Effects of naltrexone hydrochloride combined with trazodone on preventing relapse in heroin addicts after detoxification / 中国基层医药

Objective:To investigate the effects of naltrexone hydrochloride combined with trazodone on preventing relapse in heroin addicts after detoxification.Methods:A total of 274 opioid heroin addicts who received treatment in Beijing Gaoxin Hospital between June 2016 and January 2019 were included in this study. After detoxification with methadone, all patients were randomly assigned to receive either naltrexone hydrochloride combined with trazodone (group 1, n = 60) or naltrexone hydrochloride alone (group 2, n = 60) for preventing relapse in heroin addicts. The effects on relapse prevention were determined in each group. Results:There were no significant differences in age distribution, sex composition, marital status, and drug use between groups 1 and 2 (all P > 0.05). After 6 months of treatment, the non-relapse rate was 86.7% (52/60) and 6.7% (4/60) in groups 1 and 2 respectively, in the case of unchanged personal life status. There was significant difference in non-relapse rate between groups 1 and 2 ( χ2 = 77.1, P < 0.001). Conclusion:Naltrexone hydrochloride combined with trazodone exhibits superior efficacy in preventing relapse in opioid heroin addicts after detoxification to naltrexone hydrochloride alone.

Efeitos da Heroína nos Parâmetros Eletrocardiográficos / Effect of Heroin on Electrocardiographic Parameters

Resumo Fundamento Atualmente, o vício em heroína é um problema de saúde preocupante, e as informações sobre os efeitos eletrocardiográficos da heroína são limitadas. Objetivos O objetivo do presente estudo é investigar os efeitos da dependência de heroína em parâmetros eletrocardiográficos. Métodos Um total de 136 indivíduos, incluindo 66 indivíduos que fumam heroína como grupo de estudo e 70 indivíduos saudáveis sem dependência de drogas como grupo de controle, foram incluídos no estudo. Indivíduos que injetam heroína foram excluídos. A avaliação eletrocardiográfica (ECG) dos usuários de heroína foi realizada e comparada com as do grupo controle. Além disso, os ECGs pré e pós-tratamento do grupo usuário de heroína foram comparados. Um valor de p<0,05 foi aceito como estatisticamente significativo. Resultados A frequência cardíaca (77,2±12,8 versus 71,4±11,2; p=0,02) foi maior no grupo usuário de heroína em comparação com o grupo controle. Os intervalos QT (341,50±25,80 versus 379,11±45,23; p=0,01), QTc (385,12±29,11 versus 411,3±51,70; p<0,01) e o intervalo do pico ao fim da onda T (Tpe) (65,41±10,82 versus 73,3±10,13; p<0,01) foram significativamente menores no grupo usuário de heroína. Nenhuma diferença foi observada entre os grupos com respeito às razões Tpe/QT e Tpe/QTc. Na análise de subgrupo do grupo usuário de heroína, os intervalos QT (356,81±37,49 versus 381,18±40,03; p<0,01) e QTc (382,06±26,41 versus 396,06±29,80; p<0,01) foram significativamente mais curtos no período pré-tratamento. Conclusão O vício em heroína afeta significativamente os intervalos de tempo QT, QTc e Tpe. Os efeitos de arritmia desses parâmetros já são conhecidos. Os parâmetros eletrocardiográficos desses indivíduos merecem mais atenção. (Arq Bras Cardiol. 2020; 115(6):1135-1141)

Abstract Background Heroin addiction is currently a significant health problem, and information on the electrocardiographic effects of heroin is limited. Objetivo The aim of the present study is to investigate effects of heroin addiction on electrocardiographic parameters. Methods A total of 136 individuals, including 66 individuals who smoke heroin as the study group and 70 healthy individuals with no drug addiction as the control group, were included in the study. Individuals who inject heroin were excluded. Electrocardiographic (ECG) evaluation of those using heroin was performed and compared with those of the control group. In addition, pre-treatment and post-treatment ECG of the heroin group were compared. A p-value of <0.05 was accepted as statistically significant. Results Heart rate (77.2±12.8 versus 71.4±11.2; p=0.02) were found to be higher in the heroin group compared to the control group. QT (341.50±25.80 versus 379.11±45.23; p=0.01), QTc intervals (385.12±29.11 versus 411.3±51.70; p<0.01), and T peak to end time (Tpe) (65.41±10.82 versus 73.3±10.13; p<0.01) were significantly shorter in the heroin group. No difference was observed between the groups with regard to Tpe/QT and Tpe/QTc ratios. In the subgroup analysis of the heroin group, QT (356.81±37.49 versus 381.18±40.03; p<0.01) and QTc (382.06±26.41 versus 396.06±29.80; p<0.01) intervals were significantly shorter in the pre-treatment period. Conclusion Heroin addiction significantly affects the QT, QTc, and Tpe time intervals. The arrhythmia effects of these parameters are well known. More attention to the electrocardiographic parameters of these individuals should be given. (Arq Bras Cardiol. 2020; 115(6):1135-1141)

La gestión de placeres y daños: Estudio etnográfico sobre el consumo de drogas en vía pública, viviendas y salas de consumo higiénico / Managing pleasures and harms: An ethnographic study of drug consumption in public spaces, homes and drug consumption rooms

RESUMEN Las salas de consumo higiénico (SCH) son espacios para consumir drogas en condiciones higiénicas y seguras. Sin embargo, los usuarios alternan sus prácticas de consumo en vía pública y viviendas, entornos que conllevan mayores riesgos a la salud. Para comprender mejor este problema, se realizó un estudio etnográfico en diferentes espacios de consumo de Barcelona, incluyendo SCH, vía pública y viviendas. Centrándonos en los discursos y prácticas de consumo, se recogieron datos mediante la observación participante y entrevistas semiestructuradas a 16 usuarios de las SCH. Los resultados muestran que, en los diferentes espacios de consumo, los usuarios experimentan varios tipos de placer. Además, estos espacios están asociados a diversos daños, los cuales son gestionados por los usuarios autorregulando sus prácticas. Estos aspectos, por lo tanto, deben tenerse en cuenta para diseñar acciones de reducción de daños adaptadas a las necesidades de los usuarios.

ABSTRACT Drug consumption rooms (DCR) aim to facilitate consumption in hygienic and safe conditions. However, users also consume drugs in public spaces and homes generating incremental risk for health. To strengthen our understanding of consumption practices, we conducted an ethnographic study in different consumption locations in Barcelona, including DCRs, public spaces, and homes. Focusing on consumption practices and narratives, we conducted participant observation and interviewed 16 DCR users. Our findings show that different consumption spaces allow users to experiment different types of pleasures. In addition, consumption in each type of location is associated with various types of harms, which are managed by users by self-regulating their practices. These aspects, therefore, must be taken into account to design harm reduction action aligned with users' practices.

Psychosocial reintegration process in patients who receive maintenance treatment with methadone: A qualitative analysis / Proceso de reintegración psicosocial en pacientes que reciben tratamiento de mantenimiento con metadona: un análisis cualitativo

Abstract Introduction The evaluation of methadone maintenance programs reports generally positive outcomes. Objective To explore the psychosocial factors that contribute to achieve treatment goals even when patients live in conditions of precariousness and exclusion. Method Qualitative study of multiple cases, with a sample of 12 interviews with patients participating in a maintenance and detoxification program with methadone; a thematic and discursive-narrative analysis was undertaken. Results We identified the predominance of a typical discursive scheme composed of clearly differentiated narrative segments: previous conditions, establishment of a relationship with the therapeutic system, process of adjustment as a part of treatment and social reintegration. Two main themes were also identified: addiction and dealing with substances, and the problem of normative integration; there was also an experience of acceptance and recognition that constitutes a central factor for treatment. Discussion and conclusion These findings are discussed in light of the disaffiliated conditions of people using injected heroin and the need to consider psychosocial and normative adjustment as a relevant factor for treatment and social reintegration, which leads to the suggestion to include psychotherapeutic interventions to accompany and reinforce the process.

Resumen Introducción La evaluación de los programas de mantenimiento con metadona reporta, en general, resultados positivos. Objetivo Explorar factores psicosociales que contribuyan al logro de los objetivos del tratamiento, incluso cuando los pacientes se encuentran en condiciones de precariedad y exclusión. Método Estudio cualitativo de casos múltiples, con una muestra de 12 entrevistas con pacientes participantes en un programa de mantenimiento y deshabituación con metadona; se realizó un análisis discursivo-narrativo y temático. Resultados Identificamos el predominio de un esquema discursivo típico compuesto de segmentos narrativos claramente diferenciados: condiciones previas, vinculación con el sistema terapéutico, proceso de ajuste al interior del tratamiento y proceso de reintegración social. También se identificaron dos ejes de articulación temática: la adicción y el manejo de sustancias, y el problema de la integración normativa; hubo además una experiencia de aceptación y reconocimiento que constituye un factor central en el tratamiento. Discusión y conclusión Estos hallazgos se discuten a la luz de las condiciones de desafiliación del usuario de heroína y de la necesidad de considerar el ajuste psicosocial y normativo como un factor relevante para el tratamiento y la reintegración social, lo que lleva a sugerir que los programas incluyan componentes psicoterapéuticos con el objeto de acompañar y reforzar efectivamente el proceso.

fMRI observation on impact of protracted abstinence on large brain networks in heroin addicts on craving tasks / 中国医学影像技术

Objective: To investigate the impact of protracted abstinence on heroin addicts' psychological craving and brain network function under drug cue task. Methods: Totally 37 heroin addicts (protracted abstinence group) and 32 matched normal volunteers (control group) were recruited. Resting state and craving task fMRI data were acquired, and the psychological craving quantitative scoring was evaluated. Resting fMRI data were analyzed to obtain task negative correlation networks (TNN) and task positive correlation networks (TPN). After modeling task-state fMRI data and comparing with the control group, the abnormal activated brain areas in TNN and TPN in the protracted abstinence group were obtained, and the correlation with psychologic behavior was analyzed. Results: The craving scores of the protracted abstinence group were significantly higher than those of control group before and after the presentation of task cues (all P<0.01). Under the craving task, compared with control group, the right para-hippocampal gyrus was significantly activated in the protracted abstinence group in TNN, and the significantly enhanced networks in TPN included visual spatial network (bilateral anterior central gyrus and inferior frontal gyrus) and sensorimotor network (left posterior central gyrus). The activation intensity of bilateral inferior frontal gyrus in protracted abstinence group was negatively correlated with the duration of heroin use (right: r=-0.37, P=0.02; left: r=-0.41, P=0.01). Conclusion: The subjective craving of heroin addicts who are forced to quit is still increased, and the abnormal function of multiple large brain networks has not completely recovered, which may be the neuropathological basis of relapse.

Visual and Auditory Reaction Times of Patients with Opioid Use Disorder

OBJECTIVE: Reaction time is defined as the time from the start of a stimulus to the start of the voluntary movement. Time plays an important role in undertaking daily living activities. Reaction time is an important factor in respect of both quality of life and of capabilities demonstrated in the work environment. Alcohol and some addictive substances have effect on RT. The aim of this study was to compare the visual and auditory reaction times of patients with opioid use disorder with healthy control subjects. METHODS: The study was applied to two groups as the opioid use disorder group and the control group. A Sociodemographic and Clinical Data Form was prepared for each patient including age, gender, marital status and education level. Using a computer program the response to visual screen color change (red/blue) and to an auditory ‘beep’ sound of the computer system were recorded. The Student’s t-test was applied as a statistical method. RESULTS: The results showed longer reaction times in the patients with opioid use disorder. CONCLUSION: To add improving reaction time approaches in opioid use disorder treatment may contribute to treatment by increasing quality of life and work performance.

Effect of acupuncture in intervening heroin-induced brain damage via regulating ubiquitin-proteasome pathway / 针灸推拿医学（英文版）

Objective:To observe the effect of acupuncture in regulating ubiquitin-proteasome pathway (UPP),and discuss the action of acupuncture in intervening heroin-induced brain damage.Methods:Thirty male Sprague-Dawley (SD) rats were divided into a control group,a model group and an acupuncture group by using the random number table.Rats in the model and acupuncture groups received intramuscular heroin injection for successive 8 d at a progressively increased dose.Afterwards,the injection was suspended for 5 d for withdrawal.The heroin relapse rat model was established by repeating the drug addiction and withdrawal process for 3 times.The control group followed the step of the model establishment,but was given intramuscular injection of normal saline at the stage of addiction and no intervention at the stage of withdrawal;the model group was given intramuscular heroin injection at a progressively increased dose at the addiction stage and no intervention at the withdrawal stage;the acupuncture group was dealt in the same way as the model group at the addiction stage,but received acupuncture at Baihui (GV 20) and Dazhui (GV 14) at the withdrawal stage,with the needles retained for 30 min each time,1 session a day,for successive 5 d.On the 39th day,brain tissues were extracted from the hippocampus and ventral tegmental area (VTA) of the three groups of rats.The apoptosis of brain nerve cells was detected by using terminal deoxynucleotidyl transferase-mediated nick and labeling (TUNEL).The mRNA and protein expressions of ubiquitin (Ub),ubiquitin protein ligase (E3) and 26S were examined by immunohistochemistry and quantitative real-time polymerase chain reaction (RT-qPCR).Results:Compared with the model group,rat's hippocampus and VTA in the acupuncture group showed significantly fewer cells positively stained by TUNEL staining (P＜0.01),and its mRNA and protein expressions of Ub,E3,26S were significantly lower (P＜0.01).Conclusion:Reducing nerve cell apoptosis and regulating the mRNA and protein expressions of Ub,E3 and 26S in rat's hippocampus and VTA are possibly one of the action mechanisms of acupuncture in intervening heroin-induced brain damage.

Experiences and perceptions of people who use heroin: public health lessons from Hermosillo, Mexico / Experiencias y percepciones de personas que usan heroína: lecciones de salud pública desde Hermosillo, México / As experiências e percepções de usuários de heroína: lições de saúde pública de Hermosillo, México

Abstract: Heroin consumption in Mexico is low compared with its use in the United States; however, this practice is more common in the northern region of Mexico than in the rest of the country, being documented only in cities that are located exactly at the Mexico-U.S. border. The Mexican legal framework is focused on rehabilitation, but its effects on the lives of users are unknown. The objective of this research was to analyze how the regulatory Mexican framework is conceptualized and practiced in the daily life of a group of heroin users from a northern city, where consumption has recently spread and has not been documented. We collected the official registered data from users and conducted a qualitative study in Hermosillo, Sonora. A research on the legal framework was conducted, as well as on the city's context. Data on heroin users can be found at HIV health center, as there is no other source of such records. The Mexican legal framework aims at rehabilitation and at avoiding criminalization; however, the daily life of users drives them towards crime circuits: people commit crimes to stay in prison, where they can control the addiction and get heroin, in case of abstinence. The Mexican State has no empirical information to improve its programs and laws related to the use of heroin. The daily practices of users become not only epidemiological but social risks to the community and to the users themselves. Also, the lack of access due to stigmatization, criminalization and violence, increases the inequities, creating a cycle that reproduces poverty and suffering as part of a social structure. Therefore, changes are needed in the justice system.

Resumen: El consumo de heroína en México es bajo si se compara con su consumo en EE.UU.; no obstante, esta práctica es más común en la zona norte de México que en el resto del país, estando documentada solamente en ciudades que están localizadas exactamente en la frontera entre México y EE.UU. El marco legal mexicano está centrado en la rehabilitación, sin embargo sus efectos en las vidas de los consumidores son desconocidos. El objetivo de esta investigación fue analizar cómo se conceptualiza el marco regulatorio mexicano, y cómo se hace realidad en la vida diaria de un grupo de personas usuarias de heroína, procedentes de una ciudad del norte, donde recientemente el consumo se ha extendido y no se ha documentado. Nosotros recogimos datos oficiales registrados de consumidores y realizamos un estudio cualitativo en Hermosillo, Sonora. Se realizó una investigación sobre el marco legal, así como del contexto de la ciudad. Los datos sobre los consumidores de heroína sólo se pueden encontrar en centros de salud especializados en VIH, pues que no existe otra fuente para tales registros. El marco legal mexicano pretende la rehabilitación y evitar la criminalización; sin embargo, la vida diaria de los consumidores les conduce hacia los circuitos del crimen: la gente comete delitos para estar en prisión, donde pueden controlar la adicción y conseguir heroína, en caso de abstinencia. El estado mexicano no cuenta con información empírica para mejorar los programas y leyes relacionadas con el consumo de heroína. Las prácticas diarias de los consumidores se han convertido no sólo en riesgos epidemiológicas, sino tambiém en riesgos sociales para la comunidad y los propios consumidores. Asimismo, la falta de acceso debido a la estigmatización, la criminalización y la violencia, incrementa las inequidades, creando un círculo vicioso que reproduce la pobreza y el sufrimiento, como parte de la estructura social. Por ello, es necesario que se produzcan cambios en el sistema judicial.

Resumo: O consumo da heroína é baixo no México, comparado ao uso nos Estados Unidos, porém essa prática é mais comum na região Norte do México em comparação com o resto do país, sendo documentada apenas nas cidades localizadas justamente na fronteira com os Estados Unidos. A legislação mexicana visa principalmente a reabilitação, mas seus efeitos sobre a vida dos usuários não são conhecidos. Este estudo teve como objetivo analisar a maneira pela qual o arcabouço regulatório mexicano é conceituado e praticado na vida diária de um grupo de usuários de heroína de um município no Norte do México, onde o consumo tem sido disseminado recentemente, mas sem ter sido documentado até então. Foram coletados os dados oficiais sobre usuários, seguido por um estudo qualitativo em Hermosillo, no Estado de Sonora. Foram estudados a legislação pertinente e o contexto local em Hermosillo. Os dados sobre os usuários de heroína foram encontrados nos centros de atendimento a pessoas com HIV, uma vez que não existe outra fonte desses registros. A legislação mexicana visa a reabilitação dos usuários, evitando sua criminalização, mas sua vida cotidiana os empurra para os circuitos do crime. Assim, os indivíduos cometem crimes para permanecer na prisão, onde conseguem controlar a dependência e obter a droga em casos de síndrome de abstinência. O governo mexicano não dispõe de dados empíricos para melhorar os programas e leis relacionados ao uso da heroína. As práticas diárias dos usuários se transformam em riscos, não apenas epidemiológicos como também sociais, tanto para a comunidade quanto para os próprios usuários. Além disso, a falta de acesso a serviços, em função da combinação de estigmatização, criminalização e violência, aumenta as desigualdades, criando um ciclo que reproduz e o sofrimento enquanto parte de uma estrutura social. Portanto, são necessárias mudanças urgentes no sistema de justiça.

Uso de heroína inyectada y el riesgo de hepatitis C en tres ciudades de Colombia / Use of injected heroin and risk of hepatitis C in three cities in Colombia

RESUMEN: Introducción: La hepatitis C es uno de los grandes problemas de salud pública en el mundo, especialmente por su alta transmisibilidad por vía inyectada. Objetivo: Identificar la prevalencia de la infección por VHC, y factores asociados en usuarios de drogas psicoactivas inyectables en tres ciudades (Armenia, Bogotá y Cúcuta) de Colombia. Métodos: Estudio descriptivo transversal en 668 usuarios de drogas inyectables captados a través de muestreo guiado por el respondiente, a quienes se indagó sobre características demográficas y comportamientos de riesgo. Se utilizó la prueba de Anticuerpos, tomado en papel de filtro y se confirmaron los casos de VHC, con pruebas de carga viral de RNA. Se estimó la prevalencia de VHC y los factores asociados con pruebas estadísticas Chi-cuadrado y se calcularon razones de prevalencia crudas y ajustadas con regresión logística usando RDSAT y SPSS. Resultados: La prevalencia de infección por VHC fue del 17,5% y se encontraron como factores que aumentan la prevalencia de hepatitis: tener VIH, inyectarse con otra persona portadora del virus, utilizar dosis de una jeringa que estaba compartiendo, inyectarse con una jeringa casera y consumir marihuana. Como factor que reduce la prevalencia, el adquirir jeringas en droguerías u otras tiendas. Conclusión: Se evidencia un consumo establecido de drogas por vía inyectada, poniendo de relieve la importancia de generar intervenciones para la reducción de daños y la prevención de hepatitis C en estas tres ciudades del país.

ABSTRACT: Introduction: Hepatitis C is one of the most neglected diseases by governments internationally. Objective: Identify the prevalence of hepatitis C and associated injection drug users in three cities of factors Colombia. Methods: Cross-sectional study of 668 injecting drug users recruited through respondent-driven sampling, inquired about demographic characteristics and risk behaviors. Laboratory testing was used on filter paper and cases of hepatitis C viral load tests with RNA were confirmed. Hepatitis C prevalence and associated factors was estimated with Chi-square test statistics and reasons for crude and adjusted prevalence were calculated using logistic regression. Results: The prevalence of hepatitis C was 17.5% and were found as factors that increase the prevalence of hepatitis: having HIV, injecting another person carrying the virus dose used was sharing a syringe, injected with a syringe and consume marijuana. As a factor that reduces the prevalence, purchase syringes in drug stores or other stores. Conclusion: This research evidence established consumption of drugs by injection , and the presence of hepatitis C in social networks of IDUs and highlights the importance of developing interventions for harm reduction and prevention of hepatitis C in this population these three cities.

The study on the association between smoking and pain intensity in heroin-dependent patients receiving methadone maintenance treatment / 中国神经精神疾病杂志

Objective To explore the relationship between smoking and pain intensity in heroin-dependent patients (HDPs) receiving methadone maintenance treatment (MMT).Methods A total of 603 HDPs from MMT outpatients completed a socio-demographic and clinical characteristics questionnaire,a smoking questionnaire,Heaviness of Smoking Index,and Zung's Self-rating Depression Scale.Five-point Verbal Rating Scale was used to assess pain intensity.Results After adjustment for the confounding effects of socio-demographics,clinical characteristics,and depressive symptoms in the analysis of covariance,smokers had significantly higher pain intensity score compared with non-smokers (F=1 1.836,P=0.002).Multiple comparisons showed that the pain intensity level of patients with moderate-to-severe nicotine dependence was the highest,patients with mild nicotine dependence took the second place,and patients with no nicotine dependence was the lowest [(3.11±1.04) vs.(2.67±1.13) vs.(2.47± 1.15),all P＜0.05].Conclusion Smoking is significantly associated with pain in HDPs receiving MMT.The more severe the nicotine dependence that a HDP has,the intense the pain he/she has.

A correlation analysis on depression and anxiety and peripheral blood cell counts in heroin-dependent patients receiving methadone maintenance treatment / 中华行为医学与脑科学杂志

Objective To explore the relationship between depression and anxiety and peripheral blood cell counts ( white blood cell ( WBC) ,neutrophil ( NEU) ,lymphocyte ( LYM) ,red blood cell ( RBC) and hemoglobin ( HGB) ) of heroin?dependent patients receiving methadone maintenance treatment ( MMT) . Methods Two hundred and fifty?two MMT heroin addicts, who had received peripheral blood tests within the week prior to the study,were administered with a general information questionnaire,SDS and SAS. The results of blood tests of these patients were compared with those of 109 healthy people in physical examina?tion. Multiple linear regression was used to analyze associations between indicators of peripheral blood cell counts and depressive and anxiety symptoms. Results Compared with healthy controls,MMT patients had significantly higher proportions of elevated WBC(14.7%vs 3.7%),NEU(12.7% vs 2.8%) and LYM(9.9%vs 2.8%) counts (all P<0.05),and low RBC(10.3%vs 4.6%) counts and HGB(11.5%vs 4.6%) concentra?tion (both P<0.05). Multivariate linear regression analysis showed that blood cell counts of WBC ( β=0.261, P<0.01),NEU ( β=0.264, P<0.01),LYM ( β=0.196, P=0.003) and RBC ( β=-0.144, P=0.021) were independently associated with depression;and blood cell counts of WBC ( β=0.298, P<0.01) and LYM ( β=0.269, P<0.01) were independently associated with anxiety. Conclusion Improving the in?flammatory and malnutrition status may be helpful for reducing depressive and anxiety symptoms of MMT her?oin addicts.

Effect of abstinence duration on brain small-world network characteristics in heroin addicts:Resting-state fMRI study / 中国医学影像技术

Objective To investigate the effects of different abstinent duration on brain functional network of heroin addicts at resting state.Methods Sixteen heroin addicts during protracted abstinence for 11-13 months (PA12 group) and twenty heroin addicts during protracted abstinence for 5-7 months (PA6 group) were recruited in the resting-state functional MRI study.Graph theoretical methods were applied to construct topological organization of whole brain network and nodes betweenness of the networks in all subjects,and the between-group differences were analyzed.The correlation of the node betweenness with the abstinence duration was conducted.Results There was no significant difference (P＞0.05) in the small world characteristic (γ≈1,λ》1) between two groups.Compared with the PA6 group,the PA12 group demonstrated significantly decreased nodal betweenness in regions of left parahippocampal gyrus,left precentral gyrus,and significantly enhanced nodal betweenness in regions of the left cuneus,left temporal and right middle occipital gyrus (all P＜0.05).Moreover,the betweenness of the left precentral gyrus (r =-0.52,P =0.001) and parahippocampal gyrus (r=-0.49,P=0.002) were negatively related with the abstinence duration,the betweenness of the right middle occipital was positively correlated with the abstinence duration (r=0.49,P=0.003).Conclusion The brain network small world topology of heroin addicts tend to be stable after 5-7 months of abstinence.Long-term abstinence may minimize the addicfs memory of drugs and potential drug seeking behavior,and recover addicts' visual spatial attention function.

Impaired sustained attention function of heroin abusers in attention switching / 中国神经精神疾病杂志

Objective To investigate the effect of heroin abuse on attention switching. Methods Thirty-six Heroin abusers (33 males, 3 females) and 36 controls (32 males, 4 females) were enrolled in the study. Their cognitive function was tested by using the Switching Task, including Sustained Attention trials and Switching Attention trials. The reaction time and accuracy were recorded separately by the computer. Results The accuracy or reaction times were not signifi-cantly different between Switching Attention trial and Sustained Attention trial in heroin abusers, suggesting a lower Switch Costs value compared to the healthy controls [(19.7 ± 66.8) ms vs. (85.1 ± 92.4) ms]. The healthy controls showed faster reaction speed [Sustained Attention trial (695.3 ± 95.9) ms vs. Switching Attention trial (780.3 ± 93.3) ms, P<0.05] and higher accuracy [Sustained Attention trial (98.0%±2.2%) vs. Switching Attention trial (93.8%±5.0%), P<0.05] under the Sustained Attention trial. Compared with the healthy controls, the heroin abusers showed slower reaction speed [(791.6 ± 74.3) ms vs. (695.3±95.9) ms, P<0.05] and lower accuracy [(92.5%±8.4%) vs. (98.0%±2.2%), P<0.05] in Sus-tained Attention trial, but not in Switching Attention trial. Conclusions The present study has revealed absence of Switch Costs in heroin abusers, which may be related to the damage of heroin abusers in their Sustained Attention function.

The status of personality disorder and the relationship with childhood trauma in heroin addicts / 中国基层医药

Objective To investigate the status of personality disorder and the relationship with childhood trauma in heroin addicts.Methods 108 heroin dependent patients were investigated by Personality Disorder Ques-tionnaire -4 +(PDQ -4 +)and Childhood Trauma Questionnaire -Short From (CTQ -SF).Results The comor-bidity rate of heroin dependence and personality disorder was between 47.2% and 10.2%,which had a higher posi-tive rate of for borderline (47.2%)and antisocial (38.0%)personality disorder and the lowest for depression (10.2%).The borderline personality disorder score was highest[(4.63 ±2.16)points]and the lowest was histrionic personality disorder [(2.65 ±1.49)points]in 12 subscales,which were significantly higher than those in the national norm,and the differences were statistically significant (t =13.54,2.57,all P <0.05).It had significantly positive correlation between borderline and antisocial personality disorder and the each five factors of childhood trauma experi-ence (r =0.265,0.390,0.207,0.303,0.276;0.225,0.219,0.228,0.236,0.287,all P <0.05 ).In addition, depressive personality disorder and physical abuse,emotional neglect and body ignored showed significantly positive correlation (r =0.226,0.227,0.196,all P <0.05).Conclusion There was the comorbidity rate of personality disorders and heroin dependence,and the higher positive rate was borderline and antisocial personality disorders.It was a certain correlation of childhood traumatic experience and personality disorders,especially borderline,antisocial and depressive personality disorder.

Forensic Analysis of 20 Dead Cases Related to Heroin Abuse / 法医学杂志

OBJECTIVES@#To perform retrospective analysis on 20 dead cases related to heroin abuse, and to provide references for the forensic assessment of correlative cases.@*METHODS@#Among 20 dead cases related to heroin abuse, general situation, using method of drug, cause of death and result of forensic examination were analyzed by statistical analysis for summarizing the cause of death and pathologic changes.@*RESULTS@#The dead were mostly young adults, with more male than female. The results of histopathological examinations showed non-specific pathological changes. There were four leading causes of death, including acute poisoning of heroin abuse or leakage （13 cases, 65%）, concurrent diseases caused by heroin abuse （3 cases, 15%）, inspiratory asphyxia caused by taking heroin （2 cases, 10%）, and heroin withdrawal syndrome （2 cases, 10%）.@*CONCLUSIONS@#The forensic identification on dead related to heroin abuse must base on the comprehensive autopsy, and combine with the qualitative and quantitative analysis of heroin and its metabolites in death and the case information, as well as the scene investigation.

Association of single nucleotide polymorphisms of brain-derived neurotrophic factor gene with heroin dependence in the Han population of Shaanxi Province / 西安交通大学学报(医学版)

Objective To examine the association between the polymorphisms of brain-derived neurotrophic factor (BDNF)gene with heroin dependence.Methods Genomic DNA was isolated from the venous blood leukocytes of 308 unrelated patients with heroin dependence and 31 7 healthy individuals.Seven single nucleotide polymorphisms (SNPs)were genotyped using MassARRAY system.Data were analyzed using HaploView 4.0 and SPSS 20.0 software.Results There was a significant difference in the genotype frequency of rs6265 between heroin dependence group and healthy control group (χ2 =1 5.1 5 1,P =0.001).The rs6265 G allele was significantly higher than in controls (χ2 =9.864,P =0.002,OR =1.429,95% CI =1.143 -1.786).Furthermore,there was also a significant difference in the genotype frequency of rs13306221 between heroin dependence group and control group (χ2 =7.699,P =0.006).The rs13306221 G allele was significantly higher than in controls (χ2 =7.137,P =0.008,OR =0.539,95% CI =0.340-0.853).Strong linkage disequilibrium (LD)was observed in one block (D’> 0.9;r 2 >0.8),and significantly less G-G haplotype frequency of block 1 (χ2 =4.546;P =0.033)was found in heroin dependence group. Conclusion Our findings support the role of BDNF rs6265 and rs13306221 polymorphisms in heroin dependence and may guide future studies to identify other genetic risk factors for heroin dependence.

Brain Network Characteristics in Heroin Addicts:A Resting-state Functional MRI Study / 中国医学影像学杂志

PurposeHeroin addiction is a chronic and recurrent functional brain disease, there are some functional changes in specific brain regions, but the network character remains unclear. The aim of this paper is to explore the network character of brain resting-state functional network in heroin addicts, to identify the potential neuromechanism of heroin addiction from the perspective of brain network.Materials and Methods Thirty heroin addicts (HA group) and twenty-nine healthy controls (control group) underwent resting-state functional MRI scanning using GE 3.0T MRI scanner. The brain functional networks were constructed based on graph theory, the small-world properties and node properties were calculated and compared between the two groups, the correlation between the total dosage of heroin and node degree was analyzed.Results Compared with control group, the small world characteristics of HA group was altered with statistically significant difference (P<0.05, corrected by false discovery rate); the node degrees in orbit frontal regions increased, while those in occipital brain regions decreased (P<0.05, corrected by false discovery rate). No correlation was found in HA group between node degree and the total dosage of heroin.Conclusion These results suggest that topology of functional brain networks were altered in heroin addicts which tends to random networks; increased motivational driving to the salience of drug and decreased visuospatial attention in heroin addicts may provide a strategy for identifying the neuromechanism of heroin addiction.

Effect of Heroin on DLG4 Expression in Hippocampus, Amygdala and Frontal Cortex of Rats / 法医学杂志

Objective To observe the expression of discs large hom olog 4 (DLG4) protein in hippocam-pus, am ygdala and frontal cortex of rats and evaluate postsynaptic density in heroin dependence. Meth-ods The rat heroin dependent m odel was established by increasing intraperitoneal injection of heroin. DLG4 proteins in hippocam pus, am ygdala and frontal cortex of heroin dependent 9, 18, 36 days rats w ere detected with im munohistochem ical staining and com pared with that in the control group. Results DLG4 proteins in hippocam pus, am ygdala and frontal cortex w ere gradually reduced with extension of heroin dependent tim e. Conclusion Heroin dependence can affect postsynaptic density of hippocam pus, am ygdala and frontal cortex. The changes becom e m ore apparent with extension of heroin dependence tim e.

Outcomes from the Malaysian Arm of The International Survey Informing Greater Insights in Opioid Dependence Treatment (INSIGHT) Project

Background: Opioid dependence (OD) is a chronic, relapsing condition representing a significant societal burden in Asia. Opioid maintenance treatment (OMT) in combination with psychosocial treatment is considered to be the most effective strategy to treat opioid dependence. In Malaysia, about 52,000 patients reported receiving OMT in December 2012. Objective: The International Survey Informing Greater Insights in Opioid Dependence Treatment (INSIGHT) project aimed to assess aspects of OMT access and quality of care by surveying patients and users with opioid dependence, and healthcare professionals treating opioid-dependent patients. Materials and Methods: Using a structured questionnaire, 50 patients who were currently receiving OMT (or had received OMT in the past 3 months) and 77 physicians were surveyed in Malaysia regarding the provision and quality of OMT. Results: Patients were predominately male and in their thirties. Nearly all patients (98%) reported currently receiving methadone liquid; almost half (48%) reported ever having received psychosocial counselling and only 14% had ever received buprenorphine−naloxone in the past. Most physicians reported they were treating their patients with OMT (77% on methadone and 15% on buprenorphine−naloxone), and 3% used psychosocial counselling alone. Although methadone maintenance doses were close to levels recommended by WHO guidelines, induction doses of methadone, and both induction and maintenance doses of buprenorphine were well below these levels in Malaysia. Conclusions: The findings suggest that OMT implementation in Malaysia can be improved by providing patients with more education on treatment options, better access to available treatments, including abuse-deterrent formulations, and psychosocial support.

Action potential and L-type calcium channel currents in myocardial cells of rat models of heroin addiction / 中国组织工程研究

BACKGROUND:Calcium channel abnormalities can damage myocardium. Heroin can directly affect calcium ion channel, and alter myocardial structure. OBJECTIVE:To study the changes of heroin-induced myocardial ultrastructure, L-type calcium channel current and action potential of myocardial cel s after rat cardiac arrhythmia. METHODS:Sprague-Dawley rats were randomly divided into control group and model group. In the model group, rats were administered heroin at initial dose of 5 mg/kg?d. The daily dose escalation method was used (increasing dose:2.5 mg/kg?d) to replicate rat models of heroin addiction. At 20 days, models of heroin addiction were successful y established. At 30 days after increasing the dose, rat models of heroin addiction-induced arrhythmias were further established. RESULTS AND CONCLUSION:Compared with the control group, the electron microscopy demonstrated that myocardial structure changes mainly presented nuclear membrane shrinkage, nuclear condensation, nuclei became smal , chromatin assembled into blocks, mitochondria disordered and disappeared, sarcomeres disordered, focal fracture, and unclear myofilament in rat models of heroin addiction. Electric current-voltage curve of myocardial cel L-type calcium channel current showed the increasing trends. The 90%repolarization action potential was significantly shortened. These data indicated that heroin can directly lead to the pathological change of myocardial structure. Calcium channel current change is one of the main reasons for myocardial injury.