Onset Of Heroin Use Research Articles

Corticostriatal ensemble dynamics across heroin self-administration to reinstatement.

Corticostriatal projection neurons from prelimbic medial prefrontal cortex to the nucleus accumbens core critically regulate drug-seeking behaviors, yet the underlying encoding dynamics whereby these neurons contribute to drug seeking remain elusive. Here we use two-photon calcium imaging to visualize the activity of corticostriatal neurons in mice from the onset of heroin use to relapse. We find that the activity of these neurons is highly heterogeneous during heroin self-administration and seeking, with at least 8 distinct neuronal ensembles that display both excitatory and inhibitory encoding dynamics. These neuronal ensembles are particularly apparent during relapse, where excitatory responses are amplified compared to heroin self-administration. Moreover, we find that optogenetic inhibition of corticostriatal projection neurons attenuates heroin seeking regardless of the relapse trigger. Our results reveal the precise corticostriatal activity dynamics underlying drug-seeking behaviors and support a key role for this circuit in mediating relapse to drug seeking.

Restoration of a paraventricular thalamo-accumbal behavioral suppression circuit prevents reinstatement of heroin seeking

Lack of behavioral suppression typifies substance use disorders, yet the neural circuit underpinnings of drug-induced behavioral disinhibition remain unclear. Here, we employ deep-brain two-photon calcium imaging in heroin self-administering mice, longitudinally tracking adaptations within a paraventricular thalamus to nucleus accumbens behavioral inhibition circuit from the onset of heroin use to reinstatement. We find that select thalamo-accumbal neuronal ensembles become profoundly hypoactive across the development of heroin seeking and use. Electrophysiological experiments further reveal persistent adaptations at thalamo-accumbal parvalbumin interneuronal synapses, whereas functional rescue of these synapses prevents multiple triggers from initiating reinstatement of heroin seeking. Finally, we find an enrichment of μ-opioid receptors in output- and cell-type-specific paraventricular thalamic neurons, which provide a mechanism for heroin-induced synaptic plasticity and behavioral disinhibition. These findings reveal key circuit adaptations that underlie behavioral disinhibition in opioid dependence and further suggest that recovery of this system would reduce relapse susceptibility.

A comparative study of sexual behavior, dysfunction, satisfaction, relationship, and sexual quality of life amongst treatment-naïve and abstinent men (buprenorphine-maintained) with Opioid (heroin) dependence syndrome.

Association between opioid use and sexual functioning is well-known. However, data evaluating the influence of treatment on different aspects of sexuality are lacking. To compare sexual behavior, functioning, relationship, satisfaction, and sexual quality of life (sQoL) among treatment naïve patients (GROUP-I) with Opioid (heroin) dependence syndrome (ODS-H) with those maintained on buprenorphine (GROUP-II). Married adult males diagnosed with ODS-H, currently sexually active, and living with their partner were recruited. They were assessed for their sexual practices and high-risk sexual behavior (HRSB) through a semi-structured questionnaire and sexual functioning, relationships, satisfaction, and sQoL through structured questionnaires. A total of 112 individuals (GROUP-I: 63; GROUP-II: 49) were recruited from the outpatient settings. Mean age and employment in GROUP-II were higher (p < 0.05) than in GROUP-I (37 vs 32 years; 94% vs 70%, respectively). Other sociodemographic variables and the age of onset of heroin use were comparable. The current practice of HRSB (e.g., engaging in casual partner sex, sex with commercial sex workers, and sex under intoxication) was higher in GROUP-I while almost no differences were seen in lifetime HRSB. The frequency of erectile dysfunction and premature ejaculation in the two groups were: 78% vs 39% (p < 0.001), and 30% vs 6% (p = 0.001), respectively. GROUP-II had significantly higher scores in all the scales (p < 0.05) as compared to GROUP-I, indicating better sexual satisfaction, quality of life, and sexual relationship. Heroin use is associated with HRSB, poorer sexual functioning, overall satisfaction, and sQoL. Maintenance of Buprenorphine helps with improvement in all these parameters. Comprehensive management for substance use should target sexual problems as well.

Bhagwat Award Abstracts for Journal

Background:Association between opioid use and sexual functioning is well-known. However, data evaluating the influence of treatment on different aspects of sexuality are lacking.Aim:To compare sexual behaviour, functioning, relationship, satisfaction, and sexual quality of life (sQoL) among treatment naïve patients(GROUP-I) with Opioid(heroin) dependence syndrome (ODS-H) with those maintained on buprenorphine(GROUP-II).Methods:Married adult males diagnosed with ODS-H, currently sexually active, and living with their partner were recruited. They were assessed for their sexual practices and high-risk sexual behaviour(HRSB) through a semi-structured questionnaire and sexual functioning, relationships, satisfaction, and sQoL though structured questionnaires.Results: A total of 112 individuals (GROUP-I:63; ODS-H:49) were recruited from the out-patient settings. Mean age and employment in GROUP-II was higher (p<0.05) than GROUP- I (37vs32 years; 94%vs70%, respectively). Other sociodemographic variables and age of onset of heroin use were comparable. Current practice of HRSB (e.g., engaging in casual partner sex, sex with commercial sex workers, and sex under intoxication) was higher in GROUP-I while almost no differences were seen in lifetime HRSB. Frequency of erectile dysfunction and premature ejaculation in the two groups were: 78%vs39% (p<0.001), and 30%vs6% (p=0.001), respectively. GROUP-II had significantly higher scores in all the scales (p<0.05) as compared to GROUP-I, indicating better sexual satisfaction, quality of life, and sexual relationship.Conclusion: Heroin use is associated with HRSB, poorer sexual functioning, overall satisfaction, and sQoL. Maintenance on Buprenorphine helps with improvement in all these parameters. Comprehensive management for substance use should target sexual problems as well.

Can the migration process influence the clinical expression of heroin use disorder in migrants to Italy?

For some time now, there has been a strong consensus that the migration process can influence the onset, course, development, outcome, and clinical aspects of psychiatric pathologies. In this study, we have analyzed the influence of the migration process on the clinical expression of heroin use disorder (HUD). In a naturalistic case-control study, we compared, both at univariate and multivariate level, 30 migrant HUD (M-HUD) patients with 30 age/gender-matched Italian HUD (IT-HUD) patients. We also analyzed demographic data, drug addiction history, psychopathological symptoms, addictive behavior, and emotional reactivity to life events. Compared with IT-HUD pairs, at HUD Agonist Opioid Treatment, M-HUD patients were characterized by inadequate income and the presence of legal problems. They were more frequently at stage 3 of heroin addiction, with a concomitantly less frequent use of stimulants. Their age at the onset of heroin use was greater than that of subjects in the IT-HUD group. HUD post-traumatic stress disorder spectrum was present and was more severe in all M-HUD patients, but grief reactions and maladaptive behavior were the most discriminant traits. No differences were found in terms of addictive behaviors related to heroin craving or with respect to the severity/typology of psychopathology specific to HUD. The migratory process does not seem to be correlated with addictive behaviors or with psychopathology specific to HUD. It partly affects HUD history, and specifically correlates with emotional reactivity to loss and traumatic life events, so suggesting that in M-HUD individuals, the link between the migratory syndrome and HUD is very close.

A study of pathways to care among opioid dependent individuals seeking treatment at a community de-addiction clinic in India

Drug use, including opioid use disorder, is one of the rapidly rising and serious problems affecting populations globally. There is a treatment gap and delay in presentation of drug users to treatment centers. The present study aimed at assessing the pathways to care among opioid-dependent individuals seeking treatment from a community-based treatment center in India. In a cross-sectional observational study conducted at a community clinic of the National Drug Dependence Treatment Centre (NDDTC), New Delhi, India, a total of 100 treatment-seeking drug users (age 18–60 years) fulfilling DSM IV TR criteria for opioid dependence were recruited. The data were collected using a semistructured pro forma based on patient self-report and the encounter form used in the World Health Organization (WHO) Pathway Study. All participants were male, were mostly married, were employed, and belonged to nuclear families. Ninety-eight percent of participants has ever used heroin in a dependent fashion and 20% were using it currently. Mean age of the participants was 40.83 years (SD 12.7). Median age of onset of heroin use was 22 years (IQR 12). Median duration of heroin use was 138 months (IQR 132). Only 21% of participants visited the community deaddiction clinic at the first contact with care. The median time for first treatment-seeking attempt was 9.5 years (IQR 7). The study findings suggest significant delay between onset of drug-related problems and first treatment contact. There is a need to increase the availability and accessibility of treatment services to reduce the delay in treatment seeking.

Predictors of transitions across stages of heroin use and dependence prior to treatment-seeking among people in treatment for opioid dependence

Background and aimsLittle is known about transition pathways among heroin users prior to treatment. This study examined the demographic and clinical predictors of transition speed from heroin use, to dependence, to first treatment episode. Methods1149 heroin-dependent participants recruited from opioid agonist treatment clinics in Sydney, Australia, underwent a structured interview. Age of onset (AOO) was collected for heroin use, dependence and treatment-seeking, childhood maltreatment, psychiatric history and other substance dependence. Discrete-time survival analyses modelled years from onset of use to dependence, and from dependence to treatment-seeking, including demographic and clinical covariates. FindingsMedian AOO for first heroin use, dependence and treatment-seeking was 18 years (inter-quartile range, or IQR = 6), 21 years (IQR = 7), and 24 years (IQR = 10) respectively. In adjusted models, younger birth cohorts (vs. born <1960), greater childhood maltreatment and later AAO of first heroin use were associated with more rapid transitions from heroin use to dependence. Living independently, parental violence, and alcohol dependence were associated with slower transitions. Earlier treatment-seeking was associated with younger birth cohorts, having dependent children and later AOO of dependence. Delayed treatment-seeking was associated with <10 years school education, living independently, depression and alcohol dependence. ConclusionsIn this treatment sample, onset of heroin use occurred during late adolescence, suggesting the need for targeted interventions in mid-adolescence. Transitions to heroin dependence, then treatment-seeking, occurred during early adulthood. Rapid transitions from use to dependence were associated with younger birth cohorts, greater exposure to childhood maltreatment, and later onset of use.

Asthme et usage d’héroïne

RésuméIntroductionL’usage d’héroïne peut être responsable de complications pulmonaires parmi lesquelles figure l’asthme.ObjectifsRevue systématique de la littérature sur les données concernant l’asthme chez les consommateurs d’héroïne.Sources documentairesMedline® sur la période 1980–2017 avec pour mots-clés : « asthma » ou « bronchospasm » et « heroin » ou « opiate » ou « opiates », avec les limites « Title/ » ; les langues retenues étaient l’anglais et le français. Parmi 97 articles, 67 résumés sélectionnés ont donné lieu à une double lecture aboutissant à retenir 23 études.RésultatsLes sept rapports de cas incluaient 21 patients (âge moyen : 28 ans [19 à 46 ans] ; sex-ratio : 2,5 [71,5 % d’hommes]). L’héroïne était inhalée (71,4 %), sniffée (19,0 %) ou injectée par voie intraveineuse (9,5 %). Les substances addictives associées étaient le tabac (81 %), le cannabis (38 %), l’alcool (4,7 %) et la cocaïne (4,7 %). L’évolution était fatale chez 3 sujets (14,3 %). Les autres études incluaient une étude transversale, 3 études cas-témoins et 12 études longitudinales (11 études rétrospectives et une étude prospective). La proportion de consommateurs d’héroïne était plus importante chez les sujets asthmatiques et la prévalence de l’asthme et de l’hyperréactivité bronchique était plus élevée chez les consommateurs d’héroïne. La consommation d’héroïne peut favoriser le développement de l’asthme, avec une relation temporelle entre le début de l’usage d’héroïne et l’apparition de l’asthme chez 28 % à 31 % des sujets. Une association positive entre l’usage d’héroïne inhalée et l’exacerbation de l’asthme a été notée. L’observance du traitement de l’asthme est moins bonne chez les consommateurs d’héroïne. En cas d’exacerbation d’asthme, les consommateurs d’héroïne s’adressent plus souvent aux services d’urgences, sont plus souvent admis en soins intensifs et plus souvent intubés avec un recours plus fréquent à une ventilation invasive. Les décès par asthme provoqués par l’héroïne surviennent principalement après une injection intraveineuse (notamment en cas de surdose), mais aussi après une utilisation d’héroïne par voie nasale (sniff) ou pulmonaire.ConclusionLa consommation d’héroïne peut favoriser le développement d’un asthme et provoquer des exacerbations aiguës d’asthme (pouvant nécessiter une intubation et une ventilation invasive), voire des décès par asthme. Une consommation d’héroïne doit être recherchée devant une exacerbation d’asthme survenant chez des sujets jeunes et les praticiens doivent aider les usagers d’héroïne à arrêter leur consommation.

An Association Study on the Glutamate Pathway GRIN2A Gene Polymorphisms with Heroin Dependence

Background: Heroin dependence (HD) is a complex disorder characterized by disruption in particular circuits of the brain and influenced by environmental and genetic factors. Glutamate pathway plays a role in normal brain functions including learning, memory, and cognition. Disturbances in Glutamate pathways are implicated in many psychiatric disorders, including heroin dependence, and polymorphisms present in these pathway genes are reported to increase the risk of developing heroin dependence. Aim: To identify association of single nucleotide polymorphisms (SNPs) of Glutamate pathway genes with heroin dependence and correlate with heroin use parameters. Method: A total of 103 HD patients were recruited as per DSM IV criteria from the Department of Psychiatry, and 100 healthy volunteers from the general population. Genomic DNA from peripheral blood samples was processed for PCR followed by restriction digestion to screen for presence of GRIN2A polymorphisms in the glutamate pathway. GRIN2A SNPs i.e. rs11866328, rs1071502, rs1375067, rs1530669, rs12325652, rs16966381, rs1104068, rs16966448, rs9927871 and rs1366076 were selected based on the Hap Map project and Tagger program (r2 ≥ 0.8). Genotype and allele frequencies were estimated and the difference between patient and control groups were assessed by chi-square test of significance and the results correlated with duration, age at onset of heroin use, the quantity of heroin consumed and WHO ASSIST score. Statistical analysis was done using Haploview v4.1 and SPSSv21.0. Results: Haplotype analyses revealed three SNPs (rs1071502-rs1366076-rs1104068) with alleles A-T-A to confer risk while the haplotypes A-T-G had a protective effect on HD. Another haplotype (rs1530669-rs9927871) was also found significantly associated with heroin dependence (p=0.039). Conclusion: The study reports for the first time, a possible association of GRIN2A SNPs with age at onset of heroin use, duration and quantity of use, and also suggests an important role in severity of heroin dependence.

Anxiety disorders are associated with early onset of heroin use and rapid transition to dependence in methadone maintained patients.

Early onset of heroin use is a severity marker of heroin use disorder. We studied the interaction between early onset and rapid transition to heroin dependence recorded with retrospective interviews in 213 patients with severe heroin dependence and history of methadone maintenance treatment. General linear models were used to identify independent factors associated with early onset, factors associated with rapid transition to dependence, and a multivariate model was used to study the interaction of those two dimensions. Lifetime history of anxiety disorders and age at onset of cannabis use are shared common risk factors and are associated with the interaction.

Prescription Opioid Abuse, Prescription Opioid Addiction, and Heroin Abuse Among Adolescents in a Recovery High School: A Pilot Study

ABSTRACTThe progression from prescription opioid (RXO) abuse to RXO addiction is not well understood in adolescents, nor is the progression from RXO addiction to heroin abuse. The purpose of this pilot study was to characterize the development of RXO drug abuse, RXO drug addiction, and heroin abuse in a small cohort of adolescents recovering from opioid addiction at Massachusetts Recovery High Schools (RHS). A self-report questionnaire was administered to 31 adolescent, former RXO abusers across two Massachusetts RHS. RXO abuse was primarily initiated due to curiosity; RXOs were initially obtained through illicit and licit methods. Fifty-eight percent (N = 18) of the RXO abusers became addicted to RXOs. Many addicted adolescents initiated RXO abuse under the influence of marijuana, yet believed that they became addicted due to the stress from difficult life situations. A subgroup indicated they abused and became addicted to RXOs that had been obtained from legitimate prescriptions due to their pain. Sixteen percent (N = 5) of the sample abused heroin. Most heroin abusers (4/5) were addicted to RXOs prior to onset of heroin use. Heroin abusers indicated that they considered using heroin after they began tampering with RXOs. A portion of the sample felt that abuse deterrent formulations (ADFs) would have reduced their RXO use. This pilot study discovered areas where further research could be targeted, such as drug combinations, adolescent coping mechanisms, adolescent pain management, and the use of ADFs to disrupt the transition from RXO addiction to heroin use.

Demographic and Clinical Features of Chinese Heroin Users Who Switch from Non-injection to Injection

Background: Injection drug users (IDUs) are at high-risk for acquiring human immunodeficiency virus, hepatitis C virus, and other infections, and delaying the switch from non-injection drug use to injection to drug use could reduce the spread of these infections. Objectives: To estimate the incidence of switching from non-injected heroin use (usually smoking or “chasing”) to injection and to investigate the risk factors for this change. Methods: We reviewed the socio-demographic and clinical data of 7305 heroin-dependent patients treated at a detoxification clinic of a university-affiliated psychiatric hospital in China from January 2000 to February 2009. Results: Within 1 year, the majority of non-injection drug users (NIDUs) transitioned to IDUs (59.4% within 6 months and 76.7% within 12 months). Multiple logistic regression analysis showed that marital status, years of education, employment status, age at onset of heroin use, duration of drug abuse, and initial dose were associated with the switch from NIDU to IDU. Being married (B = −0.410, OR = 0.664), being employed (B = −0.243, OR = 0.784), and older age at onset (B = −0.040, OR = 0.961) were protective factors. More education (B = 0.120, OR = 1.128), longer duration of drug abuse (B = 0.010, OR = 1.010), and a higher dose at initial drug use (B = 0.234, OR = 1.264) were risk factors. Conclusions/Importance: The study has identified several risk factors for the switch to injection among heroin users. Understanding these factors can help design new approaches to more specifically target high-risk populations and high-risk behaviors to delay or prevent the transition to injection.

Pathways to Age of Onset of Heroin Use: A Structural Model Approach Exploring the Relationship of the COMT Gene, Impulsivity and Childhood Trauma

BackgroundThe interaction of the association of dopamine genes, impulsivity and childhood trauma with substance abuse remains unclear.ObjectivesTo clarify the impacts and the interactions of the Catechol -O-methyltransferase (COMT) gene, impulsivity and childhood trauma on the age of onset of heroin use among heroin dependent patients in China.Methods202 male and 248 female inpatients who meet DSM-IV criteria of heroin dependence were enrolled. Impulsivity and childhood trauma were measured using BIS-11 (Barratt Impulsiveness Scale-11) and ETISR-SF (Early Trauma Inventory Self Report-Short Form). The single nucleotide polymorphism (SNP) rs737866 on the COMT gene-which has previously been associated with heroin abuse, was genotyped using a DNA sequence detection system. Structural equations model was used to assess the interaction paths between these factors and the age of onset of heroin use.Principal FindingsChi-square test indicated the individuals with TT allele have earlier age of onset of heroin use than those with CT or CC allele. In the correlation analysis, the severity of childhood trauma was positively correlated to impulsive score, but both of them were negatively related to the age of onset of heroin use. In structure equation model, both the COMT gene and childhood trauma had impacts on the age of onset of heroin use directly or via impulsive personality.ConclusionsOur findings indicated that the COMT gene, impulsive personality traits and childhood trauma experience were interacted to impact the age of onset of heroin use, which play a critical role in the development of heroin dependence. The impact of environmental factor was greater than the COMT gene in the development of heroin dependence.

Attenuated effects of experimenter-administered heroin in adolescent vs. adult male rats: physical withdrawal and locomotor sensitization

Early onset of heroin use during adolescence might increase chances of later drug addiction. Prior work from our laboratory suggests, however, that adolescent male rats are actually less sensitive than adults to some enduring effects of heroin self-administration. In the present study, we tested two likely correlates of sensitivity to behavioral reinforcement in rats: physical withdrawal and locomotor sensitization. Adolescent (35days old at start) and adult (79days old) male Sprague-Dawley rats were administered escalating doses of heroin, increasing from 1.0 to 8.0mg/kg (i.p.) every 12h, across 13days. Somatic signs of spontaneous withdrawal were scored 12 and 24h after the last injection, and then every 24h for 5days; locomotion was recorded concurrently. Challenge injections of heroin (1mg/kg i.p.) were given at four points: as the first of the escalating doses (day 1), at days 7 and 13 during the escalating regimen, and after 12days of forced abstinence. Body mass and food intake were measured throughout experimentation. A heroin withdrawal syndrome was not observed among adolescents as it was among adults, including somatic signs as well as reduced locomotion, body mass, and food intake. On the other hand, heroin-induced locomotor sensitization did not differ across ages. Reduced withdrawal is consistent with the attenuated reinforcing effects of heroin among adolescent male rats that we reported previously. Thus, it is possible that adolescent rats could reveal important neuroprotective factors for use in treatment of heroin dependence.

Tratamiento de sustitución con Metadona para la adicción a la Heroína: evaluación de un programa en Colombia

Assessment of a methadone substitution and maintenance treatment program in Colombia using the OTI (Opiate Treatment Index) instrument. Descriptive study with a 50-patient sample attended in the period 2007- 2008 for their heroin addiction. The OTI instrument was implemented to assess drug use, HIV risk-taking behavior, social functioning, criminality, health status and psychological functioning. Men accounted for 74% of the sample, women for 26%. Mean age was 22, with 64% in the 20-24 age group. Mean reported age at onset of heroin use was 18, with a range of 13-28. In 38% of the sample (19 patients) comorbidity with other mental disorders was found, 47% of these being personality disorders. Median reported current methadone dose was 40 mg/day, with a range of 15-80 mg/day. According to the OTI subscales, HIV risk-taking behavior was low-moderate, while social functioning, criminality and health status were low-risk. In the case of psychological adjustment, a low-moderate risk score was obtained for the 0-12 month treatment group, and a moderate risk score for the 12-24 and ≥ 24 month groups. Starting age for heroin use in this population is early . In general, the risk assessed in the OTI areas is low, possibly due to problematic heroin use being in its early stages in Colombia, but comorbidity with personality disorders is high.

Role of novelty seeking personality traits as mediator of the association between COMT and onset age of drug use in Chinese heroin dependent patients.

BackgroundPersonality traits such as novelty seeking (NS) are associated with substance dependence but the mechanism underlying this association remains uncertain. Previous studies have focused on the role of the dopamine pathway.ObjectiveExamine the relationships between allelic variants of the catechol-O- methlytransferase (COMT) gene, NS personality traits, and age of onset of drug use in heroin-dependent subjects in China.MethodsThe 478 heroin dependent subjects from four drug rehabilitation centers in Shanghai who were genotyped for eight tagging single nucleotide polymorphisms (SNP) on the COMT gene completed the NS subscale from the Temperament and Character Inventory. Multivaritate analyses were used to assess the potential mediating role of NS personality traits in the association between COMT gene variants and the age of onset of heroin use.Principal Findings and ConclusionsIn the univariate analysis the COMT rs737866 gene variants were independently associated with both NS and age of onset of drug use: those with the TT genotype had higher NS subscale scores and an earlier onset age of heroin use than individuals with CT or CC genotypes. In the multivariate analysis the inclusion of the NS subscore variable weakened the relationship between the COMT rs737866 TT genotype and an earlier age of onset of drug use. Our findings that COMT is associated with both NS personality traits and with the age of onset of heroin use helps to clarify the complex relationship between genetic and psychological factors in the development of substance abuse.

30-Year trajectories of heroin and other drug use among men and women sampled from methadone treatment in California

BackgroundThis study examines 30-year trajectories of heroin and other drug use among men and women who were in methadone maintenance treatment in California in the late1970s and interviewed in 1978–1981. MethodsNearly half (N=428; 46.8%) of the original study sample (N=914) was deceased. Of the remaining 486 subjects, 343 (44.3% female) completed a follow-up interview in 2005–2009 (70.6% of those not deceased). Average age at follow-up was 58.3 (SD=4.9) years for males and 55.0 (SD=4.1) years for females. Longitudinal data was obtained on their drug use, treatment participation, and criminal justice status over the follow-up period. Trajectory group modeling was used to identify distinctive trajectory groups based on monthly averages of heroin and other drug use per year; group differences were examined. ResultsFour heroin and five alcohol and other drug (AOD) trajectory groups were identified. A greater proportion of women (60%) were in the “rapid decrease” heroin group (odds of use less than 10% by 10 years following initiation of use) as compared with the other groups. More rapid decrease of heroin use was associated with increases in AOD use, whereas a gradual decrease in heroin use was associated with a gradual decrease in AOD use. More school problems and earlier age at onset of heroin use and first arrest were associated with more persistent heroin use. ConclusionHeroin-use trajectories were linked with changes in AOD use. Childhood antecedents of heroin-use trajectories were identified as well as gender differences.

Accelerated Transition to Injection Among Male Heroin Initiates in Hanoi, Vietnam: Implications for Early Harm Reduction Interventions

This paper examines changes in the interval between first heroin smoking and onset of injection in a large, out-treatment sample of male heroin users in Hanoi, Vietnam (n = 1,115). Mean age at initiation of heroin use (smoking) was 18.4 and mean age of onset of heroin injection was 20.9 years. Full multivariate analysis indicates that the interval between first heroin use (smoking) and first heroin injection has been significantly attenuated among more recent heroin initiates (P = 0.0043), suggesting that heroin users in Vietnam may be at increased risk for exposure to HIV relatively soon after onset of heroin use, highlighting the need for behavioral interventions that target heroin smokers. Critical intervention goals include delaying the onset of injection and improved education about safer drug sharing and drug injection practices.

Differences between men and women in the course of opiate dependence: is there a telescoping effect?

According to the so-called telescoping effect, there is a gender-specific course of alcohol dependence with women starting alcohol use later than men and having a faster development of harmful consequences. There are inconsistent data regarding a telescoping effect in opiate dependence. In each of six European centres, 100 opiate addicts were investigated by a structured interview (mainly the EuropASI and CIDI) at admission to various kinds of treatment (TREAT project). In a secondary analysis of the TREAT data, women and men were compared regarding age at onset of heroin use and the current severity of addiction. In addition, a comparison of female (n = 140) and male (n = 140) addicts matched for age and study centre were carried out. Eventually, multiple logistic and linear regressions were done with the interaction term of gender and time of regular consumption as predictor for the severity of dependence, besides, other sociodemographic variables. There was no difference between genders regarding the age at onset of regular heroin consumption. Up to 4 years of regular consumption, there are gender-specific differences in the course of opiate dependence, e.g. a faster progression of legal problems in men and social problems in women. There were no differences in the severity of dependence other than more economic problems for women. A telescoping effect could only partially be observed in this large sample of opiate addicts. A gender-specific course was limited to the first years of consumption, and included domains with a faster progression for men. It has to be assumed that opiate dependence is a rapidly developing disorder with early chronification. Afterwards, only individual courses with influences of the national treatment system were observed.

Estimating incidence trends in regular heroin use in 26 regions of Switzerland using methadone treatment data

BackgroundRegional incidence trends in regular heroin use are important for assessing the effectiveness of drug policies and for forecasting potential future epidemics.MethodsTo estimate incidence trends we applied both the more traditional Reporting Delay Adjustment (RDA) method as well as the new and less data demanding General Inclusion Function (GIF) method. The latter describes the probability of an individual being in substitution treatment depending on time since the onset of heroin use. Data on year of birth, age at first regular heroin use and date of admission to and cessation of substitution treatment was available from 1997 to 2006 for 11 of the 26 regions (cantons) of Switzerland. For the remaining cantons, we used the number of patients in 5-year age group categories published in annual statistics between 1999 and 2006.ResultsApplication of the RDA and GIF methods on data from the whole of Switzerland produced equivalent incidence trends. The GIF method revealed similar incidence trends in all of the Swiss cantons. Imputing a constant age of onset of 21 years resulted in almost equal trends to those obtained when real age of onset was used. The cantonal incidence estimates revealed that in the mid 80s there were high incidence rates in various regions distributed throughout all of the linguistic areas in Switzerland. During the following years these regional differences disappeared and the incidence of regular heroin use stabilized at a low level throughout the country.ConclusionIt has been demonstrated that even with incomplete data the GIF method allows to calculate accurate regional incidence trends.