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: albrecht.ulmer@gmx.de
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
Heroin addicts'
psychopathological subtypes. Correlations with the natural history of illness
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: angelogimaremmani@gmail.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
Profile of an
Addict or Beyond the Addiction Mask
Knežević Tasić
J., Šapić R., Valkanou M.
Correspondence: Masha Valkanou,
Lorijen Hospital, Tetovska 45, 11000 Belgrade, Serbia.
E-mail: psyonics@gmail.com.
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
A compartmental
model for the pharmacokinetics of heroin and its metabolites in man.
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: : montefrance2@unisi.it
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: mercedes.lovrecic@ivz-rs.si
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:
pacogonzalez@comcadiz.com ; pacogonzalez62@hotmail.com
Summary: Not available
Publication Type: Letter to
the Editor