Heroin Addicts Research Articles

Military influences on the evolution of clinical trials throughout history.

Clinical trials of drugs, procedures, and other therapies play a crucial role in advancing medical science by evaluating the safety, efficacy, and optimal use of medical interventions. The design and implementation of these trials have evolved significantly over time, reflecting advancements in medicine, ethics, and methodology. Early historical examples, such as King Nebuchadnezzar II's and his captives' dietary experiment and Ambroise Paré's treatment of gunshot wounds, laid some foundational principles of trial design. The momentum of clinical trial development increased notably with James Lind's 1747 trial for scurvy and continued to progress during World War I with innovations in blood transfusion techniques. World War II (WWII) marked a pivotal moment with breakthroughs in oncology, including the development of the first modern chemotherapeutic agents derived from mustard gas and the introduction of the randomized controlled trial, credited to British epidemiologist Austin Bradford Hill, which revolutionized trial design. More recent conflicts, such as those in Vietnam, Iraq, and Afghanistan, have driven advancements in trauma care, heroin addiction treatment, and hemorrhage management. In response to historical abuses committed by the Nazis during WWII, the evolution of clinical trials has increasingly emphasized ethical standards, particularly informed consent, starting with the Doctors' Trial and the Nuremberg Code. This article discusses how military needs and wartime innovations have shaped modern clinical research, highlighting the interplay between military imperatives and medical progress. Ultimately, clinical trials play an essential role in advancing medical science and improving patient outcomes.

Brain microRNA profiles after exposure to heroin in rats.

Heroin addiction is one of the neuropsychiatric burdens that affects many genetic and epigenetic systems. While it is known that heroin may change the expressions of some genes in the brain during dependence, there is no detailed study related to which gene are mostly affected. Therefore, in the current study, we aimed to determine alterations in the miRNA profiles of rats' brains for providing a detailed analysis of molecular mechanisms in heroin addiction-related toxicology. Next generation global miRNA sequencing was used to predict potential miRNAs in prefrontal cortex (PC), hippocampus, ventral tegmental area (VTA), striatum, and Nucleus accumbens (NA) of rats that exposed to heroin by intravenous injections. The total daily dose was started with 2mg/kg and ended with 10mg/kg on the 10th day. In the striatum, miR-18a, miR-17-5p, miR-20a-5p, miR-106a, miR-301a-3p, miR872-5p, miR-15a-5p, miR-500-3p, and miR-339-5p expressions were upregulated by nearly 2-to-4 times with heroin. The expressions of hippocampal miR-153-3p, miR-130a-3p, miR-204-5p, miR-15b-5p, and miR-137-3p and the expressions of miR-872, miR-183-5p, miR-20a-5p, miR-325-5p, miR-379-5p, and miR-340-5p in the VTA were 2-times higher in the heroin-addicted rats. While there was nearly 2-times increase in the miR-129-1-3p and miR-3068-3p expressions in the NA, no change was noted in the PC due to heroin. The only heroin-dependent downregulation was observed in the expressions of striatal miR-450b-3p and miR-103-1-5p of VTA. These results suggested that heroin addiction might give harm to brain by altering cytokine balance and increasing neuroinflammation and apoptosis. In addition, neurons also try to compensate these abnormalities by enhancing neurogenesis and angiogenesis through several miRNAs in the different brain regions. In conclusion, the present study may provide a more integrated view of the molecular mechanism and a potential biomarker that will aid in clinical diagnosis and treatment of heroin-dependence.

Impact of Physical Exercise on the Executive Function and Mental Health of Heroin Addicts

PURPOSE: Physical exercise offers profound pleiotropic health benefits, particularly for brain function. However, the impact of such exercises on the executive functions of heroin addicts and their negative thinking/affect remains underexplored. We investigated whether physical exercise improves executive function and negative thinking/affect in male heroin addicts.METHODS: We used a pre- and post-test experimental research design involving one control group and two experimental groups. Ninety male heroin addicts with no exercise restrictions were recruited. The participants were randomly divided into three groups (resistance exercise group (n=30), aerobic exercise group (n=30), and no-exercise control group (n=30)). Executive function was measured using the Flanker Inhibitory Control and Attention, 2-Back Working Memory, and Switch Cognitive Flexibility Tests. All experiments were conducted in a quiet room. The Symptom Checklist-90 Revised (SCL-90-R) questionnaire was used to assess psychological status. All variables were measured and evaluated before and after the intervention.RESULTS: Participants exhibited a statistically significant decrease in response times following resistance exercise compared with preresistance exercise, as observed in both the flanker inhibitory control and attention tests, as well as the 2-back working memory test. Participants in the aerobic exercise group demonstrated significant reductions in reaction times on the 2-back working memory and switch cognitive flexibility tests, whereas performance accuracy significantly improved across all executive function tests. Additionally, the scores on the 10 subscales of the SCL-90-R showed a statistically significant decrease in the post-exercise period compared with the pre-exercise period.CONCLUSIONS: Physical exercise is a good non-pharmaceutical intervention for improving executive function and mental health in male heroin addicts.

Infective endocarditis in injection drug users: disease course, diagnostic and clinical aspects (clinical case analysis)

Aim. To present and clinically analyze a case of “injection drug users” infective endocarditis (IE) to increase awareness among general practitioners and cardiologists about this special variant of IE.Materials and methods. Clinical observation of a 39-year-old female patient with long-term heroin and methadone addiction, viral hepatitis C, who was diagnosed with acute primary IE caused by methicillin-sensitive Staphylococcus aureus localized on the tricuspid and mitral valves. Bilateral septic pulmonary embolism and respiratory failure, secondary anemia, thrombocytopenia, nephrotic syndrome due to secondary glomerulonephritis were observed. On the 21st day of treatment, the patient underwent tricuspid valve replacement surgery with a biological prosthesis and multicomponent reconstruction of the mitral valve, the postoperative period was complicated by the development of exudative pericarditis.Results. The clinical picture and the course of a complex case of “injection drug users” IE are discussed. The difficulties of early diagnostics of IE caused by the absence of pathognomonic clinical manifestations of the disease and the variability of the debuts of IE with the prevalence of extracardiac manifestations is highlighted. The principles of antibacterial therapy and indications for surgical treatment are reviewed.Conclusion. Clinical observation draws the attention to the high probability of diagnosing IE in cases of fever in intravenous drug users and demonstrates both the difficulties of treatment and the possibility of a favorable outcome of this serious disease with timely diagnosis, appropriate antibacterial therapy, and early cardiac surgery.

From One Joint to a Heroin Addict: Exploring Cannabis Narratives in Latvian Society

From One Joint to a Heroin Addict: Exploring Cannabis Narratives in Latvian Society

Shared orbitofrontal dynamics to a drug-themed movie track craving and recovery in heroin addiction.

Movies captivate groups of individuals (the audience), especially if they contain themes of common motivational interest to the group. In drug addiction, a key mechanism is maladaptive motivational salience attribution whereby drug cues outcompete other reinforcers within the same environment or context. We predicted that while watching a drug-themed movie, where cues for drugs and other stimuli share a continuous narrative context, fMRI responses in individuals with heroin use disorder (iHUD) will preferentially synchronize during drug scenes. Thirty inpatient iHUD (24 male) and 25 healthy controls (16 male) watched a drug-themed movie at baseline and at follow-up after 15 weeks. Results revealed such drug-biased synchronization in the orbitofrontal cortex (OFC), ventromedial and ventrolateral prefrontal cortex, and insula. After 15 weeks during ongoing inpatient treatment, there was a significant reduction in this drug-biased shared response in the OFC, which correlated with a concomitant reduction in dynamically-measured craving, suggesting synchronized OFC responses to a drug-themed movie as a neural marker of craving and recovery in iHUD.

Innovations in residential treatment that promote multi-drug addiction recovery

Abstract Background As the drug addiction crisis deepens in many countries across the globe, governments are rapidly expanding publicly funded treatment facilities. At the same time, the illicit drug market has evolved with many substances now containing multiple addictive drugs that complicate recovery. The evidence base for treatment remains primarily focused on single substances. The purpose of this study was to examine the lived experience of adults who attended in-patient treatment centres for multi-drug addiction in Canada. Methods This qualitative study was conducted in 2022 with 32 adults who voluntarily attended an in-patient treatment centre for drug addiction (44% female, 23-53 years). All had been addicted to multiple substances including opioids, crack and methamphetamines. Most (70%) were homeless before treatment. In 1-hour semi-structured interviews adults described the structures and programming that helped them recover in these facilities. Many tried multiple facilities and thus had a rich history of lived experience to draw from. Narrative inquiry was used to characterize qualitative themes across interviews using a phenomenological lens. Results Seven qualitative themes emerged from the data. Residential treatment centres that were effective at helping adults recover from multi-drug addiction: (1) provided flexible stays up to 100 days; (2) felt like a home not a prison; (3) permitted opioid replacement therapies; (4) provided a variety of recovery tools (e.g., cognitive behavioural therapy, Narcotics Anonymous, cultural supports); (5) helped adults reunite with family, find a safe place to stay, and find work before discharge; (6) provided transitional housing after discharge if needed; and (7) provided free long-term recovery support and check-ins after discharge. Conclusions The findings of this study highlight 7 actions that treatment facilities can adopt and test with their own clients in an effort to better support multi-drug addiction recovery. Key messages • A stronger evidence base is needed to inform in-patient multi-drug addiction treatment. • Findings underline 7 actions treatment facilities can take to promote multi-drug addiction recovery.

Nurse-Led Physical Screening of Patients With Substance Use Disorders: A Cross-Sectional Study.

Somatic comorbidity is the main cause of reduced life expectancy in patients with substance use disorders (SUDs). This study aims to investigate somatic health challenges in patients with SUDs using the USS. Patient self-management of somatic health and quality of life were also assessed. In our study, a stratified random sample of 136 clients who received treatment at a specialist addiction facility was drawn to investigate their physical health and lifestyle behaviours using the Utrecht Somatic Screening 2.0 (USS 2.0). The sample included three subgroups, that is, patients receiving outpatient treatment through Flexible Assertive Community Treatment (FACT), Heroin-Assisted Treatment (HAT) and Opioid Replacement Therapy (ORT). Pain, self-management and quality of life were also measured. Descriptive statistics were used to analyse the data. The findings indicate that many patients experience a large number of somatic health problems, including pain and exhaustion. The most prevalent conditions in this study are cardiovascular disease (25%) and COPD (20%), underweight and poor oral health. Tobacco smoking is prevalent among 88% of patients. Fifty percent of the patients expressed a need for support in managing their physical health. Somatic health care and lifestyle promotion should be tailored to the specific characteristics of patients. Patients with SUDs suffer from poor physical health and show unhealthy lifestyle behaviours, which demand the promotion of tailored somatic health.

Mathematical modeling of containing the spread of heroin addiction via awareness program

As many countries are hit by the social economic impact of heroin addiction, there is an urgent need to have an effective awareness program that focuses on educating the population on the danger of heroin addiction and helping the heroin‐users quit. This paper aims to study the effect of the awareness program on the spread of heroin dependence using a mathematical model with distributed delay. First, we show the existence threshold parameter , which we call the basic reproduction number of the spread of heroin use. We prove, via the Lyapunov direct method, that the drug‐free equilibrium is globally asymptotically stable if . If , the drug dependence persists, and the drug equilibrium is globally asymptotically stable. We give three possible scenarios to find the optimal awareness program strategy that puts the heroin epidemic under control. These scenarios take into consideration the reachability of the population, the immunity against heroin addiction, and the effectiveness of the program to contain the use of heroin in the population and bring below one.

“The wrong side of the desk”: Material and Discursive Struggle in Bud Osborn’s Downtown Eastside

Abstract Bud Osborn (1947-2014) was an American poet and activist who arrived in Vancouver, Canada in 1986. He landed in Vancouver’s oldest neighbourhood, the Downtown Eastside (DTES), while struggling with heroin addiction. The DTES is a complex and politically active neighbourhood and site of intersecting social crises. Osborn would spend the remainder of his life capturing this community in his poetry, which is often understood solely through activism for harm reduction and against gentrification. In this article, I engage with his poetry to understand the politics which motivate his activism. This exploration will include a variety of textual mediums, voices, and analytic perspectives to capture the complex politics contained in his words. I believe that by reading his words we can examine his complicated self-positionality as a PWUD (people who use drugs) and a member of the lumpenproletariat who occupied sociocultural spaces that often excluded those from his social standing. This examination shows how he constitutes the DTES as a space of material and discursive struggle. What emerges from this examination is how his poetic resistance at the level of the signifier intertwines with his street-level resistance. That is, how the act of writing and reading poetry can be an act of defiance.

The Effect of Acute Aerobic Exercise on Selective Hematological Parameters and Oxygen Saturation in Withdrawal Heroin Addicts

The Effect of Acute Aerobic Exercise on Selective Hematological Parameters and Oxygen Saturation in Withdrawal Heroin Addicts

Molecular Sex Differences and Clinical Gender Efficacy in Opioid Use Disorders: From Pain Management to Addiction.

Opioids have been utilized for both medical and recreational purposes since their discovery. Primarily recognized for their analgesic properties, they are also associated with the development of tolerance and dependence, contributing to a significant public health concern worldwide. Sex differences in opioid use disorder reveal that while men historically exhibit higher rates of abuse, women may develop dependence more quickly and are more susceptible to the addictive nature of opioids. This narrative review explores sex differences in opioid response in both clinical and experimental models, focusing on opioid receptor mechanisms, pain modulation, and hormonal influences. Additionally, it discusses the complexities of opioid addiction and withdrawal, highlighting sex-specific responses and the role of opioid replacement therapies. Diverse experimental outcomes, together with observational data, underscore the need for further research into sex-specific opioid biological mechanisms in a wider context, including demographic, cultural, and health-related factors. A comprehensive understanding of these complexities holds the potential to enhance personalized opioid therapies.

Resveratrol by elevating the SIRT1 BDNF, GDNF and PSD95 levels reduce heroin addiction related behaviors

ObjectiveTo study the effects of resveratrol on heroin addiction-related behaviors and to preliminarily explore the possible intervention mechanism of resveratrol in heroin dependence. MethodsThe effects of resveratrol on heroin withdrawal symptoms were observed by naloxone; The effect of resveratrol on heroin reward memory acquisition was detected by CPP paradigm; The effect of resveratrol on the mental excitability of heroin was tested by open field experiment; The effect of resveratrol on heroin spatial learning and memory was tested by water maze test. Western blot was used to detect Sirtuin 1 (SIRT1) Expression of brain-derived neurotrophic factor (BDNF), glial cell derived neurotrophic factor (GDNF), and postsynaptic density protein (PSD95). ResultsThe behavioral results showed that the withdrawal behavior of the resveratrol intervention group was reduced compared with the heroin chronic dependence group (P<0.05), and the shift score of the conditioned place preference test of the resveratrol intervention group was reduced compared with the heroin chronic dependence group (P<0.05) The spatial learning and memory ability of the water maze in the resveratrol intervention group was improved compared with the heroin chronic dependence group (P<0.05), and the mental excitability of the resveratrol intervention group was lower than that of the heroin chronic dependence group (P<0.05), but higher than that of the saline group (P<0.05); SIRT1 The expression levels of BDNF, GDNF and PSD95 protein were significantly increased (P<0.05). ConclusionThe behavioral results of this study suggest that resveratrol can be used as a potential drug to treat heroin dependence. At the same time, SIRT1 The expression of BDNF, GDNF, and PSD95 increased; SIRT1, BDNF, GDNF, and PSD95 play an essential role in heroin addiction.

Experience of Patients With Heroin Addiction Receiving Methadone Maintenance Treatment in Community Settings in Taiwan.

The World Health Organization has identified methadone maintenance therapy (MMT) as the most effective treatment for reducing patient dependence on heroin. In Taiwan, MMT has been used as a heroin harm reduction strategy since 2006. Although the effectiveness of MMT in reducing heroin addiction has been examined quantitatively in prison samples, little attention has been paid to the experiences and perspectives of patients with heroin addiction receiving MMT. This study was designed to address this gap in scientific knowledge. The aim of this study was to investigate the experiences of individuals struggling with heroin addiction who are receiving MMT in the community. A qualitative descriptive research approach and semistructured interviews were used in this study. We interviewed 14 participants who had received MMT in a medical center in central Taiwan. All of the interview data were recorded, transcribed, and analyzed using qualitative content analysis. Four themes emerged: (a) a chance to change one's life, (b) the helpfulness of MMT, (c) a sense of being restricted and controlled, and (d) need for support. This article fills a gap in current scholarly understanding of patient experiences and their perspectives on the helpfulness of MMT. Understanding patient experiences and perspectives is critical to informing and developing concrete strategies for clinical practice and MMT policy. Clinical professionals should assess patient needs and concerns to determine whether they are met by current treatment programs. Policymakers should design more flexible policies to facilitate easier access by patients to methadone to reduce the risk of relapse.

Direct effects of heroin and methadone on T cell function

Opioid addiction presents a relevant health challenge, with chronic heroin use linked to detrimental effects on various aspects of physical, mental, and sociological health. Opioid maintenance therapy (OMT), particularly using methadone, is the primary treatment option for heroin addiction. Previous studies using blood samples from current heroin addicts and OMT patients have shown immunomodulatory effects of heroin and methadone on T cell function. However, various additional factors beyond heroin and methadone affect these results, including the consumption of other substances, a stressful lifestyle, comorbid psychological and somatic disorders, as well as additional medications. Therefore, we here investigated the direct effects of heroin and methadone on purified human T cells in vitro. Our results reveal that both, heroin and methadone directly suppress Tcell activation and proliferation. Strikingly, this inhibitory effect was markedly stronger in the presence of methadone, correlating with a decrease in secretion of pro-inflammatory cytokines. While heroin did not interfere with the in vitro differentiation and expansion of regulatory Tcells (Tregs), methadone significantly impaired the proliferation of Tregs. Overall, our findings suggest a direct inhibitory impact of both opioids on effector T cell function in vitro, with methadone additionally interfering with Treg induction and expansion in contrast to heroin.

Methadone directly impairs central nervous system cells in vitro

Methadone is a synthetic long-acting opioid that is increasingly used in the replacement therapy of opioid-addicted patients, including pregnant women. However, methadone therapy in this population poses challenges, as it induces cognitive and behavioral impairments in infants exposed to this opioid during prenatal development. In animal models, prenatal methadone exposure results in detrimental consequences to the central nervous system, such as: (i) increased neuronal apoptosis; (ii) disruption of oligodendrocyte maturation and increased apoptosis and (iii) increased microglia and astrocyte activation. However, it remains unclear whether these deleterious effects result from a direct effect of methadone on brain cells. Therefore, our goal was to uncover the impact of methadone on single brain cell types in vitro. Primary cultures of rat neurons, oligodendrocytes, microglia, and astrocytes were treated for three days with 10 µM methadone to emulate a chronic administration. Apoptotic neurons were identified by cleaved caspase-3 detection, and synaptic density was assessed by the juxtaposition of presynaptic and postsynaptic markers. Apoptosis of oligodendrocyte precursors was determined by cleaved caspase-3 detection. Oligodendrocyte myelination was assessed by immunofluorescence, while microglia and astrocyte proinflammatory activation were assessed by both immunofluorescence and RT-qPCR. Methadone treatment increased neuronal apoptosis and reduced synaptic density. Furthermore, it led to increased oligodendrocyte apoptosis and a reduction in the myelinating capacity of these cells, and promoted the proinflammatory activation of microglia and astrocytes. We showed that methadone, the most widely used drug in opioid replacement therapy for pregnant women with opioid addiction, directly impairs brain cells in vitro, highlighting the need for developing alternative therapies to address opioid addiction in this population.

Challenges in the treatment of opioid dependence

The number of persons using opioids has increased worldwide in the last decade, particularly the use of opioid analgesics in North America and Africa. In Germany, the prevalence of heroin addiction has remained relatively stable. Narrative review of the literature. Opioid-assisted maintenance treatment (OMT) with the established substances methadone, levomethadone, slow-release morphine and buprenorphine is recommended as the first-line treatment for heroin dependence. The OMT reduces the use of heroin, mortality and individual suffering and improves the quality of life and physical health. A diamorphine and heroine-assisted treatment is an option for people who do not benefit from conventional OMT. An alternative to the use of diamorphine could be treatment with hydromorphone hydrochloride. The regulations on carrying out maintenance treatment in the Controlled Substances Prescription Act and the guidelines of the Federal Medical Association in Germany have been loosened based on the experiences of the COVID-19 pandemic, for example with respect to take-home prescriptions. There is an ongoing intensive discussion on how to deal with the decreasing number of outpatient clinics offering OMT. The first-line treatment for opioid addiction is opioid-assisted substitution treatment, including diamorphine and heroin-assisted treatment. Long-acting depot medications and implants still play asubordinate role.

Eysenck's Personality Questionnaire Scores of Heroin Addicts in Pakistan.

Objective The main objective of the study was to find Eysenck's Personality Questionnaire scores of heroin addicts in Pakistan and to compare the EPQ scores with demographic variables such as age, gender, and duration of addiction. Methodology of the study This cross-sectional study was conducted in Islamabad, Pakistan. Data was collected from 300 participants. The participants were recruited from various drug rehabilitation centers and clinics across Pakistan. Patients diagnosed with heroin addiction by a qualified medical professional and currently undergoing treatment or rehabilitation for heroin addiction were included in the study. Data was collected through a purposive sampling technique. Results Data was collected from 300 participants, including both males and females. The age range included subjects from 18 years to 60 years. Heroin addicts in Pakistan have a mean extraversion score of 12.4 (SD=4.8), with scores ranging from 5 to 20, indicating average levels of sociability. Neuroticism had a mean score of 17.6 (SD=5.2), with a range from 7 to 25, suggesting high emotional instability and anxiety. Psychoticism had a mean score of 8.3 (SD=3.9), with scores between 2 and 15, indicating moderate levels of aggressive and antisocial behavior. Conclusion It is concluded that heroin addicts in Pakistan exhibit high levels of neuroticism, moderate levels of extraversion, and psychoticism. Younger addicts and those with a shorter duration of addiction display higher levels of these traits, indicating a need for personalized and targeted intervention strategies.

Exploring Narcopolis as a Postmodern Narrative and Semiotic Text

Jeet Thayil’s Narcopolis (2012), inspired by his own experience as an opium and later heroin addict, paints a vivid picture of the seedy underbelly of 1970s Bombay. The novel features a multitude of characters from the opium dens of Bombay and threads multiple narratives, subversive and carnivalesque, to create a postmodern chronicle of the city. This article analyzes the narrative techniques in Jeet Thayil's novel Narcopolis (2012) to explore traits of postmodernity. It contends that the occurrence of multiple narratives, whose reliability is questionable, indicates a Barthian death of the author, encouraging the readers to give meaning to the text. Also, an inquiry into the novel’s commentary on its own narrative style indicates self-reflexivity. A study of the chronotope will be undertaken to decipher the temporality in the novel. Besides, the article will look out for possibilities of embedded narratives, plot digressions, and intertextuality. It also intends to scrutinize the novel using the tools of social semiotics. Linguistic analysis of discourse entails a monolithic approach, wherein it considers language as the only mode of interpretation of a text. Gunther Kress and Theo Van Leeuwen suggest that this limitation can be overcome by social semiotics, which studies a text in its multimodality. Signs, linguistic as well as nonlinguistic, are apparent through multiple modes, such as language, sound, visual, and so forth. The incorporation of certain pictures, changes in typography of certain pages as well as the book cover of Narcopolis poses a rich possibility of the semiotic understanding of the text through visual mode. Lastly, this article will aim to establish a connection between the narrative techniques and the semiotic interpretation of the text.

Microelectrode recording characterization of the nucleus accumbens and the anterior limb of internal capsule in patients with addiction

The nucleus accumbens (NAc) and the anterior limb of internal capsule (ALIC) are effective targets for treating addiction using deep brain stimulation (DBS). However, there have been no reports on the electrophysiological characteristics of addiction nuclei at the single-cell level in humans. This study aimed to investigate the electrical activity characteristics of neurons in the NAc and ALIC using microelectrode recording (MER) during DBS surgery in patients with addiction, and six patients with addiction were included (five with heroin addiction and one with alcohol addiction). The microelectrode recording trajectories were reconstructed and recording sites at different depths were determined by merging the pre- and post-operative images in the FrameLink system. The results showed that among the 256 neurons, 204 (80 %) were burst neurons. NAc neurons accounted for the majority (57 %), and the mean firing rate (MFR) was the highest (1.94 Hz). ALIC neurons accounted for the least (14 %), and MFR was the lowest (0.44 Hz). MFR increased after entering the NAc and decreased after entering the ALIC. In the patients with addiction treated using DBS, the single-cell level electrophysiological characteristics of the different nuclei were found to be distinct along the surgical trajectory.