Heroin Addiction and Related Clinical Problems 2012; 14(1):5-10
Ulmer A., Lamy D., Reisinger M., Haraldsen M., Maremmani I., Newman R.
Correspondence: Albrecht Ulmer, General Practitioner, Schwabstr. 26, D-70197 Stuttgart, Germany, EU
Phone: +49711/62 63 08, e-mail: firstname.lastname@example.org
Summary: Opiate Agonist Treatment (OAT-providing) physicians and pharmacists from the southwest region of Germany and the Wallonian part of Belgium came together with international experts to compare their two different sets of OAT regulations. Both countries mostly rely on methadone, but with an increasing use of buprenorphine, besides a much less frequent recourse to other opioids. German OAT is rather strictly regulated. The aim of these regulations was to ensure quality. That effect is, however, questionable. The regulations make it difficult and legally dangerous to provide OAT. Physicians and patients suffer from these regulations. Most doctors avoid getting involved. No successors are available. The future scenario will be OAT provision at only a few clinics, with a large array of controls and with a customary setting of crowds of addicted people. The Belgian system runs without these regulations. The consequence is not greater chaos, but a much more normal integration of patients into normal medical practice and into society itself. The take-home message of the conference held under the auspices of EUROPAD was that most special regulations point in the wrong direction, and lead into a costly dead end. The whole treatment procedure works better and much more effectively if we treat the patients as normally as possible, with nothing more complicated than normal diligence. Connection with a good support system, networking, regular education and periodic evaluation of how the system functions - all these factors go to constitute a guarantee of the best possible outcome for patients.
Publication Type: Expert opinion
Heroin Addiction and Related Clinical Problems 2012; 14(1):11-22
Maremmani A. G. I., Rovai L., Pani P. P., Maremmani 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: email@example.com
Summary: By recently using an exploratory factor analysis of the 90 items in the SCL-90, we identified a five-factor solution for 1055 heroin addicts who answered that questionnaire at treatment entry. On the basis of the highest z-scores obtained on these factors, subjects can be assigned to 5 mutually exclusive groups labelled “worthlessness and being trapped”, “somatization”, “sensitivity-psychoticism”, “panic anxiety”, and “violence-suicide”. In this study we correlated the distribution within these groups of 455 heroin addicts The patients belonging to the “worthlessness and being trapped” group had the highest average age and were those who, most frequently, had a white-collar job. Those belonging to the “somatization” group were less frequently at their first treatment, more frequently reported sleep disturbances and less frequently referred to their use of hallucinogens. The leading distinctive feature of those in the “sensitivity-psychoticism” group was that they were the youngest. Patients belonging to the “panic anxiety” group less frequently reported major problems with their love life, sleep disturbances, and more frequently referred to their use of CNS stimulants. The features of being more excitable and violent brought with them the highest likelihood of belonging to the “violence-suicide” group. These differences were independent of the presence of dual diagnosis. These data support the hypothesis that heroin has as its foundation a specific psychopathology.
Publication Type: Regular article
Heroin Addiction and Related Clinical Problems 2012; 14(1):23-34
Knežević Tasić J., Šapić R., Valkanou M.
Correspondence: Masha Valkanou, Lorijen Hospital, Tetovska 45, 11000 Belgrade, Serbia.
E-mail: firstname.lastname@example.org. Phone +381616717375
Summary: The main purpose of this study was to examine if there is anything that could be correctly described as the “profile of an addict”, and whether certain personality disorders occur with a higher frequency in substance abuse patients in Serbia today. The other question investigated in this study is how the presence of psychopathology can be evaluated in individuals who have developed addiction compared with those who have not. In addition, factors such as emotional relationships and education have been examined. The sample selected for this inquiry included 79 participants - 42 addicts, and 37 individuals making up a control group. Personality disorders were assessed by applying the Millon Multiaxial Clinical Inventory III (MCMI III), together with a specially constructed data sheet. Canonical discriminant analysis was used to present the model best able to generate distinct personality features that strongly predict drug abuse and determine the essence of an addiction personality profile. Canonical discriminant analysis was also used to explore differences in the presence of psychopathological features between the two groups. A chi-squared analysis examined the differences in emotional status and level of education between groups. Significant differences were found between the general population and the substance abuse group in terms of the presence of personality disorders and the level of the pathology presented. Individuals who have developed an Antisocial, a Borderline, a Depressive or a Dependent personal style are those most prone to substance abuse, whereas individuals who have adopted a Histrionic or Compulsive Personality style are those least likely to develop addiction. The study found that addiction is firmly attached to the presence of major Depression, PTSD and Dysthymia. Another significant difference in the levels of pathology between the two groups was documented, in a way that showed that the addiction group had a significantly higher overall level of pathology.
Publication Type: Rugular Article
Heroin Addiction and Related Clinical Problems 2012; 14(1):35-44
Gilchrist G., Langohr K., Fonseca F., Muga R., Torrens M.
Correspondence: Gail Gilchrist, MD, Centre for Applied Social Research, School of Health and Social Care, University of Greenwich. Avery Hill Road, London, SE9 2UG;
Tel: +44 20 8331 9621: Email: G.Gilchrist@gre.ac.uk
Summary: Records from 1,228 consecutively admitted patients (74.5% male) to an inpatient detoxification unit in Barcelona between 1993 and 2006 were examined to determine factors associated with discharge against medical advice (AMA). 21.5% of admissions were discharged AMA. In multiple logistic regression and compared with patients who were medically discharged, those discharged AMA were younger, more likely to be dependent on heroin, other opiates, cocaine or psychostimulants, or to be experiencing reduction or elimination methadone maintenance therapy [reference category: alcohol]. The provision of assistance to clinicians in identifying the patients who are most at risk of leaving inpatient detoxification AMA will enhance their ability to motivate such patients to stay in treatment.
Publication Type: Regular Article
Heroin Addiction and Related Clinical Problems 2012; 14(1):45-58
Urso R., Montefrancesco G., Rigato M.
Correspondence: Giouseppe Montefrancesco, MD. Centre for the Study of Pathological Addiction, Department of Neurological Sciences, Neurosurgery and Behavioural Sciences, “Giorgio Segre” Pharmacology Section, University of Siena, Italy
E-mail: : email@example.com
Summary: A compartmental model was used to describe the pharmacokinetics of heroin, 6-monoacetylmorphine, morphine and glucuronides. The parameters of the model were estimated by pooling the observations collected and published in various studies, and were used to predict the effect of a reduced rate of glucuronidation and renal excretion on the plasma profile of morphine and its glucuronides after single and multiple administrations of morphine. Simulations were performed by assuming that some rate constants were representative of the rates of morphine glucuronidation and renal excretion. The results showed that renal impairment may produce more extensive drug accumulation during multiple dose treatments than an impaired morphine metabolism (leading to as much as a tenfold increase in the plasma levels of morphine after a 90% reduction of renal clearance). This happens because enterohepatic recycling takes place fast enough to allow morphine to stay in equilibrium with its glucuronides in blood, while the pool of morphine and morphine-glucuronides is only slowly cleared by the kidneys.
Publication Type: Regular Article
Heroin Addiction and Related Clinical Problems 2012; 14(1):59-64
Lovrecic M., Lovrecic B.
Correspondence: Mercedes Lovrecic, MD, National Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia, EU - Email: firstname.lastname@example.org
Summary: Not available
Publication Type: Letter to the Editor
Heroin Addiction and Related Clinical Problems 2012; 14(1):65-72
González-Saiz F., Velo Camacho D.
Correspondence: Francisco González-Saiz, Avda. Libertad 48. Pinar Hondo, 11500. Puerto de Santa María. Cádiz, SPAIN, EU
E-mail: email@example.com ; firstname.lastname@example.org
Summary: Not available
Publication Type: Letter to the Editor