http://www.ncbi.nlm.nih.gov/pubmed/10836211
Ascorbic acid (vitamin C) effects on withdrawal syndrome of heroin abusers. Evangelou A, Kalfakakou V, Georgakas P, Koutras V, Vezyraki P, Iliopoulou L, Vadalouka A.
Laboratory of Experimental Physiology, Faculty of Medicine, University of Ioannina, Greece. aevaggel@uoi.gr
BACKGROUND: Ascorbic acid (vitamin C), administered orally in high doses has been observed to relieve pain and reduce opioid use in cancer patients. In vitro studies have also shown that antioxidants, such as vitamin C, may, at high concentrations, inhibit the endogenous opioid degrading metalloenzyme and increase endorphin levels. In the present study the effects of oral administration of high doses of vitamin C on withdrawal syndrome of heroin abusers were investigated. MATERIALS AND PATIENTS: Ascorbic acid at doses of 300 mg/kg b.w/day, supplemented with vitamin E (5 mg/kg b.w/day), was orally administered in two groups of heroin addict subjects consisting of in-patients (Group A, 30 males) and one of out-patients(Group B, 10 males), for a minimum of 4 weeks. The group A in-patients were also administered the conventional (diazepam + analgesic) medication. The results on the intensity of withdrawal syndrome (WS), estimated according to DMS-III criteria, were compared to a third group of heroin addict in-patients (group C, 30 males-control group), treated only by conventional medication. RESULTS: The patients of the vitamin C-treated groups (in-patients and out-patients) experienced mild WS (in 46.6% to 50% of the subjects) in contrast to the control group patients, who experienced mild WS in 6.6% of the cases. The vitamin C-treated subjects expressed major WS ranging from 10% to 16.6%, in contrast to the untreated subjects (control group), who expressed a major WS in 56.6% of the cases. CONCLUSIONS: The results indicate that high doses of ascorbic acid administered orally, may ameliorate the withdrawal syndrome of heroin addicts. Further studies are needed in order to estimate the dose- and time-dependent effects of ascorbic acid treatment, and to clarify its mechanisms of action in the withdrawal syndrome.
PMID: 10836211 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/18930603
1: Drug Alcohol Depend. 2009 Jan 1;99(1-3):222-30. Epub 2008 Oct 18.
Buprenorphine and methadone maintenance in jail and post-release: a randomized clinical trial. Magura S, Lee JD, Hershberger J, Joseph H, Marsch L, Shropshire C, Rosenblum A.
The Evaluation Center, Western Michigan University, Kalamazoo, MI 49008, USA. stephen.magura@wmich.edu
Buprenorphine has rarely been administered as an opioid agonist maintenance therapy in a correctional setting. This study introduced buprenorphine maintenance in a large urban jail, Rikers Island in New York City. Heroin-dependent men not enrolled in community methadone treatment and sentenced to 10-90 days in jail (N=116) were voluntarily randomly assigned either to buprenorphine or methadone maintenance, the latter being the standard of care for eligible inmates at Rikers. Buprenorphine and methadone maintenance completion rates in jail were equally high, but the buprenorphine group reported for their designated post-release treatment in the community significantly more often than did the methadone group (48% vs. 14%, p<.001). Consistent with this result, prior to release from Rikers, buprenorphine patients stated an intention to continue treatment after release more often than did methadone patients (93% vs. 44%, p<.001). Buprenorphine patients were also less likely than methadone patients to withdraw voluntarily from medication while in jail (3% vs. 16%, p<.05). There were no post-release differences between the buprenorphine and methadone groups in self-reported relapse to illicit opioid use, self-reported re-arrests, self-reported severity of crime or re-incarceration in jail. After initiating opioid agonist treatment in jail, continuing buprenorphine maintenance in the community appears to be more acceptable to offenders than continuing methadone maintenance.
PMID: 18930603 [PubMed - indexed for MEDLINE]
PMCID: PMC2658719 [Available on 2010/01/01]
http://www.ncbi.nlm.nih.gov/pubmed/19253806
1: J Med Assoc Thai. 2009 Feb;92(2):279-83.
A fatal heroin addict with myocardial lesion. Srettabunjong S.
Department of Forensic Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. sissb@mahidol.ac.th
This is a histological report of a myocardial lesion of a 44-year-old white man who was found dead in a hotel with circumstances strongly suggestive of heroin intoxication. Based on. autopsy findings and toxicologic analysis, the present case was an instance of straight forward heroin overdose in snorter. The most striking pathologic finding of the heart was a few patches of marked dark mottling appearance in the left ventricle and ventricular septum. Histological appearance of the lesions revealed marked congestion with intramyocardial extravasation of blood. Since the deceased had patent coronary arteries without evidence of atheroma, the lesions were thought to be the results ofcoronary artery spasm. There has also been substantial evidence in the previous reports to believe that the condition is secondary to heroin-induced coronary artery spasm. However its actual underlying mechanism remains unclear.
PMID: 19253806 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/19304418
1: Forensic Sci Int. 2009 May 30;187(1-3):42-6. Epub 2009 Mar 21.
Heroin-associated myocardial damages--conventional and immunohistochemical investigations. Dettmeyer R, Friedrich K, Schmidt P, Madea B.
Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany. reinhard.dettmeyer@forens.med.uni-giessen.de
Well-known complications related to drug abuse are myocardial insufficiency, myocardial infarction, endocarditis, myocarditis, aortic dissection, neurologic damages, ischemic colitis, thrombotic phenomenons, renal infarction and acute liver failure. Furthermore, microfocal fibrosis of the myocardium is found in stimulant abuse. The origin of myocardial fibrosis associated with opiate abuse (endocarditis, myocarditis, embolism) is still unclear. This question shall be investigated using immunohistochemical staining for early diagnosis of myocarditis. A quantification of myocardial interstitial leucocytic infiltrates was accomplished in 21 chronic drug abusers who died of heroin/morphine intoxication and compared to 15 normal subjects who died suddenly due to non-cardiac causes of death without intoxication (e.g. traffic accidents, head trauma). Toxicological investigations were performed and in addition, blood samples were checked to clarify the status of HIV, hepatitis A, B and C in both groups. To verify signs of inflammation, myocardial specimen from different locations were investigated with conventional histological stainings and immunohistochemical techniques for characterization and quantification of interstitial myocardial leucocytes, T-lymphocytes and macrophages. The number of cells were found up to fivefold increased in heroin addicts compared to the control group without reaching the cut-off values for immunohistochemically based diagnosis of myocarditis.
PMID: 19304418 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/19403243
1: Drug Alcohol Depend. 2009 Jul 1;103(1-2):37-43. Epub 2009 Apr 28.
Open-label dose-finding trial of buprenorphine implants (Probuphine) for treatment of heroin dependence. White J, Bell J, Saunders JB, Williamson P, Makowska M, Farquharson A, Beebe KL.
Discipline of Pharmacology, University of Adelaide, Adelaide, SA 5005, Australia. jason.white@adelaide.edu.au
Buprenorphine, a mu-opioid receptor partial agonist, has been shown to be safe and effective for treatment of opioid dependence. A novel implantable formulation of buprenorphine (Probuphine), using a polymer matrix sustained-release technology, has been developed to offer treatment for opioid dependence while minimizing risks of patient noncompliance and illicit diversion. The goal of the current study was to conduct an initial, open-label, evaluation of the safety, pharmacokinetics, and efficacy of two doses of Probuphine in subjects with opioid dependence maintained on sublingual buprenorphine. Two doses of Probuphine were evaluated in 12 heroin-dependent volunteers switched from daily sublingual buprenorphine dosing to either two or four Probuphine implants based upon their buprenorphine daily maintenance dose of 8 mg or 16 mg respectively, and were monitored for 6 months. Probuphine implants provided continuous steady state delivery of buprenorphine until their removal at 6 months. Withdrawal symptoms and craving remained low throughout the 6 months. For the 12 subjects, an average of 59% of urines were opioid-negative across the 6 month treatment period. Injection site reactions were present in half of patients, but none were serious. No safety concerns were evident. These results suggest that Probuphine implants offer significant promise for enhancing delivery of effective opioid substitution treatment while minimizing risk for abuse of medication.
PMID: 19403243 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/19089500
1: J Gen Intern Med. 2009 Feb;24(2):218-25. Epub 2008 Dec 17.
Integrating buprenorphine treatment into office-based practice: a qualitative study. Barry DT, Irwin KS, Jones ES, Becker WC, Tetrault JM, Sullivan LE, Hansen H, O'Connor PG, Schottenfeld RS, Fiellin DA.
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519-1187, USA. declan.barry@yale.edu
BACKGROUND: Despite the availability and demonstrated effectiveness of office-based buprenorphine maintenance treatment (BMT), the systematic examination of physicians' attitudes towards this new medical practice has been largely neglected. OBJECTIVE: To identify facilitators and barriers to the potential or actual implementation of BMT by office-based medical providers. DESIGN: Qualitative study using individual and group semi-structured interviews. PARTICIPANTS: Twenty-three practicing office-based physicians in New England. APPROACH: Interviews were audiotaped, transcribed, and entered into a qualitative software program. The transcripts were thematically coded using the constant comparative method by a multidisciplinary team. RESULTS: Eighty percent of the physicians were white; 55% were women. The mean number of years since graduating medical school was 14 (SD = 10). The primary areas of clinical specialization were internal medicine (50%), infectious disease (20%), and addiction medicine (15%). Physicians identified physician, patient, and logistical factors that would either facilitate or serve as a barrier to their integration of BMT into clinical practice. Physician facilitators included promoting continuity of patient care, positive perceptions of BMT, and viewing BMT as a positive alternative to methadone maintenance. Physician barriers included competing activities, lack of interest, and lack of expertise in addiction treatment. Physicians' perceptions of patient-related barriers included concerns about confidentiality and cost, and low motivation for treatment. Perceived logistical barriers included lack of remuneration for BMT, limited ancillary support for physicians, not enough time, and a perceived low prevalence of opioid dependence in physicians' practices. CONCLUSIONS: Addressing physicians' perceptions of facilitators and barriers to BMT is crucial to supporting the further expansion of BMT into primary care and office-based practices.
PMID: 19089500 [PubMed - in process]
PMCID: PMC2628993 [Available on 2010/02/01]