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At least 73 records · Page 4Linked to original sources
PubMed2003

Intravenous opiate maintenance in a cohort of injecting drug addicts.

BACKGROUND: Drug addiction is a major problem in many societies. The opiate maintenance program includes a prospective cohort of injecting drug addicts, treated with opiates such as heroin intravenously. An important aim of this program is to keep patients under medical supervision in order to reduce the health hazards associated with illicit drug consumption. In this paper we report the performance of this drug policy in terms of retention and analyse treatment withdrawals and hospitalisations. METHODS: Treatment retention was assessed using the Kaplan-Meier method (treatment withdrawals were defined as the event of interest). We analysed factors associated with treatment withdrawal using Cox regression analysis. In addition, we analysed hospitalisations occurring during the study period. RESULTS: Of 175 patients included in the study, 76 withdrew from the study. Of these, 29 were transferred to a substitution program. The 3-year probability of remaining in the study was 61.7% (95%CI: 54.8-69.4%). Risk of treatment withdrawal was independently associated with age (hazard ratio 0.88 [95%CI: 0.82-0.95]) and years of intravenous drug use (hazard ratio 1.11 [95%CI: 1.04-1.18]). No association was found between risk of treatment withdrawal and HIV-, Hepatitis B Virus (HBV) or Hepatitis C Virus (HCV) serostatus. The percentages of HIV, HBV and HCV seroconversions observed during the study period were 0.7, 16.2 and 23.3%, respectively. A total of 84 hospitalisations were recorded in 49 patients, mainly due to infectious diseases. Hospitalised patients were not more likely to withdraw from the program. CONCLUSIONS: Retention is high in the intravenous opiate maintenance program and favours the continuation of this drug policy. Individuals with a shorter history of injecting drug use and of older age are more likely to continue intravenous opiate maintenance treatment.

Adult↗
PubMed1993

[HIV infection. Risky behavior in drug addicts using intravenous drugs. Experience in the Alpes-Maritimes region].

HIV risk behaviours among intravenous drug users (IVDUs) were studied in southeast France, where the prevalence of HIV infection is high. Data were collected from a self-reported questionnaire distributed to drug addicts admitted in the health care or social institutions of the Alpes Maritimes department during November 1991. Among the 195 IVDUs who answered the questionnaire, 142 (73 percent) were male and 53 (27 percent) were female. One hundred and seventeen (62 percent) were HIV positive, 21 (11 percent) had an unknown HIV status, and 51 (27 percent) where HIV negative. Significant differences in HIV risk behaviours were found between HIV negative, unknown HIV status and HIV positive IDVUs: 37 percent of unknown status and 47 percent of HIV negative IVDUs continued to lend their syringe, compared with less than 20 percent HIV positive IVDUs (P < 0.001). Conversely, 57 percent of unknown HIV status and 39 percent of HIV negative IVDUs borrowed used syringes in the previous 6 months, compared with 73 percent of HIV positive IVDUs (p < 0.001). Regarding sexual prevention behaviours of patients who had had sexual intercourse during the previous 6 months: less than 20 percent of HIV negative IVDUs used condoms regularly, as against 47 percent of HIV positive IVDUs (P < 0.001). More than 70 percent of HIV negative versus 46 percent of HIV positive reported sexual intercourse without condom (p < 0.001). Logistic regression showed that the systematic use of condom was associated with a reduction of needle sharing, which suggests that IVDUs who use condoms have the best perception of risk. But the only factor associated with an increase in condom use is a HIV positive serology. These results indicate that in southeast France more efforts should be devoted to specific programmes aimed at increasing the use of condoms in the IVDU population.

Adult↗
PubMed1999

Acute injection of drugs with low addictive potential (delta(9)-tetrahydrocannabinol, 3,4-methylenedioxymethamphetamine, lysergic acid diamide) causes a much higher c-fos expression in limbic brain areas than highly addicting drugs (cocaine and morphine).

It is regarded as a common pharmacological property responsible for the addictive potential of drugs of abuse that they are able to activate brain areas involved in the sensation of pleasure, especially the nucleus accumbens. To investigate the connection between addictive potential and stimulation of critical brain areas in more detail, we studied c-fos accumulation in response to various addicting drugs in direct comparison. The substances were injected into drug-naive rats, and c-fos mRNA levels were measured throughout the brain by in situ hybridization. Cocaine in a high dose of 50 mg/kg yielded only a discrete c-fos expression in the medial and central striatum. Morphine (50 mg/kg) caused a weak c-fos synthesis in the lateral septum. THC (delta(9)-tetrahydrocannabinol), 25 mg/kg, induced c-fos mRNA again in the lateral septum and furthermore in large parts of the striatum including the nucleus accumbens. LSD (lysergic acid diamide), 1 mg/kg, elicited a similar c-fos expression pattern as THC, but there was additionally a very strong hybridization signal in the cerebral cortex, especially in the upper layers, and in the ventral part of the periaqueductal gray. The widest range of brain areas was activated by MDMA (3, 4-methylenedioxymethamphetamine, 'ecstasy'), 6 mg/kg. In addition to the regions that responded to LSD, there was a very pronounced c-fos signal in the nucleus accumbens core and shell and in the mammillary nuclei. Taken together, our study revealed that the drugs with the highest addictive potential, cocaine and morphine, yielded a very low c-fos synthesis throughout the brain whereas the brain regions closely linked to pleasure (especially the nucleus accumbens) responded strongly to drugs with an apparently lower addictive potential (THC, LSD, MDMA).

Animals↗
PubMed1993

[Methadone and drug addicts].

Dead drug addicts from Copenhagen City and County in 1981 and 1989 respectively were analysed for methadone. Ninety-four cases from 1981 and 70 cases from 1989 were analysed; from 1981, 16% were found positive for methadone, while in 1989, 37% were positive. Methadone alone was found to be the cause of death in 50% more cases in 1989 than in 1981. Only half of the methadone positive dead drug addicts had been in methadone treatment. Morphine and benzodiazepines were the most frequently occurring other substances in both 1981 and 1989. Alcohol was found present in only about 30% of the methadone-positive cases. Medians for methadone whole blood conc. were 0.9 mumol/kg with no alcohol present and 0.5 mumol/kg with alcohol present in addicts dying from methadone. In living persons using methadone, the median was 0.4 mumol methadone/kg whole blood with no alcohol present and 0.3 mumol/kg with alcohol present.

Adolescent↗
PubMed1983

Valve replacement for left-sided endocarditis in drug addicts.

Eighteen drug addicts with left-sided valvular endocarditis requiring operation are reviewed. Gram-positive bacteria were the most common organisms cultured (61%), with Staphylococcus aureus present in 7 of 11 patients. Gram-negative bacteria, exclusively Pseudomonas aeruginosa, were cultured in the remaining 39%. Indications for operation included sepsis (61%), heart failure (78%), and systemic emboli (22%). Abscesses formed in 6 of 11 patients with gram-positive endocarditis, while only one abscess was present with gram-negative endocarditis. Normal valves were infected in 17 of 18 patients (94%). Early surgical mortality (less than 30 days) was 11%. There were major complications in 79% of these patients, including persistent sepsis (50%), valvular dehiscence, prosthetic endocarditis or perivalvular leakage (37%), and mycotic aneurysms (22%). These complications were directly related to a late mortality of 44%, yielding an overall mortality of 50% in the first nine months after operation. Contrary to previous reports of acceptable surgical survival for valvular endocarditis, these data suggest that endocarditis involving the aortic or mitral valve in a drug addict is a highly lethal disease due to the virulence of the organisms, the severity of the complications encountered, and the predisposition to continued addiction.

Adolescent↗
PubMed1991

Drug addicts attending specialised institutions: towards a drug addiction data bank?

In 1986, a national survey was carried out in France among 4846 drug abusers attending specialised agencies and treatment centres. Data are analysed and compared with the results of a previous study in 1972. Most French drug abusers are men (74%) ranged in age from 20 to 29 years (68%). Data suggest increasing problems with heroin (69%), cocaine (13%), solvents (5%), alcohol (26%) and multiple drug dependence. Women are younger, they have attempted suicide more often than men but have been incarcerated half as often. Concerning drug abuse trends, women appear to use increasingly sedatives in combination with other drugs. Partial data concerning HIV seropositivity reveal a rate of 48% among drug abusers having been tested.

Adolescent↗
PubMed1999

Tobacco use as drug addiction: the scientific foundation.

Tobacco use is strongly driven by the pharmacological actions of nicotine in the central nervous system. This review will summarize some of the seminal research findings relating to nicotine dependence and will highlight fundamental questions that must yet be answered. The evidence that nicotine is an addictive drug was summarized in the 1988 Report of the Surgeon General which concluded that nicotine fulfills the criteria for a dependence-producing drug. More recently, research has further characterized the pharmacological effects of nicotine in the brain and elucidated the basic pathophysiology of nicotine addition. Moreover, research shows that nicotine replacement therapy, such as nicotine patch or gum, can prevent or reverse withdrawal symptoms. It is also clear that the form of nicotine delivery is a major determinant of addiction potential and that cigarettes and smokeless tobacco products are both highly engineered drug delivery devices that act not only to provide users with controllable doses of nicotine, but also to maximize the addictive effects of nicotine. Along with the understanding of the dependence process has come a rapidly expanding arsenal of treatment for the disorder. There are many major questions about the nature and course of nicotine addiction that remain unanswered and must be addressed if we are to continue to improve our ability to prevent tobacco dependence as well as to provide more effective and acceptable options for treatment and disease prevention in those who are already addicted.

Animals↗
PubMedDate not supplied

Drug addiction. Part II. Neurobiology of addiction.

The drug addiction may be regarded as the disease of the brain reward system. This system, closely related to the system of emotional arousal, is located predominantly in the limbic structures of the brain. Its existence was proved by demonstration of the "pleasure centers," that were discovered as location from which electrical self-stimulation is readily evoked. The main neurotransmitter involved in the reward is dopamine, but other monoamines and acetylcholine may also participate. The anatomical core of the reward system are dopaminergic neurons of the ventral tegmentum that project to the nucleus accumbens, amygdala, prefrontal cortex and other forebrain structures. Several of those structures may be specifically involved in the reward produced by different substances, when anticipating the reward. The recent discovery of CART peptides may importantly expand our knowledge about the neurochemistry of reward. Natural rewarding activities and artificial chemical rewarding stimuli act at the same locations, but while natural activities are controlled by feedback mechanisms that activate aversive centers, no such restrictions bind the responses to artificial stimuli. There are several groups of substances that activate the reward system and they may produce addiction, which in humans is a chronic, recurrent disease, characterized by absolute dominance of drug-seeking behavior. The craving induced by substances of addiction inhibits other behaviors. The adaptation of an organism to a chronic intake of drugs involves development of adaptive changes, sensitization or tolerance. It is thought that the gap between sensitization developing for the incentive value of the drug and tolerance to the reward induced by its consumption underlies the vicious circle of events leading to drug dependence. The vulnerability to addiction is dependent not only on the environment, but also on genetic factors.

Animals↗
PubMed2001

Serum vitamin E, C and A status of the drug addicts undergoing detoxification: influence of drug habit, sexual practice and lifestyle factors.

BACKGROUND: The study was carried out on the hypothesis that drug addicts would have reduced vitamin E, C and A status which could be influenced by drug habit, sexual practice and lifestyle factors. METHOD: Serum concentrations of Vitamin E, C and A of male drug addicts and cohort controls were analysed, and influence of drug habit, sexual practice and lifestyle factors of the addicts on the vitamin status was assessed. The study was conducted among 253 drug addicts who sought detoxification voluntarily during the period of June 1997 to July 1998 at the Central Drug Addiction Treatment Hospital, Dhaka, and 100 cohort control men. Research instruments were questionnaire and blood specimens. HPLC and spectrophotometric methods were used to determine the vitamin levels in sera of drug addicts. RESULTS: alpha-Tocopherol (12.60+/-3.73 compared with 16.3+/-3.37 micromol/l; t=8.6, P=0.05), ascorbic acid (21.59+/-10.5 compared with 38.3+/-13.62 micromol/l; t=10.93, P=0.003) and retinol (1.15+/-0.39 compared with 1.33+/-0.30 micromol/l; t=5.28, P=0.048) in the drug addicts were significantly low as compared to those in the cohort controls. Use of multiple illicit drugs for a longer period of time did result in reduced levels of these vitamins. A significant reduction in retinol concentration was noted among the multiple drug users (F(2,250)=3.23, P=0.041). Duration of addiction had a significant linear correlation with the level of reduction in retinol (F(2,250)=3.23, P=0.041) and alpha-tocopherol (F(2,250)=3.06, P=0.049). Apart from having a significant negative correlation between number of sexual partners and retinol level (F(3,247)=2.65, P=0.049), sexual practice did not have any influence on the vitamin status of the addicts. Occupation did have a significant effect on the ascorbic acid level (F(4,248)=2.46, P=0.046), but other socioeconomic factors like income, age etc did not influence the vitamin E, C and A levels. Body mass index had a positive linear correlation with the vitamins, but it was significant only with vitamin C (F(2,250)=7.06, P=0.001). CONCLUSIONS: These results could have important implications for providing an antioxidant therapy to drug addicts and thus rehabilitating them into normal life. Risk of HIV infection and transmission (if any) could be reduced or inhibited.

Adolescent↗
PubMed1995

[Intake of addictive drugs and traffic safety--a report of experiences of the Vienna federal police department].

Urine samples of 27 individuals with extremely conspicuous behaviour in road traffic were analysed by means of the Abbott ADx-analyser for cocaine metabolites, cannabinoids and opiates. Gas chromatography/mass spectrometry (GC/MS) confirmed positive results. 52% of those 26 positive samples confirmed the simultaneous consumption of two drugs. In 16% all three drugs tested could be found positive, exceeding the threshold values given for the tests hundred fold. Without exception, all 25 urine samples found positive in the ADx-analyser belonged to young people (22 males, 3 females) with 48% of them born between 1968 and 1970. 84% of tested people had previous convictions and 68% had drug addiction records. We also see this project as the beginning of continuing investigations of other drugs and pharmaceuticals. Given the fact that 25 out of 27 samples were found to be positive we most certainly detected nothing but the "tip of the iceberg". We should strive, in conjunction with other European countries, for a political solution to the problem of the illegal and legal consumption of drugs and pharmaceuticals and their effect on driving performance.

Accidents, Traffic↗
PubMed2004

Drug addiction and responsibility for the health care of drug addicts.

Taking care of those who are in need of health care is something that we, as a society, feel ourselves committed to insofar as public funds make that possible. Is this commitment in any way qualified by the fact that a person's medical maladies are the result of that person having voluntarily embarked on activities whose deleterious consequences for health were known and appreciated by that person beforehand? Specifically, is society's obligation to provide healthcare services to those who have addicted themselves to illicit drugs attenuated by the fact of that addiction? Some argue that it is, whereas others consider this position morally untenable. This essay explores the question of who is right on this matter and why.

Attitude to Health↗
PubMed1994

[Mortality among drug addicts 1980-1989. A comparative study of fatal poisonings among drug addicts examined at the institutes of forensic medicine in Arhus and Oslo].

Cases of fatal poisonings among drug addicts examined at the Institutes of Forensic Medicine in Aarhus (n = 238) and Oslo (n = 263) are compared and discussed on the basis of the availability of illicit and medical drugs during the 1980s. The annual number of deaths in age groups over 30 years increased in both countries. Heroin and/or morphine-related deaths comprised one-third of the Danish material compared with three-quarters of the Norwegian material. The registered medical drugs propoxyphene, methadone and ketobemidone accounted for half of the Danish cases. Alcohol and benzodiazepines were present in more than one-third of the cases in both countries.

Adult↗
PubMed2005

[Vascular reconstruction of infected pseudoaneurysm in 17 drug addicts].

OBJECTIVE: To evaluate surgical treatment of infected pseudoaneurysm (PA) caused by injection of addictive drugs. METHODS: The clinical data of 17 cases of infected PA caused by drug injection were reviewed retrospectively. Of them, 1 case was female, and the other 16 cases were male, aging 24-38 years. The locations were brachial artery in 1 case and femoral artery in 16 cases. Fourteen cases were treated by artificial blood vessel transplantation after resection of the aneurysm and radical debridement, 1 case by amputation for serious infection, and 2 cases by non-operation for different reasons. RESULTS: Among 14 cases treated by prosthetic grafts, 13 cases achieved satisfactory results, no blood drawback of lower extremity occurred after operation; 1 case had to be amputated for serious infection. After 3 months of operation, the color Doppler examination showed that the 9 artificial vessel grafts were patent and the pulse of arteria dorsal pedis was good. CONCLUSION: Though artificial vessel grafting has high risk in the vicinity of infected PA, it is still an effective procedure for revascularization in condition that there is no suitable autogenous conduit available for auto transplantation. Sufficient drainage, anti-infection and anti-coagulation therapy should be the key factors after the operation.

Adult↗
PubMed1994

[Khat: from traditional usage to risk of drug addiction].

In much of East Africa and the Arabian Peninsula, the leaves of the qat tree (Catha edulis Forsk) are highly prized for their euphoric effects. Use is deeply anchored in regional customs and traditions. Once controversial, the chemical properties of qat are now well-documented; the active agent responsible for the physical and mental effects observed when the leaves are chewed is cathinone or alpha-aminopropiophenone. According to the definition of the World Health Organization, qat is not classified as an inevitably addictive drug. However recent reports of psychosis related to qat abuse in Great Britain and the United States have raised new alarm in the Narcotics Commission of the United Nations. Should qat be prohibited? International law on this issue is currently highly ambiguous. Importation of qat is illegal in France as in Switzerland, but legal in the United States and Great Britain as in most African countries.

Africa, Eastern↗
PubMed1983

[Pneumopathies in drug addicts].

Drug-addicts frequently suffer from pulmonary diseases, particularly those who practice self-injection of the drugs intravenously. Emphasis is at present laid on the various excipients which are thought to induce acute alveolitis with subsequent acute pulmonary oedema in heroin-addicts. It has also been suggested that the deep ventilatory depression that precedes pulmonary oedema may play a part and this is interesting since the depression can now be prevented with naloxone. Infectious lesions, such as septic pulmonary embolism or endocarditis, are easier to explain. The ever increasing use of tablets crushed for injection is responsible for peri-arteriolar granulomas of the lung with possibly severe sequelae. Finally, the almost generalized consumption of marihuana in the United-States has led to the discovery of new properties of this drug, including ventilatory stimulation and broncho-dilatation. However, this is mostly of theoretical interest. The psychotropic effects of marihuana and its irritant effect on the bronchi when inhaled make it unlikely that it will be ever be used for therapeutic purposes.

Bacterial Infections↗