Heroin-addicted Patients Research Articles

Second and fourth (2D:4D) digit ratio in heroin and cannabis addicted patients

The etiology of addiction has not yet been fully elucidated. The ratio between the length of the second and fourth fingers (2D:4D ratio) has been linked with prenatal androgen concentrations, but also with addictive behvaiors. Aim: The present study aimed to evaluate the differences of 2D:4D ratio of individuals with cannabis and heroin addiction by examining them together with the control group. A total of sixty two male patients (33 opiate use disorder and 29 cannabis use disorder) with substance use disorder and the twenty-nine healthy controls were included in the present investigation. We obtained the lengths of 2D and 4D of the subjects by using sensitive calipers and calculated the 2D:4D. Heroin-addicted patients had lower 2D:4D ratio in in the right hand (significant difference between control group) (p < 0.001), there was no significant difference found between heroin-cannabis (p = 0.242) and control-cannabis 2D:4D ratios (p < 0.06). In the left hand, it was significant between the heroin-control groups (p < 0.037) and the cannabis-control groups (p < 0.023), while it was not significant between the heroin-cannabis groups (p = 1). In conclusion, we suggest that heroin-and cannabis addicted patients seem to have a lower ratio of 2D:4D compared to healthy control subjects. Our findings can be considered promising as to whether prenatal hormonal factors are important in the etiopathogenesis of addiction.

A Comparison Study of Impulsiveness, Cognitive Function, and P300 Components Between Gamma-Hydroxybutyrate and Heroin-Addicted Patients: Preliminary Findings

PurposeThe aim of this study was to investigate and compare impulsiveness, negative emotion, cognitive function, and P300 components among gamma-hydroxybutyrate (GHB)-addicted patients, heroin-dependent patients, and methadone maintenance treatment (MMT) subjects.MethodsA total of 48 men including 17 GHB addicts, 16 heroin addicts, 15 MMT subjects, and 15 male mentally healthy controls (HC) were recruited. All subjects were evaluated for symptoms of depression, anxiety, impulsiveness, and cognitive function through the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7), the Barratt Impulsiveness Scale version II (BIS-II), the Beijing version of the Montreal Cognitive Assessment (BJ-MoCA), the behavioral test (response time), and event-related potential P300 detection.Results(1) The mean scores of BIS-II in the GHB addiction group, heroin dependence group, and MMT group were significantly higher than those of the HC group (F = 30.339, P = 0.000). (2) The total scores of BJ-MOCA in GHB addiction group was the worst among the four groups, followed by heroin addiction, MMT group and HC group (F = 27.880, P = 0.000). (3) The response time in the GHB addiction group was the longest among the four groups, followed by the heroin addiction, MMT, and HC groups (F = 150.499, P = 0.000). (4) The amplitude and latency of P300 in GHB addiction subjects were significantly lower and longer than those of the MMT group and the HC group. (5) For the three types of addiction, the P300 amplitudes at Fz, Cz, Pz, T5, and T6 were negatively correlated with the scores of GAD-7, PHQ-9, and BIS-II; the P300 latencies were positively correlated with the response time and negatively correlated with the scores of the BJ-MoCA.ConclusionPeople with an addiction were likely to have increased impulsiveness. The cognitive function of the GHB and heroin-addicted subjects, including the heroin detoxification and the MMT groups, was severely impaired, especially for the GHB-addicted patients. The impairment manifested as abnormalities of BJ-MoCA, response time, and P300 components.

Predictors of Caregiver Burden in Family Caregivers of Male Patients with Opioid Use Disorders.

We aimed to determine the factors that correlate and best predict caregiver burden in family caregivers of male patients with opioid use disorders, specifically with heroin use. A total of 100 patients with opioid use disorders and their primary caregivers (n = 100) were included in the study. Both patients and caregivers completed sociodemographic data collection forms. The Addiction Severity Index was applied to the patients, and the Burden Assessment Scale, COPE Inventory, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale were applied to the caregivers. Patients and their caregivers were divided into groups according to sociodemographic and clinical characteristics and then the caregiver burden scores were compared. In addition, factors correlating with caregiver burden were determined. Finally, in considering all these data, the factors that best predict caregiver burden were identified using regression analysis. Factors that increased the burden of caregivers were duration of care, at least 1 instance of inpatient treatment, the presence of verbal and physical violence between patients and other family members, intravenous drug use, and moderate or severe dependence, according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Caregivers' active coping scores, based on the COPE Inventory, were found to negatively predict caregiver burden, while the patients' family-social relationship scores, based on the Addiction Severity Index, were found to positively predict caregiver burden. Developing caregivers' coping skills and patients' family-social relationships may thus contribute to reducing the burden of disease related to heroin-addicted patients.

The difficult challenge of postoperative pain management in heroin addicted patients undergoing breast cancer surgery.

article: The difficult challenge of postoperative pain management in heroin addicted patients undergoing breast cancer surgery - Minerva Anestesiologica 2021 September;87(9):1053-4 - Minerva Medica - Journals

Heroin-assisted treatment of heroin-addicted patients normalizes regulatory T cells but does not restore CD4+ T cell proliferation.

Heroin dependence may result in suppression of adaptive immune responses. Previously, we demonstrated an increase in relative numbers of inhibitory CD4+ regulatory T cells (Tregs) and impaired proliferative activity of CD4+ T cells from heroin-addicted patients in contrast to patients in opioid maintenance therapy and healthy controls. However, it remains elusive whether heroin has a direct impact on the CD4+ T cell compartment or whether observed effects result from stressful living conditions. Here, we analyzed the frequencies of Tregs and the proliferation as well as the cytokine production of stimulated CD4+ T cells from heroin-addicted patients with use of illicit heroin, patients in heroin-assisted treatment (HAT), and patients in methadone maintenance therapy (MMT). Relative numbers of CD4+ Tregs were significantly enhanced in patients with illicit heroin abuse compared with patients in HAT or MMT. Notably, CD4+ T cells from patients in HAT and from persons using illicit heroin showed significant reduced proliferation and secretion of the pro-inflammatory cytokines IFN-γ and IL-6 upon stimulation in vitro. From these results, we conclude that structured programs such as HAT and MMT dampen elevated frequencies of Tregs in heroin-addicted patients, whereas chronic heroin administration irrespective of using illicit heroin or receiving HAT has a direct impact on the proliferative activity and cytokine production of CD4+ T cells.

Methadone versus buprenorphine: data detected from Caltanissetta SER.T

In last years, heroin-addicted have exponentially increased: this has made it necessary to identify a pharmacological strategy as effective as possible. With this purpose, a statistical investigation was conducted in a sample of individuals, aged between 18 and 50. They were diagnosed and subjected to different treatments at Ser.T of Caltanissetta (Sicily-Italy) during the period 2013-2017. The analyzed patients were treated with three different pharmacological therapy: methadone 0.1%, methadone 0.5%, buprenorphine and suboxone. We obtained percentages of responders, low responders and non-responders patients from data processing, based on used therapy. Considering pharmacological responses of the sample examined, it is possible to observe that the treatment with buprenorphine has led to 71.98% of responders subjects, 23.52% of low responders and 4.5% of non-responders. Instead, the administration of methadone 0.1 % has produced 82.82% of responders subjects, 11.08% of low responders, 6.1% of nonresponders. The therapy with methadone 0.5% has resulted 88.98% of responders subjects, 7.8% of low responders, 3.22% of nonresponders. Finally, through the administration of suboxone, we obtained 86.34% of responders subjects, 9.84% of low responders and 3.82% of non responders. In conclusion, although it has emerged that treatment with methadone 0.5% is the most successful therapy, it is preferable to use suboxone (except in relapsing subjects) since it has also produced a high number of responders subjects and a good safety profile for heroin addicted patients.

The Conceptual Framework of Dual Disorders and Its Flaws.

When psychiatric illness and substance use disorder coexist, the clinical approach to the patient is, unsurprisingly, awkward. This fact is due to a cultural context and, more directly, to the patient’s psychiatric condition and addiction behaviors—a situation that does not favor a scientific approach. In dual disorder facilities, several types of professionals work together: counselors, social workers, psychologists, and psychiatrists. Treatment approaches vary from one service to another and even within the same service. It is crucial to provide dual disorder patients with multiple treatments, comprising hospitalization, rehabilitative and residential programs, case management, and counselling. Still, when treating dual disorder (DD) heroin use disorder (HUD) patients, it is advisable to follow a hierarchical algorithm. First, we must deal with addiction: by detoxification, whenever possible. This means starting most patients on anti-craving pharmacological maintenance, though aversion therapy may be appropriate for a few of them. Opiate antagonists may be used with heroin-addicted patients as long as those patients are only mildly ill. In contrast, agonist opioid medications, i.e., buprenorphine and methadone suit moderately and severely ill patients, respectively. Achieving control of mood instability or psychotic episodes is the next step, to be followed by a prevention strategy to counteract residual cravings and dominate mood disorders or psychotic episodes through long-term pharmacological maintenance that is focused on a double target.

Melatonin alleviates morphine analgesic tolerance in mice by decreasing NLRP3 inflammasome activation

Morphine is frequently used for pain relief, but long-term morphine therapy in patients with chronic pain results in analgesic tolerance and hyperalgesia. There are no effective therapeutic treatments that limit these detrimental side effects. We found pretreatment with melatonin could decrease morphine-induced analgesic tolerance. There was a significant activation of the NLRP3 inflammasome in the prefrontal cortex and the peripheral blood of morphine-treated mice compared to control animals, which could be blocked by melatonin. The inflammasome activation induced by morphine was mediated by the microglia. SiRNA knockdown or pharmacological inhibition of the NLRP3 abolished the morphine-induced inflammasome activation. Co-administration of melatonin and low-dose morphine had better analgesia effects in the murine models of pain and led to a lower NLRP3 inflammasome activity in brain tissues. Mice deficient for Nlrp3 had a higher nociceptive threshold and were less sensitive to develop morphine-induced analgesic tolerance and acetic acid-induced pain relative to wild-type animals. Concordantly, we observed a significantly elevated level of serum IL-1β, which indicates an increase of NLRP3 inflammasome activity associated with the reduced level of serum melatonin, in heroin-addicted patients relative to healthy individuals. Our results provide a solid basis for conducting a clinical trial with the co-administration of melatonin and morphine for the relief of severe pain.

Buprenorphine and Methadone as Opioid Maintenance Treatments for Heroin-Addicted Patients Induce Oxidative Stress in Blood.

Buprenorphine and methadone are two substances widely used in the substitution treatment of patients who are addicted to opioids. Although it is known that they partly act efficiently towards this direction, there is no evidence regarding their effects on the redox status of patients, a mechanism that could potentially improve their action. Therefore, the aim of the present investigation was to examine the impact of buprenorphine and methadone, which are administered as substitutes to heroin-dependent patients on specific redox biomarkers in the blood. From the results obtained, both the buprenorphine (n = 21) and the methadone (n = 21) groups exhibited oxidative stress and compromised antioxidant defence. This was evident by the decreased glutathione (GSH) concentration and catalase activity in erythrocytes and the increased concentrations of thiobarbituric acid reactive substances (TBARS) and protein carbonyls in the plasma, while there was no significant alteration of plasma total antioxidant capacity (TAC) compared to the healthy individuals (n = 29). Furthermore, methadone revealed more severe oxidant action compared to buprenorphine. Based on relevant studies, the tested substitutes mitigate the detrimental effects of heroin on patient redox status; still it appears that they need to be boosted. Therefore, concomitant antioxidant administration could potentially enhance their beneficial action, and most probably, buprenorphine that did not induce oxidative stress in such a severe mode as methadone, on the regulation of blood redox status.

Longitudinal behavioral and fMRI-based assessment of inhibitory control in heroin addicts on methadone maintenance treatment.

The objective of the present study was to determine whether methadone maintenance treatment (MMT) in heroin-dependent patients affects inhibitory control, whether any MMT-induced changes correlate with methadone dose and MMT duration, and whether these changes depend on the psychological characteristics of patients, such as depression, anxiety and impulsivity. Response inhibition in the GO/NO-GO test was combined with functional magnetic resonance imaging (fMRI) scanning data to examine whether MMT affects inhibitory control in 21 heroin-addicted patients who had already undergone at least three months of MMT. Patients were evaluated one year prior to and after the MMT period. Participants exhibited no difference in their GO/NO-GO reaction time and accuracy rate, or in their false alarm rate under NO-GO conditions. However, increased activation was detected in numerous brain regions in their 12-month fMRI scans, although these were not in the frontal-striatal loop. Increased fMRI activation in the left precentral gyrus and superior temporal gyrus were negatively correlated with the daily methadone dose and total methadone dose during the one-year study period. In conclusion, these results suggested that MMT over one year does not significantly change the behavioral indicators of inhibitory control function in heroin-dependent patients. The increase in activation leads to the hypothesis that MMT over one year may increase cognitive inhibitory control, which may be the result of the combined negative effect of methadone and the positive effect of functional recovery after withdrawal of heroin.

Evidence of validity and reliability of the Opiate Dosage Adequacy Scale (ODAS) in a sample of heroin addicted patients in buprenorphine/naloxone maintenance treatment

ObjectiveThe Opiate Dosage Adequacy Scale (ODAS) is a clinical tool to individually measure the “adequacy” of opioid doses in patients on maintenance treatment. The aim of this paper is to provide evidence for the validity and reliability of the ODAS in a sample of patients in buprenorphine/naloxone (B/N) maintenance treatment. MethodCross-sectional study of a convenience sample of B/N-treated patients (n = 316) from four Autonomous Communities in Spain. Participants completed a battery of instruments to assess the following: buprenorphine dose adequacy; heroin dependence severity; psychological adjustment; and patient-desired adjustment of buprenorphine dose. ResultsExploratory Factor Analysis identified four factors from the ODAS that together account for 85.4% of the total variance: “Heroin craving and use”; “Overmedication”; “Objective opiate withdrawal symptoms (OWS)” and ‘Subjective OWS’. Compared to patients with an “inadequate” B/N dose (ODAS), patients with “adequate” doses had less heroin use in the last week (0.01 vs. 0.40; t = −2.73; p < 0.01, 95% CI: −0.67, −0.10), less severe heroin dependence (2.20 vs. 5.26, t = −5.14, p < 0.001; 95% CI: −4.23, −1.88), less psychological distress (3.00 vs. 6.31, t = −4.37, p < 0.001; 95% CI: −4.80, −1.81), and greater satisfaction with their doses (42.1% vs. 13.6%, χ2 = 14.44, p < 0.01). Cronbach’s alpha coefficient was 0.76 (0.81, 0.92, 0.94, and 0.93, respectively, for the four factor dimensions). ConclusionThese findings support the validity and reliability of the ODAS as a tool to measure and assess buprenorphine dose adequacy in the context of an opioid dependency treatment program.

Demographic background and dangerous behaviors of heroin-addicted patients under maintenance treatment in the North East of Iran (North Khorasan province)

ABSTRACTBackground: In recent years, Iran has experienced an increase in heroin consumption, which endangers the health of individuals as well as the whole society. The present research investigated the demographic indices and dangerous behavior of heroin-addicted patients under maintenance treatment. Methods: This study was conducted as a cross-sectional study in 2015. The sample of this research includes the heroin-addicted patients under treatment in 79 maintenance treatment centers in North Khorasan. The information is gathered by a checklist of dangerous behaviors and demographic indices of the patients. Results: In this study, 842 heroin consumers under maintenance treatment were investigated, 82.4% of whom were male and 17.6% were female. Heroin-addicted patients showed a significant difference in terms of marital status, occupation, addiction initiation, and dangerous behaviors (such as unsafe sexual intercourse, the history of concurrency injection and unsafe sexual intercourse) in two gender groups. Conclusion: It seems that there is a significant difference between male and female heroin-addicts in dangerous behaviors and demographic indices. As such, there is a significant difference between demographic pattern and dangerous behaviors of heroin-addicted patients in Iran and patients from other countries.

Methadone maintenance treatment and sexual function of heroin addicted patients

A significant number of patients treated for heroin addiction suffer from sexual disorders. The aim of this research was to investigate the sexual function of the heroin addicted patients taking a methadone maintenance treatment (MMT), to identify the types of sexual disorders and analyze their causes. Methods: Questionnaire, scale ASEX and WHO-ASSIST V3.0 were performed by 20 sexually active patients (15 men and 5 women), undergoing MMT. Results: The data of the questionnaire have shown that 55% of the patients suffer from deterioration of their sexual function, 30% of the patients have observed the improvement of their sexual function, and 15% of the patients have not felt any changes. The patients with a worsened sexual status have taken higher daily dosage of methadone (66, 8 ± 24,11 mg). 40% of the patients have expressed the anxiety caused by the disturbance of their normal sexual function, it being known that the duration of their treatment was longer and the dosage of methadone was higher (p ˃ 0,05). According to ASEX scale, the men scored 14,13 ± 2,85 Likert points, and the women - 15,6 ± 2,88 Likert points; 5 patients (25%) have not had any sexual disorders, 4 patients(70%) have observed some disorders of their sexual functioning, and only one patient (5%) has suffered from sexual dysfunction. In general, a fade of the sexual desire (3, 25 ± 1,06 Likert points) and problems with achieving orgasm (3,0 ± 0,85 Likert points) were noticed, but the experienced orgasm was satisfactory (2,6 ± 0,99 Likert points). The patients showing relatively good indicators for the libido (2.5 Likert points), the arousal (2.3 Likert points), the satisfaction with orgasm (2,0 Likert points) took 40-50 mg of methadone per day. A marked decrease of the sexual desire, the disturbance of the ejaculatory function (3.5 Likert points), the dissatisfaction with orgasm were noted at the dosage of 80-100 mg of methadone per day. Conclusions: The methadone has an effect on the sexual function. High doses suppress the sexual desire, delay the ejaculation and prevent the achievement of orgasm, the average doses do not lead to obvious sexual disorders caused by the abuse of heroin.

Increased oxytocin levels among abstinent heroin addicts: Association with aggressiveness, psychiatric symptoms and perceived childhood neglect

A disruption of the oxytocin system seems to affect a variety of brain functions including emotions, mood and social behavior possibly underlying severe social deficits and susceptibility for substance use and mental health disorders. Early life adversity, such as insecure attachment in childhood, has been suggested to influence oxytocin tone contributing to a condition of neurobiological vulnerability.Aim of the present study was to investigate oxytocin serum levels in abstinent heroin addicted patients, in comparison with healthy controls, and the possible correlation with co-occurring psychiatric symptoms, aggressiveness and perception of parental neglect. Eighteen (18) abstinent patients, affected by heroin use disorders, and 18 control subjects, who never used drugs or abused alcohol, were included in the study and submitted to 1) collection of a blood sample for oxytocin assay, 2) Symptoms Check List 90 for psychiatric symptoms evaluation 3) Buss Durkee Hostility Inventory to measure aggressiveness 4) Child Experience of Care and Abuse-Questionnaire to retrospectively test the perception of parental neglect. Heroin exposure extent and heroin dosages were also recorded. Oxytocin serum levels were unexpectedly significantly higher among abstinent patients affected by heroin use disorders and positively correlated with psychiatric symptoms, aggressiveness and mother neglect scores. No correlation was evidenced between oxytocin and heroin exposure extent or dosages. Our findings appear to contradict the simplistic view of oxytocin as a pro-social hormone and confirm previous evidence concerning the peptide levels direct association with aggressive behavior and mood disorders. Considering a more complex mechanism, oxytocin would increase the sensitivity to social salience cues related to contextual or inter-individual factors, promoting pro-sociality in “safe” conditions and, in contrast, inducing more defensive and “anti-social” emotions and behaviors when the social cues are interpreted as “unsafe”. This latter condition is often characterizing the clinical history of addicted patients.

Relationship among methadone dose, polymorphisms of dopamine D2 receptor and tri-dimensional personality questionnaire in heroin-addicted patients.

BackgroundWe investigated whether variation in the dopamine D2 receptor gene (DRD2) and tri-dimensional personality questionnaire (TPQ) scores could be used to aid adjustment of daily methadone requirements of heroin addicts. DRD2 TaqI B polymorphisms and TPQ scores were determined in 138 male Taiwanese heroin addicts who were receiving methadone treatment. Borderline index (harm avoidance + novelty seeking—reward dependence) was calculated for each subject, and three groups were defined: high (mean from all subjects plus 1 standard deviation, or greater), low (half of the calculated high score, or lower) and medium (all values between the high and low scores).ResultsNo significant differences in age (p = 0.60), mean methadone dose (p = 0.75) or borderline index group (p = 0.25) were observed between subjects bearing the B1/B1, B1/B2 and B2/B2 DRD2 TaqI genotypes. Among the individuals with low (≤10), medium (11–20) and high (≥21) borderline index scores, there was a significant difference in mean methadone dose (p = 0.04), but not age (p = 0.90). Further analysis showed that mean methadone dose was significantly higher in subjects with low borderline index scores than in those with high scores (62.5 vs. 47.0 mg/day, p = 0.03). The odds ratio for a daily methadone requirement ≥60 mg (median dose across the 138 subjects) was 2.64-fold greater in the low borderline index group than in the high group (p = 0.04).ConclusionsAlthough the DRD2 TaqI B genotype was not associated with methadone use requirements, borderline index was revealed as a potential predictive marker for the adjustment of methadone dosage requirements in heroin addicts.

Mentalization And Personality Organization In Heroin Addicted Patients : A Narrative Analysis

The relationship between the dimensions of personality organization and the quality of mentalization is an important object of study in contemporary psychodynamic theory and it also contributes to the understanding of heroin addiction with comorbid personality disorders. The current study aims to assess levels of personality organization and its main domains (Identity, Object relations, Defense Mechanisms) in patients with opiate addiction, as well as the quality of affect mentalization and possible connections between them. In order to do so we have adopted quantitative text-analysis method of affect mentalization to parts of а interview, trying to show that the language which participants use could be in itself a psychodiagnostic means. A group of 30 heroin addicted patients in a methadone treatment programme and a control group of 30 healthy participants were assessed with the Structured Interview of Personality Organization (STIPO), VEA (Verbal Elaboration of Affect Scale) and The Measure of Affect Contents (MAC). Results show significant differences between the two groups, concerning all dimensions of personality organization as well as some core areas of affect mentalization. The capacity for affect mentalization is significantly correlated to the level of personality organization. The results are discussed from the point of view of the adopted theoretical models and the implications for psychotherapeutic work in the bio-psycho-social model.

Psychic Structure of Opioid Addiction

Background: By applying a Principal Component Analysis (PCA) to the items of the SCL-90 checklist, we previously investigated the psychopathologic structure of individuals with heroin addiction, finding a 5-factor aggregation of psychological/psychiatric symptoms: “Worthlessness and Being trapped,” “Somatic Symptoms,” “Sensitivity-Psychoticism,” “Panic-Anxiety,” and “Violence-Suicide.” Our studies on this subject did not, however, explore the possible impact of comorbid psychiatric conditions on 5 psychopathologic dimensions listed above. The aim of the present study is to verify whether there is any difference in these 5 dimensions between heroin-addicted patients with (PC-HA) or without (NPC-HA) known lifetime psychiatric problems. Methods: A total of 1195 patients with heroin dependence entering a residential therapeutic community treatment were assigned to one of the 5-factor solutions yielded by Principal Component Analysis on the basis of the highest z score obtained. Differences between NPC-HA and PC-HA patients in the frequency of the 5 psychopathologic dimensions and in their severity were then analyzed by means of univariate and multivariate analyses. Results: All the SCL-90 factor scores were, from a statistical viewpoint, significantly higher in PC-HA than in NPC-HA patients, but the only statistically significant differences in the frequency of the 5 psychopathological dimensions were those observed in the case of “Panic-Anxiety,” which turned out to be higher in the PC-HA group. Stepwise discriminant analysis showed that the severity of “Somatic Symptoms” and “Panic-Anxiety” made these 2 factors the only ones that successfully discriminated between NPC-HA and PC-HA patients. The other SCL-90-based psychopathologic dimensions were unable to improve the value of the discrimination. Conclusions: On the basis of our results, the SCL-90-defined structure of opioid addiction may be considered to be only partly dependent on the presence of a “psychiatric” condition. This observation adds to the previous ones that go to show the stability of the above aggregations of symptoms, irrespectively of other demographic and clinical characteristics, as well as active involvement with heroin abuse or the kind of treatment chosen. When the available evidence is considered as a whole, it seems to support the trait-dependent, rather than state-dependent, nature of the proposed factorial dimensions of the psychopathology of opioid addiction.

The Perioperative Management of Pain in Patients Who Are Addicted to Heroin

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.

Inflammatory response in heroin addicts undergoing methadone maintenance treatment

Opioid addiction influences many physiological functions including reactions of the immune system. The objective of this study was to investigate the immune system function in heroin addicted patients undergoing methadone maintenance treatment (MMT) compared to healthy controls. We tested the cytokine production of IL-1β, IL-6, IL-8, IL-10 and tumor necrosis factor (TNF)-α from a group of heroin addicts (n=34) and healthy controls (n=20). The results show that production of IL-1β, IL-6 and IL-8 was significantly higher in the group of methadone-maintained patients than in the healthy control group. Plasma TNF-α and IL-6 levels were significantly correlated with the dairy methadone dosage administered, and the IL-1β level was significantly correlated with the duration of methadone maintenance treatment. These findings suggest that methadone maintenance treatment influences the immune system functions of opioid-dependent patients and may also induce long-term systemic inflammation.

Does Dual Diagnosis Affect Violence and Moderate/Superficial Self-harm in Heroin Addiction at Treatment Entry?

The presence of aggressive and self-harm behaviors is common in heroin-addicted patients, but these frequent co-occurrences have been poorly investigated. Given the fact that self-harm may be seen as both a clear addictive behavior, with its opiate theory, and as part of psychiatric illness, such as psychosis and bipolar spectrum disorders, in this study, we intend to investigate which of the 2 models is more consistent. We compared dual diagnosis with the clinical features of 30 moderate/superficial self-harmed and 162 violent heroin-addicted patients who reported aggressive behavior in the month preceding their request to be treated. As control group, we selected 808 lifetime nonviolent heroin-addicted patients. The presence of a bipolar spectrum diagnosis proved to be the highest risk factor (B = 4.33; exp(B) = 76.52; 95% confidence interval for exp(B) = 35.69-164.04; P < 0.001) for the presence of aggressive behavior (χ²= 433.05; df = 5; P < 0.001). The highest risk factor for the presence of moderate/superficial self-harm (χ² = 24.83; df = 2; P < 0.001) was a dual diagnosis for chronic psychosis (β = 1.46; exp(B) = 4.34); 95% confidence interval for exp(B) = 1.11-16.98; P < 0.001). The relationships between aggressive and/or self-harm behaviors and the natural history of addiction in heroin-addicted patients seemed to be less consistent. Our data show a frequent co-occurrence of aggression and bipolar spectrum disorder in heroin-addicted patients, which is manifested as aggression directed toward others (violence). On the contrary, self-injurious behavior seems to be strongly correlated with psychotic disorders. Thus, aggressive behavior seems to be correlated, in heroin-addicted patients before entering treatment, with dual diagnosis rather than with a natural history of heroin addiction.