Treatment Of Heroin Addiction Research Articles

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

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

Prefrontal cortex activity increases after inpatient treatment for heroin addiction

Prefrontal cortex activity increases after inpatient treatment for heroin addiction

Lost lives and opportunities for the legacy of harm reduction in Scotland, UK

Lost lives and opportunities for the legacy of harm reduction in Scotland, UK

Prescription psychostimulants as a harm reduction and treatment intervention for methamphetamine use disorder and the implications for nursing clinical practice: A scoping review of the literature.

The global rise in methamphetamine use and its negative effects warrants the need for research exploring harm reduction and treatment interventions for individuals with methamphetamine use disorder. Agonist medications have been utilized for years for the treatment of heroin and opioid addiction, but have yet to be incorporated into mainstream Canadian practice for methamphetamine dependence. This review aims to provide an overview of the current trends of prescription psychostimulant usage for individuals with methamphetamine use disorder from a Canadian perspective, identifies the barriers to accessing prescription psychostimulants for methamphetamine use disorder and highlights the nursing clinical practice implications in caring for individuals with the disorder. Discourse on the sustained abstinence and harm reduction debate is presented from the perspective of methamphetamine abuse is provided along with the neuropsychiatric complications of chronic methamphetamine use. The impacts of specific prescription psychostimulants on cognition are discussed as is the use of neuroimaging techniques to assess neuronal damage in methamphetamine users. Sign of toxicity, overdose and the contraindications for use of these prescription psychostimulants is also presented. The implications to nursing clinical practice in caring for this population is provided, touching on the clinical presentation of methamphetamine use, completing thorough assessment and screening and patient education. The findings of this review indicate the need for further research in this area exploring the benefits of prescription psychostimulants as a harm reduction and treatment intervention for the global problem of methamphetamine dependence.

Association between rs1799971 in the mu opioid receptor gene and methadone maintenance treatment response.

Genetic variations can affect individual response to methadone maintenance treatment (MMT) for heroin addiction. The A118G variant (rs1799971) in the mu opioid receptor gene (OPRM1) is a potential candidate single nucleotide polymorphism (SNP) for personalized MMT. This study determined whether rs1799971 is related to MMT response or dose. We recruited 286 MMT patients from a Han Chinese population. The rs1799971 genotype was determined via TaqMan genotyping assay. The genetic effect of this SNP on MMT response or dose was evaluated using logistic regression. A meta-analysis was performed to merge all available data to evaluate the role of rs1799971 in MMT using RevMan 5.3 software. No statistical significance was observed in the association between the OPRM1 rs1799971 and MMT response or dose in our Chinese cohort. Meta-analysis indicated that the OPRM1 A118G variation was not significantly associated with MMT response or dose requirement. The results suggest that rs1799971 in OPRM1 might not play a critical role alone in influencing MMT response or dose.

Update on Cyber Health Psychology: Virtual Reality and Mobile Health Tools in Psychotherapy, Clinical Rehabilitation, and Addiction Treatment.

(1) Background: we investigated and analyzed the most recent implementations of technology in the fields of psychotherapy, clinical rehabilitation, and addiction treatment. (2) Methods: from December 2021 to January 2022, we conducted a review aimed at identifying the recent implementations of technology in cyber health psychology, with particular reference to Virtual Reality in psychotherapy, mHealth tools in clinical rehabilitation, and smartphone applications in the treatment of addiction to substances of abuse, searching for relevant studies in the databases PubMed, Web of Science, Google Scholar, Health & Medical Collection, and APA PsycArticles. (3) Results: the tools analyzed are in constant development and are increasingly used, with good results, and further technological progress could lead to even better treatment outcomes; as far as mHealth tools and smartphone applications are concerned, anti-smoking Apps are the most widespread, followed by those for the treatment of alcohol use disorder, and there is no presence of Apps for the treatment of heroin, cocaine, or crack addiction. (4) Conclusions: the results of the review indicate that these technological tools are increasingly used and are, in principle, effective and have numerous advantages, including low cost and versatility.

Metabolomics analysis reveals how water extract of Gastrodia elata helps against heroin addiction

To investigate the metabolomics changes and potential metabolic mechanisms of water extract of Gastrodia elata (WGE) in the treatment of heroin addicted mice. Sixty male Kunming mice were randomly divided into four groups as control group (n = 10), heroin addicted group (n = 10), natural withdrawal group (n = 10), and GE treatment group (500, 1000, 2000 mg/kg, n = 30). Heroin addicted group were injected subcutaneously in the 13 days with increased dosage from 3 mg/kg to 30 mg/kg. The control group was injected with the same amount of saline in the same manner. After 13 days of heroin administration, the treatment groups were given GE by gavage for a week. The natural withdrawal group was injected with the same amount of saline in the same manner. The metabolites were determined using ultra performance liquid chromatography/tandem mass spectrometry (UPLC-MS/MS). The scatting diagrams were plotted based on orthogonal partial least squares discrimination analysis (OPLS-DA). Potential differential metabolites were obtained using the combination of variable important in projection (VIP) and p value methods. Their metabolic pathways were analyzed using databases such as METLIN, HMDB, KEGG and metaboanalyst 5.0. The GE treatment group (500 mg/kg) could significantly reduce the withdrawal symptoms induced by heroin addiction and significantly improve the weight loss of heroin addicted mice. The metabolomics results showed that GE could regulate the levels of 30 different metabolites in heroin addicted mice, which mainly involved in the metabolism of Glutamic acid, Glutathione and Purine. The water extract of Gastrodia elata in the treatment of heroin addiction was confirmed for the first time in this study. The metabolomics analysis demonstrated that the metabolic disorder of endogenous substances changes from pretreatment to posttreatment. The potential biomarkers of brain damage may be feasible to elucidate its metabolic mechanisms.

Several nAChRs gene variants are associated with phenotypes of heroin addiction in Chinese Han population

Heroin addiction is a chronic and complex brain disease. Nicotinic acetylcholine receptors (nAChRs) have been shown as major control points in many of the neurological and physiological disorders involved in heroin addiction. In the present study, thirty-three SNPs across nine nAChR genes were selected and probed for their associations with heroin addiction phenotypes in 801 unrelated northwestern Chinese Han patients. We found that rs2565055 in CHRNA2 gene was associated with daily dose of methadone treatment, and rs2672215, rs2672216 and rs2741865 in CHRNA10 gene were associated with the duration of the transition from first use to dependence (DTFUD). Cox multivariable regression analysis revealed that rs3743075, rs6495309 in CHRNA3, rs2304297 in CHRNA6, and rs1948 in CHRNB4 were associated with sexual desire in patients with heroin addiction. These findings were further supported by the identification of a haplotype block spanning CHRNA5, CHRNA3, and CHRNB4 that is correlated with changes in sexual desire after long-term heroin use. Our findings highlight associations between polymorphisms in nAChRs genes and the phenotypes of heroin addiction in the Chinese Han population. We suggest several nAChRs subunits as potential novel targets for the treatment of heroin addiction.

Modulation of Attentional Bias to Drug and Affective Cues by Therapeutic and Neuropsychological Factors in Patients With Opioid Use Disorder on Methadone Maintenance Therapy.

Objective: Abnormal selective attention to drug cues and negative affect is observed in patients with substance dependence, and it is closely associated with drug addiction and relapse. Methadone maintenance is an effective replacement therapy to treat heroin addiction, which significantly reduces the relapse rate. The present study examines whether the patients with opioid use disorder on chronic methadone maintenance therapy exhibit abnormal attentional bias to drug cues and negative-affective cues. Moreover, its relation to therapeutic and neuropsychological factors is also examined.Methods: Seventy-nine patients with opioid use disorder under chronic methadone maintenance therapy and 73 age-, sex-, and education-matched healthy controls were recruited and assessed for attentional bias to drug cues and negative affect using a dot-probe detection task. Correlational analysis was used to examine the relationships between the attentional bias and the demographic, therapeutic, and neuropsychological factors.Results: No significant overall patient-control group difference is observed in drug-related or negative-affective-related attentional bias scores. In the patient group, however, a significant negative correlation is found between the attentional bias scores to negative-affective cues and the duration of methadone treatment (p = 0.027), with the patients receiving longer methadone treatment showing less attentional avoidance to negative-affective cues. A significant positive correlation is found between the negative affect-induced bias and the impulsivity score (p = 0.006), with more impulsive patients showing higher attentional avoidance to negative affective cues than less impulsive patients. Additionally, the patients detect a smaller percentage of probe stimuli following the drug (p = 0.029) or negative-affective pictures (p = 0.009) than the healthy controls.Conclusion: The results of the present study indicate that the patients under chronic methadone maintenance therapy show normalized attentional bias to drug and negative-affective cues, confirming the involuntary attention of the patients is not abnormally captured by external drug or negative-affective clues. Our findings also highlight that the attentional avoidance of negative-affective cues is modulated by the duration of methadone treatment and the impulsivity level in the patients.

Assessing brain activity in male heroin-dependent individuals under methadone maintenance treatment: A resting-state fMRI study

Methadone maintenance treatment (MMT) is recognized as an effective and mainstream alternative treatment for heroin addiction. However, the effect of long-term MMT on the local and global brain activity of heroin-dependent individuals during resting state remains unknown. Twenty-five heroin-dependent individuals under MMT, 26 heroin-dependent individuals after short-term abstinence (HA) and 42 healthy controls (HC) were included in the resting-state functional magnetic resonance imaging study. The craving before and after heroin cue exposure were evaluated among HA and MMT subjects. The difference in craving, regional homogeneity (ReHo) and related functional connectivity were analyzed among the three groups. We found that the craving before and after heroin cue exposure of MMT group was significantly lower than that of HA group. Compared with HA group, the MMT group showed higher ReHo value in the right orbitofrontal cortex and bilateral posterior central cortex. No significant difference in global brain connectivity based on differential ReHo regions was found among the three groups. This study demonstrated the long-term MMT could improve the local activity of executive control and somatosensory brain regions in heroin-dependent individuals. It suggested that MMT might be beneficial to restoring executive control and somatosensory function in the direction towards that of healthy controls.

Social Support in the Treatment of Heroin Addicts

Heroin addiction impairs every aspect of physical and psychological health of the addict, and at the same time, it impairs all forms of social functioning of the addict, as well as of everyone who loves him/her and of society as a whole, so it's necessary to put a lot of effort into treating this disease successfully. Working with heroin addicts shows that the treatment is a long and uncertain process, as the treatment must simultaneously cover three segments: psychological traits of heroin addicts, the degree of social support they have, and their motivation for this treatment. The theoretical goal of this research was to find out whether there is a link between social support and motivation for addiction treatment. The practical goal is to provide the improvement of the motivational aspect of treating heroin addicts, as well as to determine the role of social support in evaluating treatment outcomes. The research was conducted on a sample of 227 heroin addicts under treatment. The perception of social support for heroin addicts is the greatest when it comes to their families. A positive correlation was found between persistence in treatment and perceived social support from family members.

Repetitive transcranial magnetic stimulation modulates coupling among large-scale brain networks in heroin-dependent individuals: A randomized resting-state functional magnetic resonance imaging study.

The abnormal interactions of three key large-scale brain networks (default mode [DMN], salience and executive control [ECN]) were showed underlie dysfunctions in heroin addiction. Repetitive transcranial magnetic stimulation (rTMS) targeting the left dorsolateral prefrontal cortex (DLPFC) is a potential treatment for heroin addiction. It is unclear whether impaired coupling among the large-scale brain networks would be improved by rTMS in treated heroin-dependent individuals. Thirty-five heroin-dependent individuals were included in this sham-controlled, randomized study. The patients received either active or sham rTMS for 1week. The craving for heroin and resting-state functional magnetic resonance imaging data were collected before and after 1-week rTMS. Twenty-two healthy subjects were included as controls not receiving rTMS. After 1-week rTMS, only the active rTMS group showed a significant decrease in spontaneous and heroin cue-induced craving. The coupling between left DLPFC (a key node of left ECN) and left parahippocampal gyrus (PHG, included in DMN) significantly increased for the active group with a tendency towards that of controls. The coupling between the right precentral gyrus and three key regions included in DMN (posterior cingulate cortex/precuneus and bilateral inferior parietal cortex) significantly decreased for the active group with a tendency towards that of healthy controls. For the active rTMS individuals, the left DLPFC-PHG coupling negatively correlated with the spontaneous craving and the drug cue-induced craving. It suggested that the rTMS could reduce heroin craving, which might be related to the modulation of ECN-DMN coupling. This finding might shed light on the mechanism of rTMS for heroin addiction treatment.

Pharmacogenetic study of methadone treatment for heroin addiction: associations between drug-metabolizing gene polymorphisms and treatment efficacy.

Opioid dependence is currently one of the most serious problems affecting the social norms and public health system. Methadone maintenance therapy (MMT) is being widely used in treating heroin-dependent patients. The mechanism of methadone metabolism and disposition has been shown to involve cytochrome P450 (CYP450) and P-glycoprotein. The aim of this study was to explore the relationships among genetic polymorphisms, BMI and effective dose of methadone used in MMT within a northern Taiwan cohort. One hundred heroin-dependent patients were enrolled in the study. The clinical data gathered included methadone dose, sex and BMI. DNA was collected from the oral swab of the participants to analyze the relevant alleles. An effective methadone dose correlated with sex, BMI and the presence of ABCB1 2677GG (rs2032582) and CYP2B6 516GG (rs374527). Furthermore, the CYP2B6 516GG homozygote was related to a higher average dose of methadone (GG: 68.50 ± 32.43; GT: 52.28 ± 25.75; TT: 44.44 ± 29.64; P < 0.02), whereas the ABCB1 2677GG homozygote was related to a lower dose (GG: 51.09 ± 20.83; GT: 69.65 ± 37.51; TT: 62.52 ± 30.44; P < 0.05). We examined the predictive effect of polymorphisms combined with sex and BMI on methadone dose by conducting multiple linear regressions. Our data predicted the average dose of methadone in approximately 30% of heroin-dependent patients. The interactions between genetic polymorphisms and clinical features proved useful in identifying the effective dose of MMT for heroin-dependent patients in Taiwan more precisely.

Association study of genetic polymorphisms in GABRD with treatment response and dose in methadone maintenance treatment.

Aim: This study determined if gene variants in the GABA receptor delta subunit (GABRD) are associated with treatment response and dose in methadone maintenance treatment (MMT) for heroin addiction. Materials & methods:Atotal of286 MMT patients were recruited and divided into response and nonresponse groups based on retention time in therapy. A total of 177 responders were classified into low dose and high dose subgroups according to the stabilized methadone dose. Four (single nucleotide polymorphisms)SNPs (rs13303344, rs4481796, rs2376805 andrs2229110) in GABRD were genotyped using the TaqMan SNP assay. Logistic regression was used to assess the genetic effects of the SNPs in MMT. Results: No significant associations were observed between the SNPs and treatment response or dose, except the frequency of haplotype ACGC atthe four SNPs significantly differed between responders and nonresponders. Conclusion: The results indicated that GABRD variants may play a small role in modulating methadone treatment response.

The space to heal heroin addiction: The psychoanalytic case for harm reduction

AbstractHarm reduction approaches to heroin addiction treatment are safe and effective, particularly those using medication‐assisted therapy, yet they remain underutilized in the drug treatment field. This paper posits the need for a psychoanalytic formulation of harm reduction. It draws on object relations theory, to illustrate the ways in which harm reduction, as a philosophy and as a practice, maps onto the particular developmental and attachment themes of addiction. It explores heroin addiction and harm reduction at the intersection of the psyche and the social and calls upon psychoanalysis to challenge oppressive systems in the lives of heroin users.

An Intelligent Virtual-Reality System With Multi-Model Sensing for Cue-Elicited Craving in Patients With Methamphetamine Use Disorder.

Methamphetamine abuse is getting worse amongst the younger population. While there is methadone or buprenorphine harm-reduction treatment for heroin addicts, there is no drug treatment for addicts with methamphetamine use disorder (MUD). Recently, non-medication treatment, such as the cue-elicited craving method integrated with biofeedback, has been widely used. Further, virtual reality (VR) is proposed to simulate an immersive virtual environment for cue-elicited craving in therapy. In this study, we developed a VR system equipped with flavor simulation for the purpose of inducing cravings for MUD patients in therapy. The VR system was integrated with multi-model sensors, such as an electrocardiogram (ECG), galvanic skin response (GSR) and eye tracking to measure various physiological responses from MUD patients in the virtual environment. The goal of the study was to validate the effectiveness of the proposed VR system in inducing the craving of MUD patients via the physiological data. Clinical trials were performed with 20 MUD patients and 11 healthy subjects. VR stimulation was applied to each subject and the physiological data was measured at the time of pre-VR stimulation and post-VR stimulation. A variety of features were extracted from the raw data of heart rate variability (HRV), GSR and eye tracking. The results of statistical analysis found that quite a few features of HRV, GSR and eye tracking had significant differences between pre-VR stimulation and post-VR stimulation in MUD patients but not in healthy subjects. Also, the data of post-VR stimulation showed a significant difference between MUD patients and healthy subjects. Correlation analysis was made and several features between HRV and GSR were found to be correlated. Further, several machine learning methods were applied and showed that the classification accuracy between MUD and healthy subjects at post-VR stimulation attained to 89.8%. In conclusion, the proposed VR system was validated to effectively induce the drug craving in MUD patients.

Admission Practices And Cost Of Care For Opioid Use Disorder At Residential Addiction Treatment Programs In The US.

The use of acute, short-term residential care for opioid use disorder has grown rapidly, with policy makers advocating to increase the availability of "treatment beds." However, there are concerns about high costs and misleading recruitment practices. We conducted an audit survey of 613 residential programs nationally, posing as uninsured cash-paying individuals using heroin and seeking addiction treatment. One-third of callers were offered admission before clinical evaluation, usually within one day. Most programs required up-front payments, with for-profit programs charging more than twice as much ($17,434) as nonprofits ($5,712). Recruitment techniques (for example, offering paid transportation) were used frequently by for-profit, but not nonprofit, programs. Practices including admission offers during the call, high up-front payments, and recruitment techniques were common even among programs with third-party accreditation and state licenses. These findings raise concerns that residential programs, including accredited and licensed ones, may be admitting a clinically and financially vulnerable population for costly treatment without assessing appropriateness for other care settings.

Functional connectivity of posterior cingulate gyrus in heroin dependents treated by methadone maintenance and protracted abstinence measures: an event-related fMRI study.

Protracted abstinence (PA) and Methadone maintenance treatment (MMT) are two main types of heroin addiction treatment, however, the effects of both measures on the functional connectivity (FC) of the brain in heroin dependents in the drug cue event-related response are unclear. Functional magnetic resonance imaging (fMRI) based drug cue-reactivity task has been widely used in addiction research, which may provide a new way to understand the change of brain function during a certain period of treatment. The default function network (DMN) with posterior cingulate cortex (PCC) as the core is generally involved in the process of addiction. The aim of the present study was to explore the brain response of FC in patients with heroin-dependent during PA, MMT treatment under task-fMRI. Twenty-two heroin-dependent patients during PA, 18 heroin-dependent patients during MMT and 16 healthy control (HC) individuals were included to conduct the heroin cue-reactivity task during fMRI. The MMT and PA patients' subjective craving for heroin was evaluated. The psychophysiological interaction (PPI) analysis of SPM12 was used to get FC during the task state. There was a significant difference on FC between PCC and the right medial Prefrontal Cortex (mPFC) in three groups. The post-hoc analysis showed that there was a significant difference of brain regions between the MMT and the PA group. The FC of PCC-mPFC in the MMT group was significantly stronger than that in the PA group. Compared with the PA group, the FC of the DMN in the MMT group was significantly increased under drug cue response. Therefore, PA is more beneficial for the heroin-dependent patients to lower the salience value of drug related cues, in turn to reduce relapse risks. It also reflected the important role of PCC-mPFC pathway in heroin dependents induced by heroin cues.

Role of GABRD Gene Methylation in the Nucleus Accumbens in Heroin-Seeking Behavior in Rats.

Epigenetic modifications such as DNA methylation play important roles in regulating gene expression and may mediate neuroplasticity and lead to drug-induced aberrant behaviors. Although several brain regions and neurobiological mechanisms have been suggested to be involved in these processes, there is remarkably little known about the effects of DNA methylation on heroin-seeking behavior. Using a Sprague-Dawley rat model, we show that heroin self-administration resulted in gamma-aminobutyric acid type A receptor subunit delta (GABRD) gene hypomethylation, which was associated with transcriptional upregulation of GABRD in the nucleus accumbens (NAc). Systemic l-methionine (MET) administration significantly strengthened the reinstatement of heroin-seeking behavior induced by heroin priming, whereas intra-NAc injections of the DNA methyltransferase (DNMT) inhibitor 5-aza-2′-deoxycytidine (5-Aza-dC) had the opposite effect on heroin-seeking. Meanwhile, 5-Aza-dC treatment decreased DNA methylation and upregulated the expression of GABRD in the NAc, whereas MET had the opposite effect. Our results also reveal that 5-Aza-dC might alter the methylation landscape of the GABRD gene by directly repressing DNMT1 and DNMT3A expression. Furthermore, reinstatement of heroin-seeking behavior was significantly inhibited by directly overexpressing GABRD and remarkably reinforced by GABRD gene silencing in the NAc. Collectively, these results suggest that targeting the GABRD gene and its methylation might represent a novel pharmacological strategy for treating heroin addiction and relapse.

Acupuncture and Related Techniques for Pain Relief and Treatment of Heroin Addiction: Mechanisms and Clinical Application.

A neurochemical hypothesis of acupuncture analgesia suggests that the pain relief effect of acupuncture is primarily due to activation of a central endorphin system. It has been shown that the primary afferent sensory fibers, a mesolymbic neural circuit, and a descending inhibitory pathway are critical in acupuncture analgesia. The therapeutic effects of electroacupuncture (EA) and related techniques, such as transcutaneous electroacupoint stimulation (TEAS), are frequency-dependent: different frequencies of EA activate different brain regions and release different neuropeptides. EA and TEAS have been used successfully to treat heroin addiction. Activation of endorphin gene expression and release by TEAS can explain the dramatic attenuation of withdrawal syndrome and prolongation of retention time during and after detoxification treatment in patients who are addicted to heroin. However, repeated EA at high intensity should be avoided because it can induce a gradual loss of the analgesic effect. Opioid-receptor desensitization occurs and is manifested as decreased ligand-binding affinity and second-messenger detachment. Repeated large doses of morphine induce morphine tolerance. Cross-tolerance between morphine and EA suggests similar underlying mechanisms. Recent studies have demonstrated that excessive activation of cholecystokinin (CCK), an antiopioid peptide, appears to be responsible. CCK-receptor subtype B (CCKBR) and opioid μ-receptor are co-expressed in the dorsal-horn neurons. Activation of CCKBR promotes formation of heteromerization of morphine-receptor and CCKBR. Interaction of the third transmembrane domain between the 2 receptors resulted in the reduced binding affinity of the opioid receptor.