Death, related heroin

Vilke GM, Buchanan J, Dunford JV, Chan TC. Are heroin overdose deaths related to patient release after prehospital treatment with naloxone Prehosp Emerg Care Jul-Sep 1999 3(3) 183-6. 

Potenza MN, Gold SJ, Roby-Shcmkowitz A, et al Effects of regulators of G protein-signaling proteins on the functional response of the mu-opioid receptor in a mel-anophore-based assay. J Pharmacol Exp Ther 291 482 91, 1999 Quaglio G, Talamini G, Lechi A, et al Study of 2708 heroin-related deaths in northeastern Italy 1985—98 to establish the main causes of death. Addiction 96 1127— 1137, 2001... 

More than 66 percent of PCP-related deaths reported to DAWN in 1983 involved at least one other drug. Table 5 shows a statistically significant relationship for alcohol combined with PCP and heroin combined with PCP (alcohol Xz=12.41, df=l, p <. 001 heroin X2 =29.13, df=l, p <. 001). 

The number of deaths associated with alcohol combined with PCP, and for heroin combined with PCP has been increasing. Nationally, the number of alcohol PCP-related deaths was 21, 50, and 59, respectively, for the three years 1981, 1982, and 1983, according to the DAWN annual reports. The number of heroin PCP-related deaths increased from 11 in 1981, to 24 in 1982, and 58 in 1983. 

The higher than expected frequencies of alcohol PCP - and heroin PCP-related deaths also would have occurred if the combinations were preferred by the users. The motivation may involve the injection of heroin to moderate the adverse effects of PCP, or the use of PCP to ease the pain of heroin withdrawal. Another explanation assumes a stimulant effect of PCP. The use of stimulants, especially cocaine, with heroin is increasingly popular among heroin users (Kozel et al. 1982). 

The number of alcohol PCP - and heroin PCP-related deaths was higher than expected. Users may prefer taking these drugs in combination, or there may be an interaction in the effect of the combinations. Many of the PCP-related deaths are the consequence of some external event rather than a direct consequence of the drug itself. 

The answer is c. (Hardman, pp 528-537.) Morphine is a pure agonist opioid drug with agonist activity toward all the opioid subtype receptor sites. In high doses, deaths associated with morphine are related to the depression of the respiratory center in the medulla. Morphine has a high addiction potential related to the activity of heroin or dihydromorphine. Codeine has a significantly lower addiction potential. 

Further situations in which methadone can seem an unsatisfactory substitution agent are towards the other end of the treatment spectrum. In uncomplicated maintenance treatment or for detoxification, the criticisms which are levelled at methadone relate not so much to the subjective effects, but to the aspects of addictiveness, abuse potential and toxicity. The issue of whether methadone is too addictive to be really suitable for detoxification is considered in detail in Chapter 3, and the controversial subject of methadone risks and deaths in Chapter 1. It is in the relatively milder cases of heroin dependence that buprenorphine treatment as an alternative to methadone has risen to great prominence in several countries, although, importantly, the condition definitely does not have to be mild for this medication to be used. Undoubtedly the introduction of buprenorphine is one of... 

For more than 25 years, TCAs were one of the leading causes of drug-related deaths, exceeded only by alcohol-drug combinations and heroin (427). The risk of fatality resulting from a TCA overdose has severely limited their use now that newer, safer antidepressants are available. Nevertheless, overdoses of these medications still occur. There is still no simple antidote for a TCA overdose. A TCA overdose produces a characteristic clinical picture consisting of the following ... 

Most of the methamphetamine-related deaths (92%) reported in 1994 involved methamphetamine in combination with at least one other drug, most often alcohol (30%), heroin (23%), or cocaine (21%). 

However, in this study only 22% saw more than 15 GPs and 40% averaged more than 30 medical services, suggesting that most did not meet the official doctor shopping criteria, even when they increased their use of medical services. The authors suggested that an increase in doctor shopping in the years before heroin-related death while certainly a fiscal issue, may represent an opportunity to intervene and reduce mortality. 

In a review of 239 cases of heroin-related drug deaths between 1997 and 2000, 18 deaths were associated with non-intravenous administration (49). The median morphine concentration in these non-injectors was 0.05 mg/g and this was significantly lower than in injectors (2.3 mg/ g). There was concurrent use of alcohol, other illicit drugs, and/or pharmaceutical formulations in 17 of the 18 cases. 

Many heroin users use heroin and alcohol together. There has been an evaluation of the pharmacokinetic interaction between heroin and alcohol and the role of that interaction in the cause of 39 heroin-related deaths that were attributed to either heroin or heroin + ethanol (69). The... 

Polettini A, Groppi A, Montagna M. The role of alcohol abuse in the etiology of heroin-related deaths. Evidence for pharmacokinetic interactions between heroin and alcohol. J Anal Toxicol 1999 23(7) 570-6. 

Garrick TM, Sheedy D, Abernethy J, Hodda AE, Harper CG. Heroin-related deaths in Sydney, Austraha. How common are they Am J Addict 2000 9(2) 172-8. 

Much of the research on drugs and crime has concerned heroin. Most crimes committed by heroin addicts are either violations of the drug laws or ways to get money to buy more heroin. Therefore, the addict s most commonly committed crimes are burglary, larceny, assault, and other street crimes. These crimes are indeed serious and sometimes result in injury or death to the victims. The direct intent of the crime is not to harm the victim, however, but to get money. This same motive probably applies to much of the violence related to cocaine, and to conflicts over money among cocaine dealers and their customers. 

Following few deaths in the early 1990s, Greece, Ireland and Portugal have since reported substantial increases. These may be related to rising heroin use, but also reflect improved recording practices. 

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