Craving for heroin: difference between methadone maintenance therapy patients with and without ADHD / Fissura por heroína: diferença entre pacientes em terapia de manutenção com metadona com e sem TDAH

Abstract Introduction Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder persisting in adulthood in 40-60% of cases. Clinical and neuroimaging studies suggest that patients affected by both drug addiction and ADHD show higher rates of craving for drug than patients without ADHD. We designed a pilot open-label study to investigate the effects of ADHD on craving for heroin in methadone maintenance therapy patients. Method Patients were recruited from outpatient facilities in an addiction treatment unit in the municipality of Alba, Italy. They were assessed using the Structured Clinical Interview for DSM-5 (SCID-5), the SCID-5 for Personality Disorders (SCID-5-PD), the Diagnostic Interview for Adult ADHD, second edition (DIVA 2.0), and the Clinical Opiate Withdrawal Scale (COWS). Categorical variables were examined using the chi-square test, and continuous variables, the t-test and Mann-Whitney's U test for normally and non-normally distributed data, respectively. Data distribution was evaluated using Shapiro-Wilk's test. Significance was set at p=0.05. Bonferroni correction was applied (0.0063) to avoid type I error. Results A total of 104 patients were included in the study: 14 affected by ADHD (13.5%) and 90 were not affected (86.5%). Patients with ADHD showed higher intensity of craving for heroin than patients without ADHD in the absence of withdrawal symptoms. Conclusion Drug addiction and ADHD share various neurobiological mechanisms that mutually influence the evolution of both disorders. In particular, dopamine dysfunction within various brain circuits may influence impulsivity levels, motivation, inhibitory control, executive functions, and behavior and, consequently, the intensity of craving.

Resumo Introdução O transtorno de déficit de atenção e hiperatividade (TDAH) é um transtorno do neurodesenvolvimento que persiste na idade adulta em 40-60% dos casos. Estudos clínicos e de neuroimagem sugerem que pacientes afetados tanto por adição quanto por TDAH apresentam maiores índices de fissura (craving) por droga do que pacientes sem TDAH. Este estudo piloto aberto investigou os efeitos do TDAH sobre fissura por heroína em pacientes em terapia de manutenção com metadona. Método Os pacientes foram recrutados em serviços ambulatoriais em uma unidade de tratamento de adição na cidade de Alba, Itália. Eles foram avaliados usando os seguintes instrumentos: Structured Clinical Interview for DSM-5 (SCID-5), SCID-5 for Personality Disorders (SCID-5-PD), Diagnostic Interview for Adult TDAH, second edition (DIVA 2.0) e Clinical Opiate Withdrawal Scale (COWS). Variáveis categóricas foram examinadas utilizando o teste do qui-quadrado, e variáveis contínuas, o teste t e o teste U de Mann-Whitney para dados com distribuição normal e não normal, respectivamente. A distribuição dos dados foi avaliada usando o teste de Shapiro-Wilk. O nível de significância foi estabelecido em p=0,05. A correção de Bonferroni foi aplicada (0,0063) para evitar erro tipo I. Resultados Um total de 104 pacientes foram incluídos no estudo: 14 com TDAH (13,5%) e 90 sem (86,5%). Pacientes com TDAH mostraram maior intensidade de fissura por heroína do que pacientes sem TDAH na ausência de sintomas de abstinência. Conclusão Adição e TDAH compartilham mecanismos neurobiológicos que influenciam mutuamente a evolução dos dois transtornos. Em particular, a disfunção da dopamina em vários circuitos cerebrais pode influenciar os níveis de impulsividade, motivação, controle inibitório, funções executivas e comportamento, e, portanto, a intensidade da fissura.

Oral health assessment for users of marijuana and cocaine/crack substances

Abstract: The objective of this study was to assess the oral health status of users of illicit drugs such as marijuana and cocaine/crack and compare it with individuals not using these chemical substances. Questionnaires were applied to 35 illicit drugs users to gather information on demographic status, general health, and use of drugs. Then, a clinical assessment of the oral health condition was performed to collect data on decayed, missing and filled teeth (DMFT) index, salivary flow rate (SFR), and mucosal lesions. The control group was composed of 35 non-illicit drug users. In the experimental group, 91.43% were males, 80% were smokers, and 42.85% were alcoholics. Cocaine was the most common drug used (77.15%), followed by marijuana (68.6%), and crack (51.4%). The average DMFT index was 9.8 and the SFR was reduced in 60% of subjects. Mucosal alterations were detected, but no potentially malignant disorders or oral cancer were diagnosed. Compared to control group, significantly higher values for gender (40%, p = 0.0001), smoking (22.86%) and heavy drinking (5.7%) habits (p = 0.0001), SFR (31.4%; p = 0.0308), and oral lesions (p = 0.0488) were found for the experimental group, although significantly higher values were found in the control group for DMFT index (p = 0.0148). It can be concluded that the use of illicit drugs contributed to an increased prevalence of oral mucosa lesions. In addition, a decline on SFR and a reduced DMFT index was observed for illicit drug users.

Clinical effect of dynorphin on heroin addicts.

This study assessed the clinical effectiveness, physiological responses and also adverse effects of dynorphin in heroin dependent detoxication. The subjects were randomly assigned into three groups and received intravenous injections of dynorphin at the dose of 180 (6 patients) or 60 (7 patients) or 0 (8 patients) micrograms/kg three times a day for 6 days. There was no statistical difference in withdrawal syndrome between each group. However, the drug craving feeling in the dynorphin groups was reduced when compared to the placebo group. There was no report of any adverse effects of the drug or abnormal laboratory results from the subjects during the study period.

Treatment of post withdrawal depressive symptoms in detoxified heroin addicts with fluoxetine and naltrexone maintenance

Depression is a common phenomenon which might lead to early relapse in the first few weeks after opiate detoxification. There is strong evidence that depression is related to the central nervous serotonin system. To prove the hypothesis of the impact of serotonin in depressive detoxified addicts, a selective serotonin re-uptake inhibitor in the after care was used. In a prospective, open clinical trial, forty detoxified opiate addict males were randomly assigned to two groups receiving either 50mg naltrexone alone or with fluoxetine 20mg. After 30 days, the depression score was significantly lower in the floxetine group, but the incidence of continued opiate intake remained higher in this group. However, the additional naloxone provocation test did not lead to withdrawal signs, proving the naltrexone maintenance

Is it worth treating cases of heroin abuse as in-patients?

One hundred admissions of heroin abuse in a psychiatric unit were studied retrospectively for their compliance and adherence to hospital regimen. 64% ranged between 21-30 years of age, there were 92% males and students followed by merchants were the commonest population group [39% and 27%]. 71% of patients stayed less than three weeks which is the minimal period for hospital treatment and they discharged themselves against medical advice. 57% were admitted once, 22% twice, 12% thrice and 7% more than thrice. There is an obvious waste of psychiatric beds especially in developing countries where outpatient treatment of herion abuse is discouraged. These facts should outline the strategy for the treatment of herion abuse

Naltrexone: useful tool in the treatment of heroin users; a review of the literature

La Naltrexona, un efectivo antagonista de los opiaceos ha demostrado ser muy efectivo en la rehabilitación de adictos a opiaceos que estén motivados, cuenten con buen apoyo familiar y que tengan buenas destrezas vocacionales. El tratamiento debe ser ofrecido por equipo especializados en la rehabilitación de adictos. El uso comercial de la Naltrexona promete ser de una alta eficiencia en aumentar el impacto positivo de los programas de rehabilitación. Esperamos que junto a las otras técnicas de educación comunitaria, adecuadas presiones sociales y las múltiples técnicas terapéuticas ya conocidas pueda prevenirse muchas de las miles de pérdidas humanas que ocurren en el mundo todos los años debido a estas dependencias. Además, esta sustancia tiende a restaurar el equilibrio hormonal de cuerpo lo que parece contribuir a que los pacientes presenten menos signos de tensión y disforia en el período de abstinencia