Chronic Opiate Use Research Articles

Effects of chronic heroin abuse on bone and mineral metabolism

Though the chronic use of opiates can modify several body functions, only a few data are available on the effects of opioid drugs on mineral metabolism. We have examined the possible consequences of chronic opiate abuse on bone mass, bone turnover and calcium metabolism in 13 male chronic heroin users, examined 1-2 days after the last administration of the drug (group A), 14 former male heroin addicts, examined 4-24 months after drug discontinuation (group B), and 22 healthy, age- and sex-matched control subjects. In group A, the vertebral bone mineral density (measured by Dual-Photon Absorptiometry) was significantly lower (p < 0.05) than in the control subjects, despite similar values of total body bone mineral, lean body and fat mass. Blood-ionised calcium and urinary calcium and hydroxyproline were significantly increased (p < 0.01), whereas parathyroid hormone was lower than in controls (p < 0.01). Bone alkaline phosphatase and osteocalcin, however, were not significantly different from the control values. LH and testosterone levels were low (p < 0.01 vs controls). In contrast, group B subjects did not show significant differences from the control group. The chronic abuse of opioid drugs may be associated with altered bone metabolism and reduced trabecular bone mass, attributable, at least in part, to gonadal deficiency. These alterations seem reversible after drug discontinuation.

Induction of antibodies to morphine during chronic morphine treatment in rodents and opiate addicts

The phenomenon of induction of antibodies to morphine in morphine-treated animals and opiate addicts was shown by means of ELISA. The reaction of the immune system to injections of a morphine solution had the characteristics of a primary immune response. Opiate addicts differed from normal controls in the level of antibodies to morphine of IgM class. Elevated levels of such antibodies could be detected in about 70–80% of addicts with regular longterm opiate use when the time since the last drug intake did not exceed 60 days. Antibodies to morphine could serve as indicators of chronic opiate use especially in periods long after the last drug intake.

Immunoreactive "calcitonin-like" material in heroin addicts: varying reactivity with different antibodies.

High levels of immunoreactive calcitonin (iCT) in the blood of heroin addicts were previously reported. As it is well known that multiple forms of calcitonin exist in the blood and in tissues, the purpose of the present study was to investigate the immunological nature of the CT-like immunoreactive material found in the blood of these subjects. We investigated 25 addicts, who had been using heroin for more than one year and were hospitalized for a 2 week detoxication program. Blood samples were drawn at the start of the program (when the subjects were still on heroin) and after 5 and 12 days of abstinence from heroin. Twenty-five healthy subjects served as controls. We used 2 commercial RIA kits, calibrated against the same reference material (WHO 70-234), but employing different antisera. One antiserum substantially confirmed the previous findings of increased levels of calcitonin during heroin use, but the other seemed to exclude any change in the hormone concentrations. This suggests that the "calcitonin like" material found in heroin addicts contains some epitopes similar to those found in the calcitonin standard which are detected by the first antiserum. However it lacks other epitopes which are also present in calcitonin standard and which are recognized by the second antiserum. Therefore, this substance seems to be different from the standard human calcitonin 1-32. A possible involvement of a calcitonin analogue (precursor or metabolite) in the biochemical changes occurring during chronic opiate use is suggested.

Immunologic assessment of a cluster of asymptomatic HTLV-I-infected individuals in New Orleans

purpose: Although clusters of individuals infected with the human T-cell lymphotrophic virus type I (HTLV-I) have been identified in the United States, no systematic evaluation of the immunologic status of these persons has been reported. We therefore studied a group of 11 HTLV-I-infected former intravenous drug abusers who were longterm participants in a methadone maintenance program in New Orleans, Louisiana, to determine the effects of HTLV-I and chronic opiate use on immunity. patients and methods: Mitogenic responses and results of serologic studies, cell phenotype analysis, and cytotoxity assays were compared to those in two other HTLV-I seronegative groups: a similar group of 17 methadone users and 15 healthy age-, sex-, and race-matched control subjects. All study participants were seronegative for human immunodeficiency virus type 1. results: Percentages and numbers of total T lymphocytes (CD2+,CD3+), T-suppressor/cytotoxic lymphocytes (CD8+), cytotoxic lymphocytes (Leu7+, Leu11+, NKH-1+) and B lymphocytes (B4+) were similar among the study groups. Although percentages and numbers of total T-helper lymphocytes (CD4+) were also similar among the groups, HTLV-I-infected subjects had higher percentages and proportions of helper/inducer cells (CD4:4B4+) than did HTLV-I seronegative methadone users. Both methadone using groups had decreased percentages and numbers of suppressor/inducer T lymphocytes (CD4:2H4+). Major histocompatibility complex unrestricted T-cell cytotoxicity (lectin-dependent cellular cytotoxicity), natural killer cell function, and mitogenic responses to the T-cell mitogen phytohemagglutin were similar among the three study groups. Pokeweed mitogen responses were severely depressed in the HTLV-I-infected population. conclusions: We conclude that HTLV-I infection is associated with abnormalities in T-cell-dependent B-cell proliferative responses. Furthermore, both long-term methadone use and HTLV-I infection are associated with abnormalities in the distribution of CD4+ cell subpopulations. The increase in the helper/inducer and T-cell cell populations and decrease in the pokeweed mitogenic response noted in HTLV-I-infected subjects appear to be markers for infection with this retrovirus.

Cortisol levels during chronic naltrexone maintenance treatment in ex-opiate addicts

Several studies have shown a rise in cortisol and adrenocorticotropic hormone (ACTH) in response to a bolus administration of an opioid antagonist (Volavka et al. 1978, 1979; Judd et al. 1981; Nabor et al. 1981). This has fit well with the lowering of cortisol and ACTH levels that has been observed following the acute administration of all opiates and the chronic use of short-acting opiates (Chusman and Kreek 1974). However, during chronic treatment with a long-acting opiate, i.e., methadone, cortisol levels return to normal after several months (Cushman and Kreek 1974; Kreek 1978). Thus, the question has arisen whether or not chronic treatment with a long-acting opioid antagonist would result in a persistent elevation of cortisol levels, as has been found acutely. Therefore, we measured diurnal variation in cortisol levels in former opiate addicts who were being maintained for at least 15 weeks on naltrexone, a long-acting orally effective opioid antagonist.

Chronic opiate use during methadone detoxification: Effects of a dose increase treatment

The effects of administering high methadone doses during detoxification treatment were examined on illicit opiate use and treatment retention in chronic opiate supplementors. Twenty-six applicants to a 90-day outpatient detoxification program who delivered 50% or more opiate-positive urine samples during treatment weeks 2 and 3 were randomly assigned to receive a constant 30-mg dose through treatment week 10 or an increase to 60 mg in week 4 with gradual reduction to 30 mg by week 10. Dosage for both groups was reduced to 0 mg during weeks 11–13. Treatment retention was better for experimental (median = 86 days) than for control (median = 41 days) subjects, but the difference was not statistically significant. In the dose increase group, percent opiate-positive urines decreased from 80% to 62% during the first two weeks of dose increase ( t = 2.39, P < 0.05); opiate positive rates for the control group remained above 80%. A 20% between group difference in percent of opiate positive urine tests persisted through study week 10 in subjects ( N = 5 control, 7 experimental) who remained in treatment this long. Although the blind dose increase did improve treatment outcome, we concluded that the magnitude of the effect in this population of chronic opiate supplementors was insufficient to judge the procedure clinically useful.

Affective changes in chronic opiate use.

SummaryAs part of a programme to investigate the therapeutic potential of narcotic antagonists, thirteen detoxified heroin addicts were studied in an experimental situation where using operant techniques they were allowed largely self‐regulated access to heroin for a ten day period. Changes in psychiatric status were assessed using a structured interview schedule. The early effect of the heroin was to produce a decrease in somatic concern, anxiety and depression, but continuing use of the opiate produced significant increases in these variables and also an increase in social isolation and retardation. Heroin in the short term may relieve an addict's inner tensions as commonly assumed, but chronic use is a predominantly dysphoric experience.