Tobacco
smoking prevalence in a large sample of heroin users accessing
rehabilitation
Pajusco B.,
Boschini A., Chiamulera C., Begnini M., Smacchia C., Lugoboni F.
Correspondence: Benedetta
Pajusco, MD; Department of Internal Medicine, Addiction Unit, University of
Verona, Policlinico GB Rossi, 37134 Verona, Italy. Phone: +39 045 8128291; Fax:
+39 045 8128290; E-mail: bene17@live.it
Summary: Although there is a large amount of anecdotal evidence about the
association between heroin abuse and tobacco smoking, there have been only a
few epidemiological studies. The present report is a cross-sectional survey on
tobacco smoking in heroin users. The sample included 10,530 drug users
accessing the Comunità di San Patrignano during the time period 1st January
1980 to 1st May 2007. Heroin-addicted subjects (n = 10,181) were not receiving
any type of substitution or detoxification therapy. Tobacco smoking prevalence
in the heroin-addicted group was 99.2% (10,095 out of 10,181 subjects). In the
large sample of heroin users observed in the present study, this confirms the
anecdotal report that most heroin users are smokers.
Publication Type: Regular
article
Heroin Addiction and Related
Clinical Problems 2011; 13(1):11-14
Alves D., Costa A.
F., Custódio D., Natário L., Ferro-Lebres V., Andrade F.
Dr D Alves, MD - Instituto
Politécnico de Bragança – Escola Superior de Saúde, Avenida D. Afonso V - 5300-121
Bragança, Portugal, EU
Telephone: +351 273 331 593 or
+351 273 331 443 - E-mail:add_diet@hotmail.com
Summary: Forty-nine heroin addicts in methadone maintenance treatment were
evaluated with the aim of studying the anthropometric, nutritional and sociodemographic
characteristics of these individuals. The BMI of heroin addicts who live with
their spouse/partner is significantly higher compared with other housing
situations. Most of the heroin addicts evaluated do not consume the minimum
servings of fruits, vegetables and grains recommended by the food pyramid, and
their consumption of sweets is high. This study reinforced the need for
intervention programmes specifically designed to correct the poor nutritional
status and diet of drug users, while considering this to be a major public
health issue.
Publication Type: Regular
article
Heroin Addiction and Related
Clinical Problems 2011; 13(1):15-20
Vorma H., Katila H.
Helena Vorma, M.D., Ph.D.
Helsinki University Central Hospital, Department of Psychiatry, P.O.Box 590,
FI-00029 HUS, Finland
E-mail:helena.vorma@hus.fi ;
Tel. +358 50 427 0582; Fax +358 9 471 63713
Summary: This study aimed to determine whether valproate is effective in
treating benzodiazepine withdrawal symptoms in subjects receiving opioid
maintenance treatment. Thirty patients were randomly selected for
benzodiazepine discontinuation with or without valproate. Twenty-eight subjects
completed the treatment. No serious adverse events were reported. After
randomization, the baseline median diazepam-equivalent doses were 60 mg in the
valproate group and 30 mg in the control group. No statistically significant
differences were found between the weekly mean withdrawal scores of the two
groups; even so, we believe that valproate may be useful in treating
benzodiazepine withdrawal in opioid-dependent subjects. More studies are needed
to confirm this.
Publication Type: Regular
article
Heroin Addiction and Related
Clinical Problems 2011; 13(1):21-28
Opioid
addiction complicated by alcoholism (in young men)
Blagov L. N.,
Kurgak D. I.
Correspondence: Lev N. Blagov,
M.D., Ph.D., Head of Chair of Drug Addiction, Russian State Medical University,
Moscow, Russia. E-mail: lblagov@rumbler.ru
Summary: A clinical run of addictive diseases shows a variety of trends.
One of these is an amplification of the clinical picture, with the appearance
of new structural components whose dynamic psychopathological characteristics
tend to increase in severity. It is important here to look at addictive
problems not only as constituting a dependence syndrome, but as an ongoing,
ever-varying clinical reality, showing the distinctive traits of a specific
psychopathological process that comprises post-toxic problems, including
combinations of personality disorders and their environmental predisposition.
So, opioid addiction complicated by alcoholism can be seen as a prime example
of how consistent patterns can be found in the clinically dynamic aspects of
addictive diseases. A clinical description of these patterns based on reported
cases to be investigated throughout a lifelong period of illness is a step to
be taken towards a better understanding of addictive pathology as a severe
medical problem.
Publication Type: Regular
article
Heroin Addiction and Related
Clinical Problems 2011; 13(1):29-34
Tulevski I. G.
Correspondence: Dr. Ivan G.
Tulevski, Centre for the Prevention and Treatment of Drug Abuse and Abuse of
Other Psychoactive Substances, Skopje, The Republic of Macedonia
E-Mail: "Ivan G.
Tulevski" <galicnik@sonet.com.mk>
Summary: The purpose of this paper is to describe several existing
problems encountered in the management of dual diagnosis (DD) in the
psychiatric and drug treatment institutions in Macedonia. The term DD or
comorbidity refers to the co-occurrence of at least one mental and behavioural
disorder due to psychoactive substance use with another psychiatric disorder in
the same individual. These ‘dual’ subjects present greater severity from both
the clinical and social perspectives than those who have only one type of
psychiatric disorder. The cost to the health system for those with DD is
significantly higher than it is for someone with a single psychiatric disorder.
This presents a significant challenge with respect to the identification,
prevention and management of people with DD. According to the 2004 Report by
the EMCDDA, the prevalence of DD in treatment settings in various EU countries
ranged between 22% and 96%. In the Day Hospital for the Prevention and
Treatment of Drug Dependencies in Kisela Voda, Skopje in an 8-year period,
1995-2002, 9.8% – 49 out of a group of 500 heroin users – were diagnosed as
‘dual’ patients. The unmet need for treatment of people with DD is
considerable. People with DD often found themselves in the gap between the
relevant services, namely between the Day Hospital in Kisela Voda, and the
Psychiatric Hospital in Skopje, or, less frequently, in prison. In Macedonia
guidance regarding the best practice for the treatment of individuals with DD
is not available. Access to services for people with DD diagnosis is
restricted. They are under-diagnosed and receive very little treatment. The
present Author has stressed the need for increasing the capacity of the health
care system in Macedonia to meet the needs of people with DD. Further research
is needed to establish the prevalence of DD, and to improve the diagnosis,
treatment and social rehabilitation of people with DD.
Publication Type: Expert
Opinion
Heroin Addiction and Related
Clinical Problems 2011; 13(1):35-36
Does
cannabis have therapeutic benefits for withdrawing opioid
addicts?
Peloquin M., Peters
L. R., Mclarnon M. E., Barrett S. P.
Correspondence: Sean P.
Barrett, Associate Professor; Department of Psychology, Dalhousie University,
1355 Oxford Street, Halifax, Nova Scotia, B3H 4J1, 902-494-2956,
Sean.Barrett@dal.ca
Summary: Not available
Publication Type: Letter to
the editor
Heroin Addiction and Related
Clinical Problems 2011; 13(1):37-40
Rovai L., Maremmani
A. G. I.
Correspondence: Angelo Giovanni
Icro Maremmani, MD; "Vincent P. Dole" Dual Diagnosis Unit,
"Santa Chiara" University Hospital, Department of Psychiatry,
University of Pisa, Via Roma, 67 56100 PISA, Italy, EU.
Phone +39 0584 790073 Fax +39
0584 72081; E-Mail: angelogimaremmani@gmail.com
Summary: Not available
Publication Type: Letter to
the editor
Maremmani I., Pacini M., Pani P. P., On Behalf of the 'Basics on Addiction Group'
Correspondence: Icro Maremmani, MD; Vincent P. Dole Dual Diagnosis Unit, Santa Chiara University Hospital, Department of Psychiatry, University of Pisa, Via Roma, 67 56100 PISA, Italy, EU.
Phone +39 0584 790073 Fax +39 0584 72081 E-Mail: maremman@med.unipi.it
Summary: Opioid dependence is a chronic, relapsing brain disease that causes major medical, social and economic problems to both the individual and society. This seminar is intended to be a useful training resource to aid healthcare professionals – in particular, physicians who prescribe opioid pharmacotherapies – in assessing and treating opioid-dependent individuals. Herein we describe the neurobiological basis of the condition; recommended approaches to patient assessment and monitoring; and the main principles and strategies underlying medically assisted approaches to treatment, including the pharmacology and clinical application of methadone, buprenorphine and buprenorphine–naloxone.
Publication Type: Seminar
Heroin Addiction and Related
Clinical Problems 2011; 13(3):5-16
Roncero C., Fuste
G., Barral C., Rodríguez-Cintas L., Martínez-Luna N., Eiroa-Orosa F. J., Casas
M., On Behalf of the Proteus Study Investigators
Correspondence: Carlos Roncero,
MD - Department of Psychiatry, Vall d’Hebron University Hospital Passeig Vall d´Hebron,
119-129, 08035 Barcelona, Spain, EU
Tel: +34 93 489 42 95 E-mail:
croncero@vhebron.net
Summary: The aim of this study was to comprehensively describe the
clinical comorbidities, concomitant treatments and the current therapeutic
management of opiate-dependent patients undergoing a replacement therapy
programme(RTP). This is an observational, cross-sectional, multicentre,
epidemiological study conducted in 74 healthcare centres for drug users.
Patients were diagnosed with Opiate Dependence (OD), and enrolled in a RTP in
Spain (N=624). Most patients were men (84%); they received methadone (94%) at a
mean dose of 61.52mg/day during the maintenance phase, orally (95%) with
take-home doses (76%). High rates of infectious (59%) and psychiatric
comorbidities (67%) were found. Patients infected by HIV, HCV or
coinfected by HIV/HCV were given significantly higher methadone doses
(p<0.0001).
Publication Type: Regular
article
Heroin Addiction and Related
Clinical Problems 2011; 13(3):17-26
Rugani F.,
Maremmani A. G. I., Rovai L., Mautone S., Perugi P., Pani P. P., Dell’osso L.,
Maremmani I.
Correspondence: Icro Maremmani,
MD; Vincent P. Dole Dual Diagnosis Unit, Santa Chiara University Hospital,
Department of Psychiatry, University of Pisa, Via Roma, 67 56100 PISA, Italy,
EU.
Phone +39 0584 790073 Fax +39
0584 72081 E-Mail: maremman@med.unipi.it
Summary: Epidemiological data show frequent associations between
post-traumatic stress disorder (PTSD) and substance use disorders. In this
study we assessed the life events (loss events and potentially traumatic
events) of 82 heroin-dependent patients before and after the dependence age of
onset (DAO) and their emotional, physical and cognitive responses to these
events, within a trauma and loss spectrum. We also assessed personality traits
at risk for Post-Traumatic Stress Disorder (PTSD). In passing from the
before-DAO to the after-DAO period, 97.6% of patients continued to experience
life events, 82.9% loss events and 91.5% potentially traumatic events. The life
events most frequently rated as the most important by patients are “death of a
close friend or relative”, “divorce” and “being neglected or abandoned”. Sexual
abuse seems to be present, but with a lower percentage. Criminal behaviours
become very common after DAO. “Grief reactions” to loss events increase after
DAO, as well as “reactions to the most important event”, “re-experiencing”, “avoidance
and numbing”, “maladaptive coping” and “arousal”. After DAO, we found an
increase in all the emotional, physical and cognitive behaviours typically
reported in PTSD patients. This increase in the intensity of emotive reactions
during a drug addiction history seems to configure a sort of PTSD spectrum
resulting from the addictive process. At a therapeutic level it would be
appropriate to consider this higher emotional reactivity in patients as being
due to loss events and potentially traumatic events, so as to allow the
optimization of therapeutic resources when these life events occur.
Publication Type: Regular
article
Heroin Addiction and Related
Clinical Problems 2011; 13(3):27-38
Ducray K., Byrne P.,
Burke C., Smyth B. P.
Correspondence: Kevin Ducray
(Senior Clinical Psychologist), The Drug Treatment Centre Board, 30- 31 Pearse
Street, Dublin 2, Ireland, EU.
Tel: +353 1 6488673. Fax: +3536
1 6488700. Email: kducray@dtcb.ie
Summary: Cocaine use on methadone maintenance treatment (MMT) is believed
to complicate clinical outcomes. This study aimed to determine whether cocaine
users on MMT require distinct services by virtue of their differential drug
use, needs and quality of life relative to non- cocaine users. A cross
sectional survey of 108 adults attending a Dublin opioid treatment service was
conducted. The urine toxicology screens, Camberwell Assessment of Need Short
Appraisal Schedules and WHO Quality of Life- Bref responses of respondents
defined as either cocaine users or non- cocaine users were compared. Whilst
cocaine use on MMT was not significantly associated with adverse measures of
need or quality of life, it was linked to significantly greater heroin use and
to more frequent injecting.
Publication Type: Regular
article
Heroin Addiction and Related
Clinical Problems 2011; 13(3):39-48
Lovrečič
B., Šemerl J. S., Tavčar R., Maremmani I.
Correspondence: Prof. Rok Tavčar,
MD, PhD, University Psychiatric Clinic of Ljubljana, Ljubljana Studenec 48,
1260 Ljubljana-Polje, Slovenia
Telephone: +386
15872100fax:+386 15284618 E-Mail: rok.tavcar@psih-klinika.si
Summary: This study aimed to analyse the differences found among surviving
and deceased heroin addicts in opioid maintenance treatment in the years
2004-2006 in Slovenia in terms of their sociodemographic and clinical
characteristics. 3,950 heroin addicts entered our retrospective cohort study;
of these, 69 had died by the end of the
study. Mean age as recorded at entry into treatment was significantly higher
among those who had died by the end of the study than among survivors. Men and
those who had undergone more than one treatment died significantly more
frequently than women and those in their first treatment. In addition, those
who were unemployed or had had fewer years of education proved to be more
likely to die. Heroin was the main drug in both groups; among its users death
rates were significantly higher than among those taking other widely used
addictive drugs. This is the first cohort study that has taken the step of
recording indirect deaths. Further studies are now needed to acquire a better
understanding of the phenomenon.
Publication Type: Regular
Article
Heroin Addiction and Related Clinical Problems 2011;
13(4):5-12
Grönbladh L., Öhlund L. S.
Correspondence: Leif Grönbladh, PhD, University
Hospital, SE-75017 Uppsala, Sweden, EU,
E-mail: Leif.Gronbladh@neuro.uu.se,
Leif.Gronblad@akademiska.se
Summary: Although methadone maintenance treatment (MMT) has been shown to be
effective, poor compliance is always a threat. It has often been pointed out
that one variable that inevitably reduces adherence to treatment regimes is the
negative side-effects of the treatment. This study examines seventeen known
side-effects in a sample of 110 former opiate addicts consecutively admitted to
methadone maintenance treatment. Self-reported side-effects were collected through
a questionnaire. Despite the considerable increase, from 23 to 74% of the
sample, in the proportion that reported individual side-effects between the
period of opiate use and that of methadone treatment, the overall result was a
significant decrease in eleven symptoms, no change in four and a substantial
increase in only two. In some individuals a symptom that is liable to be
problematic actually does become problematic, while the same symptom becomes
less frequent in the group as a whole. Weight gain is the symptom that
increases most in the whole group and needs to be constantly monitored. Other
side-effects that remain high and need to be kept under review in clinical
practice are nervousness, decreased libido, daytime drowsiness, constipation
and perspiration.
Publication Type: Regular article
Heroin Addiction and Related Clinical Problems 2011;
13(4):13-20
Latent suicidality in heroin addicts
Budiša D., Gavrilov-Jerković V., Dickov A., Vučković
N., Mitrović D., Svilokos S.
Correspondence: Danijela Budiša, Clinic for
Psychiatry, Department for Treatment of Drug Addiction, Clinical Centre of Vojvodina, Hajduk Veljkova 1-7, 21 000 Novi
Sad, Serbia.
Phone numb: +381 63 882 86 46; e-mail:
danijela1@neobee.net
Summary: According to the transactional analysis (TA) theory of personality
development and the development of psychopathology, any behaviour that
indirectly or directly threatens someone's physical integrity could be a
manifestation of the 'Don’t exist' injunction and the script decision to die young. A
'don’t exist' injunction is defined as a parental message that challenges a
child's right to live, and that can be sent directly or indirectly, verbally or
nonverbally, intentionally or unintentionally. An (early) script decision is
defined as a compromise between the various authentic needs and requirements of
the environment. The theoretical assumption on which this work is based is that
a mentioned injunction and script decision to die young could be present in the
population of heroin addicts, considering their continuous and repeated
self-destructive behaviours and, typically, short lifetimes. The main objective
of this work was to check the assumption that the 'Don’t exist' injunction and
the script decision to die young are theoretical concepts that are available
for measurement through questionnaires and have the potential to discriminate
heroin addicts from non-clinical examinees. The general research method that
was selected was non-experimental, correlation research; the sample consisted of
50 heroin addicts and 50 non-clinical examinees. Its results confirm the
hypothesis that both measured theoretical concepts have the potential to
discriminate heroin addicts from non-clinical examinees. Heroin addicts
have, to a statistically significant degree, a more strongly marked “Don’t
exist” injunction, together with the script decision to die young. This finding
may be related to the theoretical assumptions of several authors in the TA –
assumptions which include the concept that psychoactive substances allow a
person to implement the script decision to die young.
Publication Type: Regular article
2011; 13(4):21-26
Softić J., Awad H.
Correspondence: Jasmin Softic, MD. Cantonal Institute
for the Fight against Addiction Diseases, Zenica, Bosnia Herzegovina. E-Mail:
jsoftic@yahoo.com
Summary: The objectives of the study were to identify the prevalence of alcohol
use, to find out differences in sociodemographic characteristics, the frequency
of PTSD, percentages of invalid war veterans, the average methadone dose and
number of positive urine analyses on opioids among patients undergoing
methadone substitution treatment who use alcohol from those who abstain. We
found that 42 (25.77 %) out of 163 participants had an AUDIT score > 7,
indicating alcohol use. The two groups did not differ in terms of sex, age,
education, employment, marital status or percentages of war veterans. The
statistically significant differences recorded were: lower average dose of
methadone, fewer positive urine analyses for opioids and a higher incidence of
PTSD among the patients undergoing methadone substitution treatment who were
using alcohol. Conclusions: The patients who use alcohol have a lower average
dose of methadone, fewer positive urine analyses for opioids and a more
frequent presence of PTSD. The risks arising from alcohol abuse and possible
PTSD in these patients call for greater attention in everyday practice.
Publication Type: Regular article
Heroin Addiction and Related Clinical Problems 2011;
13(4):27-34
Lovrecic M., Lovrecic B., Rovai L., Rugani F.,
Maremmani A. G. I., Maremmani I.
Correspondence: Icro Maremmani, MD; Vincent P. Dole
Dual Diagnosis Unit, Santa Chiara University Hospital, Department of
Psychiatry, University of Pisa, Via Roma, 67 56100 PISA, Italy, EU.
Phone +39 0584 790073 Fax +39 0584 72081 E-Mail:
maremman@med.unipi.it
Summary: Psychiatric symptoms are generally the rule among heroin addicts
requesting treatment, and are not always the expression of an associated mental
disorder. In a previous study we investigated the mental status of 1,090
Italian heroin addicts at the beginning of treatment, and its relationship to
relevant demographic and clinical data through the use of standardized
instruments. We concluded that the presence of depressive–anxious
symptomatology in the clinical presentation appears to be unrelated to ‘dual diagnosis’.
In this study we tried to replicate our previously reported study in a sample
of 591 Slovenian heroin addicts (462 males and 129 females aged between 18 and
52). The results showed that psychomotor excitement was the most frequent
psychiatric symptom among Slovenian heroin addicts looking for treatment; it
was linked with a lower severity of drug addiction history. By contrast, the
presence of depressive features in the clinical presentation of Slovenian
heroin addicts appears to be a reliable indicator of general addiction
severity. Psychomotor excitement and psychosis, but not depression, predict the
presence of an actual dual diagnosis, in agreement with our previous study and
providing further support for the view that it is important for clinicians to
be able to identify major as well as minor psychomotor excitement and psychotic
symptoms in heroin addicts presenting for treatment.
Publication Type: Regular article
Heroin Addiction and Related Clinical Problems 2011;
13(4):35-38
Piz L., Maremmani A. G. I., Rugani F., Pacini M.,
Rovai L., Dell'osso L., Maremmani I.
Correspondence: Icro Maremmani, MD; Vincent P. Dole
Dual Diagnosis Unit, Santa Chiara University Hospital, Department of
Psychiatry, University of Pisa, Via Roma, 67 56100 PISA, Italy, EU.
Phone +39 0584 790073 Fax +39 0584 72081 E-Mail:
maremman@med.unipi.it
Summary: Methadone Maintenance Treatment patients are significantly
under-represented in most liver transplant programmes, but the number of
patients receiving agonist opioid treatment (AOT) is increasing, and few data
are available at the moment when patients are selected for surgery. We present
a case in which an Italian patient affected by heroin dependence and
successfully treated with AOT had to stop opioid medical treatment to be able
to enter a liver transplantation programme. He successfully discontinued AOT,
received a liver transplant and continued not to abstain from heroin in the
post-transplant period. Unfortunately, he engaged in alcohol use, so shifting
over into another cross-acting substance abuse disorder, and endangering his
newly restored liver functions. He was a non-responder to alcohol abuse
treatment and, while he was abstaining from alcohol, he reported a craving for
heroin. We reintroduced opioid agonist treatment, so obtaining a non-relapsing
condition regarding heroin and a significant patient recovery on alcohol abuse,
with a complete liver function normalization. We suggest that successful
agonist opioid treatment should be continued even when transplantation is
needed, not only to avoid the risk of relapse into heroin use, but also to
avoid the risk that the patient may shift over into another substance abuse
disorder (in this case, alcoholism). The
shift from heroin to alcohol also means the transition from a highly curable
disease, as heroin addiction is, to one that is hard to cure, as alcoholism is,
which implies a greater risk to endangering
the new liver function with respect to the continuation of AOT.
Publication Type: Regular article
Heroin Addiction and Related Clinical Problems 2011;
13(4):39-40
Suboxone® switch data: A regional experience
Leonardi C.
Correspondence: Claudio Leonardi, MD. Director Drug
Addiction Centre for the Prevention and Treatment of Drug Dependence
and Alcoholism – ASL Rome C, Rome, Italy, EU
E-mail: leonardiclaudio1958@libero.it
Summary: Not available
Publication Type: Letter to the Editor
Heroin Addiction and Related Clinical Problems 2011;
13(4):41-46
What concept of ‘spectrum’ is useful in addiction
medicine?
Rovai L., Rugani F., Bacciardi S., Maremmani A. G. I.
Correspondence: Luca Rovai, MD. Department of
Psychiatry, University of Pisa, Via Roma, 67-56100 PISA, Italy, EU. Phone +39 0584 790073 Fax +39 0584 72081.
E-Mail: lucarovai@yahoo.com
Summary: Not available
Publication Type: Letter to the Editor