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Drug fatalities and treatment fatalism: Complicating the ageing cohort theory.

Fay Dennis

Sociol Health Illn 2021 May 6. Epub 2021 May 6.

Goldsmiths, University of London, London, UK.

Deaths related to drug 'misuse' remain at an all-time high in the United Kingdom (UK). Older heroin consumers are particularly at risk, with the highest rates of deaths among people aged 40-49 and the steepest rises in the over-fifty age bracket. Accordingly, a popular theory for the UK's increase in drug-related deaths, made by the government, and propelled in the media, is that there is an ageing cohort of heroin users with age-related health complications predisposing them to an overdose. Read More

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Poisonings by substances of abuse at the Oslo Accident and Emergency Outpatient Clinic 2014-18.

Tidsskr Nor Laegeforen 2021 Apr 29. Epub 2021 Apr 29.

Background: Poisonings by substances of abuse are potentially dangerous and indicate risky substance use behaviour. To be prepared to handle patients with poisonings by substances of abuse, we need updated knowledge about the kinds of substances we can be expected to encounter. Most substance use-related poisonings in Oslo are treated at the OAEOC, and we describe the poisonings observed there in the period 2014-2018. Read More

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Correlates of Self-Reported HIV Testing Among Patients in Specialized Substance Abuse Treatment Centers in South Africa.

AIDS Behav 2021 May 5. Epub 2021 May 5.

Alcohol Tobacco and Other Drug Research Unit, Medical Research Council, Cape Town, South Africa.

Substance use is a recognized risk factor for HIV acquisition, transmission and progression in South Africa. Persons who use drugs (PWUD) and access specialist substance abuse treatment centers (SSATCs) are a potentially critical target group for HIV services because of the severity of their substance use and associated health risks. SSATCs represent an opportunity for integrated programming, particularly HIV testing services (HTS), to reach PWUD who are at an increased risk of or living with HIV. Read More

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Severe rhabdomyolysis induced by co-administration of cocaine and heroin in a 45 years old man treated with rosuvastatin: a case report.

Acta Biomed 2021 Apr 30;92(S1):e2021089. Epub 2021 Apr 30.

Academy of Emergency Medicine and Care (AcEMC), Pavia, Italy.

The term rhabdomyolysis describes a damage involving striated muscle cells or fibers, often complicated by acute kidney injury. This syndrome can have different causes, but it is generally divided into two main categories: traumatic and non-traumatic rhabdomyolysis. Among medical causes, drugs and abuse substances play a pivotal role, being opioids, alcohol, cocaine and other substances of abuse. Read More

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Subjective symptoms and serum methadone concentrations: what should guide dose adjustments in methadone maintenance treatment? A naturalistic cohort study from Norway.

Subst Abuse Treat Prev Policy 2021 May 3;16(1):39. Epub 2021 May 3.

Institute of Clinical Medicine, UiT - Norway's Arctic University, Tromsø, Norway.

Background: There is little evidence-based guidance on how to optimize methadone dosages among patients with opioid addiction undergoing methadone maintenance treatment (MMT). This study aims to investigate whether self-perceived opioid withdrawal symptoms, adverse effects, and self-reported substance use in patients on MMT are related to serum methadone concentrations and the role that these variables could play in clinical decisions on dose adjustments.

Methods: This naturalistic prospective cohort study included clinical and laboratory measurements from 83 patients undergoing MMT in outpatient clinics in Bergen, Norway, from May 2017 to January 2020. Read More

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Trends and correlates of cocaine use among adults in the United States, 2006-2019.

Addict Behav 2021 Apr 20;120:106950. Epub 2021 Apr 20.

National Institutes of Health, National Institute on Drug Abuse, Bethesda, MD, USA. Electronic address:

Background: Cocaine is the most commonly reported illicit stimulant used in the U.S., yet limited research has examined recent changes in cocaine use patterns and co-occurring substance use and mental health characteristics among adults using cocaine. Read More

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Differences in cue-induced brain activation between long-term methadone maintenance treatment and protracted abstinence in heroin use disorder patients: a functional magnetic resonance imaging study.

Quant Imaging Med Surg 2021 May;11(5):2104-2113

Department of Radiology, Tangdu Hospital, Air Force Medical University, Xi'an, China.

Background: Heroin use disorder (HUD) remains one of the gravest public health issues in China. Methadone maintenance treatment (MMT) and protracted abstinence (PA) are the most commonly used treatments for HUD. Although both treatment approaches can alleviate heroin cravings, a previous study found that MMT patients had stronger cue-induced brain activation than patients undergoing PA; however, the changes associated with long-term treatment are unclear. Read More

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The effects of strain and estrous cycle on heroin- and sugar-maintained responding in female rats.

Behav Brain Res 2021 Apr 29;409:113329. Epub 2021 Apr 29.

Department of Psychology, Davidson College, Davidson, NC 28035, USA. Electronic address:

Heroin intake decreases during the proestrus phase of the estrous cycle in female, Long-Evans rats. The purpose of this study was to (1) determine if proestrus-associated decreases in heroin intake extend across rat strains and (2) determine if proestrus-associated decreases in responding extend to a nondrug reinforcer. Female rats were implanted with intravenous catheters and trained to self-administer heroin. Read More

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Community overdose surveillance: Comparing substances collected from the death scene investigation to toxicology results.

Drug Alcohol Depend 2021 Apr 24;224:108722. Epub 2021 Apr 24.

Department of Chemistry and Biochemistry, College of Science, University of Notre Dame, South Bend, IN, 46556, United States. Electronic address:

Background: Recent overdose trends are characterized by increased toxicological detection of stimulants with opioids, yet it is unclear whether these substances are mixed prior to consumption or purposefully used simultaneously.

Methods: Postmortem toxicology data were collected in Marion County, Indiana, from 45 fatal overdose cases involving heroin, fentanyl, methamphetamine, or cocaine. Substances found by death scene investigators at the scene of the fatal overdose (57 samples) were tested using high-pressure liquid chromatography mass-spectrometry (LC-MS) technology. Read More

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Role of nucleus accumbens microRNA-181a and MeCP2 in incubation of heroin craving in male rats.

Psychopharmacology (Berl) 2021 May 1. Epub 2021 May 1.

Laboratory of Behavioral Neuroscience, Ningbo Kangning Hospital, Ningbo Institute of Microcirculation and Henbane, School of Medicine, Ningbo University, Ningbo, 315010, Zhejiang, People's Republic of China.

Rationale: Epigenetic regulation has been implicated in the incubation of drug craving (the time-dependent increase in drug seeking after prolonged withdrawal from drug self-administration). There is little information available on the role of microRNAs in incubation of heroin craving.

Objective: This study aimed to investigate the roles and mechanisms of miR-181a and methyl CpG binding protein 2 (MeCP2) in the nucleus accumbens (NAc) in incubation of heroin seeking. Read More

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Ultra-High Performance Liquid Chromatography-High Resolution Mass Spectrometry and High-Sensitivity Gas Chromatography-Mass Spectrometry Screening of Classic Drugs and New Psychoactive Substances and Metabolites in Urine of Consumers.

Int J Mol Sci 2021 Apr 13;22(8). Epub 2021 Apr 13.

National Centre on Addiction and Doping, Istituto Superiore di Sanità, V.Le Regina Elena 299, 00161 Rome, Italy.

The use of the new psychoactive substances is continuously growing and the implementation of accurate and sensible analysis in biological matrices of users is relevant and fundamental for clinical and forensic purposes. Two different analytical technologies, high-sensitivity gas chromatography-mass spectrometry (GC-MS) and ultra-high-performance liquid chromatography-high-resolution mass spectrometry (UHPLC-HRMS) were used for a screening analysis of classic drugs and new psychoactive substances and their metabolites in urine of formed heroin addicts under methadone maintenance therapy. Sample preparation involved a liquid-liquid extraction. Read More

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Risk Assessment for Heroin Use and Craving Score Using Polygenic Risk Score.

J Pers Med 2021 Apr 1;11(4). Epub 2021 Apr 1.

Graduate Institute of Biomedical Sciences, China Medical University, Taichung 406040, Taiwan.

Addiction is characterized by drug-craving, compulsive drug-taking, and relapse, and results from the interaction between multiple genetic and environmental factors. Reward pathways play an important role in mediating drug-seeking and drug-taking behaviors, and relapse. The objective of this study was to identify heroin addicts who carry specific genetic variants in their dopaminergic reward systems. Read More

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Body Packer Syndrome.

J Emerg Trauma Shock 2021 Jan-Mar;14(1):51-52. Epub 2021 Mar 23.

Department of Emergency Medicine, Max Superspeciality Hospital, New Delhi, India.

"Body packers" are persons who voluntarily or through coercion, swallow or insert drug-filled packets into body cavity, generally in an attempt to smuggle them across secure borders. The drugs most often involved in body packing are heroin and cocaine. Body packers can present in the emergency department as a result of ruptured drug packets, bowel obstruction, or for medicolegal purposes. Read More

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New-onset Seizures Due to Heroin Addiction.

Ann Indian Acad Neurol 2021 Jan-Feb;24(1):103-105. Epub 2020 Jun 24.

Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.

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Comparative one-year outcomes of invasive Staphylococcus aureus infections among persons with and without drug use: an observational cohort study.

Clin Infect Dis 2021 Apr 27. Epub 2021 Apr 27.

University of California San Francisco, San Francisco, CA, USA.

Background: Persons who use drugs (PWUD) face substantial risk of Staphylococcus aureus infections. Limited data exist describing clinical and substance use characteristics of PWUD with invasive S. aureus infections or comparing treatment and mortality outcomes in PWUD vs. Read More

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Stability and bifurcation analysis of a heroin model with diffusion, delay and nonlinear incidence rate.

Model Earth Syst Environ 2021 Apr 20:1-12. Epub 2021 Apr 20.

Department of Mathematics, National Institute of Technology Durgapur, Durgapur, 713209 India.

As we all know, the use of heroin and other drugs in Europe and more specifically in Ireland and the resulting prevalence are well documented. A huge population is still dying using heroin every day. This may happen due to, several reasons like, excessive use of painkiller, lack of awareness etc. Read More

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Hypogonadism in opioid using males in an inner-city cohort: A cross-sectional study.

J Opioid Manag 2021 Mar-Apr;17(2):135-144

Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland.

Objectives: The link between male hypogonadism and opioids is well-established, but whether there is a difference in the frequency of hypogonadism between heroin and methadone for treatment of opioid use disorder (OUD) has not been -determined.

Design: Cross-sectional. Setting, patients, and participants: Male drug users and nonusers matched for socioeconomic status between 18 and 65 years, recruited in Baltimore as part of the study of HIV, injection drug use, nutrition, and endocrinology (SHINE). Read More

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A Case Report of Wound Botulism - Rare Disease on the Rise with the Opioid Crisis.

Hawaii J Health Soc Welf 2021 Feb;80(4):88-91

Department of Psychiatry, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (WH).

Wound botulism is a rare, underrecognized life-threatening illness caused by a toxin produced by Clostridium botulinum, a spore-forming anaerobic bacterium. Approximately 20 cases are reported in the United States each year, mostly from California. Most wound botulism cases occur in drug injectors, particularly among those using black tar heroin. Read More

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February 2021

Association between GABA receptor delta subunit gene polymorphisms and heroin addiction.

Neurosci Lett 2021 Apr 19;755:135905. Epub 2021 Apr 19.

Key Laboratory of Addiction Research of Zhejiang Province, Ningbo Kangning Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang, China. Electronic address:

Evidence suggests that γ-aminobutyric acid (GABA) receptors are involved in the development of drug dependence. Considering its exclusively extrasynaptic localization, GABA receptor delta subunit (GABRD) is likely involved in heroin addiction. The purpose of this study was to explore the association between the single nucleotide polymorphisms (SNPs) of GABRD and heroin addiction. Read More

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Hyperpolarisation of Mirfentanil by SABRE in the presence of heroin.

Chemphyschem 2021 Apr 19. Epub 2021 Apr 19.

Manchester Metropolitan University, Natural Sciences, John Dalton Building, Chester Street, M1 5GD, Manchester, UNITED KINGDOM.

Mirfentanil, a fentanyl derivative that is a 𝜇-opioid partial agonist, is hyperpolarised via Signal Amplification By Reversible Exchange (SABRE), a para -hydrogen-based technique. [Ir(IMes)(COD)Cl] (IMes = 1,3- bis (2,4,6-trimethylphenyl)imidazole-2-ylidene, COD = cyclooctadiene) was employed as the polarisation transfer catalyst. Following polarisation transfer at 6. Read More

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Kratom Ingestion and Emergency Care: Summary and a Case Report.

Alex Hall Dora Hall

J Emerg Nurs 2021 Apr 13. Epub 2021 Apr 13.

Kratom ingestion for its psychotropic effect or to self-treat opioid withdrawal symptoms has increased over the last 10 years in the United States. Although mild adverse effects have been observed in users, reports of respiratory failure and shock after kratom consumption remain rare. In this case, a 35-year-old man initially presented to the emergency department with profound circulatory shock, metabolic acidosis, hypoxia, and symptoms of autonomic nervous system dysfunction. Read More

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Effect of Coronavirus Disease 2019 on the Psychology and Behavior of Patients on Methadone Maintenance Treatment in Wuhan, China: A Clinical Observational Study.

Front Psychiatry 2021 30;12:653662. Epub 2021 Mar 30.

Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.

Methadone maintenance treatment (MMT) is a national strategy adopted for the treatment of heroin dependency in China. The sudden outbreak of coronavirus disease 2019 (COVID-19) and the resultant social isolation in Wuhan have also had a significant negative impact on local patients undertaking MMT. In this study, 76 patients on MMT from the Wuhan First Health Clinic were selected as the research objects to investigate the effect of COVID-19 on the levels of stress, anxiety, and depression, as well as the withdrawal symptoms and craving and substance use. Read More

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Difference in HIV testing behavior by injection status, among users of illicit drugs.

AIDS Care 2021 Apr 15:1-8. Epub 2021 Apr 15.

Division of Social Solutions and Services Research, The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA.

Human Immunodeficiency Virus (HIV) infection remains prevalent among the marginalized and drug using population in the United States. Testing for HIV is an important and cost-effective way to reduce HIV prevalence. Our objective was to determine if there is a difference in the number of HIV testing by injection status among users of illicit drugs and if a person's social network characteristics is a contributing factor. Read More

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Effects of Implementation and Enforcement Differences in Prescription Drug Monitoring Programs in 3 States: Connecticut, Kentucky, and Wisconsin.

Subst Abuse 2021 25;15:1178221821992349. Epub 2021 Mar 25.

Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA.

Background And Aims: Prescription Drug Monitoring Programs (PDMPs) were designed to curb opioid misuse and diversion by tracking scheduled medications prescribed by medical providers and dispensed by pharmacies. The effects of PDMPs on opioid prescription, misuse and overdose rates have been mixed due in part to variability in states' PDMPs and difficulties measuring this complexity, and a lack of attention to implementation and enforcement of PDMP components. The current study uses qualitative interviews with key informants from 3 states with different PDMPs, Connecticut, Kentucky and Wisconsin to explore differences in the characteristics of the PDMPs in each state; how they are implemented, monitored and enforced; and unintended negative consequences of these programs. Read More

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Longitudinal Opioid Surveillance Project Involving Toxicologic Analysis of Postmortem Specimens from 9 Counties in Michigan Suggests the Discovery of New High-Intensity Drug Trafficking Areas.

Am J Forensic Med Pathol 2021 Apr 13. Epub 2021 Apr 13.

From the Toxicology Department, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI.

Abstract: Acetyl fentanyl (AF) is a Schedule I fentanyl analog that has been increasingly seen in heroin and fentanyl polydrug toxicity overdoses in Michigan (MI). Drug users are often unaware of the presence of AF in their drugs because it is often sold mixed into or disguised as heroin. High levels of AF in heroin drug products can cause increased incidence of overdose. Read More

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Effectiveness of opiate substitution treatment in reducing HIV risk behaviors among African Caribbean and Black people: a systematic review.

JBI Evid Synth 2021 Apr 12. Epub 2021 Apr 12.

Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, ON, Canada Human Biology Program, University of Toronto, ON, Toronto Substance Abuse Service/Addictions Medicine, Women's College Hospital, Toronto, ON, Canada Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada Yale School of Nursing.

Objective: The objective of this systematic review is to identify, appraise, and synthesize the best available evidence on the effectiveness of opioid substitution treatment in reducing HIV risk behavior among African, Caribbean, and Black people.

Introduction: Substance use plays an important role in HIV transmission among Black people by increasing risky sexual behavior and the risk of HIV acquisition. Opioid substitution treatment, such as methadone maintenance treatment and buprenorphine therapy, has been found to be an effective measure to minimize HIV transmission attributable to opioid addiction. Read More

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Correlation study between anatomopathological data and levels of blood morphine concentrations in heroin-related deaths.

Leg Med (Tokyo) 2021 Apr 7;51:101877. Epub 2021 Apr 7.

Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy.

Heroin-related mortality is a complex phenomenon involving several factors that make an individual more susceptible to opioid toxicity. Among these, pre-existing pathological conditions play an important role. The current paper reviewed 51 autopsied cases performed over the last 30 years, each subject ("frequent heroin user") having taken heroin intravenously alone before death. Read More

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Prevalence and correlates of multiple non-fatal opioid overdoses among people who inject drugs who utilise needle syringe programs in Australia.

Int J Drug Policy 2021 Apr 8:103245. Epub 2021 Apr 8.

The Kirby Institute, UNSW Sydney, Sydney, Australia; The Burnet Institute, Melbourne, Australia. Electronic address:

Background: Non-fatal overdose (NFOD) is a major cause of morbidity among people who inject drugs (PWID) and multiple NFOD is associated with increased risk of fatal overdose. Despite this, few studies have examined the prevalence and correlates of drug-specific multiple NFOD. The current study aimed to determine the prevalence and correlates of recent multiple non-fatal opioid overdose (NFOOD) among PWID who access needle syringe programs (NSPs) in Australia. Read More

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Multiple Morbidities in an Inner-City English Substance Misuse Treatment Service: Hierarchical Cluster Analysis to Derive Treatment Segments.

J Dual Diagn 2021 Apr 8:1-8. Epub 2021 Apr 8.

Statistical Services Centre, Reading, UK.

Objectives: Comorbid needs of people attending substance use treatment has been well documented although there is an assumption of heterogeneity in the treated population. This study utilized hierarchical cluster analysis to explore the extent and nature of client segments within the treated population. A retrospective review of comorbid health and social needs of a random sample of client case-notes ( = 300) was undertaken on all people known to treatment in an urban, inner-London community out-patient treatment service during 2018-2019. Read More

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