lungren, Lena

    2006-01-01

    Objectives: Social workers will increasingly be required to attend to the cost-effectiveness of practices, programs, and policies. In the area of substance abuse, there is little evidence to suggest that social workers' decisions are based on evidence of either effectiveness or costs. Method: This article provides an overview of existing evidence…

  14. An Exploratory Study of Inhalers and Injectors Who Used Black Tar Heroin

    PubMed Central

    Maxwell, Jane Carlisle; Spence, Richard T.

    2011-01-01

    Aims To undertake an exploratory study to examine the characteristics of patients in narcotic treatment programs who started their use of black tar heroin either as inhalers or as injectors and to compare them with those who started as inhalers but shifted to injecting. Other studies in this area have used subjects using other forms of heroin more amenable to inhaling. Participants, Design, and Measurement A purposive sample of 199 patients in 6 methadone programs in Texas were interviewed in 2002-2003 using a structured instrument. Findings At admission to treatment, those who were heroin inhalers were more likely to be African American, to live with their families, to have income from wages, and to report fewer days of problems on most of the ASI measures. Those who shifted from inhaling to injecting were more likely to be Hispanic and to have had mental health problems that interfered with their lives and to have had less nurturing while growing up. Injectors were older at this treatment admission, had more treatment episodes and more times in jail, and were more likely to have hepatitis C, AIDS, or gonorrhea. There were high levels of physical and mental problems and histories of traumatization as children and adults for almost all the respondents. Males were as likely as females to have been sexually abused as children or as adults. Conclusions The high rates of mental and physical problems among all the clients interviewed showed the need for comprehensive services to be delivered within the substance abuse treatment programs. Histories of trauma and sexual abuse should be addressed for both male and female clients. PMID:21552428

  15. Methadone toxicity in a poisoning referral center

    PubMed Central

    Taheri, Fatemeh; Yaraghi, Ahmad; Sabzghabaee, Ali Mohammad; Moudi, Maryam; Eizadi-Mood, Nastaran; Gheshlaghi, Farzad; Farajzadegan, Ziba

    2013-01-01

    Objective: Methadone poisoning can occur accidentally or intentionally for suicide or homicide purposes. The aim of this study was to evaluate the epidemiological and clinical manifestations of Methadone poisoning. Methods: A descriptive analytical study was performed from 2010 to 2012 in the poisoning emergency and clinical toxicology departments of Noor hospital affiliated with Isfahan University of Medical Sciences (Isfahan, Iran). All patients with Methadone poisoning within this period of time were investigated. Different variables were recorded in a checklist. Findings: A total of 385 patients were studied. About 85.7% had ingested only Methadone and 14.3% had ingested other medications with Methadone. Mean ± standard deviation of the age was 32.1 ± 15 years (range: 1-90). Most of the patients were male (76.4%). Nearly 40% of the patients were narcotic addicts, 25.5% were addicts under surveillance of Methadone maintenance therapy centers and 34.5% were non-addicts. Intentional poisoning was observed in most of the patients (57.7%). Most of the patients had a low level of consciousness on admission (58.2%). Respiratory depression and hypotension was observed in 35.6% and 12.7% of the cases as the most common symptoms. Regarding vital signs, there was a significant difference in respiratory rate on admission among different evaluated groups (P = 0.02). Length of hospital stay was 18.79 ± 0.72 h (range: 4-240 h, median: 15 h). About 57 patients (25.8%) from the intentionally poisoned patients and 19 patients (12.3%) from the unintentionally poisoned patients had a history of psychiatric disorder (P = 0.001). Most of the patients survived without complications. Conclusion: Addiction, age, gender, attempt to suicide and a history of psychiatric disorder were of the most important factors effective in Methadone poisoning, which should be considered in the public training and prevention of poisoning. PMID:24991620

  16. Cocaine use and stroke

    PubMed Central

    Treadwell, Sean D; Robinson, Tom G

    2007-01-01

    Stroke is the third most common cause of death in developed countries. In England and Wales, 1000 people under the age of 30 have a stroke each year. Cocaine is the most commonly used class A drug, and the first report of cocaine?induced stroke was in 1977. Since the development of alkaloidal “crack” cocaine in the 1980s, there has been a significant rise in the number of case reports describing both ischaemic and haemorrhagic stroke associated with cocaine use. Cocaine is a potent central nervous system stimulant, and acts by binding to specific receptors at pre?synaptic sites preventing the reuptake of neurotransmitters. The exact mechanism of cocaine?induced stroke remains unclear and there are likely to be a number of factors involved including vasospasm, cerebral vasculitis, enhanced platelet aggregation, cardioembolism, and hypertensive surges associated with altered cerebral autoregulation. The evidence surrounding each of these factors will be considered here. PMID:17551070

  17. The construct and measurement equivalence of cocaine and opioid dependences: A National Drug Abuse Treatment Clinical Trials Network (CTN) study

    PubMed Central

    Wu, Li-Tzy; Pan, Jeng-Jong; Blazer, Dan G.; Tai, Betty; Brooner, Robert K.; Stitzer, Maxine L.; Patkar, Ashwin A.; Blaine, Jack D.

    2009-01-01

    Introduction Although DSM-IV criteria are widely used in making diagnoses of substance use disorders, gaps exist regarding diagnosis classification, use of dependence criteria, and effects of measurement bias on diagnosis assessment. We examined the construct and measurement equivalence of diagnostic criteria for cocaine and opioid dependences, including whether each criterion maps onto the dependence construct, how well each criterion performs, how much information each contributes to a diagnosis, and whether symptom-endorsing is equivalent between demographic groups. Methods Item response theory (IRT) and multiple indicators–multiple causes (MIMIC) modeling were performed on a sample of stimulant-using methadone maintenance patients enrolled in a multisite study of the National Drug Abuse Treatment Clinical Trials Network (CTN) (N=383). Participants were recruited from six community-based methadone maintenance treatment programs associated with the CTN and major U.S. providers. Cocaine and opioid dependences were assessed by DSM-IV Checklist. Results IRT modeling showed that symptoms of cocaine and opioid dependences, respectively, were arrayed along a continuum of severity. All symptoms had moderate to high discrimination in distinguishing drug users between severity levels. “Withdrawal” identified the most severe symptom of the cocaine dependence continuum. MIMIC modeling revealed some support for measurement equivalence. Conclusions Study results suggest that self-reported symptoms of cocaine and opioid dependences and their underlying constructs can be measured appropriately among treatment-seeking polysubstance users. PMID:19423244

  18. Characterization of (+/-)-methadone uptake by rat lung.

    PubMed Central

    Chi, C H; Dixit, B N

    1977-01-01

    1. By use of a sensitive and specific fluorescence assay procedure it was shown that after subcutaneous administration to rats, (+/-)-methadone was concentrated in the lung. Lung to serum ratios ranging from 25 to 60 were obtained indicating that the rat lung tissue was capable of extracting (+/-)-methadone against a concentration gradient. 2. This phenomenon was investigated in vitro with rat lung slices incubated in Krebs-Ringer phosphate buffer (pH 7.4). The uptake was expressed in terms of tissue to medium concentration ratios (T/M ratio). 3. The principal observations were: (i) Studies on the time-course of the uptake showed that the T/M ratios of (+/-)-methadone increased rapidly during the first 60 min of incubation and then more slowly, with a plateau occurring at 180 min; (ii) The T/M ratio of (+/-)-methadone progressively increased from 9.5 to 17 as the pH of the incubation medium was varied from 6.2 to 7.5; (iii) When the concentration of (+/-)-methadone in the incubation medium was varied from 0.005 to 0.5 mM, the T/M ratio decreased rapidly suggesting self-saturation of the transport process. Beyond the medium concentration of 0.5 mM, the T/M ratio declined very slowly. 4. These results suggested that at low concentrations, (+/-)-methadone was transported predominantly by a self-saturable process while at higher concentrations it was transported by a process of simple diffusion. 5. At low concentrations (0.01 mM) the uptake of (+)-methadone was higher than that of (-)-isomer indicating stereo-specificity of the uptake process. The uptake of (+/-)-methadone at low concentration (0.01 mM) was significantly inhibited by low temperature, lack of O2, lack of glucose, lack of Na+ in the incubation medium, and by exposure of the tissue to high temperature (approximately 100 degrees C). The uptake was also inhibited by relatively high concentration of iodoacetate (1.0 mM) and of naloxone (1.0 mM). 6. Kinetic analysis of data showed that the diffusion constant for (+/-)-methadone was 5.0 (h-1) and the Vmax of the active transport process was 6.5 micronmol g-1h-1. PMID:15696

  19. The Chemistry of Cocaine

    NSDL National Science Digital Library

    Brahmadeo Dewprashad

    2010-01-01

    This case study on the chemistry of cocaine is in the form of a classroom discussion between a professor and her students about cocaine, its addictive properties, a search for an addiction treatment, and the chemistry involved in the synthesis of cocaine in its various forms. The case can be used to teach nucleophilic addition reactions, nucleophilic acyl substitution, and cocaine metabolism. In addition, it provides students with experience in locating, reading, and analyzing a research paper.  The case was designed for the second course in a two-course sequence in undergraduate organic chemistry, but it could be adapted for medicinal chemistry classes.

  20. A functional haplotype implicated in vulnerability to develop cocaine dependence is associated with reduced PDYN expression in human brain

    PubMed Central

    Yuferov, Vadim; Ji, Fei; Nielsen, David A.; Levran, Orna; Ho, Ann; Morgello, Susan; Shi, Ruijin; Ott, Jurg; Kreek, Mary Jeanne

    2009-01-01

    Dynorphin peptides and the kappa opioid receptor play important roles in the rewarding properties of cocaine, heroin and alcohol. We tested polymorphisms of the prodynorphin gene (PDYN) for association with cocaine dependence and cocaine/alcohol codependence. We genotyped six SNPs, located in the promoter region, exon 4 coding and 3? untranslated region (UTR), in 106 Caucasians and 204 African Americans who were cocaine dependent, cocaine/alcohol codependent or controls. In Caucasians, we found point-wise significant associations of 3?UTR SNPs (rs910080, rs910079, and rs2235749) with cocaine dependence and cocaine/alcohol codependence. These SNPs are in high linkage disequilibrium, comprising a haplotype block. The haplotype CCT was significantly experiment-wise associated with cocaine dependence and with combined cocaine dependence and cocaine/alcohol codependence (FDR, q=0.04 and 0.03, respectively). We investigated allele-specific gene expression of PDYN, using SNP rs910079 as a reporter, in postmortem human brains from eight heterozygous subjects, using SNaPshot assay. There was significantly lower expression for C allele (rs910079), with ratios ranging from 0.48 to 0.78, indicating lower expression of the CCT haplotype of PDYN in both the caudate and nucleus accumbens. Analysis of total PDYN expression in 43 postmortem brains also showed significantly lower levels of preprodynorphin mRNA in subjects having the risk CCT haplotype. This study provides evidence that a 3?UTR PDYN haplotype, implicated in vulnerability to develop cocaine addiction and/or cocaine/alcohol codependence, is related to lower mRNA expression of the PDYN gene in human dorsal and ventral striatum. PMID:18923396

  1. The spectrum of Bacillus bacteremias in heroin addicts.

    PubMed

    Weller, P F; Nicholson, A; Braslow, N

    1979-03-01

    Bacillus bacteremias occurred in two heroin addicts. The first patient had one day of fever and chills after intravenous heroin use. Persistent cereus bacteremia consistent with endocarditis was documented and responded to four weeks of antibiotic therapy. The second patient had non-cereus Bacillus species isolated from blood cultures three times over eight days, each time after renewed heroin use. The patient remained well, and the bacteremias cleared spontaneously. Because Bacillus species frequently contaminate heroin injection materials and because the Bacillus bacteremias were temporally associated with intravenous heroin use, Bacillus bacteremias in both patients probably eventuated from heroin abuse. These cases, in conjunction with two previously reported cases of Bacillus endocarditis in heroin addicts, suggest that heroin addicts are at risk for developing Bacillus bacteremias, which may vary in severity from endocarditis to benign transient bacteremias. PMID:106784

  2. Pharmacogenetic Randomized Trial for Cocaine Abuse: Disulfiram and ?1A-adrenoceptor gene variation

    PubMed Central

    Shorter, D.; Nielsen, D.A.; Huang, W.; Harding, M. J.; Hamon, S.C.; Kosten, T.R.

    2013-01-01

    Disulfiram is a cocaine addiction pharmacotherapy that inhibits dopamine ?-hydroxylase (D?H) and reduces norepinephrine production. We examined whether a functional variant of the ADRA1A gene (Cys to Arg at codon 347 in exon 2, Cys347Arg) may enhance treatment response through decreased stimulation of this ?1A-adrenoceptor, since antagonists of this receptor show promise in reducing cocaine use. Sixty-nine cocaine and opioid co-dependent (DSM-IV) subjects were stabilized on methadone for two weeks and subsequently randomized into disulfiram (250 mg/day, N = 32) and placebo groups (N = 37) for 10 weeks. We genotyped the ADRA1A gene polymorphism (rs1048101) and evaluated its role for increasing cocaine free urines in those subjects treated with disulfiram using repeated measures analysis of variance, corrected for population structure. The 47 patients who carried at least one T allele of rs1048101 (TT or TC genotype) reduced their cocaine positive urines from 84% to 56% on disulfiram (p = .0001), while the 22 patients with the major allele CC genotype showed no disulfiram effect. This study indicates that a patient’s ADRA1A genotype could be used to identify a subset of individuals for which disulfiram and, perhaps, other ?1-adrenoceptor blockers may be an effective pharmacotherapy for cocaine dependence. PMID:23849431

  3. The Neuropsychology of Cocaine Addiction: Recent Cocaine Use Masks Impairment

    E-print Network

    Goldstein, Rita

    The Neuropsychology of Cocaine Addiction: Recent Cocaine Use Masks Impairment Patricia A Woicik*,1 in individuals addicted to cocaine. Neuropsychopharmacology advance online publication, 21 May 2008; doi:10.1038/npp.2008.60 Keywords: cocaine addiction; neuropsychological function; alcohol; dysphoria; cigarette

  4. The Neuropsychology of Cocaine Addiction: Recent Cocaine Use Masks Impairment

    E-print Network

    Homes, Christopher C.

    The Neuropsychology of Cocaine Addiction: Recent Cocaine Use Masks Impairment Patricia A Woicik*,1 in individuals addicted to cocaine. Neuropsychopharmacology (2009) 34, 1112­1122; doi:10.1038/npp.2008.60; published online 21 May 2008 Keywords: cocaine addiction; neuropsychological function; alcohol; dysphoria

  5. Pharmacogenomics of methadone maintenance treatment.

    PubMed

    Somogyi, Andrew A; Barratt, Daniel T; Ali, Robert L; Coller, Janet K

    2014-05-01

    Methadone is the major opioid substitution therapy for opioid dependence. Dosage is highly variable and is often controlled by the patient and prescriber according to local and national policy and guidelines. Nevertheless many genetic factors have been investigated including those affecting its metabolism (CYP2B6-consistent results), efflux transport (P-gp-inconsistent results), target ?-opioid receptor (?-opioid receptor-inconsistent results) and a host of other receptors (DRD2) and signaling elements (GIRK2 and ARRB2; not replicated). None by themselves have been able to substantially explain dosage variation (the major but not sole end point). When multiple genes have been combined such as ABCB1, CYP2B6, OPRM1 and DRD2 a greater contribution to dosage variation was found but not as yet replicated. As stabilization of dosage needs to be made rapidly, it is imperative that larger internationally based studies be instigated so that genetic contribution to dosage can be properly assessed, which may or may not tailor to different ethnic groups and each country's policy towards an outcome that benefits all. PMID:24956254

  6. European markets in cocaine

    Microsoft Academic Search

    Roger Lewis

    1989-01-01

    An established market for illicit cocaine has existed in Europe for twenty years. There is considerable elasticity in demand. Over-production in Latin America has contributed to increased availability and consumption. Retail prices vary from country to country. Professional criminals have become heavily involved in the market since the 1970s. The effect of cocaine trafficking on criminal organization may prove to

  7. Self-reported effects of methadone on cigarette smoking in methadone-maintained subjects.

    PubMed

    Baran-Furga, Helena; Chmielewska, Karina; Bogucka-Bonikowska, Anna; Habrat, Boguslaw; Kostowski, Wojciech; Bienkowski, Przemyslaw

    2005-01-01

    Subjects maintained on methadone evidence a high level of interest in quitting cigarette smoking. Readiness to quit may result, at least partially, from direct pharmacological interactions between methadone and brain nicotinic acetylcholine receptors. The aim of the present study was to assess: (1) self-reported changes in smoking habits after admission to a methadone maintenance treatment (MMT) program; (2) acute effects of methadone administration on smoking behavior in MMT patients. The study was conducted between May and December 2001, in two public outpatient MMT clinics located in Warsaw, Poland. The patients (41 men, 30 women) reported smoking fewer cigarettes after admission to the program. Most subjects (67.6%) changed their favorite brand of cigarettes after admission. Mean nicotine content (mg/cigarette) significantly decreased. On the other hand, the subjects did not report any effects of methadone administration on smoking parameters. The above findings suggest that initiation of MMT is associated with positive changes in smoking behavior. However, these changes may not be related to direct pharmacological interactions between methadone and nicotine. PMID:16040371

  8. Sexual dysfunction during methadone maintenance treatment and its influence on patient's life and treatment: a qualitative study in South China.

    PubMed

    Xia, Yinghua; Zhang, Di; Li, Xiaoming; Chen, Wen; He, Qun; Jahn, Heiko J; Li, Xin; Chen, Jun; Hu, Pei; Ling, Li

    2013-01-01

    Methadone maintenance treatment (MMT) has become an important modality of substitution treatment for opioid addicts in China since 2006. However, data are limited regarding the change in sexual function from heroin use to MMT and the influence of sexual dysfunction (SD) during MMT on patient's life and treatment. Face-to-face in-depth interviews were conducted with 13 male and 14 female MMT patients, five of their partners, and three clinicians. The interviews took place in four MMT clinics in Guangdong Province between August 2010 and February 2011. The patients and their partners were asked separately for their perceptions of patient's sexual function during MMT, and the influence of SD on personal/family life and treatment. The main SD problems patients perceived were libido inhibition and decreased sexual pleasure. Methadone was thought to have a stronger inhibition effect on sexual desire than heroin. SD decreased quality of patient's sexual life and damaged intimate relationships. There was a gender difference in coping with SD. Men generally tended to refuse, escape, or alienate their partners. Women tended to hide sexual listlessness, endure sexual activity and tried to satisfy their partners. SD might increase risk of voluntary dropout from treatment and illicit drug use during treatment. Patients with SD did not get any effective therapy from clinicians and they also lacked skills on coping with SD-related problems. Sexual dysfunction prevented patients from reconstructing a normal intimate relationship, and affected stability of maintenance treatment. Response to patient's SD and SD-related problems from clinicians was inadequate. There is a need to develop a clinical guide to deal with both SD itself and SD-related problems. PMID:23092392

  9. Methadone toxicity in infants: a report of two fatalities.

    PubMed

    Mistry, V; Jeffery, A J; Madira, W; Padfield, C J H; Rutty, G N

    2010-06-01

    Fatalities in infants resulting from methadone toxicity are rare within the United Kingdom. We report two cases of fatality attributed to methadone toxicity in infants aged 3(1/2) and 15 months of age, respectively. One of the two cases was also associated with diazepam ingestion. We discuss the difficulties with the interpretation of paediatric forensic toxicology and review the current literature related to methadone and diazepam toxicity in infants and older children. PMID:20087792

  10. Neural correlates of adherence to extended-release naltrexone pharmacotherapy in heroin dependence

    PubMed Central

    Wang, A-L; Elman, I; Lowen, S B; Blady, S J; Lynch, K G; Hyatt, J M; O'Brien, C P; Langleben, D D

    2015-01-01

    Injectable extended-release naltrexone (XRNTX) presents an effective therapeutic strategy for opioid addiction, however its utility could be hampered by poor adherence. To gain a better insight into this phenomenon, we utilized blood oxygenation level-dependent functional magnetic resonance imaging (fMRI) in conjunction with a validated cue-induced craving procedure to examine neural correlates of XRNTX adherence. We operationalized treatment adherence as the number of monthly XRNTX injections (range: 0–3) administered to a group of fully detoxified heroin-dependent subjects (n=32). Additional outcomes included urine toxicology screening and self-reported tobacco use. The presented heroin-related visual cues reliably elicited heroin craving in all tested subjects. Nine, five, three and 15 of the participants, respectively, received zero, one, two and three XRNTX injections, predicted by the individual baseline fMRI signal change in response to the cues in the medial prefrontal cortex, a brain region involved in inhibitory self-control and emotional appraisal. The incidence of opioid-positive urines during the XRNTX therapy was low and remained about half the pre-treatment rate after the XRNTX ended. During the treatment, cigarette smoking behaviors followed patterns of opioid use, while cocaine consumption was increased with reductions in opioid use. The present data support the hypothesis that medial prefrontal cortex functions are involved in adherence to opioid antagonist therapy. A potential role of concurrent non-opioid addictive substances consumption during the XRNTX pharmacotherapy warrants further investigation. Our findings set the stage for further bio-behavioral investigations of the mechanisms of relapse prevention in opioid dependence. PMID:25781230

  11. What caused the recent reduction in heroin supply in Australia?

    PubMed

    Wodak, Alex

    2008-08-01

    Heroin availability and purity decreased and prices increased in Australia suddenly in early 2001. The heroin market in Australia has still not returned to the status quo ante after more than six years. Benefits of the heroin shortage, including a substantial reduction in drug overdose deaths and property crime, are generally considered to have outweighed adverse effects which included increased use of other drugs, especially stimulants, with a subsequent increase in aggression, violence and mental illness. Some commentators attributed the heroin shortage to a combination of factors, while an influential study highlighted the importance of supply control asserting that increased funding and improved effectiveness of domestic drug law enforcement produced critical heroin seizures which disrupted major syndicates, thereby producing the heroin shortage. Evidence to support a critical role for drug law enforcement in the heroin shortage is weak with some recent evidence contradicting key assertions used to support the supply control hypothesis. Although the most likely interpretation is still a combination of multiple factors, the most important factors appear to have been a substantial recent reduction in source opium cultivation and heroin production in Burma, but probably also increased heroin consumption en route through China and a switch from heroin to amphetamine production in Burma. This interpretation is consistent with the international experience of several recent decades in numerous countries where national heroin shortages have occurred rarely and generally only briefly, notwithstanding vigorous and very well resourced supply control efforts. The recent reduction in heroin supply in Australia, the most severe, longest lasting and best-documented heroin shortage in the world, cannot be confidently attributed, solely or largely, to improved domestic drug law enforcement. At best, domestic law enforcement may have made a small contribution compared to several other factors. Evaluation of supply, demand and harm reduction should be held to the same standards. PMID:18554895

  12. Prenatal and postnatal cocaine exposure predict teen cocaine use

    Microsoft Academic Search

    Virginia Delaney-Black; Lisa M. Chiodo; John H. Hannigan; Mark K. Greenwald; James Janisse; Grace Patterson; Marilyn A. Huestis; Robert T. Partridge; Joel Ager; Robert J. Sokol

    2011-01-01

    Preclinical studies have identified alterations in cocaine and alcohol self-administration and behavioral responses to pharmacological challenges in adolescent offspring following prenatal exposure. To date, no published human studies have evaluated the relation between prenatal cocaine exposure and postnatal adolescent cocaine use. Human studies of prenatal cocaine-exposed children have also noted an increase in behaviors previously associated with substance use\\/abuse in

  13. The phosphodiesterase-4 inhibitor rolipram attenuates heroin-seeking behavior induced by cues or heroin priming in rats.

    PubMed

    Lai, Miaojun; Zhu, Huaqiang; Sun, Anna; Zhuang, Dingding; Fu, Dan; Chen, Weisheng; Zhang, Han-Ting; Zhou, Wenhua

    2014-09-01

    Inhibition of phosphodiesterase-4 (PDE4), an enzyme that specifically hydrolyzes cyclic adenosine monophosphate (cAMP) increases intracellular cAMP/cAMP-response element binding protein (CREB) signaling. Activation of this signaling is considered as an important compensatory response that decreases motivational properties of drugs of abuse. However, it is not known whether PDE4 is involved in heroin seeking. Self-administration of heroin (50 ?g/kg/infusion) was performed under the fixed ratio 1 (FR1) schedule for 14 d and then drug seeking was extinguished for 10 d. The progressive ratio schedule was used to evaluate the relative motivational value of heroin reinforcement. After training, the conditioned cue or heroin priming (250 ?g/kg) was introduced for the reinstatement of heroin-seeking behavior. Pretreatment (i.p.) with rolipram (0.03-0.3 mg/kg), a prototypical, selective PDE4 inhibitor, failed to inhibit heroin self-administration under the FR1 schedule, but decreased the reward values under the progressive ratio schedule in a dose-dependent manner. In addition, rolipram decreased the reinstatement of heroin seeking induced by cues or heroin priming even at the lowest dose (0.03 mg/kg); in contrast, the highest dose (0.3 mg/kg) of rolipram was required to decrease sucrose reinforcement. Finally, the effects of rolipram on heroin-seeking behavior were correlated with the increases in expression of phosphorylated CREB in the nucleus accumbens. The study demonstrated that rolipram inhibited heroin reward and heroin-seeking behavior. The results suggest that PDE4 plays an essential role in mediating heroin seeking and that PDE4 inhibitors may be used as a potential pharmacotherapeutic approach for heroin addiction. PMID:24832929

  14. A new mixed mode solid phase extraction strategy for opioids, cocaines, amphetamines and adulterants in human blood with hybrid liquid chromatography tandem mass spectrometry detection

    Microsoft Academic Search

    Geraldine Dowling; Liam Regan

    2011-01-01

    A rapid method has been developed to analyse morphine, codeine, 6-monoacetylmorphine, cocaine, benzoylecgonine, dihydrocodeine, cocaethylene, 3,4-methylenedioxyamphetamine, ketamine, 3,4-methylenedioxymethamphetamine, pseudoephedrine, lignocaine, benzylpiperazine, methamphetamine, amphetamine, methadone, phenethylamine and levamisole in human blood. Blood samples were cleaned up using mixed mode solid phase extraction using Evolute™ CX solid phase extraction cartridges and the sample aliquots were analysed by hybrid triple quadrupole linear ion

  15. Opioid Addiction and Abuse in Primary Care Practice: A Comparison of Methadone and Buprenorphine as Treatment Options

    PubMed Central

    Bonhomme, Jean; Shim, Ruth S.; Gooden, Richard; Tyus, Dawn; Rust, George

    2014-01-01

    Opioid abuse and addiction have increased in frequency in the United States over the past 20 years. In 2009, an estimated 5.3 million persons used opioid medications nonmedically within the past month, 200 000 used heroin, and approximately 9.6% of African Americans used an illicit drug. Racial and ethnic minorities experience disparities in availability and access to mental health care, including substance use disorders. Primary care practitioners are often called upon to differentiate between appropriate, medically indicated opioid use in pain management vs inappropriate abuse or addiction. Racial and ethnic minority populations tend to favor primary care treatment settings over specialty mental health settings. Recent therapeutic advances allow patients requiring specialized treatment for opioid abuse and addiction to be managed in primary care settings. The Drug Addiction Treatment Act of 2000 enables qualified physicians with readily available short-term training to treat opioid-dependent patients with buprenorphine in an office-based setting, potentially making primary care physicians active partners in the diagnosis and treatment of opioid use disorders. Methadone and buprenorphine are effective opioid replacement agents for maintenance and/or detoxification of opioid-addicted individuals. However, restrictive federal regulations and stigmatization of opioid addiction and treatment have limited the availability of methadone. The opioid partial agonist-antagonist buprenorphine/naloxone combination has proven an effective alternative. This article reviews the literature on differences between buprenorphine and methadone regarding availability, efficacy, safety, side-effects, and dosing, identifying resources for enhancing the effectiveness of medication-assisted recovery through coordination with behavioral/psychological counseling, embedded in the context of recovery-oriented systems of care. PMID:23092049

  16. Monitoring Pregnant Women’s Illicit Opiate and Cocaine Use With Sweat Testing

    PubMed Central

    Brunet, Bertrand R.; Barnes, Allan J.; Choo, Robin E.; Mura, Patrick; Jones, Hendrée E.; Huestis, Marilyn A.

    2011-01-01

    Dependence on illicit drugs during pregnancy is a major public health concern as there may be associated adverse maternal, fetal, and neonatal consequences. Sweat patches (n = 389) were collected from 39 pregnant volunteers who provided written informed consent for this Institutional Review Board-approved protocol and wore patches, replaced approximately weekly, from study entry until delivery. Patches were analyzed for opiates (heroin, 6-acetylmor-phine, 6-acetylcodeine, morphine and codeine) and cocaine (cocaine, benzoylecgonine, ecgonine methyl ester, anhydroecgonine methyl ester) by solid phase extraction and gas chromatography mass spectrometry. Seventy-one percent (276) of collected sweat patches were ?5 ng per patch (limit of quantification) for one or more analytes. Cocaine was present in 254 (65.3%) patches in concentrations ranging from 5.2 to 11,835 ng per patch with 154 of these high enough to satisfy the proposed Substance Abuse and Mental Health Services Administration guidelines for a confirmatory drug test (25 ng per patch). Interestingly, 6-acetylmorphine was the most prominent opiate analyte documented in 134 patches (34.4%) with 11.3% exceeding the proposed opiate Substance Abuse and Mental Health Services Administration cut-off (25 ng per patch). Heroin was identified in fewer patches (77), but in a similar concentration range (5.3–345.4 ng per patch). Polydrug use was evident by the presence of both cocaine and opiate metabolites in 136 (35.0%) patches. Sweat testing is an effective method for monitoring abstinence or illicit drug use relapse in this high-risk population of pregnant opiate- and/or cocaine-dependent women. PMID:19927046

  17. Smoked heroin self-administration in rhesus monkeys

    Microsoft Academic Search

    A. J. Mattox; M. E. Carroll

    1996-01-01

    The purpose of the present study was to evaluate behavioral and pharmacological determinants of smoked heroin self-administration. Eight rhesus monkeys were trained to self-administer smoked heroin under a chained fixed-ratio (FR, 64-1024) for lever presses, FR 5 for inhalations schedule during daily experimental sessions. Demand for heroin was determined by plotting consumption (smoke deliveries) as a function of price which

  18. 21 CFR 862.3250 - Cocaine and cocaine metabolite test system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...Drugs 8 2013-04-01 2013-04-01 false Cocaine and cocaine metabolite test system. 862.3250 Section 862... Clinical Toxicology Test Systems § 862.3250 Cocaine and cocaine metabolite test system. (a)...

  19. 21 CFR 862.3250 - Cocaine and cocaine metabolite test system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...Drugs 8 2012-04-01 2012-04-01 false Cocaine and cocaine metabolite test system. 862.3250 Section 862... Clinical Toxicology Test Systems § 862.3250 Cocaine and cocaine metabolite test system. (a)...

  20. Example 1: social stratification Example 2: methadone patients

    E-print Network

    Hennig, Christian

    Example 1: social stratification Example 2: methadone patients Example 3: Gaussian mixtures and BIC: social stratification Example 2: methadone patients Example 3: Gaussian mixtures and BIC Conclusion Example 1: social stratification Hennig & Liao (2013) looked for evidence for social strata in 2007 US

  1. Methadone induces testosterone suppression in patients with opioid addiction

    PubMed Central

    Bawor, Monica; Dennis, Brittany B.; Samaan, M. Constantine; Plater, Carolyn; Worster, Andrew; Varenbut, Michael; Daiter, Jeff; Marsh, David C.; Desai, Dipika; Steiner, Meir; Anglin, Rebecca; Coote, Margaret; Pare, Guillaume; Thabane, Lehana; Samaan, Zainab

    2014-01-01

    Sex hormones may have a role in the pathophysiology of substance use disorders, as demonstrated by the association between testosterone and addictive behaviour in opioid dependence. Although opioid use has been found to suppress testosterone levels in men and women, the extent of this effect and how it relates to methadone treatment for opioid dependence is unclear. The present multi-centre cross-sectional study consecutively recruited 231 patients with opioid dependence from methadone clinics across Ontario, Canada between June and December of 2011. We obtained demographic details, substance use, psychiatric history, and blood and urine samples from enrolled subjects. The control group included 783 non-opioid using adults recruited from a primary care setting in Ontario, Canada. Average testosterone level in men receiving methadone treatment was significantly lower than controls. No effect of opioids including methadone on testosterone level in women was found and testosterone did not fluctuate significantly between menstrual cycle phases. In methadone patients, testosterone level was significantly associated with methadone dose in men only. We recommend that testosterone levels be checked in men prior and during methadone and other opioid therapy, in order to detect and treat testosterone deficiency associated with opioids and lead to successful methadone treatment outcomes. PMID:25155550

  2. Disposition of nasal, intravenous, and oral methadone in healthy volunteers

    E-print Network

    Steinbach, Joe Henry

    with blood sampling. Results: Nasal uptake of methadone was rapid, with maximum plasma concentrations on 3 separate occasions in a crossover design. Nasal methadone (50 mg/mL in aqueous solution) was given as a 100- L spray in each nostril (Pfeiffer BiDose sprayer). Blood samples for liquid chromatography

  3. Behavioral Treatments During Outpatient Methadone Maintenance: A Controlled Evaluation.

    ERIC Educational Resources Information Center

    Bigelow, George; And Others

    The Treatment Evaluation Project was established to evaluate the feasibility of using behavioral treatment in conjunction with methadone maintenance to improve the effectiveness of methadone treatment. Over 100 outpatients were accepted into treatment and randomly assigned to one of four behavioral treatment modalities in addition to the usual…

  4. Cocaine abuse during pregnancy.

    PubMed

    Cressman, Alex M; Natekar, Aniket; Kim, Eunji; Koren, Gideon; Bozzo, Pina

    2014-07-01

    Cocaine abuse during pregnancy is a significant public health problem but is infrequently discussed between physicians and patients. The impact of in utero cocaine exposure on pregnancy and the baby has received significant media attention in preceding decades because of fears of teratogenicity, long-term health consequences, and poor cognitive and neurodevelopmental outcomes. We sought to review the medical literature examining these phenomena. We identified risks to the pregnancy and baby in women abusing cocaine during pregnancy. These include preterm birth, placenta-associated syndromes (e.g., placental abruption, preeclampsia, and placental infarction), and impaired fetal growth. Long-term neurodevelopmental and cognitive deficits include (but are not limited to) poorer language development, learning and perceptual reasoning, behavioural problems, and adverse effects on memory and executive function. However, these results should be interpreted cautiously because cocaine abuse may be accompanied by many other maternal and sociodemographic risk factors, so it is difficult to ascertain the effect of cocaine alone. Therefore, it is critical to counsel patients about potential risk, and perhaps more importantly, to treat addiction and to better understand, and advocate for improvements to, these patients' high-risk environment. PMID:25184982

  5. Cocaine uses and abuses.

    PubMed

    Fairbanks, D N; Fairbanks, G R

    1983-06-01

    Cocaine is a time-honored topical anesthetic for intranasal surgery. It combines superb anesthesia with constriction of nasal vasculature and patient euphoria, which facilitates surgery and enhances its tolerability to the patient. Dosages of 200 mg (2 ml of 10% solution) are considered safe and effective for surgical anesthesia. Central nervous system excitability is the predominant toxic reaction followed by convulsions and apnea, which require respiratory support. Intravenous diazepam effectively averts this reaction. Cardiovascular toxicity appears at higher dosages (such as with ingestion for concealment during smuggling) or when epinephrine is concurrently used with cocaine. Cocaine is also damaging to nasal membranes and the nasal septal cartilage, due to its vasoconstrictive effect and the irritative effects of its diluting contaminants. Its major psychological effect is stimulation similar to that of the amphetamines. Prolonged recreational use may lead to paranoia and violent, antisocial behavior, including homicide and suicide. PMID:6881862

  6. Factors associated with HCV risk practices in methadone-maintained patients: the importance of considering the couple in prevention interventions

    PubMed Central

    2014-01-01

    Background One important public health issue associated with opioid use today is the risk of hepatitis C (HCV) infection. Although methadone maintenance may help to decrease HCV-related risk practices, HCV risk behaviors persist and are strongly associated with specific substance use patterns, mental status and social context. The ANRS-Methaville study gave us the opportunity to better disentangle the different relationships between these various factors and HCV risk practices. Methods The ANRS-Methaville multisite randomized trial was designed to assess the feasibility of initiating methadone in primary care by comparing it with methadone initiation in specialized centers. This study recruited 195 participants initiating methadone maintenance and followed up for 12?months. Longitudinal data from this trial was used to acquire a greater understanding of HCV risk practices and their pattern of correlates in this population. We selected 176 patients who had data on HCV risk practices at M0 and M12, accounting for 312 visits. HCV risk practices were defined as follows: sharing needles or syringes, sharing drug paraphernalia, getting a tattoo or having a piercing in a non-professional context, sharing toiletry items. To identify factors associated with HCV risk practices, we performed a mixed logistic regression analysis. Results HCV risk practices were reported by 19% and 15% of participants at baseline and M12, respectively. After adjustment for age, cocaine use and alcohol dependence as well as suicidal risk, living in a couple with a non-drug user and in a couple with a drug user were both independent predictors of HCV risk practices (OR[CI95%]?=?4.16 [1.42-12.12]; OR[CI95%]?=?9.85 [3.13-31.06], respectively). Conclusions Identifying individuals at risk of HCV transmission during methadone treatment such as stimulant users, alcohol dependent individuals, and those at suicidal risk is necessary to optimize response to treatment. Innovative prevention approaches tailored to couples are also urgently needed and could decrease HCV-risk in this population. The trial is registered with the French Agency of Pharmaceutical Products (ANSM) under the number 2008-A0277-48, the European Union Drug Regulating Authorities Clinical Trials. Number Eudract 2008-001338-28, the ClinicalTrials.gov Identifier: NCT00657397 and the International Standard Randomised Controlled Trial Number Register ISRCTN31125511. PMID:25209306

  7. From gold-medal glory to prohibition: the early evolution of cocaine in the United Kingdom and the United States

    PubMed Central

    Gilchrist, Dawna

    2013-01-01

    As reported in the 2011 World Drug Report, cocaine is likely to be the most problematic drug worldwide in terms of trafficking-related violence and second only to heroin in terms of negative health consequences and drug deaths. Over a period of 60 years, cocaine evolved from the celebrated panacea of the 1860s to outlawed street drug of the 1920s. As demonstrated by the evolution of cocaine use and abuse in the United Kingdom and United States during this time period, cultural attitudes influenced both the acceptance of cocaine into the medical field and the reaction to the harmful effects of cocaine. Our review of articles on cocaine use in the United Kingdom and the United States from 1860 to 1920 reveals an attitude of caution in the United Kingdom compared with an attitude of progressivism in the United States. When the trends in medical literature are viewed in the context of the development of drug regulations, our analysis provides insight into the relationship between cultural attitudes and drug policy, supporting the premise that it is cultural and social factors which shape drug policy, rather than drug regulations changing culture. PMID:23772315

  8. The Chemistry of Cocaine

    NSDL National Science Digital Library

    Dewprashad, Brahmadeo

    This case study looks at cocaine, including its addictive properties and the chemistry involved in the synthesis of the drug in its different forms. The lesson can be used to teach nucleophilic addition reactions, nucleophilic acyl substitution, and cocaine metabolism. The material was designed for use in an undergraduate organic chemistry course but could also be used in medicinal chemistry coursework. The case study and teaching notes may be downloaded in PDF format. The site also includes a section for instructor feedback where general comments may be read and contributed.

  9. Structural-level factors affecting implementation of the methadone maintenance therapy program in China.

    PubMed

    Lin, Chunqing; Wu, Zunyou; Rou, Keming; Yin, Wenyuan; Wang, Changhe; Shoptaw, Steven; Detels, Roger

    2010-03-01

    This study identifies structural-level factors influencing methadone maintenance therapy (MMT) program implementation in China. Twenty-eight service providers and 560 randomly selected clients from 28 MMT clinics in the study area underwent face-to-face interviews. Number of clients, retention rate, coverage, and structural-level factors were collected from a survey of service providers. Individual-level factors and self-reported illicit drug use information were obtained from clients. Urine specimens were collected from the client participants to test for heroin use. Clinics affiliated with the local Centers for Disease Control and Prevention (CDC) had more clients, higher retention rates, and broader coverage than those not affiliated with the CDC. Longer operating hours, incentive for compliant clients, and comprehensive services were positively associated with client recruitment and coverage. Comprehensive services and incentives for compliant clients were negatively associated with concurrent illicit drug use. Comprehensive services should be incorporated into the MMT program. Extended operating hours and incentives for compliant clients should be implemented. PMID:20015606

  10. Hopelessness in Alcohol- and Heroin-Dependent Women.

    ERIC Educational Resources Information Center

    Beck, Aaron T.; And Others

    1984-01-01

    Administered the Beck Hopelessness Scale to alcoholic (N=20) and heroin-addicted (N=20) women. Results indicated that although both groups expressed comparable levels of overall hopelessness, alcoholic women anticipated more success and better lives in the next 10 years than did the heroin-dependent women. (LLL)

  11. Heroin-Induced Spongiform Leukoencephalopathy: Value of Diffusion MR Imaging

    Microsoft Academic Search

    Cheng-Yu Chen; Kwo-Wei Lee; Chueng-Chen Lee; Shy-Chi Chin; Hsiao-Wen Chung; Robert A. Zimmerman

    2000-01-01

    The diffusion-weighted (DW) magnetic resonance (MR) imaging findings of a patient with subacute stage of heroin-induced vacuolating myelinopathy are re- ported. The diffuse decrease of apparent diffusion coefficient (ADC) of the white matter on DW imaging is attributed to restricted water diffusion, which is known to be caused by fluid entrapment within the myelin lamellae without demyelination. Index Terms: Heroin

  12. Combined cocaine hydrolase gene transfer and anti-cocaine vaccine synergistically block cocaine-induced locomotion.

    PubMed

    Carroll, Marilyn E; Zlebnik, Natalie E; Anker, Justin J; Kosten, Thomas R; Orson, Frank M; Shen, Xiaoyun; Kinsey, Berma; Parks, Robin J; Gao, Yang; Brimijoin, Stephen

    2012-01-01

    Mice and rats were tested for reduced sensitivity to cocaine-induced hyper-locomotion after pretreatment with anti-cocaine antibody or cocaine hydrolase (CocH) derived from human butyrylcholinesterase (BChE). In Balb/c mice, direct i.p. injection of CocH protein (1 mg/kg) had no effect on spontaneous locomotion, but it suppressed responses to i.p. cocaine up to 80 mg/kg. When CocH was injected i.p. along with a murine cocaine antiserum that also did not affect spontaneous locomotion, there was no response to any cocaine dose. This suppression of locomotor activity required active enzyme, as it was lost after pretreatment with iso-OMPA, a selective BChE inhibitor. Comparable results were obtained in rats that developed high levels of CocH by gene transfer with helper-dependent adenoviral vector, and/or high levels of anti-cocaine antibody by vaccination with norcocaine hapten conjugated to keyhole limpet hemocyanin (KLH). After these treatments, rats were subjected to a locomotor sensitization paradigm involving a "training phase" with an initial i.p. saline injection on day 1 followed by 8 days of repeated cocaine injections (10 mg/kg, i.p.). A 15-day rest period then ensued, followed by a final "challenge" cocaine injection. As in mice, the individual treatment interventions reduced cocaine-stimulated hyperactivity to a modest extent, while combined treatment produced a greater reduction during all phases of testing compared to control rats (with only saline pretreatment). Overall, the present results strongly support the view that anti-cocaine vaccine and cocaine hydrolase vector treatments together provide enhanced protection against the stimulatory actions of cocaine in rodents. A similar combination therapy in human cocaine users might provide a robust therapy to help maintain abstinence. PMID:22912888

  13. [In search of the true dosage: statistics applied to the analysis of the cocaine].

    PubMed

    Dujourdy, L; Charvoz, C; Dalmasso, M; Dufour, A-B

    2013-05-01

    A method of separation by gas chromatography with a flame ionization detector was developed for quantifying cocaine in powders seized by the police. The method was validated by studying parameters of calibration, trueness, precision based on trueness error (or systematic bias) and random error. Total error, which is the combination of these errors, is used to confirm the method adequacy with the objectives fixed by the analyst. Accuracy profile is an efficient decision tool to do it. Results obtained with weighted regression model allow concluding that the method fits quantitation of heroin and cocaine in powders on 2 to 100% concentration (w/w) domain with 10% limits of acceptation and a risk of 5%. PMID:23622698

  14. Hypogonadism in men receiving methadone and buprenorphine maintenance treatment.

    PubMed

    Hallinan, R; Byrne, A; Agho, K; McMahon, C G; Tynan, P; Attia, J

    2009-04-01

    The aim of this study was to determine the prevalence and investigate the aetiology of hypogonadism in men on methadone or buprenorphine maintenance treatment (MMT, BMT). 103 men (mean age 37.6 +/- 7.9) on MMT (n = 84) or BMT (n = 19) were evaluated using hormone assays, body mass index (BMI), serological, biochemical, demographic and substance use measures. Overall 54% of men (methadone 65%; buprenorphine 28%) had total testosterone (TT) <12.0 nm; 34% (methadone 39%; buprenorphine 11%) had TT <8.0 nm. Both methadone- and buprenorphine-treated men had lower free testosterone, luteinising hormone and estradiol than age-matched reference groups. Methadone-treated men had lower TT than buprenorphine-treated men and reference groups. Prolactin did not differ between methadone, buprenorphine groups, and reference groups. Primary testicular failure was an uncommon cause of hypogonadism. Yearly percentage fall in TT by age across the patient group was 2.3%, more than twice that expected normally. There were no associations between TT and opioid dose, cannabis, alcohol and tobacco consumption, or chronic hepatitis C viraemia. On multiple regression higher TT was associated with higher alanine aminotransferase and lower TT with higher BMI. Men on MMT have high prevalence of hypogonadotrophic hypogonadism. The extent of hormonal changes associated with buprenorphine needs to be explored further in larger studies. Men receiving long term opioid replacement treatment, especially methadone treatment, should be screened for hypogonadism. Wide interindividual differences in methadone metabolism and tolerance may in a cross-sectional study obscure a methadone dose relationship to testosterone in individuals. Future studies of hypogonadism in opioid-treated men should examine the potential benefits of dose reduction, choice of opioid medication, weight loss, and androgen replacement. PMID:17971165

  15. Enhanced Choice for Viewing Cocaine Pictures in Cocaine Addiction

    SciTech Connect

    Moeller, S.J.; Goldstein, R.; Moeller, S.J.; Maloney, T. Parvaz, M.A.; Dunning, J.P.; Alia-Klein, N.; Woicik, P.A.; Hajcak, G.; Telang, F.; Wang, G.-J.; Volkow, N.D.; Goldstein, R.Z.

    2009-02-01

    Individuals with cocaine use disorder (CUD) chose cocaine over nondrug rewards. In two newly designed laboratory tasks with pictures, we document this modified choice outside of a cocaine administration paradigm. Choice for viewing cocaine, pleasant, unpleasant, or neutral pictures-under explicit contingencies (choice made between two fully visible side-by-side images) and under more implicit contingencies (selections made between pictures hidden under flipped-over cards)-was examined in 20 CUD and 20 matched healthy control subjects. Subjects also provided self-reported ratings of each picture's pleasantness and arousal. Under both contingencies, CUD subjects chose to view more cocaine pictures than control subjects, group differences that were not fully explained by the self-reported picture ratings. Furthermore, whereas CUD subjects choice for viewing cocaine pictures exceeded choice for viewing unpleasant pictures (but did not exceed choice for viewing pleasant pictures, in contrast to their self-reported ratings), healthy control subjects avoided viewing cocaine pictures as frequently as, or even more than, unpleasant pictures. Finally, CUD subjects with the most cocaine viewing selections, even when directly compared with selections of the pleasant pictures, also reported the most frequent recent cocaine use. Enhanced drug-related choice in cocaine addiction can be demonstrated even for nonpharmacologic (pictorial) stimuli. This choice, which is modulated by alternative stimuli, partly transcends self-reports (possibly indicative of a disconnect in cocaine addiction between self-reports and objective behavior) to provide an objective marker of addiction severity. Neuroimaging studies are needed to establish the neural underpinnings of such enhanced cocaine-related choice.

  16. Employment-Based Reinforcement to Motivate Naltrexone Ingestion and Drug Abstinence in the Treatment of Drug Addiction. - 1

    ClinicalTrials.gov

    2005-11-03

    Behavior Therapy; Cocaine; Cocaine (IV); Cocaine Abuse; Cocaine Dependence; Contingency Management; HIV Risk Behaviors; Heroin; Heroin Dependence; Naltrexone; Opioid Dependence; Substance Abuse, Intravenous; Sexual Risk Behaviors

  17. Prenatal and postnatal cocaine exposure predict teen cocaine use

    PubMed Central

    Delaney-Black, Virginia; Chiodo, Lisa M.; Hannigan, John H.; Greenwald, Mark K.; Janisse, James; Patterson, Grace; Huestis, Marilyn A.; Partridge, Robert T.; Ager, Joel; Sokol, Robert J.

    2015-01-01

    Preclinical studies have identified alterations in cocaine and alcohol self-administration and behavioral responses to pharmacological challenges in adolescent offspring following prenatal exposure. To date, no published human studies have evaluated the relation between prenatal cocaine exposure and postnatal adolescent cocaine use. Human studies of prenatal cocaine-exposed children have also noted an increase in behaviors previously associated with substance use/abuse in teens and young adults, specifically childhood and teen externalizing behaviors, impulsivity, and attention problems. Despite these findings, human research has not addressed prior prenatal exposure as a potential predictor of teen drug use behavior. The purpose of this study was to evaluate the relations between prenatal cocaine exposure and teen cocaine use in a prospective longitudinal cohort (n = 316) that permitted extensive control for child, parent and community risk factors. Logistic regression analyses and Structural Equation Modeling revealed that both prenatal exposure and postnatal parent/caregiver cocaine use were uniquely related to teen use of cocaine at age 14 years. Teen cocaine use was also directly predicted by teen community violence exposure and caregiver negativity, and was indirectly related to teen community drug exposure. These data provide further evidence of the importance of prenatal exposure, family and community factors in the intergenerational transmission of teen/young adult substance abuse/use. PMID:20609384

  18. Anti-cocaine vaccine development

    PubMed Central

    Kinsey, Berma M; Kosten, Thomas R; Orson, Frank M

    2010-01-01

    Cocaine abuse is an ongoing and serious problem which has lead to the growth of a brutal criminal enterprise, particularly in the Americas and Europe. At present, there are no effective pharmacological agents available to treat the addiction by blocking cocaine or reversing its effects. In order to help motivated addicts conquer their addiction, vaccines against cocaine are being developed, and one has progressed to clinical trials. This review will discuss the concept of anti-drug vaccines in general, the successes and limitations of the various anti-cocaine vaccine approaches, the results of the clinical trials with an anti-cocaine vaccine, and some new vaccine-mediated approaches to combat cocaine addiction. PMID:20822352

  19. 21 CFR 862.3620 - Methadone test system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Toxicology Test Systems § 862.3620 Methadone test system....

  20. 21 CFR 862.3620 - Methadone test system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Toxicology Test Systems § 862.3620 Methadone test system....

  1. Inmates Denied Methadone Less Likely to Choose Treatment When Released

    MedlinePLUS

    ... nlm.nih.gov/medlineplus/news/fullstory_152811.html Inmates Denied Methadone Less Likely to Choose Treatment When ... seek such treatment when they're released than inmates who keep receiving the treatment, a new study ...

  2. Male sex work and HIV risk among young heroin users in Hanoi, Vietnam

    PubMed Central

    Clatts, Michael C.; Giang, Le M.; Goldsamt, Lloyd A.; Yi, Huso

    2009-01-01

    The present study describes complex drug and sexual risk in a group of male sex workers (n=79) who were recruited in the context of a larger study of young heroin users in Hanoi, Vietnam (n=1270). Male sex workers were significantly more likely than male non-sex workers to be migrants (P<0.001) and to have unstable housing (P<0.001), to have lifetime exposure to marijuana (P<0.001), 3,4 methylenedioxymethamphetamine (MDMA, ecstasy) (P<0.01), amphetamines (P<0.05), cocaine (P<0.01) and morphine (P<0.001). Male sex workers are more likely to currently use MDMA (P<0.05), amphetamines (P<0.001), morphine (P<0.05) and to ‘smoke’ as their most frequent mode of heroin administration (P<0.01). Male sex workers are more likely to have both male and female concurrent sex partners (P<0.001), to have a history of sexual victimisation (P<0.001), to have had more than three different sex partners in the past 30 days (P<0.001), and to have had partners who injected drugs before sex (P<0.001) or who used drugs during sex (P<0.01). In their last sexual encounter with a client partner, approximately one-third (31.1%) reported having had receptive anal sex. In nearly three-quarters of these exchanges (71.4%), no condom was used. Similarly, in their last sexual encounter with a client partner, 42.2% reported having had insertive anal sex and in nearly half (47.4%) of these encounters no condom was used. Consistent with recent data from elsewhere in the region, there is an urgent need for additional research on male sex work in South-east Asia in order to properly situate behavioural interventions for male sex workers in this region. PMID:18082070

  3. Cocaine-induced pseudovasculitis.

    PubMed

    Friedman, Daphne R; Wolfsthal, Susan D

    2005-05-01

    Pseudovasculitis is a disease process that mimics the presentation and possibly the laboratory findings of true vasculitis. However, biopsy specimens do not reveal the typical histopathologic findings expected in vasculitis. One often overlooked cause of pseudovasculitis is cocaine use, which has been described in case reports to cause aggressive nasal destruction and various skin lesions and thus has been confused with Wegener granulomatosis or leukocytoclastic vasculitis. Unfortunately, serologic tests such as antinuclear antibody or antineutrophil cytoplasmic antibody cannot reliably differentiate between these entities. We describe a patient who presented with what was believed to be Wegener granulomatosis affecting the skin and upper airway. However, findings from repeated biopsies did not support this diagnosis, and the only unifying diagnosis was cocaine-induced pseudovasculitis. The ability to recognize and differentiate between true vasculitis and pseudovasculitis is essential for the clinician because treatment options are radically disparate. PMID:15887436

  4. Are empty methadone bottles empty? An analytic study

    PubMed Central

    2014-01-01

    Background Methadone maintenance treatment is the most widely prescribed treatment for opiate dependence with proven benefits for patients. In naïve users or in case of recreational misuse, methadone can be a source of potentially lethal intoxications, resulting in fatal overdoses. A few cases of infantile intoxications have been described in the literature, some of which resulted in death. Nowadays, more than 50,000 bottles are used every day in France, most of which are thrown away in the bin. Relatives at home, especially children, can have access to these empty bottles. This study aims to determine whether the residual quantity of methadone in the bottles is associated with a risk of intoxication for someone who has a low tolerance to opiates, such as a child. Methods The methadone dosage left in a sample of 175 bottles recapped after use by the patients taking their maintenance treatment in an addiction treatment program centre was analysed during a 2-week period in March 2013. Results The mean residual quantity of methadone left in each bottle after use is 1.9?±?1.8 mg and 3.3?±?2.4 mg in the sample of 60 mg bottles. Conclusions There is a potential danger of accidental overdose with empty bottles of methadone syrup, especially for children. To take into account this hazard, several harm reduction strategies can be proposed, such as favouring the taking of the treatment within the delivery centres rather than the ‘take home’ doses, asking methadone users to bring back their used bottles, and raising patients’ awareness of the intoxication risks and the necessary everyday precautions. For stable patients with take home methadone, the use of capsules could be considered. PMID:24990630

  5. Cocaine and development

    Microsoft Academic Search

    L. P Spear; M. M Silveri; M Casale; N. M Katovic; J. O Campbell; L. A Douglas

    2002-01-01

    Neurobehavioral alterations evident in offspring of Sprague–Dawley rat dams exposed to 40 mg\\/kg\\/day cocaine subcutaneously from gestational days 8–20 are reviewed. Consequences for offspring are often age dependent: for instance, reliable deficits in classical conditioning are evident during the early postnatal period, whereas cognitive effects are less pervasive in adulthood, although apparent in tasks such as reversal training. Gender of

  6. Pneumorachis after cocaine sniffing.

    PubMed

    Challita, S; Daher, M; Roche, N; Alifano, M; Revel, M P; Rabbat, A

    2014-01-01

    Air in the epidural space is called pneumorachis. The usual mechanism of pneumorachis is air diffusion from the mediastinal tissue layers through the inter-vertebral foramen. Alternatively, air can diffuse directly after spine traumas (e.g., blunt deceleration with vertebral dislocation) or medical procedures. Several mechanisms could explain pneumomediastinum and pneumorachis after cocaine sniffing. Passive apnea and/or cough that occur after sniffing can cause intra alveolar hyper-pressure, which is responsible for alveolar rupture and air diffusion. Another mechanism is alveolar wall fragility and rupture induced by repeated cocaine sniffing, in turn causing air diffusion to the mediastinum, sub-cutaneous tissues and the epidural space. The diagnosis is usually made on Chest tomography scan. Management consists in close monitoring in the intensive care unit to detect aggravation of pneumomediastinum and pneumorachis, which would require surgical management. Supplemental nasal oxygen can be given to accelerate nitrogen washout. We present a case of a 28 years old male who presented to the emergency department for chest pain directly after sniffing cocaine. A computed tomography scan of the chest showed pneumomediastinum, pneumorachis and sub-cutaneous emphysema. The patient was admitted for 24 h: after that delay, surveillance chest tomodensitometry showed stability, and he could be discharged without further treatment. PMID:26029527

  7. Gender differences in pharmacokinetics and pharmacodynamics of methadone substitution therapy

    PubMed Central

    Graziani, Manuela; Nisticò, Robert

    2015-01-01

    Gender-related differences in the pharmacological effects of drug are an emerging topic. This review examines gender differences in both pharmacokinetic and pharmacodynamic aspects of methadone, a long-acting opioid agonist that is prescribed as a treatment for opioid dependence and the management of chronic pain. Method: We performed a search in the Medline database from 1990 to 2014 in order to find published literature related to gender differences in pharmacokinetics (PK) and pharmacodynamics (PD) of methadone. Results: None of the studies were carried out with the primary or secondary aim to identify any gender differences in the pharmacokinetic profile of methadone. Importantly; high inter-subjects variability in PK parameters was found also intra female population. The reported differences in volume of distribution could be ascribed to the physiological differences between men and women in body weight and composition, taking into account that the dose of methadone was established irrespective of body weight of patients (Peles and Adelson, 2006). On the other hand, the few studies present in literature found no gender difference in some direct pharmacodynamic parameters. Some reports have suggested that female gender is associated with an increased risk for long-QT-related cardiac arrhythmias in methadone maintenance subjects. Conclusion: Even though it may be too simplistic to expect variability only in one parameter to explain inter-individual variation in methadone response, we believe that a better knowledge of gender-related differences might have significant implications for better outcomes in opioid dependence substitution therapy in women.

  8. Medication-assisted treatment for opioid addiction: methadone and buprenorphine.

    PubMed

    Saxon, Andrew J; Hser, Yih-Ing; Woody, George; Ling, Walter

    2013-12-01

    Among agents for treatment of opioid addiction, methadone is a full mu-opioid receptor agonist, whereas buprenorphine is a partial agonist. Both are long-acting. Buprenorphine has a superior safety profile. Methadone is formulated for oral administration and buprenorphine for sublingual administration. A subdermal buprenorphine implant with a 6-month duration of action is being considered for approval by the U.S. Food and Drug Administration. Both medications reduce mortality rates and improve other outcomes. Data from a recent randomized controlled comparison of both medications (N = 1269) show better treatment retention with methadone but reduced illicit opioid use early in treatment with buprenorphine. Human immunodeficiency virus (HIV) risk behaviors were measured using the Risk Behavior Survey at baseline, 12 weeks, and 24 weeks for study completers. In the 30 days prior to treatment entry, 14.4% of the completers randomized to treatment with buprenorphine (n = 340) and 14.1% of the completers randomized to methadone treatment (n = 391) shared needles. The percent sharing needles decreased to 2.4% for buprenorphine and 4.8 for methadone in the 30 days prior to Week 24 (p < 0.0001). In the 30 days prior to treatment entry, 6.8% of the completers randomized to buprenorphine and 8.2% of the completers randomized to methadone had multiple sexual partners, with only 5.2% and 5.1%, respectively, reporting multiple partners at Week 24 (p < 0.04). PMID:24436573

  9. ANCA-positive vasculitis induced by levamisole-adulterated cocaine and nephrotic syndrome: The kidney as an unusual target

    PubMed Central

    Álvarez Díaz, Hortensia; Mari?o Callejo, Ana Isabel; García Rodríguez, José Francisco; Rodríguez Pazos, Laura; Gómez Buela, Inmaculada; Bermejo Barrera, Ana María

    2013-01-01

    Patient: Male, 36 Final Diagnosis: Levamisole-induced vasculopathy Symptoms: Purpuric skin lesions Medication: Levamisole Clinical Procedure: — Specialty: Internal Medicine Objective: Unusual clinical course Background: Levamisole has been detected in seized cocaine samples and a levamisole-induced vasculopathy (LIV) has been described, mainly focused on skin. Case Report: A 36-year-old Caucasian man with history of antibodies to hepatitis C infection (negative hepatitis C virus RNA and negative HIV serology), smoking, and intravenous use of cocaine and brown heroin, presented to the hospital with purpuric skin lesions on extremities and earlobes. One month before the current presentation, a skin punch biopsy of one of these lesions was performed, showing histopathologic findings suggestive of mixed cryoglobulinemia. Laboratory testing revealed leukopenia, renal failure, and nephrotic syndrome. Antimyeloperoxidase antineutrophil cytoplasmic antibodies (MPO-ANCA) were positive. The previous skin punch biopsy was revised and demonstrated pathologic findings consistent with leukocytoclastic vasculitis. An analysis of a cocaine sample for personal use, provided by the patient, was performed using mass spectrometry-gas chromatography and levamisole was detected. Three boluses of intravenous methylprednisolone were administered, followed by oral prednisone 1 mg/Kg per day. Skin lesions and renal function improved. Conclusions: To our knowledge, this is the first report of nephrotic syndrome induced by levamisole-adulterated cocaine, proven by cocaine sample toxicology. Lack of renal biopsy is a limitation of this report. PMID:24478818

  10. Hapten optimization for cocaine vaccine with improved cocaine recognition.

    PubMed

    Ramakrishnan, Muthu; Kinsey, Berma M; Singh, Rana A; Kosten, Thomas R; Orson, Frank M

    2014-09-01

    In the absence of any effective pharmacotherapy for cocaine addiction, immunotherapy is being actively pursued as a therapeutic intervention. While several different cocaine haptens have been explored to develop anticocaine antibodies, none of the hapten was successfully designed, which had a protonated tropane nitrogen as is found in native cocaine under physiological conditions, including the succinyl norcocaine (SNC) hapten that has been tested in phase II clinical trials. Herein, we discuss three different cocaine haptens: hexyl norcocaine (HNC), bromoacetamido butyl norcocaine (BNC), and succinyl butyl norcocaine (SBNC), each with a tertiary nitrogen structure mimicking that of native cocaine which could optimize the specificity of anticocaine antibodies for better cocaine recognition. Mice immunized with these haptens conjugated to immunogenic proteins produced high titre anticocaine antibodies. However, during chemical conjugation of HNC and BNC haptens to carrier proteins, the 2? methyl ester group is hydrolyzed, and immunizing mice with these conjugate vaccines in mice produced antibodies that bound both cocaine and the inactive benzoylecgonine metabolite. While in the case of the SBNC conjugate, vaccine hydrolysis of the methyl ester did not appear to occur, leading to antibodies with high specificity to cocaine over BE. Although we observed similar specificity with a SNC hapten, the striking difference is that SBNC carries a positive charge on the tropane nitrogen atom, and therefore, it is expected to have better binding of cocaine. The 50% cocaine inhibitory concentration (IC50 ) value for SBNC antibodies (2.8 ?m) was significantly better than the SNC antibodies (9.4 ?m) when respective hapten-BSA was used as a substrate. In addition, antibodies from both sera had no inhibitory effect from BE. In contrast to BNC and HNC, the SBNC conjugate was also found to be highly stable without any noticeable hydrolysis for several months at 4 °C and 2-3 days in pH 10 buffer at 37 °C. PMID:24803171

  11. Bacillus cereus panophthalmitis after intravenous heroin.

    PubMed

    Hatem, G; Merritt, J C; Cowan, C L

    1979-03-01

    Two healthy young black men developed panophthalmitis after intravenous heroin injections. Bacillus cereus, considered to be a relatively noncommon pathogen for man, was found to be the causative agent as it was recovered from the anterior chamber and viterous cavity of both cases. The ocular findings were unilateral in each case, and neither patient had any sistemic involvement from the bacteremia. The onset of visual symptoms varied from 24 to 36 hours after the last intravenous injection with the eye becoming rapidly blind. Photographs of the early fundus lesions included preretinal hypopyon-like lesions and peculiar changes in the blood vasculature. Intracameral gentamicin and steroids did not alter the cause, and treatment was enucleation. PMID:110208

  12. Heroin - Changes In How It Is Used: 1995-2005

    MedlinePLUS

    ... 000 who used the drug for the first time. 1 Routes of administration for heroin include inhalation, ... have progressed from inhalation to injection during that time. 2 Similarly, this report shows a trend toward ...

  13. DNA profiling from heroin street dose packages.

    PubMed

    Zamir, Ashira; Cohen, Yaron; Azoury, Myriam

    2007-03-01

    A large amount of heroin street doses are seized and examined for drug content by the Israel police. These are generally wrapped in heat-sealed plastic. Occasionally it is possible to visualize latent fingerprints on the plastic wrap itself, but the small size of the plastic item and the sealing process makes the success rate very low. In this study, the possibility of extracting and profiling DNA from the burnt edge of the plastic wrap was investigated. The idea was based on the assumption that epithelial cells might be trapped during the sealing process. The results show that there are sufficient quantities of DNA deposited at the "amorphic" burnt edges of sealed street doses for DNA profiling to be carried out. A controlled experiment using a known donor was performed. This subject carried out sealing of "street drug" packages and consequent DNA extractions were performed to show that known DNA profiles could be recovered from such packages, as a result of handling by the "packer." "Square-like" burnt edges did not yield DNA profiles, probably because of differences in the sealing process. It was also shown that DNA could be recovered from the plastic wrap itself and not only from the amorphic burnt edges. As heroin dealers and drug users are often involved in other crimes and run-ins with the law, the effective extraction and addition of their DNA profiles from such items of evidence to the newly established DNA database in Israel provides new avenues in the continued fight against crime and drug traffickers. PMID:17316237

  14. Acquisition of cocaine and heroin self-administration in rats developmentally exposed to lead 

    E-print Network

    Rocha, Angelica

    2005-08-29

    Rationale: The rate of acquisition of drug self-administration may serve as a predictor of later drug-taking behavior, possibly influencing vulnerability to initiate drug use. Objectives: The present study examined the effects of perinatal...

  15. Prevalence of executive dysfunction in cocaine, heroin and alcohol users enrolled in therapeutic communities

    Microsoft Academic Search

    María José Fernández-Serrano; Miguel Pérez-García; José C. Perales; Antonio Verdejo-García

    2010-01-01

    Many studies have observed relevant executive alterations in polysubstance users but no data have been generated in terms of prevalence of these alterations. Studies of the prevalence of neuropsychological impairment can be useful in the design and implementations of interventional programs for substance abusers. The present study was conducted to estimate the prevalence of neuropsychological impairment in different components of

  16. Behavioral economic analysis of opioid consumption in heroin-dependent individuals: effects of unit price and pre-session drug supply.

    PubMed

    Greenwald, Mark K; Hursh, Steven R

    2006-10-15

    Behavioral economic analysis has been used to investigate factors underlying drug consumption in laboratory animals and, increasingly, in human drug abusers. However, there are few studies in heroin abusers, especially those who are not in treatment; such studies may be valuable for understanding the mechanisms of persistent drug use. This study investigated effects of unit price (UP) and pre-session supply of hydromorphone (HYD) on choice and consumption of HYD. Heroin-dependent research volunteers (n=13) stabilized on buprenorphine 8 mg/day completed this eight-session inpatient study. In sessions 1-2, participants sampled two total HYD doses (12 and 24 mg IM) that could be earned in later sessions. In each of the final six sessions, volunteers were given access to a 12-trial choice progressive ratio schedule lasting 3h. On each trial, volunteers could earn a HYD unit dose (1 or 2 mg, for a maximum of 12 or 24 mg, respectively) or money (US dollars 2, for a maximum of US dollars 24). Fixed ratio requirements increased exponentially, generating 24 unit prices for behavioral economic analysis. Before some choice sessions, volunteers could choose (FR 1) to receive extra HYD (12 or 24 mg; at 0915), whereas on other days no supplement was available. HYD choice and peak responding (breakpoint, O(max)) measures increased with unit dose, decreased with pre-session supplements, and were greater among volunteers who used cocaine prior to the experiment. Taking pre-session supplements decreased P(max) and made group-percent HYD consumption more demand-elastic. Consumption was functionally equivalent at differing FR/unit dose combinations. Thus, opioid demand in heroin-dependent individuals not in treatment is a function of drug supply, unit price, and cocaine use. PMID:16616994

  17. Adverse effects of cocaine abuse.

    PubMed

    Washton, A M; Tatarsky, A

    1984-03-01

    Specific consequences of cocaine abuse on health and psycho-social functioning were assessed in 55 cocaine-abusing subjects who called a telephone "helpline." REsults showed a high incidence and wide range of adverse consequences including: impairment of job functioning, interpersonal relationships, and financial status; disturbances of mood and cognitive functioning; psychiatric symptoms of depression, paranoia, and increased suicidal/violent tendencies; and physical symptoms of exhaustion, weight loss, sleep problems, and seizures. Cocaine-related automobile accidents, suicide attempts, and violent acts, including a cocaine-related homicide, were also reported. Intranasal users reported no fewer and no less severe adverse consequences than free-base smokers or intravenous users. Our findings challenge popular notions that cocaine is a benign "recreational" drug and that the intranasal route of administration guarantees protection against addictive patterns of use and adverse effects. PMID:6434968

  18. ROAD TRAFFIC CRASHES AND PRESCRIBED METHADONE AND BUPRENORPHINE: A FRENCH REGISTRY-BASED CASE-

    E-print Network

    Boyer, Edmond

    ROAD TRAFFIC CRASHES AND PRESCRIBED METHADONE AND BUPRENORPHINE: A FRENCH REGISTRY-BASED CASE traffic crash among patients under buprenorphine or methadone has not been subject to epidemiological for a road traffic crash and the use of buprenorphine and methadone. Methods: Data from three French national

  19. The Effectiveness of Matrix Interventions in Improving Methadone Treatment

    PubMed Central

    Eghbali, Hossein; Zare, Mahdi; Bakhtiari, Arva; Monirpoor, Nader; Ganjali, Alireza

    2013-01-01

    Background The treatment of opioid dependence disorder is one of the major problems in medical centers around the world. Although MMT has been the major treatment in last few years in Iran, the existence of relapse before and after detoxification is still high. Methadone treatment has had a very low percentage of complete success. Objectives To evaluate the effectiveness of matrix group interventions in improving methadone treatment in the addicted was the main goal of this research. Materials and Methods In a semi - experimental design, 24 male patients on the qualification cutoff score for the questionnaire survey (score less than 19 in depression test, and less than 21 in anxiety test) and the diagnosis of opioid dependence according to (DSM – IV) were substituted in two experimental and control groups randomly. At the beginning of the study, after the treatment period and in the follow-up phase (three months after the end of treatment), participants were evaluated by Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and the Anger Questionnaire (AQ), control group with no psychological treatment only took methadone. Data were analyzed using covariance analysis, chi square and Repeated Measures Analysis of Variance. Results Results showed that the effect of matrix group interventions on reducing relapse (P < 0.05), increasing the maintenance of treatment (P < 0.01), increasing the treatment compliance, reducing anger, anxiety and depression and methadone dose is more effective than methadone treatment (P < 0.05). Conclusions It seems matrix group interventions increase the effectiveness of methadone treatment by reducing the relapse prevention, the dose of methadone and remaining in treatment. PMID:24971256

  20. Reward and Toxicity of Cocaine Metabolites Generated by Cocaine Hydrolase.

    PubMed

    Murthy, Vishakantha; Geng, Liyi; Gao, Yang; Zhang, Bin; Miller, Jordan D; Reyes, Santiago; Brimijoin, Stephen

    2015-08-01

    Butyrylcholinesterase (BChE) gene therapy is emerging as a promising concept for treatment of cocaine addiction. BChE levels after gene transfer can rise 1000-fold above those in untreated mice, making this enzyme the second most abundant plasma protein. For months or years, gene transfer of a BChE mutated into a cocaine hydrolase (CocH) can maintain enzyme levels that destroy cocaine within seconds after appearance in the blood stream, allowing little to reach the brain. Rapid enzyme action causes a sharp rise in plasma levels of two cocaine metabolites, benzoic acid (BA) and ecgonine methyl ester (EME), a smooth muscle relaxant that is mildly hypotensive and, at best, only weakly rewarding. The present study, utilizing Balb/c mice, tested reward effects and cardiovascular effects of administering EME and BA together at molar levels equivalent to those generated by a given dose of cocaine. Reward was evaluated by conditioned place preference. In this paradigm, cocaine (20 mg/kg) induced a robust positive response but the equivalent combined dose of EME + BA failed to induce either place preference or aversion. Likewise, mice that had undergone gene transfer with mouse CocH (mCocH) showed no place preference or aversion after repeated treatments with a near-lethal 80 mg/kg cocaine dose. Furthermore, a single administration of that same high cocaine dose failed to affect blood pressure as measured using the noninvasive tail-cuff method. These observations confirm that the drug metabolites generated after CocH gene transfer therapy are safe even after a dose of cocaine that would ordinarily be lethal. PMID:25814464

  1. Cocaine Uptake Is Decreased in the Brain of Detoxified Cocaine Abusers

    Microsoft Academic Search

    N D Volkow; G-J Wang; J S Fowler; J Logan; R Hitzemann; S J Gatley; R R MacGregor; A P Wolf

    1996-01-01

    Binding of [11C]cocaine in brain was measured with positron emission tomography in 12 detoxified cocaine abusers and in 20 controls to evaluate if there were changes in cocaine binding and in dopamine (DA) transporter availability associated with chronic cocaine use. Nine controls and 10 cocaine abusers had an additional scan with [18F]N-methylspiroperidol to measure dopamine D2 receptors. Cocaine abusers had

  2. -blockers and Cocaine: Fatal Attraction? Cristina Gonzales, PharmD

    E-print Network

    Pillow, Jonathan

    and Cocaine: Fatal Attraction? Cristina Gonzales, PharmD PGY1 Pharmacy. Discuss the historic use of -blockade in cocaine toxicity 2. List the adverse effects related to cocaine use 3. Discuss the management of cocaine-associated chest

  3. Cocaine Smoking and Its Implications for Health and Health Education.

    ERIC Educational Resources Information Center

    Duncan, David F.

    1987-01-01

    The introduction of cocaine smoking in the l970s revolutionized cocaine use patterns in the United States. The history of cocaine freebase is described. The importance of health educators addressing the myths regarding cocaine smoking is emphasized. (MT)

  4. Interim vs. Standard Methadone Treatment: A Benefit-Cost Analysis

    PubMed Central

    Schwartz, Robert P.; Alexandre, Pierre K.; Kelly, Sharon M.; O’Grady, Kevin E.; Gryczynski, Jan; Jaffe, Jerome H.

    2013-01-01

    A benefit-cost analysis was conducted as part of a clinical trial in which newly-admitted methadone patients were randomly assigned to interim methadone (IM; methadone without counseling) for the first 4 months of 12 months of methadone treatment or 12 months of methadone with one of two counseling conditions. Health, residential drug treatment, criminal justice costs, and income data in 2010 dollars were obtained at treatment entry, and 4- and 12-month follow-up from 200 participants and program costs were obtained. The net benefits of treatment were greater for the IM condition but controlling for the baseline variables noted above, the difference between conditions in net monetary benefits was not significant. For the combined sample, there was a pre- to post-treatment net benefit of $1,470 (95% CI: ?$625; $3584) and a benefit-cost ratio of 1.5 (95% CI: 0.8, 2.3), but using our conservative approach to calculating benefits, these values were not significant. PMID:24239030

  5. Methadone maintenance dosing guideline for opioid dependence, a literature review.

    PubMed

    Fareed, Ayman; Casarella, Jennifer; Amar, Richard; Vayalapalli, Sreedevi; Drexler, Karen

    2010-01-01

    To date, methadone dosing is still an issue of debate and controversy among clinicians who are involved in methadone maintenance programs. The authors conducted a literature review to update clinicians about this issue and provide recommendations for proper methadone dosing. Studies eligible for inclusion in the review were retrieved from the PubMed database by searching for reports published between 1990 and September 2008 using the major medical subject headings Methadone (all fields) and dose. Only articles written in English were included. Additional reports were identified from the reference lists of retrieved articles and by manual review of the tables of contents of journals on drug of abuse included in the psychiatry and substance abuse subject category listing 2008 of the Journal Citation Reports. Abstracts of medical meetings were excluded. Twenty-four articles were included in the review. Twelve are randomized, controlled, or double-blind clinical trials, 10 are non-randomized and observational studies, and 2 are meta-analyses. Currently, the consensus is to have a goal for methadone dosing in the range of 60 to 100 mg daily. For patients who continue to use illicit opiates while prescribed this dose range, clinicians may consider doses greater than 100 mg daily. However, this is not the current consensus but rather is based on the limited promising data the authors have; it could be considered if the benefits outweigh the risks for some patients. PMID:20390694

  6. Reduced volume of the nucleus accumbens in heroin addiction.

    PubMed

    Seifert, Christian L; Magon, Stefano; Sprenger, Till; Lang, Undine E; Huber, Christian G; Denier, Niklaus; Vogel, Marc; Schmidt, André; Radue, Ernst-Wilhelm; Borgwardt, Stefan; Walter, Marc

    2014-12-01

    The neural mechanisms of heroin addiction are still incompletely understood, even though modern neuroimaging techniques offer insights into disease-related changes in vivo. While changes on cortical structure have been reported in heroin addiction, evidence from subcortical areas remains underrepresented. Functional imaging studies revealed that the brain reward system and particularly the nucleus accumbens (NAcc) play a pivotal role in the pathophysiology of drug addiction. The aim of this study was to investigate whether there was a volume difference of the NAcc in heroin addiction in comparison to healthy controls. A further aim was to correlate subcortical volumes with clinical measurements on negative affects in addiction. Thirty heroin-dependent patients under maintenance treatment with diacetylmorphine and twenty healthy controls underwent structural MRI scanning at 3T. Subcortical segmentation analysis was performed using FMRIB's Integrated Registration and Segmentation Tool function of FSL. The State-Trait Anxiety Inventory and the Beck Depression Inventory were used to assess trait anxiety and depressive symptoms, respectively. A decreased volume of the left NAcc was observed in heroin-dependent patients compared to healthy controls. Depression score was negatively correlated with left NAcc volume in patients, whereas a positive correlation was found between the daily opioid dose and the volume of the right amygdala. This study indicates that there might be structural differences of the NAcc in heroin-dependent patients in comparison with healthy controls. Furthermore, correlations of subcortical structures with negative emotions and opioid doses might be of future relevance for the investigation of heroin addiction. PMID:25467383

  7. HIV Risk Reduction With Buprenorphine-Naloxone or Methadone: Findings From A Randomized Trial

    PubMed Central

    Woody, George; Bruce, Douglas; Korthuis, P. Todd; Chhatre, Sumedha; Hillhouse, Maureen; Jacobs, Petra; Sorensen, James; Saxon, Andrew J.; Metzger, David; Ling, Walter

    2014-01-01

    Objectives Compare HIV injecting and sex risk in patients being treated with methadone (MET) or buprenorphine-naloxone (BUP). Methods Secondary analysis from a study of liver enzyme changes in patients randomized to MET or BUP who completed 24-weeks of treatment and had 4 or more blood draws. The initial 1:1 randomization was changed to 2:1 (BUP: MET) after 18 months due to higher dropout in BUP. The Risk Behavior Survey (RBS) measured past 30-day HIV risk at baseline and weeks 12 and 24. Results Among 529 patients randomized to MET, 391 (74%) were completers; among 740 randomized to BUP, 340 (46%) were completers; 700 completed the RBS. There were significant reductions in injecting risk (p< 0.0008) with no differences between groups in mean number of times reported injecting heroin, speedball, other opiates, and number of injections; or percent who shared needles, did not clean shared needles with bleach, shared cookers, or engaged in front/back loading of syringes. The percent having multiple sex partners decreased equally in both groups (p<0.03). For males on BUP the sex risk composite increased; for males on MET, the sex risk decreased resulting in significant group differences over time (p<0.03). For females, there was a significant reduction in sex risk (p<0.02) with no group differences. Conclusions Among MET and BUP patients that remained in treatment, HIV injecting risk was equally and markedly reduced, however MET retained more patients. Sex risk was equally and significantly reduced among females in both treatment conditions, but increased for males on BUP, and decreased for males on MET. PMID:24751432

  8. Cocaine, Appetitive Memory and Neural Connectivity

    PubMed Central

    Ray, Suchismita

    2013-01-01

    This review examines existing cognitive experimental and brain imaging research related to cocaine addiction. In section 1, previous studies that have examined cognitive processes, such as implicit and explicit memory processes in cocaine users are reported. Next, in section 2, brain imaging studies are reported that have used chronic users of cocaine as study participants. In section 3, several conclusions are drawn. They are: (a) in cognitive experimental literature, no study has examined both implicit and explicit memory processes involving cocaine related visual information in the same cocaine user, (b) neural mechanisms underlying implicit and explicit memory processes for cocaine-related visual cues have not been directly investigated in cocaine users in the imaging literature, and (c) none of the previous imaging studies has examined connectivity between the memory system and craving system in the brain of chronic users of cocaine. Finally, future directions in the field of cocaine addiction are suggested. PMID:25009766

  9. The Role of N-Acetylcysteine in Inhibiting Responding During Extinction in Rats Trained to Self-Administer Cocaine

    PubMed Central

    LaRowe, Steven D.; Kalivas, Peter W.

    2015-01-01

    Previous work has found that N-acetylcysteine inhibits extinction responding in rats trained to self-administer heroin. The current study examined the ability of N-acetylcysteine to inhibit extinction responding in rats trained to self-administer cocaine. Rats were trained to self-administer cocaine (0.39mg/kg) for 10 to 12 days and were pretreated with either N-acetylcysteine (60mg/kg) or saline beginning on the first day of extinction training and on each extinction training day thereafter. Results indicated that chronically administered N-acetylcysteine reduced lever pressing during extinction sessions. In addition to demonstrating the impact N-acetylcysteine has on lever pressing during extinction, the present study underscores the importance of using responding during extinction as a dependent measure in the development of medications for addictive behaviors.

  10. Unintentional methadone-related overdose death in New Mexico (USA) and implications for surveillance, 1998-2002

    Microsoft Academic Search

    Nina Shah; Sarah L. Lathrop; Michael G. Landen

    2005-01-01

    Aims To determine death rates from methadone over time, to characterize methadone-related death and to discuss public health surveillance of methadone-related death. Design We analyzed medical examiner data for all unintentional drug over- dose deaths in New Mexico, USA, between 1998 and 2002. Measurements Age-adjusted death rates for methadone-related death, logis- tic regression models for likelihood of methadone-related death among

  11. Coexisting Addiction and Pain in People Receiving Methadone for Addiction

    PubMed Central

    St. Marie, Barbara

    2014-01-01

    The aim of this qualitative study was to examine the narratives of people who experience chronic pain (lasting 6 months or more) and were receiving methadone for the treatment of their opiate addiction through a major methadone clinic. This paper featured the pathway of how the participants developed chronic pain and addiction, and their beliefs of how prescription opioids would impact their addiction in the future. Thirty-four participants who experienced chronic pain and received methadone for treatment of opiate addiction were willing to tell the story of their experiences. The findings in three areas are presented: (a) whether participants experienced addiction first or pain first and how their exposures to addictive substances influenced their experiences, (b) the significance of recreational drug use and patterns of abuse behaviors leading to chronic pain, and (c) participants’ experiences and beliefs about the potential for abuse of prescription opioid used for treatment of pain. PMID:23858068

  12. Nanomaterial-based cocaine aptasensors.

    PubMed

    Mokhtarzadeh, Ahad; Dolatabadi, Jafar Ezzati Nazhad; Abnous, Khalil; de la Guardia, Miguel; Ramezani, Mohammad

    2015-06-15

    Up to now, many different methods have been developed for detection of cocaine, but most of these methods are usually time-consuming, tedious and require special or expensive equipment. Therefore, the development of simple, sensitive and rapid detection methods is necessary. In the last decade, aptamers have been used as a new biosensor platform for detection of cocaine in different samples. Aptamers are artificial single-stranded DNA or RNA oligonucleotides capable of binding to specific molecular targets with high affinity and if integrated to nanomaterials, it may lead in precise methods for cocaine detection in the common laboratories. In this review, recent advances and applications of aptamer-based biosensors and nanobiosensors, have been updated, paying attention to the use of fluorescence, colorimetric and electrochemical techniques for the detection and quantitative determination of cocaine. PMID:25562736

  13. Quantitation of methadone enantiomers in humans using stable isotope-labeled (2H3)-, (2H5)-, and (2H8)Methadone

    SciTech Connect

    Nakamura, K.; Hachey, D.L.; Kreek, M.J.; Irving, C.S.; Klein, P.D.

    1982-01-01

    A new technique for simultaneous stereoselective kinetic studies of methadone enantiomers was developed using three deuterium-labeled forms of methadone and GLC-chemical-ionization mass spectrometry. A racemic mixture (1:1) of (R)-(-)-(2H5)methadone (l-form) and (S)-(R)-(2H3)methadone (d-form) was administered orally in place of a single daily dose of unlabeled (+/-)-(2H0)methadone in long-term maintenance patients. Racemic (+/-)-(2H8)methadone was used as an internal standard for the simultaneous quantitation of (2H0)-, (2H3)-, and (2H5)methadone in plasma and urine. A newly developed extraction procedure, using a short, disposable C18 reversed-phase cartridge and improved chemical-ionization procedures employing ammonia gas, resulted in significant reduction of the background impurities contributing to the ions used for isotopic abundance measurements. These improvements enabled the measurement of labeled plasma methadone levels for 120 hr following a single dose. This methodology was applied to the study of methadone kinetics in two patients; in both patients, the analgesically active l-enantiomer of the drug had a longer plasma elimination half-life and a smaller area under the plasma disappearance curve than did the inactive d-form.

  14. Neurocognitive characterizations of Russian heroin addicts without a significant history of other drug use

    Microsoft Academic Search

    Diana H. Fishbein; Evgeny Krupitsky; Barbara A. Flannery; Doris J. Langevin; Georgiy Bobashev; Elena Verbitskaya; Cynthia B. Augustine; Karen I. Bolla; Edwin Zvartau; Barry Schech; Valentina Egorova; Natali Bushara; Marina Tsoy

    2007-01-01

    Research on the neurocognitive characteristics of heroin addiction is sparse and studies that do exist include polydrug abusers; thus, they are unable to distinguish neurocognitive effects of heroin from those of other drugs. To identify neurocognitive correlates specific to heroin addiction, the present study was conducted in St. Petersburg, Russia where individuals typically abuse and\\/or become addicted to only one

  15. Motivated attention to cocaine and emotional cues in abstinent and current cocaine users an ERP study

    E-print Network

    Homes, Christopher C.

    Motivated attention to cocaine and emotional cues in abstinent and current cocaine users ­ an ERP National Institute on Drug Abuse, Bethesda, MD, USA Keywords: cocaine addiction, emotional processing (LPP) appears to be enhanced following cocaine-related compared with neutral stimuli in human

  16. Effects of cocaine and cocaine metabolites on mouse development in vitro

    Microsoft Academic Search

    E HUNTERIII; T. W. Sadler

    1996-01-01

    The use of cocaine use has been associated with adverse developmental effects in humans, and cocaine administration produces developmental toxicity in animal models. However, whether the adverse effects produced during organogenesis are due directly to the effects of cocaine or its metabolites remains to be established. This study was therefore undertaken to compare the morphological effects of cocaine and its

  17. Aminorex associated with possible idiopathic pulmonary hypertension in a cocaine user.

    PubMed

    Karch, Steven B; Defraia, Beatrice; Messerini, Luca; Mari, Francesco; Vaiano, Fabio; Bertol, Elisabetta

    2014-07-01

    The conversion of levamisole to aminorex in horses was first described in 2009 and, for the first time, confirmed in humans two years later by our laboratory. Aminorex and levamisole interfere with serotonin metabolism and both are proven cause of potentially fatal idiopathic pulmonary hypertension (IPH). Because most of the world's seizures of illicit cocaine is now contaminated with levamisole, this raises the possibility that users of levamisole adulterated cocaine users may be at risk for IPH. Here we describe the first case of IPH in a user of levamisole-contaminated cocaine. Levamisole and aminorex were both identified and quantified in hair and other biological specimens by means gas chromatography/mass spectrometry system (levamisole: urine, 75.05ng/mL; blood, 15.05ng/mL; brain, >0.15ng/g; liver, >0.15ng/g; hair, 12.15ngmg; aminorex: urine, 38.62ng/mL; blood, 8.92ng/mL, brain >0.15ng/g; liver, 0.15ng/g; hair 7.35ng/mg; cocaine, benzoylecgonine, morphine, 6-acetylmorphine, methadone, 2-ethylidine-1, 5-dimetil-3, 3 diphenylpyrrolidine were also detected). Moreover histological changes associated with IPH were observed in the lung. As IPH produces relatively non-specific symptoms in its early stages, this index case may serve as a harbinger of many more cases to come. It should also alert clinicians to the possibility that their patient may be suffering from this relatively rare disorder. PMID:24794740

  18. Pyrolysis and volatilization of cocaine

    SciTech Connect

    Martin, B.R.; Lue, L.P.; Boni, J.P. (Virginia Commonwealth Univ., Richmond (USA))

    1989-05-01

    The increasing popularity of inhaling cocaine vapor prompted the present study, to determine cocaine's fate during this process. The free base of (3H)cocaine (1 microCi/50 mg) was added to a glass pipe, which was then heated in a furnace to simulate freebasing. Negative pressure was used to draw the vapor through a series of glass wool, ethanol, acidic, and basic traps. Air flow rate and temperature were found to have profound effects on the volatilization and pyrolysis of cocaine. At a temperature of 260 degrees C and a flow rate of 400 mL/min, 37% of the radioactivity remained in the pipe, 39% was found in the glass wool trap, and less than 1% in the remainder of the volatilization apparatus after a 10-min volatilization. Reducing the air flow rate to 100 mL/min reduced the amount of radioactivity collected in the glass wool trap to less than 10% of the starting material and increased the amount that remained in the pipe to 58%. GC/MS analysis of the contents of the glass wool trap after volatilization at 260 degrees C and a flow rate of 400 mL/min revealed that 60% of the cocaine remained intact, while approximately 6 and 2% of the starting material was recovered as benzoic acid and methylecgonidine, respectively. As the temperature was increased to 650 degrees C, benzoic acid and methylecgonidine accounted for 83 and 89% of the starting material, respectively, whereas only 2% of the cocaine remained intact. Quantitation of cocaine in the vapor during the course of volatilization revealed high concentrations during the first two min and low concentrations for the remaining time.

  19. Cytochrome P4503A Does Not Mediate the Interaction between Methadone and Ritonavir-Lopinavir

    PubMed Central

    Stubbert, Kristi

    2013-01-01

    Plasma concentrations of orally administered methadone are reduced by the human immunodeficiency virus protease inhibitor combination ritonavir and lopinavir, but the mechanism is unknown. Methadone metabolism, clearance, and drug interactions have been attributed to CYP3A4, but this remains controversial. This investigation assessed the effects of acute (2 days) and steady-state (2 weeks) ritonavir-lopinavir on intravenous and oral methadone metabolism and clearance, hepatic and intestinal CYP3A4/5 activity (using the probe substrate intravenous and oral alfentanil), and intestinal transporter activity (using oral fexofenadine) in healthy volunteers. Plasma and urine concentrations of methadone and metabolite enantiomers, and other analytes, were determined by mass spectrometry. Acute and chronic ritonavir-lopinavir reduced plasma methadone enantiomer concentrations in half, with an average 2.6- and 1.5-fold induction of systemic and apparent oral methadone clearances. Induction was attributable to stereoselectively increased hepatic methadone N-demethylation, hepatic extraction, and hepatic clearance, and there was a strong correlation between methadone N-demethylation and clearance. Methadone renal clearance was unchanged. Alfentanil’s systemic clearance and hepatic extraction, apparent oral clearance, and intestinal extraction were reduced to 25%, 16%, and 35% of control, indicating strong inhibition of hepatic and intestinal CYP3A activities. Ritonavir-lopinavir (acute > chronic) increased fexofenadine exposure, suggesting intestinal P-glycoprotein inhibition. No correlation was found between methadone clearance and CYP3A activity. Acute and steady-state ritonavir-lopinavir stereoselectively induced methadone N-demethylation and clearance, despite significant inhibition of hepatic and intestinal CYP3A activity. Ritonavir-lopinavir inhibited intestinal transporters activity but had no effect on methadone bioavailability. These results do not support a significant role for CYP3A or ritonavir-lopinavir-inhibitable intestinal transporters in single-dose methadone disposition. PMID:24067429

  20. Cytochrome P4503A does not mediate the interaction between methadone and ritonavir-lopinavir.

    PubMed

    Kharasch, Evan D; Stubbert, Kristi

    2013-12-01

    Plasma concentrations of orally administered methadone are reduced by the human immunodeficiency virus protease inhibitor combination ritonavir and lopinavir, but the mechanism is unknown. Methadone metabolism, clearance, and drug interactions have been attributed to CYP3A4, but this remains controversial. This investigation assessed the effects of acute (2 days) and steady-state (2 weeks) ritonavir-lopinavir on intravenous and oral methadone metabolism and clearance, hepatic and intestinal CYP3A4/5 activity (using the probe substrate intravenous and oral alfentanil), and intestinal transporter activity (using oral fexofenadine) in healthy volunteers. Plasma and urine concentrations of methadone and metabolite enantiomers, and other analytes, were determined by mass spectrometry. Acute and chronic ritonavir-lopinavir reduced plasma methadone enantiomer concentrations in half, with an average 2.6- and 1.5-fold induction of systemic and apparent oral methadone clearances. Induction was attributable to stereoselectively increased hepatic methadone N-demethylation, hepatic extraction, and hepatic clearance, and there was a strong correlation between methadone N-demethylation and clearance. Methadone renal clearance was unchanged. Alfentanil's systemic clearance and hepatic extraction, apparent oral clearance, and intestinal extraction were reduced to 25%, 16%, and 35% of control, indicating strong inhibition of hepatic and intestinal CYP3A activities. Ritonavir-lopinavir (acute > chronic) increased fexofenadine exposure, suggesting intestinal P-glycoprotein inhibition. No correlation was found between methadone clearance and CYP3A activity. Acute and steady-state ritonavir-lopinavir stereoselectively induced methadone N-demethylation and clearance, despite significant inhibition of hepatic and intestinal CYP3A activity. Ritonavir-lopinavir inhibited intestinal transporters activity but had no effect on methadone bioavailability. These results do not support a significant role for CYP3A or ritonavir-lopinavir-inhibitable intestinal transporters in single-dose methadone disposition. PMID:24067429

  1. Myocardial Infarction Associated with Methadone and\\/or Dihydrocodeine

    Microsoft Academic Search

    Markus Backmund; Kirsten Meyer; Werner Zwehl; Otto Nagengast; Dieter Eichenlaub

    2001-01-01

    Chest pain and myocardial infarction occurring in young people with angiographically normal coronary arteries is well documented. Opiates have a cardioprotective effect and are used in acute heart attacks. We described a 22-year-old opioid addicted male patient who suffered a myocardial infarction following the consumption of methadone and dihydrocodeine.

  2. Sweat testing in addicts under methadone treatment: An Italian experience

    Microsoft Academic Search

    N. Fucci; N. De Giovanni; S. Scarlata

    2008-01-01

    In the last years the interest in monitoring drug exposure with human sweat as alternative biological fluid, is increasing. Sweat collection is convenient, less invasive and difficult to adulterate compared to traditional specimens. The objective of this study was to determine the excretion profile of methadone and other drugs into human sweat. Pharmscope sweat patches (Medical Europe Diagnostic, Madrid, Spain)

  3. Buprenorphine versus methadone maintenance: a cost-effectiveness analysis

    Microsoft Academic Search

    Christopher M. Doran; Marian Shanahan; Richard P. Mattick; Robert Ali; Jason White; James Bell

    2003-01-01

    This article presents the cost-effectiveness results of a randomised controlled trial conducted in two Australian cities. The trial was designed to assess the safety, efficacy and cost-effectiveness of buprenorphine versus methadone in the management of opioid dependence. The trial utilised a flexible dosing regime that was tailored to the clinical need of the patients, with high maximum doses, using the

  4. Cerebral Metabolism in Opiate Dependent Subjects: Effects of Methadone Maintenance

    Microsoft Academic Search

    IGOR I. GALYNKER; SNIEZYNA WATRAS-GANZ; CHRISTIAN MINER; RICHARD N. ROSENTHAL; DON C. DES JARLAIS; BEVERLY L. RICHMAN; EDYTHE LONDON

    Background: The long-term effects of opiate use on human brain are not known. The goal of this preliminary study was to determine whether human subjects with histories of opiate dependence have persistent differences in brain func- tion as compared with individuals without substance use disorders, and whether methadone maintenance reverses or ameliorates the potential abnormality. Methods: Positron emission tomographic (PET)

  5. Methadone-induced rigid-chest syndrome after substantial overdose.

    PubMed

    Lynch, Robert E; Hack, Richard A

    2010-07-01

    We report here the case of an infant who developed life-threatening rigid-chest syndrome after receiving an accidental overdose of methadone. The child responded to narcotic reversal. Pediatric physicians should be aware of this possible complication. PMID:20587670

  6. STUDY PROTOCOL Open Access Methadone induction in primary care

    E-print Network

    Paris-Sud XI, Université de

    STUDY PROTOCOL Open Access Methadone induction in primary care (ANRS-Methaville): a phase III, an opioid maintenance treatment (OMT), in primary care for drug users has led to an impressive reduction for drug and alcohol dependence (CSAPA) or a hospital setting) and are referred to primary care physicians

  7. Patterns of adherence to oral methadone: implications for prescribers.

    PubMed

    Haskew, Michael; Wolff, Kim; Dunn, John; Bearn, Jenny

    2008-09-01

    We investigated patterns of nonadherence to substitute treatment among patients attending an inner London community drug dependency unit and explored factors associated with nonadherence. We undertook 91 face-to-face confidential interviews with methadone-maintained patients attending community pharmacies. Thirty-eight patients (42%) had been either partial or poor adherers to their prescribed methadone regime in the past month. Multinomial logistic regression revealed that compared to full adherers, both poor adherers and partial adherers were more likely to be prescribed by unsupervised consumption. Poor adherers were also more likely to have less frequent pickups. There were seven types of nonadherent behavior detected, with dose splitting being the most prevalent (34%), followed by dose storage (28%) and missed pickups from the pharmacy (18%). We suggest that prescribers include an assessment of medication adherence at regular patient reviews as supervised consumption does not solve all adherence problems with methadone. New approaches to encouraging adherence, including a more systematic monitoring of adherence to improve the effectiveness of methadone programs, are needed. PMID:17935928

  8. Unrecognized "crack" cocaine abuse in pregnancy.

    PubMed

    Campbell, D; Parr, M J; Shutt, L E

    1996-10-01

    We report a case of "crack" cocaine abuse in a pregnant patient associated with haematuria, proteinuria, haemolytic anaemia, renal impairment, thrombocytopenia and pulmonary oedema. The case illustrates the problems for clinicians where unrecognized cocaine abuse interferes with the diagnosis and management of a complicated pregnancy. In addition, we discuss the principles for the safe conduct of anaesthesia in the pregnant cocaine abuser. PMID:8942348

  9. Third Pathophysiology of Prenatal Cocaine Exposure

    Microsoft Academic Search

    Barry M. Lester; James F. Padbury

    2009-01-01

    The pathophysiology of the effects of cocaine on fetal development has been described along 2 major pathways: neurochemical effects and vasoconstrictive effects. Following a summary of these effects, we suggest a ‘third pathophysiology’ in which altered fetal programming affects the acute and long-term adverse effects of in utero cocaine exposure. We describe how cocaine as a stressor alters the expression

  10. Detecting Cocaine Use with Wearable Electrocardiogram Sensors

    E-print Network

    Massachusetts at Amherst, University of

    Detecting Cocaine Use with Wearable Electrocardiogram Sensors Annamalai Natarajan1 Abhinav Parate1 of cocaine use. The current paper takes the first step in this important direction by posing a simple, but crucial question: Can cocaine use be reliably detected using wearable electro- cardiogram (ECG) sensors

  11. Smoked cocaine self-administration in females

    Microsoft Academic Search

    S. A. Dudish; Dorothy K. Hatsukami; P. R. Pentel

    1996-01-01

    Although approximately 32% of all smoked cocaine (“crack”) users are women, most studies investigating cocaine use have recruited only male subjects. Therefore, this study examined the smoked cocaine self-administration patterns of female crack abusers. A work requirement, where up to five tokens were earned by subjects, was followed by the administration of a sample delivery of one of three dose

  12. A Case of Heroin Induced Sensorineural Hearing Loss

    PubMed Central

    Aulet, Ricardo Mario; Sillman, Jonathan

    2014-01-01

    A case of a 31-year-old male who developed profound sensorineural hearing loss following a heroin overdose is presented. The patient subsequently had a full recovery of his hearing. Other cases of this rare phenomenon are reviewed and management options are discussed. PMID:24516766

  13. Heroin Users in Australia: Population Trends C. Yalin Kaya1

    E-print Network

    Kaya, Yalcin

    Heroin Users in Australia: Population Trends C. Yalçin Kaya1 , Yuliya Tugai2 , Jerzy A. Filar3 Australia (UniSA), Mawson Lakes, S. A. 5095 Australia. Contact E-mail: yalcin.kaya@unisa.edu.au . 2 Research Australia (DASC, SA). 6 Manager, Evidence-Based Practice Unit, DASC, SA. 7 Senior Evaluation Officer, DASC

  14. Naltrexone for heroin dependence treatment in St. Petersburg, Russia

    Microsoft Academic Search

    Evgeny M Krupitsky; Edwin E Zvartau; Dimitry V Masalov; Marina V Tsoi; Andrey M Burakov; Valentina Y Egorova; Tatyana Y Didenko; Tatyana N Romanova; Eva B Ivanova; Anton Y Bespalov; Elena V Verbitskaya; Nikolai G Neznanov; Alexandr Y Grinenko; Charles P O'Brien; George E Woody

    2004-01-01

    Naltrexone may be more effective for treating opioid (heroin) dependence in Russia than in the U.S. because patients are mostly young and living with their parents, who can control medication compliance. In this pilot study we randomized 52 consenting patients who completed detoxification in St. Petersburg to a double blind, 6-month course of biweekly drug counseling and naltrexone, or counseling

  15. Bilateral acute necrosis of the globi pallidi and rhabdomyolysis due to combined methadone and benzodiazepine toxicity.

    PubMed

    Corliss, Robert F; Mandal, Rakesh; Soriano, Benjamin J

    2013-03-01

    Methadone continues to be a widely used maintenance therapy for opiate dependence. However, methadone-related deaths have been reported frequently for over 4 decades now. Anoxic brain injury with pulmonary edema secondary to respiratory depression is the recognized mechanism of methadone death, although pathological intracranial findings are rarely described in methadone deaths. A selective area of brain injury has never been reported with methadone use. We present a case of a 23-year-old man who had acute necrosis of the bilateral globi pallidi in the brain and systemic rhabdomyolysis after ingesting methadone and nasally insufflating alprazolam. We also present a review of the literature on deaths following opioid use and associated brain injury. PMID:23361067

  16. Association Analysis of GABRB3 Promoter Variants with Heroin Dependence

    PubMed Central

    Chen, Chia-Hsiang; Huang, Chia-Chun; Liao, Ding-Lieh

    2014-01-01

    GABRB3 encoding the ?3 subunit of GABAA receptor has been implicated in multiple neuropsychiatric disorders, including substance abuse. Previous studies reported that SNPs at the 5? regulatory region of GABRB3 could regulate GABRB3 gene expression and associated with childhood absence epilepsy (CAE). The study aimed to investigate whether SNPs at the 5? regulatory region of GABRB3 were associated with heroin dependence in our population. We first re-sequenced 1.5 kb of the 5?regulatory region of GABRB3 gene to examine the SNP profile in the genomic DNA of 365 control subjects. Then, we conducted a case-control association analysis between 576 subjects with heroin dependence (549 males, 27 females) and 886 controls (472 males, 414 females) by genotyping the rs4906902 as a tag SNP. We also conducted a reporter gene assay to assess the promoter activity of two major haplotypes derived from SNPs at this region. We detected 3 common SNPs (rs4906902, rs8179184 and rs20317) at this region that had strong pair-wise linkage disequilibrium. The C allele of rs4906902 was found to be associated with increased risk of heroin dependence (odds ratio:1.27, p?=?0.002). Two major haplotypes (C-A-G and T-G-C) derived from these 3 SNPs accounted for 99% of this sample, and reporter gene activity assay showed that haplotype C-A-G that contained the C allele of the tag SNP rs4906902 had higher activity than haplotype T-G-C. Our data suggest that GABRB3 might be associated with heroin dependence, and increased expression of GABRB3 might contribute to the pathogenesis of heroin dependence. PMID:25025424

  17. Dihydrocodeine A useful tool in the detoxification of methadone-maintained patients

    Microsoft Academic Search

    J Banbery; K Wolff; D Raistrick

    2000-01-01

    We investigated the merit of dihydrocodeine tartrate for withdrawal in detoxifying 20 methadone-maintained patients presenting for treatment at the Leeds Addiction Unit (LAU). Thirteen patients (65%) successfully completed methadone detoxification and were abstinent from both methadone and opiate-type drugs at the end of the 2-week program. On completion, three patients began treatment with Naltrexone and another was abstinent at a

  18. Cocaine-specific Antibodies Blunt the Subjective Effects of Smoked Cocaine in Humans

    PubMed Central

    Haney, Margaret; Gunderson, Erik W.; Jiang, Huiping; Collins, Eric D.; Foltin, Richard W.

    2012-01-01

    Background Rates of relapse among cocaine-dependent patients are high, and new treatment approaches are needed. Clinical data demonstrate that a cocaine vaccine (TA-CD: Celtic Pharmaceutical) produces selective anti-cocaine antibodies, yet the impact of these antibodies on cocaine’s direct effects is unknown. The objective of this human laboratory study was to measure the relationship between antibody titers and the effects of smoked cocaine on ratings of intoxication, craving and cardiovascular effects. Methods Ten cocaine-dependent men not seeking drug treatment spent 2 nights per week for 13 weeks inpatient where the effects of cocaine (0, 25, 50 mg) were determined prior to vaccination and at weekly intervals thereafter. Two doses of TA-CD (82 µg, n=4; 360 µg, n=6) were administered at weeks 1, 3, 5 and 9. Results Peak plasma antibody levels, which were highly variable, significantly predicted cocaine’s effects. Those individuals in the upper half of antibody production had an immediate (within 4 minutes of cocaine smoking) and robust (55–81%) reduction in ratings of Good Drug Effect and Cocaine Quality, while those in the lower half showed only a nonsignificant attenuation (6–26%). Self-reported cocaine use while participants were outpatient tended to decrease as a function of antibody titer (p < 0.12). By contrast, higher antibody levels predicted significantly greater cocaine-induced tachycardia. Conclusions The TA-CD vaccine substantially decreased smoked cocaine’s intoxicating effects in those generating sufficient antibody. These data support further testing of cocaine immunotherapy as a treatment for cocaine dependence. PMID:19846066

  19. Methadone, monoamine oxidase, and depression: opioid distribution and acute effects on enzyme activity

    SciTech Connect

    Kaufmann, C.A.; Kreek, M.J.; Raghunath, J.; Arns, P.

    1983-09-01

    Narcotic withdrawal is often accompanied by an atypical depression which responds to resumption of narcotics. It was hypothesized that methadone might exert its antidepressant effects through monoamine oxidase (MAO) inhibition. The current study examined /sub 3/H-methadone distribution in rat brain and effects on regional MAO activity with acute doses (2.5 mg/kg) which approximate those found during chronic methadone maintenance in man. Limbic areas (amygdala, basomedial hypothalamus, caudate-putamen, hippocampus, preoptic nucleus), as well as pituitary and liver were assayed for MAO activity and methadone concentration. MAO activities did not differ significantly in acute methadone or saline-treated cage-mates at 1 or 24 hr. The concentrations of methadone at 1 hr ranged between 17 and 223 ng/100 mg wet wt tissue in the preoptic nucleus and pituitary, respectively. No significant correlation was found between change in MAO activity (MAO methadone/MAO saline) and methadone concentration in any region at 1 or 24 hr. This study does not support the hypothesis that methadone acts as an antidepressant through MAO inhibition, at least not following acute administration of this exogenous opioid.

  20. There is no age limit for methadone: a retrospective cohort study

    Microsoft Academic Search

    Kenneth M Dürsteler-MacFarland; Marc Vogel; Gerhard A Wiesbeck; Sylvie A Petitjean

    2011-01-01

    Background  Data from the US indicates that methadone-maintained populations are aging, with an increase of patients aged 50 or older.\\u000a Data from European methadone populations is sparse. This retrospective cohort study sought to evaluate the age trends and\\u000a related developments in the methadone population of Basel-City, Switzerland.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The study included methadone patients between April 1, 1995 and March 31, 2003. Anonymized

  1. Therapeutic challenges in cancer pain management: a systematic review of methadone.

    PubMed

    Good, Phillip; Afsharimani, Banafsheh; Movva, Ramya; Haywood, Alison; Khan, Sohil; Hardy, Janet

    2014-09-01

    The proven therapeutic efficacy of methadone in cancer pain is hindered by a challenging pharmacokinetic-pharmacodynamic profile, considerable interpatient variation, and increasing concern about the complexities of dosing. The objective of this study was to assess the evidence for the use of methadone in cancer pain management. The authors conducted a systematic literature search for randomized controlled trials (RCTs) published post the 2007 Cochrane review of methadone in cancer pain. Trial quality was assessed using the Oxford Quality Scoring System and Cochrane Handbook for Systematic Reviews of Interventions. Of the 152 abstracts found, 4 were RCTs (272 participants). Two RCTs compared the efficacy and safety of methadone with placebo or active control and two investigated rotation to methadone from other opioids. The studies used different routes of administration, dosing, initiation, and titration of methadone and distinct pain scoring tools and did not address the issues raised by the Cochrane review. Methadone has an important role in the management of cancer pain, with many advantages including low cost, high oral bioavailability, rapid onset of action, once-daily dosing, and postulated benefits in difficult pain control scenarios. However, due to limited research in this area, methadone dosing remains a challenge, with vigilant dose initiation, adjustment, and monitoring required. There is a need for further studies using standardized methodology to evaluate the optimal dosing strategy of methadone, the effect on different types of pain, and the role of pharmacokinetics and pharmacogenomics in clinical outcomes. PMID:25102037

  2. Methadone Maintenance and HIV Prevention: A Cost-Effectiveness Analysis

    Microsoft Academic Search

    Gregory S. Zaric; Margaret L. Brandeau; Paul G. Barnett

    2000-01-01

    We assess the cost-effectiveness of maintenance treatment for heroin addiction, with emphasis on its role in preventing HIV infection. The analysis is based on a dynamic compartmental model of the HIV epidemic among a population of adults, ages 18 to 44. The population is divided into nine compartments according to infection status and risk group. The model takes into account

  3. Diffusivity of the uncinate fasciculus in heroin users relates to their levels of anxiety

    PubMed Central

    Wong, N M L; Cheung, S-H; Chan, C C H; Zeng, H; Liu, Y-P; So, K-F; Lee, T M C

    2015-01-01

    Heroin use is closely associated with emotional dysregulation, which may explain its high comorbidity with disorders such as anxiety and depression. However, the understanding of the neurobiological etiology of the association between heroin use and emotional dysregulation is limited. Previous studies have suggested an impact of heroin on diffusivity in white matter involving the emotional regulatory system, but the specificity of this finding remains to be determined. Therefore, this study investigated the association between heroin use and diffusivity of white matter tracts in heroin users and examined whether the tracts were associated with their elevated anxiety and depression levels. A sample of 26 right-handed male abstinent heroin users (25 to 42 years of age) and 32 matched healthy controls (19 to 55 years of age) was recruited for this study. Diffusion tensor imaging data were collected, and their levels of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Our findings indicated that heroin users exhibited higher levels of anxiety and depression, but the heroin use-associated left uncinate fasciculus was only related to their anxiety level, suggesting that association between heroin and anxiety has an incremental organic basis but that for depression could be a threshold issue. This finding improves our understanding of heroin addiction and its comorbid affective disorder and facilitates future therapeutic development. PMID:25918991

  4. Buprenorphine from detox and beyond: preliminary evaluation of a pilot program to increase heroin dependent individuals' engagement in a full continuum of care.

    PubMed

    Donovan, Dennis M; Knox, Patricia C; Skytta, Jenny A F; Blayney, Jessica A; DiCenzo, Jessica

    2013-04-01

    Absence of successful transition to post-detoxification treatment leads to high rates of relapse among detoxified heroin users. The present study evaluated a pilot buprenorphine treatment program (BTP). Heroin dependent individuals were inducted onto buprenorphine/naloxone in detox, maintained while transitioning through an intensive inpatient program (IIP), and gradually tapered off medication over 5 months of outpatient (OP) treatment. Compared to programmatic indicators of treatment engagement in the year prior to BTP implementation, referrals from detox to IIP, entry into and completion of IIP and subsequent OP, and days in OP treatment increased substantially. BTP completers, compared to non-completers, viewed abstinence as more difficult and as requiring more assistance to achieve, were less likely to be current cocaine and alcohol users or to have relapsed during the course of treatment. Although preliminary and in need of replication, initial adjunctive use of buprenorphine in an abstinence-based continuum of care may improve post-detoxification treatment entry, engagement, and completion. PMID:23007109

  5. The First American Cocaine Epidemic.

    ERIC Educational Resources Information Center

    Courtwright, David T.

    1991-01-01

    Discusses the wave of cocaine abuse that followed the drug's recommendation by the late nineteenth-century medical community as a cure all. Details drug addiction among ethnic and social groups at the turn of the century. Warns that drug epidemics have important social and legal consequences. Suggests legal pressure may alter the form of drug…

  6. ARCHIVAL REPORT Nondependent Stimulant Users of Cocaine and

    E-print Network

    Squire, Larry R.

    ARCHIVAL REPORT Nondependent Stimulant Users of Cocaine and Prescription Amphetamines Show Verbal: Stimulants are used increasingly to enhance social (cocaine) or cognitive performance (stimulants normally and methylphenidate, intensifies these deficits. Key Words: Amphetamine, cocaine, executive function, stimulant

  7. 21 CFR 862.3250 - Cocaine and cocaine metabolite test system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Toxicology Test Systems § 862.3250 Cocaine and cocaine...

  8. Risk factors for cocaine-induced paranoia in cocaine-dependent sibling pairs

    Microsoft Academic Search

    Rasmon Kalayasiri; Henry R. Kranzler; Roger Weiss; Kathleen Brady; Ralitza Gueorguieva; Carolien Panhuysen; Bao-Zhu Yang; Lindsay Farrer; Joel Gelernter; Robert T. Malison

    2006-01-01

    ObjectiveCocaine-induced paranoia (CIP), an irrational intense suspicion of others, is a common manifestation of cocaine dependence. Both environmental and genetic factors are thought to play a role, but the specific nature of such contributions is poorly understood.

  9. Treating hepatitis C in methadone maintenance patients: an interim analysis

    Microsoft Academic Search

    Diana L Sylvestre

    2002-01-01

    Objective: This study evaluates the safety, tolerability, and efficacy of interferon\\/ribavirin combination therapy in methadone maintenance (MM) patients with active hepatitis C (HCV). End-of-treatment results are presented as an interim analysis of efficacy. Methods: Fifty eligible MM patients with active HCV and concomitant liver fibrosis were treated with interferon\\/ribavirin combination therapy using standard dosing regimens. Patients with active drug or

  10. Age and HIV Sexual Risk among Women in Methadone Treatment

    Microsoft Academic Search

    Malitta Engstrom; Tazuko Shibusawa; Nabila El-Bassel; Louisa Gilbert

    2011-01-01

    This study examines the relationship between age and HIV sexual risk behaviors among a random sample of 372 women in methadone\\u000a treatment in New York City. Logistic regression results indicate that women of all ages are at risk for HIV through inconsistent\\u000a condom use. Exposure to intimate partner violence (IPV), alcohol use, and HIV-negative status are associated with inconsistent\\u000a condom

  11. “I Don't Have Another Run Left With It”: Ontological Security in Illness Narratives of Recovering on Methadone Maintenance

    Microsoft Academic Search

    Lee Garth Vigilant

    2005-01-01

    This study examines the accounts of 45 opiate-addicted individuals in recovery with methadone maintenance treatment (MMT). In-depth interviews assess these individuals' meanings and practices of recovery. Results show that methadone patients, in forming their own recovery models, vacillate between competing definitions of recovery: from the strict program established by methadone clinicians and enforced through frequent urinalyses, to the ideal that

  12. Factors associated with methadone treatment duration: a Cox regression analysis.

    PubMed

    Lin, Chao-Kuang; Hung, Chia-Chun; Peng, Ching-Yi; Chao, En; Lee, Tony Szu-Hsien

    2015-01-01

    This study examined retention rates and associated predictors of methadone maintenance treatment (MMT) duration among 128 newly admitted patients in Taiwan. A semi-structured questionnaire was used to obtain demographic and drug use history. Daily records of methadone taken and test results for HIV, HCV, and morphine toxicology were taken from a computerized medical registry. Cox regression analyses were performed to examine factors associated with MMT duration. MMT retention rates were 80.5%, 68.8%, 53.9%, and 41.4% for 3, 6, 12, and 18 months, respectively. Excluding 38 patients incarcerated during the study period, retention rates were 81.1%, 73.3%, 61.1%, and 48.9% for 3 months, 6 months, 12 months, and 18 months, respectively. No participant seroconverted to HIV and 1 died during the 18-months follow-up. Results showed that being female, imprisonment, a longer distance from house to clinic, having a lower methadone dose after 30 days, being HCV positive, and in the New Taipei city program predicted early patient dropout. The findings suggest favorable MMT outcomes of HIV seroincidence and mortality. Results indicate that the need to minimize travel distance and to provide programs that meet women's requirements justify expansion of MMT clinics in Taiwan. PMID:25875531

  13. A Catalytic Antibody against Cocaine Prevents Cocaine's Reinforcing and Toxic Effects in Rats

    Microsoft Academic Search

    Berend Mets; Gail Winger; Camilo Cabrera; Susan Seo; Subhash Jamdar; Ginger Yang; Kang Zhao; Richard J. Briscoe; Rowena Almonte; James H. Woods; Donald W. Landry

    1998-01-01

    Cocaine addiction and overdose have long defied specific treatment. To provide a new approach, the high-activity catalytic antibody mAb 15A10 was elicited using a transition-state analog for the hydrolysis of cocaine to nontoxic, nonaddictive products. In a model of cocaine overdose, mAb 15A10 protected rats from cocaine-induced seizures and sudden death in a dose-dependent fashion; a noncatalytic anticocaine antibody did

  14. Effectiveness of propranolol for cocaine dependence treatment may depend on cocaine withdrawal symptom severity

    Microsoft Academic Search

    Kyle M. Kampman; Joseph R. Volpicelli; Frank Mulvaney; Arthur I. Alterman; James Cornish; Peter Gariti; Avital Cnaan; Sabrina Poole; Eric Muller; Thalia Acosta; Douglas Luce; Charles O'Brien

    2001-01-01

    Propranolol may reduce symptoms of autonomic arousal associated with early cocaine abstinence and improve treatment outcome. This trial was an 8-week, double-blind, placebo-controlled trial of propranolol in 108 cocaine dependent subjects. The primary outcome measure was quantitative urinary benzoylecgonine levels. Secondary outcome measures included treatment retention, addiction severity index results, cocaine craving, mood and anxiety symptoms, cocaine withdrawal symptoms, and

  15. Normalizing effect of heroin maintenance treatment on stress-induced brain connectivity

    PubMed Central

    Walter, Marc; Gerber, Hana; Seifritz, Erich; Brenneisen, Rudolf; Wiesbeck, Gerhard A.; Riecher-Rössler, Anita; Lang, Undine E.; Borgwardt, Stefan

    2015-01-01

    Recent evidence has shown that a single maintenance dose of heroin attenuates psychophysiological stress responses in heroin-dependent patients, probably reflecting the effectiveness of heroin-assisted therapies for the treatment of severe heroin addiction. However, the underlying neural circuitry of these effects has not yet been investigated. Using a cross-over, double-blind, vehicle-controlled design, 22 heroin-dependent and heroin-maintained outpatients from the Centre of Substance Use Disorders at the University Hospital of Psychiatry in Basel were studied after heroin and placebo administration, while 17 healthy controls from the general population were included for placebo administration only. Functional magnetic resonance imaging was used to detect brain responses to fearful faces and dynamic causal modelling was applied to compute fear-induced modulation of connectivity within the emotional face network. Stress responses were assessed by hormone releases and subjective ratings. Relative to placebo, heroin acutely reduced the fear-induced modulation of connectivity from the left fusiform gyrus to the left amygdala and from the right amygdala to the right orbitofrontal cortex in dependent patients. Both of these amygdala-related connectivity strengths were significantly increased in patients after placebo treatment (acute withdrawal) compared to healthy controls, whose connectivity estimates did not differ from those of patients after heroin injection. Moreover, we found positive correlations between the left fusiform gyrus to amygdala connectivity and different stress responses, as well as between the right amygdala to orbitofrontal cortex connectivity and levels of craving. Our findings indicate that the increased amygdala-related connectivity during fearful face processing after the placebo treatment in heroin-dependent patients transiently normalizes after acute heroin maintenance treatment. Furthermore, this study suggests that the assessment of amygdala-related connectivity during fear processing may provide a prognostic tool to assess stress levels in heroin-dependent patients and to quantify the efficacy of maintenance treatments in drug addiction. PMID:25414039

  16. Heroin addiction as a family phenomenon: a new conceptual model.

    PubMed

    Stanton, M D; Todd, T C; Heard, D B; Kirschner, S; Kleiman, J I; Mowatt, D T; Riley, P; Scott, S M; Van Deusen, J M

    1978-01-01

    The chronic relapsing nature of heroin addiction can be explained from a family systems viewpoint. The addiction cycle is part of a family pattern involving a complex homeostatic system of interlocking feedback mechanisms. These serve to maintain the addiction and consequently the overall family stability. Drug-taking usually starts at adolescence. It is related to an intense fear of separation experienced by the family in response to the addict's attempts at individuation. The family becomes stuck at a particular developmental stage. Heroin provides a solution at several levels to the dilemma of whether or not to allow him independence. Paradoxically, it permits him to simultaneously be both close and distant, "in" and "out", competent and incompetent, relative to his family of origin. This is pseudoindividuation. An understanding of these concepts, and their integration into a homeostatic model, can provide the basis for effective treatment. PMID:371388

  17. Naltrexone for heroin dependence treatment in St. Petersburg, Russia.

    PubMed

    Krupitsky, Evgeny M; Zvartau, Edwin E; Masalov, Dimitry V; Tsoi, Marina V; Burakov, Andrey M; Egorova, Valentina Y; Didenko, Tatyana Y; Romanova, Tatyana N; Ivanova, Eva B; Bespalov, Anton Y; Verbitskaya, Elena V; Neznanov, Nikolai G; Grinenko, Alexandr Y; O'Brien, Charles P; Woody, George E

    2004-06-01

    Naltrexone may be more effective for treating opioid (heroin) dependence in Russia than in the U.S. because patients are mostly young and living with their parents, who can control medication compliance. In this pilot study we randomized 52 consenting patients who completed detoxification in St. Petersburg to a double blind, 6-month course of biweekly drug counseling and naltrexone, or counseling and placebo naltrexone. Significant differences in retention and relapse favoring naltrexone were seen beginning at 1 month and continuing throughout the study. At the end of 6 months, 12 of the 27 naltrexone patients (44.4%) remained in treatment and had not relapsed as compared to 4 of 25 placebo patients (16%; p<0.05). Since heroin dependence is the main way HIV is being spread in Russia, naltrexone is likely to improve treatment outcome and help reduce the spread of HIV if it can be made more widely available. PMID:15182893

  18. Researching a local heroin market as a complex adaptive system.

    PubMed

    Hoffer, Lee D; Bobashev, Georgiy; Morris, Robert J

    2009-12-01

    This project applies agent-based modeling (ABM) techniques to better understand the operation, organization, and structure of a local heroin market. The simulation detailed was developed using data from an 18-month ethnographic case study. The original research, collected in Denver, CO during the 1990s, represents the historic account of users and dealers who operated in the Larimer area heroin market. Working together, the authors studied the behaviors of customers, private dealers, street-sellers, brokers, and the police, reflecting the core elements pertaining to how the market operated. After evaluating the logical consistency between the data and agent behaviors, simulations scaled-up interactions to observe their aggregated outcomes. While the concept and findings from this study remain experimental, these methods represent a novel way in which to understand illicit drug markets and the dynamic adaptations and outcomes they generate. Extensions of this research perspective, as well as its strengths and limitations, are discussed. PMID:19838792

  19. Adolescents at risk: pain pills to heroin: part I.

    PubMed

    Fogger, Susanne; McGuinness, Teena M

    2014-12-01

    Prescription pain medication has proliferated in the United States in the past 10 years, and opioid agents are the second most commonly abused substance in the United States. The opioid class comprises various prescription medications, including hydrocodone, as well as illicit substances, such as opium and heroin. The current article offers an example of one adolescent's history that began as weekend use of prescription opioid agents but expanded to daily use and physical dependence. Currently, a trend exists in which adolescents and young adults are moving from prescription opioid medication to heroin use due to increasing restrictions on prescription opioid agents. Nursing implications and web-based resources for teaching are also presented. PMID:25453507

  20. Randomized Clinical Trial Examining Duration of Voucher-Based Reinforcement Therapy for Cocaine Abstinence

    PubMed Central

    Kirby, Kimberly C.; Carpenedo, Carolyn M.; Dugosh, Karen L.; Rosenwasser, Beth J.; Benishek, Lois A.; Janik, Alicia; Keashen, Rachel; Bresani, Elena; Silverman, Kenneth

    2013-01-01

    Background This is the first study to systematically manipulate duration of Voucher-Based Reinforcement Therapy (VBRT) to see if extending the duration increases abstinence during and following VBRT. Methods We randomized cocaine-dependent methadone-maintained adults to Standard (12 weeks; n=62) or Extended (36 weeks; n=68) VBRT and provided escalating voucher amounts contingent upon urinalysis verification of cocaine abstinence. Urinalysis was scheduled at least every two weeks during the 48-week study and more frequently during VBRT (3/week) and 12 weeks of Aftercare (2/week). Results Extended VBRT produced longer durations of continuous cocaine abstinence during weeks 1–24 (5.7 vs 2.7 weeks; p=0.003) and proportionally more abstinence during weeks 24–36 (X2 =4.57, p=.03, OR=2.18) compared to Standard VBRT. Duration of VBRT did not directly predict after-VBRT abstinence; but longer continuous abstinence during VBRT predicted abstinence during Aftercare (p=0.001) and during the last 12 weeks of the study (p < 0.001). Extended VBRT averaged higher monthly voucher costs compared to Standard VBRT ($96 vs $43, p < .001); however, the average cost per week of abstinence attained was higher in the Standard group ($8.06 vs $5.88, p < .001). Participants in the Extended group with voucher costs exceeding $25 monthly averaged 20 weeks of continuous abstinence. Conclusions Greater abstinence occurred during Extended VBRT, but providing a longer duration was not by itself sufficient to maintain abstinence after VBRT. However, if abstinence can be captured and sustained during VBRT, then providing longer durations may help increase the continuous abstinence that predicts better long-term outcomes. PMID:23680075

  1. Aggressive responding in abstinent heroin addicts: neuroendocrine and personality correlates

    Microsoft Academic Search

    Gilberto Gerra; Amir Zaimovic; Gabriele Moi; Monica Bussandri; Cristina Bubici; Matteo Mossini; Maria Augusta Raggi; Francesca Brambilla

    2004-01-01

    Objective measures of experimentally induced aggressiveness were evaluated in 20 abstinent heroin-dependent subjects, in comparison with 20 normal healthy male subjects. All the subjects were preliminarily submitted to DSM-IV interviews, Buss–Durkee Hostility Inventory (BDHI) and Minnesota Multiphasic Personality Inventory (MMPI II). During a laboratory task, the Point Subtraction Aggression Paradigm (PSAP), subjects earned monetary reinforcers with repeated button presses and

  2. Impaired insight in cocaine addiction: laboratory evidence and effects on cocaine-seeking behaviour

    SciTech Connect

    Moeller, S.J.; Moeller, S.J.; Maloney, T.; Parvaz, M.A.; Alia-Klein, N.; Woicik, P.A.; Telang, F.; Wang, G.-J.; Volkow, N.D.; Goldstein, R.Z.

    2010-04-15

    Neuropsychiatric disorders are often characterized by impaired insight into behaviour. Such an insight deficit has been suggested, but never directly tested, in drug addiction. Here we tested for the first time this impaired insight hypothesis in drug addiction, and examined its potential association with drug-seeking behaviour. We also tested potential modulation of these effects by cocaine urine status, an individual difference known to impact underlying cognitive functions and prognosis. Sixteen cocaine addicted individuals testing positive for cocaine in urine, 26 cocaine addicted individuals testing negative for cocaine in urine, and 23 healthy controls completed a probabilistic choice task that assessed objective preference for viewing four types of pictures (pleasant, unpleasant, neutral and cocaine). This choice task concluded by asking subjects to report their most selected picture type; correspondence between subjects self-reports with their objective choice behaviour provided our index of behavioural insight. Results showed that the urine positive cocaine subjects exhibited impaired insight into their own choice behaviour compared with healthy controls; this same study group also selected the most cocaine pictures (and fewest pleasant pictures) for viewing. Importantly, however, it was the urine negative cocaine subjects whose behaviour was most influenced by insight, such that impaired insight in this subgroup only was associated with higher cocaine-related choice on the task and more severe actual cocaine use. These findings suggest that interventions to enhance insight may decrease drug-seeking behaviour, especially in urine negative cocaine subjects, potentially to improve their longer-term clinical outcomes.

  3. Interpersonal relationships in heroin use by men and women and their role in treatment outcome.

    PubMed

    Eldred, C A; Washington, M N

    1976-01-01

    The majority of both male and female heroin addicts entering a city treatment program were introduced to heroin by a male. But by contrast with the males, females were in many cases introduced to heroin by another woman, more often used drugs with persons of both sexes, and were more likely to be living with a current or former heroin user at intake. Encouragement to give up drugs was reported more frequently by both men and women than attempts to discourage their entry into treatment, but only the encouragement of the spouse or opposite-sexed partner was significantly related to treatment outcome. PMID:1254363

  4. Neurocognitive Characterizations of Russian Heroin Addicts without a Significant History of Other Drug Use

    PubMed Central

    Fishbein, Diana H.; Krupitsky, Evgeny; Flannery, Barbara A.; Langevin, Doris J.; Bobashev, Georgiy; Verbitskaya, Elena; Augustine, Cynthia B.; Bolla, Karen I.; Zvartau, Edwin; Schech, Barry; Egorova, Valentina; Bushara, Natali; Tsoy, Marina

    2007-01-01

    Research on the neurocognitive characteristics of heroin addiction is sparse and studies that do exist include polydrug abusers; thus, they are unable to distinguish neurocognitive effects of heroin from those of other drugs. To identify neurocognitive correlates specific to heroin addiction, the present study was conducted in St. Petersburg, Russia where individuals typically abuse and/or become addicted to only one substance, generally alcohol or heroin. Heroin addicts were recruited from an inpatient treatment facility in St. Petersburg. Three comparison groups included alcoholics, addicts who used both alcohol and heroin, and non-abusers. Psychiatric, background, and drug history evaluations were administered after detoxification to screen for exclusion criteria and characterize the sample. Executive Cognitive Functions (ECF) that largely activate areas of the prefrontal cortex and its circuitry measured include complex visual pattern recognition (Paired Associates Learning), working memory (Delayed Matching to Sample), problem solving (Stockings of Cambridge), executive decision making (Cambridge Decision Making Task), cognitive flexibility (Stroop Color-Word Task) and response shifting (Stop Change Task). In many respects, the heroin addicts were similar to alcohol and alcohol\\heroin dependent groups in neurocognitive deficits relative to controls. The primary finding was that heroin addicts exhibited significantly more disadvantageous decision making and longer deliberation times while making risky decisions than the other groups. Because the nature and degree of recovery from drug abuse are likely a function of the type or pattern of neurocognitive impairment, differential drug effects must be considered. PMID:17382488

  5. Neurocognitive characterizations of Russian heroin addicts without a significant history of other drug use.

    PubMed

    Fishbein, Diana H; Krupitsky, Evgeny; Flannery, Barbara A; Langevin, Doris J; Bobashev, Georgiy; Verbitskaya, Elena; Augustine, Cynthia B; Bolla, Karen I; Zvartau, Edwin; Schech, Barry; Egorova, Valentina; Bushara, Natali; Tsoy, Marina

    2007-09-01

    Research on the neurocognitive characteristics of heroin addiction is sparse and studies that do exist include polydrug abusers; thus, they are unable to distinguish neurocognitive effects of heroin from those of other drugs. To identify neurocognitive correlates specific to heroin addiction, the present study was conducted in St. Petersburg, Russia where individuals typically abuse and/or become addicted to only one substance, generally alcohol or heroin. Heroin addicts were recruited from an inpatient treatment facility in St. Petersburg. Three comparison groups included alcoholics, addicts who used both alcohol and heroin, and non-abusers. Psychiatric, background, and drug history evaluations were administered after detoxification to screen for exclusion criteria and characterize the sample. Executive Cognitive Functions (ECF) that largely activate areas of the prefrontal cortex and its circuitry measured include complex visual pattern recognition (Paired Associates Learning), working memory (Delayed Matching to Sample), problem solving (Stockings of Cambridge), executive decision making (Cambridge Decision Making Task), cognitive flexibility (Stroop Color-Word Task) and response shifting (Stop Change Task). In many respects, the heroin addicts were similar to alcohol and alcohol+heroin dependent groups in neurocognitive deficits relative to controls. The primary finding was that heroin addicts exhibited significantly more disadvantageous decision making and longer deliberation times while making risky decisions than the other groups. Because the nature and degree of recovery from drug abuse are likely a function of the type or pattern of neurocognitive impairment, differential drug effects must be considered. PMID:17382488

  6. QT Interval Screening in Methadone Maintenance Treatment: Report of a SAMHSA Expert Panel

    Microsoft Academic Search

    Judith A. Martin; Anthony Campbell; Thomas Killip; Margaret Kotz; Mori J. Krantz; Mary Jeanne Kreek; Brian A. McCarroll; Davendra Mehta; J. Thomas Payte; Barry Stimmel; Trusandra Taylor; Mark C. P. Haigney; Bonnie B. Wilford

    2011-01-01

    In an effort to enhance patient safety in opioid treatment programs, the Substance Abuse and Mental Health Saervices Administration convened a multi-disciplinary Expert Panel on the Cardiac Effects of Methadone. Panel members (Appendix A) reviewed the literature, regulatory actions, professional guidances, and opioid treatment program experiences regarding adverse cardiac events associated with methadone. The Panel concluded that, to the extent

  7. Slow tapering from methadone maintenance in a program encouraging indefinite maintenance

    Microsoft Academic Search

    Donald A. Calsyn; Jason A. Malcy; Andrew J. Saxon

    2006-01-01

    Longitudinal studies have indicated that most opioid agonist-using patients are not able to successfully complete tapering attempts. Little is known, however, about tapering within a treatment environment that is supportive of indefinite agonist treatment and medication tapering. In this study, all records of patients beginning a slow methadone taper were reviewed (N = 30). No patient successfully completed methadone tapering.

  8. Prenatal care in cocaine-exposed pregnancies

    Microsoft Academic Search

    Gene Burkett; Orlando Gomez-Marin; Salih Y Yasin; Marleny Martinez

    1998-01-01

    Objective: To examine the effect of prenatal care with and without drug rehabilitation on perinatal outcome in cocaine-using women.Methods: Cocaine-exposed pregnancies of 905 human immunodeficiency virus (HIV)-negative women were frequency matched (ratio 6:1) and compared with 150 nonusers. Cocaine subgroups consisted of 278 women who received prenatal care and drug rehabilitation (“comprehensive care”), 206 women who received prenatal care only,

  9. Anti-cocaine antibody and butyrylcholinesterase-derived cocaine hydrolase exert cooperative effects on cocaine pharmacokinetics and cocaine-induced locomotor activity in mice.

    PubMed

    Brimijoin, Stephen; Orson, Frank; Kosten, Thomas R; Kinsey, Berma; Shen, Xiao Yun; White, Sarah J; Gao, Yang

    2013-03-25

    We are investigating treatments for cocaine abuse based on viral gene transfer of a cocaine hydrolase (CocH) derived from human butyrylcholinesterase, which can reduce cocaine-stimulated locomotion and cocaine-primed reinstatement of drug-seeking behavior in rats for many months. Here, in mice, we explored the possibility that anti-cocaine antibodies can complement the actions of CocH to reduce cocaine uptake in brain and block centrally-evoked locomotor stimulation. Direct injections of test proteins showed that CocH (0.3 or 1mg/kg) was effective by itself in reducing drug levels in plasma and brain of mice given cocaine (10mg/kg, s.c., or 20mg/kg, i.p). Administration of cocaine antibody per se at a low dose (8 mg/kg, i.p.) exerted little effect on cocaine distribution. However, a higher dose of antibody (12 mg/kg) caused peripheral trapping (increased plasma drug levels), which led to increased cocaine metabolism by CocH, as evidenced by a 6-fold rise in plasma benzoic acid. Behavioral tests with small doses of CocH and antibody (1 and 8 mg/kg, respectively) showed that neither agent alone reduced mouse locomotor activity triggered by a very large cocaine dose (100mg/kg, i.p.). However, dual treatment completely suppressed the locomotor stimulation. Altogether, we found cooperative and possibly synergistic actions that warrant further exploration of dual therapies for treatment of cocaine abuse. PMID:22960160

  10. Therapeutic Use of Butyrylcholinesterase for Cocaine Intoxication

    Microsoft Academic Search

    C. E. Mattes; T. J. Lynch; A. Singh; R. M. Bradley; P. A. Kellaris; R. O. Brady; K. L. Dretchen

    1997-01-01

    The most common complications of cocaine ingestion are on the cardiovascular and central nervous systems and produce chest pain and generalized seizures. In humans, decreased levels of butyrylcholinesterase (BChE) (EC 3.1.1.8) have been associated with sustained effects of cocaine and life-threatening complications. Administration of purified human BChE has previously been demonstrated to protect against cocaine-associated cardiovascular toxicity in rats. A

  11. [Comorbidity between cocaine addiction and personality disorders].

    PubMed

    Fernández-Montalvo, J; Lorea, I

    2007-01-01

    The aim of this paper was to review the current knowledge about the comorbidity between cocaine dependence and personality disorders. Results concerning a specific profile of cocaine patients are not conclusive. The prevalence rate of personality disorders in cocaine dependents is very heterogeneous (with a mean of 66% of cases), and a great variability is observed between all the studies carried out. There is a tendency for a higher proportion of cocaine dependents to be found within the cluster B category (mainly antisocial and borderline). Lastly, implications of this kind of study for future research and clinical practice are commented upon. PMID:17898818

  12. Epigenetic Inheritance of a Cocaine Resistance Phenotype

    PubMed Central

    Vassoler, Fair M.; White, Samantha L.; Schmidt, Heath D.; Sadri-Vakili, Ghazaleh; Pierce, R. Christopher

    2012-01-01

    A heritable phenotype resulting from the self-administration of cocaine in rats was delineated. We observed delayed acquisition and reduced maintenance of cocaine self-administration in male, but not female, offspring of sires that self-administered cocaine. Brain-derived neurotrophic factor (BDNF) mRNA and protein were increased in the medial prefrontal cortex (mPFC) and there was an increased association of acetylated histone H3 with BDNF promoters only in the male offspring of cocaine-experienced sires. Administration of a BDNF receptor antagonist (the TrkB receptor antagonist ANA-12) reversed the diminished cocaine self-administration in male cocaine-sired rats. In addition, the association of acetylated histone H3 with BDNF promoters was increased in the sperm of sires that self-administered cocaine. Collectively, these findings indicate that voluntary paternal ingestion of cocaine results in epigenetic reprograming of the germline resulting in profound effects on mPFC gene expression and resistance to cocaine reinforcement in male offspring. PMID:23242310

  13. Neuropsychiatric effects of cocaine use disorders.

    PubMed Central

    Nnadi, Charles U.; Mimiko, Olubansile A.; McCurtis, Henry L.; Cadet, Jean Lud

    2005-01-01

    Individuals who use cocaine report a variety of neuropsychiatric symptoms that are yet to be adequately targeted with treatment modalities. To address this problem requires an understanding of these symptoms and their neurobiological origins. Our paper reviewed the existing data on the neuropsychiatic implications of cocaine. We conducted a Medline search from 1984-2004 using terms, such as "cocaine", "cocaine addiction", "cocaine abuse", "cocaine neuropsychiatry" and "dual diagnosis". The search produced additional reference materials that were used in this review, although we focused on data that have likely clinical implications. The literature evidence suggested that, whereas acute cocaine overdose is potentially fatal, the ingestion of mild-to-moderate doses could result in fatal or nonfatal neuropsychiatric events. Also, chronic cocaine use may be associated with deficits in neurocognition, brain perfusion and brain activation patterns. Some of these deficits were unresolved with periods of abstinence ranging from 3-200 days. Taken together, these studies suggest the need for further investigations to fully characterize the neurobiological substrates of cocaine use disorders (CUDs) with the future possibility of more efficient treatment modalities. PMID:16334497

  14. An Antidote for Acute Cocaine Toxicity

    PubMed Central

    Treweek, Jennifer B.; Janda, Kim D.

    2012-01-01

    Not only has immunopharmacotherapy grown into a field that addresses the abuse of numerous illicit substances, but also the treatment methodologies within immunopharmacotherapy have expanded from traditional active vaccination to passive immunization with anti-drug monoclonal antibodies, optimized mAb formats, and catalytic drug-degrading antibodies. Many laboratories have focused on transitioning distinct immunopharmacotherapeutics to clinical evaluation, but with respect to the indication of cocaine abuse, only the active vaccine TA-CD, which is modeled after our original cocaine hapten GNC1, has been carried through to human clinical trials.2 The successful application of murine mAb GNC92H2 to the reversal of cocaine overdose in a mouse model prompted investigations of human immunoglobulins with the clinical potential to serve as cocaine antidotes. We now report the therapeutic utility of a superior clone, human mAb GNCgzk (Kd = 0.18 nM), which offers a 10-fold improvement in cocaine binding affinity. The GNCgzk manifold was engineered for rapid cocaine clearance, and administration of the F(ab?)2 and Fab formats even after the appearance of acute behavioral signs of cocaine toxicity granted nearly complete prevention of lethality. Thus, contrary to the immunopharmacotherapeutic treatment of drug self-administration, minimal antibody doses were shown to counteract the lethality of a molar excess of circulating cocaine. Passive vaccination with drug-specific antibodies represents a viable treatment strategy for the human condition of cocaine overdose. PMID:22380623

  15. Heroin: from drug to ambivalent medicine : on the introduction of medically prescribed heroin and the emergence of a new space for treatment.

    PubMed

    Schepelern Johansen, Birgitte; Schepelern Johansen, Katrine

    2015-03-01

    This article provides an anthropological analysis of the introduction of medically prescribed heroin as part of official substance abuse treatment. While anthropological inquiries of substance abuse treatment have mainly focused on providing the users perspectives on the (ab)use or unraveling the conflicts and negotiations between users and staff, the present article argues for the merits of paying attention to the spatial dimensions of substance abuse treatment. Focusing on the spatial and material ramification of the treatment can shed a nuanced light on the still vulnerable process of altering the heroin from drug to medicine, and thereby on the attempts to settle heroin in a new practical and semantic landscape. The heroin is anchored in some powerful discourses of crime, death, and pleasure, and the analysis shows how these discourses (re-)appear in the spatial textures of the clinic, contesting the attempts to medicalize the heroin. Further, the article argues that even though the treatment aims at a marginalization of the heroin in the life of the clients, the spatial arrangements and the practices within them simultaneously enforces a centralization of the heroin, making the space for treatment highly ambivalent. PMID:25287574

  16. A hybrid liquid chromatography–mass spectrometry strategy in a forensic laboratory for opioid, cocaine and amphetamine classes in human urine using a hybrid linear ion trap-triple quadrupole mass spectrometer

    Microsoft Academic Search

    Geraldine Dowling; Liam Regan; Julie Tierney; Michael Nangle

    2010-01-01

    A rapid method has been developed to analyse morphine, codeine, morphine-3-glucuronide, 6-monoacetylmorphine, cocaine, benzoylegonine, buprenorphine, dihydrocodeine, cocaethylene, 3,4-methylenedioxyamphetamine, ketamine, 3,4-methylenedioxymethamphetamine, pseudoephedrine, lignocaine, benzylpiperazine, methamphetamine, amphetamine, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine and methadone in human urine. Urine samples were diluted with methanol:water (1:1, v\\/v) and sample aliquots were analysed by hybrid linear ion trap-triple quadrupole mass spectrometry with a runtime of 12.5min. Multiple reaction monitoring

  17. Failure to identify or effectively manage prescription opioid dependence acted as a gateway to heroin use-buprenorphine/naloxone treatment and recovery in a surgical patient.

    PubMed

    Conroy, Stephen; Hill, Duncan

    2014-01-01

    The prescribing of opioid pain medication has increased markedly in recent years, with strong opioid dispensing increasing 18-fold in Tayside, Scotland since 1995. Despite this, little data is available to quantify the problem of opioid pain medication dependence (OPD) and until recently there was little guidance on best-practice treatment. We report the case of a young mother prescribed dihydrocodeine for postoperative pain relief who became opioid dependent. When her prescription was stopped without support, she briefly used heroin to overcome her withdrawal. After re-exposure to dihydrocodeine following surgery 9 years later and treatment with methadone for dependency, she was transferred to buprenorphine/naloxone. In our clinical experience and in agreement with Department of Health and Royal College of General Practitioner guidance, buprenorphine/naloxone is the preferred opioid substitution treatment for OPD. Our patient remains within her treatment programme and has returned to work on buprenorphine 16 mg/naloxone 4 mg in conjunction with social and psychological support. PMID:25519865

  18. Effects of chronic varenicline treatment on nicotine, cocaine, and concurrent nicotine+cocaine self-administration.

    PubMed

    Mello, Nancy K; Fivel, Peter A; Kohut, Stephen J; Carroll, F Ivy

    2014-04-01

    Nicotine dependence and cocaine abuse are major public health problems, and most cocaine abusers also smoke cigarettes. An ideal treatment medication would reduce both cigarette smoking and cocaine abuse. Varenicline is a clinically available, partial agonist at ?4?2* and ?6?2* nicotinic acetylcholine receptors (nAChRs) and a full agonist at ?7 nAChRs. Varenicline facilitates smoking cessation in clinical studies and reduced nicotine self-administration, and substituted for the nicotine-discriminative stimulus in preclinical studies. The present study examined the effects of chronic varenicline treatment on self-administration of IV nicotine, IV cocaine, IV nicotine+cocaine combinations, and concurrent food-maintained responding by five cocaine- and nicotine-experienced adult rhesus monkeys (Macaca mulatta). Varenicline (0.004-0.04?mg/kg/h) was administered intravenously every 20?min for 23?h each day for 7-10 consecutive days. Each varenicline treatment was followed by saline-control treatment until food- and drug-maintained responding returned to baseline. During control treatment, nicotine+cocaine combinations maintained significantly higher levels of drug self-administration than nicotine or cocaine alone (P<0.05-0.001). Varenicline dose-dependently reduced responding maintained by nicotine alone (0.0032?mg/kg/inj) (P<0.05), and in combination with cocaine (0.0032?mg/kg/inj) (P<0.05) with no significant effects on food-maintained responding. However, varenicline did not significantly decrease self-administration of a low dose of nicotine (0.001?mg/kg), cocaine alone (0.0032 and 0.01?mg/kg/inj), or 0.01?mg/kg cocaine combined with the same doses of nicotine. We conclude that varenicline selectively attenuates the reinforcing effects of nicotine alone but not cocaine alone, and its effects on nicotine+cocaine combinations are dependent on the dose of cocaine. PMID:24304823

  19. Effects of Chronic Varenicline Treatment on Nicotine, Cocaine, and Concurrent Nicotine+Cocaine Self-Administration

    PubMed Central

    Mello, Nancy K; Fivel, Peter A; Kohut, Stephen J; Carroll, F Ivy

    2014-01-01

    Nicotine dependence and cocaine abuse are major public health problems, and most cocaine abusers also smoke cigarettes. An ideal treatment medication would reduce both cigarette smoking and cocaine abuse. Varenicline is a clinically available, partial agonist at ?4?2* and ?6?2* nicotinic acetylcholine receptors (nAChRs) and a full agonist at ?7 nAChRs. Varenicline facilitates smoking cessation in clinical studies and reduced nicotine self-administration, and substituted for the nicotine-discriminative stimulus in preclinical studies. The present study examined the effects of chronic varenicline treatment on self-administration of IV nicotine, IV cocaine, IV nicotine+cocaine combinations, and concurrent food-maintained responding by five cocaine- and nicotine-experienced adult rhesus monkeys (Macaca mulatta). Varenicline (0.004–0.04?mg/kg/h) was administered intravenously every 20?min for 23?h each day for 7–10 consecutive days. Each varenicline treatment was followed by saline-control treatment until food- and drug-maintained responding returned to baseline. During control treatment, nicotine+cocaine combinations maintained significantly higher levels of drug self-administration than nicotine or cocaine alone (P<0.05–0.001). Varenicline dose-dependently reduced responding maintained by nicotine alone (0.0032?mg/kg/inj) (P<0.05), and in combination with cocaine (0.0032?mg/kg/inj) (P<0.05) with no significant effects on food-maintained responding. However, varenicline did not significantly decrease self-administration of a low dose of nicotine (0.001?mg/kg), cocaine alone (0.0032 and 0.01?mg/kg/inj), or 0.01?mg/kg cocaine combined with the same doses of nicotine. We conclude that varenicline selectively attenuates the reinforcing effects of nicotine alone but not cocaine alone, and its effects on nicotine+cocaine combinations are dependent on the dose of cocaine. PMID:24304823

  20. Complaints of heroin-maintained patients: A survey of symptoms ascribed to diacetylmorphine

    Microsoft Academic Search

    Kenneth M. Dürsteler-MacFarland; Rudolf Stohler; Andreas Moldovanyi; Simone Rey; Raphaela Basdekis; Patrick Gschwend; Susanne Eschmann; Jürgen Rehm

    2006-01-01

    Prescribing of injectable diacetylmorphine (DAM) for heroin dependence has raised concerns about its safety. In light of various reports by heroin-maintained patients of DAM-related adverse events, and previously established unwanted effects of opioids in pain management, we undertook a survey in February 2001 of a random sample of 132 (127 participated) of 1061 patients prescribed DAM in Switzerland at that

  1. Heroin Use on The Rise Among Women, Wealthier People, CDC Finds

    MedlinePLUS

    ... the biggest increases in heroin use in recent years were found in groups that typically aren't expected to go near the drug, including women, people with private insurance and higher-income individuals, the report said. The gaps in heroin use between men and women, people ...

  2. Heroin Mismatch in the Motor City: Addiction, Segregation, and the Geography of Opportunity

    Microsoft Academic Search

    Paul Draus; Juliette Roddy; Mark Greenwald

    2012-01-01

    In this article, the authors used data from economic and ethnographic interviews with heroin users from Detroit, Michigan, as well as other sources, to illustrate the relationship between heroin users’ mobility patterns and urban and suburban environments, especially in terms of drug acquisition and the geography of opportunity. The authors found that although geographic location and social networks associated with

  3. DEVELOPING A VACCINE AGAINST MULTIPLE PSYCHOACTIVE TARGETS: A CASE STUDY OF HEROIN

    PubMed Central

    Stowe, G. Neil; Schlosburg, Joel E.; Vendruscolo, Leandro F.; Edwards, Scott; Misra, Kaushik K.; Schulteis, Gery; Zakhari, Joseph S.; Koob, George F.; Janda, Kim D.

    2012-01-01

    Heroin addiction is a wide-reaching problem with a spectrum of damaging social consequences. Currently approved heroin addiction medications include drugs that bind at the same receptors (e.g. opioid receptors) occupied by heroin and/or its metabolites in the brain, but undesired side effects of these treatments, maintenance dependence and relapse to drug taking remains problematic. A vaccine capable of blocking heroin’s effects could provide an economical, long-lasting and sustainable adjunct to heroin addiction therapy without the side effects associated with available treatment options. Heroin, however, presents a particularly challenging vaccine target as it is metabolized to multiple psychoactive molecules of differing lipophilicity, with differing abilities to cross the blood brain barrier. In this review, we discuss the opiate scaffolding and hapten design considerations to confer immunogenicity as well as the specificity of the immune response towards structurally similar opiates. In addition, we detail different strategies employed in the design of immunoconjugates for a vaccine-based therapy for heroin addiction treatment. PMID:22229311

  4. Heroin users as ‘folk devils’ and French public attitudes toward public health policy

    Microsoft Academic Search

    Patrick Peretti-Watel

    2003-01-01

    A national telephone survey was conducted to investigate public opinions and attitudes toward drugs issues in France (N=2009). This article aims to study: (a) how French people perceive heroin users and (b) how this perception shapes opinions toward risk reduction policy, alcohol and tobacco. Overall, 73% of respondents considered that heroin users are a danger to their friends and relatives,

  5. Policy makers ignoring science and scientists ignoring policy: the medical ethical challenges of heroin treatment

    Microsoft Academic Search

    Dan Small; Ernest Drucker

    2006-01-01

    A decade of research in Switzerland, The Netherlands, Germany, and Spain now constitutes a massive body of work supporting the use of heroin treatment for the most difficult patients addicted to opiates. These trials concur on this method's safety and efficacy and are now serving as a prelude to the institution of heroin treatment in clinical practice throughout Europe. While

  6. Anticipatory conditioned responses to subjective and physiological effects of heroin in addicted persons

    Microsoft Academic Search

    Humberto M. Trujillo; Eugenia Oviedo-Joekes; Cristina Vargas

    2005-01-01

    Study 1: The aim of this experiment was to analyze in persons detoxified of heroin, conditioned responses (CRs) that are opposite to the unconditioned physiological and subjective effects that are induced by this substance. The basic procedure consisted in presenting slides with images of neutral stimuli (NSs) and conditioned stimuli (CSs) of heroin to both non-addicted and detoxified addicted persons.

  7. Maternal Cocaine Addiction: Correlates and Consequences.

    ERIC Educational Resources Information Center

    Hawley, Theresa Lawton

    This study investigated the effects of cocaine addiction on mothers' ability to care for their children. The population interviewed included 25 cocaine-addicted mothers in a drug treatment center and a comparison group of 25 mothers of children in a Head Start program. Each mother was questioned about: (1) her pregnancy with a specific child…

  8. Effects of crack cocaine on neurocognitive function

    Microsoft Academic Search

    Anne L. Hoff; Henry Riordan; Laurette Morris; Victor Cestaro; Mary Wieneke; Robert Alpert; Gene-Jack Wang; Nora Volkow

    1996-01-01

    Because crack cocaine appears to have a preferential effect on the metabolic and electrophysiological activity of the frontal and temporal regions of the brain (Pascual-Leone et al., 1991a, 1991b; Volkow, 1992), we hypothesized that cognitive measures of those regions would be impaired in crack cocaine users relative to measures in normal volunteers. We used logistic regression to determine the relationship

  9. Cocaine Abuse: The Evolution from Coca Leaves to Freebase.

    ERIC Educational Resources Information Center

    Forno, Joseph J.; And Others

    1981-01-01

    Describes historical and sociological patterns of cocaine use. Discusses cocaine as an example of a new drug abuse trend as users search for new ways of using old drugs in ways that produce enhanced euphoria. Describes the use of cocaine freebase and emergency treatment of cocaine toxicity. (Author)

  10. Smoked cocaine discrimination in humans: Effects of gabapentin

    Microsoft Academic Search

    Margaret Haney; Carl Hart; Eric D. Collins; Richard W. Foltin

    2005-01-01

    ?-Aminobutyric acid (GABA) agonists, such as the GABA analogue, gabapentin, may provide new avenues for pharmacological treatment of cocaine dependence. The purpose of this study was to develop a smoked cocaine drug discrimination procedure in humans to test the effects of gabapentin maintenance on the discriminative stimulus, subjective, cognitive and cardiovascular effects of smoked cocaine. Eight male, nontreatment-seeking, cocaine-dependent volunteers,

  11. The interpretation of cocaine and benzoylecgonine concentrations in postmortem cases

    Microsoft Academic Search

    Amanda J Jenkins; Barry Levine; Jack Titus; John E Smialek

    1999-01-01

    This study examined cocaine and benzoylecgonine concentrations in 100 consecutive deaths where either compound was identified in blood or urine specimens to determine whether any relationship between these concentrations and cause of death can be found. Forty-seven of the 100 cases were deaths attributed to cocaine, narcotic or combined cocaine and narcotic intoxication. There were 13 cases of cocaine intoxication

  12. Challenges and Outcomes of Parallel Care for Patients with Co-Occurring Psychiatric Disorder in Methadone Maintenance Treatment

    PubMed Central

    King, Van L.; Brooner, Robert K.; Peirce, Jessica; Kolodner, Ken; Kidorf, Michael

    2014-01-01

    Objective Most opioid users seeking treatment in community-based substance abuse treatment programs have at least one co-occurring psychiatric disorder, and the presence of psychiatric comorbidity in this population is associated with increased psychological distress, poorer quality of life, and reduced response to substance abuse treatment. This observational study describes clinical outcomes of referring patients receiving methadone maintenance and diagnosed with at least one co-occurring psychiatric disorder to a community psychiatry program located on the same hospital campus. Methods Participants (n=156) were offered priority referrals to a community psychiatry program that included regularly scheduled psychiatrist appointments, individual and group therapy, and enhanced access to psychiatric medications for one-year. Psychiatric distress was measured with the Symptom Checklist (SCL-90-R), which participants completed monthly. Results While about 80% of the sample (n=124) initiated psychiatric care, the average length of treatment was only 128.2 days (SD = 122.8), participants attended only 33% of all scheduled appointments (M = 14.9 sessions, SD = 14.1), and 84% (n = 104) did not complete a full year of care. Of those who did not complete a full year, almost two-thirds (65%, n = 68) left psychiatric care while still receiving substance abuse treatment. Exploratory negative binomial regression showed that baseline cocaine and alcohol use disorder (p = .002 and .022, respectively), and current employment (p = .034), were associated with worse psychiatric treatment retention. Modest reductions in psychiatric distress over time were observed (SCL-90-R Global Severity Index change score = 2.5; paired t = 3.54, df = 121, p = .001). Conclusions Referral of patients with co-occurring psychiatric disorders receiving methadone maintenance to a community psychiatry program is often ineffective, even after reducing common barriers to care. Service delivery models designed to improve attendance and retention, such as integrated care models, should be evaluated. This study is part of a larger clinical trial, registered at www.clinicaltrials.gov under #NCT00787735. PMID:24976801

  13. Buprenorphine, methadone, and morphine treatment during pregnancy: behavioral effects on the offspring in rats.

    PubMed

    Chen, Hwei-Hsien; Chiang, Yao-Chang; Yuan, Zung Fan; Kuo, Chung-Chih; Lai, Mei-Dan; Hung, Tsai-Wei; Ho, Ing-Kang; Chen, Shao-Tsu

    2015-01-01

    Methadone and buprenorphine are widely used for treating people with opioid dependence, including pregnant women. Prenatal exposure to opioids has devastating effects on the development of human fetuses and may induce long-term physical and neurobehavioral changes during postnatal maturation. This study aimed at comparing the behavioral outcomes of young rats prenatally exposed to buprenorphine, methadone, and morphine. Pregnant Sprague-Dawley rats were administered saline, morphine, methadone, and buprenorphine during embryonic days 3-20. The cognitive function, social interaction, anxiety-like behaviors, and locomotor activity of offsprings were examined by novel object recognition test, social interaction test, light-dark transition test, elevated plus-maze, and open-field test between 6 weeks and 10 weeks of age. Prenatal exposure to methadone and buprenorphine did not affect locomotor activity, but significantly impaired novel object recognition and social interaction in both male and female offsprings in the same manner as morphine. Although prenatal exposure to methadone or buprenorphine increased anxiety-like behaviors in the light-dark transition in both male and female offsprings, the effects were less pronounced as compared to that of morphine. Methadone affected elevated plus-maze in both sex, but buprenorphine only affected the female offsprings. These findings suggest that buprenorphine and methadone maintenance therapy for pregnant women, like morphine, produced detrimental effects on cognitive function and social behaviors, whereas the offsprings of such women might have a lower risk of developing anxiety disorders. PMID:25834439

  14. Methadone ameliorates multiple-low-dose streptozotocin-induced type 1 diabetes in mice

    SciTech Connect

    Amirshahrokhi, K.; Dehpour, A.R. [Department of Pharmacology School of Medicine, Tehran University of Medical Sciences, Tehran (Iran, Islamic Republic of); Hadjati, J. [Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran (Iran, Islamic Republic of); Sotoudeh, M. [Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran (Iran, Islamic Republic of); Ghazi-Khansari, M. [Department of Pharmacology School of Medicine, Tehran University of Medical Sciences, Tehran (Iran, Islamic Republic of)], E-mail: ghazikha@sina.tums.ac.ir

    2008-10-01

    Type 1 diabetes is an autoimmune disease characterized by inflammation of pancreatic islets and destruction of {beta} cells by the immune system. Opioids have been shown to modulate a number of immune functions, including T helper 1 (Th1) and T helper 2 (Th2) cytokines. The immunosuppressive effect of long-term administration of opioids has been demonstrated both in animal models and humans. The aim of this study was to determine the effect of methadone, a {mu}-opioid receptor agonist, on type 1 diabetes. Administration of multiple low doses of streptozotocin (STZ) (MLDS) (40mg/kg intraperitoneally for 5 consecutive days) to mice resulted in autoimmune diabetes. Mice were treated with methadone (10mg/kg/day subcutaneously) for 24days. Blood glucose, insulin and pancreatic cytokine levels were measured. Chronic methadone treatment significantly reduced hyperglycemia and incidence of diabetes, and restored pancreatic insulin secretion in the MLDS model. The protective effect of methadone can be overcome by pretreatment with naltrexone, an opioid receptor antagonist. Also, methadone treatment decreased the proinflammatory Th1 cytokines [interleukin (IL)-1{beta}, tumor necrosis factor-{alpha} and interferon-{gamma}] and increased anti-inflammatory Th2 cytokines (IL-4 and IL-10). Histopathological observations indicated that STZ-mediated destruction of {beta} cells was attenuated by methadone treatment. It seems that methadone as an opioid agonist may have a protective effect against destruction of {beta} cells and insulitis in the MLDS model of type 1 diabetes.

  15. Buprenorphine and methadone for opioid addiction during pregnancy.

    PubMed

    Mozurkewich, Ellen L; Rayburn, William F

    2014-06-01

    Buprenorphine and methadone are opioid-receptor agonists used as opioid substitution therapy during pregnancy to limit exposure of the fetus to cycles of opioid withdrawal and reduce the risk of infectious comorbidities of illicit opioid use. As part of a comprehensive care plan, such therapy may result in improved access to prenatal care, reduced illicit drug use, reduced exposure to infections associated with intravenous drug use, and improved maternal nutrition and infant birth weight. This article describes differences in patient selection between the two drugs, their relative safety during pregnancy, and changes in daily doses as a guide for prescribing clinicians. PMID:24845488

  16. Management of chronic neuropathic pain with methadone: a review of 13 cases.

    PubMed

    Altier, Nadège; Dion, Dominique; Boulanger, Aline; Choinière, Manon

    2005-01-01

    The synthetic opioid methadone has generated much interest in recent years among clinicians involved in the management of intractable chronic cancer pain. Its use as an analgesic is starting to extend to the treatment of noncancer pain, particularly neuropathic pain. Unfortunately, the evidence for its use in the management of neuropathic pain is limited to a few case studies. We examined retrospectively during a 12-month study period the clinical response of all 13 patients at our pain clinic who were prescribed methadone in an attempt to control neuropathic pain resistant to conventional analgesics. A questionnaire was also administered to the 9 patients who continued to take methadone at 12 months posttreatment. A total of 4 patients (31%) discontinued it by the end of the 12-month study period. Patients discontinued methadone due to the absence of pain relief and due to various intractable, undesirable side effects. Somnolence was the most common adverse effect reported, followed by nausea, constipation, and vomiting. All patients took coanalgesics (eg, amitriptyline, gabapentin) or other analgesics (eg, morphine, nonsteroidal anti-inflammatory drugs) during methadone treatment to control pain. The 9 patients who continued to take methadone at 12 months reported experiencing on average 43% pain relief (range 0-80%), 47% improvement in quality of life (range 0-100%), and 30% improvement in quality of sleep (range 0-60%). Methadone was effective at relieving pain and ameliorating quality of life and sleep in 62% of patients. These findings suggest that methadone can offer an acceptable success rate for the treatment of neuropathic pain. Prospective randomized, placebo-controlled studies are now needed to examine more rigorously the benefits of methadone for this type of pain. PMID:15951657

  17. There is no age limit for methadone: a retrospective cohort study

    PubMed Central

    2011-01-01

    Background Data from the US indicates that methadone-maintained populations are aging, with an increase of patients aged 50 or older. Data from European methadone populations is sparse. This retrospective cohort study sought to evaluate the age trends and related developments in the methadone population of Basel-City, Switzerland. Methods The study included methadone patients between April 1, 1995 and March 31, 2003. Anonymized data was taken from the methadone register of Basel-City. For analysis of age distributions, patient samples were split into four age categories from '20-29 years' to '50 years and over'. Cross-sectional comparisons were performed using patient samples of 1996 and 2003. Results Analysis showed a significant increase in older patients between 1996 and 2003 (p < 0.001). During that period, the percentage of patients aged 50 and over rose almost tenfold, while the proportion of patients aged under 30 dropped significantly from 52.8% to 12.3%. The average methadone dose (p < 0.001) and the 1-year retention rate (p < 0.001) also increased significantly. Conclusions Findings point to clear trends in aging of methadone patients in Basel-City which are comparable, although less pronounced, to developments among US methadone populations. Many unanswered questions on medical, psychosocial and health economic consequences remain as the needs of older patients have not yet been evaluated extensively. However, older methadone patients, just as any other patients, should be accorded treatment appropriate to their medical condition and needs. Particular attention should be paid to adequate solutions for persons in need of care. PMID:21592331

  18. Cocaine-induced psychosis and impulsivity in cocaine-dependent patients.

    PubMed

    Roncero, Carlos; Daigre, Constanza; Grau-López, Lara; Rodríguez-Cintas, Laia; Barral, Carmen; Pérez-Pazos, Jesús; Gonzalvo, Begoña; Corominas, Margarita; Casas, Miguel

    2013-01-01

    Cocaine-dependent patients have high impulsiveness. Cocaine-induced psychosis is common among cocaine-dependent patients. Different risk factors associated with cocaine-induced psychosis have been reported. The aim of this study is to analyze the relationship between psychotic symptoms in cocaine-dependent patients and impulsivity and mental disorders characterized by impulsivity. This descriptive study included 287 outpatients with cocaine dependence according to the DSM-IV-TR criteria. The Structured Clinical Interview for DSM-IV Axis I and II, the Barratt Impulsiveness Scale, and a specific questionnaire on the presence of cocaine-induced psychosis were used to assess patients. Symptoms were observed in 59.9% of the study population. Total and cognitive impulsiveness scores obtained from the Barratt Impulsiveness Scale were significantly higher in patients with cocaine-induced psychosis. Individuals from this group reported more overdose incidents, initiated more treatments during their lifetime, and had a significantly greater prevalence of attention deficit hyperactivity disorder. Patients with cocaine-induced psychosis have a greater degree of impulsivity and a higher prevalence of attention deficit hyperactivity disorder. Thus, if these disorders are observed in cocaine-dependent participants, the presence of psychotic symptoms should be evaluated to prevent further occurrence and their consequences. PMID:24074192

  19. Heroin-Induces Differential Protein Expression by Normal Human Astrocytes (NHA)

    PubMed Central

    Reynolds, Jessica L.; Mahajan, Supriya D.; Sykes, Donald; Nair, Madhavan P.N.

    2006-01-01

    Heroin use is postulated to act as a cofactor in the neuropathogenesis of human immunodeficiency virus (HIV-1) infection. Astrocytes, integral components of the CNS, are reported to be susceptible to HIV-1 infection. Upon activation, astrocytes release a number of immunoregulatory products or modulate the expression of a number of proteins that foster the immunopathogenesis of HIV-1 infection. However, the role of heroin on HIV-1 infectivity and the expression of the proteome of normal human astrocytes (NHA) have not been elucidated. We hypothesize that heroin modulates the expression of a number of proteins by NHA that foster the neuoropathogenesis of HIV-1 infection. We utilized LTR amplification and the p24 antigen assay to quantitate the effect of heroin on HIV-1 infectivity while difference gel electrophoresis (DIGE) combined with protein identification through high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) to analyze the effects of heroin on the proteomic profile of NHA. Results demonstrate that heroin potentiates HIV-1 replication in NHA. Furthermore, heroin significantly increased protein expression levels for protein kinase C (PKC), reticulocalbin 1 precursor, reticulocalbin 1, tyrosine 3-monooxgenase/tryptophan 5-monooxgenase activation protein, chloride intracellular channel 1, cathepsin D preproprotein, galectin 1 and myosin light chain alkali. Heroin also significantly decreased protein expression for proliferating cell nuclear antigen, proteasome beta 6 subunit, tropomyosin 3, laminin receptor 1, tubulin alpha 6, vimentin, EF hand domain family member D2, Tumor protein D54 (hD54), ATP synthase, H+ transporting, mitochondrial F1 complex and ribosomal protein S14. Identification of unique, heroin-induced proteins may help to develop novel markers for diagnostic, preventative and therapeutic targeting in heroin using subjects. PMID:17235376

  20. Preparation and in vivo characterization of a cocaine hydrolase engineered from human butyrylcholinesterase for metabolizing cocaine

    PubMed Central

    Xue, Liu; Hou, Shurong; Tong, Min; Fang, Lei; Chen, Xiabin; Jin, Zhenyu; Tai, Hsin-Hsiung; Zheng, Fang; Zhan, Chang-Guo

    2015-01-01

    Cocaine is a widely abused drug without an FDA-approved medication. It has been recognized as an ideal anti-cocaine medication to accelerate cocaine metabolism producing biologically inactive metabolites via a route similar to the primary cocaine-metabolizing pathway, i.e. human butyrylcholinesterase (BChE)-catalyzed hydrolysis. However, the native human BChE has a low catalytic activity against cocaine. We recently designed and discovered a BChE mutant (A199S/F227A/S287G/A328W/Y332G) with a high catalytic activity (kcat = 5700 min?1, KM = 3.1 ?M) specifically for cocaine, and the mutant was proven effective in protecting mice from acute cocaine toxicity of a lethal dose of cocaine (180 mg/kg, LD100). Further characterization in animal models requires establishment of a high-efficiency stable cell line for the BChE mutant production in a relatively larger scale. It has been extremely challenging to develop a high-efficiency stable cell line expressing BChE or its mutant. In the present study, we successfully developed a stable cell line efficiently expressing the BChE mutant by using a lentivirus-based repeated-transduction method. The scale-up protein production enabled us to determine for the first time the in vivo catalytic activity and the biological half-life of this high-activity mutant of human BChE in accelerating cocaine clearance. In particular, it has been demonstrated that the BChE mutant (administrated to mice 1 min prior to cocaine) can quickly metabolize cocaine and completely eliminate cocaine-induced hyperactivity in rodents, implying that the BChE mutant may be developed as a promising therapeutic agent for cocaine abuse treatment. PMID:23849058

  1. Taste function in methadone-maintained opioid-dependent men.

    PubMed

    Bogucka-Bonikowska, Anna; Baran-Furga, Helena; Chmielewska, Karina; Habrat, Boguslaw; Scinska, Anna; Kukwa, Andrzej; Koros, Eliza; Kostowski, Wojciech; Polanowska, Elzbieta; Bienkowski, Przemyslaw

    2002-09-01

    It has been shown repeatedly that opioid dependence is associated with increased consumption of refined sugars. It is possible that this association results from altered taste reactivity in opioid-dependent subjects. Thus, in the present study, we compared taste responses to sweet, bitter, sour and salty solutions in methadone-maintained opioid-dependent men and healthy control subjects. The two groups did not differ in terms of rated intensity or pleasantness of sucrose (1-30%), quinine (0.001-0.005%), citric acid (0.02-0.1%) and sodium chloride (0.18-0.9%) solutions. Proportions of 'sweet-likers', i.e. subjects rating a 30% sucrose (0.88 M) solution as the most pleasant, were also similar in both groups. In line with the previous findings, the methadone-maintained subjects reported adding more table sugar to caffeinated beverages. The results of the present study suggest that changes in taste reactivity may not be responsible for altered dietary choices in opioid addicts. PMID:12167557

  2. Cardiorespiratory function in stable methadone maintenance treatment (MMT) patients.

    PubMed

    Teichtahl, Harry; Wang, David; Cunnington, David; Kronborg, Ian; Goodman, Cathy; Prodromidis, Andy; Drummer, Olaf

    2004-01-01

    Patients in methadone maintenance programmes (MMT) often smoke tobacco and cannabis and many have ongoing illicit drug use. There is therefore potential for these patients to have abnormal cardiorespiratory function; however, few studies address this in stable MMT patients. We assessed resting cardiorespiratory function on 50 stable MMT patients (25 males, 25 females). Forty-six MMT patients were current tobacco smokers, 19 were current cannabis users and none were currently using opioids other than prescribed methadone. We defined abnormalities of respiratory function as those results outside the 95% confidence interval of reference values for normal subjects adjusted for age, weight, height and sex. Thirty-one (62%) MMT patients had reduced carbon monoxide transfer factor (D(L)CO); 17 (34%) had elevated single breath alveolar volume (V(A)) and 43 (86%) had a reduced D(L)CO/V(A) ratio. Six patients (12%) had reduced FEV1; one (2%) had reduced FVC; and nine (18%) had an obstructive ventilatory defect. Ten (20%) patients had PaCO2 higher than 45 mmHg and 14 (28%) had alveolar to arterial oxygen gradient (A-aPO2) higher than 15 mmHg. CXR, Echocardiography and ECG showed no significant abnormalities. We conclude that stable MMT patients have abnormalities of resting respiratory function which may be due to ongoing tobacco cigarette and current or past cannabis smoking. PMID:15511720

  3. Conditioned responses to cocaine-related stimuli in cocaine abuse patients

    Microsoft Academic Search

    Ronald N. Ehrman; Steven J. Robbins; Anna Rose Childress; Charles P. O'Brien

    1992-01-01

    Subjects with a history of free-basing and smoking cocaine but no history of opiate injections were exposed to three sets of stimuli. They received cocaine-related stimuli in one session, opiate-related stimuli in a second session, and non-drug stimuli on a third occasion. Compared to the opiate and non-drug cues, the cocaine-related events caused reliable decreases in skin temperature and skin

  4. Believability of Messages about Cannabis, Cocaine and Heroin among Never-Triers, Trier-Rejecters and Current Users of Cannabis

    ERIC Educational Resources Information Center

    Jones, Sandra C.; Rossiter, John R.

    2004-01-01

    This paper examines the believability of strong warnings about the negative consequences of drug use among young adults in Australia who have never tried, currently use, or have tried and rejected cannabis. It finds that the strong warnings about cannabis are generally believed by never-triers. The same warnings are perceived by current users as…

  5. Effect of Reinforcement Probability and Prize Size on Cocaine and Heroin Abstinence in Prize-Based Contingency Management

    ERIC Educational Resources Information Center

    Ghitza, Udi E.; Epstein, David H.; Schmittner, John; Vahabzadeh, Massoud; Lin, Jia-Ling; Preston, Kenzie L.

    2008-01-01

    Although treatment outcome in prize-based contingency management has been shown to depend on reinforcement schedule, the optimal schedule is still unknown. Therefore, we conducted a retrospective analysis of data from a randomized clinical trial (Ghitza et al., 2007) to determine the effects of the probability of winning a prize (low vs. high) and…

  6. Cocaine attenuates vasoconstriction to ethanol

    SciTech Connect

    Bove, A.A.; Morley, D.; Vosacek, R.; Zhang, X.Y.; Shah, R. (Temple Univ., Philadelphia, PA (United States))

    1991-03-11

    The purpose of this study was to determine the combined effects of cocaine and ethanol on vasomotor tone. Using a standard isolated vascular ring preparation, 24 rings from 7 New Zealand White Rabbits were studied. All rings were denuded as verified by methacholine challenge. The dose response to NE for each ring was used as a standard for vasoconstrictors Dose response curves to ETH and C were done in random order. Concentrations of both ETH and C employed were physiologically attainable in man and below thresholds for coma or death. The dose response curve to ETH was repeated after addition of 4 {times} 10{sup {minus}5} M C to the arterial bath. After adding 1,500 ug/ml of ETH, the dose response curve to C was repeated. Ethanol, alone caused significant vasoconstriction of arterial rings. After the addition of C to the bath, the dose response to ETH was significantly shifted to the right, peak contraction achieved was 36.6 {plus minus} 3.2% of maximal NE contraction. Cocaine alone did not result in any change in resting tension of the rings. When ETH was added to the bath, C caused vasoconstriction, the peak value equivalent to 12.5 {plus minus} 2.2% of maximal contraction to NE.

  7. Use of hair testing to determine methadone exposure in pediatric deaths.

    PubMed

    Tournel, Gilles; Pollard, Jocelyn; Humbert, Luc; Wiart, Jean-François; Hédouin, Valéry; Allorge, Delphine

    2014-09-01

    A case of death attributed to methadone acute poisoning in an infant aged 11 months is reported. A sudden infant death syndrome (SIDS) was suspected, whereas a traumatic cause of death was excluded regarding autopsy findings. Specimens were submitted to a large toxicological analysis, which included ethanol measurement by HS-GC-FID, a targeted screening for drugs of abuse and various prescription drug classes followed by quantification using UPLC-MS/MS methods. Methadone and its metabolite (EDDP) were detected in all the tested fluids, as well as in hair, with a blood concentration of methadone considered as lethal for children (73 ng/mL). The cause of death was determined to be acute "methadone poisoning", and the manner of death was "accidental". A discussion of the case circumstances, the difficulties with the interpretation of toxicological findings in children (blood concentration and hair testing), and the origin of exposure are discussed. PMID:24588273

  8. Adapting problem-solving therapy for depressed older adults in methadone maintenance treatment

    PubMed Central

    Rosen, Daniel; Morse, Jennifer Q; Reynolds, Charles F

    2011-01-01

    Late life depression is prevalent in older adults who are dependent on opiates. Depressive disorders among opiate abusers have detrimental effects on their well-being and ability to refrain from illegal drugs. There are numerous barriers to the provision of appropriate mental health care to older adults receiving methadone maintenance treatment. This article focuses on problem solving therapy (PST) and presents evidence that PST may be a promising non-pharmacological treatment for older methadone clients with comorbid depressive disorders that can be applied within the staffing and resource limits of methadone maintenance treatment facilities. The advantages of PST relative to other behavioral therapies for this population are based on evidence that PST is less cognitively demanding for an older adult population with mood and substance use disorders. A properly modified PST for an older adult substance dependent population with subsyndromal or diagnosed depression may be a viable option for methadone maintenance programs with limited resources. PMID:21036509

  9. Methadone as a rescue for failed high-dose opiate therapy for catastrophic pain

    Microsoft Academic Search

    Mellar P. Davis

    2000-01-01

    Methadone is a unique opioid with several special properties besides being a mu agonist, which makes for difficulty in the\\u000a calculation of equianalgesic doses. A series of three cases is presented to illustrate this point.

  10. Psychopathic Heroin Addicts are not Uniformly Impaired across Neurocognitive Domains of Impulsivity

    PubMed Central

    Vassileva, Jasmin; Georgiev, Stefan; Martin, Eileen; Gonzalez, Raul; Segala, Laura

    2010-01-01

    Background Impulsivity is a hallmark characteristic of drug addiction and a prominent feature of externalizing disorders such as psychopathy that are commonly comorbid with drug addiction. In a previous study (Vassileva et al., 2007) we have shown that psychopathic heroin addicts evidence more impulsive decision-making on the Iowa Gambling Task relative to non-psychopathic heroin addicts. The goal of the current study was to investigate whether the observed impulse-control deficits in psychopathic heroin addicts would generalize to other neurocognitive domains of impulsivity, such as delay discounting and behavioral inhibition among a group of relatively “pure” heroin addicts in Bulgaria who participated in our previous study. Methods We tested 92 currently abstinent male heroin addicts, classified as psychopathic or non-psychopathic based on the Hare Psychopathy Checklist – Revised (PCL-R). We administered two neurocognitive tasks of impulsivity: (1) Delayed Rewards Discounting Task, a measure of temporal discounting of rewards; and (2) Passive Avoidance Learning Task, a measure of behavioral inhibition. Results Psychopathic heroin addicts were not impaired relative to non-psychopathic heroin addicts on the Delayed Rewards Discounting Task and the Passive Avoidance Learning Task, on the latter of which they showed better attentional capacity. Conclusions These results indicate that psychopathic heroin users are not uniformly impaired across neurocognitive domains of impulsivity. Combined with our previous findings, these results suggest that the presence of psychopathy may exacerbate decision-making deficits in psychopathic heroin addicts, but it may not have significant effect on other neurocognitive domains of impulsivity in this population. PMID:21112701

  11. Methadone block of K+ current in squid giant fiber lobe neurons.

    PubMed

    Horrigan, F T; Gilly, W F

    1996-02-01

    Voltage-dependent ionic currents were recorded from squid giant fiber lobe neurons using the whole-cell patch-clamp technique. When applied to the bathing solution, methadone was found to block IK, I Na and I Ca. Both I Na and I Ca were reduced without apparent change in kinetics and exhibited IC(50)'s of 50-100 and 250-500 mu M, respectively, at +10 mV. In contrast, IK was reduced in a time-dependent manner that is well fit by a simple model of open channel block (K(D)= 32+/- or 2 mu M, +60 mV, 10 degrees Celsius). The mechanism of I(K) block was examined in detail and involves a direct action of methadone, a tertiary amine, on K channels rather than an opioid receptor-mediated pathway. The kinetics of I(K) block resemble those reported for internally applied long chain quaternary ammonium (QA) compounds; and recovery from I(K) block is QA-like in its slow time course and strong dependence on holding potential. A quaternary derivative of methadone (N-methyl-methadone) only reproduced the effects of methadone on I(K) when included in the pipette solution; this compound was without effect when applied externally. I(K) block thus appears to involve diffusion of methadone into the cytoplasm and occlusion of the open K channel at the internal QA blocking site by the protonated form of the drug. This proposed mode of action is supported by the pH and voltage dependence of block as well as by the observation that high external K+ speeds the rate of drug dissociation. In addition, the effect of methadone on I(K) evoked during prolonged (300 ms) depolarizations suggests that methadone block may interfere with endogenous K+ channel inactivation. The effects of temperature, methadone stereoisomers, and the methadone-like drugs propoxyphene and nor-propoxyphene on IK block were examined. Methadone was also found to block I(K) in GH3 cells and in chick myoblasts. PMID:8833344

  12. Double-blind randomized trial of buprenorphine and methadone in opiate dependence

    Microsoft Academic Search

    Sylvie Petitjean; Rudolf Stohler; Jean-Jacques Déglon; Santino Livoti; Doris Waldvogel; Claude Uehlinger; Dieter Ladewig

    2001-01-01

    This study compared the safety and efficacy of sublingual buprenorphine tablets with oral methadone in a population of opioid-dependent individuals in a double-blind, randomized, 6-week trial using a flexible dosing procedure. Fifty-eight patients seeking treatment for opioid dependence were recruited in three outpatient facilities and randomly assigned to substitution with buprenorphine or methadone. The retention rate was significantly better in

  13. Reduction in self-reported nicotine dependence after stabilization in methadone maintenance treatment

    Microsoft Academic Search

    Lubomir Okruhlica; Ferdinand Devinsky; Danica Klemplova; Jindra Valentova

    Summary ICD-10 criteria have been used for the assessment of opioid dependence and the Fagerstrom Tolerance Questionnaire (FTQ) to assess tobacco smoking. The mean methadone dose was 106 mg (SD=45) in the studied group, after twelve months in the methadone maintenance treatment programme (MMTP). The mean FTQ score was 6.5 (SD+1.8) before entering, 5.6 (SD+2.1) after stabilization in the MMTP

  14. Daily treadmill exercise attenuates cocaine cue-induced reinstatement and cocaine induced locomotor response but increases cocaine-primed reinstatement

    PubMed Central

    Thanos, Panayotis K.; Stamos, Joshua; Robison, Lisa S.; Heyman, Gary; Tucci, Andrew; Wang, Gene-Jack; Robinson, John K.; Anderson, Brenda J.; Volkow, Nora D.

    2013-01-01

    Exercise affects neuroplasticity and neurotransmission including dopamine (DA), which modulates drug-taking behavior. Previous research in rodents has shown that exercise may attenuate the rewarding effects of drugs of abuse. The present study examined the effects of high and low exercise on cocaine responses in male Wistar rats that had been trained to self-administer and were compared to a group of sedentary rats. High exercise rats (HE) ran daily on a treadmill for 2 h and low exercise (LE) ran daily for 1 h. After 6 weeks of this exercise regimen, rats were tested over 2 days for reinstatement (day 1: cue-induced reinstatement; day 2: cocaine-primed reinstatement). During cue-induced reinstatement, the sedentary rats showed the expected increase in active lever responses when compared to maintenance, whereas these increased responses were inhibited in the exercised rats (HE and LE). During cocaine-primed reinstatement, however, there was a significant increase in active lever presses when compared to maintenance only in the HE group. This data suggests that chronic exercise during abstinence attenuates the cue-induced reinstatement seen in the sedentary rats by 26% (LE) and 21% (HE). In contrast, only the high exercise rats exhibited sensitized cocaine-seeking behavior (active lever presses) following cocaine-primed reinstatement. Finally, while sedentary rats increased locomotor activity during cocaine-primed reinstatement over that seen with cocaine during maintenance, this was not observed in the exercised rats, suggesting that exercise may interfere with the sensitized locomotor response during cocaine reinstatement. PMID:23103403

  15. Vital Signs: Demographic and Substance Use Trends Among Heroin Users - United States, 2002-2013.

    PubMed

    Jones, Christopher M; Logan, Joseph; Gladden, R Matthew; Bohm, Michele K

    2015-07-10

    During 2002-2013, heroin overdose death rates nearly quadrupled in the United States, from 0.7 deaths to 2.7 deaths per 100,000 population, with a near doubling of the rates from 2011-2013. Data from the National Survey on Drug Use and Health (NSDUH) indicate heroin use, abuse, and dependence have increased in recent years. In 2013, an estimated 517,000 persons reported past-year heroin abuse or dependence, a nearly 150% increase since 2007. PMID:26158353

  16. Heroin-assisted treatment: has a controversial treatment come of age?†.

    PubMed

    Farrell, Michael; Hall, Wayne

    2015-07-01

    This editorial considers the findings of the systematic review of heroin-assisted treatment, with six different studies from six different countries, published in this issue. The meta-analysis focuses on supervised injected heroin and reports significant crime reduction and an overall cost-effectiveness of treatment. Despite this body of evidence, policy makers remain reluctant to develop this treatment further. The question remains, what else is required to convince policy makers of the value of such treatment for severe and refractory heroin dependence? PMID:26135569

  17. The relative risk of fatal poisoning by methadone or buprenorphine within the wider population of England and Wales

    PubMed Central

    Marteau, Dave

    2015-01-01

    Objective To examine the population-wide overdose risk emerging from the prescription of methadone and buprenorphine for opioid substitution treatment in England and Wales. Design Retrospective administrative data study. Setting National databases for England and Wales. Participants/cases Drug-related mortality data were drawn from the Office for National Statistics, and prescription data for methadone and buprenorphine were obtained from the National Health Service for the years 2007–2012. During this 6-year period, a total of 2366 methadone-related deaths and 52 buprenorphine-related deaths were registered, corresponding to 17?333?163 methadone and 2?602?374 buprenorphine prescriptions issued. The analysis encompassed poisoning deaths among members of the wider population of England and Wales who consumed, but were not prescribed these medications, in addition to patients prescribed methadone or buprenorphine. Main outcome measures Mortality risk: substance-specific overdose rate per 1000 prescriptions issued; relative risk ratio of methadone in relation to buprenorphine. Results During the years 2007–2012, the pooled overdose death rate was 0.137/1000 prescriptions of methadone, compared to 0.022/1000 prescriptions of buprenorphine (including buprenorphine-naloxone). The analysis generated a relative risk ratio of 6.23 (95% CI 4.79 to 8.10) of methadone in relation to buprenorphine. UK Borders Agency data were taken into consideration and revealed that only negligible amounts of methadone and buprenorphine were seized on entering UK territory between 2007 and 2012, suggesting domestic diversion. Conclusions Our analysis of the relative safety of buprenorphine and methadone for opioid substitution treatment reveals that buprenorphine is six times safer than methadone with regard to overdose risk among the general population. Clinicians should be aware of the increased risk of prescribing methadone, and tighter regulations are needed to prevent its diversion. PMID:26024998

  18. Methylphenidate attenuates limbic brain inhibition after cocaine-cues exposure in cocaine abusers.

    SciTech Connect

    Volkow, N.D.; Wang, G.; Volkow, N.D.; Wang, G.-J.; Tomasi, D.; Telang, F.; Fowler, J.S.; Pradhan, K.; Jayne, M.; Logan, J.; Goldstein, R.Z.; Alia-Klein, N.; Wong, C.T.

    2010-07-01

    Dopamine (phasic release) is implicated in conditioned responses. Imaging studies in cocaine abusers show decreases in striatal dopamine levels, which we hypothesize may enhance conditioned responses since tonic dopamine levels modulate phasic dopamine release. To test this we assessed the effects of increasing tonic dopamine levels (using oral methylphenidate) on brain activation induced by cocaine-cues in cocaine abusers. Brain metabolism (marker of brain function) was measured with PET and {sup 18}FDG in 24 active cocaine abusers tested four times; twice watching a Neutral video (nature scenes) and twice watching a Cocaine-cues video; each video was preceded once by placebo and once by methylphenidate (20 mg). The Cocaine-cues video increased craving to the same extent with placebo (68%) and with methylphenidate (64%). In contrast, SPM analysis of metabolic images revealed that differences between Neutral versus Cocaine-cues conditions were greater with placebo than methylphenidate; whereas with placebo the Cocaine-cues decreased metabolism (p<0.005) in left limbic regions (insula, orbitofrontal, accumbens) and right parahippocampus, with methylphenidate it only decreased in auditory and visual regions, which also occurred with placebo. Decreases in metabolism in these regions were not associated with craving; in contrast the voxel-wise SPM analysis identified significant correlations with craving in anterior orbitofrontal cortex (p<0.005), amygdala, striatum and middle insula (p<0.05). This suggests that methylphenidate's attenuation of brain reactivity to Cocaine-cues is distinct from that involved in craving. Cocaine-cues decreased metabolism in limbic regions (reflects activity over 30 minutes), which contrasts with activations reported by fMRI studies (reflects activity over 2-5 minutes) that may reflect long-lasting limbic inhibition following activation. Studies to evaluate the clinical significance of methylphenidate's blunting of cue-induced limbic inhibition may help identify potential benefits of this medication in cocaine addiction.

  19. Contribution of Cytochrome P450 and ABCB1 Genetic Variability on Methadone Pharmacokinetics, Dose Requirements, and Response

    PubMed Central

    Fonseca, Francina; de la Torre, Rafael; Díaz, Laura; Pastor, Antonio; Cuyàs, Elisabet; Pizarro, Nieves; Khymenets, Olha; Farré, Magí; Torrens, Marta

    2011-01-01

    Although the efficacy of methadone maintenance treatment (MMT) in opioid dependence disorder has been well established, the influence of methadone pharmacokinetics in dose requirement and clinical outcome remains controversial. The aim of this study is to analyze methadone dosage in responder and nonresponder patients considering pharmacogenetic and pharmacokinetic factors that may contribute to dosage adequacy. Opioid dependence patients (meeting Diagnostic and Statistical Manual of Mental Disorders, [4th Edition] criteria) from a MMT community program were recruited. Patients were clinically assessed and blood samples were obtained to determine plasma concentrations of (R,S)-, (R) and (S)- methadone and to study allelic variants of genes encoding CYP3A5, CYP2D6, CYP2B6, CYP2C9, CYP2C19, and P-glycoprotein. Responders and nonresponders were defined by illicit opioid consumption detected in random urinalysis. The final sample consisted in 105 opioid dependent patients of Caucasian origin. Responder patients received higher doses of methadone and have been included into treatment for a longer period. No differences were found in terms of genotype frequencies between groups. Only CYP2D6 metabolizing phenotype differences were found in outcome status, methadone dose requirements, and plasma concentrations, being higher in the ultrarapid metabolizers. No other differences were found between phenotype and responder status, methadone dose requirements, neither in methadone plasma concentrations. Pharmacokinetic factors could explain some but not all differences in MMT outcome and methadone dose requirements. PMID:21589866

  20. Methadone inhibits CYP2D6 and UGT2B7/2B4 in vivo: a study using codeine in methadone- and buprenorphine-maintained subjects

    PubMed Central

    Gelston, Eloise A; Coller, Janet K; Lopatko, Olga V; James, Heather M; Schmidt, Helmut; White, Jason M; Somogyi, Andrew A

    2012-01-01

    AIMS To compare the O-demethylation (CYP2D6-mediated), N-demethylation (CYP3A4-mediated) and 6-glucuronidation (UGT2B4/7-mediated) metabolism of codeine between methadone- and buprenorphine-maintained CYP2D6 extensive metabolizer subjects. METHODS Ten methadone- and eight buprenorphine-maintained subjects received a single 60 mg dose of codeine phosphate. Blood was collected at 3 h and urine over 6 h and assayed for codeine, norcodeine, morphine, morphine-3- and -6-glucuronides and codeine-6-glucuronide. RESULTS The urinary metabolic ratio for O-demethylation was significantly higher (P = 0.0044) in the subjects taking methadone (mean ± SD, 2.8 ± 3.1) compared with those taking buprenorphine (0.60 ± 0.43), likewise for 6-glucuronide formation (0.31 ± 0.24 vs. 0.053 ± 0.027; P < 0.0002), but there was no significant difference (P = 0.36) in N-demethylation. Similar changes in plasma metabolic ratios were also found. In plasma, compared with those maintained on buprenorphine, the methadone-maintained subjects had increased codeine and norcodeine concentrations (P < 0.004), similar morphine (P = 0.72) and lower morphine-3- and -6- and codeine-6-glucuronide concentrations (P < 0.008). CONCLUSION Methadone is associated with inhibition of CYP2D6 and UGTs 2B4 and 2B7 reactions in vivo, even though it is not a substrate for these enzymes. Plasma morphine was not altered, owing to the opposing effects of inhibition of both formation and elimination; however, morphine-6-glucuronide (analgesically active) concentrations were substantially reduced. Drug interactions with methadone are likely to include drugs metabolized by various UGTs and CYP2D6. PMID:22092298

  1. Prevalent cocaine use and myocardial infarction.

    PubMed

    Aslibekyan, Stella; Levitan, Emily B; Mittleman, Murray A

    2008-10-15

    Studies have reported a possible link between cocaine use and risk for cardiovascular events. The aim of this study was to examine the association between self-reported cocaine use and physician-diagnosed myocardial infarction (MI) in the Third National Health and Nutrition Examination Survey (NHANES III), conducted from 1988 to 1994. Odds ratios (ORs) were estimated using logistic regression models adjusted for age and additionally for gender, race, and other MI risk factors, which accounted for the complex sampling design. In the group aged 18 to 59 years, there was no statistically significant association between any exposure to cocaine and MI (age-adjusted OR 1.56, 95% confidence interval [CI] 0.44 to 5.50, p = 0.48; multivariate-adjusted OR 1.06, 95% CI 0.30 to 3.73, p = 0.92). Participants who reported using cocaine >10 times had a nonsignificant higher prevalence of MI (age-adjusted OR 3.13, 95% CI 0.80 to 12.25, p = 0.10; multivariate-adjusted OR 1.84, 95% CI 0.46 to 7.29, p = 0.40). However, participants aged 18 to 45 years who reported >10 occasions of cocaine use had a significantly elevated prevalence of MI in age-adjusted models (OR 4.60, 95% CI 1.12 to 18.88, p = 0.035). The association was attenuated in multivariate-adjusted models (OR 3.84, 95% CI 0.98 to 15.07, p = 0.054). The lifetime prevalence of cocaine use increased from 14% in NHANES III to 19% in NHANES 2005-2006. In conclusion, these data support a substantial association between cocaine use and MI; the temporal trend in cocaine use may increase the occurrence of MI, particularly in younger populations. PMID:18929694

  2. Prevalent Cocaine Use and Myocardial Infarction

    PubMed Central

    Aslibekyan, Stella; Levitan, Emily B.; Mittleman, Murray A.

    2008-01-01

    Studies have reported a possible link between cocaine use and risk of cardiovascular events. We examined the association between self-reported cocaine use and physician diagnosed myocardial infarction (MI) in the Third National Health and Nutrition Examination Survey (NHANES III) conducted from 1988–1994. We estimated odds ratios (OR) using logistic regression models adjusted for age and additionally for sex, race, and other MI risk factors, which accounted for the complex sampling design. In the 18–59 age group, there was no statistically significant association between any exposure to cocaine and MI (age-adjusted OR = 1.56, 95% confidence interval (CI): 0.44– 5.50, p-value= 0.48, multivariate-adjusted OR = 1.06, 95% CI: 0.30– 3.73, p-value= 0.92). Participants who reported using cocaine >10 times had a non-significant higher prevalence of MI (age-adjusted OR = 3.13, 95% CI: 0.80- 12.25, p-value= 0.10, multivariate-adjusted OR = 1.84, 95% CI: 0.46– 7.29, p-value= 0.40). However, participants aged 18–45 who reported >10 occasions of cocaine use had a significantly elevated prevalence of MI in age-adjusted models (OR= 4.60, 95% CI: 1.12– 18.88, p-value= 0.035). The association was attenuated in multivariate-adjusted models (OR = 3.84, 95% CI: 0.98– 15.07, p-value= 0.054). The lifetime prevalence of cocaine use increased from 14% in NHANES III to 19% in NHANES 2005–2006. In conclusion, these data support a substantial association between cocaine use and MI; the temporal trend in cocaine use may increase the occurrence of MI, particularly among younger populations. PMID:18929694

  3. Strain dependence of adolescent Cannabis influence on heroin reward and mesolimbic dopamine transmission in adult Lewis and Fischer 344 rats.

    PubMed

    Cadoni, Cristina; Simola, Nicola; Espa, Elena; Fenu, Sandro; Di Chiara, Gaetano

    2015-01-01

    Adolescent Cannabis exposure has been hypothesized to act as a gateway to opiate abuse. In order to investigate the role of genetic background in cannabinoid-opiate interactions, we studied the effect of ?(9) -tetrahydrocannabinol (THC) exposure of adolescent Lewis and Fischer 344 rats on the responsiveness of accumbens shell and core dopamine (DA), as monitored by microdialysis, to THC and heroin at adulthood. Heroin reward and reinstatement by heroin priming were studied by conditioned place preference (CPP) and cognitive and emotional functions by object recognition, Y maze and elevated plus maze paradigms. THC stimulated shell DA in Lewis but not in Fischer 344 rats. Adolescent THC exposure potentiated DA stimulant effects of heroin in the shell and core of Lewis and only in the core of Fischer 344 rats. Control Lewis rats developed stronger CPP to heroin and resistance to extinction compared with Fischer 344 strain. In Lewis rats, THC exposure did not affect heroin CPP but potentiated the effect of heroin priming. In Fischer 344 rats, THC exposure increased heroin CPP and made it resistant to extinction. Lewis rats showed seeking reactions during extinction and hedonic reactions in response to heroin priming. Moreover, adolescent THC exposure affected emotional function only in Lewis rats. These observations suggest that long-term effects of Cannabis exposure on heroin addictive liability and emotionality are dependent on individual genetic background. PMID:23957273

  4. Factors in Sustained Recovery from Cocaine Dependence

    PubMed Central

    McKay, James R.; Van Horn, Deborah; Rennert, Lior; Drapkin, Michelle; Ivey, Megan; Koppenhaver, Janelle

    2013-01-01

    The goal was to identify factors that predicted sustained cocaine abstinence and transitions from cocaine use to abstinence over 24 months. Data from baseline assessments and multiple follow-ups were obtained from three studies of continuing care for patients in intensive outpatient programs (IOPs). In the combined sample, remaining cocaine abstinent and transitioning into abstinence at the next follow-up were predicted by older age, less education, and less cocaine and alcohol use at baseline, and by higher self-efficacy, commitment to abstinence, better social support, lower depression, and lower scores on other problem severity measures assessed during the follow-up. In addition, higher self-help participation, self-help beliefs, readiness to change, and coping assessed during the follow-up predicted transitions from cocaine use to abstinence. These results were stable over 24 months. Commitment to abstinence, self-help behaviors and beliefs, and self-efficacy contributing independently to the prediction of cocaine use transitions. Implications for treatment are discussed. PMID:23561331

  5. Intimate partner violence and monogamy among women in methadone treatment.

    PubMed

    Hearn, Kimberly D; O'Sullivan, Lucia F; El-Bassel, Nabila; Gilbert, Louisa

    2005-06-01

    It is now becoming clear how important it is to understand women's HIV risk in the context of their sexual relationships with male partners, particularly among more vulnerable populations of women such as drug-involved women and women with physically abusive partners. Drawing from in-depth interviews with a sample of 38 ethnically diverse women, this study explores the meanings of monogamy and concurrent sexual partnerships in the relationships of women in methadone treatment with a history of physical abuse. Moreover, the ways in which having a history of intimate partner violence influences women's desire and ability to insist on monogamy is addressed. The women's narratives indicated that the majority valued monogamy and reported practicing it; however, many women were indifferent to this ideal or were unable to challenge non-monogamous partners for fear of severe reprisals. In addition, men's suspicions about violations of monogamy on the part of the women often resulted in extreme violence. PMID:15933837

  6. Ratio size and cocaine concentration effects on oral cocaine-reinforced behavior.

    PubMed Central

    Macenski, M J; Meisch, R A

    1998-01-01

    Monkeys were given a choice between cocaine solutions and water under concurrent fixed-ratio reinforcement schedules. The operant response was spout contact. Six rhesus monkeys served as subjects. The cocaine concentration was varied from 0.0125 to 0.8 mg/ml, and the fixed-ratio value was varied from 8 to 128. Cocaine maintained higher response rates than did water over a wide range of conditions. Response rate and number of cocaine deliveries per session were inverted U-shaped functions of concentration. These functions were shifted to the right as the fixed ratio was increased. The number of cocaine deliveries was more persistent as fixed-ratio value was increased when the unit dose was larger rather than smaller. Cocaine consumption was analyzed as a function of unit price (fixed-ratio value divided by cocaine concentration), and unit price accounted for between 77% and 92% of the variance in cocaine consumption for individual monkeys. The current data support the claim that a drug's reinforcing effects increase directly with dose and underscore the need to gather parametric data when examining the effects of experimental manipulations on a drug-reinforced baseline. PMID:9768506

  7. Antecedents and Correlates of Alcohol, Cocaine, and Alcohol-Cocaine Abuse in Early Adulthood.

    ERIC Educational Resources Information Center

    Windle, Michael; Miller-Tutzauer, Carol

    1991-01-01

    Performed secondary analysis of data from National Longitudinal Survey of Youth, involving 12,686 subjects, to examine patterns of alcohol and cocaine abuse. Found joint alcohol and cocaine abusers demonstrated highest levels of previous 30-day and lifetime drug use, high levels of delinquent activity, and highest rates of unemployment and marital…

  8. Reconceptualizing Early- and Late-Onset: A Life Course Analysis of Older Heroin Users

    PubMed Central

    Boeri, Miriam Williams; Sterk, Claire E.; Elifson, Kirk W.

    2013-01-01

    Purpose Our knowledge regarding older users of illicit drugs is limited despite their increasing numbers. In this paper we apply a life course perspective to gain a further understanding of older adult drug use, specifically contrasting early- and late-onset heroin users. Design and Methods Qualitative data were collected from 29 older heroin users. Life course analysis focused on the users’ experiences across the life span. Results The findings suggest that those aging-into heroin use (late-onset) are disadvantaged compared to those who are maturing-in (early-onset) except in areas of health. Implications We propose that conceptualizing the use of heroin and other illicit drugs among older adults based on their life course trajectory will provide insights for social and health services, including drug treatment. PMID:18981280

  9. Correlations Between Awareness of Illness (Insight) and History of Addiction in Heroin-Addicted Patients

    PubMed Central

    Maremmani, Angelo Giovanni Icro; Rovai, Luca; Rugani, Fabio; Pacini, Matteo; Lamanna, Francesco; Bacciardi, Silvia; Perugi, Giulio; Deltito, Joseph; Dell’Osso, Liliana; Maremmani, Icro

    2012-01-01

    In a group of 1066 heroin addicts, who were seeking treatment for opioid agonist treatment, we looked for differences in historical, demographic, and clinical characteristics, between patients with different levels of awareness of illness (insight). The results showed that, in the cohort studied, a majority of subjects lacked insight into their heroin-use behavior. Compared with the impaired-insight group, those who possessed insight into their illness showed significantly greater awareness of past social, somatic, and psychopathological impairments, and had a greater number of past treatment-seeking events for heroin addiction. In contrast with other psychiatric illnesses, the presence of awareness appears to be related to the passing of time and to the worsening of the illness. Methodologies to improve the insight of patients should, therefore, be targeted more directly on patients early in their history of heroin dependence, because the risk of lack of insight is greatest during this period. PMID:22787450

  10. Nonmedical Use of Prescription Pain Relievers May Raise the Risk of Turning to Heroin Use

    MedlinePLUS

    ... turning to heroin use + Newsroom Media Guidelines for Bullying Prevention Press Announcements SAMHSA in the News Speeches and Presentations Newsroom Media Guidelines for Bullying Prevention Press Announcements SAMHSA in the News Speeches ...

  11. Methadone induction in primary care (ANRS-Methaville): a phase III randomized intervention trial

    PubMed Central

    2012-01-01

    Background In France, the rapid scale-up of buprenorphine, an opioid maintenance treatment (OMT), in primary care for drug users has led to an impressive reduction in HIV prevalence among injecting drug users (IDU) but has had no major effect on Hepatitis C incidence. To date, patients willing to start methadone can only do so in a methadone clinic (a medical centre for drug and alcohol dependence (CSAPA) or a hospital setting) and are referred to primary care physicians after dose stabilization. This study aims to assess the effectiveness of methadone in patients who initiated treatment in primary care compared with those who initiated it in a CSAPA, by measuring abstinence from street opioid use after one year of treatment. Methods/Design The ANRS-Methaville study is a randomized multicenter non-inferiority control trial comparing methadone induction (lasting approximately 2 weeks) in primary care and in CSAPA. The model of care chosen for methadone induction in primary care was based on study-specific pre-training of all physicians, exclusion criteria and daily supervision of methadone during the initiation phase. Between January 2009 and January 2011, 10 sites each having one CSAPA and several primary care physicians, were identified to recruit patients to be randomized into two groups, one starting methadone in primary care (n?=?147), the other in CSAPA (n?=?48). The primary outcome of the study is the proportion of participants abstinent from street opioids after 1 year of treatment i.e. non-inferiority of primary care model in terms of the proportion of patients not using street opioids compared with the proportion observed in those starting methadone in a CSAPA. Discussion The ANRS-Methaville study is the first in France to use an interventional trial to improve access to OMT for drug users. Once the non-inferiority results become available, the Ministry of Health and agency for the safety of health products may change the the New Drug Application (NDA) of methadone and make methadone induction by trained primary care physicians possible. The trial is registered with the French Agency of Pharmaceutical Products (AFSSAPS) under the number 2008-A0277-48, the European Union Drug Regulating Authorities Clinical Trials. Number Eudract 2008-001338-28, the ClinicalTrials.gov Identifier: NCT00657397 and the International Standard Randomised Controlled Trial Number Register ISRCTN31125511. PMID:22741944

  12. Prolonged withdrawal following cocaine self-administration increases resistance to punishment in a cocaine binge

    PubMed Central

    Gancarz-Kausch, Amy M.; Adank, Danielle N.; Dietz, David M.

    2014-01-01

    Drug addiction is characterized by compulsive drug-taking behaviors and a high propensity to relapse following drug cessation. Drug craving and seeking can increase during a period of abstinence, but this phenomenon is not observed in drug-induced reinstatement models. To investigate the effect of withdrawal on cocaine relapse, rats were exposed to extended-access cocaine self-administration and subjected to either 1 or 30?d of withdrawal. When tested during 12?h unlimited access to cocaine (binge), the duration of the withdrawal did not influence cocaine intake. However, using a histamine punishment procedure that greatly suppresses drug-taking behavior, we demonstrate that longer periods of abstinence from cocaine induce a greater persistence in responding for drug in the face of negative consequences. PMID:25363133

  13. Pharmacokinetics and cytokine production in heroin and morphine-treated mice

    Microsoft Academic Search

    Roberta Pacifici; Simonetta di Carlo; Antonella Bacosi; Simona Pichini; Piergiorgio Zuccaro

    2000-01-01

    The parallelism between serum levels of heroin and morphine (M) metabolites and the production of interleukin-1? (IL-1?), interleukin-2 (IL-2), interleukin-10 (IL-10), tumor necrosis factor ? (TNF-?), transforming growth factor-?1 (TGF-?1), and interferon-? (IFN-?) from murine splenocyte cultures following s.c. injection with 20 mg\\/kg heroin or M in C57\\/BL mice is described. The pharmacokinetic profiles of M and inactive morphine-3-glucuronide (M3G)

  14. Mixed Candida glabrata and Candida albicans disseminated candidiasis in a heroin addict

    Microsoft Academic Search

    M. E. Bougnoux; C. Dupont; L. Turner; E. Rouveix; M. Dorra; M. H. Nicolas-Chanoine

    1997-01-01

    The case of a white-heroin addict who developed disseminated candidiasis following coinfection byCandida glabrata andCandida albicans is reported. Genomic random amplified polymorphic DNA typing suggested that theCandida glabrata blood isolates originated in the oral cavity of the patient. This case strengthens the evidence thatCandida species other thanCandida albicans can be involved in the pathogenesis of disseminated candidiasis in heroin addicts.

  15. Unlimited Access to Heroin Self-Administration: Independent Motivational Markers of Opiate Dependence

    Microsoft Academic Search

    Scott A Chen; Laura E O'Dell; Michael E Hoefer; Thomas N Greenwell; Eric P Zorrilla; George F Koob

    2006-01-01

    The goal of the present study was to develop and validate an animal model of unlimited access to intravenous heroin self-administration combined with responding for food and water to characterize the transition to drug dependence. Male Wistar rats were allowed to lever press for heroin (60 ?g\\/kg\\/0.1 ml infusion\\/s; fixed ratio 1; 20-s time out) and nosepoke for food and

  16. Functional consequences of cocaine re-exposure after discontinuation of cocaine availability.

    PubMed

    Beveridge, Thomas J R; Smith, Hilary R; Nader, Susan H; Nader, Michael A; Porrino, Linda J

    2014-10-01

    Cocaine users exhibit a wide range of behavioral impairments accompanied by brain structural, neurochemical and functional abnormalities. Metabolic mapping studies in cocaine users and animal models have shown extensive functional alterations throughout the striatum, limbic system, and cortex. Few studies, however, have evaluated the persistence of these effects following cessation of cocaine availability. The purpose of this study, therefore, was to assess the functional effects of re-exposure to cocaine in nonhuman primates after the discontinuation of cocaine self-administration for 30 or 90 days, using the quantitative autoradiographic 2-[14C]deoxyglucose (2DG) method. Rhesus monkeys self-administered cocaine (fixed interval 3-min schedule, 30 infusions per session, 0.3 mg/kg/infusion) for 100 sessions followed by 30 (n=4) or 90 days (n=3) during which experimental sessions were not conducted. Food-reinforced control animals (n=5) underwent identical schedules of reinforcement. Animals were then re-exposed to cocaine or food for one final session and the 2DG method applied immediately after session completion. Compared to controls, re-exposure to cocaine after 30 or 90 day drug-free periods resulted in lower rates of glucose utilization in ventral and dorsal striatum, prefrontal and temporal cortex, limbic system, thalamus, and midbrain. These data demonstrate that vulnerability to the effects of cocaine persists for as long as 90 days after cessation of drug use. While there was some evidence for recovery (fewer brain areas were affected by cocaine re-exposure at 90 days as compared to 30 days), this was not uniform across regions, thus suggesting that recovery occurs at different rates in different brain systems. PMID:24953829

  17. [The Perioperative Management of Pain in Patients Who Are Addicted to Heroin].

    PubMed

    Lee, Wen-Yi; Weng, Chia-Hsing; Hsu, Yu-Ping; Lin, Pao-Chen

    2015-06-01

    Heroin addicts admitted to the hospital for surgery should be treated as high-risk patients because these patients face a significantly higher risk of experiencing severe drug withdrawal symptoms and of pain management complications during hospitalization. The lack of proper pain management often suffered by heroin addicts during hospitalization has been attributed to care providers' insufficient knowledge regarding opioid medications and their addicting effects as well as fears that opioid medications may cause addiction symptoms to reemerge. The objective of this article is to illustrate the pain management process across the entire hospitalization period for heroin-addicted patients undergoing surgical procedures. This process includes management of the heroin-related physical and psychological reactions from surgery, of the mechanism of pain induced specifically from surgery, and of the heroin addiction during the surgical procedure and subsequent clinical management and nursing care. It is hoped that this article assists healthcare providers to better understand the need for the proper pain management and care of heroin-addicted surgical patients over the entire period of hospitalization and thus the enhancement of the overall quality and safety of patient care management procedures. PMID:26073959

  18. Synaptic glutamate spillover due to impaired glutamate uptake mediates heroin relapse.

    PubMed

    Shen, Hao-wei; Scofield, Michael D; Boger, Heather; Hensley, Megan; Kalivas, Peter W

    2014-04-16

    Reducing the enduring vulnerability to relapse is a therapeutic goal in treating drug addiction. Studies with animal models of drug addiction show a marked increase in extrasynaptic glutamate in the core subcompartment of the nucleus accumbens (NAcore) during reinstated drug seeking. However, the synaptic mechanisms linking drug-induced changes in extrasynaptic glutamate to relapse are poorly understood. Here, we discovered impaired glutamate elimination in rats extinguished from heroin self-administration that leads to spillover of synaptically released glutamate into the nonsynaptic extracellular space in NAcore and investigated whether restoration of glutamate transport prevented reinstated heroin seeking. Through multiple functional assays of glutamate uptake and analyzing NMDA receptor-mediated currents, we show that heroin self-administration produced long-lasting downregulation of glutamate uptake and surface expression of the transporter GLT-1. This downregulation was associated with spillover of synaptic glutamate to extrasynaptic NMDA receptors within the NAcore. Ceftriaxone restored glutamate uptake and prevented synaptic glutamate spillover and cue-induced heroin seeking. Ceftriaxone-induced inhibition of reinstated heroin seeking was blocked by morpholino-antisense targeting GLT-1 synthesis. These data reveal that the synaptic glutamate spillover in the NAcore results from reduced glutamate transport and is a critical pathophysiological mechanism underling reinstated drug seeking in rats extinguished from heroin self-administration. PMID:24741055

  19. Cocaine

    MedlinePLUS

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  20. Cocaine

    MedlinePLUS

    ... Prescription Stimulant Medications (Amphetamines) Salvia Spice Tobacco, Nicotine, & E-Cigarettes Brain and Addiction HIV/AIDS and Drug Use + ... Prescription Stimulant Medications (Amphetamines) Salvia Spice Tobacco, Nicotine, & E-Cigarettes Brain and Addiction HIV/AIDS and Drug Use ...

  1. Medication of l-tetrahydropalmatine significantly ameliorates opiate craving and increases the abstinence rate in heroin users: a pilot study

    Microsoft Academic Search

    Zheng Yang; Yong-cong Shao; Shi-jiang Li; Jian-lin Qi; Mei-jie Zhang; Wei Hao; Guo-zhang Jin

    2008-01-01

    Aim:Drug addiction is a chronic brain disease with constant relapse requiring long-term treatment. New pharmacological strategies focus on the development of an effective antirelapse drug. This study examines the effects of levotetrahydropalmatine (l-THP) on reducing heroin craving and increasing the abstinence rate among heroin-dependent patients.Methods:In total, 120 heroin-dependent patients participated in the randomized, double-blinded, and placebo-controlled study using l-THP treatment.

  2. Neurobehavioral Syndromes in Cocaine-Exposed Newborn Infants.

    ERIC Educational Resources Information Center

    Lester, Barry M.; And Others

    1991-01-01

    The effects of fetal cocaine exposure on newborn cry characteristics were studied in 80 cocaine-exposed and 80 control infants. Findings were consistent with the notion that two neurobehavioral syndromes, excitable and depressed, can be described in cocaine-exposed infants and that these two syndromes are a result of direct neurotoxic effects and…

  3. Adolescent Cocaine AbuseAddictive Potential, Behavioral and Psychiatric Effects

    Microsoft Academic Search

    Todd W. Estroff; Richard H. Schwartz; Norman G. Hoffmann

    1989-01-01

    Four hundred seventy-nine drug abusing adolescent patients enrolled in seven Straight, Inc. Adolescent Drug-Abuse Treatment Programs in five geographic regions across the United States were studied to determine the severity and patterns of cocaine abuse. Of these, 341 admitted to cocaine use and became part of this survey. Cocaine use was categorized as heavy, intermediate, or light. Areas examined were

  4. Decreased striatal dopaminergic responsiveness in detoxified cocaine-dependent subjects

    Microsoft Academic Search

    N. D. Volkow; G.-J. Wang; J. S. Fowler; J. Logan; S. J. Gatley; R. Hitzemann; A. D. Chen; S. L. Dewey; N. Pappas

    1997-01-01

    Cocaine blocks the reuptake of dopamine, a neurotransmitter involved in the control of movement, cognition, motivation and reward. This leads to an increase in extracellular dopamine; the reinforcing effect of cocaine is associated with elevated dopamine levels in the nucleus accumbens1,2. But addiction to cocaine involves other effects, such as craving, loss of control and compulsive drug intake; the role

  5. Brief Communications Dopaminergic Response to Drug Words in Cocaine

    E-print Network

    Homes, Christopher C.

    Brief Communications Dopaminergic Response to Drug Words in Cocaine Addiction Rita Z. Goldstein,1 imaging (fMRI), 15 individuals with cocaine use disorders and 15 demographically matched healthy control words in cocaine-addicted individuals in mesencephalic regions as possibly associated with dopaminergic

  6. Relationship between subjective effects of cocaine and dopamine transporter occupancy

    Microsoft Academic Search

    N. D. Volkow; G.-J. Wang; M. W. Fischman; R. W. Foltin; J. S. Fowler; N. N. Abumrad; S. Vitkun; J. Logan; S. J. Gatley; N. Pappas; R. Hitzemann; C. E. Shea

    1997-01-01

    Cocaine is believed to work by blocking the dopamine transporter (DAT) and thereby increasing the availability of free dopamine within the brain1-4. Although this concept is central to current cocaine research and to treatment development, a direct relationship between DAT blockade and the subjective effects of cocaine has not been demonstrated in humans. We have used positron emission tomography to

  7. A Recombinant Humanized Anti-Cocaine Monoclonal Antibody Inhibits the Distribution of Cocaine to the Brain in Rats

    PubMed Central

    Gooden, Felicia C. T.; Tabet, Michael R.; Ball, William J.

    2014-01-01

    The monoclonal antibody (mAb), h2E2, is a humanized version of the chimeric human/murine anti-cocaine mAb 2E2. The recombinant h2E2 protein was produced in vitro from a transfected mammalian cell line and retained high affinity (4 nM Kd) and specificity for cocaine over its inactive metabolites benzoylecgonine (BE) and ecgonine methyl ester. In rats, pharmacokinetic studies of h2E2 (120 mg/kg i.v.) showed a long terminal elimination half-life of 9.0 days and a low volume of distribution at steady state (Vdss) of 0.3 l/kg. Pretreatment with h2E2 produced a dramatic 8.8-fold increase in the area under the plasma cocaine concentration-time curve (AUC) and in brain a concomitant decrease of 68% of cocaine’s AUC following an i.v. injection of an equimolar cocaine dose. Sequestration of cocaine in plasma by h2E2, shown via reduction of cocaine’s Vdss, indicates potential clinical efficacy. Although the binding of cocaine to h2E2 in plasma should inhibit distribution and metabolism, the elimination of cocaine remained multicompartmental and was still rapidly eliminated from plasma despite the presence of h2E2. BE was the major cocaine metabolite, and brain BE concentrations were sixfold higher than in plasma, indicating that cocaine is normally metabolized in the brain. In the presence of h2E2, brain BE concentrations were decreased and plasma BE was increased, consistent with the observed h2E2-induced changes in cocaine disposition. The inhibition of cocaine distribution to the brain confirms the humanized mAb, h2E2, as a lead candidate for development as an immunotherapy for cocaine abuse. PMID:24733787

  8. Respiratory effects of diazepam/methadone combination in rats: a study based on concentration/effect relationships

    E-print Network

    Paris-Sud XI, Université de

    1 Respiratory effects of diazepam/methadone combination in rats: a study based on concentration, Réanimation Médicale et Toxicologique, Université Paris-Diderot, Paris, France Short title: Methadone/diazepam; DZP, diazepam; EDDP, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine; f, respiratory frequency; HPLC

  9. Effect of Rifampin and Nelfinavir on the Metabolism of Methadone and Buprenorphine in Primary Cultures of Human Hepatocytes

    E-print Network

    Omiecinski, Curtis

    Effect of Rifampin and Nelfinavir on the Metabolism of Methadone and Buprenorphine in Primary and buprenorphine. Hepatocytes (five donors) were preincubated with dimethyl sulfoxide (DMSO) (vehicle), rifampin, or nelfinavir before incubation with methadone or buprenorphine. Culture me- dia (0­60 min) was analyzed

  10. [Guillain-Barre syndrome as a result of poisoning with a mixture of "kompot"(Polish heroin) and drugs].

    PubMed

    Gawlikowski, T; Winnik, L

    2001-01-01

    Guillain-Barré Syndrome is the most common form of polineuropathy. It is suggested that some infectious, immune and allergic factors are involved in developing the syndrome. "Kompot" or "Polish heroine", a domestic product, is produced from poppy straw or juice of poppy head (Papaver somniferum) and it is administered intravenously. "Kompot" shows variable contents of heroine, 6-MAM, 3-MAM, morphine, acetylo-codeine and codeine as well as papaverine, thebaine and narcotine. The case history of a young man dependent on "Polish heroine" who developed the Guillain-Barré Syndrome due to severe intoxication induced by home made heroine, barbiturates and benzodiazepines is described. PMID:11450369

  11. Novel pharmacotherapeutic treatments for cocaine addiction

    PubMed Central

    2011-01-01

    Cocaine is a stimulant that leads to the rapid accumulation of catecholamines and serotonin in the brain due to prevention of their re-uptake into the neuron that released the neurotransmitter. Cocaine dependence is a public health concern and cause of significant morbidity and mortality worldwide. At present, there are no approved medications for the treatment of this devastating illness, and behavioral interventions have proven to be of limited use. However, there have been a number of recent trials testing promising agents including dopamine agonists, GABAergic medications and the cocaine vaccine. Here we discuss the most recent human clinical trials of potential medications for treatment of cocaine dependence, as well as pre-clinical studies for another promising agent, levo tetrahydropalmatine. Examination of these recent findings shows promise for GABAergic medications and the cocaine vaccine, as well as unique medications such as disulfiram, whose mechanism remains to be determined. Future work may also confirm specific subgroups of patients for treatment response based on clinical characteristics, biomarkers and pharmacogenetics. This review highlights the need for further, bigger studies in order to determine optimal clinical usage. PMID:22047090

  12. Differential Antagonism of Cocaine Self-Administration and Cocaine-Induced Disruptions of Learning by Haloperidol in Rhesus Monkeys

    ERIC Educational Resources Information Center

    Winsauer, Peter J.; Moerschbaecher, Joseph M.; Roussell, Alison M.

    2008-01-01

    Six rhesus monkeys responding under a three-component multiple schedule were administered haloperidol to determine its effects on cocaine self-administration and on cocaine's disruptive effects on the repeated acquisition and performance of response chains. In the absence of haloperidol, 0.0032 - 0.032 mg/kg/infusion of cocaine increased response…

  13. Reduced Metabolsim in Brain 'Control Networks' Following Cocaine-Cues Exposure in Female Cocaine Abusers

    SciTech Connect

    Volkow, N.D.; Wang, G.; Volkow, N.D.; Tomasi, D.; Wang, G.-J.; Fowler, J.S.; Telang, F.; Goldstein, R.Z.; Alia-Klein, N.; Wong, C.T.

    2011-03-01

    Gender differences in vulnerability for cocaine addiction have been reported. Though the mechanisms are not understood, here we hypothesize that gender differences in reactivity to conditioned-cues, which contributes to relapse, are involved. To test this we compared brain metabolism (using PET and {sup 18}FDG) between female (n = 10) and male (n = 16) active cocaine abusers when they watched a neutral video (nature scenes) versus a cocaine-cues video. Self-reports of craving increased with the cocaine-cue video but responses did not differ between genders. In contrast, changes in whole brain metabolism with cocaine-cues differed by gender (p<0.05); females significantly decreased metabolism (-8.6% {+-} 10) whereas males tended to increase it (+5.5% {+-} 18). SPM analysis (Cocaine-cues vs Neutral) in females revealed decreases in frontal, cingulate and parietal cortices, thalamus and midbrain (p<0.001) whereas males showed increases in right inferior frontal gyrus (BA 44/45) (only at p<0.005). The gender-cue interaction showed greater decrements with Cocaine-cues in females than males (p<0.001) in frontal (BA 8, 9, 10), anterior cingulate (BA 24, 32), posterior cingulate (BA 23, 31), inferior parietal (BA 40) and thalamus (dorsomedial nucleus). Females showed greater brain reactivity to cocaine-cues than males but no differences in craving, suggesting that there may be gender differences in response to cues that are not linked with craving but could affect subsequent drug use. Specifically deactivation of brain regions from 'control networks' (prefrontal, cingulate, inferior parietal, thalamus) in females could increase their vulnerability to relapse since it would interfere with executive function (cognitive inhibition). This highlights the importance of gender tailored interventions for cocaine addiction.

  14. Motivated Attention to Cocaine and Emotional Cues in Abstinent and Current Cocaine Users: An ERP Study

    PubMed Central

    Dunning, Jonathan P.; Parvaz, Muhammad A.; Hajcak, Greg; Maloney, Thomas; Alia-Klein, Nelly; Woicik, Patricia A.; Telang, Frank; Wang, Gene-Jack; Volkow, Nora D.; Goldstein, Rita Z.

    2011-01-01

    Event-related potentials (ERPs) are a direct measure of neural activity and are ideally suited to study the time-course of attentional engagement with emotional and drug-related stimuli in addiction. In particular, the late positive potential (LPP) appears enhanced following cocaine-related compared to neutral stimuli in individuals with cocaine use disorders (CUD). However, previous studies have not directly compared cocaine-related to emotional stimuli while examining potential differences between abstinent and current cocaine users. The present study examined ERPs in 55 CUD (27 abstinent and 28 current users) and 29 matched healthy controls while they passively viewed pleasant, unpleasant, neutral, and cocaine-related pictures. To examine the time-course of attention to these stimuli, we analyzed both an early and later window in the LPP as well as the early posterior negativity (EPN), established in assessing motivated attention. Cocaine pictures elicited increased electrocortical measures of motivated attention in ways similar to affectively pleasant and unpleasant pictures in all CUD, an effect that was no longer discernible during the late LPP window for the current users. This group also exhibited deficient processing of the other emotional stimuli (early LPP window: pleasant pictures; late LPP window: pleasant and unpleasant pictures). Results were unique to the LPP and not EPN. Taken together, results support a relatively early attention bias to cocaine stimuli in cocaine addicted individuals further suggesting that recent cocaine use decreases such attention bias during later stages of processing but at the expense of deficient processing of other emotional stimuli. PMID:21450043

  15. Cocaine abuse in North America: a milestone in history.

    PubMed

    Das, G

    1993-04-01

    The euphoric effects of coca leaves have been known to mankind for thousands of years. Yet the first epidemic of cocaine use in America occurred during the late 19th century. Initially, there were no laws restricting the consumption or sale of cocaine. In fact, cocaine was freely available in drug stores, saloons, from mail-order vendors, and even in grocery stores. It is reported that one drug manufacturer, in 1885, was selling cocaine in 15 different forms, including cigarettes, cheroots, inhalants, cordials, crystals, and solutions. Many famous imported wines, such as "Vin Mariani," contained a mixture of wine and coca. For consumers on budgets, the wonder drug was available as Coca-Cola and dozens of other soda pops and pick-me-up drinks. One of them even had a simple and direct name, Dope. Soon enough, the ill effects of cocaine became apparent, and by the 1920s cocaine was the most feared of all illicit drugs. Most states began enacting laws against cocaine use. President William Taft proclaimed cocaine as Public Enemy No. 1, and in 1914 the Congress passed the Harrison act, which tightly regulated the distribution and sale of cocaine. By the late 1950s, cocaine use in the United States was simply considered a problem in the past. Unfortunately, the people who were aware of the nation's first cocaine epidemic gradually passed away, and America once again was ready for its fling with cocaine in the 1960s. Today, it is estimated that upwards of 50 million Americans, that is one in four, have used cocaine. In addition, another fifty thousand people use this substance for the first time each day. More than 6 million Americans use cocaine on a regular basis. Little wonder, then, that America as well as the other countries have declared a "War on Drugs." In this review, pharmacology of cocaine, major complications arising from its use, and efforts to curb its abuse are discussed. PMID:8473543

  16. Butyrylcholinesterase Genetic Variants: Association with Cocaine Dependence and Related Phenotypes

    PubMed Central

    Negrão, André Brooking; Pereira, Alexandre Costa; Guindalini, Camila; Santos, Hadassa Campos; Messas, Guilherme Peres; Laranjeira, Ronaldo; Vallada, Homero

    2013-01-01

    Objective The search for genetic vulnerability factors in cocaine dependence has focused on the role that neuroplasticity plays in addiction. However, like many other drugs, the ability of an individual to metabolize cocaine can also influence susceptibility to dependence. Butyrylcholinesterase (BChE) metabolizes cocaine, and genetic variants of the BChE gene (BCHE) alter its catalytic activity. Therefore, we hypothesize that cocaine users with polymorphisms in BCHE can show diverse addictive behaviors due to differences in effective plasma concentrations of cocaine. Those polymorphisms might also influence users to prefer one of the two main preparations (crack or powder cocaine), despite having equal access to both. The present work investigates polymorphisms in BCHE and if those genetic variants constitute risk factors for cocaine dependence and for crack cocaine use. Methods A total of 1,436 individuals (698 cocaine-dependent patients and 738 controls) were genotyped for three single nucleotide polymorphisms (SNPs) in BCHE: rs1803274, rs4263329, and rs4680662. Results For rs4263329, a nominal difference was found between cases and controls. For rs1803274 (the functional SNP), a statistically significant difference was found between patients who used crack cocaine exclusively and those who used only powder cocaine (P?=?0.027; OR?=?4.36; 95% CI?=?1.18–16.04). Allele frequencies and genotypes related to other markers did not differ between cases and controls or between the two cocaine subgroups. Conclusions Our findings suggest that the AA genotype of rs1803274 is a risk factor for crack cocaine use, which is more addictive than powder cocaine use. Further studies are needed in order to confirm this preliminary result and clarify the role of BCHE and its variants in cocaine dependence. PMID:24312228

  17. Effects of chronic cocaine abuse on postsynaptic dopamine receptors

    SciTech Connect

    Volkow, N.D.; Fowler, J.S.; Wolf, A.P.; Schlyer, D.; Shiue, C.Y.; Alpert, R.; Dewey, S.L.; Logan, J.; Bendriem, B.; Christman, D. (Brookhaven National Laboratory, Upton, NY (USA))

    1990-06-01

    To assess the effects of chronic cocaine intoxication on dopamine receptors in human subjects, the authors evaluated ({sup 18}F)N-methylspiroperidol binding using positron emission tomography in 10 cocaine abusers and 10 normal control subjects. Cocaine abusers who had been detoxified for 1 week or less showed significantly lower values for uptake of ({sup 18}F)N-methylspiroperidol in striatum than the normal subjects, whereas the cocaine abusers who had been detoxified for 1 month showed values comparable to those obtained from normal subjects. The authors conclude that postsynaptic dopamine receptor availability decreases with chronic cocaine abuse but may recover after a drug-free interval.

  18. Analysis of volatile organic compounds from illicit cocaine samples

    SciTech Connect

    Robins, W.H.; Wright, B.W.

    1994-07-01

    Detection of illicit cocaine hydrochloride shipments can be improved if there is a greater understanding of the identity and quantity of volatile compounds present. This study provides preliminary data concerning the volatile organic compounds detected in a limited Set of cocaine hydrochloride samples. In all cases, cocaine was one of the major volatile compounds detected. Other tropeines were detected in almost all samples. Low concentrations of compounds that may be residues of processing solvents were observed in some samples. The equilibrium emissivity of. cocaine from cocaine hydrochloride was investigated and a value of 83 parts-per-trillion was determined.

  19. Novel cocaine vaccine linked to a disrupted adenovirus gene transfer vector blocks cocaine psychostimulant and reinforcing effects.

    PubMed

    Wee, Sunmee; Hicks, Martin J; De, Bishnu P; Rosenberg, Jonathan B; Moreno, Amira Y; Kaminsky, Stephen M; Janda, Kim D; Crystal, Ronald G; Koob, George F

    2012-04-01

    Immunotherapy is a promising treatment for drug addiction. However, insufficient immune responses to vaccines in most subjects pose a challenge. In this study, we tested the efficacy of a new cocaine vaccine (dAd5GNE) in antagonizing cocaine addiction-related behaviors in rats. This vaccine used a disrupted serotype 5 adenovirus (Ad) gene transfer vector coupled to a third-generation cocaine hapten, termed GNE (6-(2R,3S)-3-(benzoyloxy)-8-methyl-8-azabicyclo [3.2.1] octane-2-carboxamido-hexanoic acid). Three groups of rats were immunized with dAd5GNE. One group was injected with (3)H-cocaine, and radioactivity in the blood and brain was determined. A second group was tested for cocaine-induced locomotor sensitization. A third group was examined for cocaine self-administration, extinction, and reinstatement of responding for cocaine. Antibody titers were determined at various time-points. In each experiment, we added a control group that was immunized with dAd5 without a hapten. The vaccination with dAd5GNE produced long-lasting high titers (>10(5)) of anti-cocaine antibodies in all of the rats. The vaccination inhibited cocaine-induced hyperlocomotor activity and sensitization. Vaccinated rats acquired cocaine self-administration, but they showed less motivation to self-administer cocaine under a progressive-ratio schedule than control rats. When cocaine was not available in a session, control rats exhibited 'extinction burst' responding, whereas vaccinated rats did not. Moreover, when primed with cocaine, vaccinated rats did not reinstate responding, suggesting a blockade of cocaine-seeking behavior. These data strongly suggest that our dAd5GNE vector-based vaccine may be effective in treating cocaine abuse and addiction. PMID:21918504

  20. Cerebellar hallmarks of conditioned preference for cocaine.

    PubMed

    Carbo-Gas, Maria; Vazquez-Sanroman, Dolores; Gil-Miravet, Isis; De las Heras-Chanes, Joan; Coria-Avila, Genaro A; Manzo, Jorge; Sanchis-Segura, Carla; Miquel, Marta

    2014-06-10

    Pavlovian conditioning tunes the motivational drive of drug-associated stimuli, fostering the probability of those environmental stimuli to promote and trigger drug seeking and taking. Interestingly, different areas in the cerebellum are involved in the formation and long-lasting storage of Pavlovian emotional memory. Very recently, we have shown that conditioned preference for an odour associated with cocaine was directly correlated with cFOS expression in cells at the dorsal region of the granule cell layer of the cerebellar vermis. The main goal of the current investigation was to further extend the description of cFOS-IR patterns in cerebellar circuitry after training mice in a cocaine-odour Pavlovian conditioning procedure, including now the major inputs (the inferior olive and pontine nuclei) and one of the output nuclei (the medial deep nucleus) of the cerebellum. The results showed that the cerebellar hallmark of preference towards an odour cue associated to cocaine is an increase in cFOS expression in the dorsal part of the granule cell layer. cFOS-IR levels expressed in the granule cell layer of mice that did not show cocaine conditioned preference did not differ from the basal levels. Remarkably, mice subjected to a random cocaine-odour pairing procedure (the unpaired group) exhibited higher cFOS-IR in the inferior olive, the pontine nuclei and in the deep medial nucleus. Therefore, our findings suggest that inputs and the output of cerebellar circuitry are enhanced when contingency between the CS+ and cocaine is lacking. PMID:24813699

  1. Demonstration of specific binding of cocaine to human spermatozoa

    SciTech Connect

    Yazigi, R.A.; Odem, R.R.; Polakoski, K.L. (Washington Univ., St. Louis, MO (United States))

    1991-10-09

    Exposure of males to cocaine has been linked to abnormal development of their offspring. To investigate the possible role of sperm, this study examined the interaction of cocaine with human spermatozoa. Washed sperm were incubated with tritiated cocaine and the samples were filtered and the remaining radioactivity quantitated. The specific binding was optimal at 20 minutes and 23C. Competition studies with tritiated cocaine indicated the presence of approximately 3.6 {times} 10{sup 3} binding sites per cell, with a high affinity receptor dissociation constant. Cocaine concentrations as high as 670 {mu}mol/L had no detectable effect on either the motility or viability of the cells. These results support the hypothesis that the sperm may act as a vector to transport cocaine into an ovum. This novel mechanism could be involved in the abnormal development of offspring of cocaine-exposed males.

  2. A “Bottom-Counting” Video System for Measuring Cocaine-Induced Behaviors in Drosophila

    Microsoft Academic Search

    Rebecca George; Kevin Lease; James Burnette; Jay Hirsh

    2005-01-01

    Cocaine exposure elicits a set of stereotypic behaviors in Drosophila that are strikingly similar to the cocaine-induced behaviors observed in vertebrates. This provides a valuable model for the study of cocaine abuse and has led to the discovery of a connection between the cocaine response pathway and the circadian system. This article describes a simplified assessment of cocaine-induced behavior combined

  3. The trajectory of methadone maintenance treatment in Nepal.

    PubMed

    Ambekar, Atul; Rao, Ravindra; Pun, Anan; Kumar, Suresh; Kishore, Kunal

    2013-11-01

    There are about 28,500 people who inject drugs (PWID) in Nepal and HIV prevalence among this group is high. Nepal introduced harm reduction services for PWID much earlier than other countries in South Asia. Methadone maintenance treatment (MMT) was first introduced in Nepal in 1994. This initial small scale MMT programme was closed in 2002 but reopened in 2007 as an emergency HIV prevention response. It has since been scaled up to include three MMT clinics and continuation of MMT is supported by the Ministry of Home Affairs (MOHA; the nodal ministry for drug supply reduction activities) and has been endorsed in the recent National Narcotics policy. Pressure from drug user groups has also helped its reintroduction. Interestingly, these developments have taken place during a period of political instability in Nepal, with the help of strong advocacy from multiple stakeholders. The MMT programme has also had to face resistance from those who were running drug treatment centres. Despite overcoming such troubles, the MMT programme faces a number of challenges. Coverage of MMT is low and high-risk injecting and sexual behaviour among PWID continues. The finance for MMT is largely from external donors and these donations have become scarce with the current global economic problems. With a multitude of developmental challenges for Nepal, the position of MMT in the national priority list is uncertain. Ownership of the programme by government, a cost-effective national MMT scale up plan and rigorous monitoring of its implementation is needed. PMID:23845916

  4. Functional Impact of ABCB1 Variants on Interactions between P-Glycoprotein and Methadone

    PubMed Central

    Hung, Chin-Chuan; Chiou, Mu-Han; Teng, Yu-Ning; Hsieh, Yow-Wen; Huang, Chieh-Liang; Lane, Hsien-Yuan

    2013-01-01

    Methadone is a widely used substitution therapy for opioid addiction. Large inter-individual variability has been observed in methadone maintenance dosages and P-glycoprotein (P-gp) was considered to be one of the major contributors. To investigate the mechanism of P-gp’s interaction with methadone, as well as the effect of genetic variants on the interaction, Flp-In™-293 cells stably transfected with various genotypes of human P-gp were established in the present study. The RNA and protein expression levels of human P-gp were confirmed by real-time quantitative RT-PCR and western blot, respectively. Utilizing rhodamine 123 efflux assay and calcein-AM uptake study, methadone was demonstrated to be an inhibitor of wild-type human P-gp via non-competitive kinetic (IC50?=?2.17±0.10 µM), while the variant-type human P-gp, P-gp with 1236T-2677T-3435T genotype and P-gp with 1236T-2677A-3435T genotype, showed less inhibition potency (IC50?=?2.97±0.09 µM and 4.43±1.10 µM, respectively) via uncompetitive kinetics. Methadone also stimulated P-gp ATPase and inhibited verapamil-stimulated P-gp ATPase activity under therapeutic concentrations. These results may provide a possible explanation for higher methadone dosage requirements in patients carrying variant-type of P-gp and revealed the possible drug-drug interactions in patients who receive concomitant drugs which are also P-gp substrates. PMID:23527191

  5. Examining Variation in Treatment Costs: A Cost Function for Outpatient Methadone Treatment Programs

    PubMed Central

    Dunlap, Laura J; Zarkin, Gary A; Cowell, Alexander J

    2008-01-01

    Objectives To estimate a hybrid cost function of the relationship between total annual cost for outpatient methadone treatment and output (annual patient days and selected services), input prices (wages and building space costs), and selected program and patient case-mix characteristics. Data Sources Data are from a multistate study of 159 methadone treatment programs that participated in the Center for Substance Abuse Treatment's Evaluation of the Methadone/LAAM Treatment Program Accreditation Project between 1998 and 2000. Study Design Using least squares regression for weighted data, we estimate the relationship between total annual costs and selected output measures, wages, building space costs, and selected program and patient case-mix characteristics. Principal Findings Findings indicate that total annual cost is positively associated with program's annual patient days, with a 10 percent increase in patient days associated with an 8.2 percent increase in total cost. Total annual cost also increases with counselor wages (p<.01), but no significant association is found for nurse wages or monthly building costs. Surprisingly, program characteristics and patient case mix variables do not appear to explain variations in methadone treatment costs. Similar results are found for a model with services as outputs. Conclusions This study provides important new insights into the determinants of methadone treatment costs. Our findings concur with economic theory in that total annual cost is positively related to counselor wages. However, among our factor inputs, counselor wages are the only significant driver of these costs. Furthermore, our findings suggest that methadone programs may realize economies of scale; however, other important factors, such as patient access, should be considered. PMID:18454774

  6. Temporal Difference Error Prediction Signal Dysregulation in Cocaine Dependence

    PubMed Central

    Rose, Emma Jane; Salmeron, Betty Jo; Ross, Thomas J; Waltz, James; Schweitzer, Julie B; McClure, Samuel M; Stein, Elliot A

    2014-01-01

    Cocaine dependence impacts drug-related, dopamine-dependent reward processing, yet its influence on non-drug reward processing is unclear. Here, we investigated cocaine-mediated effects on reward learning using a natural food reinforcer. Cocaine-dependent subjects (N=14) and healthy controls (N=14) learned to associate a visual cue with a juice reward. In subsequent functional imaging sessions they were exposed to trials where juice was received as learned, withheld (negative temporal difference error (NTDE)), or received unexpectedly (positive temporal difference error (PTDE)). Subjects were scanned twice in sessions that were identical, except that cocaine-dependent participants received cocaine or saline 10?min before task onset. In the insula, precentral and postcentral gyri NTDE signals were greater, and PTDE-related function was reduced in cocaine-dependent subjects. Compared with healthy controls, in the cocaine-dependent group PTDE signals were also reduced in medial frontal gyrus and reward-related function, irrespective of predictability, was reduced in the putamen. Group differences in error-related activity were predicted by the time as last self-administered cocaine use, but TDE function was not influenced by acute cocaine. Thus, cocaine dependence seems to engender increased responsiveness to unexpected negative outcomes and reduced sensitivity to positive events in dopaminergic reward regions. Although it remains to be established if these effects are a consequence of or antecedent to cocaine dependence, they likely have implications for the high-cocaine use recidivism rates by contributing to the drive to consume cocaine, perhaps via influence on dopamine-related reward computations. The fact that these effects do not acquiesce to acute cocaine administration might factor in binge-related escalated consumption. PMID:24569319

  7. Temporal difference error prediction signal dysregulation in cocaine dependence.

    PubMed

    Rose, Emma Jane; Salmeron, Betty Jo; Ross, Thomas J; Waltz, James; Schweitzer, Julie B; McClure, Samuel M; Stein, Elliot A

    2014-06-01

    Cocaine dependence impacts drug-related, dopamine-dependent reward processing, yet its influence on non-drug reward processing is unclear. Here, we investigated cocaine-mediated effects on reward learning using a natural food reinforcer. Cocaine-dependent subjects (N = 14) and healthy controls (N = 14) learned to associate a visual cue with a juice reward. In subsequent functional imaging sessions they were exposed to trials where juice was received as learned, withheld (negative temporal difference error (NTDE)), or received unexpectedly (positive temporal difference error (PTDE)). Subjects were scanned twice in sessions that were identical, except that cocaine-dependent participants received cocaine or saline 10 min before task onset. In the insula, precentral and postcentral gyri NTDE signals were greater, and PTDE-related function was reduced in cocaine-dependent subjects. Compared with healthy controls, in the cocaine-dependent group PTDE signals were also reduced in medial frontal gyrus and reward-related function, irrespective of predictability, was reduced in the putamen. Group differences in error-related activity were predicted by the time as last self-administered cocaine use, but TDE function was not influenced by acute cocaine. Thus, cocaine dependence seems to engender increased responsiveness to unexpected negative outcomes and reduced sensitivity to positive events in dopaminergic reward regions. Although it remains to be established if these effects are a consequence of or antecedent to cocaine dependence, they likely have implications for the high-cocaine use recidivism rates by contributing to the drive to consume cocaine, perhaps via influence on dopamine-related reward computations. The fact that these effects do not acquiesce to acute cocaine administration might factor in binge-related escalated consumption. PMID:24569319

  8. Preclinical assessment of lisdexamfetamine as a candidate “agonist” medication for cocaine addiction: Effects in rhesus monkeys trained to discriminate cocaine or to self-administer cocaine in a cocaine-vs.-food choice procedure

    PubMed Central

    Banks, Matthew L.; Hutsell, Blake A.; Blough, Bruce E.; Poklis, Justin L.; Negus, S. Stevens

    2015-01-01

    Background Chronic amphetamine treatment decreases cocaine consumption in preclinical and human laboratory studies and in clinical trials. Lisdexamfetamine is an amphetamine prodrug in which L-lysine is conjugated to the terminal nitrogen of d-amphetamine. Prodrugs may be advantageous relative to their active metabolites due to slower onsets and longer durations of action; however, lisdexamfetamine treatment efficacy to decrease cocaine consumption is unknown. Methods This study compared lisdexamfetamine and d-amphetamine effects in rhesus monkeys using two behavioral procedures: 1) a cocaine discrimination procedure (training dose = 0.32 mg/kg cocaine, IM), and 2) a cocaine-vs.-food choice self-administration procedure. Results In the cocaine-discrimination procedure, lisdexamfetamine (0.32-3.2 mg/kg, IM) substituted for cocaine with lower potency, slower onset, and longer duration of action than d-amphetamine (0.032-0.32 mg/kg, IM). Consistent with the function of lisdexamfetamine as an inactive prodrug for amphetamine, the time course of lisdexamfetamine effects was related to d-amphetamine plasma levels by a counter-clockwise hysteresis loop. In the choice procedure, cocaine (0-0.1 mg/kg, IV) and food (1-g banana-flavored pellets) were concurrently available, and cocaine maintained a dose-dependent increase in cocaine choice under baseline conditions. Treatment for seven consecutive days with lisdexamfetamine (0.32-3.2 mg/kg/day, IM) or d-amphetamine (0.032-0.1 mg/kg/h, IV) produced similar dose-dependent rightward shifts in cocaine dose-effect curves and decreases in preference for 0.032 mg/kg/injection cocaine. Conclusions Lisdexamfetamine has a slower onset and longer duration of action that amphetamine but retains amphetamine's efficacy to reduce cocaine-vs.-food choice in rhesus monkeys. These results support further consideration of lisdexamfetamine as a candidate “agonist-based” medication for cocaine addiction. PMID:25618405

  9. Thermostable variants of cocaine esterase for long-time protection against cocaine toxicity.

    PubMed

    Gao, Daquan; Narasimhan, Diwahar L; Macdonald, Joanne; Brim, Remy; Ko, Mei-Chuan; Landry, Donald W; Woods, James H; Sunahara, Roger K; Zhan, Chang-Guo

    2009-02-01

    Enhancing cocaine metabolism by administration of cocaine esterase (CocE) has been recognized as a promising treatment strategy for cocaine overdose and addiction, because CocE is the most efficient native enzyme for metabolizing the naturally occurring cocaine yet identified. A major obstacle to the clinical application of CocE is the thermoinstability of native CocE with a half-life of only a few minutes at physiological temperature (37 degrees C). Here we report thermostable variants of CocE developed through rational design using a novel computational approach followed by in vitro and in vivo studies. This integrated computational-experimental effort has yielded a CocE variant with a approximately 30-fold increase in plasma half-life both in vitro and in vivo. The novel design strategy can be used to develop thermostable mutants of any protein. PMID:18987161

  10. Teaching and Assessing Residents’ Skills in Managing Heroin Addiction with Objective Structured Clinical Exams (OSCEs)

    PubMed Central

    Parish, Sharon J.; Stein, Melissa R.; Hahn, Steven R.; Goldberg, Uri; Arnsten, Julia H.

    2013-01-01

    Background Heroin abusing patients present a significant challenge. Objective Structured Clinical Exams (OSCEs) allow evaluation of residents’ clinical skills. The objective of our study was to examine resident OSCE performance assessing and managing heroin abuse. Methods Evaluation and comparison of heroin-specific communication, assessment and management skills in a five-station PGY3 substance abuse OSCE. Faculty used a four-point Likert scale to assess residents’ skills; standardized patients provided written comments. Results 265 internal and family medicine residents in an urban university hospital participated over five years. In the heroin station, residents’ skills were better (p<0.001 for both comparisons) in communication (mean overall score 3.16±0.51) than in either assessment (mean overall score 2.66±0.60) or management (mean overall score 2.50±0.73). The mean score for assessing specific high risk behaviors was lower than the mean overall assessment score (2.22±1.01 vs. 2.74±.59, p < 0.0001), and the mean score for recommending appropriate harm reduction management strategies was lower than the mean overall management score (2.39±.89 vs. 2.54±.74, p < 0.005). Standardized patients’ comments reflected similar weaknessess in residents’ skills. Conclusions Assessment and management of heroin abuse were more challenging for residents than general communication. Additional training is required for residents to assess and counsel patients about high risk behaviors. PMID:24159905

  11. Correlates of Heroin and Methamphetamine Use among Homeless Male Ex-Jail and Prison Offenders.

    PubMed

    Nyamathi, Adeline; Salem, Benissa E; Farabee, David; Hall, Elizabeth; Zhang, Sheldon; Marfisee, Mary; Khalilifard, Farinaz; Musto, Stefanie; Leake, Barbara

    2014-12-01

    Homeless men exiting California State jails and prisons are a heterogeneous community with varied childhood, incarceration and drug use histories. This cross-sectional study assessed whether homeless men who were discharged from either jail or prison into a residential substance abuse treatment program, differed in terms of methamphetamine and heroin use. This study utilized baseline data collected on 540 recently paroled men randomized to one of three programs that assessed the impact of a peer coaching intervention on subsequent drug use and re-incarceration. We found that younger ex-offenders exiting prisons and jails were more likely to have used methamphetamine alone, whereas African American ex-offenders were less likely to have used methamphetamine alone when compared to other ethnic groups. Further, ex-offenders exiting jails and self-reporting use of heroin only at baseline were significantly more likely than their counterparts to have been removed from home before age 18. For men exiting jails, there was an association between lower self-esteem and having used methamphetamine but not heroin. However, having used both heroin and methamphetamine was associated with both violent crime and cognitive problems in both jail and prison samples. Our findings showcase the need to understand unique correlates of both heroin and methamphetamine as they relate to jail and prison populations. PMID:25489295

  12. Comparative behavioral pharmacology and toxicology of cocaine and its ethanol-derived metabolite, cocaine ethyl-ester (cocaethylene)

    SciTech Connect

    Katz, J.L.; Terry, P.; Witkin, J.M. (NIDA Addiction Research Center, Baltimore, MD (United States))

    1992-01-01

    The present study compared the behavioral and toxic effects of cocaine and its ethanol derived metabolite, cocaine ethyl-ester (cocaethylene). Both drugs produced qualitatively similar psychomoter stimulant effects. Cocaine and cocaethylene increased locomotor activity in mice, with cocaine approximately four times more potent than cocaethylene. The durations of action of ED{sub 75} doses of each of the drugs were comparable. Each of the drugs also produced stimulation of operant responding in rats. In rats and squirrel monkeys trained to discriminate cocaine injections from saline, cocaine was approximately three to five times more potent than cocaethylene in producing these cocaine-like interoceptive effects. In contrast to the behavioral effects, cocaine and cocaethylene were equipotent in producing convulsions, and cocaethylene was more potent than cocaine in producing lethality. These results suggest that the conversion of cocaine to cocaethylene with simultaneous cocaine and alcohol use may produce an increased risk of toxicity due to a decrease in the potency of cocaethylene in producing psychomotor stimulant effects, and its increased potency in producing toxicity.

  13. Effects of escitalopram on attentional bias to cocaine-related stimuli and inhibitory control in cocaine-dependent subjects

    PubMed Central

    Liu, Shijing; Lane, Scott D; Schmitz, Joy M; Cunningham, Kathryn A; John, Vineeth P; Moeller, F Gerard

    2014-01-01

    Key characteristics of cocaine dependence include attentional bias to cocaine cues and impaired inhibitory control. Studies suggest that serotonin modulates both cocaine cue reactivity and inhibitory control. We investigated effects of the selective serotonin reuptake inhibitor escitalopram on cocaine cue reactivity and inhibitory processes in cocaine-dependent subjects. In a double-blind placebo-controlled design, cocaine-dependent subjects received placebo (n=12) or escitalopram (n=11; 10 mg on days 1–3, 20 mg on days 4–24 and 10 mg on days 25–28) orally, once daily for 4 weeks. The cocaine Stroop and immediate memory task (IMT) were administered at baseline, days 1, 4, 11, 18 and 25 after placebo or escitalopram initiation. There were no significant between-group differences in baseline performance on the cocaine Stroop task or the IMT. On day 1 (acute phase), escitalopram produced a significantly greater decrease from baseline than placebo in attentional bias measured by cocaine Stroop task 5 hours post-dose. No significant changes from baseline in attentional bias were observed on subsequent test days (chronic phase). Inhibitory control as measured by IMT commission error rate was not significantly different between two groups in either the acute or chronic phase. Consistent with preclinical data, serotonin-modulating drugs like escitalopram may have acute effects on cocaine cue reactivity in human cocaine users. PMID:23761390

  14. [Neuroleptic therapy of comorbid narcotic dependent patients in ambulatory methadone maintenance].

    PubMed

    Unglaub, Willi; Kandel, Michael; Zenner, Dirk; Wodarz, Norbert; Klein, Helmfried

    2003-05-01

    Methadon maintenance therapy with opiate addicts who suffer from a comorbid schizophrenia in an outpatient treatment setting of a psychiatric hospital is described. We examined five patients looking for periods of inpatient treatment, drug free urine tests, social integration and illegal activities before and after neuroleptic treatment. In comparison with standard neuroleptics patients show under the therapy with atypical neuroleptics better outcome in drug urine tests especially concerning cannabis and benzodiazepines. According to these findings, the best improvements seem to occur with a combination of methadone and clozapine. PMID:14509056

  15. Augmentation of cocaine-sensitized dopamine release in the nucleus accumbens of adult mice following prenatal cocaine exposure.

    PubMed

    Malanga, C J; Ren, Jia-Qian; Guerriero, Réjean M; Kosofsky, Barry E

    2009-01-01

    Behavioral changes in adult mice after prenatal exposure to cocaine have been identified. Mice exposed to cocaine in utero (40 or 20 mg/kg/day) and controls were given a sensitizing cocaine regimen (15 mg/kg every other day x 7 doses), withdrawn for 21 days, and challenged with 15 mg/kg cocaine. In vivo microdialysis for dopamine (DA), serotonin, and their metabolites in awake behaving mice on the first, seventh and challenge doses showed increased cocaine-stimulated DA release in the nucleus accumbens, which was significantly enhanced after prenatal cocaine exposure. This effect was not due to fetal malnutrition or changes in the total tissue DA content. Early developmental cocaine exposure may alter adaptation of brain reward systems to chronic psychostimulant exposure in adulthood. PMID:19372689

  16. Reinstatement of extinguished cocaine-taking behavior by cocaine and caffeine 

    E-print Network

    Worley, Christina Mae

    1993-01-01

    revealed that both cocaine and caffeine induced a dose-dependent increase in the number of responses made on the previously cocaine-associated lever. These results confirm findings that the originally self-administered drug can serve as a "prime..." to reinstate drug-taking behavior, and also that non- dopaminergic agonists can provide an effective prime to reinstate responding. Potential mechanisms and potential consequences for these effects are discussed. ACKNOWLEDGEMENTS Arriving at the end...

  17. The effects of alcohol preexposure on cocaine, alcohol and cocaine\\/alcohol place conditioning

    Microsoft Academic Search

    Gregory D. Busse; Elizabeth T. Lawrence; Anthony L. Riley

    2005-01-01

    The present experiment examined the effects of alcohol preexposure on place conditioning with cocaine, alcohol or the cocaine\\/alcohol combination. Specifically, 91 male Sprague–Dawley rats were injected i.p. with 1.5 g\\/kg alcohol (n=46) or vehicle (n=45) every fourth day for 17 days prior to conditioning. On day 21, half of the animals from each preexposure condition were injected with 20 mg\\/kg

  18. The skinny on cocaine: Insights into eating behavior and body weight in cocaine-dependent men????

    PubMed Central

    Ersche, Karen D.; Stochl, Jan; Woodward, Jeremy M.; Fletcher, Paul C.

    2013-01-01

    There is a general assumption that weight loss associated with cocaine use reflects its appetite suppressing properties. We sought to determine whether this was justified by characterizing, in detail, alterations in dietary food intake and body composition in actively using cocaine-dependent individuals. We conducted a cross-sectional case-control comparison of 65 male volunteers from the local community, half of whom satisfied the DSM-IV-TR criteria for cocaine dependence (n = 35) while the other half had no personal or family history of a psychiatric disorder, including substance abuse (n = 30). Assessments were made of eating behavior and dietary food intake, estimation of body composition, and measurement of plasma leptin. Although cocaine users reported significantly higher levels of dietary fat and carbohydrates as well as patterns of uncontrolled eating, their fat mass was significantly reduced compared with their non-drug using peers. Levels of leptin were associated with fat mass, and with the duration of stimulant use. Tobacco smoking status or concomitant use of medication did not affect the significance of the results. Weight changes in cocaine users reflect fundamental perturbations in fat regulation. These are likely to be overlooked in clinical practice but may produce significant health problems when cocaine use is discontinued during recovery. PMID:23920064

  19. The skinny on cocaine: insights into eating behavior and body weight in cocaine-dependent men.

    PubMed

    Ersche, Karen D; Stochl, Jan; Woodward, Jeremy M; Fletcher, Paul C

    2013-12-01

    There is a general assumption that weight loss associated with cocaine use reflects its appetite suppressing properties. We sought to determine whether this was justified by characterizing, in detail, alterations in dietary food intake and body composition in actively using cocaine-dependent individuals. We conducted a cross-sectional case-control comparison of 65 male volunteers from the local community, half of whom satisfied the DSM-IV-TR criteria for cocaine dependence (n=35) while the other half had no personal or family history of a psychiatric disorder, including substance abuse (n=30). Assessments were made of eating behavior and dietary food intake, estimation of body composition, and measurement of plasma leptin. Although cocaine users reported significantly higher levels of dietary fat and carbohydrates as well as patterns of uncontrolled eating, their fat mass was significantly reduced compared with their non-drug using peers. Levels of leptin were associated with fat mass, and with the duration of stimulant use. Tobacco smoking status or concomitant use of medication did not affect the significance of the results. Weight changes in cocaine users reflect fundamental perturbations in fat regulation. These are likely to be overlooked in clinical practice but may produce significant health problems when cocaine use is discontinued during recovery. PMID:23920064

  20. [Preliminary study on identification of heroin from different route with clustering analysis by fourier transform infrared spectroscopy].

    PubMed

    Cai, Xi-lan; Wu, Guo-ping

    2007-12-01

    In the present paper, using Fourier transform infrared (FTIR) absorption spectrometry, the characteristic peaks of fingerprint infrared spectra of heroin samples from different routes were identified with clustering analysis successfully. It is a very fast, simple and reliable method. That is to say, a new method for the discrimination of heroin seizured from different routes is provided. PMID:18330280

  1. ‘It’s more about the heroin’: Injection drug users’ response to an overdose warning campaign in a Canadian setting

    PubMed Central

    Kerr, Thomas; Small, Will; Hyshka, Elaine; Maher, Lisa; Shannon, Kate

    2014-01-01

    Aims To assess heroin injectors’ perceptions of and responses to a warning issued by public health officials regarding high-potency heroin and increases in fatal overdoses. Design Semi-structured qualitative interviews Setting Vancouver, Canada. Participants Eighteen active heroin injectors Measurements Semi-structured interview guide focussing on heroin injectors’ perceptions of and responses to the overdose warning, including reasons for failing to adhere to risk reduction recommendations. Findings Although nearly all participants were aware of the warning, their recollections of the message and the timing of its release were obscured by on-going social interactions within the drug scene focussed on heroin quality. Many injection drug users reported seeking the high potency heroin and nearly all reported no change in overdose risk behaviours. Responses to the warning were shaped by various social, economic and structural forces that interacted with individual behaviour and undermined efforts to promote behavioural change, including sales tactics employed by dealers, poverty, the high cost and shifting quality of available heroin, and risks associated with income-generating activities. Individual-level factors, including emotional suffering, withdrawal, entrenched injecting routines, perceived invincibility and the desire for intense intoxication also undermined risk reduction messages. Conclusions Among heroin injectors in British Columbia, a 2011 overdose warning campaign appeared to be of limited effectiveness and also produced unintended negative consequences that exacerbated overdose risk. PMID:23551565

  2. Increased intra-individual reaction time variability in cocaine-dependent subjects: role of cocaine-related cues

    PubMed Central

    Liu, Shijing; Lane, Scott D.; Schmitz, Joy M.; Green, Charles E.; Cunningham, Kathryn A.; Moeller, F. Gerard

    2011-01-01

    Neuroimaging data suggest that impaired performance on response inhibition and information processing tests in cocaine-dependent subjects is related to prefrontal and frontal cortical dysfunction and that dysfunction in these brain areas may underlie some aspects of cocaine addiction. In subjects with attention-deficit hyperactivity disorder and other psychiatric disorders, the Intra-Individual Reaction Time Variability (IIRTV) has been associated with frontal cortical dysfunction. In the present study, we evaluated IIRTV parameters in cocaine-dependent subjects vs. controls using a cocaine Stroop task. Fifty control and 123 cocaine-dependent subjects compiled from three studies completed a cocaine Stroop task. Standard deviation (SD) and coefficient of variation (CV) for reaction times (RT) were calculated for both trials with neutral and trials with cocaine-related words. The parameters mu, sigma, and tau were calculated using an ex-Gaussian analysis employed to characterize variability in RTs. The ex-Gaussian analysis divides the RTs into normal (mu, sigma) and exponential (tau) components. Using robust regression analysis, cocaine-dependent subjects showed greater SD, CV and Tau on trials with cocaine-related words compared to controls (p < 0.05). However, in trials with neutral words, there was no evidence of group differences in any IIRTV parameters (p > 0.05). The Wilcoxon matched-pairs signed-rank test showed that for cocaine-dependent subjects, both SD and tau were larger in trials with cocaine-related words than in trials with neutral words (p < 0.05). The observation that only cocaine-related words increased IIRTV in cocaine-dependent subjects suggests that cocaine-related stimuli might disrupt information processing subserved by prefrontal and frontal cortical circuits. PMID:22047976

  3. A recombinant humanized anti-cocaine monoclonal antibody inhibits the distribution of cocaine to the brain in rats.

    PubMed

    Norman, Andrew B; Gooden, Felicia C T; Tabet, Michael R; Ball, William J

    2014-07-01

    The monoclonal antibody (mAb), h2E2, is a humanized version of the chimeric human/murine anti-cocaine mAb 2E2. The recombinant h2E2 protein was produced in vitro from a transfected mammalian cell line and retained high affinity (4 nM Kd) and specificity for cocaine over its inactive metabolites benzoylecgonine (BE) and ecgonine methyl ester. In rats, pharmacokinetic studies of h2E2 (120 mg/kg i.v.) showed a long terminal elimination half-life of 9.0 days and a low volume of distribution at steady state (Vdss) of 0.3 l/kg. Pretreatment with h2E2 produced a dramatic 8.8-fold increase in the area under the plasma cocaine concentration-time curve (AUC) and in brain a concomitant decrease of 68% of cocaine's AUC following an i.v. injection of an equimolar cocaine dose. Sequestration of cocaine in plasma by h2E2, shown via reduction of cocaine's Vdss, indicates potential clinical efficacy. Although the binding of cocaine to h2E2 in plasma should inhibit distribution and metabolism, the elimination of cocaine remained multicompartmental and was still rapidly eliminated from plasma despite the presence of h2E2. BE was the major cocaine metabolite, and brain BE concentrations were sixfold higher than in plasma, indicating that cocaine is normally metabolized in the brain. In the presence of h2E2, brain BE concentrations were decreased and plasma BE was increased, consistent with the observed h2E2-induced changes in cocaine disposition. The inhibition of cocaine distribution to the brain confirms the humanized mAb, h2E2, as a lead candidate for development as an immunotherapy for cocaine abuse. PMID:24733787

  4. A new mixed mode solid phase extraction strategy for opioids, cocaines, amphetamines and adulterants in human blood with hybrid liquid chromatography tandem mass spectrometry detection.

    PubMed

    Dowling, Geraldine; Regan, Liam

    2011-04-01

    A rapid method has been developed to analyse morphine, codeine, 6-monoacetylmorphine, cocaine, benzoylecgonine, dihydrocodeine, cocaethylene, 3,4-methylenedioxyamphetamine, ketamine, 3,4-methylenedioxymethamphetamine, pseudoephedrine, lignocaine, benzylpiperazine, methamphetamine, amphetamine, methadone, phenethylamine and levamisole in human blood. Blood samples were cleaned up using mixed mode solid phase extraction using Evolute™ CX solid phase extraction cartridges and the sample aliquots were analysed by hybrid triple quadrupole linear ion trap (QTRAP) mass spectrometry with a runtime of 12.5 min. Multiple reaction monitoring (MRM) as survey scan and an enhanced product ion (EPI) scan as dependent scan were performed in an information-dependent acquisition (IDA) experiment. Finally, drug identification and confirmation was carried out by library search with a developed in-house MS/MS library based on EPI spectra at a collision energy spread of 35 ± 15 in positive mode and MRM ratios. The method was validated in blood, according to the criteria defined in Commission Decision 2002/657/EC. At least two MRM transitions for each substance were monitored in addition to EPI spectra. Deuterated analogues of analytes were used as internal standards for quantitation where possible. The method proved to be simple and time efficient and was implemented as an analytical strategy for the illicit drug monitoring of opioids, cocaines, amphetamines and adulterants in forensic cases of crime offenders, abusers or victims in the Republic of Ireland. PMID:21194869

  5. Comprehensive automation of the solid phase extraction gas chromatographic mass spectrometric analysis (SPE-GC/MS) of opioids, cocaine, and metabolites from serum and other matrices.

    PubMed

    Lerch, Oliver; Temme, Oliver; Daldrup, Thomas

    2014-07-01

    The analysis of opioids, cocaine, and metabolites from blood serum is a routine task in forensic laboratories. Commonly, the employed methods include many manual or partly automated steps like protein precipitation, dilution, solid phase extraction, evaporation, and derivatization preceding a gas chromatography (GC)/mass spectrometry (MS) or liquid chromatography (LC)/MS analysis. In this study, a comprehensively automated method was developed from a validated, partly automated routine method. This was possible by replicating method parameters on the automated system. Only marginal optimization of parameters was necessary. The automation relying on an x-y-z robot after manual protein precipitation includes the solid phase extraction, evaporation of the eluate, derivatization (silylation with N-methyl-N-trimethylsilyltrifluoroacetamide, MSTFA), and injection into a GC/MS. A quantitative analysis of almost 170 authentic serum samples and more than 50 authentic samples of other matrices like urine, different tissues, and heart blood on cocaine, benzoylecgonine, methadone, morphine, codeine, 6-monoacetylmorphine, dihydrocodeine, and 7-aminoflunitrazepam was conducted with both methods proving that the analytical results are equivalent even near the limits of quantification (low ng/ml range). To our best knowledge, this application is the first one reported in the literature employing this sample preparation system. PMID:24788888

  6. MEXICAN AMERICAN YOUTH AND ADULT PRISON GANGS IN A CHANGING HEROIN MARKET

    PubMed Central

    Valdez, Avelardo

    2010-01-01

    This article focuses on the interaction between the larger community’s drug markets and youth and adult prison gangs, and the process that leads to specific adverse consequences both to the youth gangs as organizations, and to individual members. Described is the emergence of a restructured heroin market dominated by an adult prison gang. A major consequence of this was the increasing use of heroin among Mexican American gang members and their transformation from autonomous youth gangs to extensions of the adult prison gangs or their demise. Data was collected from 160 members of 26 Mexican American youth gangs and key informants in San Antonio. Findings focus on organizational rules, drug market transformations, consequences on members, and the impact of heroin on the gang’s organization. Discussed is how the dominance of prison gangs is related to the increased incarceration and recidivism rates of Mexican Americans and declining economic opportunities for urban minorities. PMID:21614143

  7. Reversal of cocaine addiction by environmental enrichment

    PubMed Central

    Solinas, Marcello; Chauvet, Claudia; Thiriet, Nathalie; El Rawas, Rana; Jaber, Mohamed

    2008-01-01

    Environmental conditions can dramatically influence the behavioral and neurochemical effects of drugs of abuse. For example, stress increases the reinforcing effects of drugs and plays an important role in determining the vulnerability to develop drug addiction. On the other hand, positive conditions, such as environmental enrichment, can reduce the reinforcing effects of psychostimulants and may provide protection against the development of drug addiction. However, whether environmental enrichment can be used to “treat” drug addiction has not been investigated. In this study, we first exposed mice to drugs and induced addiction-related behaviors and only afterward exposed them to enriched environments. We found that 30 days of environmental enrichment completely eliminates behavioral sensitization and conditioned place preference to cocaine. In addition, housing mice in enriched environments after the development of conditioned place preference prevents cocaine-induced reinstatement of conditioned place preference and reduces activation of the brain circuitry involved in cocaine-induced reinstatement. Altogether, these results demonstrate that environmental enrichment can eliminate already established addiction-related behaviors in mice and suggest that environmental stimulation may be a fundamental factor in facilitating abstinence and preventing relapse to cocaine addiction. PMID:18955698

  8. Particle size distribution of cocaine hydrochloride

    NASA Astrophysics Data System (ADS)

    Kuhlman, Michael R.; Gooding, Rachel E.; Kogan, Vladimir G.; Bridges, Curtis

    1997-02-01

    A principal method for the detection of concealed shipments of cocaine hydrochloride relies upon the intake of an air sample taken near a surface onto an analytical instrument, and the detection of the narcotic present in the air or surface materials collected. The low vapor pressure of cocaine at normal temperatures indicates that particulate material present on the surfaces of target packages affords a higher probability of collection of detectable mass than does a vapor sample. An accurate representation of the particles in question is required, both for theoretical sampler design and for the performance of meaningful tests of instrument capabilities. Existing test methods for target particle preparation call for use of sand particles ranging in size from 20 to 100 micrometers in diameter, coated with a solution of cocaine hydrochloride. In this study, three seized samples and pharmaceutical cocaine hydrochloride were analyzed using an Aerosizer to measure the size distribution of the air-dispersed particles. The results obtained during these tests indicate that the actual size range of the particles is significantly smaller than the test particles cited. Results obtained in instrument evaluations using the larger target particles may therefore be misleading.

  9. Outpatient Cocaine Abuse Treatment: Predictors of Success.

    ERIC Educational Resources Information Center

    Westhuis, David J.; Gwaltney, Lisa; Hayashi, Reiko

    2001-01-01

    Uses data from the U.S. Army's Alcohol and Drug Abuse Prevention and Control Program to analyze which treatment and demographic variables have an effect on cocaine treatment outcomes. Results suggest the following treatment variables had an effect on outcomes: type of treatment; length of time in treatment; and the length of time since the patient…

  10. Smoked cocaine in socially-depressed areas

    Microsoft Academic Search

    Jordi Delas; Elena Adán; Olga Díaz; Margarita Aguas; Montserrat Pons; Ricardo Fuertes

    2010-01-01

    BACKGROUND: The main objectives of this study are to describe the smoked cocaine user's profile in socially-depressed areas and their needs from a harm-reduction perspective, to investigate their use of smoking crack and compare the acute effects between injecting and smoking consumption. METHODS: The study took place in SAPS, Barcelona, Spain. Two focus group sessions were undertaken with a total

  11. The interplay between brain 5-hydroxytryptamine levels and cocaine addiction.

    PubMed

    Nonkes, Lourens J P; van Bussel, Inge P G; Verheij, Michel M M; Homberg, Judith R

    2011-12-01

    Cocaine addiction is a major health problem that affects millions of people. Cocaine acts by inhibiting dopamine, noradrenaline and serotonin [5-hydroxytryptamine(5-HT)] reuptake. The dopaminergic system is generally assumed to be involved in the reinforcing aspects of the drug, but the role of 5-HT in the addictive potential of cocaine is unclear. In light of pharmacological manipulations and cocaine use-related disease states affecting brain 5-HT levels, we review studies on the effect of cocaine on central 5-HT function. In addition, the contribution of 5-HT to the rewarding, aversive, discriminative and subjective, as well as the motivational and reinforcing effects of cocaine is discussed. We specifically focus on net changes in the extracellular 5-HT levels that occur as a consequence of acute and chronic cocaine exposure and how these influence cocaine abuse-related behaviour. Overall, the data indicate that 5-HT plays a major role in the psychomotor stimulant, rewarding and discriminative stimulant effects of cocaine, but also affects the motivational and reinforcing effects of the drug. In addition, 5-HT mediates, to some extent, the aversive effects of cocaine. Difficulties with data interpretation are discussed. PMID:22015806

  12. Regulation of genes involved in dopamine transporter modulation by acute cocaine in rat striatum

    E-print Network

    Paris-Sud XI, Université de

    1 Regulation of genes involved in dopamine transporter modulation by acute cocaine in rat striatum of several proteins involved in the various proposed processes following cocaine administration by acute cocaine treatment. Interestingly, acute amphetamine treatment did not increase either

  13. Injecting Transition Risk and Depression among Mexican American Non-Injecting Heroin Users

    PubMed Central

    Cepeda, Alice; Kaplan, Charles; Neaigus, Alan; Cano, Miguel Ángel; Villarreal, Yolanda; Valdez, Avelardo

    2015-01-01

    INTRODUCTION Existing research has documented high comorbid rates for injecting drug use (IDU) and social and health consequences including HIV infection, a condition that disproportionately affects U.S. Hispanic populations. Few studies have examined the specific associations between injecting transition risk among non-injecting heroin using (NIU) populations and mental health conditions. This study hypothesizes that injecting transition risk will be strongly associated with depression symptomatology controlling for age and gender among Mexican American NIUs. METHODS Street-recruited NIUs (n=300) were administered structured interviews. The Mexican American sample was predominantly male (66%), unemployed (75%) with more than half experiencing incarceration in their lifetimes (58%). Depression was measured using the CES-D scale. Univariate and multivariate logistic regression analysis were employed to determine the associations between the dependent variable of heroin injecting transition risk and the key independent variables of depression symptomatology and other independent variables. RESULTS Depression symptomatology was the strongest independent correlate of injecting transition risk. Those NIUs with high levels of depression symptomatology had more than three times the heroin injecting transition risk than those NIUs with low levels. Heroin use network influence was also found to be a strong correlate. Acculturation level was significantly associated with injecting transition risk. CONCLUSION The comorbid condition of depression symptomatology and heroin use places Mexican American NIUs at elevated risk of contracting blood-borne pathogens such as HIV. Development of prevention and treatment strategies that target Hispanic non-injecting heroin users in socially disadvantaged communities should consider depression symptoms and develop interventions that build new social networks. PMID:22749681

  14. Is Inhalant Use a Risk Factor for Heroin and Injection Drug Use Among Adolescents in the United States?

    PubMed Central

    Wu, Li-Tzy; Howard, Matthew O.

    2007-01-01

    Purpose We examined whether inhalant use was associated with heroin and injection drug use (IDU) among American adolescents aged 12 to 17. Methods Data were drawn from the 2002/2003 administrations of the National Survey on Drug Use and Health (NSDUH). We conducted logistic regression analyses to estimate associations of inhalant use with heroin use, heroin injection, and IDU, respectively, among adolescent drug users (N = 8,161). Results Approximately 30.9% of adolescents had ever used at least one illicit drug. More than one-fifth (22.2%) of adolescents were past-year or recent drug users. Among past-year adolescent drug users, 1.4% had progressed to heroin use and 1.2% reported IDU. Adolescents who had used inhalants and marijuana were 2.8 and 2.9 times as likely as adolescents who had used marijuana but not inhalants to report heroin use and any IDU, respectively. Adolescents who had used inhalants or other drugs but not marijuana were unlikely to use heroin. However, inhalant users, irrespective of their marijuana use histories, had greater odds of IDU than drug users who had not used inhalants. Adolescent drug users who were females, school dropouts, whites, or delinquents had significantly increased odds of heroin use and IDU. Cigarette smoking before the age of 15 was strongly associated with heroin use, and a history of foster care placement was associated with IDU. Conclusions This national study of American adolescents identifies several subgroups of recent drug users, such as females, school dropouts, and youth who have used inhalants and marijuana, which have substantially increased odds of heroin use and IDU. Screening, prevention, and treatment interventions targeted to these groups might reduce medical and social complications of heroin use and IDU. PMID:16713124

  15. Drug Interactions of Clinical Importance among the Opioids, Methadone and Buprenorphine, and other Frequently Prescribed Medications: A Review

    PubMed Central

    McCance-Katz, Elinore F.; Sullivan, Lynn; Nallani, Srikanth

    2012-01-01

    Drug interactions are a leading cause of morbidity and mortality. Methadone and buprenorphine are frequently prescribed for the treatment of opioid addiction. Patients needing treatment with these medications often have co-occurring medical and mental illnesses that require medication treatment. The abuse of illicit substances is also common in opioid-addicted individuals. These clinical realities place patients being treated with methadone and buprenorphine at risk for potentially toxic drug interactions. A substantial literature has accumulated on drug interactions between either methadone or buprenorphine with other medications when ingested concomitantly by humans. This review summarizes current literature in this area. PMID:20132117

  16. Opioid dependence and substitution therapy: thymoquinone as potential novel supplement therapy for better outcome for methadone maintenance therapy substitution therapy

    PubMed Central

    Adnan, Liyana Hazwani Mohd; Bakar, Nor Hidayah Abu; Mohamad, Nasir

    2014-01-01

    Methadone is widely being used for opioid substitution therapy. However, the administration of methadone to opioid dependent individual is frequently accompanied by withdrawal syndrome and chemical dependency develops. Other than that, it is also difficult to retain patients in the treatment programme making their retention rates are decreasing over time. This article is written to higlights the potential use of prophetic medicines, Nigella sativa, as a supplement for opioid dependent receiving methadone. It focuses on the potential role of N. sativa and its major active compound, Thymoquinone (TQ) as a calcium channel blocking agent to reduce withdrawal syndrome and opioid dependency. PMID:25859295

  17. Prenatal Exposure to Cocaine Alters the Development of Conditioned Place-Preference to Cocaine in Adult Mice

    PubMed Central

    Malanga, C.J.; Pejchal, Martina; Kosofsky, Barry E.

    2007-01-01

    As addiction is increasingly formulated as a developmental disorder, identifying how early developmental exposures influence later responses to drugs of abuse is important to our understanding of substance abuse neurobiology. We have previously identified behavioral changes in adult mice following gestational exposure to cocaine that differ when assessed with methods employing contingent and non-contingent drug administration. We sought to clarify this distinction using a Pavlovian behavioral measure, conditioned place-preference. Adult mice exposed to cocaine in utero (40 or 20 mg/kg/day), vehicle and pair-fed controls were place-conditioned to either cocaine (5 mg/kg or 20 mg/kg, i.p.) or saline injections. The development of conditioned place-preference to cocaine was impaired in mice exposed to cocaine in utero, and was abolished by fetal malnutrition. A context-specific place-aversion to vehicle but not cocaine injection was observed in prenatally cocaine-exposed mice. Locomotor behavior did not differ among prenatal treatment groups. We conclude that early developmental exposure to cocaine may diminish the subsequent rewarding effects of cocaine in adulthood measured with classical conditioning techniques, and that this is not due to changes in locomotor behavior. Sensitivity to acute stress is also altered by prenatal cocaine exposure, consistent with earlier findings in this model. PMID:17644167

  18. Prelimbic and infralimbic cortical regions differentially encode cocaine-associated stimuli and cocaine-seeking before and following abstinence

    PubMed Central

    West, Elizabeth A.; Saddoris, Michael P.; Kerfoot, Erin C.; Carelli, Regina M.

    2014-01-01

    Cocaine stimuli often trigger relapse of drug-taking, even following periods of prolonged abstinence. Here, electrophysiological recordings were made in rats (n = 29) to determine how neurons in the prelimbic (PrL) or infralimbic (IL) regions of the medial prefrontal cortex (mPFC) encode cocaine-associated stimuli and cocaine-seeking, and whether this processing is differentially altered after 1 month of cocaine abstinence. After self-administration training, neurons (n=308) in the mPFC were recorded during a single test session conducted either the next day or 1 month later. Test sessions consisted of three phases during which (i) the tone–houselight stimulus previously paired with cocaine infusion during self-administration was randomly presented by the experimenter, (ii) rats responded on the lever previously associated with cocaine during extinction and (iii) the tone–houselight was presented randomly between cocaine-reinforced responding during resumption of cocaine self-administration. PrL neurons showed enhanced encoding of the cocaine stimulus and drug-seeking behavior (under extinction and self-administration) following 30 days of abstinence. In contrast, although IL neurons encoded cocaine cues and cocaine-seeking, there were no pronounced changes in IL responsiveness following 30 days’ abstinence. Importantly, cue-related changes do not represent a generalized stimulus-evoked discharge as PrL and IL neurons in control animals (n=4) exhibited negligible recruitment by the tone–houselight stimulus. The results support the view that, following abstinence, neural encoding in the PrL but not IL may play a key role in enhanced cocaine-seeking, particularly following re-exposure to cocaine-associated cues. PMID:24690012

  19. Preparation and in vivo characterization of a cocaine hydrolase engineered from human butyrylcholinesterase for metabolizing cocaine.

    PubMed

    Xue, Liu; Hou, Shurong; Tong, Min; Fang, Lei; Chen, Xiabin; Jin, Zhenyu; Tai, Hsin-Hsiung; Zheng, Fang; Zhan, Chang-Guo

    2013-08-01

    Cocaine is a widely abused drug without an FDA (Food and Drug Administration)-approved medication. It has been recognized that an ideal anti-cocaine medication would accelerate cocaine metabolism producing biologically inactive metabolites via a route similar to the primary cocaine-metabolizing pathway, i.e. human BChE (butyrylcholinesterase)-catalysed hydrolysis. However, the native human BChE has a low catalytic activity against cocaine. We recently designed and discovered a BChE mutant (A199S/F227A/S287G/A328W/Y332G) with a high catalytic activity (kcat=5700 min-1, Km=3.1 ?M) specifically for cocaine, and the mutant was proven effective in protecting mice from acute cocaine toxicity of a lethal dose of cocaine (180 mg/kg of body weight, LD100). Further characterization in animal models requires establishment of a high-efficiency stable cell line for the BChE mutant production at a relatively larger scale. It has been extremely challenging to develop a high-efficiency stable cell line expressing BChE or its mutant. In the present study, we successfully developed a stable cell line efficiently expressing the BChE mutant by using a lentivirus-based repeated-transduction method. The scaled-up protein production enabled us to determine for the first time the in vivo catalytic activity and the biological half-life of this high-activity mutant of human BChE in accelerating cocaine clearance. In particular, it has been demonstrated that the BChE mutant (administered to mice 1 min prior to cocaine) can quickly metabolize cocaine and completely eliminate cocaine-induced hyperactivity in rodents, implying that the BChE mutant may be developed as a promising therapeutic agent for cocaine abuse treatment. PMID:23849058

  20. Evaluation of the analgesic effect of subcutaneous methadone after cesarean section

    PubMed Central

    Jabalameli, Mitra; Kalantari, Forough

    2014-01-01

    Background: Inadequate pain control has a significant role in maternal and neonatal health in early post-partum period which interferes with breastfeeding and has a negative influence on child normal growth. The aim of this study is evaluation of subcutaneous methadone effectiveness on post-operative pain control. Materials and Methods: Double blind randomized prospective clinical trial involving 60 term pregnancy patients through 2008 to 2009 Undergo cesarean. Inclusion criteria: Prime gravid candidate of elective cesarean and spinal anesthesia class 1 or 2. Known case of drug allergy and methadone interaction, addiction, uncontrolled medical disease excluded. Case group injected 10 mg of subcutaneous methadone in the site of incision before final suture. Morphine was a pain reliever in follow up examination. Data include mean of pain, nausea and vomiting, MAP, etc., collected and analyzed by independent-T test and Man Whitney test. Results: Although mean usage of morphine between groups was not significant statistically but the mean pain severity (P value < 0.05) and mean satisfactory (P value = 0.02) was statistically significant between groups. Other parameters were not statistically significant. Conclusion: We suggest subcutaneous methadone as a safe pain reliever in post cesarean section patients. PMID:25337527

  1. A Social Network Profile and HIV Risk Among Men on Methadone: Do Social Networks Matter?

    Microsoft Academic Search

    Nabila El-Bassel; Louisa Gilbert; Elwin Wu; Mingway Chang

    2006-01-01

    The paper describes structural and HIV-related network characteristics and examines associations between these various social network domains and HIV risk behaviors among a sample of 356 men randomly selected from a methadone maintenance treatment program (MMTP) in New York City. Multiple logistic regression analyses suggest that (1) a higher level of perceived sexual risk among network members, referred to as

  2. Working in the Conflict-Free Sphere: Adaptation Group in Methadone Maintenance Treatment

    Microsoft Academic Search

    David Potik; Yali Abramsohn; Einat Peles; Shaul Schreiber; Miriam Adelson

    2011-01-01

    Many studies have been published on various types of psychoeducational group therapy in methadone maintenance treatment (MMT), but none has ever addressed the issue of group therapy for new beginners, despite the fact that the initial period following the cessation of drug abuse holds promise for many significant changes in an individual's lifestyle and behavior. This article presents an integrative

  3. Voucher reinforcement improves medication adherence in HIV-positive methadone patients: A randomized trial

    Microsoft Academic Search

    James L. Sorensen; Nancy A. Haug; Kevin L. Delucchi; Valerie Gruber; Evan Kletter; Steven L. Batki; Jacqueline P. Tulsky; Paul Barnett; Sharon Hall

    2007-01-01

    This clinical trial evaluated a contingency management intervention designed to improve medication adherence among HIV-positive methadone maintenance patients. After a 4-week baseline observation phase, eligible participants (N=66) were randomly assigned to: (a) medication coaching sessions every other week to assist with adherence strategies (comparison group) or (b) medication coaching plus voucher reinforcement for opening electronic medication caps on time (voucher

  4. Effect of Methadone Treatment on Incarceration Rates among Injection Drug Users

    Microsoft Academic Search

    Daniel Werb; Thomas Kerr; David Marsh; Kathy Li; Julio Montaner; Evan Wood

    2008-01-01

    Background: Methadone maintenance treatment (MMT) has been shown to dramatically reduce illicit opioid use and criminal activity among injection drug users (IDU). However, questions remain concerning the effect of MMT in reducing rates of incarceration among IDU. We therefore sought to investigate the long-term effect of MMT on rates of incarceration. Methods: We performed a generalized estimating equation longitudinal analysis

  5. Developing an electronic health record (EHR) for methadone treatment recording and decision support

    Microsoft Academic Search

    Liang Xiao; Gráinne Cousins; Brenda Courtney; Lucy Hederman; Tom Fahey; Borislav D Dimitrov

    2011-01-01

    BACKGROUND: In this paper, we give an overview of methadone treatment in Ireland and outline the rationale for designing an electronic health record (EHR) with extensibility, interoperability and decision support functionality. Incorporating several international standards, a conceptual model applying a problem orientated approach in a hierarchical structure has been proposed for building the EHR. METHODS: A set of archetypes has

  6. An innovative approach to reducing cannabis use in a subset of methadone maintenance clients

    Microsoft Academic Search

    D. A. Calsyn; A. J. Saxon

    1999-01-01

    Cannabis use rates among methadone maintenance clients are high. We attempted to decrease cannabis use in our most stable clients by adding a requirement to the take home dose policy that clients provide cannabis free urines to achieve twice a week pick up status (2×\\/week). The urine records and take home status of all clients were monitored for the 6

  7. An extended physiological pharmacokinetic model of methadone disposition in the rat: Validation and sensitivity analysis

    Microsoft Academic Search

    Johan L. Gabrielsson; Torgny Groth

    1988-01-01

    An extended physiological model of methadone disposition in the rat was constructed and evaluated in various tests of model validity. A separate circulation model of the fetus was included due to the large tissue concentration differences obtained after a constant rate infusion but also to propose the use of this type of model for optimization of toxicological tests. Simulations were

  8. The Relationship between Sugar-Containing Methadone and Dental Caries: A Systematic Review

    ERIC Educational Resources Information Center

    Tripathee, Sheela; Akbar, Tahira; Richards, Derek; Themessl-Huber, Markus; Freeman, Ruth

    2013-01-01

    Objectives: To review the evidence of a relationship between sugar-containing methadone and dental caries. Data sources: A systematic search of Cochrane Library, PubMed, PsychINFO, EMBASE, MEDLINE, Current Controlled Trials, WHO, OHRN, SIGLE and ERIC databases was conducted from January 1978 up to June 2010. Study selection: Articles were assessed…

  9. Methadone Induction in Primary Care for Opioid Dependence: A Pragmatic Randomized Trial (ANRS Methaville)

    PubMed Central

    Carrieri, Patrizia Maria; Michel, Laurent; Lions, Caroline; Cohen, Julien; Vray, Muriel; Mora, Marion; Marcellin, Fabienne; Spire, Bruno; Morel, Alain; Roux, Perrine

    2014-01-01

    Objective Methadone coverage is poor in many countries due in part to methadone induction being possible only in specialized care (SC). This multicenter pragmatic trial compared the effectiveness of methadone treatment between two induction models: primary care (PC) and SC. Methods In this study, registered at ClinicalTrials.Gov (NCT00657397), opioid-dependent individuals not on methadone treatment for at least one month or receiving buprenorphine but needing to switch were randomly assigned to start methadone in PC (N?=?155) or in SC (N?=?66) in 10 sites in France. Visits were scheduled at months M0, M3, M6 and M12. The primary outcome was self-reported abstinence from street-opioids at 12 months (M12) (with an underlying 15% non-inferiority hypothesis for PC). Secondary outcomes were abstinence during follow-up, engagement in treatment (i.e. completing the induction period), retention and satisfaction with the explanations provided by the physician. Primary analysis used intention to treat (ITT). Mixed models and the log-rank test were used to assess the arm effect (PC vs. SC) on the course of abstinence and retention, respectively. Results In the ITT analysis (n?=?155 in PC, 66 in SC), which compared the proportions of street-opioid abstinent participants, 85/155 (55%) and 22/66 (33%) of the participants were classified as street-opioid abstinent at M12 in PC and SC, respectively. This ITT analysis showed the non-inferiority of PC (21.5 [7.7; 35.3]). Engagement in treatment and satisfaction with the explanations provided by the physician were significantly higher in PC than SC. Retention in methadone and abstinence during follow-up were comparable in both arms (p?=?0.47, p?=?0.39, respectively). Conclusions Under appropriate conditions, methadone induction in primary care is feasible and acceptable to both physicians and patients. It is as effective as induction in specialized care in reducing street-opioid use and ensuring engagement and retention in treatment for opioid dependence. Trial registration Number Eudract 2008-001338-28; ClinicalTrials.gov: NCT00657397; International Standard Randomized Controlled Trial Number Register ISRCTN31125511 PMID:25393311

  10. Cocaine and butyrylcholinesterase (BChE): Determination of enzymatic parameters

    Microsoft Academic Search

    C. Mattes; R. Bradley; E. Slaughter; S. Browne

    1996-01-01

    In humans, the plasma enzyme, butyrylcholinesterase (E.C. 3.1.1.8), metabolizes cocaine to the water-soluble, pharmacologically inactive compounds, ecgonine methylester and benzoic acid. Homogenous enzyme was purified from human plasma and used to determine the enzyme kinetic parameters of Km and Vmax with cocaine as the substrate. The KM (11.9 ?M) indicates that cocaine is tightly bound to the four active sites

  11. Increasing effects of repetitive cocaine administration in the rat

    Microsoft Academic Search

    Robert M. Post; Harvey Rose

    1976-01-01

    REPORTS of chronic cocaine (and related psychomotor stimulant) administration suggest that tolerance develops to many drug effects1-3. A few studies of high dose cocaine administration have suggested that, on the contrary, repetitive administration may be associated with increasing effects on cocaine-induced convulsions in the rat4,5 and monkey6 and increasing bizarre visual and inhibitory behaviour, as well as dyskinesias, in the

  12. Development of translational preclinical models in substance abuse: Effects of cocaine administration on cocaine choice in humans and non-human primates.

    PubMed

    Foltin, Richard W; Haney, Margaret; Rubin, Eric; Reed, Stephanie C; Vadhan, Nehal; Balter, Rebecca; Evans, Suzette M

    2015-07-01

    Human drug use involves repeated choices to take drugs or to engage in alternative behaviors. The purpose of this study was to examine how response cost for cocaine and the value of an alternative reinforcer (opportunity to play a game of chance) and how 'free' doses (with minimal response cost) affected cocaine choice. Two laboratory studies of cocaine self-administration were conducted in a group of humans who were habitual cocaine smokers and in a group of rhesus monkeys that intravenously self-administered cocaine. Nine human cocaine smokers who were not seeking treatment for their cocaine were repeatedly presented with the choice to smoke 25mg cocaine base or play a game of chance for a monetary bonus paid at study completion. The response cost for choosing cocaine varied (up to 4000 responses/dose) and the number of game plays varied (up to 8). In this sample of humans, increasing either the response cost for cocaine or increasing the value of the alternative reinforcer did not significantly affect cocaine choice, while increasing both simultaneously slightly decreased cocaine choice and increased choice of the alternative. In monkeys, the dose-response function for cocaine self-administration (10 choices of 0.0125-0.1mg/kg/infusion vs. candy coated chocolate) was steep and we failed to achieve a 50/50 cocaine/candy choice even after substantially manipulating cost and number of candies available. Providing a large 'free' self-administered cocaine dose to humans did not significantly affect cocaine choice, whereas in monkeys, a large free dose of cocaine decreased cocaine choice when higher doses of cocaine were available for self-administration. The present results demonstrate that in the laboratory, it is difficult to modify on-going cocaine self-administration behavior in both humans and non-human primates. PMID:25933796

  13. Correlation between cocaine-induced locomotion and cocaine disposition in the brain among four inbred strains of mice.

    PubMed

    Wiener, H L; Reith, M E

    1990-07-01

    BALB/cByJ, C57BL/6ByJ, CXBH/By, and CXBK/By mice differed in their locomotor response to cocaine measured 1-10 min after administration of 25 mg/kg IP of the compound. These differences were paralleled by differences in the disposition of cocaine (measured at 12 min) in the brain. Among all individual animals taken together, there was a significant correlation between locomotor stimulation and the brain concentration of cocaine. These results suggest that the differences between strains in their locomotor responsiveness to cocaine are determined, in part, by the disposition of cocaine in the brain following IP administration of cocaine. PMID:2377671

  14. Interaction of the indirectly acting topical sympathomimetics cocaine and pholedrine.

    PubMed

    Wilhelm, H; Wilhelm, B; Kriegbaum, C

    1996-05-01

    In suspected Horner's syndrome, cocaine eye drops are applied to verify the diagnosis. Subsequent application of hydroxyamphetamine or pholedrine eye drops allows localization of the site of the interruption in the oculosympathetic pathway. In the present study the influence of cocaine on subsequent pholedrine testing was examined. Cocaine 5% and pholedrine 5% eye drops were applied to eight (72-h interval only six) normal volunteers with light-colored irides. The ages of the subjects ranged from 23 to 40 years. Eye drops were applied to the same eye at varying intervals of up to 72 h, with the cocaine being given between 8:30 and 9:30 a.m. Pupil diameters were recorded by means of a frame-grabber card in a personal computer and were subsequently measured before and at 50-60 min after each drug application in 1.7 cd/m2 ambient light. In the absence of pretreatment with cocaine, pholedrine changed the mean pupil diameter from 6.89 to 8.57 mm. At 12 h after cocaine pretreatment the pupil remained dilated. Pholedrine dilated the pupil further, from 7.69 to 8.61 mm. When cocaine was given 24 h before pholedrine, the pupil dilated from 6.75 to 8.25 mm; at 48 h after cocaine application, pholedrine dilated the pupil from 6.14 to 8.20 mm; and at 72 h after cocaine pretreatment, pholedrine dilated the pupil from 5.74 to 8.00 mm. As compared with the mean diameter of the untreated contralateral pupil, the pholedrine-induced dilation amounted to 2.32 mm in the absence of cocaine pretreatment, 1.04 mm at 12 h after cocaine application, 1.29 mm at 24 h after cocaine administration, 1.89 mm at 48 h after cocaine pretreatment, and 2.18 mm at 72 h after cocaine application. The residual cocaine effect interfered with the mean pupil dilation produced by pholedrin for at least 48 h. To ensure that the sensitivity of the pholedrine test is maximal, the examiner should delay its use for more than 48 h after the cocaine test. PMID:8803579

  15. Cannabidiol Rescues Acute Hepatic Toxicity and Seizure Induced by Cocaine

    PubMed Central

    Vilela, Luciano Rezende; Gomides, Lindisley Ferreira; David, Bruna Araújo; Antunes, Maísa Mota; Diniz, Ariane Barros; Moreira, Fabrício de Araújo; Menezes, Gustavo Batista

    2015-01-01

    Cocaine is a commonly abused illicit drug that causes significant morbidity and mortality. The most severe and common complications are seizures, ischemic strokes, myocardial infarction, and acute liver injury. Here, we demonstrated that acute cocaine intoxication promoted seizure along with acute liver damage in mice, with intense inflammatory infiltrate. Considering the protective role of the endocannabinoid system against cell toxicity, we hypothesized that treatment with an anandamide hydrolysis inhibitor, URB597, or with a phytocannabinoid, cannabidiol (CBD), protects against cocaine toxicity. URB597 (1.0?mg/kg) abolished cocaine-induced seizure, yet it did not protect against acute liver injury. Using confocal liver intravital microscopy, we observed that CBD (30?mg/kg) reduced acute liver inflammation and damage induced by cocaine and prevented associated seizure. Additionally, we showed that previous liver damage induced by another hepatotoxic drug (acetaminophen) increased seizure and lethality induced by cocaine intoxication, linking hepatotoxicity to seizure dynamics. These findings suggest that activation of cannabinoid system may have protective actions on both liver and brain induced by cocaine, minimizing inflammatory injury promoted by cocaine, supporting its further clinical application in the treatment of cocaine abuse. PMID:25999668

  16. Comparison of acute effects of heroin and Kerack on sensory and motor activity of honey bees (Apis mellifera)

    PubMed Central

    Hassanpour-Ezatti, Majid

    2015-01-01

    Objective(s): Previous studies demonstrated a functional similarity between vertebrate and honey bee nervous systems. The aim of the present study was to compare the effects of heroin and Iranian street Kerack, a combination of heroin and caffeine, on sensory threshold and locomotor activity in honey bees. Materials and Methods: All drugs were given orally to honey bees 30 min before each experiment. The levels of these drugs and their metabolites in brain samples of honey bees were determined by GC/MS. The sucrose sensitivity test was used for evaluation of changes in honey bees’ sensory threshold. Following the administration of both drugs, the honey bees’ locomotor activity changes were evaluated in open fields. Results: 6-acetylmorphine had a higher concentration in comparison with other heroin metabolites in honey bees’ brains. Concentration of the compound in the brain was directly proportional to the amount ingested. Heroin reduced the sensory threshold of honey bees, but Kerack increased it in the same doses. Locomotor activity of honey bee in open field was enhanced after the administration of both drugs. However, immobility time of honey bees was only affected by high doses of heroin. Conclusion: Acute effects of heroin andKerack on the sensory and motor functions of honey bees were different. Findings of this research suggest that these differences originated from the activation of different neurotransmitter systems by caffeine together with activation of opioid receptors by heroin. PMID:26019799

  17. Incubation of cocaine seeking following brief cocaine experience in mice is enhanced by mGluR1 blockade.

    PubMed

    Halbout, Briac; Bernardi, Rick E; Hansson, Anita C; Spanagel, Rainer

    2014-01-29

    The incubation of cocaine craving describes the time-dependent augmentation of cue-induced cocaine seeking during withdrawal from prolonged cocaine self-administration and requires time-dependent changes in neuroplasticity at the level of glutamatergic synapses in the nucleus accumbens (NAc). In contrast to most studies that use multiple cocaine-cue conditioning sessions, the present study tested mice with limited cocaine experience (i.e., a single conditioning session) in the incubation of cue-mediated cocaine seeking and its associated changes in the glutamate system. Mice that self-administered cocaine during a single session exhibited a time-dependent increase in their response for the drug-associated cue as compared to mice that self-administered saline. This behavior was associated with changes in AMPA and NMDA receptor binding characteristics. Furthermore, Group I metabotropic glutamate receptor (mGluR1) mRNA levels were altered in several brain regions, including the NAc. Because of the pivotal role of mGluR1 in the control of cocaine-induced plasticity, we investigated the role of mGluR1 in the formation of drug cue-mediated cocaine seeking. After prolonged withdrawal, mice in which an mGluR1 antagonist was administered following cocaine self-administration displayed increased cocaine seeking compared to vehicle-treated mice. These results suggest that limited cocaine experience is sufficient to induce neurobiological changes that enable an initially neutral cue to acquire motivational value that increases over time, an effect that likely involves glutamate signaling through mGluR1. PMID:24478360

  18. Effects of phendimetrazine treatment on cocaine vs food choice and extended-access cocaine consumption in rhesus monkeys.

    PubMed

    Banks, Matthew L; Blough, Bruce E; Fennell, Timothy R; Snyder, Rodney W; Negus, S Stevens

    2013-12-01

    There is currently no Food and Drug Administration-approved pharmacotherapy for cocaine addiction. Monoamine releasers such as d-amphetamine constitute one class of candidate medications, but clinical use and acceptance are hindered by their own high-abuse liability. Phendimetrazine (PDM) is a schedule III anorectic agent that functions as both a low-potency monoamine-uptake inhibitor and as a prodrug for the monoamine-releaser phenmetrazine (PM), and it may serve as a clinically available, effective, and safer alternative to d-amphetamine. This study determined efficacy of chronic PDM to reduce cocaine self-administration by rhesus monkeys (N=4) using a novel procedure that featured both daily assessments of cocaine vs food choice (to assess medication efficacy to reallocate behavior away from cocaine choice and toward choice of an alternative reinforcer) and 20?h/day cocaine access (to allow high-cocaine intake). Continuous 21-day treatment with ramping PDM doses (days 1-7: 0.32?mg/kg/h; days 8-21: 1.0?mg/kg/h) reduced cocaine choices, increased food choices, and nearly eliminated extended-access cocaine self-administration without affecting body weight. There was a trend for plasma PDM and PM levels to correlate with efficacy to decrease cocaine choice such that the monkey with the highest plasma PDM and PM levels also demonstrated the greatest reductions in cocaine choice. These results support further consideration of PDM as a candidate anti-cocaine addiction pharmacotherapy. Moreover, PDM may represent a novel pharmacotherapeutic approach for cocaine addiction because it may simultaneously function as both a monoamine-uptake inhibitor (via the parent drug PDM) and as a monoamine releaser (via the active metabolite PM). PMID:23893022

  19. Early methylphenidate exposure enhances cocaine self-administration but not cocaine-induced conditioned place preference in young adult rats

    PubMed Central

    Crawford, Cynthia A.; Baella, Shelley A.; Farley, Cristal M.; Herbert, Matthew S.; Horn, Leslie R.; Campbell, Rachel H.; Zavala, Arturo R.

    2010-01-01

    Rationale Previous studies in rodents show that early exposure to methylphenidate alters later responsiveness to drugs of abuse. An interesting feature of these studies is that early methylphenidate treatment decreases the rewarding value of cocaine when measured by conditioned place preference (CPP), but the same treatment increases cocaine self-administration. Objective The goal of the present study was to examine the effects of early methylphenidate exposure on cocaine-induced responding using both reward paradigms. Methods Rats were treated with methylphenidate (0, 2, or 5 mg/kg) from postnatal day (PD) 11 to PD 20 and then cocaine-induced CPP or cocaine self-administration was measured in separate groups of rats in adulthood. The CPP procedure included eight days of acquisition training, eight days of extinction training, and a reinstatement test. Rats were conditioned with 0, 10 or 20 mg/kg cocaine. Reinstatement was assessed after a priming dose of cocaine (10 mg/kg). For the self-administration experiment, a jugular catheter was implanted and rats were trained to press a lever reinforced with cocaine (0.25 or 0.75 mg/kg/infusion) on a fixed ratio (FR) 1 schedule. Rats were gradually moved from an FR1 to an FR10 schedule and, after criterion was reached, rats were placed on a progressive ratio schedule for five days. Results Cocaine produced robust rewarding effects as determined by both the CPP and self-administration experiments; however, early methylphenidate exposure only enhanced the reinforcing effects of cocaine on the self-administration paradigm. Interestingly, this methylphenidate enhancement was only seen in male rats. Conclusions These data suggest that in males methylphenidate enhances the reinforcing value of cocaine, but not cocaine-associated cues. PMID:20848087

  20. Religion and Therapy: Religious Conversion and the Mental Health of Chronic Heroin-Addicted Persons

    Microsoft Academic Search

    Ho-Yee Ng; Daniel T. L. Shek

    2001-01-01

    Eighty-six Chinese heroin-addicted men from different stages of a gospel drug rehabilitation programme, including the pre-conversion stage (N = 26), post-conversion stage (N = 20), halfway house stage (N = 19), and peer leaders stage (N = 21) were recruited. Participants responded to instruments assessing their depressive symptoms, sense of hopelessness, and purpose in life. Results showed that there was

  1. Cinderella vs Statistics: The Silent Movie Heroine as a Jazz Age Working Girl.

    ERIC Educational Resources Information Center

    Higashi, Sumiko

    The portrayal of the working girl in the silent films of the 1920s ignored the fact that in reality women worked to help support their families, to be financially independent, or to supplement their family's income. A study of movie heroines from that era reveals that these characterizations reinforce the image of the traditionally dependent woman…

  2. Using a Group Approach to Preventing Heroin Overdose in North London

    ERIC Educational Resources Information Center

    Phillips, Peter; Glover, Chris; Allan, Teresa; Khoo, Mary Ellen

    2009-01-01

    Aims: This study used group psycho-education methods to assist injecting heroin users in preventing, and responding to overdose. Methods: An "OD Prevention" group was advertised in a London prescribing service and associated primary care unit. The intervention took place in a small group over one afternoon (3.5 hours), and trained participants in…

  3. Marathon Groups. Facilitating the Personal Growth of Imprisoned, Black Female Heroin Abusers.

    ERIC Educational Resources Information Center

    Page, Richard C.; Kubiak, Larry

    1978-01-01

    Apparent success of the marathon groups in altering the perceptions of Black female heroin addicts toward the future, counseling, and themselves offers preliminary evidence that marathons may have potential as a counseling strategy with these clients. Future research needs to be performed to substantiate or reject these findings. (Author/PD)

  4. Role of Acetylcholine Transmission in Nucleus Accumbens and Ventral Tegmental Area in Heroin-Seeking Induced by Conditioned Cues

    PubMed Central

    Zhou, Wenhua; Liu, Huifen; Zhang, Fuqiang; Tang, Suien; Zhu, Huaqiang; Lai, Miaojun; Kalivas, Peter W.

    2007-01-01

    The involvement of cholinergic transmission in heroin self-administration and the reinstatement of heroin-seeking was examined in rats trained to nose-poke for intravenous heroin. Systemic treatment with physostigmine, an inhibitor of acetylcholinesterase, modestly reduced the acquisition and rate of heroin self-administration, and this suppression of heroin intake was reversed by pretreatment with scopolamine but not by mecamylamine. Following 10–14 days of self-administration, rats were left in the home environment for 14 days. Subsequently, rats were evaluated for extinction of nose-pokes during the first hour after being returned to the self-administration apparatus. One hr later a conditioned stimulus (house light, light in the nose-poke hole, sound of the infusion pump) was presented to initiate cue-induced reinstatement. Physostigmine produced a dose-dependent inhibition of cue-induced reinstatement, but only the dose of 0.5 mg/kg significantly decreased nose-poke responding in the extinction test. Chronic treatment with physostigmine (0.1 mg/kg) did not impair performance during acquisition of heroin self-administration. However, during a subsequent reinstatement test conducted in the absence of physostigmine pretreatment, heroin seeking was significantly below that of rats chronically pretreated with saline. To evaluate brain regions mediating the effects of systemic drug treatment on reinstatement, physostigmine was microinjected into the nucleus accumbens (NAc) or ventral tegmental area (VTA). Microinjection of physostigmine into the NAc prior to presenting conditioned cues inhibited the reinstatement of heroin-seeking, without affecting extinction responding. In contrast, microinjection of physostigmine into the VTA augmented the reinstatement induced by conditioned cues and extinction responding. Inactivation of either NAc or VTA by microinjecting tetrodotoxin blocked both extinction responding and cue-induced reinstatement. These data demonstrate that cholinergic transmission influences heroin self-administration and reinstatement. Moreover, cue-induced reinstatement was inhibited by physostigmine in the NAc and potentiated by cholinergic stimulation in the VTA. PMID:17184925

  5. The evidence for the contribution of the autism susceptibility candidate 2 (AUTS2) gene in heroin dependence susceptibility.

    PubMed

    Dang, Wei; Zhang, Qian; Zhu, Yong-Sheng; Lu, Xiao-Yun

    2014-12-01

    The single-nucleotide polymorphisms (SNP) rs6943555 in autism susceptibility candidate 2 (AUTS2) has been reported to be significantly associated with alcohol consumption in Europeans. In this study, we identified the SNP in AUTS2 contributing to the genetic susceptibility to heroin dependence. The potential association between heroin dependence and 21 SNPs (rs2270162, rs2851510, rs513150, rs595681, rs210606, rs10237984, rs13228123, rs10235781, rs6969375, rs6943555, rs10251416, rs17141963, rs12669427, rs723340, rs2293507, rs2293508, rs6960426, rs9886351, rs2293501, rs10277450, rs1918425) of AUTS2 was examined in a Chinese Han population using the MassARRAY system. The participants included 426 patients with heroin dependence and 416 healthy controls. Single SNP association, haplotype association, and clinical phenotype association were analyzed. Single SNP association revealed that AA homozygotes of rs6943555 were significantly over-represented in the patients with heroin dependence compared with the control subjects (P=0.0019). The patients with heroin dependence had a significantly higher frequency of the A allele (P=0.0003, odd ratio (OR)=1.429, 95% confidence interval (CI)=1.175-1.738). Strong linkage disequilibrium (LD) was observed in five blocks (D'>0.9). In block 2, significantly more A-A haplotypes (P=0.006 after Bonferroni corrections) and significantly fewer T-A haplotypes (P=0.040) were found in the patients with heroin dependence. The genotype and clinical phenotype correlation study of the rs6943555 carriers showed that the amount of heroin self-injection was lower in the patients with the AA genotype relative to AT+TT genotypes (P<0.01). Our results confirmed that, in addition to heroin consumption, the SNP rs6943555 of AUTS2 may also play an important role in the etiology of heroin dependence. PMID:25398668

  6. Methadone treatment as a determinant of HIV risk reduction among injecting drug users: A nested case-control study

    Microsoft Academic Search

    G. Serpelloni; M. P. Carrieri; G. Rezza; S. Morganti; M. Gomma; N. Binkin

    1994-01-01

    In order to evaluate the protective effect of methadone treatment on HIV infection, we performed a nested case-control study on seroconverters (cases) who were part of a cohort of HIV-negative injecting drug users (IDUs) (controls). Controls were matched with cases by sex, age, duration of drug use and follow-up time. Information on methadone treatment in the year prior to seroconversion

  7. The effect of methadone on immunological parameters among HIV-positive and HIV-negative drug users.

    PubMed

    Carballo-Diéguez, A; Sahs, J; Goetz, R; el Sadr, W; Sorell, S; Gorman, J

    1994-08-01

    Our objective was to assess the effects of methadone use on immune parameters. A convenience sample of men and women drug injectors who knew their HIV serostatus were enrolled in a longitudinal observational study of HIV illness. During analysis of baseline data, differences were noted in immune parameters among Methadone users. Study participants were recruited in Manhattan, New York, from a methadone maintenance clinic, and infectious disease clinic of an inner city hospital, and a drug-free community center. The participants were 220 men and women, current or former drug injectors, approximately half of them HIV-antibody positive and the rest HIV-antibody negative. Candidates with opportunistic infections and secondary neoplasms were excluded. Methadone users were compared to nonmethadone users for absolute and percentage counts of CD4, CD8, and activated T lymphocytes; CD4/CD8 ratio; an HIV symptom check list; and medical staging. The results discussed in this paper were formulated after data collection was complete. Our data indicate that methadone treatment, while not significantly affecting absolute CD4 lymphocyte count, is associated with a lower CD4 percentage and CD4/CD8 cell ratio, and with a higher CD8 absolute count and percentage. These differences are present regardless of HIV serostatus. Our findings should be interpreted with caution since we did not set out to investigate the effects of methadone on the immune system. Nevertheless, if it is corroborated that methadone has a detrimental effect on the immune system, finding alternatives to methadone-maintenance treatment for drug injectors will be a necessity. PMID:7977217

  8. Effects of sleep deprivation on sleep homeostasis and restoration during methadone-maintenance: A [31]P MRS brain imaging study

    Microsoft Academic Search

    George H. Trksak; J. Eric Jensen; David T. Plante; David M. Penetar; Wendy L. Tartarini; Melissa A. Maywalt; Michael Brendel; Cynthia M. Dorsey; Perry F. Renshaw; Scott E. Lukas

    2010-01-01

    Insomnia afflicts many individuals, but particularly those in chronic methadone treatment. Studies examining sleep deprivation (SD) have begun to identify sleep restoration processes involving brain bioenergetics. The technique [31]P magnetic resonance spectroscopy (MRS) can measure brain changes in the high-energy phosphates: alpha-, beta-, and gamma-nucleoside triphosphate (NTP). In the present study, 21 methadone-maintained (MM) and 16 control participants underwent baseline

  9. Two anthrax cases with soft tissue infection, severe oedema and sepsis in Danish heroin users

    PubMed Central

    2013-01-01

    Background Anthrax had become extremely rare in Europe, but in 2010 an outbreak of anthrax among heroin users in Scotland increased awareness of contaminated heroin as a source of anthrax. We present the first two Danish cases of injectional anthrax and discuss the clinical presentations, which included both typical and more unusual manifestations. Case presentations The first patient, a 55-year old man with HIV and hepatitis C virus co-infection, presented with severe pain in the right thigh and lower abdomen after injecting heroin into the right groin. Computed tomography and ultrasonographic examination of the abdomen and right thigh showed oedematous thickened peritoneum, distended oedematous mesentery and subcutaneous oedema of the right thigh. At admission the patient was afebrile but within 24 hours he progressed to severe septic shock and abdominal compartment syndrome. Cultures of blood and intraperitoneal fluid grew Bacillus anthracis. The patient was treated with meropenem, clindamycin, ciprofloxacin and metronidazole. Despite maximum supportive care including mechanical ventilation, vasopressor treatment and continuous veno-venous hemodiafiltration the patient died on day four. The second patient, a 39-year old man with chronic hepatitis C virus infection, presented with fever and a swollen right arm after injecting heroin into his right arm. The arm was swollen from the axilla to the wrist with tense and discoloured skin. He was initially septic with low blood pressure but responded to crystalloids. During the first week, swelling progressed and the patient developed massive generalised oedema with a weight gain of 40 kg. When blood cultures grew Bacillus anthracis antibiotic treatment was changed to meropenem, moxifloxacin and metronidazole, and on day 7 hydroxycloroquin was added. The patient responded to treatment and was discharged after 29 days. Conclusions These two heroin-associated anthrax cases from Denmark corroborate that heroin contaminated with anthrax spores may be a continuous source of injectional anthrax across Europe. Clinicians and clinical microbiologists need to stay vigilant and suspect anthrax in patients with a history of heroin use who present with soft tissue or generalised infection. Marked swelling of affected soft tissue or unusual intra-abdominal oedema should strengthen clinical suspicion. PMID:24004900

  10. Correlates of syringe coverage for heroin injection in 35 large metropolitan areas in the US in which heroin is the dominant injected drug

    PubMed Central

    Tempalski, Barbara; Cooper, Hannah L.; Friedman, Samuel R.; Des Jarlais, Don C.; Brady, Joanne; Gostnell, Karla

    2009-01-01

    Background Scientific consensus holds that if, at the outset of the HIV/AIDS epidemic, injection drug users (IDUs) had had better access to sterile syringes, much of the epidemic among IDUs in the U.S. could have been prevented. In the context of preventing infectious diseases, 100% syringe coverage—that is, one sterile syringe per injector for each injection—is a public health goal. Notably, we know little about variations in syringe coverage within the U.S. and elsewhere, or about the social and political factors that might determine this coverage. Methods Using data from Holmberg (AJPH, 1996), the 1990 United States Census, the 2000 Beth Israel National Syringe Exchange Survey (n=72), and estimates of IDUs in metropolitan areas (MSAs); (Friedman et al., 2004), we explore the impact of (1) political factors (ACT UP, outreach, early syringe exchange programme (SEP) presence, men who have sex with men (MSM) per capita, drug arrests, and police per capita); (2) local resources for SEPs; and (3) indicators of socioeconomic inequality on SEP coverage. We define “syringe coverage” as the ratio of syringes distributed at SEPs to the number of syringes heroin injectors need in a year. We calculated the number of syringes heroin injectors need in a year by multiplying an estimate of the number of IDUs in each MSA by an estimate of the average number of times heroin injectors inject heroin per year (2.8 times per day times 365 days). In this analysis, the sample was limited to 35 MSAs in which the primary drug of choice among injectors was heroin. Results SEP coverage varies greatly across MSAs, with an average of 3 syringes distributed per 100 injection events (std dev = 0.045; range: 2 syringes per 10 injection events, to 3 syringes per 10,000 injection events). In bivariate regression analyses, a 1 unit difference in the proportion of the population that was MSM per 1,000 was associated with a difference of 0.002 in SEP coverage (p=0.052); early SEP presence was associated with a difference of 0.038 in coverage (p=0.012); and having government funding was associated with a 0.040 difference in SEP coverage (p=0.021). Conclusions This analysis suggests that longer duration of SEP presence may increase syringe distribution and enhance successful programme utilization. Furthermore, MSAs with greater proportions of MSM tend to have better SEP coverage, perhaps providing further evidence that grassroots activism plays an important role in programme implementation and successful SEP coverage. This research provides evidence that government funding for SEPs contributes to better syringe coverage. PMID:18295468

  11. Differential Modulation of Cocaine’s Discriminative Cue by Repeated and Variable Stress Exposure: Relation to Monoamine Transporter Levels

    PubMed Central

    Decicco-Skinner, Kathleen L.; Johari, Shirin; Hurwitz, Zachary E.; Baumann, Michael H.; Riley, Anthony L.

    2012-01-01

    Discriminative stimulus functions of drugs of abuse play an important role in the acquisition, maintenance and reinstatement of drug-taking behavior. The present study tested whether two different schedules of stressor presentation, i.e., repeated and variable, for 10 days, can modify the discriminative stimulus effects of cocaine in male rats trained to discriminate cocaine (10 mg/kg, i.p.) from saline. Dopamine (DAT), serotonin (SERT) and norepinephrine (NET) transporter levels in mesocorticolimbic areas were also measured using western blotting after stress exposure to determine if the relative ratio of these proteins may explain differences in behavior. Rats exposed to both repeated and variable stress displayed shifts in the cocaine dose-response curve but with different patterns of responding. In handled controls, ED50 values for cocaine-like responding were stable after 10 days of handling compared to baseline. Repeated stress produced a transient left-ward shift in cocaine-like responding, indicating increased sensitivity to the cocaine cue. ED50 values after variable stress did not differ from baseline, although maximal cocaine-like responding was lower at the two highest doses of cocaine tested at which variably stressed rats switched from cocaine to saline-like responding. Alterations in DAT and NET were found in the Repeated stress group and DAT and SERT in the Variable stress group in select brain regions which may be responsible for differences in behavior. PMID:22516586

  12. Cognitive Effects of Cocaine and Polydrug Abuse

    Microsoft Academic Search

    Monica Rosselli; Alfredo Ardila

    1996-01-01

    One hundred and eighty-three participants were divided into three groups containing: 61 cocaine-dependent; 59 polydrug-dependent; and 63 normal subjects. All were evaluated using a basic neuropsychological assessment battery. The dependent groups exhibited significantly lower scores on short-term memory, attention, and concept formation tests. Performance on some subtests correlated negatively with the length of dependency and frequency of substance use. As

  13. Diamorphine treatment for opiate dependence: putative markers of concomitant heroin misuse.

    PubMed

    McLachlan-Troup, Neil; Taylor, Graham W.; Trathen, Bruce C.

    2001-07-01

    The supply of substitute opioid medication as a treatment for heroin dependence is now common practice. There is growing international interest in the prescription of injectable diamorphine for subgroups of patients who are unable to stop injecting opiate drugs; in the United Kingdom it is estimated that there are currently 300 patients prescribed diamorphine for this purpose. The detection of illicit heroin misuse (through urinary diamorphine metabolites) is confounded in subjects prescribed diamorphine. We investigated the potential to distinguish between the use of street heroin and pharmaceutical diamorphine through the detection in urine of various opiate alkaloids originating in the opium poppy, Papaver somniferum. Over a 7-week period, 532 clients of an urban substance misuse service provided a total of 1122 urine samples for clinical purposes. Using a novel mixed-mode solid-phase extraction and gas chromatography/mass spectrometry technique, we screened samples for morphine, 6-monoacetylmorphine, codeine, meconine, papaverine, noscapine, thebaine and their metabolites. All urine samples from diamorphine-treated patients were positive for morphine. Of samples from patients receiving other treatments, 30% (95%CI: 27-33%) were positive for morphine, indicating probable street heroin misuse. Of morphine-positive samples, 61% (95%CI: 55-67%), from the "other treatments" group were positive for at least one of codeine, meconine and putative noscapine or papaverine metabolites. This was reduced to 56% (95%CI: 50-62%) when excluding codeine. Only one sample (0.1%) was positive for any one of these putative markers in the absence of morphine, when excluding codeine. These findings show that the detection of urinary noscapine and papaverine metabolites is useful in distinguishing between use of pharmaceutical diamorphine and street heroin. This may be of benefit to promote safer and more effective prescribing of diamorphine in opiate dependency, and as an outcome measure in trials of diamorphine prescribing. PMID:11900600

  14. Pain is Associated with Heroin Use over Time in HIV-Infected Russian Drinkers

    PubMed Central

    Tsui, Judith I.; Cheng, Debbie M.; Coleman, Sharon M.; Blokhina, Elena; Bridden, Carly; Krupitsky, Evgeny; Samet, Jeffrey H.

    2014-01-01

    Aims This study evaluated whether pain was associated with increased risk of using heroin, stimulants or cannabis among HIV-infected drinkers in Russia. Design Secondary analysis of longitudinal data from the HERMITAGE study, a behavioral randomized controlled trial, with data collected at baseline, 6 month and 12 month visits. Setting Recruitment occurred at HIV and addiction treatment sites in St. Petersburg, Russian Federation. Participants Six-hundred and ninety-nine HIV-infected adult drinkers. Measurements The primary outcome was past month illicit drug use; secondary outcomes examined each drug (heroin, stimulants and cannabis) separately. The main predictor was pain that at least moderately interfered with daily living. General estimating equations (GEE) logistic regression models were used to evaluate the association between pain and subsequent illicit drug use adjusting for potential confounders. Findings Participants reporting pain appeared to have higher odds of using illicit drugs, although the results did not reach statistical significance (adjusted Odds Ratio [OR]=1.32; 95% CI: 0.99, 1.76, p=0.06). There was a significant association between pain and heroin use (OR=1.54; 95% CI: 1.11 to 2.15, p=0.01) but not other drugs (OR=0.75; 95% CI: 0.40 to 1.40, p=0.35 for stimulants and OR=0.70; 95% CI: 0.45 to 1.07, p=0.09 for cannabis). Conclusions HIV-infected Russian drinkers who reported pain were more likely to use heroin over time. Pain may be an unrecognized risk factor for persistent heroin use with implications for HIV transmission in Russia. PMID:23773361

  15. Possible mechanism for inhibition of morphine formation from 6-acetylmorphine after intake of street heroin.

    PubMed

    Andersson, Maria; Björkhem-Bergman, Linda; Beck, Olof

    2015-07-01

    Heroin is de-acetylated in the body to morphine in two steps. The intermediate 6-acetylmorphine (6-AM) is formed rapidly and is considered important for the pharmacological effect of heroin. In urine drug testing, an atypical pattern of morphine and 6-AM is known to occur in low frequency. The aim of this study was to investigate this atypical pattern in more detail and to identify responsible substances for a possible inhibition of the conversion from 6-AM to morphine. Urine samples were selected from a routine flow of samples sent for drug testing. Out of 695 samples containing morphine and 6-acetylmorphine, 11.5% had the atypical pattern of a 6-AM to morphine ratio above 0.26 as derived from a bimodal frequency distribution. An in vitro study of the conversion of 6-acetylmorphine to morphine in human liver homogenates demonstrated that a number of known carboxylesterase inhibitors were able to inhibit the reaction mimicking the situation in vivo. Compound 3 (3,6-Dimethoxy-4-acetoxy-5-[2-(N-methylacetamido)ethyl]phenanthrene) a substance formed from thebaine during the production of heroin was found to be a strong inhibitor. Liquid chromatography-mass spectrometry was used to identify possible inhibitors present in vivo. This part of the investigation demonstrated that several components may contribute to the effect. It is concluded that inhibition of liver carboxylesterase activity is a possible mechanism causing the atypical pattern and that one candidate compound is the result of the heroin production process. An inhibition of 6-AM metabolism is likely to increase the pharmacological effect of heroin and may be related to a higher risk of lethal toxicity. PMID:26002801

  16. Cocaine Induced Pleural and Pericardial Effusion Syndrome

    PubMed Central

    Alqalyoobi, Shehabaldin; Vaidya, Omkar; Abu Ghanimah, Al-Ma'Mon; Elkhanany, Ahmed; Gohar, Ashraf

    2015-01-01

    A 42-year-old African American female with chronic cocaine use for 20 years, presented with two-day history of exertional shortness of breath and pleuritic chest pain. She was admitted three years back with acute kidney injury and skin rashes. At that time, skin biopsy was consistent with leukocytoclastic vasculitis and renal biopsy revealed proliferative glomerulonephritis. She responded to oral prednisone and mycophenolate with complete recovery of her kidney functions. Skin rash was waxing and waning over the last two years. On the second admission, patient was found to have large pleural effusion on computerized tomography scan and pericardial effusion on echocardiogram as shown in the figures. Pleural fluid analysis was exudative. Her serology was negative for ANA (antineutrophilic antibody) and anti-dsDNA (double stranded DNA). Complements levels were normal. She had positive low titers of ANCA levels. The patient was started on a course of prednisone for 6 months. Her pleural and pericardial effusion resolved completely on follow-up imaging with computerized tomography scan and echocardiogram. This case is unique since the pericardial and pleural effusions developed without any other etiology in the setting of cocaine; hence, we describe this clinical syndrome as cocaine induced pleural and pericardial effusions syndrome (CIPP). PMID:25918664

  17. Factors associated with early initiation into sex work and sexually transmitted infections among female sex workers in two Mexico-U.S. border cities

    E-print Network

    Loza, Oralia

    2009-01-01

    abuse treatment populations whose drug of choice is crack cocaine.Cocaine Tranquilizers Methamphetamine Heroin Any drug use* Emotional abuseCocaine Tranquilizers Methamphetamine Heroin Any drug use* Emotional abuse

  18. NONHUMAN PRIMATE MODELS OF SOCIAL BEHAVIOR AND COCAINE ABUSE

    PubMed Central

    Nader, Michael A.; Czoty, Paul W.; Nader, Susan H.; Morgan, Drake

    2012-01-01

    Rationale Although cocaine is often abused in social situations, very few animal studies examine the effects of cocaine in the context of social behavior. Objectives This review highlights studies investigating the behavioral effects of cocaine in the context of social housing conditions using nonhuman primates. In addition, this review presents recent findings examining the effects of self-administering cocaine on social behavior and the effects of manipulations hypothesized to be stressful or enriching on the interactions between cocaine reinforcement and social rank. The following dependent variables are examined: 1) cocaine-induced changes in social behavior and 2) cocaine self-administration in cynomolgus monkeys of varying social ranks. The independent variables examined include several environmental and pharmacological manipulations. Conclusions The studies reviewed here indicate that several variables can differentially affect cocaine self-administration when studied in a social context, rather than in individually housed animals. These variables include the social rank and sex of the individual, drug history, the nature of the “fear”-inducing manipulation, and the reliability of cortisol as an appropriate measure of “stress.” While the inclusion of socially housed animals necessitates larger sample sizes, animal models incorporating social behavior are more homologous to the human condition and should be implemented when possible. PMID:22895674

  19. Paradoxical abatement of striatal dopaminergic transmission by cocaine and methylphenidate.

    PubMed

    Federici, Mauro; Latagliata, Emanuele Claudio; Ledonne, Ada; Rizzo, Francesca R; Feligioni, Marco; Sulzer, Dave; Dunn, Matthew; Sames, Dalibor; Gu, Howard; Nisticò, Robert; Puglisi-Allegra, Stefano; Mercuri, Nicola B

    2014-01-01

    We combined in vitro amperometric, optical analysis of fluorescent false neurotransmitters and microdialysis techniques to unveil that cocaine and methylphenidate induced a marked depression of the synaptic release of dopamine (DA) in mouse striatum. In contrast to the classical dopamine transporter (DAT)-dependent enhancement of the dopaminergic signal observed at concentrations of cocaine lower than 3 ?M, the inhibitory effect of cocaine was found at concentrations higher than 3 ?M. The paradoxical inhibitory effect of cocaine and methylphenidate was associated with a decrease in synapsin phosphorylation. Interestingly, a cocaine-induced depression of DA release was only present in cocaine-insensitive animals (DAT-CI). Similar effects of cocaine were produced by methylphenidate in both wild-type and DAT-CI mice. On the other hand, nomifensine only enhanced the dopaminergic signal either in wild-type or in DAT-CI mice. Overall, these results indicate that cocaine and methylphenidate can increase or decrease DA neurotransmission by blocking reuptake and reducing the exocytotic release, respectively. The biphasic reshaping of DA neurotransmission could contribute to different behavioral effects of psychostimulants, including the calming ones, in attention deficit hyperactivity disorder. PMID:24280216

  20. Cocaine and the Risk of Low Birth Weight.

    ERIC Educational Resources Information Center

    Petitti, Diana B.; Coleman, Charlotte

    1990-01-01

    Assesses the relation between cocaine use and the risk of low birth weight in Alameda County (California) through a population-based case-control study of women with low birth-weight infants. Results show that cocaine use increases the risk of both pre-term delivery and intrauterine growth retardation. Limitations of this study are discussed. (JS)

  1. The cocaine-exposed infant, Part I: Identification and assessment.

    PubMed

    Forrest, D C

    1994-01-01

    The incidence of cocaine use among women of childbearing years is rapidly increasing. The identification and assessment of the cocaine-exposed infant provides a challenge to the nurse practitioner. This article, the first of two parts, describes identification and assessment techniques. Part two will discuss intervention and teaching methods. PMID:8120778

  2. Permeation and metabolism of cocaine in the nasal mucosa.

    PubMed

    Zhang, Hefei; Prisinzano, Thomas E; Donovan, Maureen D

    2012-12-01

    The rapid onset of psychostimulatory effects of cocaine following intranasal administration suggests either extremely rapid absorption into the bloodstream or the potential for cocaine's access to the suggested direct nose-to-brain transport pathway. Cocaine transport was measured across excised bovine olfactory and respiratory mucosa to investigate site-specific uptake of cocaine. Flux in both the mucosal-to-submucosal (J (m-s)) and submucosal-to-mucosal (J (s-m)) directions across normal, 2, 4-dinitrophenol (2, 4-DNP) exposed, and de-epithelialized tissues increased linearly with increasing cocaine concentration, and no significant differences (p < 0.05) in directional permeability were observed for each condition. Some metabolism of cocaine to benzoylecgonine was observed, both in full-thickness and de-epithelialized tissues, demonstrating the activity of the submucosal tissues, in addition to the epithelial cell layer, in determining the disposition of cocaine. Results indicate that cocaine is transported across the nasal mucosa predominantly via passive diffusion, and no significant differences were observed between transport behaviors in the olfactory and nasal respiratory tissues. PMID:22351075

  3. Neuropsychological performance of recently abstinent alcoholics and cocaine abusers

    Microsoft Academic Search

    William W Beatty; Vickie M Katzung; Valerie J Moreland; Sara J Nixon

    1995-01-01

    To examine possible influences of premorbid and comorbid factors on the neuropsychological test performance of recently abstinent (3–5 weeks) drug abusers, we studied 24 alcoholics, 23 cocaine abusers, and 22 healthy controls of comparable age and education. Both alcoholics and cocaine abusers performed significantly more poorly than controls on most measures of learning and memory, problem solving and abstraction and

  4. Psychosocial treatments for cocaine abuse 12-month treatment outcomes

    Microsoft Academic Search

    Jeffrey A. Hoffman; Barry D. Caudill; Joseph J. Koman; James W. Luckey; Patrick M. Flynn; Dale W. Mayo

    1996-01-01

    The 12-month posttreatment outcome results for a randomized clinical trial that tested the effectiveness of various combinations of 4-month psychosocial treatment interventions are reported for 184 clients who used cocaine. Clients primarily used crack (93 %), and the majority were African American (95%). Overall, clients exhibited substantial pre-post treatment gains: reduced regular cocaine use, reduced other drug use, reduced regular

  5. Cocaine self-administration in dopamine-transporter knockout mice

    Microsoft Academic Search

    Beatriz A. Rocha; Fabio Fumagalli; Raul R. Gainetdinov; Sara R. Jones; Robert Ator; Bruno Giros; Gary W. Miller; Marc G. Caron

    1998-01-01

    The plasma membrane dopamine transporter (DAT) is responsible for clearing dopamine from the synapse. Cocaine blockade of DAT leads to increased extracellular dopamine, an effect widely considered to be the primary cause of the reinforcing and addictive properties of cocaine. In this study we tested whether these properties are limited to the dopaminergic system in mice lacking DAT. In the

  6. Neuroleptic malignant syndrome: A complication of neuroleptics and cocaine abuse

    Microsoft Academic Search

    MaCaulay J. Akpaffiong; Pedro Ruiz

    1991-01-01

    One hundred and sixty psychiatric patients on Neuroleptics, with and without a history of substance abuse were daily monitored in order to establish the incidence of neuroleptic malignant syndrome in these two groups. Four (5.1%) of the cocaine abusers and none of the non-cocaine abusers developed neuroleptic malignant syndrome when treated with neuroleptics. Thus we argue that psychiatric patients with

  7. Neuroleptic reduction of cocaine-induced paranoia but not euphoria?

    Microsoft Academic Search

    Frank H. Gawin

    1986-01-01

    Central dopaminergic activation is hypothesized to underly schizophrenia and, paradoxically, stimulant euphoria. Four cocaine abusers with histories of stimulant-induced paranoid psychoses reported selective reduction in psychotic symptoms but not euphoria when treated with dopamine blockers. This provides preliminary evidence against efficacy of neuroleptics in cocaine abuse prevention, and suggests euphoria and paranoia may have discriminable neurophysiological substrates.

  8. Cocaine and benzoylecgonine constrict cerebral arteries by different mechanisms

    Microsoft Academic Search

    Jane A. Madden; Richard J. Konkol; Peter A. Keller; Tomas A. Alvarez

    1995-01-01

    This study was designed to determine possible mechanisms underlying the vasoconstrictor activity of cocaine and its principal metabolite, benzoylecgonine (BE) in cat isolated cerebral arteries. The arteries constricted significantly in response to single doses of cocaine, BE and norepinephrine (NE; (P < 0.05). After 6-OHDA treatment to remove adrenergic nerve endings, NE-induced constrictions were essentially unchanged from those before treatment.

  9. Cardiovascular Effects of Acute and Chronic Cocaine Administration in Pregnant and Nonpregnant Rabbits

    Microsoft Academic Search

    Roy L. Sutliff; Pamela A. Gayheart-Walsten; David L. Snyder; Jay Roberts; Mark D. Johnson

    1999-01-01

    The effects of cocaine administration on cardiovascular parameters were studied in anesthetized nonpregnant and pregnant rabbits with no prior exposure to cocaine and in pregnant rabbits repeatedly administered cocaine (4 mg\\/kg, bid, iv) for 15–20 days prior to the experiment. Rabbits were instrumented to determine the effects of cocaine on blood pressure, heart rate, and organ blood flows. Administration of

  10. Effect of chronic cocaine exposure on carotid artery reactivity in neonatal rabbits

    Microsoft Academic Search

    Maureen M. O'Rourke; Alex L. Loeb; Pamela Feuer; Constance L. Monitto; C. Dean Kurth

    1996-01-01

    Chronic cocaine abuse by pregnant women results in chronic neonatal drug exposure. In adults, chronic cocaine use alters neurotransmitter concentrations and receptor dose-response relationships. Similar changes may also occur in the neonatal cerebrovasculature after in utero cocaine exposure. This study examined the effect of chronic cocaine exposure on internal carotid artery reactivity to norepinephrine, serotonin, acetylcholine, sodium nitroprusside, adenosine, and

  11. Cocaine: Pharmacology, Effects, and Treatment of Abuse. National Institute on Drug Abuse Research Monograph 50.

    ERIC Educational Resources Information Center

    Grabowski, John, Ed.

    This monograph consists of eight papers which refer in one way or another to the pharmacology of cocaine. The papers are: (1) Cocaine 1984: Introduction and Overview" (John Grabowski); (2) "Cocaine: A Growing Public Health Problem" (Edgar H. Adams and Jack Durell); (3) "Neural Mechanisms of the Reinforcing Action of Cocaine" (Roy A. Wise); (4)…

  12. The Influence of Alternative Reinforcers on Cocaine Use and Abuse: A Brief Review

    Microsoft Academic Search

    Stephen T Higgins

    1997-01-01

    This report reviews experimental studies conducted with nonhuman and human subjects demonstrating that: a) cocaine’s abuse liability is, in part, a function of its positive reinforcing effects, b) cocaine use is operant behavior, c) the degree of behavioral control that cocaine exerts as a reinforcer is malleable and dependent on environmental context, and d) increasing the availability of alternative, nondrug

  13. Case Report Shared vulnerability between seizures and psychosis in cocaine addiction?

    E-print Network

    Hayar, Abdallah

    Case Report Shared vulnerability between seizures and psychosis in cocaine addiction? Benjamin Available online 15 September 2011 Keywords: Cocaine Seizures Psychosis N-methyl-D-aspartate Dopamine Kindling effect Cocaine-induced seizures (CIS) and cocaine-induced psychosis (CIP) may be complications

  14. C analyses quantify time lag between coca leaf harvest and street-level seizure of cocaine

    E-print Network

    Ehleringer, Jim

    14 C analyses quantify time lag between coca leaf harvest and street-level seizure of cocaine James. Introduction Cocaine is a widely distributed and highly addictive stimulant, and is categorized in the United­2009, the amount of cocaine seized in the U.S. averaged 76,802 kg [1]. Cocaine is easily obtained on the street

  15. The Neural Consequences of Repeated Cocaine Exposure Revealed by Functional MRI in Awake Rats

    E-print Network

    Duong, Timothy Q.

    The Neural Consequences of Repeated Cocaine Exposure Revealed by Functional MRI in Awake Rats models of cocaine addiction is an invaluable tool for investigating the neuroadaptations that lead circuits affected by repeated cocaine administration. Rats were given an injection of cocaine (15 mg/kg, i

  16. Transplacental pharmacokinetics of cocaine and benzoylecgonine in plasma and hair of rhesus monkeys

    Microsoft Academic Search

    Benoit Bailey; Paul Morris; Kristen I McMartin; Julia Klein; Helen M Duhart; Michael P Gillam; Zbigniew Binienda; William Slikker; Merle G Paule; Gideon Koren

    1998-01-01

    There is large variability in the rate and extent of fetal damage from cocaine in humans; however, the sources of such variability are not presently known. In order to study the relationship between maternal cocaine pharmacokinetics at the end of pregnancy and maternal or infant cocaine and benzoylecgonine hair concentrations at birth, ten rhesus monkeys were administered cocaine intramuscularly throughout

  17. Lessons for Control of Heroin-Associated Anthrax in Europe from 2009–2010 Outbreak Case Studies, London, UK

    PubMed Central

    Abbara, Aula; Brooks, Tim; Taylor, Graham P.; Nolan, Marianne; Donaldson, Hugo; Manikon, Maribel

    2014-01-01

    Outbreaks of serious infections associated with heroin use in persons who inject drugs (PWIDs) occur intermittently and require vigilance and rapid reporting of individual cases. Here, we give a firsthand account of the cases in London during an outbreak of heroin-associated anthrax during 2009–2010 in the United Kingdom. This new manifestation of anthrax has resulted in a clinical manifestation distinct from already recognized forms. During 2012–13, additional cases of heroin-associated anthrax among PWIDs in England and other European countries were reported, suggesting that anthrax-contaminated heroin remains in circulation. Antibacterial drugs used for serious soft tissue infection are effective against anthrax, which may lead to substantial underrecognition of this novel illness. The outbreak in London provides a strong case for ongoing vigilance and the use of serologic testing in diagnosis and serologic surveillance schemes to determine and monitor the prevalence of anthrax exposure in the PWID community. PMID:24959910

  18. The Severity, Frequency, and Variety of Crime in Heroin-Dependent Prisoners Enrolled in a Buprenorphine Clinical Trial

    PubMed Central

    Gordon, Michael S.; Kinlock, Timothy W.; Schwartz, Robert P.; Couvillion, Kathryn A.; O’Grady, Kevin E.

    2014-01-01

    Data were obtained on four dimensions of criminal activity (frequency, variety, severity, and income) from male and female prisoners (N = 200) with preincarceration heroin dependence who participated in a randomized clinical trial of buprenorphine treatment. The article examines the above-mentioned dimensions of crime and their relationships with demographic characteristics, substance use, legitimate employment, drug treatment episodes, and psychological problems. Results largely show several important similarities to results on previous prison inmate cohorts with histories of heroin addiction, although the present sample may have more of a tendency toward violent crime than earlier cohorts of heroin-dependent offenders. This study’s findings may have implications for the design of appropriate treatment interventions for prisoners with preincarceration heroin dependence that address not only substance use but also criminal activity. PMID:25392564

  19. Cocaine and metabolites in waste and surface water across Belgium.

    PubMed

    van Nuijs, Alexander L N; Pecceu, Bert; Theunis, Laetitia; Dubois, Nathalie; Charlier, Corinne; Jorens, Philippe G; Bervoets, Lieven; Blust, Ronny; Neels, Hugo; Covaci, Adrian

    2009-01-01

    Cocaine abuse, a growing social problem, is currently estimated from population surveys, consumer interviews and crime statistics. A new approach based on the analysis of cocaine (COC) and metabolites, benzoylecgonine (BE) and ecgonine methyl ester (EME), in water samples was applied to 28 rivers and 37 waste water treatment plants in Belgium using solid-phase extraction and liquid chromatography coupled to tandem mass spectrometry. While EME was undetectable, COC and BE were detectable with concentrations ranging from <1 to 753 ng/L and <1 to 2258 ng/L, respectively. BE concentrations were employed to calculate the local amount of abused cocaine. The highest values (up to 1.8 g/day cocaine per 1000 inhabitants) were found in large cities and during weekends. The estimation of cocaine abuse through water analysis can be executed on regular basis without cooperation of patients. It also gives clear geographical information, while prevention campaigns can easily be implemented and evaluated. PMID:18789832

  20. Disrupted Functional Connectivity with Dopaminergic Midbrain in Cocaine Abusers

    SciTech Connect

    Tomasi, D.; Tomasi, D.; Volkow, N.D.; Wang, R.; Carrillo, J.; Maloney, T.; Alia-Klein, N.; Woicik, P.A.; Telang, F.; Goldstein, R.Z.

    2010-06-01

    Chronic cocaine use is associated with disrupted dopaminergic neurotransmission but how this disruption affects overall brain function (other than reward/motivation) is yet to be fully investigated. Here we test the hypothesis that cocaine addicted subjects will have disrupted functional connectivity between the midbrain (where dopamine neurons are located) and cortical and subcortical brain regions during the performance of a sustained attention task. We measured brain activation and functional connectivity with fMRI in 20 cocaine abusers and 20 matched controls. When compared to controls, cocaine abusers had lower positive functional connectivity of midbrain with thalamus, cerebellum, and rostral cingulate, and this was associated with decreased activation in thalamus and cerebellum and enhanced deactivation in rostral cingulate. These findings suggest that decreased functional connectivity of the midbrain interferes with the activation and deactivation signals associated with sustained attention in cocaine addicts.

  1. Changes in the cAMP-related signal transduction mechanism in postmortem human brains of heroin addicts

    Microsoft Academic Search

    S. Shichinohe; H. Ozawa; E. Hashimoto; T. Tatschner; P. Riederer; T. Saito

    2001-01-01

    Summary.   Immunoreactivities of adenylyl cyclase (AC) type I (AC-I), and basal, forskolin- and Mn2+-stimulated AC activities with or without calcium and calmodulin (Ca2+\\/CaM) were estimated in temporal cortex (TC)-and nucleus accumbens (NAc) membranes from brains of heroin addicts and controls.\\u000a Immunoreactivity of AC-I was significantly decreased in TC from brains of heroin addicts, but that did not change in NAc.

  2. Hair testing for cocaine and metabolites by GC/MS: criteria to quantitatively assess cocaine use.

    PubMed

    López-Guarnido, O; Álvarez, I; Gil, F; Rodrigo, L; Cataño, H C; Bermejo, A M; Tabernero, M J; Pla, A; Hernández, A F

    2013-08-01

    A simple, rapid and sensitive method has been developed and validated for the determination of cocaine and its main metabolites (benzoylecgonine and cocaethylene) in human hair. The method involved solid-phase extraction with an Oasis HLB extraction cartridge and subsequent analysis by GC/MS. The limit of detection was 0.01?ng?mg(-1) for cocaine, 0.04 for benzoylecgonine and 0.03 for cocaethylene. The method validation included linearity (with a correlation coefficient >0.99 over the range 0.2-50?ng?mg(-1) ), intra- and inter-day precision (always lower than 12%) and accuracy (mean relative error always below 17%) to meet the bioanalytical acceptance criteria. The procedure was further applied to 40 hair samples from self-reported cocaine users arrested by the police who provided a positive urine-analysis for cocaine, and was demonstrated to be suitable for its application in forensic toxicology. New approaches were raised to detect false-negative results that allow a better interpretation of hair testing results. PMID:22407992

  3. Enhanced regional brain metabolic responses to benzodiazepines in cocaine abusers

    SciTech Connect

    Volkow, N.D.; Wang, G.J.; Fowler, J.S. [Brookhaven National Lab., Upton, NY (United States)] [and others

    1997-05-01

    While dopamine (DA) appears to be crucial for cocaine reinforcement, its involvement in cocaine addiction is much less clear. Using PET we have shown persistent reductions in striatal DA D2 receptors (which arc predominantly located on GABA cells) in cocaine abusers. This finding coupled to GABA`s role as an effector for DA led us to investigate if there were GABAergic abnormalities in cocaine abusers. In this study we measured regional brain metabolic responses to lorazepam, to indirectly assess GABA function (benzodiazepines facilitate GABAergic neurotransmission). Methods: The experimental subjects consisted of 12 active cocaine abusers and 32 age matched controls. Each subject underwent two PET FDG scans obtained within 1 week of each other. The first FDG scan was obtained after administration of placebo (3 cc of saline solution) given 40-50 minutes prior to FDG; and the second after administration of lorazepam (30 {mu}g/kg) given 40-50 minutes prior to FDG. The subjects were blind to the drugs received. Results: Lorazepam-induced sleepiness was significantly greater in abusers than in controls (p<0.001). Lorazepam-induced decreases in brain glucose metabolism were significantly larger in cocaine abusers than in controls. Whereas in controls whole brain metabolism decreased 13{+-}7 %, in cocaine abusers it decreased 21{+-}13 % (p < 0.05). Lorazepam-induced decrements in regional metabolism were significantly larger in striatum (p < 0.0 1), thalamus (p < 0.01) and cerebellum (p < 0.005) of cocaine abusers than of controls (ANOVA diagnosis by condition (placebo versus lorazepam) interaction effect). The only brain region for which the absolute metabolic changes-induced by lorazepam in cocaine abusers were equivalent to those in controls was the orbitofrontal cortex. These results document an accentuated sensitivity to benzodiazepines in cocaine abusers which is compatible with disrupted GABAergic function in these patients.

  4. ALDH5A1 variability in opioid dependent patients could influence response to methadone treatment.

    PubMed

    Fonseca, Francina; Gratacòs, Mònica; Escaramís, Geòrgia; De Cid, Rafael; Martín-Santos, Rocío; Farré, Magi; Estivill, Xavier; Torrens, Marta

    2014-03-01

    Methadone maintenance treatment is the most widely-used therapy in opioid dependence, but some patients relapse or drop out from treatment. We genotyped a genetic variant in the succinic semialdehyde dehydrogenase enzyme gene, ALDH5A1, and found that subjects carrying the T variant allele have a higher risk to be nonresponders to methadone treatment (OR=3.16; 95% CI [1.48-6.73], P=0.0024). This could be due to a reduction in the ALDH5A1 enzyme activity, that would increase endogenous gamma-hydroxbutyric acid (GHB) and gamma-aminobutyric acid (GABA) levels and therefore, inducing symptoms such as sedation and impaired pschomotor performance. These neuropsychological effects related with the reduction in enzyme activity could be responsible for a higher propensity to relapse in these genetically predisposed patients. PMID:24230997

  5. Methadone use in a male with the FMRI premutation and FXTAS.

    PubMed

    Muzar, Zukhrofi; Lozano, Reymundo; Schneider, Andrea; Adams, Patrick E; Faradz, Sultana M H; Tassone, Flora; Hagerman, Randi J

    2015-06-01

    The fragile X-associated tremor ataxia syndrome (FXTAS) is caused by the premutation in FMR1 gene. Recent reports of environmental toxins appear to worsen the progression of FXTAS. Here we present a case of male adult with FXTAS and a long history of methadone use. The patient shows a faster progression in both symptoms of disease and MRI changes compared to what is typically seen in FXTAS. There has been no research regarding the role of narcotics in onset, progression, and severity of FXTAS symptoms. However, research has shown that narcotics can have a negative impact on several neurodegenerative diseases, and we hypothesize that in this particular case, methadone may have contributed to a faster progression of FXTAS as well as exacerbating white matter disease through RNA toxicity seen in premutation carriers. © 2015 Wiley Periodicals, Inc. PMID:25900641

  6. Risk of anaphylaxis in opioid dependent persons: effects of heroin versus substitution substance

    PubMed Central

    2014-01-01

    Background Across Europe, illicit drug-related mortality has not declined despite ever increasing prevention measures. The cause of these deaths has traditionally been associated with overdose. Previous findings have revealed the appearance of non-lethal opioid concentrations, leading us to investigate a further cause of death. The symptoms of heroin intoxication with asphyxia and/or cardiovascular involvement resemble anaphylaxis, and therefore it has been speculated that such deaths might be caused by an allergic reaction. The study´s aims were to investigate levels of allergic mediators in long-term injecting drug users (IDU) compared to healthy controls and to determine if oral opioid substitution therapy (OST) resulted in similar allergic symptoms to those reported by IDU after intravenous (IV) heroin use. Methods We quantified the concentrations of histamine, diamine oxidase (DAO), tryptase and lipoprotein-associated phospholipase A2 (LpPLA2) at baseline and 1 h after administration of Substitol®retard (482?±?220 mg) in 56 patients at a withdrawal centre (Austria) and compared them with healthy controls (n?=?103). Questionnaires and face-to-face interviews were used to assess allergic symptoms and side effects in IDU. Descriptive statistical analyses of quantitative data were performed by using SPSS. Results Baseline histamine, tryptase and LpPLA2 were significantly elevated in IDU compared to the healthy control group, while DAO decreased. Blood levels showed no significant change after oral substitution uptake. Self-reported allergic symptoms and side effects after IV heroin use were reported in 55 cases (98.2%), minimal symptoms were documented after OST (12.5%, 7/56). Conclusions This study revealed that baseline histamine concentrations were elevated in chronic IDU, although only relatively small changes in tryptase plasma levels occurred. After IV heroin application the reported allergic symptoms were mostly mild and did not lead to clinically relevant side effects. The substitution substance was clearly better tolerated than IV administered heroin. Elevated levels of allergic mediators such as histamine in IDUs may place them at greater risk of severe or fatal anaphylaxis when exposed to heroin; however, this requires further investigation. PMID:24576327

  7. Reduction in crime by drug users on a methadone maintenance therapy programme in New Zealand

    Microsoft Academic Search

    Ian Sheerin; Terri Green; Douglas Sellman; Simon Adamson; Daryle Deering

    Aim The study aimed to estimate changes in drug use, crime, imprisonment and societal costs among a sample of Maori and non-Maori injecting drug users (IDUs) on a methadone maintenance therapy (MMT) programme in Christchurch, New Zealand. Methods Fifty-one non-Maori and 34 Maori IDUs were interviewed to obtain a self- reported history of drug use, crime, imprisonment, and effects on

  8. Cognitive performance in methadone maintenance patients: Effects of time relative to dosing and maintenance dose level

    PubMed Central

    Rass, Olga; Kleykamp, Bethea A.; Vandrey, Ryan G.; Bigelow, George E.; Leoutsakos, Jeannie-Marie; Stitzer, Maxine L.; Strain, Eric; Copersino, Marc L.; Mintzer, Miriam Z.

    2014-01-01

    Given the long-term nature of methadone maintenance treatment, it is important to assess the extent of cognitive side effects. This study investigated cognitive and psychomotor performance in fifty-one methadone maintenance patients (MMP) as a function of time since last methadone dose and maintenance dose level. MMP maintained on doses ranging from 40 to 200 mg (Mean = 97 mg) completed a battery of psychomotor and cognitive measures across two sessions, during peak and trough states, in a double-blind crossover design. Peak sessions were associated with worse performance on measures of sensory processing, psychomotor speed, divided attention, and working memory, compared to trough sessions. The effects of maintenance dose were mixed, with higher dose resulting in worse performance on aspects of attention and working memory, improved performance on executive function, and no effects on several measures. Longer treatment duration was associated with better performance on some measures, but was also associated with increased sensitivity to time since last dose (i.e., worse performance at peak vs. trough) on some measures. The results suggest that cognitive functioning can fluctuate as a function of time since last dose even in MMP who have been maintained on stable doses for an extended time (mean duration in treatment = 4 years), but worsened performance at peak is limited to a subset of functions and may not be clinically significant at these modest levels of behavioral effect. For patients on stable methadone maintenance doses, maintenance at higher doses may not significantly increase the risk of performance impairment. PMID:24548244

  9. Effectiveness of Intervention on Improvement of Drug Use Among Methadone Maintained Adults

    Microsoft Academic Search

    Adeline M. Nyamathi; Karabi Nandy; Barbara Greengold; Mary Marfisee; Farinaz Khalilifard; Allan Cohen; Barbara Leake

    2010-01-01

    The purpose of this study is to evaluate the effectiveness of three interventions (individual motivational interviewing, group motivational interviewing, or nurse-led hepatitis health promotion) in reducing drug use. A randomized, controlled trial was conducted with 256 methadone maintained moderate-to-heavy alcohol-using adults attending one of five MM outpatient clinics. Drug use in the overall sample was significantly reduced from baseline to

  10. Varenicline for Smoking Cessation Among Methadone-Maintained Smokers: A Randomized Clinical Trial

    PubMed Central

    MD, Stein; CM, Caviness; ME, Kurth; D, Audet; J, Olson; BJ, Anderson

    2013-01-01

    Background With smoking rates far exceeding the general population, methadone-maintained (MMT) opiate-dependent smokers experience high rates of tobacco-related health consequences. Previous treatment studies have used nicotine replacement and produced low quit rates. Methods We test, using a three-group randomized design, the efficacy of varenicline vs. placebo, in comparison with nicotine replacement therapy (NRT) that combines nicotine patch prescription plus ad libitum nicotine rescue, for smoking cessation. We recruited methadone-maintained smokers from nine treatment centers in southern New England and provided six months of treatment, and a minimal behavioral intervention at baseline (NCI's 5A's). Outcomes included carbon monoxide (CO) confirmed 7-day point smoking cessation prevalence at 6 months and self-reported change in mean cigarettes per day. Results The 315 participants had a mean age of 40, with 50% male and 79% non-Hispanic White, smoked an average of 19.6 (± 10.4) cigarettes / day, and had a mean daily methadone dose of 109 mg. Intent-to-treat analyses, with missing considered to be smoking, showed the rate of CO-confirmed 7-day abstinence at 6-months was 5.4% overall, with varenicline 3.7% compared to placebo 2.2%, and NRT 8.3% (p>.05). Adherence rates during the 7-days immediately prior to 6-month assessment were 34.2% in varenicline, 34.4% in placebo, and 48.8% in NRT. Between baseline and 6-months there was an overall self-reported mean reduction of 8.3 cigarettes / day. Conclusion Varenicline did not increase quit rates over placebo. Smoking cessation rates in methadone-maintained smokers are low and novel treatment strategies are required. PMID:23953658

  11. Comparison of methadone and high dosage buprenorphine users in French care centres

    Microsoft Academic Search

    Karine Barrau; Xavier Thirion; Joëlle Micallef; Christine Chuniaud-Louche; Béatrice Bellemin; Jean Louis San Marco

    2001-01-01

    Aims. In France, maintenance programmes for opiate users were adopted later than in other countri~s. Two maintenance treatments are available: methadone is only delivered in specialized centres while high dosage (HD) buprenorphine can be prescribed by al1 general practitioners and in specialized centres. The aim of this study was to compare the socio-demographic projiles, the practices and drug consumption patterns

  12. Voucher-Based Contingent Reinforcement of Smoking Abstinence Among Methadone-Maintained Patients: A Pilot Study

    Microsoft Academic Search

    KELLY E. DUNN; S TACEY C. SIGMON; Colleen S Thomas; SARAH H. HEIL; STEPHEN T. HIGGINS

    2008-01-01

    This study evaluated the efficacy of a contingency management (CM) intervention to promote smoking cessation in methadone-maintained patients. Twenty participants, randomized into contingent (n 5 10) or noncontingent (n 5 10) experimental conditions, completed the 14-day study. Abstinence was determined using breath carbon monoxide and urine cotinine levels. Contingent participants received voucher-based incentives for biochemical evidence of smoking abstinence. Noncontingent

  13. The policy culture of drugs: Ritalin, methadone, and the control of deviant behavior.

    PubMed

    Smith, T A; Kronick, R F

    1979-10-01

    Various concepts are introduced which may be new to most readers of sociological journals. The concepts include policy culture and the medicalization of deviant behavior. Treatment drugs such as methadone and Ritalin are discussed within a framework which utilizes these concepts. It is concluded that the policy culture surrounding the introduction and use of these drugs is highly particularistic. This process in turn tends to produce certain unintended consequences. PMID:511396

  14. Distinct mu, delta, and kappa opioid receptor mechanisms underlie low sociability and depressive-like behaviors during heroin abstinence.

    PubMed

    Lutz, Pierre-Eric; Ayranci, Gulebru; Chu-Sin-Chung, Paul; Matifas, Audrey; Koebel, Pascale; Filliol, Dominique; Befort, Katia; Ouagazzal, Abdel-Mouttalib; Kieffer, Brigitte L

    2014-10-01

    Addiction is a chronic disorder involving recurring intoxication, withdrawal, and craving episodes. Escaping this vicious cycle requires maintenance of abstinence for extended periods of time and is a true challenge for addicted individuals. The emergence of depressive symptoms, including social withdrawal, is considered a main cause for relapse, but underlying mechanisms are poorly understood. Here we establish a mouse model of protracted abstinence to heroin, a major abused opiate, where both emotional and working memory deficits unfold. We show that delta and kappa opioid receptor (DOR and KOR, respectively) knockout mice develop either stronger or reduced emotional disruption during heroin abstinence, establishing DOR and KOR activities as protective and vulnerability factors, respectively, that regulate the severity of abstinence. Further, we found that chronic treatment with the antidepressant drug fluoxetine prevents emergence of low sociability, with no impact on the working memory deficit, implicating serotonergic mechanisms predominantly in emotional aspects of abstinence symptoms. Finally, targeting the main serotonergic brain structure, we show that gene knockout of mu opioid receptors (MORs) in the dorsal raphe nucleus (DRN) before heroin exposure abolishes the development of social withdrawal. This is the first result demonstrating that intermittent chronic MOR activation at the level of DRN represents an essential mechanism contributing to low sociability during protracted heroin abstinence. Altogether, our findings reveal crucial and distinct roles for all three opioid receptors in the development of emotional alterations that follow a history of heroin exposure and open the way towards understanding opioid system-mediated serotonin homeostasis in heroin abuse. PMID:24874714

  15. Methadone Maintenance and the Cost and Utilization of Health Care among Individuals Dependent on Opioids in a Commercial Health Plan

    PubMed Central

    McCarty, Dennis; Perrin, Nancy A.; Green, Carla A.; Polen, Michael R.; Leo, Michael C.; Lynch, Frances

    2010-01-01

    Background Few health plans provide maintenance medication for opioid dependence. This study assessed the cost of treating opioid dependent members in a commercial health plan and the impacts of methadone maintenance on costs of care. Methods Individuals with diagnoses of opioid dependence (two or more diagnoses per year) and at least nine months of health plan eligibility each year were extracted from electronic health records for the years 2000 through 2004 (1,518 individuals and 2,523 observations across the study period – some individuals were in multiple years). Analyses examined the patterns and costs of health care for three groups of patients: 1) one or more methadone visits during the year (n = 1,298; 51%); 2) no methadone visits and 0 or 1 visits in the Addiction Medicine Department (n = 370; 15%); and 3) no methadone visits and 2 or more visits in addiction medicine (n = 855; 34%). Results Primary care (86%), emergency department (48%) and inpatient (24%) visits were common. Mean total annual costs to the health plan were $11,200 (2004 dollars) per member per year. The health plan’s costs for members receiving methadone maintenance were 50% lower ($7,163) when compared to those with two or more outpatient addiction treatment visits but no methadone ($14,157) and 62% lower than those with one or zero outpatient addiction treatment visits and no methadone treatment ($18,694). Conclusions Use of opioid maintenance services was associated with lower total costs of care for opioid dependent members in a commercial health plan. PMID:20627427

  16. Correlates of Depressive Symptoms among Alcohol-Using Methadone Maintained Adults

    PubMed Central

    Nyamathi, Adeline; Albarrán, Cynthia R.; Branson, Catherine; Marfisee, Mary; Khalilifard, Farinaz; Leake, Barbara

    2012-01-01

    Background Alcohol-using clients are considered at great risk for hepatitis and ongoing liver damage. This study explores the correlates of depression among a sample of methadone maintained treatment (MMT) adults in the Los Angeles area, and is part of a larger study on hepatitis health promotion among MMT clients who use alcohol. Objectives We sought to determine correlates of depressive symptoms among moderate and heavy alcohol-using adults enrolled in methadone maintenance. Methods A cross-sectional correlation study was conducted of baseline data from a randomized control trial of adults (N = 189) receiving methadone maintenance treatment (MMT) in Los Angeles. Depressive symptoms were measured with the 10-item short-form CES-D. Results Multiple regression analysis revealed that pain and social support were key correlates of depressive symptoms. More pain was associated with higher levels of depressive symptoms (p=.001), while more social support was related to lower depressive symptom severity (p=.001). Having been in sufficiently poor health that a blood transfusion, clotting factors, or an organ transplant was necessary was associated with greater depressive symptomatology, as was having injected drugs in the past month (p=.024). Conclusions The findings from this investigation can aid clinicians in selecting clients to monitor for early signs of depression and encourage early treatment for opioid users with comorbidities. Scientific Significance The use of an interdisciplinary team to care for MMT clients, routinely screen for depressive symptoms, and emphasize adequate pain control is indicated. PMID:23786510

  17. A Randomized Trial of a Hepatitis Care Coordination Model in Methadone Maintenance Treatment

    PubMed Central

    Delucchi, Kevin L.; McKnight, Courtney; Hettema, Jennifer; Khalili, Mandana; Min, Albert; Jordan, Ashly E.; Pepper, Nicole; Hall, Jessica; Hengl, Nicholas S.; Young, Christopher; Shopshire, Michael S.; Manuel, Jennifer K.; Coffin, Lara; Hammer, Hali; Shapiro, Bradley; Seewald, Randy M.; Bodenheimer, Henry C.; Sorensen, James L.; Des Jarlais, Don C.; Perlman, David C.

    2013-01-01

    Objectives. We evaluated the efficacy of a hepatitis care coordination intervention to improve linkage to hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination and clinical evaluation of hepatitis C virus (HCV) infection among methadone maintenance patients. Methods. We conducted a randomized controlled trial of 489 participants from methadone maintenance treatment programs in San Francisco, California, and New York City from February 2008 through June 2011. We randomized participants to a control arm (n?=?245) and an intervention arm (n?=?244), which included on-site screening, motivational-enhanced education and counseling, on-site vaccination, and case management services. Results. Compared with the control group, intervention group participants were significantly more likely (odds ratio [OR]?=?41.8; 95% confidence interval [CI]?=?19.4, 90.0) to receive their first vaccine dose within 30 days and to receive an HCV evaluation within 6 months (OR?=?4.10; 95% CI?=?2.35, 7.17). A combined intervention adherence outcome that measured adherence to HAV–HBV vaccination, HCV evaluation, or both strongly favored the intervention group (OR?=?8.70; 95% CI?=?5.56, 13.61). Conclusions. Hepatitis care coordination was efficacious in increasing adherence to HAV–HBV vaccination and HCV clinical evaluation among methadone patients. PMID:23947319

  18. Effect of prenatal methadone and ethanol on opioid receptor development in rats

    SciTech Connect

    Peters, M.A.; Braun, R.L. (Loma Linda Univ., CA (United States))

    1991-03-11

    The current literature shows that the offspring of female rats exposed to methadone or ethanol display similar neurochemical and neurobehavioral alterations, and suggests that these drugs may be operating through a common mechanism. If this hypothesis is true, their effect on the endogenous opioid systems should be qualitatively similar. In this study virgin females were treated with methadone or 10% ethanol oral solution starting prior to conception and continued throughout gestation. When the offspring had reached 15 or 30 days of age they were sacrificed, the brain was removed and prepared for opioid receptor binding studies. ({sup 3}H)DAGO and ({sup 3}H)DADLE were used as ligands for the mu and delta receptors, respectively. These studies show significant treatment-related differences in both the number of mu and delta binding sites as well as in apparent receptor affinity. Significant sex- and age-related differences between treatments were also observed. These data show that methadone and ethanol, while manifesting some similar neurochemical and behavioral effects, have unique effects on opioid receptor binding, suggesting that they may be acting by different mechanisms.

  19. Serotonin syndrome caused by fentanyl and methadone in a burn injury.

    PubMed

    Hillman, Ashley D; Witenko, Corey J; Sultan, Said M; Gala, Gary

    2015-01-01

    Serotonin syndrome is a syndrome identified by a triad of altered mental status, neuromuscular overactivity, and autonomic instability caused by the overstimulation of serotonin in the central nervous system and periphery. Serotonin syndrome may be provoked with the addition or increase in serotonergic agents such as selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, and monoamine oxidase inhibitors as well as other agents with serotonergic properties. Some narcotics, including fentanyl and methadone, have these properties and may be associated with the development of serotonin syndrome when used in conjunction with other agents. Currently, there are no identified case reports of narcotics as the sole agent causing serotonin syndrome. This report provides a brief overview of serotonin syndrome, particularly with cases involving administration of narcotics such as fentanyl and methadone. The case described is the first report associated with fentanyl and methadone without the coadministration of other serotonergic agents, and a possible drug interaction with voriconazole is discussed. This raises awareness of using multiple serotonergic narcotics and the potential precipitation of serotonin syndrome. PMID:25615513

  20. Mid-Gestational Enlargement of Fetal Thalami in Women Exposed to Methadone during Pregnancy

    PubMed Central

    Schulson, Meredith; Liu, Anthony; Björkman, Tracey; Quinton, Ann; Mann, Kristy P.; Benzie, Ron; Peek, Michael; Nanan, Ralph

    2014-01-01

    Methadone maintenance therapy is the standard of care in many countries for opioid-dependent women who become pregnant. Despite recent evidence showing significant neurodevelopmental changes in children and adults exposed to both licit and illicit substances in utero, data on the effects of opioids in particular remains scarce. The purpose of this study was to examine the effects of opiate use, in particular methadone, on various fetal cortical and biometric growth parameters in utero using ultrasound measurements done at 18–22?weeks gestation. Head circumference (HC), bi-parietal diameter, lateral ventricle diameter, transcerebellar diameter, thalamic diameter, cisterna magna diameter, and femur length were compared between fetuses born to methadone-maintained mothers and non-substance using controls. A significantly larger thalamic diameter (0.05?cm, p?=?0.01) was observed in the opiate-exposed group. Thalamic diameter/HC ratio was also significantly raised (0.03?mm, p?=?0.01). We hypothesize here that the increase in thalamic diameter in opiate-exposed fetuses could potentially be explained by regional differences in opioid and serotonin receptor densities, an alteration in monoamine neurotransmitter systems, and an enhancement of the normal growth increase that occurs in the thalamus during mid-gestation. PMID:25593952