Hostname: page-component-848d4c4894-ttngx Total loading time: 0 Render date: 2024-05-15T12:08:05.528Z Has data issue: false hasContentIssue false
  • English
  • Français

New aspects in the treatment of heroin dependence with special reference to neurobiological aspects

Published online by Cambridge University Press:  16 April 2020

Dieter Ladewig ,
Kenneth M. Dürsteler-MacFarland ,
Erich Seifritz ,
Christoph Hock  and
Rudolf Stohler
Dieter Ladewig*
Affiliation:
Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse 27, CH-4025, Basel, Switzerland
Kenneth M. Dürsteler-MacFarland
Affiliation:
Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse 27, CH-4025, Basel, Switzerland Department of Psychiatry, University of Zürich, Militärstr. 8. CH-8021, Zürich, Switzerland
Erich Seifritz
Affiliation:
Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse 27, CH-4025, Basel, Switzerland
Christoph Hock
Affiliation:
Department of Psychiatric Research, University of Zürich, Lenggstrasse 31, CH-8029, Zürich, Switzerland
Rudolf Stohler
Affiliation:
Department of Psychiatry, University of Zürich, Militärstr. 8. CH-8021, Zürich, Switzerland
*
*Corresponding author. Tel.: +41-61-325-5132; fax: +41-61-325-5583 E-mail address: dieter.ladewig@pukbasel.ch (D. Ladewig).
Get access

Summary

The Swiss trials on medical prescription of injectable diacetylmorphine (pharmaceutical heroin) for “severe” heroin dependence provoked very controversial commentaries. Despite methodological shortcomings, the evaluation of the Swiss heroin trials yielded some interesting findings. Study participants showed substantial improvements in health and well-being and noticeable declines in illicit drug use and criminal activities. Heroin prescription may thus be helpful for some of those who continue to regularly use illicit heroin while maintained on methadone or who refuse other available treatment options. However, research-based evidence suggests that the intravenous (IV) application of heroin under medical supervision may have untoward side effects. Recent studies have shown that heroin injections produce transient, but significant decreases in systemic and cortical oxygenation most likely secondary to respiratory depression. Among others, these effects are the subject of ongoing studies.

Keywords

HeroinIV maintenance treatmentNeurobiologyDeoxygenationNear-infrared spectroscopy
Type
Article original
Information
European Psychiatry , Volume 17 , Issue 3 , May 2002 , pp. 163 - 166
Copyright
Copyright © Éditions scientifiques et médicales Elsevier SAS. 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

This article was presented at 5th AEP symposium, November 13–14, 1999, Strasbourg, France.

References

Uchtenhagen, AGutzwiller, FDobler-Mikola, A editors. Programme for a Medical Prescription of Narcotics: Final Report of Research Representatives, Addiction Research Institute and Institute for Social and Preventive Medicine. Zurich: University of Zurich; 1997.Google Scholar
Kilias, MRabasa, JDoes heroin prescription reduce crime? Results from the evaluation of the Swiss heroin prescription projects. Stud. Crime Prevent. 1998;7:127–33.Google Scholar
Alldredge, BKLowenstein, DHSimon, RPSeizures associated with recreational drug abuse. Neurology 1989;39:1037–9.Google ScholarPubMed
Reisine, TPasternak, GOpioid analgesics and antagonists. In: Hardman, JGGilman, AGLimbird, LE editors. Goodman and Gilman’s the Pharmacological Basis of Therapeutics. ninth ed. New York: McGraw-Hill Inc.; 1996. p. 521–55.Google Scholar
Hug, IEpileptiforme Störungen bei opiatabhängigen Patienten unter intravenöser Substitutionstherapie mit Heroin. Morphin und Methadon, Medical thesis, University of Basel, Basel 1997: 117.Google Scholar
Sagratella, SScotti-de-Carolis, AIn vivo and in vitro epilepto-genic effects of the enkephalinergic system. Ann. Ist Super Sanità. 1993;29:413–8.Google ScholarPubMed
Hock, CStörmer, RDürsteler, KMüller-Spahn, FLadewig, DStohler, RHeroin-induced deoxygenation of cerebral hemoglobin: monitoring by means of near-infrared spectros-copy. Ann. Neurol. 1999;45:134–5.Google Scholar
Stohler, RDürsteler, KMStörmer, RSeifritz, EHug, ISattler-Mayr, JMüller-Spahn, FLadewig, DHock, CRapid cortical hemoglobin deoxygenation after heroin and methadone injection in humans: a preliminary report. Drug Alcohol Depend. 1999;15:23–8.CrossRefGoogle Scholar
Dürsteler-Mac Farland, KMStörmer, RSeifritz, EHug, IMüller-Spahn, FLadewig, DStohler, ROpioid-associated effects on oxygen saturation in humans. Addiction 2000;95: 285–7.Google Scholar
Brust, JCRichter, RWStroke associated with addiction to heroin. J. Neurol. Neurosurg. Psychiatry 1976;39:194–9.CrossRefGoogle ScholarPubMed
Jensen, ROlsen, TSWinter, BBSevere non-occlusive ischemic stroke in young heroin addicts. Acta Neurol. Scand. 1990;81: 354–7.CrossRefGoogle ScholarPubMed
Kelly, MAGorelick, PBMirza, DThe role of drugs in the etiology of stroke. Clin. Neuropharmacol. 1992;15:249–75.CrossRefGoogle ScholarPubMed
King, JRichards, MTress, BCerebral arteritis associated with heroin abuse. Med. J. Aust. 1978;2:444–5.CrossRefGoogle ScholarPubMed
Pascual-Calvet, JPou, APedro-Botet, JGutierrez-Cebollada, JNon-infective neurologic complications associated to heroin use. Arch. Neurobiol. 1989;52(Suppl. 1):155–61.Google ScholarPubMed
Sloan, MAKittner, SJRigamonti, DPrice, TROccurrence of stroke associated with use/abuse of drugs. Neurology 1991; 41(9):1358–64.CrossRefGoogle ScholarPubMed
Andersen, SNSkullerud, KHypoxic/ischaemic brain damage, especially pallidal lesions, in heroin addicts. Forensic Sci. Int. 1999;102:51–9.Google ScholarPubMed
Oehmichen, MMeissner, CReiter, ABirkholz, MNeuropa-thology in non-human immunodeficiency virus-infected drug addicts: hypoxic brain damage after chronic intravenous drug abuse. Acta Neuropathol. 1996;91(6):642–6.CrossRefGoogle ScholarPubMed
Pearson, JBaden, MBRichter, RWNeuronal depletion in the globus pallidus of heroin addicts. Drug Alcohol Depend. 1976; 1:349–56.Google ScholarPubMed
Pezawas, LMFischer, GDiamant, KSchneider, CSchin-dler, SDThurnher, MPloechl, WEder, HKasper, SCerebral CT findings in male opioid-dependent patients: stereological, planimetric and linear measurements. Psychiatry Res. 1998;83: 139–47.Google ScholarPubMed
Haselhorst, RDürsteler, KMScheffler, KBilecen, DSeelig, JLadewig, DStohler, RSeifritz, EEffect of chronic opioid abuse on the NAA concentration in the human frontal lobe as detected by 1H MRS. Proc. Int. Soc. Magn. Reson. Med. 1999;2:1407.Google Scholar
Submit a response

Comments

No Comments have been published for this article.