A strategy for the control of HIV infection and viral hepatitides against the background of the narcotic abuse epidemic

The presence of the epidemic of drug addiction in the Russian Federation is stated: for the recent 10 years the number of drug addicts increased 3.5-fold. The questioning of several thousand drug addicts has revealed that 60% of them have hepatitis B, 80% have hepatitis C, 10% have syphilis. The strategy of controlling HIV infection among drug addicts is proposed. It includes, in the first place, the prevention of the secondary infection from HIV-infected addicts; in the second place, the detection of HIV-infected persons in groups of drug addicts, difficult to establish contacts with; in the third place, the primary prophylaxis within the program "Harm reduction" in the most susceptible groups of drug addicts. The thesis that the prevention of HIV infection must become the prevention of drug addiction by rendering multi-stage assistance to HIV-infected persons, including mainly drug addicts, is substantiated.     

Deaths of drug addicts in the United Kingdom 1967-81.

A search of the Home Office index of notified drug addicts identified 1499 deaths during 1967-81, of which 226 (15%) were of therapeutic addicts--that is, patients who had become addicted during medical treatment with a notifiable drug--and 1273 (85%) were of non-therapeutic addicts. The crude mortality fell from 23.5/1000/year for the period 1968-70 to 18.4/1000/year for 1978-80. Altogether 416 addicts aged under 50 at notification died after 1972, which was 16 times the number of deaths expected in a population with a similar age and sex composition. A more detailed examination of the cohorts of addicts notified each year showed little variation between them in the first two years of follow up. Nineteen addicts (1.6%) had died by 31 December of the year of their notification and 39 (3.3%) one year later. These figures may be an indication of the clinical course of addiction. Most deaths of non-therapeutic addicts in which a drug was implicated (939 cases (74%] were due to medically prescribed drugs--barbiturates at first and later opiates such as dipipanone hydrochloride and dextromoramide. Heroin was implicated in only 65 (7%) of these deaths. The Home Office index is a valuable source for identifying drugs of abuse and serious problems of addiction. The fact that prescribed drugs are causing the death of so many addicts demands a response from the medical profession.     

Opiate addiction in adult offspring through possible imprinting after obstetric treatment.

OBJECTIVE--To test the hypothesis that opiate addiction in adults might stem partly from an imprinting process during birth when certain drugs are given to the mother. DESIGN--Retrospective study by logistic regression of opiate addicts with siblings as controls. SETTING--Stockholm, Sweden. SUBJECTS--200 Opiate addicts born in Stockholm during 1945-66, comprising 41 identified during interviews of probands for an earlier study; 75 patients whose death from opiate addiction had been confirmed during 1978-88; and 84 accepted for the methadone programme. 262 Siblings (controls) born in Stockholm during the same period, 24 of whom were excluded for drug addiction or being brought up outside the family. Birth records were unavailable for eight, leaving 230 siblings and 139 corresponding probands. MAIN OUTCOME MEASURES--Administration of opiates, barbiturates, and nitrous oxide (for greater than 1 h) to mothers of all subjects during labour within 10 hours before birth as a risk factor for adult opiate addiction. RESULTS--In subjects who had subsequently become addicts a significant proportion of mothers had received opiates or barbiturates, or both, compared with unmatched siblings (25% v 16%, chi 2 = 5.83, df = 1, p = 0.02), and these mothers had received nitrous oxide for longer and more often. After controlling for hospital of birth, order of birth, duration of labour, presentation other than vertex, surgical intervention, asphyxia, meconium stained amniotic fluid, and birth weight the relative risk for offspring subsequently becoming an adult opiate addict increased with the number of administrations of any of the three drugs. When the addicts were matched with their own siblings the estimated relative risk was 4.7 (95% confidence interval 1.8 to 12.4, p for trend = 0.002) for three administrations compared with when no drug was given. CONCLUSIONS--The results are compatible with the imprinting hypothesis. Therefore, for obstetric pain relief methods are preferable that do not permit substantial passage of drugs through the placenta.     

The prevalence of the use of narcotics and other psychoactive substances in Russia today

The epidemiological analysis of morbidity in drug addiction in Russia for the period of 25 years is presented. As shown in this analysis, by 1992 the number of drug addicts rose twofold in comparison with 1986, and by 1998 this number rose tenfold, reaching 109.5 per 100,000 of the population. The total number of persons given medical assistance on account of the abuse of narcotic and non-narcotic substances exceeded 295,000. The analysis states that the ratio of persons having problems with drugs and applying for medical assistance to the actual number of drug addicts is 1:7, i.e. the number of drug addicts among the population exceeds 2 million persons. The spread of drug addiction among adolescents, which grew eightfold during the last 10 years, is a particularly unfavorable phenomenon. The established tendencies towards the growth of morbidity rates in individual groups of population in Russia and the data obtained by questioning among the population are indicative of growth in the spread of drug addiction. This regularity is confirmed by the growing proportion of children, adolescents and women among those who applied for medical assistance for the first time.     

Rethinking Informed Consent in Research on Heroin‐Assisted Treatment

Can heroin addicts give consent to research on trials in which heroin is prescribed to them? Analyses of addicts and informed consent have been objects of debate in several articles. Informed consent requires the agent not only to be competent but also to give consent voluntarily. This has been questioned because of alleged features of heroin addiction. Until recently the discussion has focused on heroin addicts' desires for heroin, whether these are irresistible and thus pose a problem for giving consent. Still, in light of empirical evidence, there seems to be a consensus more or less that the problem is not whether the addicts can resist their desire for heroin. A recent article concentrates specifically on heroin addicts' false assumptions of options and voluntariness. We argue that the prevailing framing of the options in this discussion in terms of heroin and access to it is problematic. The way in which the options are typically laid out suggests an assumption that participation in the research is allegedly based on the addicts' views on using the drug. We argue that this way of presenting the options is, first, a mismatch to the studies carried out and, second, symptomatic of potential misconceptions about heroin addiction and addicts. Furthermore, we also suggest that the account of voluntariness needs to be realistic in order for subjects to be able to give consent voluntarily in actual situations, and for medical research to carry out studies on improving outcomes in addiction treatment in an ethical way.     

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) colonization and infection in intravenous and inhalational opiate drug abusers

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen in hospital-acquired and community-acquired infections. We hypothesized that drug abuse is a risk factor for community-acquired MRSA (CA-MRSA) infection, and we employed a rapid multiplex PCR technique for MRSA identification. The study was conducted on MRSA isolates from 60 opiate addicts (intravenous and inhalational drug users) to detect the rate and location of MRSA colonization and infection among them in comparison to 60 non-addict patients and 15 healthy volunteer controls. The proportion of addicts with MRSA colonization (and/or infection) was significantly higher than non-addict patients with MRSA colonization. MRSA colonization was associated with infection in 58% of MRSA-colonized addicts. The MRSA nasal carriage in the addicts was significantly higher than MRSA carriage elsewhere, whether in the addicts group or in the non-addict patients group. Moreover, the nasopharyngeal carriage rate of MRSA among addicts was significantly higher than among the non-addict patients. Increasing the duration of addiction resulted in a significant increase in CA-MRSA colonization in opiate addicts. Both inhalational and intravenous drug use led to significant MRSA colonization in the addict population. In conclusion, this study demonstrated how drug abusers, a high-risk group for infections with MRSA, could be a source or a reservoir of CA-MRSA infection in the non-addict population.     

Drug Addiction - Pushers Generated from the Addicts

This work develops a model for the spread of drug addiction in a closed population of size N. The spread of addiction is considered as an epidemic process where the addicts mix homogeneously within the population. There is an additional group (or pushers) with whom the susceptibles interact, but who are generated from the addicts. State probabilities and moments are obtained for this stochastic process. An extension to a generalized model is also made.     

The monitoring of the spread of drug abuse as an element in the epidemiological surveillance of socially significant infections

The necessity of monitoring the spread of drug addiction in the system of epidemiological surveillance on HIV infection and parenteral virus hepatitides is shown. The results of the epidemiological diagnostics of registered drug addiction are presented. The criteria for the assessment of the epidemiological effectiveness of epidemiological surveillance on drug addiction are determined. As revealed in this study, during the period of 1991-1998 morbidity in drug addiction rose 57-fold in Perm Province, while the number of HIV-infected persons increased 75-fold. Pronounced direct relationship between the number of drug addicts, as well as persons belonging to groups of high risk of developing drug addiction, and the dynamics of morbidity in HIV infection and parenteral virus hepatitides B and C was established.     

Mortality among drug addicts in Greater London.

During January 1970 to December 1974, 134 deaths in people aged 10-50 years investigated by coroners in Greater London were recorded as being due to drug addiction. Over three-quarters of the addicts were under 30, and 105 (78%) were male; 55 (41%) were unknown to the Home Office. Barbiturate overdose accounted for over half of the deaths, though two-thirds of these were in people registered as addicts to notifiable drugs. Since the Home Office index is concerned with addiction to one class of drugs only, it fails to reflect accurately the prevalence of all serious forms of addiction. Owing to the continuous change in drug-taking behaviour, however, probably no one method of assessment can provide a complete picture, and thus complementary research methods are essential.     

药物依赖临床治疗的研究新进展

随着吸毒人员的剧增,药物依赖极大的危害着人类健康和社会稳定,已经成为目前严重的社会性问题。心瘾是患者复吸的重要原因,心瘾的戒断是治疗成瘾的关键。供临床医生选择的治疗方法有很多,但是根据成瘾者的病情合理的选择治疗措施是目前临床工作中面临的巨大挑战。本文综述了目前物质依赖的药物治疗的作用机制以及临床疗效、各种手术戒毒的效果以及不良反应、心理行为治疗的原因以及具体措施,药物治疗、手术治疗以及中西医联合治疗的最新进展。     

The determinants of the spread of HIV among injection drug addicts in Ukraine

The main tendencies in the development of drug addiction in the Ukraine, the dynamics of the spread of HIV among drug addicts introducing drugs intravenously, epidemiological data on HIV, AIDS and drug addiction, as well as prognoses on the development of HIV infection are presented. Since 1995 the number of HIV-infected persons grew 34-fold, the number of cases of HIV infection resulting from the intravenous use drugs rose to 70% simultaneously with the rise (about 34-fold) of the number of persons infected with HIV through sexual contacts (about 13 fold). In 1996-1997 such tendency increased. On the whole, the proportion of drug addicts introducing drugs by intravenous injection was 83% in the Ukraine. By April 1, 1998, official registration covered 18,800 HIV-infected persons, including 270 foreign nationals, as well as 499 AIDS patients, including 487 Ukrainian citizens, among them 28 children. Out of 18,800 HIV-infected persons, 78.3% were drug addicts, most of them young people aged 15-30 years; about 18% were young people under 20 years of age, 80% being males. According to the model the rapid spread of HIV from the group of drug addicts to the heterosexual population, the total number of HIV-infected persons reaching 1,500,000 is expected in the country by 2014.     

Cortical thickness abnormalities in cocaine addiction--a reflection of both drug use and a pre-existing disposition to drug abuse?

The structural effects of cocaine on neural systems mediating cognition and motivation are not well known. By comparing the thickness of neocortical and paralimbic brain regions between cocaine-dependent and matched control subjects, we found that four of 18 a priori regions involved with executive regulation of reward and attention were significantly thinner in addicts. Correlations were significant between thinner prefrontal cortex and reduced keypresses during judgment and decision making of relative preference in addicts, suggesting one basis for restricted behavioral repertoires in drug dependence. Reduced effortful attention performance in addicts also correlated with thinner paralimbic cortices. Some thickness differences in addicts were correlated with cocaine use independent of nicotine and alcohol, but addicts also showed diminished thickness heterogeneity and altered hemispheric thickness asymmetry. These observations suggest that brain structure abnormalities in addicts are related in part to drug use and in part to predisposition toward addiction.     

Spread of Drug Addiction in the Presence of Two Competing Drugs

This paper considers the spread of drug addiction when addiction is by taking one of two competing drugs available. Community is assumed to be closed and each individual is classified as belonging to one of three mutually exclusive groups: susceptibles, addicts and pushers. A deterministic model is presented in general form and, in a special case, the stochastic model is analysed. An illustration is also presented where the parameters take a specific set of numerical values.     

Listen to one another and act in concert (the Renewal Project)

The organization of work on the project "Harm Reduction for Intravenous Drug Users in Kazan" is substantiated. Difficulties in the realization of such projects due to the lack of coordination between different services, also taking part in controlling the spread of drug addiction and ensuring the treatment of addicts, are emphasized. The coordination of actions of various state structures will make it possible to enhance the effectiveness of programs of harm reduction. The expediency of the development of the general state program of primary prophylaxis, realized by trained specialists with the use of effective technology, is discussed.     

Profiles of brain functional asymmetry in patients with alcoholism and drug addiction

Profiles of motor, sensory, and cognitive asymmetries in patients with drug addiction and alcoholism and in people of relevant control group were studied. To reveal the profiles of interhemispheric asymmetry, a set of tests for determination of lateralization of motor (the dominant hand and leg), sensory (eye and ear) and cognitive (right- and left-hemispheric mode of solution of verbal and/or spatial tasks) was used. In patients with drug addiction and alcoholism as compared with the control group, a statistically significant domination of the left-sided lateralization of motor and sensory indexes was found. The right-hemispheric mode was essentially prevailing in solving the verbal and spatial tasks. No differences in motor asymmetry were observed in narcotic addicts and alcoholics. The dominant left eye and ear were statistically significantly more frequent in patients with alcoholism than in patients with drug addiction. The right-hemispheric mode in solution of cognitive tasks was used more often statistically significantly by narcotic addicts than by alcoholics. The obtained data indicate an essential impairment of profiles of the motor, sensory, and cognitive asymmetries in patients with the chemical addiction.Translated from Zhurnal Evolyutsionnoi Biokhimii i Fiziologii, Vol. 40, No. 5, 2004, pp. 450–454.Original Russian Text Copyright © 2004 by Egorov, Tikhomirov.To the 100-Anniversary of N. N. Traugott     

Giving addicts their drug of choice: the problem of consent

Researchers working on drug addiction may, for a variety of reasons, want to carry out research which involves giving addicts their drug of choice. In carrying out this research consent needs to be obtained from those addicts recruited to participate in it. Concerns have been raised about whether or not such addicts are able to give this consent. Despite their differences, however, both sides in this debate appear to be agreed that the way to resolve this issue is to determine whether or not addicts have irresistible cravings for drugs – if they do, then they cannot consent to this type of research; if they do not, then they can. This I will argue is a mistake. Determining whether or not addicts can say 'No' to offers of drugs will not help us to make much progress here. Instead we need to look at the various ways in which different types of research may undermine an addict's competence to give consent. What we will find is that the details of the research make a big difference here and that, as such, we need to steer a course between, on the one hand, painting all addicts as being unable to consent to research which involves providing them with drugs, and, on the other, maintaining that there are no problems in obtaining consent from addicts to take part in such research.     

ADDICTION AND AUTONOMY: CAN ADDICTED PEOPLE CONSENT TO THE PRESCRIPTION OF THEIR DRUG OF ADDICTION?

It is often claimed that the autonomy of heroin addicts is compromised when they are choosing between taking their drug of addiction and abstaining. This is the basis of claims that they are incompetent to give consent to be prescribed heroin. We reject these claims on a number of empirical and theoretical grounds. First we argue that addicts are likely to be sober, and thus capable of rational thought, when approaching researchers to participate in research. We reject behavioural evidence purported to establish that addicts lack autonomy. We present an argument that extrinsic forces must be irresistible in order to make a choice non-autonomous. We argue that heroin does not present such an irresistible force. We make a case that drug-oriented desires are strong regular appetitive desires, which do not compromise consent. Finally we argue that an addict's apparent desire to engage in a harmful act cannot be construed as evidence of irrational or compulsive thought. On these arguments, a sober heroin addict must be considered competent, autonomous and capable of giving consent. More generally, any argument against legalisation of drugs or supporting infringement of the liberty of those desiring to take drugs of addiction must be based on considerations of harm and paternalism, and not on false claims that addicts lack freedom of the will.     

Heroin addiction in African Americans: a hypothesis-driven association study

Heroin addiction is a chronic complex disease with a substantial genetic contribution. This study was designed to identify gene variants associated with heroin addiction in African Americans. The emphasis was on genes involved in reward modulation, behavioral control, cognitive function, signal transduction and stress response. We have performed a case–control association analysis by screening with 1350 variants of 130 genes. The sample consisted of 202 former severe heroin addicts in methadone treatment and 167 healthy controls with no history of drug abuse. Single nucleotide polymorphism (SNP), haplotype and multi-SNP genotype pattern analyses were performed. Seventeen SNPs showed point-wise significant association with heroin addiction (nominal P < 0.01). These SNPs are from genes encoding several receptors: adrenergic ( ADRA1A ), arginine vasopressin ( AVPR1A ), cholinergic ( CHRM2 ), dopamine (DRD1 ), GABA-A ( GABRB3 ), glutamate ( GRIN2A ) and serotonin ( HTR3A ) as well as alcohol dehydrogenase ( ADH7 ), glutamic acid decarboxylase ( GAD1 and GAD2 ), the nucleoside transporter ( SLC29A1 ) and diazepam-binding inhibitor ( DBI ). The most significant result of the analyses was obtained for the GRIN2A haplotype G-A-T (rs4587976-rs1071502-rs1366076) with protective effect ( P _uncorrected = 9.6E- 05, P _corrected = 0.058). This study corroborates several reported associations with alcohol and drug addiction as well as other related disorders and extends the list of variants that may affect the development of heroin addiction. Further studies will be necessary to replicate these associations and to elucidate the roles of these variants in drug addiction vulnerability.     

Failure of the gamma-aminobutyric acid (GABA) derivative, baclofen, to stimulate growth hormone secretion in heroin addicts.

In order to establish possible alterations in the gamma aminobutyric acid (GABA)ergic control of growth hormone (GH) secretion in heroin addicts, ten patients (age, 25.8 +/- 1.07 yr (mean +/- SE); duration of heroin addiction, range 3-8 yr; weight, 67.3 +/- 0.87 kg body weight), and ten age (29.1 +/- 0.84 yr)- and weight (69.7 +/- 0.87 kg)-matched normal controls were tested with the GABAergic B-receptor agonist baclofen (10 mg p.o. at 09.00 h) (experimental test) or a placebo (control test). Blood samples for GH assay were taken every 15 min for the next 150 min. Normal controls underwent one control and one experimental test. Heroin addicts were submitted to both baclofen and placebo test twice, once around the time of their admission to a recovery community for drug abusers, when they were still assuming heroin, and again after two months of permanence in the community. From the time of their admission to the community, the patients were forbidden to use heroin. For two weeks after admission they were treated with clonidine and acetylsalicilic acid to attenuate withdrawal symptoms. Thereafter, the patients underwent a period of wash-out of pharmacological treatments for at least 6 weeks before being retested. Basal GH levels were similar in normal controls and heroin addicts in all tests and remained unmodified during control tests in all subjects. The administration of baclofen increased four times the serum GH levels within 120 minutes in the normal controls, whereas it did not modify serum GH concentrations in heroin addicts either during the period of drug abuse or after two months of abstinence. These data show that the control of GH secretion mediated by GABAergic B-receptors is impaired in heroin addicts. It is hypothesized that this neuroendocrine alteration might represent a trait marker of heroin addiction, or more likely, that it was a consequence of a long addiction to heroin persisting after two months of abstinence.