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Addiction (Abingdon, England) Mar 2022Several randomized controlled trials (RCTs) conclude that heroin-assisted-treatment (HAT) has a larger benefit-cost ratio than oral methadone because HAT more reliably... (Review)
Review
BACKGROUND AND AIMS
Several randomized controlled trials (RCTs) conclude that heroin-assisted-treatment (HAT) has a larger benefit-cost ratio than oral methadone because HAT more reliably and substantially reduces participants' criminal activity. This review: (1) summarizes results from RCTs concerning the comparative effectiveness of HAT for reducing criminal activity and (2) examines the role of different mechanisms for explaining changes in crime.
DESIGN
Systematic search of five databases for RCTs evaluating comparative effectiveness of HAT on participant crime outcomes and potential mediators of crime. Narrative synthesis with tabular comparisons of outcomes extracted across RCTs.
SETTING
Europe and Canada.
PARTICIPANTS
Twenty studies, spanning 10 RCTs with 2427 participants, met inclusion criteria.
INTERVENTIONS
HAT compared to other treatments for opioid use disorder, primarily oral methadone.
MEASUREMENTS
The primary outcome was criminal activity. Mediator outcomes included illicit heroin use, drug expenditures, employment and earnings and social functioning.
FINDINGS
All trials found significantly reduced criminal activity among HAT participants, and four found significantly larger reductions for HAT compared to control condition [median odds ratios (ORs) = 0.45]. Reductions in crime are concentrated in drug-related and property offenses (ORs range from 0.14 to 0.90 and from 0.12 to 1.89, respectively). Comparative efficacy of HAT for reducing illicit heroin use probably explains reductions in drug possession offenses, but does not show consistent correlation with drug dealing or property offenses. While three trials showed reductions in drug expenditures as possibly driving crime reductions, others did not report expenditures. There is little evidence that treatment effects on economic and social functioning outcomes explain within-trial changes in criminal activity.
CONCLUSIONS
Existing literature suggests that heroin-assisted treatment reduces criminal activity, but trials varied in whether these effects exceeded those from oral methadone treatment. Inconsistency in outcome measures across trials complicates understanding drivers of heterogeneity. More detailed information on legal and illegal income, drug expenditures and social interactions could improve our understanding of the causal mechanisms underlying the effect of heroin-assisted-treatment on crime.
Topics: Crime; Heroin; Heroin Dependence; Humans; Methadone; Narcotics; Randomized Controlled Trials as Topic
PubMed: 34105206
DOI: 10.1111/add.15601 -
The Journal of Emergency Medicine Jun 2017
Topics: Heroin; Heroin Dependence; Humans
PubMed: 28410961
DOI: 10.1016/j.jemermed.2017.03.015 -
Canadian Journal of Psychiatry. Revue... Jul 2017Six recent randomised control trials (RCTs) have suggested that supervised injectable heroin (SIH) can be effective in patients who persist in street heroin use during... (Review)
Review
BACKGROUND
Six recent randomised control trials (RCTs) have suggested that supervised injectable heroin (SIH) can be effective in patients who persist in street heroin use during methadone treatment. However, short-term randomised control trials have limitations in assessing the effectiveness of treatments for addictive disorders, which are chronic and relapsing disorders of motivation. These RCTs particularly fail to capture the process of the SIH treatment and the diversity of influence and change over time.
METHOD
This narrative review is based on the analysis of published data. Conclusions are drawn from a process of reflection informed by experience in delivering one of the published trials, subsequent experiences in varying the way SIH is delivered, and through consideration of possible mechanisms of action of SIH.
OBSERVATIONS
Many long-term, socially marginalised and demoralised people who are addicted to heroin experience few rewards from the stability afforded by methadone treatment. Supervised injected heroin is sufficiently reinforcing for many of these individuals to attend daily and participate in highly structured treatment. With an adequate daily dose of supervised methadone to avoid withdrawal dysphoria, occasional diamorphine injections-not necessarily twice daily, or even every day-is enough to hold people in treatment. Participation was associated with reduced amounts of non-prescribed drug use, a gradual change in self-image and attitude, and for some subjects, a movement towards social reintegration and eventual withdrawal from SIH.
CONCLUSIONS
Prescribed heroin is sufficiently motivating to hold a proportion of recidivist addicts in long-term treatment. Participation in structured treatment provides respite from compulsive drug use, and a proportion of subjects develop sufficient rewards from social reintegration to successfully withdraw from treatment. Such change, when it occurs, is slow and stuttering.
Topics: Heroin; Heroin Dependence; Humans; Methadone; Narcotics; Opiate Substitution Treatment
PubMed: 28683227
DOI: 10.1177/0706743716673966 -
Harm Reduction Journal Mar 2023As societal attitudes toward narcotics have changed, harm reduction strategies have emerged which make it safer to inject intravenous drugs. Diamorphine (heroin) is... (Review)
Review
As societal attitudes toward narcotics have changed, harm reduction strategies have emerged which make it safer to inject intravenous drugs. Diamorphine (heroin) is commonly sold as its free base-better known as brown-which has extremely poor aqueous solubility. As such, it needs to be chemically modified (cooked) to enable administration. Needle exchange programmes commonly supply citric or ascorbic acids which facilitate intravenous administration by increasing heroin solubility. If heroin users mistakenly add too much acid, the low solution pH can cause damage to their veins and, after repeated injury, could result in the loss of that injection site. Currently, advice cards supplied with these exchange kits suggest that the acid should be measured in pinches, which could result in considerable error. This work employs Henderson-Hasselbalch models to analyse the risk of venous damage by placing solution pH within the context of the buffer capacity of the blood. These models also highlight the significant risk of heroin supersaturation and precipitation within the vein, an event that has the potential to cause further harm to the user. This perspective closes with a modified administration method which could be included as part of a wider harm reduction package.
Topics: Humans; Heroin; Heroin Dependence; Harm Reduction; Substance Abuse, Intravenous; Narcotics
PubMed: 36998076
DOI: 10.1186/s12954-023-00758-1 -
Revue Medicale de Liege 2013Heroin (or diacetylmorphine), a depressant nervous central system, is a semi-synthetic opiate. Its main adverse effect, respiratory depression, can lead to death,...
Heroin (or diacetylmorphine), a depressant nervous central system, is a semi-synthetic opiate. Its main adverse effect, respiratory depression, can lead to death, especially after an intravenous injection. By loss of tolerance, an overdose can be lethal following heroin use after a period of abstinence (voluntary or not). Mortality rate among heroin users is between 1 and 3%. Addiction, following a regular and continuous use, occurs in less than a quarter of persons who ever tried heroine. Heroin addicts often present with different problems (for instance, a criminal behaviour), without any obvious link with addiction. For a fraction of the addicts, addiction becomes a chronic relapsing disease, requiring a long term maintenance substitution therapy. However, relapses and sometimes continuous heroin use are frequent, For treatment resistant and severe heroin addicts, heroin-assisted treatment can be a solution. Despite the numerous available therapies, heroin is considered to be the drug with the most negative effects on the user.
Topics: HIV Infections; Hepatitis C; Heroin; Heroin Dependence; Humans; Molecular Structure; Narcotics; Needle Sharing
PubMed: 23888578
DOI: No ID Found -
Praxis 2018Foil Smoking/Heroin Inhalation Foil smoking is generally heroin consumption by inhalation. By heating an aluminum foil with a fire lighter the heroin on top of the foil...
Foil Smoking/Heroin Inhalation Foil smoking is generally heroin consumption by inhalation. By heating an aluminum foil with a fire lighter the heroin on top of the foil starts melting and the smoke is then inhaled using a straw. Foil smoking is the second most common form of heroin consumption after the intravenous use. In contrast to the IV administration, heroin inhalation effects are delayed by a few minutes and the risk of transmission of HIV, Hepatitis or other infectious diseases is not relevant. Severe bronchospasms can occur in patients with or without prior pulmonary disease such as asthma bronchiale. One cerebral consequence of foil smoking is leukoencephalopathy, a spongiform degeneration of the white matter. This is likely triggered by the pyrolysate generated during the heating process. Multiple drug use and concomitant cigarette smoking in heroin addicts make cause-effect relationships difficult to assess. In general, the history of inhalative heroin consumption should be considered in patients presenting with any unkown pulmonary disease with severe bronchospasms as may happen in a severe asthma exacerbation.
Topics: Administration, Inhalation; Heroin; Humans; Narcotics; Smoking
PubMed: 31166873
DOI: 10.1024/1661-8157/a003128 -
Drug and Alcohol Dependence Oct 2021To review the scientific literature on the pharmacokinetics, pharmacodynamics and clinical efficacy and safety of (supervised) oral diacetylmorphine for patients with... (Review)
Review
OBJECTIVE
To review the scientific literature on the pharmacokinetics, pharmacodynamics and clinical efficacy and safety of (supervised) oral diacetylmorphine for patients with severe heroin dependence.
METHODS
The PubMed, Embase, Web of Science and PsycINFO databases were searched. Eleven published studies were identified and selected based on defined eligibility and exclusion criteria.
RESULTS
Four pharmacokinetic studies reported negligible plasma concentrations of diacetylmorphine and its active metabolite 6-monacetylmorphine. Among six pharmacodynamic studies, three trials showed that oral diacetylmorphine reduced opioid withdrawal symptoms, one open-label pilot study reported that two patients experienced a modest 'rush' after oral diacetylmorphine and two studies found that patients could not distinguish between oral diacetylmorphine, methadone, or morphine. Regarding the clinical studies, a Swiss prospective cohort study in patients with heroin dependence showed high retention rates of oral diacetylmorphine treatment with few serious adverse events, whereas in the Canadian SALOME trial, oral diacetylmorphine treatment was prematurely discontinued because treatment retention of oral diacetylmorphine was lower than injectable diacetylmorphine maintenance treatment. Finally, two case studies illustrate the limitations and potential problems of oral diacetylmorphine in the treatment of treatment-refractory heroin dependent patients.
CONCLUSIONS
Based on all published data, it is unlikely that oral diacetylmorphine produces a substantial 'rush'. Prescription of oral diacetylmorphine might therefore be effective only for treatment-refractory patients with heroin dependence (i) as maintenance treatment for those who never injected or inhaled opioids; (ii) as maintenance treatment for those who want to switch from injection to oral administration of diacetylmorphine; and/or (iii) to reduce opioid withdrawal symptoms.
Topics: Administration, Oral; Canada; Heroin; Heroin Dependence; Humans; Methadone; Narcotics; Pilot Projects; Prospective Studies
PubMed: 34482044
DOI: 10.1016/j.drugalcdep.2021.108984 -
Analytical Chemistry Jun 2019Electrochemical strategies to selectively detect heroin in street samples without the use of complicated electrode modifications were developed for the first time. For...
Electrochemical strategies to selectively detect heroin in street samples without the use of complicated electrode modifications were developed for the first time. For this purpose, heroin, mixing agents (adulterants, cutting agent, and impurities), and their binary mixtures were subjected to square wave voltammetry measurements at bare graphite electrodes at pH 7.0 and pH 12.0, in order to elucidate the unique electrochemical fingerprint of heroin and mixing agents as well as possible interferences or reciprocal influences. Adjusting the pH from pH 7.0 to pH 12.0 allowed a more accurate detection of heroin in the presence of most common mixing agents. Furthermore, the benefit of introducing a preconditioning step prior to running square wave voltammetry on the electrochemical fingerprint enrichment was explored. Mixtures of heroin with other drugs (cocaine, 3,4-methylenedioxymethamphetamine, and morphine) were also tested to explore the possibility of their discrimination and simultaneous detection. The feasibility of the proposed electrochemical strategies was tested on realistic heroin street samples from forensic cases, showing promising results for fast, on-site detection tools of drugs of abuse.
Topics: Electrochemistry; Electrodes; Graphite; Heroin; Hydrogen-Ion Concentration
PubMed: 31117413
DOI: 10.1021/acs.analchem.9b01796 -
British Medical Journal Dec 1964
Topics: England; Heroin; Heroin Dependence; Substance-Related Disorders; Toxicology
PubMed: 14213093
DOI: 10.1136/bmj.2.5425.1662-a -
British Medical Journal Apr 1964
Topics: Heroin; Substance-Related Disorders; Toxicology; United Kingdom
PubMed: 14113834
DOI: 10.1136/bmj.1.5390.1116-c