The medieval Persian manuscript of Afyunieh: the first individual treatise on the opium and addiction in history / 中西医结合学报

According to historical evidence, the abuse of opium has been reported all over the globe-specifically throughout Eastern nations-since the sixteenth century. Before that, opium had mostly been applied as medication. Reference has been made in traditional Persian medical literature to the method of cultivation, properties, side effects and toxicity. In sixteenth century Iran, during the reign of the Safavids, opium abuse began. It was from then that prominent Persian scholars started to think of solutions to this societal problem. One of the most famous scholars was Imad al-Din Mahmud ibn Mas'ud Shirazi, who composed a book concerning addiction-Afyunieh, a comprehensive book on the topic of opium and all issues of opium. Furthermore, he recommended methods for reducing opium dose as well as substitution with other medications that had a narrower range of side effects, in order to eradicate dependency upon opium and opium-derived materials. This is most likely the first book that comprehensively addressed opium and discussed drug rehabilitation methodology, in traditional Persian medical literature. In this historical review, the authors have introduced the book Afyunieh, which presents methods for treating addiction to and giving up opium; the text comprises a synthesis of the author's opinions, professional experience and references to the work of other famous physicians.

Drop-out from a drug treatment clinic and associated reasons

The aim of this study was to assess drop-out rates and associated reasons among patients at the Iranian National Center for Addiction Studies [INCAS] clinic. In a one-year period [April 2014 to March 2015], all patients with drug dependence who had been referred for treatment and attended for a first assessment were included in this study [N=242]. Those who received treatment were followed until March 2016. Survival analysis showed that 70.2% had dropped out from treatment. Log rank test showed that treatment drop-out rates differed between the different approaches used [P < 0.001], with the lowest slope inbuprenorphine maintenance treatment and the highest in the detoxification programme. Drop-out rates within the first three months was 62% [SE= 0.05] and 82.4% [SE=0.03] for opioids and stimulants dependence, respectively. Analyses were performed using SPSS [Version 21.0] and STATA software, [version 13.0]. From the patients' perspective, motivational inconsistencies were considered as the main reason for not starting or leaving treatment. The findings of this study could give service providers a better grasp of drop-out rates and the associated reasons

Exploring neural correlates of different dimensions in drug craving self-reports among heroin dependents

Introduction: Drug craving could be described as a motivational state which drives drug dependents towards drug seeking and use. Different types of self-reports such as craving feeling, desire and intention, wanting and need, imagery of use, and negative affect have been attributed to this motivational state. By using subjective self-reports for different correlates of drug craving along with functional neuroimaging with cue exposure paradigm, we investigated the brain regions that could correspond to different dimensions of subjective reports for heroin craving

Methods: A total of 25 crystalline-heroin smokers underwent functional magnetic resonance imaging [fMRI], while viewing heroin-related and neutral cues presented in a block-design task. During trial intervals, subjects verbally reported their subjective feeling of cue induced craving [CIC]. After fMRI procedure, participants reported the intensity of their [need for drug use] and [drug use imagination] on a 0-100 visual analog scale [VAS]. Afterwards, they completed positive and negative affect scale [PANAS] and desire for drug questionnaire [DDQ] with 3 components of [desire and intention to drug use], [negative reinforcement,] and [loss of control]

Results: The study showed significant correlation between [subjective feeling of craving] and activation of the left and right anterior cingulate cortex, as well as right medial frontal gyrus. Furthermore, the [desire and intention to drug use] was correlated with activation of the left precentral gyrus, left superior frontal gyrus, and left middle frontal gyrus. Subjects also exhibited significant correlation between the [need for drug use] and activation of the right inferior temporal gyrus, right middle temporal gyrus, and right parahippocampal gyrus. Correlation between subjective report of [heroin use imagination] and activation of the cerebellar vermis was also observed. Another significant correlation was between the [negative affect] and activation of the left precuneus, right putamen, and right middle temporal gyrus

Discussion: This preliminary study proposes different neural correlates for various dimensions of subjective craving self-reports. It could reflect multidimensionality of cognitive functions corresponding with drug craving. These cognitive functions could represent their motivational and affective outcomes in a single item [subjective craving feeling] or in self-reports with multiple dissociable items, such as intention, need, imagination, or negative feeling. The new psychological models of drug craving for covering various dimensions of subjective craving self-reports based on their neurocognitive correspondence could potentially modify craving assessments in addiction medicine

Human laboratory settings for assessing drug craving; implications for the evaluation of treatment efficacy

Research on assessing craving in laboratory settings often involves inducing and then measuring craving in subjects. Cue-induced craving is studied in laboratory settings using the cue reactivity paradigm, in which drug-related photos, videos, evocative scripts, olfactory cues, and paraphernalia may induce craving. Cueinduced craving evoked by drug-related stimuli could be associated with relapse and recurrence of drug addiction. In this article, the authors review different methods of assessing craving in laboratory settings and explain how human laboratory settings can bridge the gap between randomized clinical trials [RCTs] and animal models on pharmacological treatments for drug dependence. The brief reviewed literature provides strong evidence that laboratory-based studies of craving may improve our understanding of how subjective reports of drug craving are related to objective measures of drug abuse and laboratory settings provide an opportunity to measure the degree to which they co-vary during pharmacological interventions. This issue has important implications in clinical studies

Role of maintenance treatment in opioid dependence

Methadone maintenance treatment [MMT] involves the daily administration of the oral opioid agonist methadone as a treatment for opioid dependence-a persistent disorder with a substantial risk of premature death. MMT improves health and reduces illicit heroin use, infectious-disease transmission, and overdose death. However, its effectiveness is compromised if low maintenance doses of methadone [<60 mg] are used and patients are pressured to become prematurely abstinent from methadone. Pregnancy and psychiatric comorbidity are not contraindications for MMT. As an alternative to MMT, other oral opioid agents [eg, naltrexone, buprenorphine] may increase patient choice and avoid some of the more unpleasant aspects of MMT. The public-health challenge for the future is to develop and continue to deliver safe and effective forms of opioid maintenance treatment to as many opioid-dependent individuals as can benefit from them