Heroin Addiction and Related Clinical Problems 1999; 1(1):1-8
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies - University of Pisa, Via Roma 67 - 56100 Pisa - Italy
Summary: The medical, psychiatric, psychological and social manifestations of heroin addiction require more than an integrated intervention. To effectively treat addiction, rehabilitation and/or prevention is necessary but we must also treat the patients according to the phase of illness. In other words, it is often necessary to adapt the intervention to the clinical phase of illness, by trying to raise the programme “retention rate”. This condition is indispensable in the rehabilitative process. The nature of drug addiction will often make it necessary for patients to be contacted in the street, so that they can benefit from counselling and “harm reduction”. Finally, primary or secondary prevention cannot be separated from a global intervention philosophy.
Publication Type: Editorial
Heroin Addiction and Related Clinical Problems 1999; 1(1):9-12
Institute of Nervous and Mental Diseases, Section of Pharmacology, University of Siena, Via Aldo Moro, 4-53100 Siena, Italy
Summary: History teaches us how difficult it is to challenge some axioms that are rooted in common culture, even when they are not supported by scientifically indisputable evidence. The two most famous examples of controversial scientific novelty were the Copernican theory and the theory of evolution. Do analogous mechanisms underlie the refusal of behaviour disorder, i.e. psychiatric disease or drug addiction, as a biological phenomenon? Man, it is said, was created by God in his own image and likeness, and God gave him a soul; according to this view, it must be the soul that is responsible for his behaviour. With increasing precision, modern psychobiology is succeeding in correlating specific aspects of animal and human behaviour with definite brain areas, and with the neurotransmitters that are located in them. Various behaviours have a clear genetic basis, but particular genes take part in organizing each behaviour; similarly, various neurotransmitters in specific brain areas interact, so causing a given form of behaviour. Psychiatric disturbances, including drug addiction, are leaving the limbo of approximation or even of utopianism, to enter into the scientific dimension of medical empiricism
Publication Type: Point of View
Heroin Addiction and Related Clinical Problems 1999; 1(1):13-17
Dole V. P.
The Rockfeller University Hospital, 1230 York Avenue, New York, NY, 10021 USA
Summary: Methadone maintenance treatment in the United States is reaching maturity. During the past three decades it has progressed from an innocent childhood, through a turbulent adolescence, to recognition as an essential medical procedure. At present approximately 115,000 former heroin addicts in the United States are being treated in 750 clinics located in 40 of the 50 states. The treatment has survived challenge by professional sceptics, by ideologically hostile agencies, by competitive modalities, and even by well-intentioned clinicians in methadone programs who have prescribed inadequate doses of the medication
Publication Type: Personal Perspectives
Heroin Addiction and Related Clinical Problems 1999; 1(1):19-34
Eap C. B., Deglon J. J., Baumann P.
DUPA, Hospital de Cery, CH-1008 Prilly-Lousanne, Switzerland
Summary: Recent data on the pharmacokinetics and the pharmacogenetics of methadone, taking into account its enantiomers, have been collected. In particular, it has been demonstrated that isozymes belonging to the cytochrome P450 superfamily play a major role in the metabolism of methadone. During the past ten years, a large amount of informations has been collected on this enzymatic system. In particular it is now well known that these isozymes can be inhibited or can be induced by specific compounds. A large variability in the activities of these isozymes has been shown, a variability which is both genetically and environmentally controlled. These data allow us to explain and possibly avoid the majority of metabolic interactions involving methadone and to undestand the interindividual variability of methadone pharmacokinetics. This latter point is of major clinical relevance and stresses the importance of individualization of methadone treatment
Publication Type: Review Article
Heroin Addiction and Related Clinical Problems 1999; 1(1):35-41
Kastelic A., Kostnapfel-Rihtar T.
Centre for Treatment of Drug Addiction, Zaloska, 29, 1000 Ljublijana, Slovenia
Summary: In this article on the quality of service in the methadone maintenance program the authors wished to determine whether the establishment of the network of centers for the prevention and treatment of dependence on illegal drugs enabled higher quality professional services in the execution of the methadone maintenance program, greater relevance in the program and more satisfaction on the part of those involved.
Publication Type: Policy Initiatives
Heroin Addiction and Related Clinical Problems 1999; 1(1):42-42
IVS Deventer, Brink 40, Deventer 7411-BT, The Netherlands
Summary: Not Available
Publication Type: Letter to the editor
Heroin Addiction and Related Clinical Problems 1999; 1(1):43-44
Pani P. P., Agus A., Gessa G. L.
SerT, AUSL 8, Cagliari, Italy
Summary: Not available
Publication Type: Letter to the editor
Heroin Addiction and Related Clinical Problems 1999; 1(2):7-13
Maremmani I., Shinderman M. S.
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, University of Pisa, Via Roma, 67-56100 Pisa, Italy
Summary: The authors, on the basis of their clinical experience suggest that polydrug abuse in heroin addicts could be correlated with a condition of opiate dependence improperly compensated by street heroin or by substitutive treatment dosages. Thus the search for an appropriate methadone dosage is crucial not only because it enhances patient’s retention rate within the treatment group, so allowing an improvement in social rehabilitation, but also because it reduces the risk of polydrug abuse.
Publication Type: Proposals
Heroin Addiction and Related Clinical Problems 1999; 1(2):15-18
Weinbergstr. 9, Zurich, Switzerland
Summary: Switzerland's drug problems became notorious, when 'needlepark' Platspitz and heroin trials made international headlines. Its mass of drug addicts and the dilemma they caused shook Swiss society. An overwhelming majority of the Swiss voted to make it legal to treat drug addicts with heroin. Drugs have threatened the independence and the liberal foundations of the Swiss federation. Drug problems still threaten all that.
Publication Type: Point of view
Heroin Addiction and Related Clinical Problems 1999; 1(2):19-26
Rue de la Vanne, 27-1000 Brussels, Belgium
Summary: All the data currently available seem to indicate that the fact that the availability of methadone treatment was limited may one day be seen as an inexcusable error of judgement (much more serious than that committed in some countries with regard to haemophiliacs and transfusion recipients) which will cost the lives of hundreds of thousands of people and wreak havoc on the health care budgets of several European countries
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 1999; 1(2):27-34
Dineeva N. R.
Institute of Raising the Level of Professional Skill, Volokolamskoe shosse, 30- Moscow, Russia, 123182
Summary: Part I. In Russia, units of narcological dispensaries for adolescents are the basic organizational structure conducting treatment and prophylactic work with adolescents who consume alcohol, drugs and toxic substances. Over a five-year period, the incidence the incidence of drug-addicted adolescents rose to 13 times the 1992 level, when 4.5 per 100 thousand adolescents were registered. In 1996, 3891 adolescent drug addicts were counted, corresponding to 59.8 per 100 thousand adolescents. The group of adolescents using spirits is the largest – 4067 people, The group using toxic substances is the second largest, comprising 1118 patients. The third largest group, with 914 subjects, consists of drug addicts and patients who consume drugs. Their number is 914 subjects. Consumers of “strong” drugs are adolescents in the 16-18 age who have been hospitalized with a non-remissional history of drug addiction, or with only short-term periods of abstinence from using drugs. Part II. In order to set away from settled conceptions, an attempt has been made to treat the assessment of the prevalence of narcomanias and toxicomanias from the point of view of social rather than exclusively medical factors connected with them. As predictors of narcomanias we considered medical, socio-economic, demographic, cultural, physical training and sports indices. As a result, it was established that the prevalence of narcotism depends on 4 basic indices, as follows: (1) the specific gravity of group B production (i.e. the production of means of consumption); (2) wages per family member per month; (3) average number of square meters in the dwelling-place per inhabitant; (4) the number of those working in the non-production field.
Publication Type: Research Article
Heroin Addiction and Related Clinical Problems 1999; 1(2):35-38
Guffens J. M.
SETHS Saint Tropez, Le Vieux Murier, Route de Tahiti, 83 - 990 Saint tropez, France
Summary: The incidence of hepatitis C in intravenous drug addicts is widespread; while that of hepatitis B is frequent; the co-infection of both with the HIV virus is not rare.
Publication Type: Clinical Practice
Heroin Addiction and Related Clinical Problems 1999; 1(2):39-42
Michelazzi A., Vecchiet F., Cimolino T.
Combatt-SITD - Via San Lazzaro, 9 - Trieste, Italy
Summary: In the summer of 1994, family doctors in Trieste (Italy) began to treat patients who had opiate drug-addiction problems by giving them methadone substitute therapy within therapeutic programmes decided in surgeries. The drug-addict became just a patient once again, often a chronic patient who could be treated in the family doctor’s surgery. More than 50 doctors now prescribe substitute medicine in their surgeries, in Trieste.
Publication Type: Policy Initiative