A study of pathways to care among opioid dependent individuals seeking treatment at a community de-addiction clinic in India.

Drug use, including opioid use disorder, is one of the rapidly rising and serious problems affecting populations globally. There is a treatment gap and delay in presentation of drug users to treatment centers. The present study aimed at assessing the pathways to care among opioid-dependent individuals seeking treatment from a community-based treatment center in India. In a cross-sectional observational study conducted at a community clinic of the National Drug Dependence Treatment Centre (NDDTC), New Delhi, India, a total of 100 treatment-seeking drug users (age 18-60 years) fulfilling DSM IV TR criteria for opioid dependence were recruited. The data were collected using a semistructured pro forma based on patient self-report and the encounter form used in the World Health Organization (WHO) Pathway Study. All participants were male, were mostly married, were employed, and belonged to nuclear families. Ninety-eight percent of participants has ever used heroin in a dependent fashion and 20% were using it currently. Mean age of the participants was 40.83 years (SD 12.7). Median age of onset of heroin use was 22 years (IQR 12). Median duration of heroin use was 138 months (IQR 132). Only 21% of participants visited the community deaddiction clinic at the first contact with care. The median time for first treatment-seeking attempt was 9.5 years (IQR 7). The study findings suggest significant delay between onset of drug-related problems and first treatment contact. There is a need to increase the availability and accessibility of treatment services to reduce the delay in treatment seeking.

2Hz-electroacupuncture attenuates heroin-seeking behaviors via adjusts CB1-Rs and CB2-Rs expression in relapse-relevant brain regions of heroin self-administration rats.

Opiate addiction has a high rate of relapse. The accumulating evidence shows that electroacupuncture (EA) may be effective for the treatment of opiate relapse. However, the change of expression of CB1-Rs and CB2-Rs involve in 2Hz EA anti-relapse pathway is still unclear. To explore the changes of expression of CB1-Rs and CB2-Rs, heroin self-administration (SA) model rats were adopted and treated using 2Hz EA. The expressions of CB1-Rs and CB2-Rs were observed using immunohistochemistry method. The results showed that, compared with the control group, active pokes in the heroin-addicted group increased, while the active pokes decreased significantly in 2Hz EA group compared with heroin-addicted group. Correspondingly, the expression of CB1-Rs in prefrontal cortex (PFC), hippocampus (Hip), nucleus accumbens (NAc) and ventral tegmental area (VTA) all increased significantly while the expression of CB2-Rs in those relapse-relevant brain regions decreased obviously in heroin-addicted group when compared with the control group. In addition, the expression of CB1-Rs obviously decreased in the 2Hz EA group while the expression of CB2-Rs in those relapse-relevant brain regions increased significantly when compared with the heroin-addicted group. It indicated that 2Hz EA could attenuate the heroin-evoked seeking behaviors effectively. The anti-relapse effects of 2Hz EA might be related to the decrease of CB1-Rs and increase of CB2-Rs expression in relapse-relevant brain regions of heroin SA rats.

Abstinence Following a Motivation-Skill-Desensitization-Mental Energy Intervention for Heroin Dependence: A Three-year Follow-up Result of a Randomized Controlled Trial.

The high rate of relapse among heroin users remains a significant public concern in China. In the present study, we utilized a Motivation-Skill-Desensitization-Mental Energy (MSDE) intervention and evaluated its effects on abstinence and mental health. Eighty-nine male heroin users in a drug rehabilitation center were enrolled in the study. The participants in the MSDE intervention group (n=46) received MSDE intervention, which included motivational interviewing, coping skills training, eye movement desensitization and reprocessing, and mindfulness-based psychotherapy. The participants in the control group (n=43) received a series of lectures on skills training. A significant increase in Contemplation Ladder score (P<0.001) and decreases in scores on the Obsessive Compulsive Drug Use Scale (P<0.001), Beck Depression Inventory (P<0.001), and Aggression Questionnaire (P=0.033) were found immediately after intervention. Compared to the control group, the MSDE intervention group reported significantly higher abstinence rates (P=0.027) and retention rates (P<0.001) at follow-up. Overall, the MSDE intervention, which uses a combined strategy for relapse prevention, could be a promising approach for preventing relapse among heroin users in China.

Medical marijuana laws are associated with increases in substance use treatment admissions by pregnant women.

BACKGROUND AND AIMS: Between 2002 and 2014, past-month marijuana use among pregnant women in the United States increased 62%, nearly twice the growth of the general population. This growth coincides with the proliferation of state medical marijuana laws (MMLs) authorizing physicians to recommend marijuana for approved conditions. We estimated the association between MMLs and substance use treatment utilization among pregnant and non-pregnant women of reproductive age. We also examined whether the association varied across MML provisions, age groups and treatment referral sources to clarify potential pathways. DESIGN: Nation-wide administrative data from the 2002-14 Treatment Episodes Data Set Admissions, and a difference-in-differences design that exploited the staggered implementation of MMLs to compare changes in outcomes before and after implementation between MML and non-MML states. SETTING: Twenty-one MML and 27 non-MML US states. PARTICIPANTS: Pregnant and non-pregnant women aged 12-49 admitted to publicly funded specialty substance use treatment facilities. MEASUREMENTS: The primary outcome variable was the number of treatment admissions per 100 000 women aged 12-49, aggregated at the state-year level (n = 606). Admissions for marijuana, alcohol, cocaine and opioids were considered. The primary independent variable was an indicator of MML implementation in a state. FINDINGS: Among pregnant women, the rate of marijuana treatment admissions increased by 4.69 [95% confidence interval (CI) = 1.32, 8.06] in MML states relative to non-MML states. This growth was accompanied by increases in treatment admissions involving alcohol (ß = 3.19; 95% CI = 0.97, 5.410 and cocaine (ß = 2.56; 95% CI = 0.34, 4.79), was specific to adults (ß = 5.50; 95% CI = 1.52, 9.47) and was largest in states granting legal protection for marijuana dispensaries (ß = 6.37; 95% CI = -0.97, 13.70). There was no statistically significant association between MMLs and treatment admissions by non-pregnant women. CONCLUSIONS: Medical marijuana law implementation in US states has been associated with greater substance use treatment utilization by pregnant adult women, especially in states with legally protected dispensaries.

Predictors of heroin abstinence in opiate substitution therapy in heroin-only users and dual users of heroin and crack.

AIMS: To analyse predictors of heroin abstinence in opiate substitution therapy (OST) based on frequency of crack use and its interactions with other predictors in a clinical non-experimental setting. DESIGN: Retrospective study. SETTING: A community drug service in London, UK. PARTICIPANTS: 325 clients starting OST between 2010 and 2014 (197 methadone and 128 buprenorphine). MEASUREMENTS: Logistic regression models (a general model and separate models for methadone and buprenorphine) assessed demographic and clinical data as predictors of heroin abstinence at one year after treatment start (or at the date of transfer to another service). FINDINGS: For the general model participants choosing methadone were more likely to use heroin at follow up (OR=2.36, 95% CI: 1.40-3.17) as were daily crack users on methadone (OR=2.62, 95% CI: 0.96-7.16). For the methadone model only daily crack use predicted heroin use at follow up (OR=2.62, 95% CI: 0.96-7.16). For buprenorphine, higher amounts of baseline heroin use, lower buprenorphine dose and daily drinking predicted heroin use at follow up (OR=0.85, 95% CI: 0.75-0.95; OR=1.31, 95% CI: 1.06-1.60 and OR=6.04, 95% CI: 1.26-28.92). Both use of cannabis and depression increased likelihood of heroin abstinence for clients not using crack compared to occasional (OR=6.68, 95% CI: 0.37-119.59; OR=106.31, 95% CI: 3.41-3313.30) and daily (OR=57.49 (95% CI: 2.37-1396.46; OR=170.99 (95% CI: 4.61-6339.47) users. CONCLUSIONS: Most of the predictors in the general model were found significant only in the buprenorphine but not in the methadone model, suggesting that a general model has little predictive value. Crack use was a significant predictor of heroin abstinence at follow up in all models, however for buprenorphine only when depression or cannabis use was present. Further research is needed to assess effective treatment approaches for the growing population of dual users.

Suicidal Ideation Among Heroin-Abusing Mothers in Methadone Maintenance Treatment.

BACKGROUND: There is a dearth of information about mothers in methadone maintenance treatment (MMT), their parental stress, and suicidal ideation. AIM: To evaluate parenting stress and suicidal ideation among heroin-dependent mothers in MMT. METHOD: The study was conducted at an MMT center. Inclusion criteria were mothers with at least one child between 6-12 years of age. Mothers (n = 41) were interviewed about their background characteristics, drug use, parenting stress, and suicide ideation. RESULTS: The mothers' median age was 44 (27-63 years), 35% were single, 20% married or with a partner, 45% separated or divorced, 83% were Jewish, and about one-third completed elementary school only. Among the study participants, 52% reported ever thinking about suicide, 28% reported past-year ideation, and 15% indicated they were likely to complete suicide someday. Mothers who have used heroin and cannabis reported high levels of parenting stress. Mothers with high parenting stress levels were more likely to report suicidal ideation. Country of origin status did not differentiate those interviewed. CONCLUSION: This study provides insight into a hard-to-reach population of mothers needing treatment, parental skills training, and mental stress reduction. Further research is needed to generalize the findings for treatment, education, and training purposes.

Acupuncture regulates the unfolded protein response and inhibits apoptosis in a rat model of heroin relapse.

OBJECT: To explore the unfolded protein response (UPR) in the hippocampus of rats undergoing heroin relapse and the mechanisms underlying the acupuncture-mediated inhibition of brain damage caused by heroin relapse. METHODS: 60 Sprague-Dawley rats (30 females and 30 males) were randomly divided into four groups: Control group, Heroin group, Heroin+acupuncture group, and Heroin+methadone group (n=15 each). In the latter three groups, a model of heroin addiction was established by successive increments of intramuscular heroin injections for 8 days, according to the exposure (addiction)→detoxification method. A UPR RT2 Profiler PCR array was used to screen for differentially expressed genes in the hippocampus. Apoptosis was detected by terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) staining. The protein expression levels of the following three differentially expressed genes were detected by Western blot to validate the results of the PCR array: heat shock protein (HSP)70, HSP105, and valosin-containing protein (Vcp). RESULTS: The UPR RT2 Profiler PCR Array detection results indicated that acupuncture increased the expression levels of the molecular chaperones HSP70, HSP105, and Vcp. The degree of neuronal apoptosis in the hippocampus of rats in the Heroin+acupuncture and Heroin+methadone groups was significantly reduced compared with the untreated Heroin group (p<0.01). Protein expression of HSP70, HSP105, and Vcp in the Heroin+acupuncture and Heroin+methadone groups was significantly higher than the Heroin group (p<0.01). CONCLUSIONS: The positive effects of acupuncture on brain damage caused by heroin may be closely related to up-regulation of HSP70, HSP105, and Vcp, and reduced apoptosis.

Transcutaneous electrical acupoint stimulation for the treatment of withdrawal syndrome in heroin addicts.

OBJECTIVE: To assess the therapeutic effect of transcutaneous electric acupoint stimulation (TEAS) for the treatment of withdrawal syndrome in heroin addicts. METHODS: A total of 63 male heroin addicts with withdrawal score higher than 20 were recruited in the Detoxification Center of Zhongshan city, Guangdong province, China. They were randomly distributed into two groups: TEAS group (n = 31) received TEAS by using a Han's acupoint nerve stimulator (HANS) model 200A with two output channels, 2-3 sessions per day, 30 minutes per session for 10 consecutive days. Electrical stimulation of alternating frequencies of 2- and 100-Hz with 3 second each, and with intensity of 10-15 mA was applied on Hegu (LI-4) and Laogong (PC-8) points on one hand, and Neiguan (PC-6) and Waiguan (SJ-5) points on the other forearm via electroconductive skin pads of 4 cm × 4 cm in size. The control group (n = 32) was treated with similar procedure except that the leads of the output of the stimulator was disconnected. Assessments of the severity of the withdrawal syndrome were conducted one day before and on each day during the whole treatment period of 10 days. Buprenorphin of 1 mg per day sublingually was provided to all subjects in the first two days, and then to those with withdrawal score over 20 in the following days. RESULTS: The TEAS treatment dramatically alleviated the withdrawal syndrome during heroin detoxification. No significant difference was found in withdrawal scores between the two groups at the beginning of the observation. Withdrawal scores showed a more marked drop in TEAS group than the control starting from the second day, and maintained at a lower level for the whole course of treatment. The area under the curve of withdrawal score in TEAS group was only 40% of that in the control (P < 0.001, two way repeated measures analysis of variance), and the requirement of buprenorphine was only 10% of that in the control. No adverse effects were observed in either group. CONCLUSION: TEAS of 2/100 Hz for 10 days in abrupt abstinence of the heroin addicts resulted in a marked reduction of the withdrawal syndrome as well as a reduced requirement for rescue opioids.

A mosque-based methadone maintenance treatment strategy: implementation and pilot results.

BACKGROUND: This paper describes the rationale, implementation and operation of a "world first" Islamic inspired methadone maintenance treatment project delivered in a mosque setting and presents the outcome for the first group of participants. The project explored the viability of expanding addiction recovery services through the network of mosques in Muslim communities. METHODS: The project combined methadone maintenance with peer and religious counseling. Participants consisted of 36 male Muslim heroin users who went through the project. Urine tests and self-reported measures on various dimensions relevant to drug use and quality of life were collected at baseline and 12 months. RESULTS: The project had a 12 month retention rate of 80%. At 12 months all but one participant tested negative for opioids and other substances. Self-report measures showed significant reductions in the degree and variety of drug use, improvements in general health, and psychological and social functioning of participants. Qualitative data showed that availability of methadone, convenient location and religion were the main reasons drawing participants to the program. CONCLUSIONS: Mosques are viable venues for offering medication assisted recovery services and offer an alternative approach for managing addiction in Muslim communities. The prospect of mobilizing community resources to offer community-oriented long-term recovery management programs in mosques and other places of worship deserves consideration.

Clinical efficacy of acupuncture as an adjunct to methadone treatment services for heroin addicts: a randomized controlled trial.

Scant scientific evidence supports the efficacy of acupuncture in the treatment of opiate dependence. The purpose of this study was to examine the effectiveness of acupuncture for heroin addicts on methadone maintenance by measuring the daily consumption of methadone, variations in the 36-item Short Form Health Survey-36 (SF-36) and Pittsburgh Sleep Quality Index (PSQI) scores, and heroin craving. Sixty heroin addicts were randomly assigned to true acupuncture (electroacupuncture at the Hegu [LI4] and Zusanli [ST36] acupoints, as well as acupuncture at the Ear Shenmen) or sham acupuncture (minimal acupuncture at the Hegu and Zusanli acupoints without electrical stimulation and superficial acupuncture at the Ear Shenmen), twice weekly for 4 weeks. From week 2 onwards, the daily dose of methadone was reduced by a significantly greater amount with true acupuncture compared with sham acupuncture. True acupuncture was also associated with a greater improvement in sleep latency at follow-up. All adverse events were mild in severity. Acupuncture appears to be a useful adjunct to methadone maintenance therapy (MMT) in heroin addiction.

Biofeedback combined with cue-exposure as a treatment for heroin addicts.

The aim of this study was to test if cue-exposure therapy (CET) combined with biofeedback therapy (BT) could decrease craving and physiological reactivity to drug-related cues in heroin dependents. Forty-five participants were randomly assigned to usual rehabilitation with or without CET combined with BT. Craving was assessed by a 100-point visual analog scale (VAS). Skin conductance (SC) and muscle electromyography (MEG) were recorded using a biofeedback device. After 2 months of treatment, both the pre-cue exposure craving and the post-cue exposure craving, SC, and MEG were lower in the experimental group than in the control group. Compared to the control group, the experimental group had a greater decrease in craving, SC, and MEG from baseline after the treatment. The results suggest that CET combined with BT treatment is effective in reducing craving and physiology reactivity in heroin dependents and could be used as a component of heroin-dependence rehabilitation.

Neurotransmitter-precursor-supplement intervention for detoxified heroin addicts.

This study examined the effects of combined administration of tyrosine, lecithin, L-glutamine and L-5-hydroxytryptophan (5-HTP) on heroin withdrawal syndromes and mental symptoms in detoxified heroin addicts. In the cluster-randomized placebo-controlled trial, 83 detoxified heroin addicts were recruited from a detoxification treatment center in Wuhan, China. Patients in the intervention group (n=41) were given the combined treatment with tyrosine, lecithin, L-glutamine and 5-HTP and those in the control group (n=42) were administered the placebo. The sleep status and the withdrawal symptoms were observed daily throughout the study, and the mood states were monitored pre- and post-intervention. The results showed that the insomnia and withdrawal scores were significantly improved over time in participants in the intervention group as compared with those in the control group. A greater reduction in tension-anxiety, depression-dejection, anger-hostility, fatigue-inertia and total mood disturbance, and a greater increase in their vigor-activity symptoms were found at day 6 in the intervention group than in the control group (all P<0.05). It was concluded that the neurotransmitter-precursor-supplement intervention is effective in alleviating the withdrawal and mood symptoms and it may become a supplementary method for patients' recovery from heroin addiction.

Impact of an 18-month, NHS-based, treatment exposure for heroin dependence: results from the London Area Treat 2000 Study.

We set out to examine the impact of treatment for heroin dependence on drug use, injecting behavior, health problems, criminality, and physical and mental health over 18 months among heroin-dependent Londoners. A total of 100 heroin users were recruited for this longitudinal prospective cohort study with repeated measures (T0 as baseline, T1 after 9 months, and T2 after 18 months). The psychiatric evaluation and assessment of drug abuse levels were determined by the CIDI and the EuropASI. Additional evaluations included the WHO-DAS II for disability assessment and the UCLA-SSI for social support. The number of days of heroin use in the 30 days previous to each single assessment significantly reduced over time (p < .001). Similar reduction levels were observed for cocaine (p < .05), benzodiazepines (p < .001), and polydrug abuse (p < .001), but not for cannabis and alcohol. The number of injecting occasions reduced in parallel, with increase in days in work and reduction of money spent for drug acquisition activities and money obtained from criminal/illegal activities. The number of subjects experiencing suicidal ideation reduced over time (p < .05). In line with previous suggestions, significant reductions in drug use, criminality, psychopathology, and injecting behavior following treatment exposure for heroin dependence were observed. It is, however, of concern that alcohol and cannabis misuse levels remained unchanged.

[Effect of acupuncture on heroin cue-induced functional magnetic resonance images in heroin-addicted human subjects].

OBJECTIVE: To observe heroin cue-induced changes of cerebral functional magnetic resonance images (fMRI) and the effect of acupuncture of Zusanli (ST 36) on them under craving state in heroin-addicted volunteers. METHODS: Fourteen male volunteer heroin addicts were recruited in the present study. Brain images were acquired before, during (2 min) and after visualizing heroin (placed in a transparent glass mug) and acupuncture of Zusanli (ST 36) on a 1.5-T Siemens Symphony MRI system equipped with a standard head coil. Acupuncture stimulation was applied to bilateral Zusanli (ST 36) by manipulating a filiform needle at a frequency of about 60 cycles/min and an angle of about 180 degrees for 2 min. The acquired neuroimaging data were analyzed by AlphaSim, AFNI. RESULTS: During heroin-visual stimulation, the markedly activated brain areas (increase of blood oxygen level-dependent signal) of fMRI were bilateral middle frontal gyrus, left cingulate gyrus, bilateral insula, occipital cortex, left cuneus, cerebellum, bilateral thalamus, right hippocampus and right amygdala etc. which are closely related to the human's craving psychological activities. When acupuncture given, meaning processing stronger sensory task, the heroin-addicted subjects showed apparent activation of the brain areas including the right anterior cingulate gyrus, right insula, thalamus, right hippocampal gyrus etc. which activation degrees were significant lower than those of heroin related visual stimulation. CONCLUSION: Acupuncture of Zusanli (ST 36) can lessen heroin cue-induced activation degree of the brain areas involving psychological craving, suggesting that acupuncture is able to suppress the heroin addiction patients' drug abuse craving.

Effect of electro-acupuncture intervention on cognition attention bias in heroin addiction abstinence-a dot-probe-based event-related potential study.

OBJECTIVE: To study the changes of cognitive attention-related brain function in the heroin addicts before and after electro-acupuncture (EA) intervention for exploring the concerned neuro-mechanism of addictive relapse and the central action role of EA intervention. METHODS: Adopting event-related potential (ERP) technique, the ERP at 64 electrode spots in 10 heroin addicts (test group) were recorded before and after EA intervention with dot-probe experimental form during implementing cognitive task on positive emotional clue (PEC), negative emotional clues (NEC), and heroin-related clue (HRC). The P200 amplitude components on the selected observation points (Fz, Cz, and Pz) were analyzed and compared with those obtained from 10 healthy subjects as the control. RESULTS: Before EA, the ERP of attention on HRC in the test group was higher than that on PEC and NEC (P<0.05) and significantly higher than that in the control group (P<0.05); after EA, the P200 amplitude of attention on HRC at Cz and Pz was significantly lowered (P<0.05) and that on PEC at Fz was significantly elevated (P<0.05). After EA, the P200 amplitude at Pz was ranked as NEC > PEC > HRC, but in the control group, it showed PEC > HRC at all three observation points and PEC > NEC at Pz. CONCLUSION: Heroin addicts show attention bias to HRC, which could be significantly reduced by EA intervention, illustrating that EA could effectively inhibit the attention bias to heroin and so might have potential for lowering the relapse rate.

[Effect of electroacupuncture at Jiaji (EX-B 2) on drug craving of heroin addicts and beta-EP and Dyn-A in plasma].

OBJECTIVE: To explore the clinical effect and mechanism of electroacupuncture at Jiaji (EX-B 2) on drug craving of heroin addicts. METHODS: One hundred and twenty cases of heroin addicts were randomly divided into 4 groups, 30 cases in each. In acupuncture group 1, the Jiaji (EX-B 2) points of T5-T7 and Shenshu (BL 23) were selected with electroacupuncture; in acupuncture group 2, Neiguan (PC 6), Shenmen (HT 7) and Zusanli (ST 36) etc. were selected with electroacupuncture; in simulation group, Zusanli (ST 36) and Sanyinjiao (SP 6) were selected with analog electrical stimulation, and in blank group no any therapy was applied. The changes of drug craving were evaluated by Visual Analogue Scale (VAS) and the changes of beta-EP and Dyn-A in plasma before and after treatment were tested by radioimmunoassay. RESULTS: The relapse rate of 77.3% (17/22) in acupuncture group 1 was lower than those of 88.5% (23/26) in acupuncture group 2, 90.5% (19/21) in simulation group and 95.7% (22/23) in blank group (all P < 0.05). At the 8th and 10th week of treatment, the VAS scores in acupuncture group 1 and 2 were much lower than those in blank group and simulation group (all P < 0.01); in which, it was lower in acupuncture group 1 than that in acupuncture group 2 (P < 0.05), and lower in simulation group than that in blank group. After 10 weeks of treatment, compared with the status before treatment, beta-EP and Dyn-A in plasma were increased in acupuncture group 1 and 2 (P < 0.05, P < 0.01), Dyn-A was decreased in both simulation and blank groups (both P < 0. 01) which was less obvious than those in both acupuncture groups (both P < 0.01) and superior in acupuncture group 1 than that in group 2 (P < 0.05). CONCLUSION: Electroacupuncture at Jiaji (EX-B 2) can suppress the drug craving and reduce the relapse rate, and the mechanism may be related with the content of beta-EP, especially the increase of Dyn-A in plasma.

[Influence of acupuncture and moxibustion on conditional position preference and prefrontal cortical ultrastructure in heroin re-addicted rats].

OBJECTIVE: To observe the effect of acupuncture and moxibustion on the conditional position preference (CPP) and prefrontal cortical ultrastructure in heroin re-addicted rats. METHODS: Thirty-two Wistar rats were randomly divided into normal, model, medication and acu-moxibustion (acu-moxi) groups, with 8 cases in each. Re-addiction model was established by repeated intramuscular injection of heroin into the hindlimbs. Rats of medication group were treated with intragastric administration of Methadone during detoxification. For rats in acu-moxi group, acupuncture needle was inserted into "Baihui" (GV 20) and moxibustion treatment was used to bilateral "Shenshu" (BL 23) for 30 min during detoxification. Rats in normal group were given with intramuscular injection of normal saline during addiction. CPP tests were conducted once daily in a spatial place preference box for 8 days. On the 39th day of the experiment, the rats under anesthesia were killed for sampling the prefrontal cortex (PFC) tissue on an ice plate, then, the ultrastructure of the neurons was observed by using a transmission electron microscope. RESULTS: After modeling, the rats' staying duration in the dark-box was shortened obviously (P < 0. 1). After the treatment, the staying duration in dark-box in acu-moxi group was significantly longer than that in model and medication groups (P < 0.01). Compared with normal control group, electron-microscopic results indicated that in PFC tissues of model and medication groups, vacuoles and edema of cytoplasm at different degrees, enlargement of the rough endoplasmic reticulum (REPR), vacuoles or disappearance of mitochondria, reduction of ribosome in number, and widening of the nuclear intermembrance interstice were seen. While in acu-moxi group, the number of mitochondria and ribosome increased slightly, the mitochondrial cristae was clear, the number of REPR increased relatively but dilated slightly, and the intermembrance space was basically normal. CONCLUSION: Acu-moxibustion can improve heroin re-addicted rats' conditional position preference and has a protection effect on the cerebral cortical neurons. disappearance of mitochondria, reduction of ribosome in number, and widening of the nuclear intermembrance interstice were seen. While in acu-moxi group, the number of mitochondria and ribosome increased slightly, the mitochondrial cristae was clear, the number of REPR increased relatively but dilated slightly, and the intermembrance space was basically normal. CONCLUSION: Acu-moxibustion can improve heroin re-addicted rats' conditional position preference and has a protection effect on the cerebral cortical neurons.

Efficacy of treatment in an opioid -dependent population group using the Maudsley Addiction Profile (MAP) tool.

A pilot study was performed to assess the effectiveness of treatment in an opioid dependent population using the Maudsley Addiction Profile (MAP) tool1.The primary outcome of the study was to assess if treatment had an effect on 1. Substance use (quantity and frequency of use), 2. Health risk behaviour (injecting and sharing injecting equipment), 3. Health symptoms (physical and psychological) and 4. Personal /Social functioning (relationships, employment and crime). A secondary outcome was also sought.The study took place in 2007 in an inner city Belfast hospital specialising in the treatment of addiction, over a two month period. Fifteen patients, all opioid dependent and receiving outpatient community treatment, were interviewed at baseline (prior to the commencement of treatment) and at eight weeks follow up.Three patients were lost to follow up. Two patients stopped using altogether. Of the remaining patients, improvements were seen in most areas. There was a decrease in the use of heroin (71.28%), cocaine (99.72%), crack cocaine (100%), cannabis (99.94%) and alcohol (33.17%). There was a reduction in injecting behaviour (60.93%). Improvements were observed in health with a reduction in physical (41.35%) and psychological (35%) symptoms. Overall personal and social functioning improved regarding interactions with family and friends. A reduction in crime was also observed (75%).Opinions and views of staff involved in the study were generally positive.This patient population presents with multiple and complex needs. Effective treatment needs to address these needs and not just drug addiction alone. The Maudsley Addiction Profile tool highlights this.