Heroin dependence

Jerry Jbnes is to begin receiving methadone for the treatment of heroin dependency, tkrry asks why methadone, a narcotic, is effective in the treatment of narcotic dependency. How wouldyou explain this to the patient What information would be important to give this patient while he is in the methadone program ... 

Tan EC, Tan CH, Karupathivan U, et al Mu opioid receptor gene polymorphisms and heroin dependence in Asian populations. Neuroreport 14 569—572, 2003... 

Umbricht A, Hoover DR, Tucker MJ, et al Opioid detoxification with buprenorphine, clonidine, or methadone in hospitalized heroin-dependent patients with HIV infection. Drug Alcohol Depend 69 263-272, 2003 Villagomez RE, Meyer TJ, Lin MM, et al Post-traumatic stress disorder among inner city methadone maintenance patients. Subst Abuse Treat 12 253—257, 1995 Mining E, Kosten TR, Kleber H Clinical utility of rapid clonidine-naltrexone detoxification for opioid abusers. Br J Addict 83 567-575, 1988 Washton AM, Pottash AC, Gold MS Naltrexone in addicted business executives and physicians. J Clin Psychiatry 45 39 1, 1984 Wesson DR Revival of medical maintenance in the treatment of heroin dependence (editorial). JAMA 259 3314-3315, 1988... 

Fiellin DA, Pantalon MV, Pakes JP, et al Treatment of heroin dependence with bu-prenorphine in primary care. Am J Drug Alcohol Abuse 28 231-241, 2002 Fleming M, Manwell LB Brief intervention in primary care settings a primary treatment method for at-risk, problem, and dependent drinkers. Alcohol Res Health... 

O Connor PG, Fiellin DA. Pharmacologic treatment of heroin-dependent patients. Ann Intern Med 2000 133 40-54. 

Gallimberti, L., Spella, M. R., Soncini, C. A., and Gessa, G. L. (2000) Gamma-hydroxybu-tyric acid in the treatment of alcohol and heroin dependence. Alcohol 20,257-262. 

Ornoy, A., Michailevskaya, V., Lukashov, I., Bar-Hamburger, R. and Hard, S. (1996) The developmental outcome of children born into heroin-dependent mothers, raised at home or adopted. Child Abuse and Neglect 20, 5, 385-396. 

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... 

May lead to established heroin dependence, with buprenorphine often a suitable approach... 

ATOS). Addiction, 98, 1129-35 Darke S, Ross J, Williamson A, Mills KL, Harvard A Teesson M (2007). Borderline personality disorder and persistently elevated levels of risk in 36 month outcomes for the treatment of heroin dependence. Addiction, 102, 1140-6... 

Greenwald MK, Johanson CE, Moody DE, Woods JH, Kilbourne MR, Koeppe RA, Schuster CR Zubieta JK (2003). Effects of buprenorphine maintenance dose on m-opioid receptor availabihty, plasma concentrations, and antagonist blockade in heroin-dependent volunteers. Neuropsychopharmacology, 28, 2000-9... 

Kakko J, Svanborg KD, Kreek MJ Heilig M (2003). 1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden a randomized, placebo-controlled trial. Lancet, 361, 662-8... 

Teesson M, Ross J, Darke S, Lynskey M, Ali R, Ritter A Cooke R (2006). One year outcomes for heroin dependence findings from the Australian Treatment Outcome Study (ATOS). Drug and Alcohol Dependence, 83,174-80... 

Wille, R. (1983) Processes of recovery from heroin dependence relationship to treatment, social changes and drug use , Journal of Drug Issues, 13 333-42. 

For detoxification of a heroin-dependent addict, low doses of methadone (5-10 mg orally) are given two or three times daily for 2 or 3 days. Upon discontinuing methadone, the addict experiences a mild but endurable withdrawal syndrome. 

Yet another source of reports is to be found in some studies that are exploring ibogaine as a treatment for heroin dependency (see De Rienzo and Beal). This end-goal of searching for evidence of addiction confrontation and addiction control certainly can color any published reports in its own way. Here, its the chemical ibogaine only that is used, and typical dosages are at or above 1000 milligrams. 

Greenwald, M.K., Johanson, C.E., and Schuster, C.R., Opioid reinforcement in heroin-dependent volunteers during outpatient buprenorphine maintenance, Drug Alcohol Depend., 56, 191, 1999. 

Another synthetic heroin-like compound was sold to heroin-dependent individuals in California in 1982 as "new heroin", which was soon recognized to cause severe Parkinsonian symptoms in young people. Eventually it was discovered that "new heroin" contained pethidine together with an N-methyl-phenyl-tetrahydropyridine (MPTP) contaminant. It is now established that MPTP is converted to a neurotoxic... 

In a case-control study in 106 heroin-dependent individuals undergoing an opioid detoxification program (n = 19) or a methadone maintenance treatment program (n = 87) there were large significant differences in the mean values of some vitamins and minerals between the heroin-dependent individuals and the healthy, non-dependent controls (37). Dependent individuals had higher white cell counts and transaminases and lower erythrocyte counts and cholesterol, albumin, tocopherol, folic acid, sodium, selenium, and copper concentrations. 

Restless legs syndrome was a feature of opioid withdrawal on days 3-4 in two heroin-dependent individuals (55). They were treated with levodopa and clonidine. 

Ritter AJ. Naltrexone in the treatment of heroin dependence relationship with depression and risk of overdose. Aust NZ J Psychiatry 2002 36(2) 224-8. 

Morphine or heroin dependence is more disabling physically and socially than is opium dependence (treatment of pain in opioid dependent subjects, see p. 343). Chronic exposure to opioids leads to adaptive changes in the endogenous opioid system and no doubt in receptor numbers, sensitivity and cellular response. The abrupt withdrawal of administered opioid usually provokes rebound or a withdrawal syndrome. This consists largely of the opposite of the normal actions of opioids. Also, noradrenergic mechanisms are modulated by endogenous opioids and these mechanisms are depressed by continuous opioid administration. Abrupt withdrawal reboimd can be described as noradrenergic storm. ... 

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