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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Heroin overdose is a major cause of death among heroin users, and often occurs in the company of other users. However, sudden death after injection is rare, giving ample opportunity for intervention. Naloxone hydrochloride, an injectable opioid antagonist which reverses the respiratory depression, sedation and hypotension associated with opioids, has long been used to treat opioid overdose. Experts have suggested that, as part of a comprehensive overdose prevention strategy, naloxone should be provided to heroin users for peer administration after an overdose. A trial could be conducted to determine whether this intervention improves the management of overdose or results in a net increase in harm (by undermining existing prevention strategies, precipitating naloxone-related complications, or resulting in riskier heroin use).
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PMID:Should we conduct a trial of distributing naloxone to heroin users for peer administration to prevent fatal overdose? 1113 Mar 52

Previous studies provide evidence for the selective processing of disorder related stimuli on anxiety, depression, and eating disorders. There exist some preliminary indications that selective processing of drug cues may be involved in drug craving and relapse that deserve further investigation. In order to investigate the role of processing bias in an abnormal motivational system, the attentional bias for drug related stimuli was studied in a heroin dependent population. Heroin dependent participants (n = 21) and control participants (n = 30) performed a supra- and subliminal heroin Stroop task and heroin craving was assessed. Heroin dependent participants showed a considerable attentional bias for supraliminally presented heroin cues. However, there was no evidence for a preattentive bias on the subliminal presented cues. Reaction time on heroin cues was significantly predicted by heroin craving-levels. Results indicate that selective processing may be related to motivational induced states in general. The finding are discussed in the context of selective information processing in general psychopathology and in motivational processes as addiction specifically.
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PMID:Selective cognitive processing of drug cues in heroin dependence. 1119 58

The Swiss trials on medical prescription of injectable diacetylmorphine (pharmaceutical heroin) for "severe" heroin dependence provoked very controversial commentaries. Despite methodological shortcomings, the evaluation of the Swiss heroin trials yielded some interesting findings. Study participants showed substantial improvements in health and well-being and noticeable declines in illicit drug use and criminal activities. Heroin prescription may thus be helpful for some of those who continue to regularly use illicit heroin while maintained on methadone or who refuse other available treatment options. However, research-based evidence suggests that the intravenous (IV) application of heroin under medical supervision may have untoward side effects. Recent studies have shown that heroin injections produce transient, but significant decreases in systemic and cortical oxygenation most likely secondary to respiratory depression. Among others, these effects are the subject of ongoing studies.
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PMID:New aspects in the treatment of heroin dependence with special reference to neurobiological aspects. 1205 77

The major pharmacological effects of heroin can be traced back to some structural properties of the morphine molecule. The analgesic effects of heroin derive from the two active metabolites, 6-O-acetylmorphine and morphine, which bind specifically to the mu-opioid receptors of the central nervous system. mu-receptors also mediate other pharmacological actions of heroin i.e. respiratory depression, euphoria and physical dependence. Heroin is more potent and faster acting than morphine as an analgesic drug. Presently, there is a considerable dispute whether heroin should be legalized for the treatment of pain in terminal cancer. Chronic administration of heroin results in the development of tolerance. It is characterized by a shortened duration and decreased intensity of the analgesic, euphoric, sedative and other CNS-depressant effects. Tolerance to opioids is due to increased adaptation of the cells which changes their receptor sites after chronic exposure to the drug. Toxicity of heroin depends markedly on the route of administration in animal studies. Variable composition of street heroin or sudden loss of tolerance can cause fatal heroin overdose of addicts. Respiratory arrest is the most common reason for death among heroin addicts.
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PMID:[Heroin, part III: the pharmacology of heroin]. 1511 43

Heroin use typically produces a well-recognized syndrome of euphoria, miosis, and respiratory and central nervous system depression; cardiovascular effects are not a common finding. In January 2005, a man aged 21 years in New Jersey was hospitalized with an atypical reaction (e.g., tachycardia and palpitations) after reported heroin use. During the next 3 months, 25 additional persons in five states were reported to poison control centers (PCCs) and local public health agencies with a similar reaction after reported heroin use; in all, 24 of 26 patients were hospitalized. Analysis of drug specimens or testing of urine was performed in certain cases; in eight patients, the veterinary pharmaceutical clenbuterol was detected. This report describes four representative cases and summarizes the investigation by state and local health and law enforcement authorities and CDC into the 26 cases of atypical reactions after heroin use reported in five states (Connecticut, New Jersey, New York, North Carolina, and South Carolina) during January 28-April 17, 2005. Unintentional or intentional adulteration of illicit drugs such as cocaine or heroin is an additional potential hazard associated with their use.
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PMID:Atypical reactions associated with heroin use--five states, January-April 2005. 1610 83

The prevalence of overdose deaths from opioids is still generally increasing throughout the world. Heroin is still the predominant illicit opioid of interest to toxicology laboratories because of its continuing widespread availability and its ability to elicit respiratory depression and coma. In many countries methadone continues to play a major role in cases of drug toxicity because of its large-scale use to treat opioid dependency and its high potency and long duration of action. Increasingly, buprenorphine is being used as an alternative pharmacotherapy, and although apparently safer than methadone, it still has an inherent risk of toxicity when used with CNS depressants such as benzodiazepines or when injected. Morphine continues to be the dominant analgesic; however, oxycodone, hydromorphone, hydrocodone, and fentanyl are increasingly being used and will require increasing efforts by toxicology laboratories to ensure that these substances are adequately covered by testing programs.
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PMID:Recent trends in narcotic deaths. 1640 7

The prescription of heroin (diamorphine) for the management of heroin dependence is a controversial treatment approach that was limited to Britain until the 1990s. Since then a number of countries have embarked upon clinical trials of this approach, and it is currently licensed and available in several European countries. To date, six randomized controlled trials (RCTs) with over 1600 patients and several cohort studies have examined injected (or inhaled) heroin treatment. This article reviews relevant clinical pharmacology, how heroin treatment programmes are delivered, and the evidence regarding safety, efficacy and cost-effectiveness from RCTs. Heroin is usually prescribed in intravenous dosages of 300-500 mg/day, divided in two or three doses. Uncommon but serious side effects include seizures and respiratory depression immediately following injection. Despite methodological shortcomings, RCTs generally indicate that heroin treatment results in a comparable retention, improved general health and psychosocial functioning, and less self-reported illicit heroin use than oral methadone treatment. Cost-effectiveness studies indicate heroin treatment to be more expensive to deliver but to result in savings in the criminal justice sector. There has been debate regarding how heroin treatment should be positioned within the range of treatment approaches for this condition. There is increasing consensus that, in countries that have robust and accessible treatment systems for heroin users, heroin treatment is suited to a minority of heroin users as a second-line treatment for those individuals who do not respond to methadone or buprenorphine treatment delivered under optimal conditions.
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PMID:Prescription of heroin for the management of heroin dependence: current status. 1948 Apr 66

The aim of this study was to investigate temperament, hopelessness (a measure of suicide risk), and health perception in heroin addicts. The study involved the administration of the TEMPS-A Rome, the Beck Hopelessness Scale (BHS), the MINI Neuropsychiatric Interview, and the Multidimensional Health Questionnaire. Participants were 100 heroin addicts who were matched by age and sex with 100 randomly selected non-users. Heroin addicts obtained higher scores on TEMPS-A Dys/Cyc/Anx temperament and on the irritable temperament. In the heroin addicts, anxiety, depression, preoccupation with health, health illness self-blame, health monitoring, and negative thinking about health were positively associated with hopelessness, dysthymic/anxious/cyclothymic temperament, and irritable temperament. Motivation to avoid unhealthiness, health assertiveness, health expectation optimism, and health satisfaction were negatively associated with hopelessness, dysthymic/anxious/cyclothymic temperament, and irritable temperament. More knowledge on health attitudes in heroin addicts may help in delivering a treatment plan for this selective population.
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PMID:Hopelessness, temperament, and health perception in heroin addicts. 2063 84

The aims of this study were to examine unfavorable attitudes toward receiving methadone maintenance therapy (MMT) and associated factors among inmates using intravenous heroin in Taiwan. A total of 315 inmates using intravenous heroin were recruited. Their unfavorable attitudes toward receiving MMT after discharge from prison were evaluated using the Client Attitudes Toward Methadone Programs Scale. The associations of unfavorable attitudes toward receiving MMT with sociodemographic and drug-using characteristics, human immunodeficiency virus serostatus, perceived family support, and depression were examined using multiple regression analysis. The results of this study showed that the mean score of unfavorable attitudes toward receiving MMT, determined on the Client Attitudes Toward Methadone Programs Scale, was 9.918 (standard deviation=2.277, range=5-20). Heroin-using inmates who were young, started using heroin earlier, perceived many advantages and few disadvantages of heroin use, had never received MMT, and had severe depression, had unfavorable attitudes toward receiving MMT. Based on the results of this study, we suggest that inmates who have the factors associated with unfavorable attitudes toward receiving MMT should receive intervention and motivational interviewing to improve their attitudes toward MMT and to increase their opportunity to receive MMT after discharge from prison.
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PMID:Unfavorable attitudes toward receiving methadone maintenance therapy and associated factors among the inmates using intravenous heroin. 2132 89

Heroin administration by "chasing the dragon," whereby the user places freebase heroin on aluminum foil, heats it below with a flame, and inhales the pyrolysate through a straw, can be associated with the rare development of a delayed-onset spongiform leukoencephalopathy. We report the case of a 46-year-old woman with a psychiatric diagnosis of depression and heroin dependence by "chasing the dragon" admitted with features of altered mental status and later development of catatonia, abulia, and akinetic mutism. A brain magnetic resonance image evidenced bilateral symmetric high-signal lesions in the white matter of the cerebrum and cerebellum on T2-weighted images compatible with toxic leukoencephalopathy. The patient's condition resolved after a hospital stay of 2 months with supportive treatment. Acute onset of neurobehavioral changes, including confusion, apathy, and cerebellar signs in a person with exposure to heroin, should prompt one to consider toxic leukoencephalopathy as a cause of presentation.
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PMID:'Chasing the dragon': new knowledge for an old practice. 2151 16


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