Heroin Abstinence Research Articles

Cocaine Use Immediately Prior to Entry in an Inpatient Heroin Detoxification Unit as a Predictor of Discharges Against Medical Advice

Detection of benzyolecgonine, the major metabolite of cocaine, in the urinalysis conducted on the first day of an inpatient heroin detoxification treatment program was studied as a predictor of discharge against medical advice (AMA). With this aim, we conducted a chart-review procedure of 275 heroin dependents (DSM-III-R) who received methadone or dextropropoxyphene chlorhydrate to treat Opioid Withdrawal Syndrome. Data were analyzed following a case-control design. The 49 (17.8%) patients who did not complete the treatment due to discharged AMA were characterized by having achieved total heroin abstinenceduring fewer months from the time they began consumption of this substance to the time of hospitalization (p =. 001). Moreover, those patients who requested discharge AMA were characterized by more frequent detection of benzoylecgonine in their urine on the day of admission (p =. 004). The value of the odds ratio of this association was 3.81 (95% CI; 1.30 to 11.04). Lastly, noncompleters due to discharge AMA were more likely to be single than ever married (p =. 037). The logistic regression model confirmed that there is a significant relationship between an AMA event and the presence of benzoylecgonine in urine upon beginning detoxification and to a shorter duration of the period of total heroin abstinence. In the discussion, the influence that recent interruption of cocaine consumption has on the decision to drop out of a detoxification program AMA is considered.

Acute eosinophilic pneumonia in a heroin smoker

Inhalation of heroin is known to provoke asthma. We report on the case of a patient who, after repeated inhalation of heroin, presented with decreased lung volume associated with bronchial hyperresponsiveness, diffuse pulmonary infiltrates, and bronchoalveolar lavage fluid eosinophilia. Rapid remission was obtained after heroin abstinence and initiation of corticosteroid treatment.

Pathways to heroin abstinence: a longitudinal study of urban black youth.

Reported here is a study of the effectiveness of treatment in reducing the duration of heroin careers, with a special focus on gender differences. The longitudinal research is based on a community representative sample of urban black youth, ages 18-23, and utilizes a recently introduced statistical methodology, event-history analysis. Simple hazard probability analysis confirmed that males and females did not differ significantly in their cumulative probabilities of abstinence from heroin. The more elaborated event-history model demonstrated, however, that treatment played a significantly different role among young men and women in attaining abstinence. While a man's likelihood of abstinence was but marginally greater with treatment than without it, women's likelihood of abstinence was significantly increased by entering treatment.

Is acute tolerance to 5-hydroxytryptamine opioid dependent? Its absence in migraine sufferers.

The human dorsal hand vein, exhausted in vivo (tachyphylaxis) by repeated inoculations of 5-hydroxytryptamine, recovers its capacity to contract in response to the 5HT when naloxone (per se ineffective) is inoculated into the same vein. It would seem, therefore, that in the 5HT tachyphylactic mechanism a role could be played by the progressive excitation of a local opioid modulator apparatus (silent in basal condition); naloxone's capacity for neutralizing the vein's fatigue could be indirect evidence of this. This postulation of an opioid role in the tachyphylactic mechanism differs from the conventional thesis, which explains tachyphylaxis as a progressive exhaustion of NA released from the sympathetic neuron by 5HT (see Table 1). Tachyphylaxis is poor, delayed or absent in migraine sufferers; this anomaly is present even in the period between attacks. The anomaly of inverted tachyphylaxis appears amplified during attacks. The loss or inversion of 5HT-tachyphylaxis is constantly observed in heroin addicts during acute abstinence. The fact that the clinical phenomena of acute heroin abstinence are comparable with those of a migraine attack could be a matter for further investigation.

Naloxone reversible reduction in brain monoamine synthesis following sciatic nerve stimulation

Brain monoaminergic neurons seem to be influenced by endogenous opioid systems as judged from largely indirect evidence. In an attempt to more directly study this interaction, we have analyzed the effect of sciatic nerve stimulation (rectangular pulses, frequency 3 Hz, pulse duration 0.2 msec, current intensity 6-20 times muscle twitch threshold) on the in vivo rate of tyrosine-and tryptophanhydroxylation, respectively, in the rat brain. This stimulation procedure has previously been shown to evoke naloxone reversible pain threshold elevation and a longlasting blood pressure reduction rats, with maximum reached about 1.5 h after stimulation. The formation of DOPA and 5-HTP in various parts of the central nervous system during 30 min after inhibition of L-amino-acid-decarboxylase by NSD 1015 was measured. Two hours after the sciatic nerve stimulation procedure a significant decrease in DOPA formation was obtained in the cerebral cortex and in the spinal cord. This effect was reversed by pretreatment with a high dose of naloxone (15 mg/kg s.c., 10 min before stimulation). A reduction in 5-HTP formation was also obtained in the cerebral cortex, with a concomitant reduction in tryptophan concentration. These effects appeared to be antagonized by naloxone treatment. In the spinal cord there was no change in the 5-HTP accumulation after stimulation, but an increase after stimulation plus naloxone pretreatment was obtained. These data infer that the activity of some central monoamine systems, such as the NA pathways originating in locus coeruleus can be reduced by physiological activation of endogenous opioid systems. This effect of the acupuncture like stimulation procedure may be related to clinically reported actions of acupuncture stimulation, which apart from pain relief include, for example, antagonism of heroin abstinence symptoms.

Acute heroin abstinence in man: I. Changes in behavior and sleep

The purpose of this study was to examine overt behavioral characteristics and sleep during acute heroin abstinence in man. Both heroin-dependent patients and drug-free control subjects were observed and monitored on a 24-hour per day basis for 5 to 7 days. Observational data were analyzed for frequency of occurrence of various behaviors including the signs and symptoms of withdrawal. Electroencephalographic (EEG) data were scored into awake and sleep stages according to standard techniques. The heroin-dependent subjects generally displayed a higher number of observations across all recording days as compared to the controls. In addition, the signs and symptoms of withdrawal for these patients peaked on day 1 or day 2 and then declined over the remaining recording days. The EEG state data showed an increase in waking and decrease in both slow wave and REM sleep during acute heroin withdrawal. Total sleep was maximally suppressed on withdrawal days 2 and 3 and was still below normal control values on withdrawal days 5–7. REM sleep was more disrupted than slow-wave sleep during withdrawal from heroin. Results of this study indicate that heroin withdrawal produces a differential action upon central nervous system structures responsible for the various states of sleep, waking and related behaviors.

Heroin Detoxification

Propoxyphene napsylate and methadone hydrochloride were each administered under double-blind conditions to 36 outpatients for 21-day heroin detoxification. The initial dosage was 24 mg/day for methadone hydrochloride and 800 mg/day for propoxyphene napsylate. At these dosages, methadone more effectively suppressed the opiate-withdrawal syndrome, and patients remained in treatment longer in the methadone group (P greater than .05). In regard to heroin abstinence, however, results were not statistically significant in either group, as indicated by the number of patients whose urine was positive for morphine on admission and became negative during treatment, and the number who had morphine-negative urine at the conclusion of 21-day treatment. A one-month follow-up of patients showed that more patients given methadone had entered long-term medical maintenance while more patients given propoxyphene were heroin-abstinent. This study indicates that 21-day heroin detoxification, regardless of chemotherapeutic agent, yields a low rate of heroin abstinence.

Plasma testosterone levels during chronic heroin use and protracted astinence. A study of Hong Kong addicts.

The effects of heroin use and subsequent prolonged abstinence on plasma testosterone levels were examined in 31 male heroin addicts. Heroin (alone and in combination with methadone) significantly suppressed plasma testosterone levels. However, drug-induced testosterone suppression does not appear to be permanent in adult addicts. Recovery of testosterone levels to normal occurred after about one month of heroin abstinence.