Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019158 (hepatitis)
 30,205 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pregnant heroin addicts tend to be younger than nonaddicted pregnant patients, unmarried or separated from spouses, and a disproportionately large number are members of minority ethnic groups. Heroin addiction during pregnancy is associated with several significant medical and obstetrical complications and may result in both acute and chronic abnormalities in neonates. Malnutrition, venereal disease, hepatitis, pulmonary complications, preeclampsia and third-trimester bleeding are the most common maternal complications, while fetal death, intrauterine growth retardation, prematurity and withdrawal symptoms affect the fetus and neonate. There is controversy about treating addicts with methadone during pregnancy. The findings of studies in animals suggest that there may be a long-lasting drug-induced syndrome, characterized by growth retardation, delayed motor development and behavior abnormalities in offspring of heroin-addicted or methadone-treated mothers.
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PMID:Heroin addiction and pregnancy. 725 65

Methadone maintenance has been evaluated since its development in 1964 as a medical response to the post-World War II heroin epidemic in New York City. The findings of major early studies have been consistent. Methadone maintenance reduces and/or eliminates the use of heroin, reduces the death rates and criminality associated with heroin use, and allows patients to improve their health and social productivity. In addition, enrollment in methadone maintenance has the potential toreduce the transmission of infectious diseases associated with heroin injection, such as hepatitis and HIV. The principal effects of methadone maintenance are to relieve narcotic craving, suppress the abstinence syndrome, and block the euphoric effects associated with heroin. A majority of patients require 80-120 mg/d of methadone, or more, to achieve these effects and require treatment for an indefinite period of time, since methadone maintenance is a corrective but not a curative treatment for heroin addiction. Lower doses may not be as effective or provide the blockade effect. Methadone maintenance has been found to be medically safe and nonsedating. It is also indicated for pregnant women addicted to heroin. Reviews issued by the Institute of Medicine and the National Institutes of Health have defined narcotic addiction as a chronic medical disorder and have claimed that methadone maintenance coupled with social services is the most effective treatment for this condition. These agencies recommend reducing governmental regulation to facilitate patients access to treatment. In addition, they recommend that the number of programs be expanded, and that new models of treatment be implemented,if the nationwide problem of addiction is to be brought under control. The National Institutes of Health also recommend that methadone maintenance be available to persons under legal supervision, such as probationers, parolees and the incarcerated. However, stigma and bias directed at the programs and the patients have hindered expansion and the effective delivery of services. Professional community leadership is necessary to educate the general public if these impediments are to be overcome.
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PMID:Methadone maintenance treatment (MMT): a review of historical and clinical issues. 1106 85

(1) The aim of replacement therapy for heroin addiction is to suppress craving for other opiates and to prevent opiate withdrawal symptoms. (2) In France, methadone was the first drug to be licensed for this use, in 1995, with very strict prescribing and dispensing conditions. Buprenorphine was approved in 1996, and was subject to less restrictive conditions. (3) In 2003 in France, an estimated 80 000 people were receiving replacement therapy with buprenorphine and 14 000 with methadone. (4) A meta-analysis of 13 comparative trials involving a total of 2544 patients showed that buprenorphine 6 to 12 mg initially reduced both opiate and benzodiazepine use, whereas doses of 2 to 4 mg had no marked impact on heroin use. This meta-analysis concluded that buprenorphine and methadone had similar efficacy in clinical trials in which the dose was adjusted to outcome. There were more dropouts with buprenorphine than with methadone. A daily dose of 16 mg appeared to be roughly equivalent to 60 mg/day methadone. (5) France appears to be the only country to have relied primarily on buprenorphine as replacement therapy for heroin addiction. This has been the case in France since 1996. The frequency of heroin overdose has fallen markedly in France since 1996, possibly due in part to the availability of replacement therapies. Overall mortality among drug users has also declined, but this is largely due to more effective treatment of HIV infection. (6) In France, a two-year cohort study of patients treated with buprenorphine and a survey conducted during the first year of buprenorphine replacement were funded by the manufacturer, Schering-Plough. The results showed that more than two-thirds of patients remained on treatment, and that, overall, the patients' general condition improved. (7) Opioid-like adverse effects are infrequent under normal conditions of use. There are reports of cases of hepatitis in patients taking buprenorphine, with or without a benzodiazepine. Attribution to buprenorphine is unclear, however, due to the lack of appropriate analyses. (8) Some of the key adverse effects occur during misuse: buprenorphine tablets are often injected, especially during the first few months of treatment (sometimes for more than two years). Injection carries a risk of infections; other potential long-term effects are poorly understood. Compared with methadone users, and regardless of the substances involved, buprenorphine users appear more likely to self-inject. (9) The consequences of sniffing crushed buprenorphine tablets have not been studied. (10) Deaths have been reported following buprenorphine overdose, but they appear to be less frequent than with methadone (0.2 and 0.7 deaths per 1000 users, respectively in 1998). (11) Approaches designed to help patients stop self-injecting have not been tested in comparative trials. Prescriptions of methadone syrup or an injection opiate may be worth trying when all other measures fail.
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PMID:Buprenorphine replacement therapy: a confirmed benefit. 1660 48

A brief history of drug addiction in France can be garnered from a combination of the fragmented testimonies of physicians, social scientists, drug users, and of the OFDT reports edited since the middle of the nineties. It shows a tremendous evolution in the nature of drugs abused and the number of addicts, taking place in less than fifty years, from a small number of opiate addicts restricted to the major French ports to two separate drug scenes (urban and festive) accounting for several hundred thousand people. Those two scenes have shown a tendency to merge following the unification of drug trafficking. The failure of the repression policy initialized in 1970 was responsible of the AIDS and hepatitis epidemic which resulted in the introduction of large scale substitution treatments in 1996. Initiated to reduce contamination risks, later on, they were recognized as an effective treatment of heroin addiction. Beside the positive effects of this "French revolution", emergence of buprenorphine as a new urban drug must be accounted and dealt with.
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PMID:[Management of drug addiction in France (a short history)]. 1796 35

Heroin addiction is one of the most devastating and expensive of public health problems. The most effective treatment is opioid replacement therapy. Replacement of heroin, a short-acting euphoriant with methadone or other opioids that have significantly longer duration of action provides a number of therapeutic benefits. Opioid detoxification has a role in both preventing acute withdrawal and maintaining long-term abstinence. Opioid-based detoxification is based on the principle of cross-tolerance, in which one opioid is replaced with another one that is slowly tapered. For the treatment of heroin addicts a wide range of psychosocial and pharmacotherapeutic treatments are available; of these, methadone maintenance therapy has the most evidence of benefit. Methadone maintenance reduces and/or eliminates the use of heroin, reduces the death rate and criminality associated with heroin use, and allows patients to improve their health and social productivity. In addition, enrollment in methadone maintenance has the potential to reduce the transmission of infectious diseases associated with heroin injection, such as hepatitis and HIV. The principal effects of methadone maintenance are to relieve narcotic craving, suppress the abstinence syndrome, and block the euphoric effects associated with heroin. There is growing interest in expanding treatment into primary care, allowing opioid addiction to be managed like other chronic illnesses. Buprenorphine which is a long-acting partial agonist was also approved as pharmacotherapy for opioid dependence. Opioid antagonists can reduce heroin self-administration and opioid craving in detoxified addicts. Naltrexone, which is a long-acting competitive antagonist at the opioid receptors, blocks the subjective and objective responses produced by intravenous opioids. Naltrexone is employed to accelerate opioid detoxification by displacing heroin and as a maintenance agent for detoxified formerly heroin-dependent patients who want to remain opioid-free.
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PMID:[Therapy in heroin addiction]. 2534 42