Heroin Smoking Research Articles

Impact of Donor High-Risk Social Behaviors on Recipient Survival in Cardiac Transplantation

To investigate the impact of cardiac donor participation in high-risk social behaviors (HRSBs) on recipient survival. Retrospective chart review queried cardiac transplantations performed at our institution from August 1994 to November 2007 involving donors known to have engaged in HRSBs. Kaplan-Meier methodology was used to analyze survival rates, and a Cox proportional hazards regression was performed to determine the impact of donor HRSBs on survival. We identified 143 donors with social histories containing the following HRSBs: incarceration (n=69), unprofessional tattoos or piercings (n=44), alternative lifestyle practice (n=11), cocaine use (n=60), heroin smoking (n=6), marijuana use (n=79), oral narcotic abuse (n=20), and intravenous drug use (n=21). At the time of donation, viral screens detected 10 donors who were hepatitis B virus (HBV) positive, 11 donors who were hepatitis C virus (HCV) positive, and no donors who were positive for the HIV. One-year and 5-year survival were 92.2% and 84.4%, respectively. Cox regression analysis found only donor HCV infection to be associated with poorer recipient survival (P=0.14). Using cardiac allografts from high-risk donors who are serologically negative for viruses does not seem to impact recipient survival. There is a considerable risk for transmission of HBV and HCV when these are detected by pretransplant screens. However, if pretransplant screening does not discover donor HBV, HCV, or HIV infection, it is unlikely that subclinical disease transmission will occur.

Heroin smoking and heroin using trends in Norway

A.L. Bretteville & A. Skretting: Heroin smoking and heroin using trends in Norway The aim is to ascertain whether new ways of administering heroin have gained ground in Norway by examining three series of cross-sectional surveys (D1–D3). D1–D2 are based on postal questionnaires for which D1 is a representative sample of 15–20 year olds in Oslo (1968–2006) and D2 is a corresponding sample of 21–30 year olds (1998, 2002, 2006). D3 is based on personal interviews and consists of users of a needle-exchange service in Oslo (1993–2008). Despite a substantial rise in illegal drug use over the study period, there is no indication of increased heroin use by young people. The prevalence rates are relatively low for all heroin use (1–2%). Routes of heroin administration seem to have changed, however, as more young people (21–30 years) now report having smoked heroin and fewer report having injected the drug. There also seem to be changes in drug use patterns among current injecting drug users (IDUs). Splitting the sample by year of injection debut, we find among those starting since year 2000; i) a rise in average injection debut age of 10 years (25.6 versus 15.5 years); ii) a higher proportion with heroin smoking experience (74% versus 53%); and iii) a higher proportion having smoked heroin before injecting the drug (73% versus 16%), compared to the IDUs debuting before 1980. Consequently, the data suggest changes in drug use patterns, particularly heroin use, among recreational users and heavy drug users. So, in addition to an increase in the number of IDUs, it seems likely that the number of heroin smokers has risen too.

The ageing heroin user: Career length, clinical profile and outcomes across 36 months

The study examined the relationships between length of career (LOC), clinical presentation and outcomes across 36 months among a cohort of 615 heroin users. Longitudinal cohort study. At baseline, each additional year of heroin use was associated with increased likelihood of: being male, exposure to treatment, having been imprisoned, daily injecting, lifetime and recent polydrug use, having overdosed, poorer physical health and reduced likelihood of heroin smoking. In contrast, LOC was not related to frequency of heroin use, current polydrug use, recent heroin overdose, recent imprisonment, recent criminality or psychopathology. There were also no associations between LOC and outcomes across 36 months in terms of treatment, drug use, crime, severe psychiatric disability or major depression. Longer LOC was associated across 36 months, however, with daily injecting, poorer physical health, severe physical disability and poorer mental health. The data point to the maintenance of heroin-related harms well into the third decade of use.

Drug Abuse by Adolescents: General Considerations

1. Ximena Sanchez-Samper, MD* 2. John R. Knight, MD* 1. *Center for Adolescent Substance Abuse Research, Children's Hospital Boston, Boston, Mass After completing this article, readers should be able to: 1. Discuss current trends in adolescent substance use and the specific substances used most commonly among 8th, 10th, and 12th graders. 2. Identify risk and protective factors, including genetic and environmental correlates, for the initiation of substance use in adolescents. 3. Discuss the most common concomitant mental health disorders and how they can affect the course of diagnosis and treatment for substance abuse. 4. Delineate the variety of treatment options available. 5. Describe the role of the pediatrician in educating patients and families on substance abuse prevention; performing screening and initial assessments; and providing support, brief counseling, or referrals for in-depth treatment. Adolescence is a time of physical, emotional, and psychological maturation as well as a period of searching for independence and experimentation. One area of experimentation associated with adolescence is substance use. (1) Although many adolescents experiment with drugs and alcohol from time to time without enduring problems, those who develop the disorders of substance abuse and dependence make substance use a major public health concern. The Monitoring the Future Study (MTFS) is a nationwide survey measuring smoking, drinking, and illicit drug use among nearly 50,000 8th, 10th, and 12th graders in more than 400 secondary schools in the United States each year. (2)(3) According to the 2006 overview of findings from the MTFS, approximately one fifth (21%) of today's 8th graders, more than one third (36%) of 10th graders, and nearly half (48%) of all 12th graders reported using an illicit drug at least once during their lifetimes. Despite a minimum legal age requirement to purchase alcohol, 6% of 8th graders, 19% of the 10th graders, and 30% of the 12th graders self-reported drunkenness during the month prior to being interviewed. (2)(3) Among the problems experienced by adolescents who use alcohol and drugs are …

Problematic heroin use incidence trends in Spain

To estimate the annual incidence of heroin use in Spain. Data on individuals' year of first heroin use (from 1971 to 2005), year of first heroin treatment between 1991 and 2005 and most frequent route of heroin administration when presenting to treatment were obtained from the Spanish Drug Observatory Register and used to calculate the delay between onset and treatment. By using a log-linear model approach it was possible to correct for missing observations (heroin users who presented for treatment before 1991 and those who had still not presented by the end of 2005) and to estimate heroin incidence over time. The estimated incidence of problematic heroin use in the population aged 15-44 peaked at 190 per 100,000 in 1980--after rising rapidly from less than 40 per 100,000 in 1971--and fell subsequently to about 8 per 100,000 in 2005. On average, incidence was five times higher in men. Injecting heroin incidence peaked and declined rapidly from 1980; as heroin smoking did not decline as rapidly, from 1985 onwards its estimated incidence has remained above that of heroin injecting. The delay between starting heroin use and entering treatment had a median of 3 years. We demonstrate the utility of a method to estimate heroin incidence from analysis of observed trends in presentations at specialist drug treatment facilities. The estimates suggest that incidence of heroin use, especially injecting, has fallen since 1980 and is now lower than in the early 1970s.

Potential population impact of changes in heroin treatment and smoking prevalence rates: using Population Impact Measures

The drug misuse and asthma are major health problems in urban settings. There are effective interventions to reduce cigarette smoking and also to treat heroin use; in the context of European System of Urban Health Indicators Project (EURO-URHIS), we explored the use of Population Impact Measures (PIMs) to describe the potential for increase in methadone use and reduction in cigarette smoking to reduce deaths -from heroin use- and asthma events in examples of urban populations. The two PIMs calculated here are the Number of Events Prevented in your Population (NEPP) and the Population Impact Number of Eliminating (or reducing the prevalence of) a Risk Factor (PIN-ER-t). Increasing methadone treatment uptake from its current levels to 90% would prevent 21 (95% CI: 11-34) deaths in Manchester City, 218 (95% CI: 114-339) in Greater London and overall 1 243 (95% CI: 641-1953) in England in 1 year. In males 2 (95% CI: -22 to 28), 27 (95% CI: -296 to 363) and 170 (95% CI: -1757 to 2186) and in females 36 (95% CI: 6-70), 0 and 2312 (95% CI: 934-3783) fewer asthma cases per year would have been expected in Manchester City, Greater London and overall in England respectively, if the smoking prevalence is reduced from current levels to 20% in both sexes. PIMs provide estimates of absolute risk and benefit to a total population, of potential use to policy-makers since current practice and intervention goals are taken into account.

Transitions to Injecting and Risk of Hepatitis C Transmission among Ethnic Vietnamese Heroin Smokers in Melbourne, Australia

Background and Aims: To examine factors associated with transition from non-injecting to injecting routes of drug administration and testing antibody positive to hepatitis C virus (HCV) among ethnic Vietnamese heroin users in Melbourne, Australia. Methods: In a cross-sectional convenience survey, sample recruited by peer-workers using snowball sampling technique with a finger prick blood collection. Two-hundred ethnic Vietnamese heroin users were recruited and interviews conducted mainly in Footscray, an area of high ethnic Vietnamese residency with a prominent street based drug market. A structured questionnaire was administered. Measures included patterns of drug use, transition from smoking to injecting and vice versa, injection related risk behaviours and HCV sero-status. Results: Ninety-three percent of the sample commenced drug use by non-injecting routes of administration. More than a half had made the transition from smoking to injecting and almost two thirds of participants had ever injected. The factors associated with making this transition included being male and a longer duration of use. Prevalence of exposure to HCV among injectors was over 50%. Factors associated with being HCV positive were longer duration of injecting, sharing injecting equipment and being older. Conclusions: Smoking heroin is a common route of drug administration among heroin users of Vietnamese ethnicity in this study. The transition from smoking to injecting was very common in the sample. The need for targeted harm reduction initiatives is indicated, and these must take into account patterns of heroin use as well as the social context

Injecting and Noninjecting Heroin Administration: Transitions and Treatment Outcomes across 36 Months

To examine long-term stability in route of administration and treatment outcomes for noninjecting (NIHU) and injecting (IHU) heroin users, a cohort of 429 heroin users were followed over 36 months. Across follow-up, 35.3% of NIHU injected heroin and a transition to primary heroin injecting was made by 8.5%. Amongst IHU, 11.1% smoked heroin and a transition to primary heroin smoking was made by 2.3%. While NIHU were less likely to be in treatment at 36 months, there were no differences in overall treatment exposure. At 36 months, there were no differences in heroin use, polydrug use, crime, physical health, or psychopathology. NIHU were, however, less likely to be injecting and to have injection-related health problems. It is concluded that there is a substantial risk of injecting occurring amongst NIHU and that route of administration does not differentially predict long-term treatment response.

Necrolytic migratory erythema in an opiate-dependent patient

An 18-year-old woman presented with severe features of seborrhoeic dermatitis involving her scalp. Subsequently, the toe webs and intertriginous areas became affected by an erythematous, slightly scaly and weepy rash. The groin area was most severely affected, and complicated by intermittent infections with staphylococci and herpes simplex. The patient admitted to smoking heroin and was subsequently enrolled in a methadone programme. A biopsy from the groin area showed a combination of parakeratosis and keratinocyte vacuolar changes, supporting a diagnosis of necrolytic migratory erythema (NME). On completion of methadadone withdrawal, the rash cleared. The rash returned upon recommencing methadone. NME consists of an irregular annular eruption with an erythematous crusted edge. It is often mistaken for intertrigo or seborrhoeic dermatitis. In this patient, a direct effect of heroin and methadone on the epidermal metabolism might be speculated. There could be a variant of the opiate recepter, which is especially sensitive to the effects of opiates. This is the second case occurring in association with opiate dependency and the first case where the patient was rechallenged, although the precise role of the opiates in the aetiology remains somewhat speculative.

Clinical update: codeine maintenance in opioid dependence

In Australia, the USA, and Europe, 0·4%–0·8% of adults develop a dependence on illicit opioids. These people typically use opioids daily, despite being arrested, imprisoned, infected with blood-borne viruses, and having non-fatal drug overdoses. 1 Degenhardt L Hall WD Warner-Smith M Lynskey M Illicit drug use. in: Ezzati M Lopez A Rodgers A Murray CJL Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. World Health Organization, Geneva2004: 1109-1175 Google Scholar Users of illicit opioids have generally been those who inject heroin, but, during the 1990s, many in Europe, North America, and parts of Asia reverted to older methods of use, including smoking and chasing of heroin—inhalation of the fumes released when heroin is heated. 1 Degenhardt L Hall WD Warner-Smith M Lynskey M Illicit drug use. in: Ezzati M Lopez A Rodgers A Murray CJL Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. World Health Organization, Geneva2004: 1109-1175 Google Scholar Because of a substantial reduction in heroin supply in the early 21st century, users in Australia, Canada, and the USA have increasingly used pharmaceutical opioids. 2 Fischer B Rehm J Patra J Cruz MF Changes in illicit opioid use across Canada. CMAJ. 2006; 175: 1385-1387 Crossref PubMed Scopus (93) Google Scholar

Inhaled heroin causing a life-threatening asthma exacerbation and marked peripheral eosinophilia

Miss H was born in 1982 and diagnosed with asthma at the age of 7 years. In 2004 she presented with cough and wheeze, a peak flow of 55% predicted, an eosinophil count of 3.75 × 109/litre (normal range 0−0.4 × 109/litre) and a normal chest radiograph. In the preceding year, she attended the accident and emergency department twice and required six courses of prednisolone, despite taking low-dose inhaled steroids on a regular basis. A smoker, she lived in a rented room and was not registered with a doctor. Following standard treatment, she was prescribed an inhaled corticosteroid and long-acting β2-agonist. She took discharge against medical advice and failed to attend follow-up clinic. Two months later she was admitted with increasing wheeze and breathlessness, but refused investigations. During this admission, but only after direct questioning, she admitted to smoking heroin. She was discharged with community drug liaison service follow-up and abstained from heroin until she attended clinic 6 weeks later. At this point she had no symptoms and a supranormal peak flow. In February 2005, she become wheezy after inhaling heroin and was admitted overnight. She took her own discharge before seeing the hospital drug liaison team and again refused investigation. Admissions followed in June, July and August 2005, with life-threatening features on the last occasion, when she narrowly avoided ventilation. During this admission she recognized that exacerbations always followed heroin inhalation and she was referred to a direct access clinic to commence oral buprenorphine (Subutex, Schering-Plough, NJ, USA), a partial opioid antagonist.

Pulmonary multinodular mucormycosis in Type 1 diabetic patient with diabetic ketoacidosis

We report a case of pulmonary multinodular mucormycosis in a Type 1 diabetic patient with diabetic ketoacidosis. He had a history of 20-pack-year tobacco use. The initial chest roentgenogram and thorax tomography (after the treatment of diabetic ketoacidosis) revealed multiple nodular lesions with cavitation in the upper lobes of pulmonary parenchyma. Resection of three nodular lesion demonstrated cheesy necrotic mass in the cavitating lesions. The diagnosis of pulmonary multinodular mucormycosis was made depending on the histopathologic examination yielding nonseptated right angle branching-shaped hyphae typical of mucormycosis. The patient was started on liposomal amphotericin B and discharged at the sixth week of therapy with a scheduled therapy of amphotericin B. When he came back after 33 months, he was metabolically unregulated under the insulin therapy. He confessed that he had been smoking heroin besides tobacco for the last 5 years. A new thorax computerized tomography showed that pulmonary nodules were slightly regressed but not resolved.

Changes in High-Risk Behaviors Over Time Among Young Drug Users in South Vietnam: A Three-Province Study

Vietnam is in the midst of an expanding HIV epidemic, primarily driven by an increase in injection drug use in young people. This study was conducted to understand the patterns and initiation of drug use, and the sexual risk behavior among youth in three provinces in southern Vietnam. A cross-sectional survey was conducted among male and female drug users under age 25 recruited from drug treatment centers (N = 560) and the community (N = 240) in Ho Chi Minh City, Dong Nai and Ba Ria-Vung Tau. The majority of those surveyed (82%) began by smoking heroin; after a year, 57% were injecting heroin and/or opium. Initiation of drug use frequently occurred in entertainment venues. Among injectors, 23% shared needles; 71% of all users were sexually active of whom 77% had unprotected sex. More than half of those recruited from treatment centers had previously been in drug treatment. Public health programs to prevent and treat the dual epidemics of HIV and drug abuse must be able to access and respond to the needs of youth, many of whom are unemployed and exposed to drug traffic.

Galactorrhoea may be associated with methadone use

We report persistent galactorrhoea and raised prolactin in a woman taking methadone, which is commonly prescribed for the treatment of opiate dependence. A heroin smoking 28 year old mother of...

Descriptive Epidemiology of Hepatitis C Virus Among Male Heroin Abusers in Taiwan

The purpose of this study was to explore the epidemiology of hepatitis C virus (HCV) infection and to determine the risk factors for HCV infection among heroin abusers in Taiwan. This was a cross-sectional study. From November 2004 to February 2005, 577 subjects, including 423 subjects (73.3%) using injectable heroin and 154 subjects (26.7%) using smoked heroin from one male prison located in Taiwan, were enrolled in this study. The mean age was 33.3 +/- 7.9 years (age range 19-65 years). Anti-HCV antibody was tested. A face-to-face interview focusing on sociodemographic information and risk behaviors was addressed. The t test, chi-squared test, and multivariate logistic regression were used. The overall prevalence of anti-HCV antibody positivity was 74.9%, with 89.8% among injecting heroin abusers and 33.8% among smoking heroin abusers (P < 0.0001). The multivariate logistic regression analysis demonstrated that needle sharing was independently related to HCV infection (odds ratio = 5.25, 95% confidence interval = 2.48-11.12). The prevalence of anti-HCV antibody positivity among male injecting drug abusers is high in Taiwan. Needle sharing is identified as a potential risk factor for HCV infection.

Development of the dopamine transporter selective RTI-336 as a pharmacotherapy for cocaine abuse

The discovery and preclinical development of selective dopamine reuptake inhibitors as potential pharmacotherapies for treating cocaine addiction are presented. The studies are based on the hypothesis that a dopamine reuptake inhibitor is expected to partially substitute for cocaine, thus decreasing cocaine self-administration and minimizing the craving for cocaine. This type of indirect agonist therapy has been highly effective for treating smoking addiction (nicotine replacement therapy) and heroin addiction (methadone). To be an effective pharmacotherapy for cocaine addiction, the potential drug must be safe, long-acting, and have minimal abuse potential. We have developed several 3-phenyltropane analogs that are potent dopamine uptake inhibitors, and some are selective for the dopamine transporter relative to the serotonin and norepinephrine transporters. In animal studies, these compounds substitute for cocaine, reduce the intake of cocaine in rats and rhesus monkeys trained to self-administer cocaine, and have demonstrated a slow onset and long duration of action and lack of sensitization. The 3-phenyltropane analogs were also tested in a rhesus monkey self-administration model to define their abuse potential relative to cocaine. Based on these studies, 3beta-(4-chlorophenyl)-2beta-[3-(4'-methylphenyl)isoxazol-5-yl]tropane (RTI-336) has been selected for preclinical development.

Prevalence and Correlates of Suicidal Ideation Among Young Injection vs. Noninjection Drug Users

The objective of this study was to identify correlates of suicidal ideation and to examine the hypothesis that injection drug users (IDUs) were more likely to report suicidal ideation than noninjection drug users (NIDUs). Participants included IDUs (n = 244) and NIDUs (n = 73) from Baltimore, Maryland, aged 15–30 who began snorting or smoking heroin or cocaine/crack (NIDUs) or injecting drugs (IDUs) within the past 5 years who were recruited between August 2000 and March 2002. Among the 317 participants, 42% were female, 59% were white, and median age was 24. The prevalence of suicidal ideation was 27%. IDUs were more likely to report suicidal ideation than NIDUs (31% vs. 14%, p = 0.003). Adjusting for age, gender, and race, IDUs were 2.4 times more likely than NIDUs to report suicidal ideation [95% Confidence Interval (CI): 1.1–5.2]. However, on further adjustment for homelessness, depressive symptoms, and gay/lesbian/bisexual identity, IDU status was no longer independently associated with suicidal ideation. These results suggest that factors associated with injection drug users' lifestyles and mental health status may account for the higher prevalence of suicidal ideation in IDUs vs. NIDUs. Further study into these associations is warranted in identifying avenues for suicide prevention among these populations.

MAPPING THE CONSEQUENCES OF AN UNANTICIPATED DRUG SUPPLY CHANGE OF UNCERTAIN ORIGINS: RESPONSE TO THE COMMENTARIES

MAPPING THE CONSEQUENCES OF AN UNANTICIPATED DRUG SUPPLY CHANGE OF UNCERTAIN ORIGINS: RESPONSE TO THE COMMENTARIES

Heroin and HIV risk in Dar es Salaam, Tanzania: Youth hangouts, mageto and injecting practices

HIV risk through needle sharing is now an emerging phenomenon in Africa. This article describes the practices that heroin users are producing as they establish the rules and organization surrounding their drug use. Their practices and interactions reveal the ways that they become initiated into its use, how they progress to injecting, and the important role of local neighbourhood hangouts in facilitating this process. Their practices, interactions and narratives also provide insights into what may be the most appropriate HIV-prevention interventions. Semi-structured interviews were conducted during the months of February and July 2003 with 51 male and female injectors residing in 8 neighbourhoods in the Dar es Salaam, Tanzania. Interviews were content coded and codes were collapsed into emergent themes around hangout places, initiation of heroin use, and progression to injecting. Interviews reveal that Dar es Salaam injectors begin smoking heroin in hangout areas with their friends, either because of peer pressure, desire, or trickery. One hangout place in particular, referred to as the ‘geto’ (ghetto) is the main place where the organization and rules governing heroin use are produced. Three main types of heroin ‘ghettoes’ are operating in Dar es Salaam. As users build a tolerance for the drug they move along a continuum of practices until they begin to inject. Injecting heroin is a comparatively recent practice in Africa and coincides with: (1) Tanzania transitioning to becoming a heroin consuming community; (2) the growing importance of youth culture; (3) the technical innovation of injecting practices and the introduction and ease of use of white heroin; and (4) heroin smokers, sniffers, and inhalers perceived need to escalate their use through a more effective and satisfying form of heroin ingestion.

Potential Uptake and Correlates of Willingness to Use a Supervised Smoking Facility for Noninjection Illicit Drug Use

Many cities are experiencing infectious disease epidemics and substantial community harms as a result of illicit drug use. Although medically supervised smoking facilities (SSFs) remain untested in North America, local health officials in Vancouver are considering to prepare a submission to Health Canada for an exemption to open Canada's first SSF for evaluation. Reluctance of health policymakers to initiate a pilot study of SSFs may be due in part to outstanding questions regarding the potential uptake and community impacts of the intervention. This study was conducted to evaluate the prevalence and correlates of willingness to use an SSF among illicit drug smokers who are enrolled in the Vancouver Injection Drug Users Study. Participants who reported actively smoking cocaine, heroin, or methamphetamine who returned for follow-up between June 2002 and December 2002 were eligible for these analyses. Those who reported willingness to use an SSF were compared with those who were unwilling to use an SSF by using logistic regression analyses. Four hundred and forty-three participants were eligible for this study. Among respondents, 124 (27.99%) expressed willingness to attend an SSF. Variables that were independently associated with willingness to attend an SSF in multivariate analyses included sex-trade work (adjusted odds ratio [AOR]=1.85), crack pipe sharing (AOR=2.24), and residing in the city's HIV epicentre (AOR =1.64). We found that participants who demonstrated a willingness to attend an SSF were more likely to be involved in the sex trade and share crack pipes. Although the impact of SSFs in North America can only be quantified by scientific evaluation, these data indicate a potential for public health and community benefits if SSFs were to become available.