Heroin Injection Research Articles

Maintenance Therapy with Opium Tincture for Injecting Drug Users; Implications for Prevention from Viral Infections

Maintenance Therapy with Opium Tincture for Injecting Drug Users; Implications for Prevention from Viral Infections

Effects of heroin dependence on the expression of DBH and CCK in the VTA and NAc regions of rat brain

To investigate the effect of the heroin addicts on rat's DβH‐, CCK‐immunoreactive cells in the ventral tegmental area(VTA) and nucleus accumbens(NAc) regions, and exploring the effect of heroin dependence on regulation of dopamine release and self‐protective mechanism in brain. Adulthood 55 male SD rats were randomly divided into normal control group(NCG), saline control group(SCG) and the heroin‐dependent group(HDG). Heroin‐dependent rat models were set up by the way of subcutaneous injection of heroin and brain tissues are excised on the 10th, 17th, 24th, 31th, and 38th days after models are set up. Immunohistochemical staining was performed to test the expression of DβH and CCK in the VTA and NAc regions. The expression of DβH and CCK was observed as brown yellow particle in the cytoplasm of neurons in the VTA and NAc regions. The expression of DβH‐ immunoreactive cells is down‐regulated, while the expression of CCK‐immunoreactive cells is up‐regulated in the VTA and NAc regions from HDG rats than that from SCG and NCG rats at different time points. The results suggest that the secretion of DβH is inhibited during heroin dependence, and it might be one reason causing dopamine increase in VTA and NAc. The increased secretion of CCK in VTA and NAc might be self‐protective mechanism in brain.Grant sponsor(s): NSFC(Natural Science Foundation of China)Grant number(s):81060110Grant Funding Source: Natural Science Foundation of China

Role of phosphodiesterase‐4 (PDE4) in alcohol‐ and heroinseeking behavior

Cyclic AMP (cAMP) signaling is important in mediating drug abuse and dependence, including alcoholism. As a critical controller of intracellular cAMP levels in the brain, phosphodiesterase‐4 (PDE4), an enzyme that specifically hydrolyzes cAMP, may play a role in drug dependence. Here we examined the effects of rolipram, a selective PDE4 inhibitor, on alcohol or heroin seeking behavior in mice and/or rats. Treatment with rolipram (0.1–0.5 mg/kg) decreased ethanol (7–12%) intake and preference in high alcohol preferring mice and rats in two‐bottle choice and/or ethanol drink‐in‐dark tests. Deficiency of PDE4B diminished rolipram‐induced decreases in ethanol consumption in mice. In addition, rolipram (0.025–0.05) also decreased ethanol responses in operant self‐administration in rats. Further, in heroin self‐administration, rolipram (0.03–0.3 mg/kg) decreased cues‐ or heroin priming‐induced responses, but did not alter responses to heroin injections. These results suggest that PDE4 plays an important role in the regulation of ethanol‐ and heroin‐seeking behaviors, which are attenuated by PDE4 inhibitors such as rolipram. Targeting PDE4, in particular PDE4B, may be an efficient approach for treatment alcoholism and heroin dependence [This work was supported by research grants from NIH/NIAAA (AA020042; to HTZ), National Nature Science Foundation of China (30870894; to JHL/81071077; to WHZ), and National Basic Research Program of China (2009CB522008; to WHZ)].

“El Lado Oscuro”: “The Dark Side” of Social Capital in Mexican American Heroin Using Men

This article describes social capital in a cohort of 227 Mexican American men who are long-term injection heroin users. Social capital scores for current and former users were similar, suggesting equal absolute values of capital, but associated with illicit activities in current users and with cessation efforts in former users. Stable drug-using relationships provided high negative capital, whereas conventional relationships provided positive capital. Thus, social capital functions dichotomously in positive and negative contextualized roles. This study provides an alternative understanding of the dynamic interactions between individuals, environment, and drug abuse and can inform prevention and treatment interventions for an important demographic group.

‘It's more about the heroin’: injection drug users' response to an overdose warning campaign in a Canadian setting

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. Semi-structured qualitative interviews. Vancouver, Canada. Eighteen active heroin injectors. 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. 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. 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.

Comparison of survivors and nonsurvivors in 27 confirmed injectional anthrax cases from the 2009 outbreak in Scotland

From December 2009 to December 2010, 47 patients in Scotland presented with confirmed anthrax infection manifested by soft tissue disease related to heroin injection. These cases represent the first known outbreak of a recently recognized form of anthrax, termed injectional anthrax, which appears to be associated with a high mortality rate (28% in confirmed cases from the UK outbreak). While epidemiologic data from this outbreak have been published, no report has systematically described findings in patients at presentation or compared these findings in nonsurvivors and survivors.

Positive association between −1021TT genotype of dopamine beta hydroxylase gene and progressive behavior of injection heroin users

By balancing the ratios of dopamine and norepinephrine, dopamine beta hydroxylase (DBH) plays an important role in brain reward circuit that is involved with behavioral effects of heroin addiction. DBH −1021C/T (rs1611115) is a functional variant with strong correlation with plasma DBH activity and several nerval and psychic disorders. In the present study, we have collected 333 male cases with heroin addiction and 200 male healthy controls to explore the role of −1021C/T in heroin addiction. There is no evidence of association between −1021C/T and heroin addiction on both genotype and allele levels (P>0.05). In the injection subgroup of cases, −1021TT carriers have longer heroin addiction time (P<0.001) and higher dosage of self-administered heroin (P=0.045) than carriers with −1021CC or −1021CT, suggesting that patients with TT genotype are likely to have more progressive style of heroin users with injection route. In conclusion, our results support −1021TT genotype may be implicated with a more progressive nature of heroin addiction, although DBH −1021C/T is unlikely to be involved in the risk of heroin addiction.

Transition to injecting 3,4-methylene-dioxy-pyrovalerone (MDPV) among needle exchange program participants in Hungary

In 2011, anecdotal data indicated that 3,4-methylene-dioxy-pyrovalerone (MDPV) might become popular among needle exchange program (NEP) clients in Hungary as a possible substitute for formerly used substances such as amphetamines and heroin. The aim of the study reported here was to examine how the emergence of MDPV influenced the choice of the injecting substance among NEP clients. A total of 183 injecting drug users (IDUs) participating in the largest NEP in Budapest agreed to participate in the study and report on their drug use habits. During 2011, remarkable changes occurred in the structure of the primary injected substances. Amphetamine was cited as the primary injected substance by 45.9% of the respondents and MDPV by 48.1%. Close to half of the former amphetamine injectors had switched to MDPV (64 persons, 45.1%) as had 10 (41.7%) of the former heroin injectors and 11 (78.6%) of those using other substances (cocaine and mephedrone). The appearance of MDPV on the illegal drug market had a substantial effect on the drug use patterns of the IDU population. Further research should be conducted to explain the changes, that might include the purity, price and availability of amphetamine and heroin.

Risks and Predictors of Current Suicidality in HIV-Infected Heroin Users in Treatment in Yunnan, China

Suicide is an important public health problem in China. Elsewhere, injection drug use and HIV infection have independently been associated with suicidality, but research has often overlooked these high-risk groups in China. We determined the frequency and predictors of suicidal ideas in Chinese HIV-infected (HIV(+)) and HIV-uninfected (HIV(-)) heroin injection drug users (IDUs) in treatment and a control sample. We hypothesized that rates of suicidal ideas would be significantly higher among IDUs compared with controls and highest among HIV IDUs. We assessed suicidal ideas within the past 2 weeks in HIV(+) (n = 204) and HIV(-) (n = 202) heroin IDUs in methadone treatment in Yunnan, a province at the intersection of the heroin and HIV epidemics, and in demographically matched HIV non-drug-using controls (n = 201). Rates of suicidality were higher in IDUs than controls, but there was no additive effect of HIV infection (HIV(+) IDU: 43.1%; HIV(-) IDU: 37.1%; controls: 8.5%). Among HIV(+) IDUs, suicidality was associated most strongly with a combination of prior history of major depression, low perceived social support, and experience of HIV-relevant stress, but not with AIDS diagnosis. Among HIV(-) IDUs, suicidality was associated with prior history of major depressive or alcohol use disorder. Less than 25% of IDUs with suicidality had histories of mood or alcohol use diagnoses. Because suicidal ideation is frequent in IDUs in China, regardless of HIV status, and is not fully accounted for by past psychiatric history, additional research may be warranted.

Polymicrobial endocarditis involving Veillonella parvula in an intravenous drug user: case report and literature review of Veillonella endocarditis

Veillonella spp. are strictly anaerobic, Gram-negative cocci able to ferment various substrates (pyruvate and lactate) that usually present as commensals in the oral, gastrointestinal, and female genital tract microflora [1]. This genus has been reported to be pathogenically involved in periodontitis, periodontal abscess, and various acute oral conditions. In addition, Veillonella spp. may be exceptionally involved in severe infections, including meningitis, osteomyelitis, or prosthetic joint infection [2]. Infective endocarditis (IE) constitutes one of the most serious, albeit uncommon, complications of bloodstream infection (BSI) by Veillonella spp. in patients with predisposing conditions such as valvular heart disease or intravenous (IV) drug abuse [3]. Here we describe a case of IE due to V. parvula in an IV drug user (IDU) and review the scarce literature on this entity. A 35-year-old man presented to the Emergency Department (ED) of our hospital with fever, chills, purulent sputum, and pleuritic pain for about 48 h. He was a current smoker (index of 20 pack-years) and acknowledged a history of active IV drug abuse (heroine and cocaine). His temperature was 39 C, blood pressure was 120/70 mmHg, and his respiratory rate was 24 breaths per minute (bpm). Physical examination revealed a poor oral hygiene with periodontal disease, venipuncture marks in the upper extremities, and basal crackles over the right lung, with no audible cardiac murmurs. Laboratory data showed a mild normocytic anemia (hemoglobin 11.3 g/dL) and white cell count (WCC) of 9.8 9 10/L. A chest X-ray was unremarkable. Because of our clinical suspicion of IE, we initiated empiric treatment with IV ceftriaxone, cloxacillin, and gentamicin. A transthoracic echocardiography (TTE) revealed two oscillating masses (1.5 9 0.5 and 1.5 9 0.4 cm, respectively) on the tricuspid valve with mild regurgitation, and a thoracic computed tomography (CT) showed multiple cavitating nodules compatible with pulmonary septic embolisms. Viridans group Streptococcus was identified by the semiautomated WIDER system (Francisco Soria Melguizo S.A., Madrid, Spain) in four out of four aerobic bottles of blood cultures (BCs) taken at admission and processed using the BacT/Alert System (bioMerieux, Marcy l’Etoile, France). The isolate was not identified to species and was sensitive to penicillin, cefotaxime, ceftriaxone, erythromycin, clindamycin, levofloxacin, trimethoprim–sulfamethoxazole, and vancomycin; therefore, treatment with cloxacillin was discontinued. The patient initially became afebrile, but after 14 days of treatment with ceftriaxone and gentamicin persistent daily fever reappeared. Before the results of repeated BCs were available, the patient had left the hospital ward without medical authorization. He returned 3 days later to the ED complaining of fever (38.8 C) and left pleuritic chest pain a few hours after an IV heroin injection. He was hemodynamically stable, and tachypneic (18 bpm), and the abdominal examination was remarkable for the identification of a 2-cm tender hepatomegaly and 4-cm splenomegaly that had not been noted on the previous admission. The WCC M. A. Perez-Jacoiste Asin I. Serrano-Navarro S. Prieto-Rodriguez Department of Internal Medicine, University Hospital ‘‘12 de Octubre’’, Instituto de Investigacion Hospital ‘‘12 de Octubre’’ (i?12), Universidad Complutense, Madrid, Spain

Trends of heroin use and heroin injection epidemics in Europe: Findings from the EMCDDA treatment demand indicator (TDI)

We estimate trends and geographical differences in the heroin epidemic in the European Union plus Croatia and Turkey by analyzing aggregated data on first heroin treatment admissions (cases) during 2000–2009.In 2005–2009 the proportion of drug injectors was higher in Central and Eastern European countries (CEECs) than in Western European countries (WECs), whereas the opposite occurred with mean age at first heroin use and first treatment. During this period, the number of cases, cases per center, and proportion of injectors in WECs declined, whereas mean age at first treatment and first heroin use increased. The opposite occurred in Turkey, except for proportion of injectors, while trends were less clear in the other CEECs. In the 7 WECs with data, trends in 2000–2005 and 2005–2009 were similar. This suggests that the number of recent-onset heroin users and heroin injectors may have declined some years before the study period, especially in WECs.

2. Risk of Hepatitis C Among Heroin and Prescription Opioid-Injecting Youth

Despite dramatic increases in illicit use of prescription opioids, it remains unclear to what extent intravenous injection of prescription opioids places users at risk of acquiring hepatitis C virus (HCV). This study is among the first to compare risk of HCV acquisition associated with prescription opioid injection to heroin injection in a cohort of at-risk youth.

High rates of midazolam injection and associated harms in Bangkok, Thailand

To identify the prevalence and correlates of midazolam injection among injecting drug users in Thailand. Serial cross-sectional mixed-methods study. Bangkok, Thailand. A total of 435 adults who had injected drug(s) in the past 6 months were recruited through peer outreach and word of mouth in Bangkok in 2011. Multivariable logistic regression was used to analyze self-reported data collected through an interviewer-administered survey in July-October 2011 (n = 435). Additionally, qualitative data were collected in June-July 2009 (n = 10) and analyzed to explore the health problems attributable to midazolam injection. Among 435 survey participants, the prevalence of daily midazolam injection in the past 6 months was 37.0% (95% confidence interval: 32-42). While 75.8% of the daily midazolam injectors identified heroin as their drug of choice, 91.8% of these individuals reported substituting heroin with midazolam when heroin was unavailable. In multivariable analyses, daily midazolam injection was associated with femoral vein injection [adjusted odds ratio (AOR) = 4.48], polydrug use (AOR = 4.94), daily heroin injection (AOR = 3.25), binge use (AOR = 1.75) and perceived increase in policing pressure (AOR = 1.95) (all P < 0.05). Qualitative accounts indicated severe health problems associated with midazolam injection, including nerve and vascular injuries. Midazolam misuse is increasing among injecting drug users in Bangkok and appears to be used primarily as a substitute for heroin. Midazolam injection was associated independently with various risk factors for injection-related complications. Given the many deleterious effects of midazolam injection, novel interventions for midazolam injectors are needed urgently.

Injecting drug use among gay and bisexual men in Sydney: prevalence and associations with sexual risk practices and HIV and hepatitis C infection

Injecting drug use is commonly reported among gay and bisexual men in Australia. We examined the prevalence and covariates of injecting drug use among men participating in the Sydney Gay Community Periodic Survey between 2004-06 and 2011. In 2004-06, data was collected about which drugs were injected, while in 2011, data was collected about hepatitis C (HCV) and esoteric sexual practices. In 2004-06, 5.6 % of men reported injecting drugs in the previous 6 months; 3.4 % reported methamphetamine injection and 0.4 % heroin injection. In 2011, men who injected drugs were less likely to be employed full-time, and more likely to be HCV-positive, HIV-positive, to have used party drugs for sex, and to have engaged in esoteric sexual practices. The strong associations between injecting drug use, sexual risk practices and blood-borne virus infection suggests the need for combined sexual health and harm reduction services for gay and bisexual men who inject drugs.

Living Conditions And Illness Among Injecting Drug Users In Montreal

Abstract Background: The harsh living conditions of injecting drug users (IDUs) are associated with substantial morbidity. Despite the many steps taken to improve the health of IDUs, notably through harm reduction programs, most strategies have focused primarily on proximal risk factors, whereas distal determinants have been poorly addressed. 1.2. Objectives: This study identifies distal and proximal factors associated with recent episodes of illness among IDUs living in Montreal in 2005. 1.3. Methods: A cross-sectional survey was carried out between February and September 2005 in 666 IDUs 18 years old and over, living in Montreal, Quebec. 1.4. Results: The living conditions of IDUs illustrate their marginality: 70% are on social welfare, 38% beg for a living, 48% have a history of imprisonment, and 20% live on the street. Among the study sample, 176 subjects (26%) reported an episode of illness in the 6 months before the interview. Multiple regression analysis showed that the pathway from socio-demographic conditions to illness in IDUs is mediated by financial strain, marginality, risk behaviors and chronic health conditions. Eight distal factors were associated with episodes of illness in the last 6 months: female gender, older age, bisexual orientation, financial strain (begging on the street, receiving help from community centers), marginality (history of imprisonment or fine for criminal offenses, stealing, having no identity card), heroin injection, combined use of both cocaine and heroin, and sharing injection material. More proximally related factors were HIV infection, HCV infection and depression. 1.5. Conclusions: Current IDUs in Montreal live under difficult conditions which have serious health consequences. Efforts to improve their health should focus on changing these conditions.

Establishing the Melbourne injecting drug user cohort study (MIX): rationale, methods, and baseline and twelve-month follow-up results

BackgroundCohort studies provide an excellent opportunity to monitor changes in behaviour and disease transmission over time. In Australia, cohort studies of people who inject drugs (PWID) have generally focused on older, in-treatment injectors, with only limited outcome measure data collected. In this study we specifically sought to recruit a sample of younger, largely out-of-treatment PWID, in order to study the trajectories of their drug use over time.MethodsRespondent driven sampling, traditional snowball sampling and street outreach methods were used to recruit heroin and amphetamine injectors from one outer-urban and two inner-urban regions of Melbourne, Australia. Information was collected on participants’ demographic and social characteristics, drug use characteristics, drug market access patterns, health and social functioning, and health service utilisation. Participants are followed-up on an annual basis.Results688 PWID were recruited into the study. At baseline, the median age of participants was 27.6 years (IQR: 24.4 years – 29.6 years) and two-thirds (67%) were male. Participants reported injecting for a median of 10.2 years (range: 1.5 months – 21.2 years), with 11% having injected for three years or less. Limited education, unemployment and previous incarceration were common. The majority of participants (82%) reported recent heroin injection, and one third reported being enrolled in Opioid Substitution Therapy (OST) at recruitment. At 12 months follow-up 458 participants (71% of eligible participants) were retained in the study. There were few differences in demographic and drug-use characteristics of those lost to follow-up compared with those retained in the study, with attrition significantly associated with recruitment at an inner-urban location, male gender, and providing incomplete contact information at baseline.ConclusionsOur efforts to recruit a sample of largely out-of-treatment PWID were limited by drug market characteristics at the time, where fluctuating heroin availability has led to large numbers of PWID accessing low-threshold OST. Nevertheless, this study of Australian injectors will provide valuable data on the natural history of drug use, along with risk and protective factors for adverse health outcomes associated with injecting drug use. Comprehensive follow-up procedures have led to good participant retention and limited attrition bias.

Severe Tracheal Dislocation Secondary to Neck Abscess, Successfully Treated by Urgent Percutaneous Drainage

Abscesses and cellulitis represent the leading causes for emergency department visits and hospital admissions for intravenous drug addicts’ patients. Since these patients frequently use the neck for vascular access, neck abscesses are also commonly developed causing serious airway problems. A 28-year old Intravenous Drug Addict (IVDA) Caucasian male patient, presented to the casualty Department due to progressive neck swelling and pain after self-administered, unsterile, deep-cervical intravenous injection of heroin. Emergency contrast computed tomography scan revealed a large abscess causing significant dislocation of the trachea. The patient was urgently treated by percutaneous neck abscess drainage, via an 8Fr catheter, under ultrasound guidance Emergency computed tomography scan of the affected area and ultrasound scan of the major vascular supply are helpful in designing the therapeutic approach in terms of percutaneous drainage or surgery in cases of neck abscess that may cause airway obstruction in intravenous drug addicts. Percutaneous drainage under ultrasound guidance represents an effective treatment option relieving the life threatening trachea dislocation and eliminating the need for surgical intervention.

Evaluation of Oxidative Markers, Apoptosis and Reproductive Efficiency in Heroin Addicted Rats

Background and Objective: Heroin abuse and addiction represent one of the major problems globally. The objective of this study is to evaluate the oxidative stress enzyme markers, apoptosis, sperm quality and testosterone of heroin administered rats via intraperitoneal injection. MATERIALS AND METHODS: Thirty male rats were randomly allocated into three groups. Frst group regarded as control, while in group2 and 3, the animals were daily injected intraperitoneally with (1 and 5 mg Heroin/kg b.w.) for seven successive days. Enzymatic activities of alkaline phosphatase (ALP), Xanthine Oxidase (XO), Glucose-6-phosphate dehydrogenase (G6PDH) and lactate dehydrogenase (LDH) in serum were analyzed, and concentration of Malondialdehyde (MDA) and testosterone hormone assayed, besides determining the percent count of hepatocyte apoptosis and sperm head abnormalities. RESULTS: The activity of XO, G6PDH and LDH significantly changed, whereas ALP not affected. The lipid peroxidation marker (MDA) significantly elevated in high dose treatment. The mean percent of apoptotic hepatocytes count reported a clear increase in concentration dependent manner. Also heroin showed significant impact on testosterone level, and sperm head abnormalities counting as well. CONCLUSION: This finding suggests that intraperitoneal injection of heroin cause alteration in oxidation processes, reproductive efficiency and apoptosis mostly in concentration dependent manner.

Low-Frequency Heroin Injection among Out-of-Treatment, Street-Recruited Injection Drug Users

Low-Frequency Heroin Injection among Out-of-Treatment, Street-Recruited Injection Drug Users

Intravenous drug abuse and tricuspid valve endocarditis: Growing trends in the Middle East Gulf region.

Traditionally, tricuspid valve endocarditis is uncommon in the Middle East region. However, recent global data indicate growing trends in the use of illicit drug abuse, specifically injectable heroin, in the Middle East Gulf region. The presence of many transit port services in the Middle East Gulf States has led to smuggling of substance abuse drugs in the region. The Middle East Gulf States, currently a transit market, are also becoming a growing consumer market in view of the increased substance abuse in the youth. However, there is a paucity of data with respect to the prevalence or incidence of tricuspid valve endocarditis in the region, probably due to underdiagnosis or underreporting. A high index of suspicion of tricuspid valve endocarditis is essential in patients with a history of intravenous drug abuse. This article reviews the epidemiology of illicit drug abuse in the Middle East Gulf region, as well as the diagnosis and treatment of tricuspid valve endocarditis, and calls for all physicians in the region to be vigilant while dealing with intravenous drug abuse.