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CORK Bibliography: Opiates and Heroin

85 citations. July 2012 to present

Prepared: December 2012

Akhgari M; Jokar F; Bahmanabadi L; Aleagha AE. Street-level heroin seizures in Iran: A survey of components. Journal of Substance Use 17(4): 348-355, 2012. (40 refs.)

Background: Street-level heroin is one of the most abused drugs in Iran. Law enforcement agencies and police try to seize illicit heroin and ban the trafficking of this opioid. Toxicological analysis of heroin samples is one of the major work loads of forensic toxicology laboratories in Iran. Design: The aim of this study was to analyse heroin samples qualitatively over 2 years study. In a cross-sectional study 85 heroin samples were analysed in Tehran Forensic Toxicology Laboratory. Findings: About 91% of samples contained diacetylmorphine. The most frequently occurring synthesis by-products and adulterants were acetylcodeine, 6-monoacetylmorphine, caffeine, papaverine, noscapine, dextromethorphan, morphine, codeine, phenobarbital and diazepam. Conclusions: In conclusion, the chemical composition of street-level heroin (Iranian Crack) varies not only with heroin content, but also in the adulterants added to cut the heroin. Illicit manufacture of street heroin results in the formation of some synthesis by-products. Identifying the composition of illicit heroin based on the presence or absence of other pharmaceuticals and by-products is presented in this study.

Copyright 2012, Informa Healthcare

Attari MA; Asgary S; Shahrokhi S; Naderi GA; Shariatirad S. Cannabis and opium abuse patterns and their associated complications in a sample of young Iranians. Journal of Child & Adolescent Substance Abuse 21(3): 238-246, 2012. (35 refs.)

The prevalence of drug abuse has been reported to be up to 17.0% in Iran. The aim of this study was to investigate the prevalence of two frequently abused substances-cannabis and opium-in samples of the young population in Isfahan, Iran. In a survey done from January 2005 to December 2006, 537 individuals aged 13-20 years were recruited using a multistage probability sampling method. Demographic and clinical data were recorded through face-to-face interviews, physical examinations, and reviews of the patients' medical records by trained interviewers. Morphine and cannabis were detected by Enzyme-Linked Immunosorbent Assay (ELISA) on each blood sample. The rates of morphine and cannabis abuse were 2.2% and 3.2%, respectively. They were abused in 0.5% and 15.3% of cigarette smokers as well. Male-to-female ratio in addicts was 4: 1, and the mean age of addicts was 17.54 +/- 1.86 years old. There was a significant relationship between male gender and addiction (P = 0.002). The prevalence of substance abuse in urban and rural areas was 6.3% and 9.5%, respectively. A total of 2.5% of rural females were addicted, compared to 2.4% in Isfahan (city). In Isfahan, opium was the most commonly abused substance while in rural areas cannabis was the most commonly abused. Substance abuse among adolescents has increased dramatically and has a significant negative effect on society. It seems that substance abuse is more prevalent than it is estimated. Therefore, developing and implementing appropriate solutions for solving this problem seems necessary.

Copyright 2012, Taylor & Francis

Barrio G; Bravo MJ; Brugal MT; Diez M; Regidor E; Belza MJ. Harm reduction interventions for drug injectors or heroin users in Spain: Expanding coverage as the storm abates. Addiction 107(6): 1111-1122, 2012. (62 refs.)

Aims: To show the utility of analysing time trends of need and coverage of needle-exchange programmes (NEPs) and opioid substitution treatment (OST) to assess harm reduction policies targeting drug injectors or heroin users. Design Multiple methods applied to secondary data. Setting: Spain. Participants Thousands of drug injectors or heroin users included in administrative registers, surveys and published studies during 19872010. Measurements Coverage for the general population was calculated as the ratio between interventions provided (obtained directly from the sources) and interventions needed (estimated by multiple methods), and as the difference between the two. Timeliness was estimated by time elapsed between year of highest need and year in which coverage reached a reference level. Findings In 2010 NEPs provided 138 syringes per drug injector [95% confidence interval (CI) 100223], covering 25.7% (95% CI 18.343.3) of their need. OST coverage was 60.3% (95% CI 44.394.2). Syringe and OST provision increased between 1991 and 2001 and then declined. Syringe and OST coverage also increased substantially during this period and then stabilized, due mainly to decreases in drug injection or heroin use. Medium-level coverage for both syringes and OST was not achieved until 2000, 8 years after the peak in need (1992). Conclusions: In Spain, the expansion of harm reduction interventions was greatly delayed, although the concomitant decrease in heroin and injecting drug use led to reasonable coverage after 2000. A longitudinal measurement of need and coverage provides insight into the timeliness and potential population impact of interventions, enabling better assessment of their adequacy.

Copyright 2012, Wiley-Blackwell

Beckmann YY; Seckin M; Manavgat AI; Zorlu N. Headaches related to psychoactive substance use. Clinical Neurology and Neurosurgery 114(7): 990-999, 2012. (31 refs.)

Aim: To investigate a possible association between headache and psychoactive substance use. Methods: 1055 psychoactive substance abusers were consecutively admitted. All patients filled out a detailed headache questionnaire and 1015 patients were included. Results: Twenty seven percent of patients reported having headache. Eighteen percent of patients reported having headache attributed to a substance or its withdrawal and 1.4% had unclassified headache. The most commonly used substances were cannabis (80.5%), alcohol (74.6%), methylamphetamine (18.7%), benzodiazepine (10.4%), volatile solvent (5.8%), cocaine (4.4%), heroin (2.1%), opioids (0.5%), and other substances (1.7%). Fifteen patients reported that onset of headache occurred prior to onset of substance use, while 94.5% had headaches occurred after substance abuse. A higher incidence of headache was found in the benzodiazepine, methylamphetamine, cocaine, heroin, volatile solvent abusers. Seventy-eight percent of headache patients have never sought help from a physician despite the severity and frequency of headache. Conclusions: In our study, the prevalence of headache among all psychoactive substance abusers was 26.9%. Although this is one-group study without any comparison with non-addict population and associational data must be interpreted with caution, the results of this study indicate a possible relationship may exist between headache and substance use since 94.5% of substance users described headaches after the onset of substance use. The younger start and the longer duration of cannabis use caused the higher incidence of headache, but this correlation was not observed in other substance use. Migraine was far more prevalent in the abusers than in previously reported community populations.

Copyright 2012, Elsevier Science

Behnam B; Semnani V; Saghafi N; Ghorbani R; Shori MD; Choobmasjedi SG. Gabapentin effect on pain associated with heroin withdrawal in Iranian crack: A randomized double-blind clinical trial. Iranian Journal of Pharmaceutical Research 11(3): 979-983, 2012. (20 refs.)

Gabapentin seems to be a safe and well tolerated medication for treating heroin dependence. This study examined the efficacy of gabapentin for relieving withdrawal-related pain due to heroin use. Sixty men were recruited from an inpatient psychiatric ward of Fatemieh hospital in Semnan and randomized to receive either placebo (n = 30) or gabapentin (1800 mg/day) (n = 30) for 7 days. Subjective Opioid Withdrawal Scale (SOWS) was measured as a self-administered scale for grading body pain at baseline, and on days 1, 2, 3, 4, 6, and 7. Mean of pain score had a significant decrease trend in both gabapentin and placebo groups. Pain severity during the most of detoxification duration was significantly lower in gabapentin group compared with the placebo group. It is suggested that gabapentin may have an effective role in removing heroin withdrawal-related pain.

Copyright 2012, Shaheed Beheshti University, School of Pharmacy

Bernstein E; Ashong D; Heeren T; Winter M; Bliss C; Madico G. The impact of a brief motivational intervention on unprotected sex and sex while high among drug-positive emergency department patients who receive STI/HIV VC/T and drug treatment referral as standard of care. AIDS & Behavior 16(5): 1203-1216, 2012. (33 refs.)

This randomized, controlled trial, conducted among out-of-treatment heroin/cocaine users at an emergency department visit, tests the impact on sexual risk of adding brief motivational intervention (B-MI) to point-of-service testing, counseling and drug treatment referral. 1,030 enrollees aged 18-54 received either voluntary counseling/testing (VC/T) with drug treatment referral, or VC/T, referral, and B-MI, delivered by an outreach worker. We measured number and proportion of non-protected sex acts (last 30 days) at 6 and 12 months ( = 802). At baseline, 70% of past-30-days sex acts were non-protected; 35% of sex acts occurred while high; 64% of sexual acts involved main, 24% casual and 12% transactional sex partners; 1.7% tested positive for an STI, and 8.8% for HIV. At six or 12 month follow-up, 20 enrollees tested positive for Chlamydia and/or Gonorrhea, and 6 enrollees HIV sero-converted. Self-reported high-risk behaviors declined in both groups with no significant between-group differences in behaviors or STI/HIV incidence.

Copyright 2012, Springer Publishing

Blanken P; Hendriks VM; Koeter MWJ; van Ree JM; van den Brink W. Craving and illicit heroin use among patients in heroin-assisted treatment. Drug and Alcohol Dependence 120(1-3): 74-80, 2012. (43 refs.)

Aims: To investigate in heroin-assisted treatment (HAT) compared to methadone maintenance treatment (MMT): the course of heroin craving and illicit heroin use, their mutual association, and their association with multi-domain treatment response. Design: RCTs on the efficacy of 12 months co-prescribed injectable or inhalable HAT compared to 12 months continued oral MMT. Setting: Outpatient treatment in MMT- or specialized HAT-centers in the Netherlands. Participants: Chronic, treatment-refractory heroin dependent patients (n=73). Study parameters: General craving for heroin (Obsessive Compulsive Drug Use Scale): self-reported illicit heroin use; multi-domain treatment response in physical, mental and social health and illicit drug use. Findings: The course of heroin craving and illicit heroin use differed significantly, with strong reductions in HAT but not in MMT. General heroin craving was significantly related to illicit heroin use. Heroin craving was not and illicit heroin use was marginally related to multi-domain treatment response, but only in MMT and not in HAT. Conclusions: Heroin craving and illicit heroin use were significantly associated and both strongly decreased in HAT but not in MMT. Craving was not related to multi-domain treatment response and illicit heroin use was marginally related to treatment response in MMT, but not in HAT. The latter was probably due to the strong reduction in illicit heroin use in most patients in HAT and the small sample size of the sub-study. It is hypothesized that the strong reductions in craving for heroin in HAT are related to the stable availability of prescribed, pharmaceutical grade heroin.

Copyright 2012, Elsevier Science

Bohnert ASB; Tracy M; Galea S. Characteristics of drug users who witness many overdoses: Implications for overdose prevention. Drug and Alcohol Dependence 120(1-3): 168-173, 2012. (35 refs.)

Background: Programs to improve response of drug users when witnessing an overdose can reduce overdose mortality. Characteristics of drug users may be associated with the number of overdoses ever witnessed. This information could inform overdose prevention programs. Methods: Participants in New York City, who were age 18 and older with heroin and/or cocaine use in the past two months, were administered structured interviews (n = 1184). Survey topics included overdose response, drug use behavior, treatment history, and demographic information. Results: In a multivariable negative binomial regression model, those persons who were male (IRR [Incidence Rate Ratio] = 1.7, Cl [95% Confidence Interval] = 1.4,2.2), had experienced homelessness (IRR = 1.9, CI =1.4,2.6), had used heroin (IRR = 2.0, CI = 1.3,3.2), had overdosed themselves (IRR = 1.9, CI = 1.6,2.4), or had attended Narcotics Anonymous (IRR = 1.3, Cl = 1.1,1.6) witnessed a greater count of overdoses in their lifetime. Those persons who have witnessed more overdoses were less likely to have sought medical assistance (OR [Odds Ratio] = 0.7) and more likely to report counter-productive or ineffective actions (ORs between 1.9 and 2.4) at the last overdose they witnessed compared to persons who had only ever witnessed one or two overdoses. Conclusions: Persons at high risk for overdose are likely to witness more overdoses. Persons who had witnessed more overdoses were more likely to report taking ineffective action at the last overdose witnessed. Individuals who have witnessed many overdoses are likely key targets of overdose response training.

Copyright 2012, Elsevier Science

Bond AJ; Reed KD; Beavan P; Strang J. After the randomised injectable opiate treatment trial: Post-trial investigation of slow-release oral morphine as an alternative opiate maintenance medication. Drug and Alcohol Review 31(4): 492-498, 2012. (25 refs.)

Introduction and Aims. To establish if slow-release oral morphine (SROM) is an acceptable maintenance medication in heroin users currently being prescribed injectable diamorphine, who are intolerant to supplementary methadone. Design and Methods. Case note review of interviews and medication details before and after change in medication in 12 treatment-resistant chronic heroin users attending a supervised injecting clinic twice a day for prescribed injectable diamorphine plus supplementary oral methadone to ensure 24 h stability. SROM was substituted for oral methadone by cross-titration. The patients' experiences of methadone treatment and expectations of SROM were recorded before the switch. Their responses to SROM and changes in injectable diamorphine requirements were recorded after a mean of 10 weeks' SROM treatment. Results. The patients described a dislike and intolerance of methadone but had positive expectations of SROM which they believed would allow them to reduce their diamorphine dose. The mean stable methadone : SROM maintenance dose ratio was 1:7.5. After 10 weeks' SROM treatment, the average daily diamorphine dose reduced from 382 mg to 315 mg and patients reported fewer cravings and improved sleep and well-being. Discussion and Conclusions. Alternative forms of maintenance medication are required for patients who are intolerant to methadone. SROM is a valuable alternative which enabled some patients to reduce both their dose and number of injections of diamorphine. SROM treatment may therefore represent a route to stop injecting.

Copyright 2012, Wiley-Blackwell

Bourgain C; Falissard B; Blecha L; Benyamina A; Karila L; Reynaud M. A damage/benefit evaluation of addictive product use. Addiction 107(2): 441-450, 2012. (20 refs.)

Aims To obtain damage/benefit assessments of eight commonly used addictive products and one addictive behaviour from French addiction experts and link these to overall evaluations. Design and setting: Criteria-based evaluation by experts in addiction. Specific statistical modelling to estimate the relative contribution of various criteria to formulating expert general opinion on products. Participants: Forty-eight French experts in addiction. Measurements Twelve criteria covering the whole spectrum of damages and benefits to users and to society evaluated using visual analogue scales (VAS). Direct measure of expert overall subjective opinions on products from user and from social perspectives. Findings: Damage scoring identified alcohol (damage score = 48.1), heroin (damage score = 44.9) and cocaine (damage score = 38.5) as the most harmful products to users and to society; gambling was considered the least harmful (score = 22.5), replicating previous results. Damage scoring correlated poorly with legal status or with overall subjective expert opinions of products. Benefit perception scores indicated alcohol as a clear outlier (benefit score = 45.5) followed by tobacco (benefit score = 34.3) and cannabis (benefit score = 31.1). Statistical modelling suggested that experts attributed 10 times more importance to benefit perception than to damages when making their subjective opinion from a user perspective and two times more importance to benefit perception than to damages in formulating their opinion from a social perspective. Conclusions The perceived benefits of addictive products appear to have a major impact on the opinion of those products expressed by a number of French addiction experts.

Copyright 2012, Society for the Study of Addiction to Alcohol and Other Drugs

Branson CE; Clemmey P; Harrell P; Subramaniam G; Fishman M. Polysubstance use and heroin relapse among adolescents following residential treatment. Journal of Child & Adolescent Substance Abuse 21(3): 204-221, 2012. (35 refs.)

This study examined post-treatment patterns of polysubstance use and heroin relapse in a sample of 43 adolescents (ages 14-20) entering short-term residential treatment for primary heroin use. At 12-month follow-up, youths that achieved heroin abstinence (N = 19) were significantly less likely than youths that relapsed to heroin (N = 24) to endorse polysubstance use and cannabis, cocaine, or benzodiazepine use. Furthermore, heroin-abstinent youths significantly reduced their cannabis and cocaine use across the study period while youths that relapsed made initial reductions before returning to their pretreatment levels of use for these drugs. Clinical implications for heroin-using youths and areas for future research are discussed.

Copyright 2012, Taylor & Francis

Brown C; Krishnan S; Hursh K; Yu M; Johnson P; Page K et al. Dental disease prevalence among methamphetamine and heroin users in an urban setting A pilot study. Journal of the American Dental Association 143(9): 992-1001, 2012. (33 refs.)

Background. Researchers have reported rampant caries among methamphetamine users. The authors investigated the prevalence of dental disease and associated risk behaviors in methamphetamine users compared with those in heroin users. Methods. This pilot project was a cross-sectional study of an ongoing cohort of young adult injection-drug users (IDUs) in San Francisco. Participants completed an oral health questionnaire administered by a research assistant, and dentists performed clinical examinations to record the participants' data in terms of scores on the decayed-missing-filled surfaces (DMFS) index, presence of residual roots, scores on an oral hygiene index and whether any salivary hypofunction was observed. Results. The prevalence of dental disease among 58 young adult IDUs was strikingly high compared with that in the U.S. general population; however, the authors found no difference in the level of dental disease between users of methamphetamine and users of heroin. The mean DMFS score and number of decayed surfaces exceeded 28 in both groups. Conclusions. Although the authors detected no difference in dental disease between methamphetamine and heroin users, they found a high prevalence of caries and caries-associated behaviors in the sample of young adult IDUs. Clinical Implications. Given the high level of dental disease observed in this population of young adult IDUs, one next step may be to explore the feasibility and effectiveness of providing low-intensity preventive measures (such as distribution of chlorhexidine rinses or xylitol gum or application of fluoride varnishes) through outreach workers.

Copyright 2012, American Dental Association

Caiata-Zufferey M. From danger to risk: Categorising and valuing recreational heroin and cocaine use. Health Risk & Society 14(5, special issue): 427-443, 2012. (44 refs.)

This article examines how former drug addicts who now feel that they can safely use heroin and cocaine recreationally distinguish between problematic and non-problematic drug-taking. This is a crucial question in current Western societies. After having been linked for most of the twentieth century to deviance and illness, the concept of drug use has recently undergone a process of extension and dilution. The threshold between 'dangerous' and 'safe' has become nebulous and susceptible to categorical revision. In consequence, there is some scope for individuals to define what is problematic or recreational. In this sense, illicit drug use has ceased to be a social scourge, and instead has become a personal risk. To explore the process of categorising recreational heroin/cocaine use, in-depth interviews were conducted in Switzerland with nine former drug addicts, now self-defined recreational users, using a grounded theory approach. Results showed that participants make sense of recreational drug-taking by stressing its positive meaning and pointing out its disciplined modalities of use. This process of making sense is a narrative, social and contingent construction in that it is supported by a discourse, built up in interactions with the social system, and is time-and space-dependent. Because of these features, we called this process of making sense 'legitimation'. The results are discussed in relation to the conjoint socio-cognitive work of homogenisation/differentiation and valorisation that are central to risk categorisation, and this process is considered in relation to the legitimation of otherwise socially stigmatised behaviours.

Copyright 2012, Taylor & Francis

Cepeda A; Kaplan C; Neaigus A; Cano MA; Villarreal Y; Valdez A. Injecting transition risk and depression among Mexican American non-injecting heroin users. Drug and Alcohol Dependence 125(Supplement 1, special issue): S12-S17, 2012. (58 refs.)

Introduction: Existing research has documented high comorbid rates for injecting drug use (IDU) and social and health consequences including HIV infection, a condition that disproportionately affects U.S. Hispanic populations. Few studies have examined the specific associations between injecting transition risk among non-injecting heroin using (NIU) populations and mental health conditions. This study hypothesizes that injecting transition risk will be strongly associated with depression symptomatology controlling for age and gender among Mexican American NIUs. Methods: Street-recruited NIUs (n = 300) were administered structured interviews. The Mexican American sample was predominantly male (66%), unemployed (75%) with more than half experiencing incarceration in their lifetimes (58%). Depression was measured using the CES-D scale. Univariate and multivariate logistic regression analysis were employed to determine the associations between the dependent variable of heroin injecting transition risk and the key independent variables of depression symptomatology and other independent variables. Results: Depression symptomatology was the strongest independent correlate of injecting transition risk. Those NIUs with high levels of depression symptomatology had more than three times the heroin injecting transition risk than those NIUs with low levels. Heroin use network influence was also found to be a strong correlate. Acculturation level was significantly associated with injecting transition risk. Conclusion: The comorbid condition of depression symptomatology and heroin use places Mexican American NIUs at elevated risk of contracting blood-borne pathogens such as HIV. Development of prevention and treatment strategies that target Hispanic non-injecting heroin users in socially disadvantaged communities should consider depression symptoms and develop interventions that build new social networks.

Copyright 2012, Elsevier Science

Chekuri V; Gerber D; Brodie A; Krishnadas R. Premature ejaculation and other sexual dysfunctions in opiate dependent men receiving methadone substitution treatment. Addictive Behaviors 37(1): 124-126, 2012. (18 refs.)

A significant number of men with opiate misuse have sexual problems. Premature ejaculation (PE) occurs predominantly on discontinuation of the opiate but seems to persist in some cases. The aims of this study were to determine the rates of PE and other sexual dysfunctions in patients maintained on methadone; to determine the time of onset of PE in relation to onset of opiate misuse; and to look at the patients' perception of the effect of heroin and methadone on PE. Sixty five men attending a tertiary referral clinic for methadone maintenance treatment were assessed cross-sectionally using a semi-structured questionnaire, clinical interview, review of clinical records and the International Index of Erectile Function (IIEF). Thirty eight (58.5%) subjects reported a "lifetime" history of PE. Twenty (30.76%) of them reported "current" history of PE. Eleven (16.9%) people reported that PE preceded opiate misuse. Twenty four (63.2%) felt that heroin helped their PE and 7 (18.4%) felt that heroin worsened it. Fourteen (36.8%) felt that methadone helped PE, while 10 (26.3%) felt methadone worsened PE. Only 2 out of 65 (3.07%) reported that they had been asked about their sex life by the addiction services. Prevalence of "current" premature ejaculation was almost 3 times greater than reported in the general population. A significant number of patients perceived heroin to be beneficial on PE. Presence of sexual dysfunction could therefore be a risk factor for relapse into heroin misuse. Most clinicians avoid asking patients questions of a sexual nature. Nevertheless, managing sexual difficulties among patients with opiate misuse could be a significant step in relapse prevention.

Copyright 2012, Elsevier Science

Cheng JQ; Lu YH; Han XD; Gonzalez-Vallejo C; Sui N. Temporal discounting in heroin-dependent patients: No sign effect, weaker magnitude effect, and the relationship with inhibitory control. Experimental and Clinical Psychopharmacology 20(5): 400-409, 2012. (51 refs.)

Impulsive behavior in heroin-dependent individuals and matched smokers was studied within the framework of temporal discounting. Two well-known effects were examined: the sign and magnitude effects (Kirby, 1997). The study also investigated the relationship between cognitive impulsivity and inhibitory control as measured by a Go/No-go task. Fifty-six heroin-dependent patients in the postmethadone treatment stage and an equal number of matched daily smokers participated in the study. The heroin-dependent patients showed higher discount rates in both gain and loss conditions. They also showed no sign effect by demonstrating similar discount rates in gains and losses. Heroin-dependent patients also exhibited a magnitude effect, which was weaker than that observed in smokers. Differential relationships between impulsivity and inhibitory control were found in the two groups. For smokers, decision-making and inhibitory control behaviors pertained to different psychological processes, whereas for heroin-dependent patients, the two behaviors were partially related. Finally, a significant correlation between length of heroin use and temporal discounting with small magnitude was found. The present study advances our understanding of the specific behavioral impulsive patterns in heroin-dependent individuals.

Copyright 2012, American Psychological Society

Clarke TK; Ambrose-Lanci L; Ferraro TN; Berrettini WH; Kampman KM; Dackis CA et al. Genetic association analyses of PDYN polymorphisms with heroin and cocaine addiction. Genes, Brain and Behavior 11(4): 415-423, 2012. (50 refs.)

Genetic factors are believed to account for 30-50% of the risk for cocaine and heroin addiction. Dynorphin peptides, derived from the prodynorphin (PDYN) precursor, bind to opioid receptors, preferentially the kappa-opioid receptor, and may mediate the aversive effects of drugs of abuse. Dynorphin peptides produce place aversion in animals and produce dysphoria in humans. Cocaine and heroin have both been shown to increase expression of PDYN in brain regions relevant for drug reward and use. Polymorphisms in PDYN are therefore hypothesized to increase risk for addiction to drugs of abuse. In this study, 3 polymorphisms in PDYN (rs1022563, rs910080 and rs1997794) were genotyped in opioid-addicted [248 African Americans (AAs) and 1040 European Americans (EAs)], cocaine-addicted (1248 AAs and 336 EAs) and control individuals (674 AAs and 656 EAs). Sex-specific analyses were also performed as a previous study identified PDYN polymorphisms to be more significantly associated with female opioid addicts. We found rs1022563 to be significantly associated with opioid addiction in EAs [P = 0.03, odds ratio (OR) = 1.31; false discovery rate (FDR) corrected q-value]; however, when we performed female-specific association analyses, the OR increased from 1.31 to 1.51. Increased ORs were observed for rs910080 and rs199774 in female opioid addicts also in EAs. No statistically significant associations were observed with cocaine or opioid addiction in AAs. These data show that polymorphisms in PDYN are associated with opioid addiction in EAs and provide further evidence that these risk variants may be more relevant in females.

Copyright 2012, Wiley-Blackwell

Cornford CS; Umeh K; Manshani N. Heroin users' experiences of depression: A qualitative study. Family Practice 29(5): 586-592, 2012. (29 refs.)

Heroin users represent a challenging group of patients for GPs, with a high morbidity including a high prevalence of depression. Compared to other groups, management of 'depression' in heroin users is likely to require different approaches. To examine heroin users' beliefs about connections between depressive symptoms and drug taking. Qualitative. Primary care. A total of 17 semi-structured interviews were conducted with patients receiving opioid substitution therapy and antidepressants. One focus group of service users was also interviewed. A wide range of thoughts and emotions were described as 'depression'. Adverse childhood events were viewed as both the cause of depression and as simultaneously placing the individual in social circles where drug use was common. Drug taking was thought to lead to depression through resultant adverse social consequences, though illicit drug use was also regarded as an understandable way to cope with depression. Examples of stigma from taking drugs were commonly described and thought a cause of depression; in contrast, stigmatizing effects of depression were not apparent. The participants often felt isolated. Beliefs about how antidepressants worked incorporated ideas about blocking out thoughts, stopping thoughts racing and keeping emotions level. Self-management techniques for treating depression were rarely described. Heroin users' experiences of depression-including ideas about causation, how symptoms are felt and experienced and treatment strategies-are overwhelmingly framed by the context of drug taking.

Copyright 2012, Oxford University Press

Darke S; Kaye S; Torok M. Age-related patterns of drug use initiation among polydrug using regular psychostimulant users. Drug and Alcohol Review 31(6): 784-789, 2012. (29 refs.)

Introduction and Aims. To determine age-related patterns of drug use initiation, drug sequencing and treatment entry among regular psychostimulant users. Design and Methods. Cross-sectional study of 269 regular psychostimulant users, administered a structured interview examining onset of use for major licit and illicit drugs. Results. The mean age at first intoxication was not associated with age or gender. In contrast, younger age was associated with earlier ages of onset for all of the illicit drug classes. Each additional year of age was associated with a 4 month increase in onset age for methamphetamine, and 3 months for heroin. By the age of 17, those born prior to 1961 had, on average, used only tobacco and alcohol, whereas those born between 1986 and 1990 had used nine different drug classes. The period between initial use and the transition to regular use, however, was stable. Age was also negatively correlated with both age at initial injection and regular injecting. Onset sequences, however, remained stable. Consistent with the age-related patterns of drug use, each additional year of age associated with a 0.47 year increase in the age at first treatment. Discussion and Conclusions. While the age at first intoxication appeared stable, the trajectory through illicit drug use was substantially truncated. The data indicate that, at least among those who progress to regular illicit drug use, younger users are likely to be exposed to far broader polydrug use in their teens than has previously been the case.

Copyright 2012, Wiley-Blackwell

Demaret I; Lemaitre A; Ansseau M. Staff concerns in heroin-assisted treatment centres. Journal of Psychiatric and Mental Health Nursing 19(6): 563-567, 2012. (29 refs.)

Heroin-assisted treatment (HAT) is a solution for improving the condition of treatment-resistant heroin addicts. Since 1994, six randomized controlled trials have concluded that HAT is more efficacious than oral methadone for severe heroin addicts. We visited seven HAT treatment centres in four countries in order to observe diacetylmorphine (DAM) administration and to study the main concerns of the staff. Nurses were concerned by the risk taken if a previously intoxicated patient received his dose of DAM. Another concern was the smuggling of DAM doses. The HAT centres face a dilemma: treating patients while at the same time allowing their risky street habits in the centre.

Copyright 2012, Wiley-Blackwell

Fibbi M; Silva K; Johnson K; Langer D; Lankenau SE. Denial of prescription opioids among young adults with histories of opioid misuse. Pain Medicine 13(8): 1040-1048, 2012. (38 refs.)

Objectives. An exploratory study was undertaken to examine how being denied prescription opioids to treat pain impacted the drug-using careers of young adults with a history of misuse of prescription drugs. Design. Ethno-epidemiological methodology utilizing a cross-sectional design, semi-structured interviews, and qualitative/quantitative data analysis. Settings. Non-clinical participants were recruited from natural settings, such as streets, parks, beaches, and college campuses, in New York City and Los Angeles during 2008 and 2009. Participants. One hundred fifty participants aged 16 to 25 who had misused a prescription opioid, tranquilizer, or stimulant in the past 90 days. Outcome Measures. Analyses focused on denial of opioids and associated consequences, including self-medication with prescription opioids and heroin. Results. Thirty-four participants (22.7%) described being denied prescription opioids for the treatment of a painful condition. Current opioid misuse and current pain problems were higher in this group compared to those who had never been denied prescription opioids. Reasons for denial included being identified as a drug user by a physician, lack of health insurance, and having medication withheld by a parent or authority figure. Approximately half reported self-medicating pain with either illegally obtained prescription opioids or heroin. Self-medication often coincided with initiation of new risk behaviors and more intensive drug use. Conclusion. Being denied prescription opioids was an important moment in the drug using careers of many study participants. Results suggest that effective pain management techniques are needed to prevent high-risk young adults with pain problems from engaging in escalated opioid misuse and risk behaviors.

Copyright 2012, Wiley-Blackwell

Gerber H; Borgwardt SJ; Schmid O; Gerhard U; Joechle W; Riecher-Rossler A et al. The Impact of diacetylmorphine on hypothalamic-pituitary-adrenal axis activity and heroin craving in heroin dependence. European Addiction Research 18(3): 116-123, 2012. (52 refs.)

Background/Aim: Heroin dependence is a chronic relapsing disorder characterized by the compulsion to seek and use heroin. Stress and craving are seen as key factors for heroin use. Moreover, altered hypothalamic-pituitary-adrenal (HPA) axis function has been frequently reported. However, the acute effects of diacetylmorphine (DAM) on HPA axis activity and craving have not been investigated in a controlled study. The present randomized controlled study examined whether DAM administration differs from placebo (saline) administration with regard to HPA axis response and heroin craving. Methods: In a crossover experiment, 28 DAM-maintained heroin-dependent patients were first injected with DAM and then saline, or the converse. Plasma adrenocorticotropic hormone (ACTH) and cortisol in saliva and serum were measured at baseline and 20 and 60 min after both injections. Heroin craving was measured at baseline and 60 min after both injections, by means of the Heroin Craving Questionnaire. Results: Compared to saline, DAM administration induced a significant decrease in plasma ACTH (p < 0.01), serum cortisol (p < 0.0001) and saliva cortisol (p < 0.01), as well as in craving (p < 0.0001), over time. Conclusion: Since acute DAM administration suppresses the stress response, DAM-assisted treatment may be an effective alternative to methadone maintenance in stress-sensitive heroin-dependent patients.

Copyright 2012, Karger

Gilbert L; El-Bassel N; Chang MW; Wu EW; Roy L. Substance use and partner violence among urban women seeking emergency care. Psychology of Addictive Behaviors 26(2): 226-235, 2012. (58 refs.)

Growing evidence suggests intimate partner violence (IPV) and substance misuse are co-occurring problems that disproportionately affect low income urban women seeking care in emergency departments (EDs) and represent leading causes of injuries that result in ED visits. This paper examines temporal bidirectional associations between different types of drug and alcohol use and different types of IPV in a longitudinal study of a representative sample of 241 low-income urban women receiving emergency care from an ED in the Bronx, New York. After adjusting and matching for sociodemographics and potentially confounding multilevel risk and protective covariates, women who reported using heroin in the prior 6 months at Wave 1 were twice as likely as nonheroin-using women to indicate any physical, injurious, or sexual IPV at subsequent waves and were 2.7 times more likely to indicate experiencing an injury from IPV at subsequent waves. Crack or cocaine use in the past 6 months at Wave 1 was associated with an increased likelihood of injurious IPV and severe verbal abuse at subsequent waves. Findings also suggested that sexual IPV was significantly associated with subsequent use of crack or cocaine. The multiple bidirectional associations found linking these problems underscore the need for conducting routine screening for IPV and substance misuse among women in low-income urban EDs, and for improving linkages to services that will ultimately reduce the risk of morbidity, disability, and mortality related to these co-occurring problems.

Copyright 2012, American Psychological Association

Gilchrist G; Langohr K; Fonseca F; Muga R; Torrens M. Factors associated with discharge against medical advice from an alcohol and drug inpatient detoxification unit in Barcelona between 1993 and 2006. Heroin Addiction and Related Clinical Problems 14(1): 35-43, 2012. (31 refs.)

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.

Copyright 2012, Pacini Editore

Griffiths P; Mounteney J; Laniel L. Understanding changes in heroin availability in Europe over time: Emerging evidence for a slide, a squeeze and a shock. (editorial). Addiction 107(9): 1539-1540, 2012. (9 refs.)

Guerrero EG; Cepeda A; Duan L; Kim T. Disparities in completion of substance abuse treatment among Latino subgroups in Los Angeles County, CA. Addictive Behaviors 37(10): 1162-1166, 2012. (33 refs.)

Rationale: A growing body of research has revealed disparities with respect to drug use patterns within Latino subgroups. However, the extent to which these potential disparities enable different Latino subgroups to respond favorably to treatment is unclear. Methods: This study analyzed a subset of multicross-sectional data (2006-2009) on Latinos collected from publicly funded facilities in Los Angeles County, CA (N = 12,871). We used multilevel logistic regressions to examine individual and service-level factors associated with treatment completion among subgroups of first-time Latino treatment clients. Results: Univariate analysis showed that Cubans and Puerto Ricans were less likely to complete treatment than Mexicans and other Latinos. Cubans and Puerto Ricans entered treatment at an older age and with higher formal education than Mexicans, yet they were more likely to report mental health issues and use of cocaine and heroin as primary drugs of choice respectively. Multivariate analysis showed that age, having mental health issues, reporting high use of drugs at intake, and use of methamphetamines and marijuana were associated with decreased odds of completing treatment among all Latino subgroups. In contrast, age at first drug use, treatment duration, and referral monitoring by the criminal system increased the odds of completing treatment for all members. Conclusion: These findings have implications for targeting interventions for members of different Latinos groups during their first treatment episode. Promising individual and service factors associated with treatment completion can inform the design of culturally specific recovery models that can be evaluated in small-scale randomized pilot studies.

Copyright 2012, Elsevier Science

Guo Z; Zheng H; Lu YZ; Wei Y. Isolation and purification of heroin from heroin street samples by preparative high performance liquid chromatography. Forensic Science International 221(1-3): 120-124, 2012. (19 refs.)

The present study established a novel method using preparative high performance liquid chromatography to isolate and purify heroin center dot HCl from heroin street samples to be used as a reference standard. Different kinds of mobile phases and columns were used, ultimately the mobile phase consisting of hexane-isopropanol-methanol (65:28: 7, v/v) and the SIL preparative column prepared in laboratory were selected as the final condition. Heroin was further purified by the drowning-out crystallization method using isopropanol-methanol (50:1, v/v) and hexane as drowning-out antisolvents and salting-out agents, respectively. The purity was assessed by analytical high performance liquid chromatography and the confirmation of the chemical structure was performed by IR and NMR. About 110.7 mg of heroin center dot HCl at a purity of over 99.52% was obtained from 180 mg of heroin street samples which contained 156.15 mg of heroin center dot HCl component by preparative high performance liquid chromatography. This method is suitable for preparing heroin standards in forensic science area.

Copyright 2012, Elsevier Science

Hadland SE; Marshall BDL; Kerr T; Lai C; Montaner JS; Wood E. Ready access to illicit drugs among youth and adult users. American Journal on Addictions 21(5): 488-490, 2012. (16 refs.)

Background: Current drug-control strategies in Canada focus funding and resources predominantly on drug law enforcement, often at the expense of preventive, treatment, and harm reduction efforts. This study aimed to examine the availability of the most commonly used substances in Vancouver, Canada after the implementation of such strategies. Methods: Using data from two large cohorts of drug-using youth and adults in Vancouver from the calendar year 2007, we assessed perceived availability of heroin, crack, cocaine, crystal methamphetamine, and marijuana. Results: Compared to youth (n= 330), a greater proportion of adults (n= 1,160) reported immediate access (ie, within 10 minutes) to heroin (81.0% vs. 55.9%, p < .001), crack (90.4% vs. 69.3%, p < .001), and cocaine (83.7% vs. 61.1%, p < .001). Conversely, larger proportions of youth reported immediate access to crystal methamphetamine (62.8% vs. 39.4%, p < .001) and marijuana (88.4% vs. 73.2%, p < .001) compared to adult users. Conclusions: Regardless of differences in illicit drug availability by age, all drugs are readily accessed in Vancouver despite drug law enforcement efforts. This includes drugs that are frequently injected and place users at risk of human immunodeficiency virus (HIV) infection and transmission of other blood-borne disease.

Copyright 2012, Wiley-Blackwell

Hicks CW; Sweeney DA; Cui XZ; Li Y; Eichacker PQ. An overview of anthrax infection including the recently identified form of disease in injection drug users. (review). Intensive Care Medicine 38(7): 1092-1104, 2012. (98 refs.)

Bacillus anthracis infection (anthrax) can be highly lethal. Two recent outbreaks related to contaminated mail in the USA and heroin in the UK and Europe and its potential as a bioterrorist weapon have greatly increased concerns over anthrax in the developed world. This review summarizes the microbiology, pathogenesis, diagnosis, and management of anthrax. Anthrax, a gram-positive bacterium, has typically been associated with three forms of infection: cutaneous, gastrointestinal, and inhalational. However, the anthrax outbreak among injection drug users has emphasized the importance of what is now considered a fourth disease form (i.e., injectional anthrax) that is characterized by severe soft tissue infection. While cutaneous anthrax is most common, its early stages are distinct and prompt appropriate treatment commonly produces a good outcome. However, early symptoms with the other three disease forms can be nonspecific and mistaken for less lethal conditions. As a result, patients with gastrointestinal, inhalational, or injectional anthrax may have advanced infection at presentation that can be highly lethal. Once anthrax is suspected, the diagnosis can usually be made with gram stain and culture from blood or tissue followed by confirmatory testing (e.g., PCR). While antibiotics are the mainstay of anthrax treatment, use of adjunctive therapies such as anthrax toxin antagonists are a consideration. Prompt surgical therapy appears to be important for successful management of injectional anthrax.

Copyright 2012, Springer

Holland R; Matheson C; Anthony G; Roberts K; Priyardarshi S; MacRae A et al. A pilot randomised controlled trial of brief versus twice weekly versus standard supervised consumption in patients on opiate maintenance treatment. Drug and Alcohol Review 31(4): 483-491, 2012. (17 refs.)

Introduction and Aims. Methadone maintenance remains the mainstay of treatment for opiate dependence in Scotland. Guidelines recommend supervised self-administration for at least 3 months, yet this is often interpreted as long-term supervision. However, there is no evidence base for deciding the optimal period of supervision. We tested the feasibility of conducting a randomised controlled trial (RCT) of different supervision models. Design and Methods. Three armed pilot RCT, set in three Scottish treatment areas, recruited opiate-dependent patients who had received methadone treatment for 3 months. Participants were randomised to: (i) no supervision; (ii) twice weekly supervision; or (iii) daily supervision for further 3 months. As a pilot, key process measures were: recruitment rates, follow-up rates and treatment fidelity. We also wanted to estimate effect sizes of two co-primary outcomes for a full RCT: treatment retention and illicit heroin use. The recruitment target was 60 participants. Results. One hundred and two eligible patients were identified, 60 (59%) participated, and 46 followed up (77%). Study fidelity was good with two participants moving group. Those randomised to no supervision were significantly happier with their group allocation. No significant differences were found in primary outcomes, although retention decreased with increased supervision, while illicit heroin use was least in those most supervised. Discussion and Conclusions. It is possible to recruit and randomise participants to an RCT comparing different forms of supervised consumption. Pilot data suggest increased supervision may reduce illicit heroin use, but may decrease retention. This should now be tested in a large-scale multicentre RCT.

Copyright 2012, Wiley-Blackwell

Holzmann T; Frangoulidis D; Simon M; Noll P; Schmoldt S; Hanczaruk M et al. Fatal anthrax infection in a heroin user from southern Germany, June 2012. Eurosurveillance 17(26): 2-6, 2012. (12 refs.)

Blood cultures from a heroin user who died in June 2012, a few hours after hospital admission, due to acute septic disease, revealed the presence of Bacillus anthracis. This report describes the extended diagnosis by MALDI-TOF and real-time PCR and rapid confirmation of the anthrax infection through reference laboratories. Physicians and diagnostic laboratories were informed and alerted efficiently through the reporting channels of German public health institutions, which is essential for the prevention of further cases.

Copyright 2012, European Centre for Disease Prevention and Control

Huang WL; Lin YH; Kuo TBJ; Chang LR; Chen YZ; Yang CCH. Methadone-mediated autonomic functioning of male patients with heroin dependence: The influence of borderline personality pattern. PLoS ONE 7(5): e-article 37464, 2012. (43 refs.)

Background: We hypothesize that the population with borderline personality shows different autonomic response to methadone compared to individuals with other personalities. This study applies heart rate variability (HRV) measurements and the Tridimensional Personality Questionnaire (TPQ) to examine this hypothesis. Methodology/Principal Findings: Forty-four male patients with heroin dependence were recruited from a methadone maintenance treatment program. Eight personality patterns were classified according to the TPQ norm used in Taiwan. The borderline pattern (BP, composed of high novelty seeking, high harm avoidance and low reward dependence) and the other personality patterns (OP) were separated into two groups. We compared the HRV profiles between the BP and OP groups. Correlation and regression analysis were performed to clarify relationship between HRV differences and the borderline index (BI, a new concept defined by us, which is calculated as novelty seeking + harm avoidance - reward dependence). The HRV targets investigated included low frequency (LF) power, high frequency (HF) power, total power (TP), normalized LF (LF%), and LF/HF. No baseline HRV parameters showed any inter-group difference. The BP group had a significantly lower Delta HF and a higher Delta LF/HF than the OP group. The personality dimension, reward dependence, showed a negative correlation with Delta LF/HF and Delta LF%. BI was negatively correlated with Delta HF and positively correlated with Delta LF/HF and Delta LF%. Conclusions/Significance: Borderline personality individuals show increased sympathetic activity and decreased parasympathetic activity compared to other personalities after taking methadone. The results support the hypothesis that there is an interaction between borderline personality and autonomic modulation.

Copyright 2012, Public Library of Science

Johnson S; MacDonald SF; Cheverie M; Myrick C; Fischer B. Prevalence and trends of non-medical opioid and other drug use histories among federal correctional inmates in methadone maintenance treatment in Canada. Drug and Alcohol Dependence 124(1-2): 172-176, 2012. (24 refs.)

Background: The prevalence of illicit drug use among correctional populations is high, and associated with high levels of drug related morbidity risks and harms. The purpose of this study was to examine temporal and regional patterns of illicit drug use among a sample of Canadian federal correctional inmates participating in correctional methadone maintenance treatment (MMT). Methods: Socio-demographic and drug use data collected from 1272 male federal offenders admitted to Correctional Service Canada's (CSC) MMT program between 2003 and 2008 were examined. Univariate analyses were conducted on inmates' key demographic and correctional characteristics, pre-MMT opioid use and other problematic drug use, and opioid and injecting use while incarcerated. Bivariate associations on drug use measures across regions and over time were computed. Results: Prevalence of heroin use decreased, and prevalence of prescription opioid (PO) use increased over the study period. Significant regional differences existed for PO use, specifically for morphine/hydromorphone and oxycodone use. The majority used opioids and injected while incarcerated, with overall downward trends over time and regional variations. Approximately half the sample indicated a history of lifetime non-opioid problematic drug use, most commonly cocaine (72%) for which substantial regional differences were found. Conclusions: Pre-MMT opioid and other problematic non-opioid drug use in the sample was high. Temporal and regional patterns of drug use observed may reflect developments in the general population, e.g. increasing PO misuse. The observed drug use patterns underscore the need for targeted drug specific prevention/treatment measures in correctional environments beyond existing interventions.

Copyright 2012, Elsevier Science

Johnston LD; O'Malley PM; Bachman JG. Monitoring the Future: National Results on Adolescent Drug Use. Overview of Key Findings 2011. Bethesda MD: National Institute on Drug Abuse, 2012

This report the third volume in Monitoring the Future study's 2011 nationwide survey of 8th, 10th, and 12th grade students presents the key findings from the survey. Recent trends are presented in the use of licit and illicit drugs, in the levels of perceived risk and personal disapproval associated with each drug, and in perceived availability of each drug. Drugs covered in this report include any illicit drug use, marijuana, inhalants, LSD, cocaine, crack cocaine, amphetamines, methamphetamine and "ice", heroin, other narcotics, tranquilizers, sedatives (barbiturates), Ecstacy (MDMA) and other club drugs, alcohol, cigarettes, smokeless tobacco, and steroids. Sub-group differences in respect to race/ethnicity, population density, gender, socioeconomic levels, region of the country, gender, and college plans. Among the important findings in this year's results is the fact that, after a decade of gradual decline, marijuana use has begun to tilt up. One important finding of the MTF study is that cohort effects -- lasting differences between different cohorts entering secondary school-have emerged, beginning with increases in drug use during the early 1990s. Such cohort effects mean that usage rates (and sometimes attitudes and beliefs about various drugs) reach peaks and valleys in different years for different grades. Since then, 8th graders have tended to be the first to show turnarounds in illicit drug use, and have generally shown the greatest proportional declines from recent peak levels of use, attained for the most part during the 1990s. Marijuana use, which had been rising among teens for the past three years, continued to rise in 2011 in all prevalence periods for 10th and 12th graders. The recent rise in use stands in stark contrast to the long, gradual decline that had been occurring over the preceding decade. (Among 8th graders there was some decrease in annual prevalence in 2011 although annual prevalence has been rising overall since 2004.). It is relevant that perceived risk for marijuana has been falling for the past five years. Synthetic marijuana, such as Spice and K-2, was not scheduled by the Drug Enforcement Administration, some 11.4% indicated use in the prior 12 months. Any effects of the scheduling by the DEA will not be evident until next year. Finally, alcohol use, including binge drinking, continued its longer term decline among teens, reaching historically low levels in 2011 for all three grades.

Copyright 2012, Project Cork

Johnston LD; O'Malley PM; Bachman JG; Schulenberg JE. Monitoring the Future National Survey Results on Drug Use, 1975-2011. Volume II: College Students & Adults Ages 19-50. Bethesda MD: National Institute on Drug Abuse, 2012. (69 refs.)

This is the second volume of the three part 2011 report of findings from the Monitoring the Future Survey. It presents data on drug use among college students and adults, ages 19-50. There report is organized in nine chapters. The first three provide an introduction, key findings, and an overview of the study design and procedures. The next six address prevalence of drug use in early and middle adulthood; trends in drug use in early and middle adulthood; attitudes; beliefs about drugs among young adults; and the social context. The last two chapters deal with the prevalence of drug use among college students and trends in drug use among the college population. There is also consideration of sub-groups, regional differences, differences by various demographic characteristics, and cohort differences. Data is summarized in 30 tables and 84 figures.

Copyright 2012, Project Cork

Kerr T; Marshall BDL; Milloy MJ; Zhang R; Guillemi S; Montaner JSG et al. Patterns of heroin and cocaine injection and plasma HIV-1 RNA suppression among a long-term cohort of injection drug users. Drug and Alcohol Dependence 124(1-2): 108-112, 2012. (38 refs.)

Background: Previous studies suggest that active drug use may compromise HIV treatment among HIV-positive injection drug users (IOU). However, little is known about the differential impacts of cocaine injection, heroin injection, and combined cocaine and heroin injection on plasma HIV-1 RNA suppression. Methods: Data were derived from a longstanding open prospective cohort of HIV-positive IOU in Vancouver, Canada. Kaplan-Meier methods and Cox proportional hazards regression were used to examine the impacts of different drug use patterns on rates of plasma HIV-1 RNA suppression. Results: Between May 1996 and April 2008, 267 antiretroviral (ART) naive participants were seen for a median follow-up duration of 50.6 months after initiating ART. The incidence density of HIV-1 RNA suppression was 65.2 (95%CI: 57.0-74.2) per 100 person-years. In Kaplan-Meier analyses, compared to those who abstained from injecting, individuals injecting heroin, cocaine, or combined heroin/cocaine at baseline were significantly less likely to achieve viral suppression (all p < 0.01). However, none of the drug use categories remained associated with a reduced rate of viral suppression when considered as time-updated variables (all p > 0.05). Conclusions: Active injecting at the time of ART initiation was associated with lower plasma HIV-1 RNA suppression rates; however, there was no difference in suppression rates when drug use patterns were examined over time. These findings imply that adherence interventions for active injectors should optimally be applied at the time of ART initiation.

Copyright 2012, Elsevier Science

Keshtkar A; Majdzadeh R; Nedjat S; Gholipour M; Badakhshan A; Qorbani M. Characteristics of high-risk sexual behaviors for human immunodeficiency virus infection among Iranian drug abusers. Journal of Addiction Medicine 6(2): 153-158, 2012. (25 refs.)

Objectives: This study was conducted to estimate the prevalence and the associated factors of high-risk sexual behaviors among drug abusers referred to a methadone clinic in Gorgan, the capital of Golestan province in the northeast of Iran, to help health care decision makers on designing interventional programs. Methods: In this cross-sectional study, 400 drug abusers referred to our methadone clinic were evaluated for high-risk sexual behavior. A logistic regression model was fitted for the association between independent variables and high-risk sexual behavior. Results: Approximately a quarter of patients (25.5%) had high-risk sexual behavior among which 47% had not used a condom in their last sexual contact. Drug abusers who had poor economic status had a lower chance of high-risk sexual behavior than those with good economic status (adjusted odds ratio [AOR] = 0.35, 95% confidence interval [CI] = 0.13-0.96). Also, 1-year increase in age reduced the chance by 6% (AOR = 0.94, 95% CI = 0.91-0.98). Heroin abusers, compared with opium abusers, had a duplicated chance of having high-risk sex (AOR = 2.11, 95% CI = 1.12-3.96). Conclusion: According to this study, high-risk sexual behavior in the drug abusers referred to methadone clinic was associated with younger age, good economic status, and heroin addiction. Hence, in interventional planning, more attention should be paid to young drug abusers, patients with good economic status, and heroin addicts as well.

Copyright 2012, Lippincott, Williams & Wilkins

Kinner SA; Milloy MJ; Wood E; Qi JZ; Zhang R; Kerr T. Incidence and risk factors for non-fatal overdose among a cohort of recently incarcerated illicit drug users. Addictive Behaviors 37(6): 691-696, 2012. (55 refs.)

Background: Release from prison is associated with a markedly increased risk of both fatal and non-fatal drug overdose, yet the risk factors for overdose in recently released prisoners are poorly understood. The aim of this study was to identify risk and protective factors for non-fatal overdose (NFOD) among a cohort of illicit drug users in Vancouver, Canada, according to recent incarceration. Methods: Prospective cohort of 2515 community-recruited illicit drug users in Vancouver, Canada, followed from 1996 to 2010. We examined factors associated with NFOD in the past six months separately among those who did and did not also report incarceration in the last six months. Results: One third of participants (n = 829, 33.0%) reported at least one recent NFOD. Among those recently incarcerated, risk factors independently and positively associated with NFOD included daily use of heroin, benzodiazepines, cocaine or methamphetamine, binge drug use, public injecting and previous NFOD. Older age, methadone maintenance treatment and HIV seropositivity were protective against NFOD. A similar set of risk factors was identified among those who had not been incarcerated recently. Conclusions: Among this cohort, and irrespective of recent incarceration, NFOD was associated with a range of modifiable risk factors including more frequent and riskier patterns of drug use. Not all ex-prisoners are at equal risk of overdose and there remains an urgent need to develop and implement evidence-based preventive interventions, targeting those with modifiable risk factors in this high risk group.

Copyright 2012, Elsevier Science

Larney S; Toson B; Burns L; Dolan K. Effect of prison-based opioid substitution treatment and post-release retention in treatment on risk of re-incarceration. Addiction 107(2): 372-380, 2012. (70 refs.)

Aims: People who use heroin are frequently incarcerated multiple times. Reducing re-incarceration of this group is important for reducing both health risks associated with incarceration and the costs of correctional administration. Opioid substitution treatment (OST) in prisons may help to reduce re-incarceration, but research findings on this topic have been mixed. In this study, we examined the effect of OST in prison and after release on re-incarceration. Design: Longitudinal cohort study. Setting, participants and measurements Data on OST and incarceration were linked for a cohort of 375 male heroin users recruited originally in prisons in New South Wales, Australia. Data were linked for the period 1 June 1997-31 December 2006. Re-incarceration was examined using recurrent-event survival analysis models. Model 1 examined the effect of OST status at release from prison (i. e. in treatment versus out of treatment on the day of release) on re-incarceration. Model 2 considered the effect of remaining in OST after release on risk of re-incarceration. Findings: Ninety per cent of participants were re-incarcerated following their first observed release. Pre-incarceration cocaine use was associated with a 13% increase in the average risk of re-incarceration. There was no significant association between simply being in OST at the time of release and risk of re-incarceration; however, in the model taking into account post-release retention in treatment, the average risk of re-incarceration was reduced by 20% while participants were in treatment. Conclusions: In New South Wales, Australia, opioid substitution treatment after release from prison has reduced the average risk of re-incarceration by one-fifth.

Copyright 2012, Society for the Study of Addiction to Alcohol and Other Drugs

Li Q; Wang YR; Zhang Y; Li W; Yang WC; Zhu J et al. Craving correlates with mesolimbic responses to heroin-related cues in short-term abstinence from heroin: An event-related fMRI study. Brain Research 1469: 63-72, 2012. (46 refs.)

Craving is an important factor in relapse to drug abuse, and cue-induced craving is an especially powerful form of this construct. Neuroimaging methods have been utilized to study drug cue-induced craving and neural correlates in the human brain. However, very few studies have focused on characterizing craving and the neural responses to heroin-related cues in short-term abstinent heroin-dependent patients. Twenty-four heroin-dependent subjects and 20 demographically matched drug-naive subjects participated in this study. An event-related cue-reactivity paradigm was employed, while changes in blood oxygen level-dependent (BOLD) signals were acquired by functional magnetic resonance imaging (fMRI). The heroin-dependent group reported significantly increased craving following exposure to heroin-related cues. Direct comparison between the two groups showed that brain activation to heroin-related minus neutral cues was significantly greater for the heroin-dependent group in the bilateral nucleus accumbens (NAc), caudate, putamen, amygdala, hippocampus/parahippocampus, midcingulate cortex, dorsolateral prefrontal cortex (DLPFC), orbitofrontal cortex (OFC), medial frontal gyrus (MeFG), midbrain, thalamus, left anterior cingulate cortex (ACC), posterior cingulate cortex (PCC), and subcallosal gyrus. Changes in craving in the heroin-dependent group correlated positively with brain activation in the bilateral NAc, caudate, right putamen, and left ACC. The abstinence duration correlated positively with brain activation in the left caudate and right parahippocampal gyrus. In conclusion, the cue-reactivity paradigm significantly activated neural responses in the mesolimbic dopamine (DA) system and prefrontal cortex (PFC) and induced increased craving in short-term abstinent heroin-dependent patients. We suggest that these response patterns characterize the high vulnerability of relapse in short-term abstinent heroin-dependent subjects.

Copyright 2012, Elsevier Science

Lindsey WT; Stewart D; Childress D. Drug interactions between common illicit drugs and prescription therapies. American Journal of Drug and Alcohol Abuse 38(4): 334-343, 2012. (51 refs.)

Objective: The aim was to summarize the clinical literature on interactions between common illicit drugs and prescription therapies. Methods: Medline, Iowa Drug Information Service, International Pharmaceutical Abstracts, EBSCO Academic Search Premier, and Google Scholar were searched from date of origin of database to March 2011. Search terms were cocaine, marijuana, cannabis, methamphetamine, amphetamine, ecstasy, N-methyl-3,4-methylenedioxymethamphetamine, methylenedioxymethamphetamine, heroin, gamma-hydroxybutyrate, sodium oxybate, and combined with interactions, drug interactions, and drug-drug interactions. This review focuses on established clinical evidence. All applicable full-text English language articles and abstracts found were evaluated and included in the review as appropriate. Results: The interactions of illicit drugs with prescription therapies have the ability to potentiate or attenuate the effects of both the illicit agent and/or the prescription therapeutic agent, which can lead to toxic effects or a reduction in the prescription agent's therapeutic activity. Most texts and databases focus on theoretical or probable interactions due to the kinetic properties of the drugs and do not fully explore the pharmacodynamic and clinical implications of these interactions. Clinical trials with coadministration of illicit drugs and prescription drugs are discussed along with case reports that demonstrate a potential interaction between agents. The illicit drugs discussed are cocaine, marijuana, amphetamines, methylenedioxymethamphetamine, heroin, and sodium oxybate. Conclusion: Although the use of illicit drugs is widespread, there are little experimental or clinical data regarding the effects of these agents on common prescription therapies. Scientific Significance: Potential drug interactions between illicit drugs and prescription drugs are described and evaluated on the Drug Interaction Probability Scale by Horn and Hansten.

Copyright 2012, Informa Healthcare

Mackesy-Amiti ME; Donenberg GR; Ouellet LJ. Prevalence of psychiatric disorders among young injection drug users. Drug and Alcohol Dependence 124(1-2): 70-78, 2012. (52 refs.)

Background: Studies of individuals in treatment for substance use have found high rates of psychiatric disorders, however little is known about the mental health of drug users not in treatment. This study aimed to assess the prevalence of lifetime and recent substance use and psychiatric disorders among young injection drug users (IDU) outside of a treatment setting. Methods: Participants were recruited through outreach and respondent-driven sampling. Trained interviewers administered the Psychiatric Research Instrument for Substance and Mental Disorders. Interviews were conducted at two field stations operated by Community Outreach Intervention Projects in Chicago. Participants were 570 young adults (18-25 years) who injected drugs in the previous 30 days. Heroin was the primary drug used in this sample. Past 12-month and lifetime substance use disorders and primary and substance-induced mental disorders were based on DSM-IV diagnostic criteria. Results: Nearly all participants met the criteria for heroin dependence. Multiple substance use disorders were common; cannabis was the most common substance involved after heroin, followed by alcohol and cocaine. Major depression, alcohol dependence, antisocial personality disorder, and borderline personality disorder were highly prevalent. Other psychiatric disorders were observed at levels consistent with other young adult samples. Conclusions: Young IDU experience major depression, alcohol dependence, anti-social personality disorder, and borderline personality disorder at high rates, and multiple substance use disorders are common. Anxiety disorders in this population appear to be similar in prevalence to young adults in general.

Copyright 2012, Elsevier Science

Malekinejad M; Vazirian M. Transition to injection amongst opioid users in Iran: Implications for harm reduction. International Journal of Drug Policy 23(4): 333-337, 2012. (51 refs.)

Driven by opioid use, HIV prevalence is high (15-27%) amongst injection drug users (IDU) in Iran. Harm reduction programmes are associated with a reduction in high risk injecting behaviours; however, Iran has a large number of non-injecting opioid users not immediately targeted by harm reduction programmes. The vast majority of heroin injectors tend to have a history of several years of smoking opium or heroin before transitioning to injection, and a small fraction may even start their drug career by injection of opioids, behaviours that can undermine the effectiveness of the harm reduction programmes. In this study, we have reviewed evidence on the HIV epidemic, extent and pattern of opioid use, and correlates of the transition to injection in Iran. We have concluded that harm reduction policies should also emphasize prevention of the transition to injection amongst high-risk non-injecting opioid users as an additional strategy against the spread of HIV infection in Iran.

Copyright 2012, Elsevier Science

Maremmani AGI; Rovai L; Pani PP; Maremmani I. Heroin addicts' psychopathological subtypes. Correlations with the natural history of illness. Heroin Addiction and Related Clinical Problems 14(1): 11-21, 2012. (67 refs.)

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.

Copyright 2012, Pacini Editore

McHugh RK; Weitzman M; Safren SA; Murray HW; Pollack MH; Otto MW. Sexual HIV risk behaviors in a treatment-refractory opioid-dependent sample. Journal of Psychoactive Drugs 44(3): 237-242, 2012. (42 refs.)

The propensity to engage in risk behaviors confers an elevated risk of HIV and other infectious disease transmission in opioid-dependent populations. Although drug abuse treatment may decrease drug-related risk behaviors such as needle-sharing, additional intervention may be needed to reduce HIV risk behavior. In this investigation, we assessed sexual HIV risk behaviors in opioid-dependent patients who were engaging in regular drug use despite ongoing counseling and methadone maintenance therapy. Potential risk and protective factors for engaging in sexual HIV risk behavior were examined. Taking into account demographic, psychiatric, substance use, and psychological variables, the only significant predictor of risk behavior was age. Specifically, younger patients were more likely to engage in sexual HIV risk behavior. The implications of these results for reducing sexual HIV risk behavior and for HIV prevention in methadone-maintained, treatment-refractory opioid-dependent patients are discussed.

Copyright 2012, Haight-Ashbury Publishing

Messier P; Michaud J. 'The nice culture and the good behaviour' state media and ethnic minorities in Lao Cai province, Vietnam. Identities: Global Studies in Culture and Power 19(3): 339-359, 2012. (78 refs.)

In the northern highlands of Vietnam, a very specific official vision of culture is at the core of the modernisation projects of Vietnam Television VTV5 (Dai Truyen hinh Viet Nam), a channel dedicated to educating ethnic minorities, and of the Lao Cai provincial branch of the Ministry of Culture, Sports and Tourism (MCST, Bo Van hoa, The thao va Du lich). These two state institutions jointly organise film screenings - for instance condemning the production and consumption of opium and heroin - in remote villages where they intend to modify cultural practices. These state social actors also produce films that represent what are deemed exemplary minority traditions for public consumption. Our observations of these media processes lead us to suggest that the subjects of these exogenous initiatives are adjusting strategically, activating patterns of quiet resistance to maintain their identities and subvert marginalisation.

Copyright 2012, Taylor & Francis

Mirmoghtadaee P; Eizadi-Mood N; Sabzghabaee AM; Yaraghi A; Hosseinzadeh F; Dorvashi G. Risk factors for endotracheal intubation and mechanical ventilation in patients with opioids intoxication. Pakistan Journal of Medical Sciences 28(2): 279-282, 2012. (19 refs.)

Objectives: Patients poisoned with opioids sometimes need endotracheal intubation with or without the use of mechanical ventilation. This study was done to determine the prognostic risk factors for of the need for endotracheal intubation and mechanical ventilation. Methodology: In this cross-sectional study which was performed in Isfahan (Iran), one hundred (n = 100) opioid poisoned patients whom their overdoses were diagnosed by their full and reliable history, physical examination and positive response to naloxone; vital signs at the hospital admission, blood biochemistry, ABG details and also the type and estimated dosage of opioid, route of consumption, and their need to mechanical ventilation were evaluated. Results: Patients were mostly aged between 20-40 years old. Seventy nine patients were male and 26 cases (21 men) required endotracheal intubation and 15 cases (14 men) needed both intubation and mechanical ventilation. The most consumed opiates among the poisoned patients were opium (35%), heroin (16%), Tramadol (15%), Methadone (9%), crack (6%), Diphenoxylate (4%) and others (15%). There was a significant difference between the mean heart rates and respiratory rate of the patients who were connected to the ventilator and others (99.8 +/- 21.8 and 87.3 +/- 16.3; p = 0.01). The lower level of consciousness [OR: 2.2 95% Confidence Interval (CI): 1.2-4.2], and lower admission level of hemoglobin (OR: 3.6; CI: 1.2-10.8) were among the factors for predicting the need for intubation and ventilation. Conclusion: Determining the risk factors with prognostic value for the need to intubation or ventilation seems to be necessary for improving the standard of therapy in opioids poisoned patients.

Copyright 2012, Professional Medical Publications

Mitchell SG; Kelly SM; Brown BS; O'Grady KE; Schwartz RP. HIV sex-risk behaviors among in-versus out-of-treatment heroin-addicted adults. American Journal of Drug and Alcohol Abuse 38(4): 328-333, 2012. (24 refs.)

Background: Relatively limited empirical evidence exists comparing the impact on HIV sex risk behavior for patients admitted to methadone treatment programs (MTPs) as compared with nontreatment seekers. Methods: This longitudinal cohort study examined HIV sex-risk behavior among 164 out-of-treatment heroin-dependent adults recruited from the street and 351 newly admitted MTP patients. The AIDS Risk Assessment was administered at baseline, 6 months, and 12 months. Generalized linear mixed model and generalized estimating equation analyses were used to examine the changes in sex risk behavior over time. Results: The participants mean age was 41.5 years, 74.8% were African-American, 24.3% were White, and 54.4% were men. There were no significant differences between the groups in age, race, or gender. At baseline, the out-of-treatment group compared with the in-treatment group reported more sex partners (p < .001) and higher frequency of sex (p = .001). There was a group x time interaction for three of the sex-risk items and the out-of-treatment group reported having significantly more sex partners at both follow-up time points and having significantly more frequent unprotected sex while high at 6 months (all values of p < .01). Conclusions: Nontreatment seekers are at higher HIV risk than those entering MTPs and should be a focus of sex-risk reduction interventions, even if they are not interested in treatment at that time.

Copyright 2012, Informa Healthcare

Nielsen DA; Ho A; Bahl A; Varma P; Kellogg S; Borg L et al. Former heroin addicts with or without a history of cocaine dependence are more impulsive than controls. Drug and Alcohol Dependence 124(1-2): 113-120, 2012. (57 refs.)

Background: Personality traits such as impulsivity and sensation seeking may contribute to the initiation and maintenance of illicit drug use. Since studies have reported higher impulsivity and sensation seeking traits in cocaine dependent subjects, we were interested in determining whether former heroin addicts in methadone pharmacotherapy with comorbid cocaine addiction have greater impulsivity than those without. Methods: Instruments to assess impulsivity (Barratt Impulsiveness Scale version 11) and sensation seeking (Sensation Seeking Scale version V) were administered to former severe heroin addicts meeting Federal criteria for methadone maintenance pharmacotherapy with (n = 71) or without cocaine dependence (n = 31) and to 145 normal healthy (non-methadone-maintained) volunteers. Results: The methadone-maintained without cocaine dependence and the methadone-maintained with cocaine dependence groups, both scored higher than did the normal volunteer group on the Barratt Impulsiveness Scale total score (p < 0.001). On the Barratt Impulsiveness Scale Attentional, Nonplanning, and Motor subscales, the methadone-maintained and methadone-maintained with cocaine dependence groups scored higher than did normal volunteers with no history of drug abuse or dependence (p < 0.001). There was no difference among groups on total score or any subscale of the Sensation Seeking Scale. However, males in all groups overall scored higher than did females on Disinhibition and Thrill and Adventure seeking subscales of the Sensation Seeking Scale version V (p < 0.001). Conclusions: This study demonstrates higher impulsivity in former severe heroin addicts meeting criteria for or currently in stable methadone maintenance pharmacotherapy, irrespective of a positive or negative history of cocaine dependence.

Copyright 2012, Elsevier Science

Nielsen DA; Kreek MJ. Common and specific liability to addiction: Approaches to association studies of opioid addiction. Drug and Alcohol Dependence 123(Supplement 1): S33-S41, 2012. (113 refs.)

Background: Opioid addiction, whether to opiates such as heroin and morphine, and/or to non-medical use of opioids, is a major problem worldwide. Although drug-induced and environmental factors are essential for the liability to develop opioid addiction, the genetic background of an individual is now known also to play a substantial role. Methods: The overall goal of this article is to address the common and specific liabilities to addiction in the context of approaches to studies of one addiction, opioid addiction. Literature on identifying genetic variants that may play a role in the development of opioid addiction was reviewed. Results: A substantial number of genetic variants have been reported to be associated with opioid addiction. No single variant has been found in any of the reported GWAS studies with a substantial effect size on the liability to develop heroin addiction. It appears that there is a complex interaction of a large number of variants, some rare, some common, which interact with the environment and in response to specific drugs of abuse to increase the liability of developing opioid addiction. Conclusions: In spite of the inherent difficulties in obtaining large well-phenotyped cohorts for genetic studies, new findings have been reported that are being used to develop testable hypotheses into the biological basis of opioid addiction.

Copyright 2012, Elsevier Science

Nielsen S; Hillhouse M; Mooney L; Fahey J; Ling W. Comparing buprenorphine induction experience with heroin and prescription opioid users. Journal of Substance Abuse Treatment 43(3): 285-290, 2012. (23 refs.)

Prescription opioid (PO)-dependent treatment presentations are becoming increasingly common; however, most research on the treatment of opioid-dependent populations has been conducted in heroin users. The aim of this secondary data analysis was to compare the buprenorphine induction experience of 167 heroin and 61 PO users. Results demonstrate that although the groups differed on some baseline characteristics, many of the key induction experience variables were comparable between the groups. Heroin users were found to have significantly higher pre-induction Clinical Opiate Withdrawal Scale (COWS) scores (p = .014) and post-induction COWS score (p = .008) compared with the PO users. No differences between groups were found for self-reported craving and withdrawal scores, mean buprenorphine dose on Day I, or retention at the end of the first week. The findings of this study suggest that existing buprenorphine induction practices developed for heroin users appear to be equally effective with PO users.

Copyright 2012, Elsevier Science

Oei JL; Xu HX; Abdel-Latif ME; Vunnam K; Al-Amry A; Clews S et al. Dopamine D2 receptor gene polymorphisms in newborn infants of drug-using women. Archives of Disease in Childhood. Fetal and Neonatal Edition 97(3): F193-F198, 2012. (41 refs.)

Objectives: To determine the characteristics of dopamine D2 receptor gene (DRD2) polymorphisms in drug-exposed and unexposed neonates and the relationship to neonatal abstinence syndrome (NAS). Design: Retrospective case-control analysis between drug-exposed and unexposed infants between DRD2 polymorphisms, drug exposure and NAS treatment. Patients: Drug-exposed (n=48) and drug-free (n=49) infants born between March 1999 and December 2006. Methods: Analysis of DNA for the Taq1A, -141Ins/Del and Ser311Cys DRD2 polymorphisms. Drug exposure was determined by antenatal maternal drug and alcohol history. Frequency measures of DRD2 polymorphisms were compared between drug-exposed infants, treatment NAS medication and with control infants. Setting: Tertiary maternity hospital, Sydney, Australia. Main outcome measures: All infants were born in a good condition (25.7% <37 weeks gestation). Opiates (methadone and heroin) were used by 45 (93.8%) of drug-exposed mothers. The A2A2 allele was more common in drug-exposed infants (37 (77.0%) versus 23 (46.9%), p=0.003) but the A1A2 allele was more common in control infants (23 (46.9%) versus 4 (8.3%), p=0.00002). The-ins allele was more common in control (39 (79.6%) versus 20 (41.7%), p=<0.01) and unmedicated drug-exposed (14/25 (56%) versus 5/23 (21.7%), p=0.02) infants. The majority of infants (41 (83.7%) controls versus 41 (85.4%), p=1.000) expressed the least common, Ser polymorphism. Conclusions: DRD2 polymorphisms are detectable from DNA obtained from stored blood spots. The-ins allele is more common in control and unmedicated drug-exposed infants. Further study is recommended to explore postneonatal outcomes especially in relation to neuropsychiatric behaviours.

Copyright 2012, BMJ Publishing Group

Papke G; Greenwald MK. Motivational assessment of non-treatment buprenorphine research participation in heroin dependent individuals. Drug and Alcohol Dependence 123(1-3): 173-179, 2012. (42 refs.)

Background: Heroin abuse remains an important public health problem, particularly in economically disadvantaged areas. Insight into this problem is gained from interviewing addicted individuals. However, we lack systematic data on factors that motivate heroin users to participate in non-treatment research that offers both financial incentives (compensation) and non-financial incentives (e.g., short-term medication). Aim: To better understand the relative importance of several types of personal motivations to participate in non-treatment buprenorphine research, and to relate self-motivations to social, economic, demographic and drug use factors. Methods: Heroin dependent volunteers (N = 235 total; 57 female and 178 male; 136 African American, 86 Caucasian, and 13 Other) applied for non-therapeutic buprenorphine research in an urban outpatient setting from 2004 to 2008. We conducted a semi-structured behavioral economic interview, after which participants ranked 11 possible motivations for research participation. Results: Although the study was repeatedly described as non-treatment research involving buprenorphine, participants often ranked some treatment-related motivations as important (wanting to reduce/stop heroin use, needing a medication to get stabilized/detoxify). Some motivations correlated with income, heroin use, and years since marketing of buprenorphine. Two dimensions emerged from principal component analysis of motivation rankings: (1) treatment motivation vs. greater immediate needs and (2) commitment to trying alternatives vs. a more accepting attitude toward traditional interventions. In summary, heroin addicts' self-motivations to engage in non-therapeutic research are complex -- they value economic gain but not exclusively or primarily -- and relate to variables such as socioeconomic factors and drug use.

Copyright 2012, Elsevier Science

Pasche S; Myers B. Substance misuse trends in South Africa. Human Psychopharmacology: Clinical and Experimental 27(3): 338-341, 2012. (21 refs.)

This paper, the first in a series related to the Joint European South African Research Network in Anxiety Disorders programme, examines substance use trends in South Africa. Alcohol remains the substance with the greatest burden of harm. Yet, trends vary by region, with for example methamphetamine being a major driver of psychiatric and substance abuse treatment demand in the Western Cape province. Heroin use is increasing in several provinces, where rapid intervention is required to avoid an epidemic. In particular, the state (the main funder of drug services) urgently needs to provide opioid substitution treatment. Apart from an inadequate number of treatment services, barriers to treatment are high. Barriers are predominantly cost, transport and resource related. Services are also impacted by a small and inadequately trained workforce and poor integration with mental health services. To adequately intervene with substance use disorders, South Africa needs an evidence-based policy and service planning framework that forges linkages with the mental health service system.

Copyright 2012, Wiley-Blackwell

Peavy KM; Banta-Green CJ; Kingston S; Hanrahan M; Merrill JO; Coffin PO. "Hooked on" prescription-type opiates prior to using heroin: Results from a survey of syringe exchange clients. Journal of Psychoactive Drugs 44(3): 259-265, 2012. (34 refs.)

The availability and diversion of prescription-type opioids increased dramatically in the first decade of the twenty-first century. One possible consequence of increased prescription opioid use and accessibility is the associated rise in opioid dependence, potentially resulting in heroin addiction. This study aimed to determine how common initial dependence on prescription-type opioids is among heroin injectors; associations with demographic and drug-using characteristics were also examined. Interview data were collected at syringe exchanges in King County, Washington in 2009. Among the respondents who had used heroin in the prior four months, 39% reported being "hooked on" prescription-type opioids first. Regression analysis indicated that younger age, sedative use and no recent crack use were independently associated with self-report of being hooked on prescription-type opioids prior to using heroin. These data quantify the phenomenon of being hooked on prescription-type opioids prior to initiating heroin use. Further research is needed to characterize the epidemiology, etiology and trajectory of prescription-type opioid and heroin use in the context of continuing widespread availability of prescription-type opioids.

Copyright 2012, Haight-Ashbury Publishing

Pedersen K; Waal H; Kringlen E. Patients with nonaffective psychosis are at increased risk for heroin use disorders. European Addiction Research 18(3): 124-129, 2012. (21 refs.)

Background/Aim: It is well-established knowledge that persons with nonaffective psychotic disorders often have problematic use of alcohol, cannabis and stimulants, but heroin use is usually not included. Our aim was to investigate the prevalence of heroin use disorders in patients with nonaffective psychosis. Methods: As the combination of heroin use and nonaffective psychosis is infrequent, epidemiological studies have to include large populations. The present study is a case count study using information from all psychiatric and social services in Oslo. Prevalence was calculated for four possible scenarios of minimum and maximum case counts and prevalences of nonaffective psychosis. Odds ratios were calculated for the resulting prevalences compared to the minimum and maximum prevalence of heroin use disorder in the general population. Results: We found between 39 and 56 subjects with nonaffective psychoses and comorbid heroin use disorder. The number of individuals with nonaffective psychosis was estimated to be between 692 and 1, 730. This corresponds to a prevalence of heroin use disorder of between 2.3 and 8.1%. The odds ratio compared to the general population will range from 1.83 with a prevalence of heroin use disorder in the general population of 1.2% to 9.43 with a prevalence of 0.9%. Conclusion: Individuals with non-affective psychosis are at increased risk of heroin use.

Copyright 2012, Karger

Peles E; Schreiber S; Sutzman A; Adelson M. Attention deficit hyperactivity disorder and obsessive-compulsive disorder among former heroin addicts currently in methadone maintenance treatment. Psychopathology 45(5): 327-333, 2012. (48 refs.)

Background: The aim of this study was to evaluate the prevalence of childhood and adulthood attention deficit hyperactivity disorder (ADHD) and clinical obsessive-compulsive disorder (OCD) among adult patients in methadone maintenance treatment (MMT) and to characterize possible risk factors. Sampling and Methods: A random sample of 154 current MMT patients was studied for childhood ADHD (Wender Utah Rating Scale), current clinical OCD (Yale-Brown Obsessive Compulsive Scale), lifetime trauma history and modified Addiction Severity Index for demographics, as well as any lifetime DSM-IV-TR psychiatric diagnosis. Results: Fifty-one patients (33.1%) had childhood ADHD, and more of this group currently had clinical OCD compared to patients who did not have childhood ADHD (55.3 vs. 30.1%). The two groups did not differ with regard to gender and age of admission to MMT. Logistic regression found that the childhood ADHD group had a higher risk of having OCD [odds ratio (OR) 3.8, 95% confidence interval (CI) 1.6-8.8], more severe nicotine smoking (OR 1.4, 95% CI 1.1-1.7) and fewer years of education (OR 0.8, 95% CI 0.6-1) and were more likely to have a DSM-IV-TR axis II disorder (OR 4.3, 95% CI 1.4-13.4) and a history of falls (OR 4.3, 95% CI 1.4-12.9). Conclusions: Although ADHD is more prevalent among males in the general population, the rates in our MMT population were similar in each gender. One third of our sample had suffered from ADHD during childhood, which may have led them to self-medicate with drugs and thus to addiction. Childhood ADHD was associated with current OCD, and both conditions were highly prevalent among our MMT patients. The reason for a history of repeated falls warrants further study.

Copyright 2012, Karger

Preti A; Usai I; Pintus E; Sardu C; Petretto DR; Masala C. Left-handedness is statistically linked to lifetime experimentation with illicit drugs. Laterality 17(3): 318-339, 2012. (100 refs.)

Handedness has been linked to an enhanced risk of alcohol abuse, while less is known about other drugs. A convenience sample of 1004 male and female Italian participants (females = 58%) from the general community (18 to 65 years old: average age = 30; standard deviation = 10, median = 25) was asked about: handedness (preference in writing); lifetime use of alcohol, tobacco, and illicit drugs; levels of psychological distress, as measured by the General Health Questionnaire (GHQ); and levels of delusion proneness, as measured by the Peters et al. Delusions Inventory (PDI). Overall, 92 individuals (9.2%) were classified as left-handed, with no significant difference reported among genders. Lifetime use of illicit drugs, primarily cannabis, was reported by 20% of the sample. In a multiple logistic regression analysis, after taking into account sex, age, and caseness on GHQ and PDI, left-handed people in the sample were statistically more likely to report lifetime experimentation with heroin, ecstasy/amphetamine, and, marginally, hallucinogens, but not alcohol or tobacco. Different mechanisms might contribute to an explanation of greater lifetime experimentation with some illicit drugs among left-handed people as compared to right-handed people. However, replications with clinical samples are necessary before any definitive statements can be made.

Copyright 2012, Psychology Press

Price EP; Seymour ML; Sarovich DS; Latham J; Wolken SR; Mason J et al. Molecular epidemiologic investigation of an anthrax outbreak among heroin users, Europe. Emerging Infectious Diseases 18(8): 1307-1313, 2012. (39 refs.)

In December 2009, two unusual cases of anthrax were diagnosed in heroin users in Scotland. A subsequent anthrax outbreak in heroin users emerged throughout Scotland and expanded into England and Germany, sparking concern of nefarious introduction of anthrax spores into the heroin supply. To better understand the outbreak origin, we used established genetic signatures that provided insights about strain origin. Next, we sequenced the whole genome of a representative Bacillus anthracis strain from a heroin user (Ba4599), developed Ba4599-specific single-nucleotide polymorphism assays, and genotyped all available material from other heroin users with anthrax. Of 34 case-patients with B. anthracis positive PCR results, all shared the Ba4599 single-nucleotide polymorphism genotype. Phylogeographic analysis demonstrated that Ba4599 was closely related to strains from Turkey and not to previously identified isolates from Scotland or Afghanistan, the presumed origin of the heroin. Our results suggest accidental contamination along the drug trafficking route through a cutting agent or animal hides used to smuggle heroin into Europe.

Copyright 2012, Centers for Disease Control

Proctor SL. Substance use disorder prevalence among female state prison inmates. American Journal of Drug and Alcohol Abuse 38(4): 278-285, 2012. (39 refs.)

Background: Substance use disorders (SUDs) are prevalent among female inmates. As the female state prison population continues to increase, describing the specific clinical and demographic characteristics of female prisoners remains of paramount importance to better define women's needs in the state prison system. Objectives: To determine the prevalence and patterns of current DSM-IV SUDs and explore whether particular demographic characteristics are more strongly associated with specific SUD categories. Methods: Data were derived from routine clinical assessments of 801 female inmates incarcerated in the Minnesota Department of Corrections state prison system. The Substance Use Disorder Diagnostic Schedule-IV (Hoffmann NG, Harrison PA. SUDDS-IV: Substance Use Disorder Diagnostic Schedule-IV. Smithfield, RI: Evince Clinical Assessments, 1995) was administered to all inmates as a computer-prompted interview on admission to the prison. Results: Of the inmates, 70.0% were dependent on at least one substance, and 7.9% met criteria for substance abuse. Alcohol dependence (30.2%) and cocaine dependence (30.1%) were the two most prevalent SUDs. The remaining substance dependence diagnoses that predominated were as follows: stimulant dependence, 24.1%; marijuana dependence, 15.6%; and heroin dependence, 9.6%. Over half (56.9%) were dependent on a substance other than alcohol. Prevalence of cocaine dependence [odds ratio (OR) 2.83, 95% confidence interval (CI) 1.92-4.16] was significantly higher among African Americans, whereas prevalence of stimulant dependence (OR 9.24, 95% CI 5.40-15.80) was significantly higher among Caucasians. Prevalence of alcohol (OR 2.12, 95% CI 1.38-3.25) and heroin (OR 2.67, 95% CI 1.50-4.77) dependence was significantly higher among Native Americans. Conclusions and Scientific Significance: SUDs in general, and illicit drug use disorders in particular, are prevalent among female inmates entering a state prison system. Membership to a particular ethnic group may identify a set of inmates at elevated risk for the presence of substance-specific dependence diagnoses.

Copyright 2012, Informa Healthcare

Rao R; Ambekar A; Yadav S; Sethi H; Dhawan A. Slow-release oral morphine as a maintenance agent in opioid dependence syndrome: An exploratory study from India. Journal of Substance Use 17(3): 294-300, 2012. (17 refs.)

Aim: Slow-release oral morphine (SROM) as agonist maintenance agent was introduced recently in India while buprenorphine is available for the past two decades. In this study, the drug use and psychosocial status of opioid-dependent patients who were maintained on buprenorphine and subsequently shifted to SROM were assessed. Design: This is an observational study. Procedure: This study was carried out in a community-based drug treatment clinic in New Delhi. Thirty-nine opioid-dependent males maintained on sublingual buprenorphine (for at least 1 month) were included in this study. Due to difficulty in buprenorphine procurement for some period, 34 patients were shifted to SROM after informed consent. Assessments were made prior to the switch-over and after 4 weeks of stabilisation on SROM. Results: All patients initiated on SROM continued to remain in the treatment during the 4-week period. The low scores on measures of opioid withdrawal symptoms, craving and high scores on quality of life observed while on buprenorphine continued even after 4 weeks of SROM treatment. Patients on SROM reported mild adverse effects. Conclusion: SROM is as effective as buprenorphine in controlling withdrawal, craving and quality of life on short-term follow-up.

Copyright 2012, Informa Healthcare

Reece AS. Differing age related trajectories of dysfunction in several organ systems in opiate dependence. Aging. Clinical and Experimental Research 24(1): 85-96, 2012. (39 refs.)

Background: Several lines of evidence suggest that the multisystem disease seen in drug addicts may reflect acceleration of underlying degenerative or ageing processes. Patients presenting for management of their clinical opiate substance use disorder (SUD) were therefore compared with general medical non-SUD (N-SUD) patients. Methods: Differences in dental, psychiatric and hair graying indices at both temple and vertex were studied and combined with principal component (PC) analysis. Arcsinh transformation of the data were considered, as this improved the normality of the parameter distributions. Results: 95 opiate dependent SUD and 32 N-SUD patients were studied. The mean (+/-SD) ages were 33.47+/-7.98 vs 57.81+/-17.13 years and sex was 75.8% and 63.6% male (p - n.s.) in the SUD and N-SUD groups respectively. The addicted population was more severe as a function of age on all indices (p<0.05). The arcsinh transformation of PC1+PC2 was significantly different by addiction status both as a category on its own and after interaction with age (both p<0.0005), and was associated with a calculated 22.3% age advancement at 60 years of age. Interactions between age, and PC's of opiate and inhaled intoxicant dose and duration of exposure were highly significant (p<0.01). Tobacco, cannabis, heroin and methadone dose and/or duration of exposure were significantly related to the identified physiological deficit both alone, and as interactions with each other and with age (most interactions p<0.01). Conclusions: These findings have implications for understanding the pathophysiology of drug addiction and imply that the high rate of morbidity seen in drug dependent patients may be related to underlying subclinical ager related changes, choice of opiate pharmacotherapeutic agent, considerations of duration of treatment, and conversely for the pathophysiology of the development of age related disease.

Copyright 2012, Editrice Kurtis

Robertson AM; Rangel MG; Lozada R; Vera A; Ojeda VD. Male injection drug users try new drugs following US deportation to Tijuana, Mexico. Drug and Alcohol Dependence 120(1-3): 142-148, 2012. (83 refs.)

Background: Among male injection drug users (IDUs) in Tijuana, Mexico, U.S. deportation is associated with HIV transmission. Changing drug use behaviors following deportation, including the use of new drugs, may increase HIV risk but are understudied. We identify correlates of trying new drugs following male IDUs' most recent U.S. deportation to Mexico. Methods: In 2010, we recruited 328 deported male IDUs in Tijuana, Mexico. Questionnaires collected retrospective data on drug use and other HIV risk behaviors throughout migratory events. Logistic regression identified correlates of trying new drugs/combinations following their most recent deportations. Informed consent was obtained from all participants. Results: Nearly one in six men (n = 52, 16%) tried new drugs following their most recent deportation, including heroin (n = 31), methamphetamine (n = 5), and heroin/methamphetamine combined (n = 17). Trying new drugs following deportation was independently associated with U.S. incarceration (adjusted odds ratio [AOR] = 3.96; 95% confidence interval [Cl.] 1.78, 8.84), increasing numbers of U.S. deportations (AOR=1.11 per deportation; C.I. 1.03, 1.20), feeling sad following deportation (AOR 2.69; C.I. 1.41, 5.14), and perceiving that one's current lifestyle increases HIV/AIDS risk (AOR 3.91; C.I. 2.05, 7.44). Conclusions: Trying new drugs following U.S. deportation may be related to the unique contexts and stressors experienced by drug-abusing migrants as they attempt to reestablish their lives in Mexico. Findings imply an unmet need for health and social programs to alleviate pre- and post-deportation stressors faced by undocumented and return migrants in the U.S.-Mexico context.

Copyright 2012, Elsevier Science

Sawitri AAS; Blogg J; Angela R. Estimating the number of the people who inject drugs in Bali, 2010. Drug and Alcohol Review 31(6): 813-817, 2012. (11 refs.)

Introduction and Aims. A population estimation study was performed in 20092010 to understand the apparent decrease in people who inject drugs (PWID) attending needle syringe programs (NSPs) and to calculate the number of people who inject drugs in Bali for service planning. Design and Methods. The multiplier method was applied to the results of a survey of 125 people who inject drugs using data from 16 institutions to calculate benchmarks for five events. Respondents were also asked to nominate other people who inject drugs and the services they used and to name people who inject drugs who had died in the previous 3 years. Results. There was consistency in the estimates calculated using the multipliers for police arrests, voluntary counselling and testing and NSP which produced estimates of 700, 723 and 769 people who inject drugs, respectively. The nominator method identified 529 people who inject drugs . The number of reported people who inject drugs deaths had decreased over the past 3 years and may reflect a shrinking in the population of people who inject drugs in Bali. Police data revealed a dramatic shift in arrests for drug possession in 2002-2003 compared with arrests during 2009. Heroin possession was recorded in 37.4% of 2002-2003 arrests but decreased to 3.1% in 2009, whereas amphetamine possession increased from 11% to 30.9% in the same period. Discussion and Conclusions. Bali appears to have experienced a decrease in the number of people who inject drugs, which is likely to be related to death and to a pronounced shift to non-injected drug use.

Copyright 2012, Wiley-Blackwell

Shah NG; Lathrop SL; Flores JE; Landen MG. The influence of living along the US-Mexico border on unintentional drug overdose death, New Mexico (USA), 2005-2009. Drug and Alcohol Dependence 125(1-2): 19-26, 2012. (45 refs.)

Background: The objective of this study was to characterize unintentional drug overdose death patterns among Hispanic ethnicity/sex strata by residence in New Mexico counties that border Mexico and non-border counties. Methods: We analyzed medical examiner data for all unintentional drug overdose death in New Mexico during 2005-2009. Logistic and Poisson regression was used to examine the relationship of unintentional drug overdose death with border residence and demographics. Risk of overdose death was examined by the interactions of ethnicity, sex and border residence. Results: During 2005-2009, the statewide drug overdose death rate was 17.6 per 100,000 (n = 1812). Border decedents were more likely to have died from overdose of prescription opioids other than methadone (Schedule II, Adjusted Odds Ratio (aOR) = 1.98; Schedule III/IV, aOR = 1.56) but less likely to have died from heroin overdose (aOR = 0.35), compared to non-border decedents. In population-based analyses, people living in border counties had lowest rates of overall overdose death and from illicit drugs, particularly heroin and cocaine. Hispanic males (adjusted incidence rate ratio [aRR] = 2.41), Hispanic females (aRR = 1.77) and non-Hispanic males (aRR = 1.37) from non-border counties had higher risk of drug overdose death than their counterparts from border counties. Border residence had no effect on risk of drug overdose death among non-Hispanic females. Conclusions: Residents in border counties incurred a protective effect for drug overdose death, most pronounced among Hispanics. There is a component of overdose death risk for which border residence is a proxy, likely an array of cultural and healthcare-related factors.

Copyright 2012, Elsevier Science

Shekarchizadeh H; Ekhtiari H; Khami MR; Virtanen JI. Patterns of pre-treatment drug abuse, drug treatment history and characteristics of addicts in methadone maintenance treatment in Iran. Harm Reduction Journal 9: article 18, 2012. (25 refs.)

Background: Opiates are the main drugs of abuse, and Methadone Maintenance Treatment (MMT) is the most widely administered drug addiction treatment program in Iran. Our study aimed to investigate patterns of pre-treatment drug abuse, addiction treatment history and characteristics of patients in MMT in Tehran. Methods: We applied a stratified cluster random sampling technique and conducted a cross-sectional survey utilizing a standard patient characteristic and addiction history form with patients (n = 810) in MMT. The Chi-square test and t-test served for statistical analyses. Results: A clear majority of the participants were men (96%), more than 60% of whom were between 25 and 44 years of age, educated (89% had more than elementary education), and employed (>70%). The most commonly reported main drugs of abuse prior to MMT entry were opium (69%) and crystalline heroin (24%). The patients' lifetime drug experience included opium (92%), crystalline heroin (28%), cannabis (16%), amphetamines (15%), and other drugs (33%). Crystalline heroin abusers were younger than opium users, had begun abusing drugs earlier, and reported a shorter history of opiate addiction. Conclusion: Opium and crystalline heroin were the main drugs of abuse. A high rate of addiction using more dangerous opiate drugs such as crystalline heroin calls for more preventive efforts, especially among young men.

Copyright 2012, Biomed Central

Shen YX; Wang EL; Wang XR; Lou MW. Disrupted integrity of white matter in heroin-addicted subjects at different abstinent time. Journal of Addiction Medicine 6(2): 172-176, 2012. (29 refs.)

Purpose: To investigate and compare the integrity of white matter in heroin-addicted and healthy control subjects at different abstinent time using diffusion tensor imaging. Materials and Methods: We performed voxelwise analysis of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in 35 currently abstinent heroin abusers who were divided into long-term group (n = 17) and short-term group (n = 18) and 17 healthy volunteers. Measurements of FA and ADC of the identified regions (genu and splenium of corpus callosum, bilateral frontal lobe) were obtained from all subjects. Results: The FA at callosal splenium was higher in the long-term group than in the short-term group (P < 0.05). The FA at left prefrontal cortex was higher in the short-term group than in the long-term group (P < 0.05). No significant difference in ADC was found among the 3 groups. The education history had a positive correlation with the FA value on the gena of corpus callosum (r = 0.402, P = 0.017). Months of abstinence had a negative correlation with left frontal FA (r = -0.366, P = 0.03) and a positive correlation with splenium FA (r = 0.348, P = 0.04). Conclusions: Heroin abuse seems to alter white matter microstructure differentially in long-term and short-term heroin addicts. This study will contribute to the current literature by examining the quality of white matter fiber structure in heroin abstinence.

Copyright 2012, Lippincott, Williams & Wilkins

Sordo L; Chahua M; Bravo MJ; Barrio G; Brugal MT; Domingo-Salvany A et al. Depression among regular heroin users: The influence of gender. Addictive Behaviors 37(1): 148-152, 2012. (28 refs.)

The aim of this study was to determine the prevalence of recent (last 12months) depression in regular young heroin users and to ascertain factors associated with depression in this population, broken down by gender. A sample of 561 participants completed a cross-sectional survey. Eligibility criteria were: age 30years or younger, and having used heroin for at least 12days in the last 12months and at least one day in the last 3months. Participants were recruited outside of health-care facilities in the cities of Barcelona, Madrid and Seville by targeted sampling and chain referral methods. Depression was assessed using the World Mental Health Composite International Diagnostic Interview. The prevalence of recent depression was 22.3% (35.2% among women and 17.3% among men, p<0.001). In the multivariate analysis, the factors positively associated with recent depression in the whole sample were female gender, age 25 or less, inability to work due to health problems and high risk consumption of alcohol. Among woman, the related variables were age 25 or less, cocaine dependence in the last 12months, and alcohol consumption in that period. Among men, employment status was the only related variable. Analysis of an overall sample without the gender breakdown may hide important differences in the factors associated with depression in men and women. Both prevention and treatment of depression should rely on specific gender analysis.

Copyright 2012, Elsevier Science

Stafford J; Burns L. ACT Drug Trends 2011. Findings from the Illicit Drug Reporting System (IDRS). Australian Drug Trend Series No. 73. Sydney, Australia: National Drug and Alcohol Research Centre, 2012. (64 refs.)

This annual report provides data on current drug use in Australia. It cover heroin, other opiates, methamphetamine, cocaine, cannabis, and other drug use - including benzodiazepines, pharmaceutical stimulants, and benzodiazepines. Beyond use patterns and demographic profiles, there is also information on route of administration. Information is also provided on the drug market: price, purity, availability, and purchasing patterns for each drug. Information is also provided on the health-related trends associated with drug use including treatment utilization, injecting risk behaviors, psychiatric illness, and alcohol- and drug-related driving. Law enforcement-related trends associated with drug use are described, along with special topics of interest, such as over-the-counter codeine, pharmaceutical opioids, smoking patterns, and policy concerns. Data is presented in 114 tables and 78 figures.

Copyright 2012, National Drug and Alcohol Research Centre (Australia)

Stancliff S; Joseph H; Fong CK; Furst T; Comer SD; Roux P. Opioid maintenance treatment as a harm reduction tool for opioid-dependent individuals in New York City: The need to expand access to buprenorphine/naloxone in marginalized populations. Journal of Addictive Diseases 31(3, special issue): 278-287, 2012. (36 refs.)

The aim of this pilot study was to assess the effectiveness of buprenorphine/naloxone (BUP/NX) among marginalized, opioid-dependent individuals in terms of retention in and cycling into and out of a harm-reduction program. This pilot study enrolled 100 participants and followed them from November 2005 to July 2008. The overall proportion of patients retained in the program at the end of 3, 6, 9, and 12 months was 68%, 63%, 56%, and 42%, respectively. This pilot study demonstrated that BUP/NX could be successfully used to treat marginalized heroin users.

Copyright 2012, Taylor & Francis

Substance Abuse and Mental Health Services, Center for Behavioral Health Statistics and Quality. Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings. NSDUH Series H-44. Rockville MD: Substance Abuse and Mental Health Administration, 2012. (58 refs.)

This report presents the first information from the 2011 National Survey on Drug Use and Health (NSDUH), an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The survey is the primary source of information on the use of illicit drugs, alcohol, and tobacco in the civilian, noninstitutionalized population of the United States aged 12 years old or older. Approximately 67,500 persons are interviewed in NSDUH each year. Unless otherwise noted, all comparisons in this report described using terms such as "increased," "decreased," or "more than" are statistically significant at the .05 level. Information is summarized in 58 figures, 64 tables. The Report opens with a summary of the highlights and central findings of the Survey. This is followed by 8 chapters with deal with the following topics: Chapter 1, a summary of survey and methodology; Chapter 2. Illicit drug use by population groups and demographic characteristics, sources of illicit and prescription drug use; Chapter 3. alcohol use, by age, gender, geogrpahy, and other demographic characteristics, and separately considers underage drinking; Chapter 4. addresses tobacco use in a similar fashion; Chapter 5. the initiation of substance use, both licit and illicit drugs; Chapter 6 addresses youth prevention efforts, including discussion of the perceptions of risks, availability, and approval/disapproval of peers and family; the role of religiosity and religious involvement, and exposure to prevention efforts; Chapter 7 focuses upon substance dependence, abuse, and treatment, and beyond demographic characteristics also presents information on treatment entry, need for treatment, and for both illicit and licit drugs; Chapter 8 focuses upon trends in marijuana, prescription drug, heroin, and other substance use by youth and young adults and it compares the data from the Survey to other survey results.

Public Domain

Thoumi FE. Illegal drugs, anti-drug policy failure, and the need for institutional reforms in Colombia. Substance Use & Misuse 47(8): 972-1004, 2012. (128 refs.)

This paper is inspired by two anomalies encountered in the study of the illegal drugs industry. First, despite the very high profits of coca/cocaine and poppy/opium/heroin production, most countries that can produce do not. Why, for example, does Colombia face much greater competition in the international coffee, banana, and other legal product markets than in cocaine? And second, though illegal drugs are clearly associated with violence, why is it that illegal drug trafficking organizations have been so much more violent in Colombia and Mexico than in the rest of the world? The answers to these questions cannot be found in factors external to Colombia (and Mexico). They require identifying the societal weaknesses of each country. To do so, the history of the illegal drugs industry is surveyed, a simple model of human behavior that stresses the conflict between formal (legal) and informal (socially accepted) norms as a source of the weaknesses that make societies vulnerable is formulated. The reasons why there is a wide gap between formal and informal norms in Colombia are explored and the effectiveness of anti-drug policies is considered to explain why they fail to achieve their posited goals. The essay ends with reflections and conclusion on the need for institutional change.

Copyright 2012, Informa Healthcare

Trenz RC; Harrell P; Scherer M; Mancha BE; Latimer WW. A model of school problems, academic failure, alcohol initiation, and the relationship to adult heroin injection. Substance Use & Misuse 47(10): 1159-1171, 2012. (65 refs.)

The current study uses structural equation modeling to investigate factors associated with alcohol initiation and injection heroin use. Baseline data from the NEURO-HIV Epidemiologic Study in Baltimore, Maryland, were used. Participants were 404 injection heroin users (M-age = 32.72) with a history of regular injection in their lifetime. Latent variables were created for self-reported school problems and academic failure. The final model indicated that greater school problems were associated with earlier alcohol initiation (beta = -0.22, p < .001) and earlier alcohol initiation was associated with greater frequency of recent heroin use (beta = -0.12, p < .05). Academic failure was directly related to greater frequency of recent heroin injection (beta = 0.15, p < .01). The results expand research investigating the relationship between adolescent behavior and illicit drug use in adulthood.

Copyright 2012, Informa Healthcare

United Nations Office on Drugs and Crime (UNODC). Misuse of Licit Trade for Opiate Trafficking in Western and Central Asia: A Threat Assessment. Vienna: United Nations, 2012. (0 refs.)

This report was prepared by the UNODC Afghan Opiate Trade Project of the Studies and Threat Analysis Section (STAS), Division for Policy Analysis and Public Affairs (DPA), within the framework of UNODC Trends Monitoring and Analysis Programme. It analyses the role of dry ports in the regional trade network and the risk of their abuse by drug traffickers. It also contains an in-depth analysis of the ways in which drug traffickers abuse the trade network to smuggle opiates. Many of the problems and risks that are identified in relation to trade agreements, dry ports and the transportation network in Western and Central Asia. The first section contains an overview of the major trade routes used to transport goods in Western and Central Asia, and an explanation of the role of dry ports in the regional transportation network. The second section contains an overview of the eight major bilateral and regional trade and transit trade agreements that Afghanistan has entered into over the last 10 years; The third section contains a discussion of the ways in which opiates are trafficked by sea from South-West Asia to East Africa. With the exception of a decline in 2009, the volume of trade between Afghanistan and other countries in Western and Central Asia has risen continuously since 2004. The total volume of Afghan imports and exports within the region more than tripled between 2004 and 2010. The key findings include the following: There has been no corresponding enhancement in the law enforcement capacity to combat the illegal trade in narcotics at dry ports, seaports and border control points. Most drug seizures have taken place at the main hubs along the trade and transit trade routes in Central Asia and within Afghanistan, the Islamic Republic of Iran and Pakistan. This suggests that traffickers have been misusing these trade routes to smuggle opiates from Afghanistan to the global market. For countries in the region with no direct access to the sea, dry ports are crucial hubs for commercial trade. At present, there are 48 dry ports in Western and Central Asia, of which the largest number (17) are in Afghanistan. The rail network links a number of dry ports in Central Asia and plays a vital role in the region. In recent years, the Central Asian rail network has been extended to Afghanistan. Since this extension, several important heroin seizures have reportedly taken place along the network, suggesting that traffickers are abusing the lack of efficient law enforcement control along it. Dry ports are handling an increasingly large quantity of trade. For example, at Chaman dry port in Afghanistan, close to the border of the Baluchistan province of Pakistan, the number of containers that pass through annually increased by 18 per cent between 2008 and 2011, from 76,500 to 90,300. Seizures are often reported to have taken place in the vicinity of major dry ports in the region, but not at the dry ports themselves. Owing to the large volume of trade in the region, only a limited number of containers can be inspected by customs officials at seaports, dry ports and border control points. Although drug traffickers continue to use overland routes to smuggle opiates from Afghanistan and chemical precursors into Afghanistan, they are increasingly relying on maritime transportation to ship opiates around the world. In the last few years, more and more Afghan opiates have been trafficked by sea from Pakistan and the Islamic Republic of Iran to East and West Africa, Europe, and South and South-East Asia. East African countries have reported a sharp increase in the number of seizures of heroin trafficked from Pakistan and, to a lesser extent, the Islamic Republic of Iran. The trafficking of heroin by marine transportation between Pakistan and East Asia (mainly China) has been observed for several years. There has been an increase in heroin trafficking from dry ports and seaports in Pakistan and the Islamic Republic of Iran to West and Central Europe. There needs to be an improvement in the level of intelligence-sharing in Western and Central Asia and a strengthening of links with relevant law enforcement agencies worldwide. In addition, risk profiling systems need to be introduced at all dry ports and seaports in the region. Data is presented in 10 tables and 9 figures.

Public Domain

United Nations Office on Drugs and Crime (UNODC). Opiate Flows through Northern Afghanistan and Central Asia: A Threat Assessment. Vienna: United Nations, 2012. (299 refs.)

This report describes the illicit trade of opiates along the Northern route from northern Afghanistan to Central Asia up to the borders of the Russian Federation. It has been organized in three sections. The first section begins by addressing the dynamics of trafficking in northern Afghanistan, including the groups involved, the volumes of opiate flows and opiate consumption, as well as the share that southern Afghanistan production takes in Northern route trafficking. A second section explores trafficking dynamics through Central Asia, including the methods involved and the groups managing the trade. Lastly, the final section briefly analyzes the regional capacity to respond to the threat of Afghan opiates. Among the key findings: Northern Afghanistan sources heroin mostly from the southern and eastern parts of the country. The low volume of seizures heading northward highlights weaknesses in law enforcement manning these routes. Surprisingly, there is more evidence of opium flows from the largely poppy-free north than from the opium-rich south. In 2010-2011, several seizures of opium were reported en route from north to south, but hardly any seizures were made traveling in the opposite direction. More than 65 per cent of 2010 opiate consumption in Afghanistan is accounted for by regions with little or virtually no opium production, namely northern and central Afghanistan. By contrast, southern Afghanistan consumes the least but produces the most opiates. Opium cultivation is likely to reappear in northern Afghanistan in order to replenish dwindling stocks. Otherwise, larger opiate supplies will be required from other regions of Afghanistan, notably from the opium-rich south, to compensate for the sustained low opium production in the north. Most internal opiate routes converge on Afghanistan's capital, Kabul. The city is the key node connecting the various opiate producing regions of Afghanistan. The value of domestic and export sales of illicit opiates in northern Afghanistan was estimated to be close to US$ 400 million in 2010. Northern Afghanistan is one of the safest regions of the country, but it seizes very little opiates relative to its importance in processing and trafficking for the Northern route. Crime groups controlling the trade in this region also appear to operate with a high degree of impunity. Corruption rather than insecurity appears to be the main corollary to high-volume opiate trafficking in northern Afghanistan. In 2010, it is estimated that approximately 85 per cent of the opiate flow through Central Asia, passed through Tajikistan.

Public Domain

United Nations Office on Drugs and Crime (UNODC). Afghanistan Opium Survey 2012. Opium Risk Assessment for all Regions. Vienna: United Nations, 2012. (0 refs.)

In 2012, the Opium Risk Assessment is carried out in two phases similar to last year. The first phase was carried out in December 2011 and January 2012 and covered the Central, Eastern, Southern and Western region, where opium is sown in fall 2011. The second phase took place in February-March 2012 and covered the Northern and North-eastern regions, where opium poppy is cultivated in spring. This report presents the findings of both phases. The result of this assessment in the Phase-1 regions indicates that the largest opium cultivating provinces, Hilmand and Kandahar, are not likely to see an increase in cultivation despite the current high price of opium. In Hilmand, no major changes in the level of opium cultivation are expected and in Kandahar, opium cultivation is expected to decrease in 2012. The reasons for this development were multiple and differed from area to area. In parts of Hilmand and Kandahar the main dominant reason for declining in poppy cultivation is due to improvement in the security situation, campaign by the government, fear of eradication and agriculture assistance particularly within the Hilmand food zone. In the western provinces namely Farah, Hirat Ghor and Nimroz, poppy cultivation is expected to increase. Similar increasing trends were reported in eastern region namely Nangarhar, Kunar and Kapisa. However, these provinces would still remain at much lower level of cultivation as compared to Hilmand and Kandahar. The increase in poppy cultivation in Ghor province may lead to the loss of its poppy-free status if poppy eradication is not implemented in time. The remaining provinces in the central and eastern regions, which were poppy-free in 2011, are expected to remain so in 2012. The result in the Phase-2 Regions indicates that the largest cultivating province in the north-east, Badakhshan is likely to see an increase in opium cultivation this year. The status of opium cultivation in Takhar remains unpredictable due to large part of the province covered with snow during the survey. There would be no major changes expected in opium cultivation in Faryab and Baghlan provinces in the Northern region. These two provinces lost their poppy-free status last year after two years. The remaining provinces in the northern region would remain poppy-free this year as well. Confirming the findings of the 2011 Afghanistan Opium Survey, the Risk Assessment of this year indicated the strong association between insecurity, lack of agricultural assistance and opium cultivation. Villages with a low level of security and which had not received agricultural assistance in the previous year were significantly more likely to grow poppy in 2012 than villages with good security and those, which had received assistance. Similarly, villages which had been targeted by an anti-poppy awareness campaign were significantly less likely to grow poppy in 2012.

Public Domain

United Nations Office on Drugs and Crime (UNODC). World Drug Report, 2012. Vienna: United Nations, 2012. (163 refs.)

About 230 million people, or 5 per cent of the world's adult population, are estimated to have used an illicit drug at least once in 2010. Problem drug users number about 27 million, which is 0.6 per cent of the world adult population. Throughout the world, illicit drug use appears to be generally stable, though it continues to be rising in several developing countries. Heroin, cocaine and other drugs kill around 0.2 million people each year. Global opium production amounted to 7,000 tons in 2011. That is more than a fifth less than the peak of 2007 but an increase from the low level of 2010, the year in which a plant disease destroyed almost half of the opium harvest in Afghanistan, which continues to be the world's biggest producer. The total area under coca bush cultivation in the world fell by 18 per cent between 2007 and 2010 and by 33 per cent since 2000. Efforts to reduce cultivation and production of the main plant-based problem drugs have, however, been offset by rising levels of synthetic drug production, including significant increases in the production and consumption of psychoactive substances that are not under international control. The report has two major parts. Section I provides recent statistics and trend analysius of illicit drug markets. This includes the extent of illicit drug use and health consequences, the opiate, cocaine and cannabis markets, and illicit markets for amphetamine-type stimulants. Section II characterizes the contemporary drug problem in terms of the the fundamental characteristics of illict drug production and use, the shifts in the problems of drug use over time, and the factors which shape the evolution of drug use problems.

Copyright 2012, United Nations

Urso R; Montefrancesco G; Rigato M. A compartmental model for the pharmacokinetics of heroin and its metabolites in man. Heroin Addiction and Related Clinical Problems 14(1): 45-57, 2012. (15 refs.)

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.

Copyright 2012, Pacini Editore

Vidal SI; Vandeleur C; Rothen S; Gholam-Rezaee M; Castelao E; Halfon O et al. Risk of mental disorders in children of parents with alcohol or heroin dependence: A controlled high-risk study. European Addiction Research 18(5): 253-264, 2012. (50 refs.)

Aim: To assess the specific effect of alcohol dependence (AD) or heroin dependence (HD) in patients and their spouses on the risk of psychopathology in their 276 6.0-to 17.9-year-old children (mean 11.3 years). Methods: The sample included 101 offspring of patients with AD, 23 of patients with HD, and 152 of medical controls, as well as their 2 parents. Participants were assessed using semistructured diagnostic interviews and family history reports by psychologists blind to patient diagnoses. Results: Children of HD and AD patients had largely elevated rates of recurrent major depressive disorder. Children of HD patients were also at an increased risk for attention deficit hyperactivity disorder and substance use disorders (SUD). There were interactions between SUD in the 2 parents to increase the risk of SUD in offspring. Conclusions: These results emphasize the need for prompt identification and treatment of these children and highlight the need to pay clinical attention not only to the patient, but also to the co-parent in order to optimize prevention in offspring.

Copyright 2012, Karger

Vindenes V; Lund HME; Andresen W; Gjerde H; Ikdahl SE; Christophersen AS et al. Detection of drugs of abuse in simultaneously collected oral fluid, urine and blood from Norwegian drug drivers. Forensic Science International 219(1-3): no page number, 2012. (42 refs.)

Blood and urine samples are collected when the Norwegian police apprehend a person suspected of driving under the influence of drugs other than alcohol. Impairment is judged from the findings in blood. In our routine samples, urine is analysed if morphine is detected in blood to differentiate between ingestion of heroin, morphine or codeine and also in cases where the amount of blood is too low to perform both screening and quantification analysis. In several cases, the collection of urine might be time consuming and challenging. The aim of this study was to investigate if drugs detected in blood were found in oral fluid and if interpretation of opiate findings in oral fluid is as conclusive as in urine. Blood, urine and oral fluid samples were collected from 100 drivers suspected of drugged driving. Oral fluid and blood were screened using LC-MS/MS methods and urine by immunological methods. Positive findings in blood and urine were confirmed with chromatographic methods. The analytical method for oral fluid included 25 of the most commonly abused drugs in Norway and some metabolites. The analysis showed a good correlation between the findings in urine and oral fluid for amphetamines, cocaine/benzoylecgonine, methadone, opiates, zopiclone and benzodiazepines including the 7-amino-benzodiazepines. Cocaine and the heroin marker 6-monoacetylmorphine (6-MAM) were more frequently detected in oral fluid than in urine. Drug concentrations above the cut-off values were found in both samples of oral fluid and urine in 15 of 22 cases positive for morphine, in 18 of 20 cases positive for codeine and in 19 of 26 cases positive for 6-MAM. The use of cannabis was confirmed by detecting THC in oral fluid and THC-COOH in urine. In 34 of 46 cases the use of cannabis was confirmed both in oral fluid and urine. The use of cannabis was confirmed by a positive finding in only urine in 11 cases and in only oral fluid in one case. All the drug groups detected in blood were also found in oral fluid. Since all relevant drugs detected in blood were possible to find in oral fluid and the interpretation of the opiate findings in oral fluid was more conclusive than in urine, oral fluid might replace urine in driving under the influence cases. The fast and easy sampling is time saving and less intrusive for the drivers.

Copyright 2012, Elsevier Science

Wang GB; Zhang XL; Zhao LY; Sun LL; Wu P; Lu L et al. Drug-related cues exacerbate decision making and increase craving in heroin addicts at different abstinence times. Psychopharmacology 221(4): 701-708, 2012. (41 refs.)

Relapse is a persistent problem in the management of addiction. Drug-related cues are powerful instigators of relapse. Impulsive decision making may contribute to relapse through a poorly considered assessment of the consequences of drug use. Drug cues robustly increase subjective craving, which is frequently associated with relapse. The present study explored the effects of drug-related cues on decision making and craving in heroin addicts at different abstinence times: 1, 3, 12, and 24 months. The 75 male participants were given 5 min exposure to neutral and drug-associated cues while decision making performance, craving, blood pressure, heart rate, and emotional state pre- and post-exposure were assessed. The Iowa Gambling Task was used to evaluate decision making ability in heroin addicts. Drug-related cues exacerbated impulsive decision making and increased craving, heart rate, and systolic pressure in heroin addicts at all abstinence times. Drug-related cues aggravated decision making and increased craving in former heroin addicts who had been drug-free for 1-24 months, which might have significant clinical implications for the prevention of relapse.

Copyright 2012, Springer

Wang QL; Liu ZM. Characteristics of psychopathology and the relationship between routes of drug administration and psychiatric symptoms in heroin addicts. Substance Abuse 33(2): 130-137, 2012. (53 refs.)

The objective of this study was to explore the characteristics of comorbid psychiatric symptoms and the relationship between different routes of drug administration and psychiatric symptoms. Five hundred and nine heroin addicts were studied in Drug Detoxification and Rehabilitation Centers in Yunnan and Heilongjiang provinces of China. The measure instrument, including demographic characteristics, history of drug abuse, and the Symptom Checklist-90 (SCL-90) scale (Chinese version), was administered to eligible heroin addicts. Among the subjects, comorbid psychopathology conditions were more severe on all dimensions of SCL-90 comparing with normal adults and the average score of Depression was highest among the 9 dimensions in heroin addicts; psychiatric symptoms were more severe in heroin injecting group than in "chasing the dragon" group and only the difference in Obsessive-Compulsive was significant, but more significant differences were found between snorting heroin addicts and chasing or injecting heroin addicts, and the average score of each dimension of SCL-90 was higher in the snorting group than in the other 2 groups. The reasons of the results and meaning for the present study are discussed. In summary, comorbid psychiatric symptoms in the heroin addicts were very common and severe and their severity varied with different routes of drug administration, suggesting that routes of drug administration should be considered as an important risk factor to mental health of heroin addicts.

Copyright 2012, Taylor & Francis

Wang TY; Lee SY; Chen SL; Chen SH; Chu CH; Huang SY et al. The aldehyde dehydrogenase 2 gene is associated with heroin dependence. Drug and Alcohol Dependence 120(1-3): 220-224, 2012. (44 refs.)

Background: Determining the influences of genes involved in metabolizing dopamine and encoding dopamine receptors, such as the aldehyde dehydrogenase 2 (ALDH2) and dopamine D2 receptor/ankyrin repeat and kinase domain containing 1 (DRD2/ANKK1) genes, is critical for understanding addictive behavior. Therefore, we investigated the association between the ALDH2 and DRD2/ANKK1 Tag IA polymorphisms and heroin dependence. Methods: Heroin-dependent Han Chinese patients (250) and healthy controls (312) were recruited. ALDH2 and DRD2/ANKK1 Taq IA polymorphisms were genotyped. Results: The frequency of ALDH2*1/*2 and *2/*2 genotypes was significantly higher in heroin-dependent patients than in controls, but the frequency of DRD2 Taq IA genotypes was not significantly different. Logistic regression analysis showed no significant interaction between ALDH2 and DRD2 Taq IA genotypes in patients. Conclusions: The ALDH2 polymorphism, but not the DRD2, was associated with heroin dependence.

Copyright 2012, Elsevier Science

White J; Mortensen LH; Batty GD. Cognitive ability in early adulthood as a predictor of habitual drug use during later military service and civilian life: The Vietnam Experience Study. Drug and Alcohol Dependence 125(1-2): 164-168, 2012. (32 refs.)

Background: Recent reports have linked cognitive ability (IQ) with alcohol dependency, but the relationship with illegal drug use is not well understood. Methods: Participants were 14,362 male US Vietnam veterans with IQ test results at entry into military service in 1965-1971 (mean age 22.58) who participated in a telephone interview in 1985-1986. A structured diagnostic telephone interview was used to ascertain habitual drug use during military service (for once a week, >= 3 months) and in civilian life (in the past 12 months, >= once a week), combat exposure, and post-traumatic stress disorder according to established Diagnostic and Statistical Manual of Mental disorders criteria (version III). Results: In unadjusted analysis, men with high IQ scores were less likely to be habitual users of cannabis (OR = 0.89, 95% CI = 0.86, 0.93), cocaine (OR = 0.69, 95% CI = 0.61, 0.78), heroin (OR = 0.80, 95% CI = 0.73, 0.88), amphetamines (OR = 0.90, 95% CI = 0.83, 0.98), barbiturates (OR = 0.79, 95% CI = 0.72, 0.86) and LSD (OR = 0.91, 95% CI = 0.82, 0.99) during military service and civilian life. These associations were markedly attenuated after adjustment for socioeconomic status in early and later civilian life. Conclusion: In this cohort, socioeconomic position might lie on the pathway linking earlier IQ and later habitual drug use but might also act as a surrogate for IQ. This suggests interventions to prevent drug use could attempt to improve early life IQ and opportunities for employment.

Copyright 2012, Elsevier Science

Xue Y-X; Luo Y-X; Shi H-S; Xue L-F; Chen C; Zhu W-L et al. A memory-retrieval extinction procedure to prevent drug craving and relapse. Science 336(6078): 241-245, 2012. (62 refs.)

Drug use and relapse involve learned associations between drug-associated environmental cues and drug effects. Extinction procedures in the clinic can suppress conditioned responses to drug cues, but the extinguished responses typically reemerge after exposure to the drug itself (reinstatement), the drug-associated environment (renewal), or the passage of time (spontaneous recovery). We describe a memory retrieval-extinction procedure that decreases conditioned drug effects and drug seeking in rat models of relapse, and drug craving in abstinent heroin addicts. In rats, daily retrieval of drug-associated memories 10 minutes or 1 hour but not 6 hours before extinction sessions attenuated drug-induced reinstatement, spontaneous recovery, and renewal of conditioned drug effects and drug seeking. In heroin addicts, retrieval of drug-associated memories 10 minutes before extinction sessions attenuated cue-induced heroin craving 1, 30, and 180 days later. The memory retrieval-extinction procedure is a promising nonpharmacological method for decreasing drug craving and relapse during abstinence.

Copyright 2012, American Association for the Advancement of Science