High prevalence but low awareness of hepatitis C virus infection

Addict Behav. 2013 Apr;38(4):2089-93. doi: 10.1016/j.addbeh.2013.01.010. Epub 2013 Jan 17.

High prevalence but low awareness of hepatitis C virus infection among heroin users who received methadone maintenance therapy in Taiwan.

The prevalence of HCV infection was 90.8%. All participants who were HIV-positive were also infected with HCV. Multivariate logistic regression analysis showed that the route of heroin administration (injection), HIV-infection, and criminal records were significantly related to HCV infection. 

Few (34.8%) HCV positive heroin users were aware of their infection.

Return to drug use and overdose after release from prison

Addict Sci Clin Pract. 2012;7(1):3. doi: 10.1186/1940-0640-7-3. Epub 2012 Mar 15.

Return to drug use and overdose after release from prison: a qualitative study of risk and protective factors.

1) Relapse to drugs and alcohol occurred in a context of poor social support, medical co-morbidity and inadequate economic resources;

 2) former inmates experienced ubiquitous exposure to drugs in their living environments;

 3) intentional overdose was considered "a way out" given situational stressors, and accidental overdose was perceived as related to decreased tolerance;

 4) protective factors included structured drug treatment programs, spirituality/religion, community-based resources (including self-help groups), and family.

Heroin on the Hypothalamic-Pituitary-Adrenal Axis

J Clin Psychopharmacol. 2013 Feb 14. [Epub ahead of print]

Acute Effects of Intravenous Heroin on the Hypothalamic-Pituitary-Adrenal Axis Response: A Controlled Trial.

 Heroin administration reduces craving, withdrawal, and anxiety levels and leads to significant decreases in ACTH and cortisol concentrations (P < 0.01).

 After heroin administration, cortisol concentrations did not differ from healthy controls, and ACTH levels were significantly lower (P < 0.01).

 In contrast, when patients receive saline, all hormone levels were significantly higher in patients than in healthy controls (P < 0.01).

Heroin-dependent patients showed a normalized HPA axis response compared to healthy controls when they receive their regular heroin dose.

 These findings indicate that regular opioid administration protects addicts from stress and underscore the clinical significance of heroin-assisted treatment for heroin-dependent patients.

 

Heroin Abstinence in 33-Year Observational Cohort

Characterizing Durations of Heroin Abstinence in the California Civil Addict Program: Results From a 33-Year Observational Cohort Study.

Am J Epidemiol. 2013 Feb 27. [Epub ahead of print]

 

Among 471 heroin-dependent males, 387 (82.2%) reported 932 abstinence episodes, 60.3% of which lasted at least 1 year.

 1. Demographic factors such as age and ethnicity did not explain variation in durations of abstinence episodes. Eemployment and lower drug use severity predicted longer episodes. 

2. Abstinence durations were longer following sustained treatment versus incarceration.

3. Individuals with multiple abstinence episodes remained abstinent for longer durations in successive episodes.

4.Abstinence episodes initiated >10 and ≤20 years after first use lasted longer than others.

Erectile Dysfunction Methadone Maintenance Therapy

Risk Factors of Erectile Dysfunction (ED) in Patients Receiving Methadone Maintenance Therapy

J Sex Med. 2013 Feb 27. doi: 10.1111/jsm.12105. [Epub ahead of print]

 

The rate of ED among men on MMT was 68.5% (mild ED, 36.1%; mild to moderate ED, 22.2%; severe ED, 3.7%). The mean age of the participants was 43.45 years. Older age (P = 0.002), concurrent illicit heroin use (P = 0.024), and having an older partner (P = 0.039) were significantly associated with ED. Following multivariate analysis, it was found that older age was the only significant predictor of ED, with an adjusted odds ratio of 1.07 (95% CI = 1.02-1.16). Methadone dose and duration of methadone treatment were not significantly associated with ED.