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1.
PLoS One ; 19(6): e0304399, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38865318

RESUMO

This study aims to investigate the effect of detoxification on acoustic features of Mandarin speech. Speech recordings were collected from 66 male abstinent heroin users with different durations of drug detoxification, specifically early abstinent users with a detoxification duration of less than 2 years, sustained abstinent users with 2 years of detoxification, and long-term abstinent users with a detoxification duration of more than 2 years. The results of the acoustic analyses showed that early abstinent users exhibited lower loudness, relative energies of F1, F2, and F3, higher H1-A3, and fewer loudness peaks per second, as well as a longer average duration of unvoiced segments, compared to the sustained and long-term abstinent users. The findings suggest that detoxification may lead to a rehabilitation process in the speech production of abstinent heroin users (e.g., less vocal hoarseness). This study not only provides valuable insights into the effect of detoxification on speech production but also provides a theoretical basis for the speech rehabilitation and detoxification treatment of heroin users.


Assuntos
Dependência de Heroína , Acústica da Fala , Humanos , Masculino , Dependência de Heroína/fisiopatologia , Adulto , Fala/fisiologia , Adulto Jovem , Idioma , Inativação Metabólica
2.
Rev Med Suisse ; 20(877): 1115-1118, 2024 Jun 05.
Artigo em Francês | MEDLINE | ID: mdl-38836394

RESUMO

Sexual health is a key element to the well-being and quality of life of individuals. However, it is rarely incorporated into care delivery for women with an addictive condition. Female with severe dependence to opiate have their medical and social conditions improved by diacetylmorphine treatment. Which allows them to escape situations of high-risk of sexual violence. However, this pharmacotherapy can also induce adverse effects on the sexual sphere. This paper describes the relevance of integrating psycho-socio-sexological counselling into the care provision for the opiate dependence. The counselling should be oriented to respond to the specific relational and sexual issues faced by these female patients and empowering them on their lives and in recovering a better quality of life.


La santé sexuelle constitue un élément important au bien-être et à la qualité de vie, or c'est un élément peu abordé au cours des soins des patientes souffrant de trouble addictologique. Le traitement de diacétylmorphine améliore la situation médicale et sociale des patientes souffrant d'une dépendance sévère aux opiacés et leur permet de sortir de situations à haut risque de violences sexuelles ; mais il peut également induire des effets indésirables sexuels. Cet article décrit l'importance d'intégrer à la prise en charge addictologique un accompagnement psychosocio-sexologique axé sur les difficultés sexuelles et relationnelles spécifiquement rencontrées par les patientes afin de leur offrir la possibilité de retrouver du pouvoir sur leur vie et une meilleure qualité de vie.


Assuntos
Heroína , Transtornos Relacionados ao Uso de Opioides , Humanos , Feminino , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Heroína/efeitos adversos , Saúde Sexual , Qualidade de Vida , Entorpecentes/uso terapêutico , Aconselhamento/métodos , Subtratamento
3.
Drug Alcohol Depend ; 259: 111318, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38692135

RESUMO

BACKGROUND: Amidst an increasingly toxic drug supply in North America, people who inject drugs may be transitioning to smoking them. We aimed to assess changes in injecting and smoking opioids and methamphetamine among a cohort of people who inject drugs from San Diego, California. METHODS: Over five six-month periods spanning October 2020-April 2023, we assessed prevalence of injecting and smoking opioids or methamphetamine and whether participants used these drugs more frequently by smoking than injecting. Multivariable Poisson regression via generalized estimating equations was used to examine time trends. RESULTS: Of 362 participants, median age was 40 years; a minority were female (29%), Hispanic/Latinx/Mexican (45%), and housed (33%). Among this cohort, of whom 100% injected (and 84% injected and smoked) in period one (October 2020-April 2021), by period five (November 2022-April 2023), 34% only smoked, 59% injected and smoked, and 7% only injected. By period five, the adjusted relative risk (aRR) of injecting opioids was 0.41 (95% Confidence Interval [CI]: 0.33, 0.51) and the aRR for injecting methamphetamine was 0.50 (95% CI: 0.39, 0.63) compared to period one. Risks for smoking fentanyl rose significantly during period three (aRR=1.44, 95% CI: 1.06, 1.94), four (aRR=1.65, 95% CI: 1.24, 2.20) and five (aRR=1.90, 95% CI: 1.43, 2.53) compared to period one. Risks for smoking heroin and methamphetamine more frequently than injecting these drugs increased across all periods. CONCLUSIONS: Opioid and methamphetamine injection declined precipitously, with notable increases in smoking these drugs. Research is needed to understand the health consequences of these trends.


Assuntos
Fentanila , Heroína , Metanfetamina , Abuso de Substâncias por Via Intravenosa , Humanos , Feminino , Masculino , Metanfetamina/administração & dosagem , Adulto , California/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Pessoa de Meia-Idade , Heroína/administração & dosagem , Fumar/epidemiologia , Fumar/tendências , Estudos de Coortes , Prevalência , Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia
4.
Addict Behav ; 156: 108060, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38735160

RESUMO

BACKGROUND: Prior studies have shown that individuals and their peers often have similar substance use behaviors, but the mechanisms driving these similarities - particularly in rural settings, are not well understood. The primary objectives of this analysis are to (1) identify factors that contribute to relationship turnover and maintenance within a rural network of persons who use drugs (PWUD), (2) determine whether assimilation and/or homophily shape participants use of injection drugs, heroin, and stimulants (methamphetamine and cocaine), and (3) assess the extent that these mechanisms influence networks ties and/or behaviors and whether these effects vary across time. METHODS: Sociometric network data were collected from a cohort of PWUD in rural Eastern Kentucky at baseline (2008-2010) and at four follow-up visits conducted approximately semiannually. Stochastic actor-oriented models (SAOMS) were used to model network structure and participant behaviors as jointly dependent variables and to identify characteristics associated with the maintenance, dissolution, and formation of network ties and changes in drug use behaviors. RESULTS: Findings suggest (1) greater network stability over time for reciprocal and transitive relationships, (2) both homophily and assimilation played a greater role in shaping injection drug use (IDU) initiation and cessation than they did in shaping heroin and stimulant use, and (3) the importance of these mechanisms appeared consistent over time. CONCLUSION: Given the stability of particular network structures and evidence of both homophily and assimilation with respect to drug-use behaviors, interventions that leverage social networks could be used to motivate health-promoting behaviors.


Assuntos
População Rural , Transtornos Relacionados ao Uso de Substâncias , Humanos , Masculino , Feminino , Adulto , Estudos Longitudinais , Região dos Apalaches/epidemiologia , População Rural/estatística & dados numéricos , Kentucky/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Pessoa de Meia-Idade , Dependência de Heroína/epidemiologia , Dependência de Heroína/psicologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/psicologia , Apoio Social , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/psicologia , Adulto Jovem
5.
Neuropharmacology ; 252: 109947, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38631564

RESUMO

A growing body of research indicates that ß-caryophyllene (BCP), a constituent present in a large number of plants, possesses significant therapeutic properties against CNS disorders, including alcohol and psychostimulant use disorders. However, it is unknown whether BCP has similar therapeutic potential for opioid use disorders. In this study, we found that systemic administration of BCP dose-dependently reduced heroin self-administration in rats under an FR2 schedule of reinforcement and partially blocked heroin-enhanced brain stimulation reward in DAT-cre mice, maintained by optical stimulation of midbrain dopamine neurons at high frequencies. Acute administration of BCP failed to block heroin conditioned place preference (CPP) in male mice, but attenuated heroin-induced CPP in females. Furthermore, repeated dosing with BCP for 5 days facilitated the extinction of CPP in female but not male mice. In the hot plate assay, pretreatment with the same doses of BCP failed to enhance or prolong opioid antinociception. Lastly, in a substitution test, BCP replacement for heroin failed to maintain intravenous BCP self-administration, suggesting that BCP itself has no reinforcing properties. These findings suggest that BCP may have certain therapeutic effects against opioid use disorders with fewer unwanted side-effects by itself.


Assuntos
Heroína , Sesquiterpenos Policíclicos , Autoadministração , Animais , Masculino , Heroína/administração & dosagem , Sesquiterpenos Policíclicos/farmacologia , Sesquiterpenos Policíclicos/administração & dosagem , Feminino , Camundongos , Ratos , Analgésicos Opioides/farmacologia , Analgésicos Opioides/administração & dosagem , Sesquiterpenos/farmacologia , Sesquiterpenos/administração & dosagem , Ratos Sprague-Dawley , Relação Dose-Resposta a Droga , Condicionamento Operante/efeitos dos fármacos , Extinção Psicológica/efeitos dos fármacos , Reforço Psicológico , Recompensa , Camundongos Transgênicos , Nociceptividade/efeitos dos fármacos , Camundongos Endogâmicos C57BL
6.
Am J Nurs ; 124(5): 13, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38661686
7.
J Subst Use Addict Treat ; 162: 209365, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38626850

RESUMO

INTRODUCTION: The opioid crisis continues to evolve with increasing opioid-related overdose deaths among under-represented minorities. A better understanding of substance use differences in the route of administration for people using heroin and other opioids can lead to targeted strategies and interventions. METHODS: Using the 2015-2019 Treatment Episode Data Set - Admissions (TEDS-A), a multinomial logistic regression model examined the relationship between race/ethnicity and secondary substance use with route of administration in a subset of 591,078 admissions. RESULTS: For individuals reporting heroin as their primary substance, minoritized clients were both more likely to smoke (NH Blacks RR: 2.28, 95 % CI 2.16-2.41; Hispanic RR: 1.80, 95 % CI: 1.74, 1.87; Other RR: 2.09, 95 % CI: 2.00, 2.20) or inhale heroin (Hispanic RR: 1.82, 95 % CI 1.78-1.85; Other RR: 1.30, 95 % CI 1.25, 1.34) compared to non-Hispanic (NH) Whites. NH Black clients were nearly seven and a half times more likely to report inhaling (RR: 7.45, 95 % CI 7.28, 7.62) heroin over injecting it. Clients were more likely to smoke heroin compared to injection if they reported secondary drug use of methamphetamines (RR: 2.28, 95 % CI 2.21, 2.35) and other opioids (RR: 1.21, 95 % CI 1.15, 1.28). For clients reporting other opioids as their primary substance, Hispanic (RR: 1.33, 95 % CI 1.19, 1.47) and other racial/ethnic minority clients (RR: 2.50, 95 % CI 2.23, 2.79) were more likely to smoke opioids vs take it orally compared to their NH White counterparts. Individuals who reported methamphetamine use as a secondary substance were significantly more than three times as likely to smoke (RR: 3.07, 95 % CI 2.74, 3.45) or inject (RR: 3.36, 95 % CI 3.17, 3.57) compared to orally ingesting opioids, while those who reported cocaine or crack cocaine use were more than twice as likely to inject (RR: 2.22, 95 % CI 2.09-2.36) opioids than taking them orally. CONCLUSION: Findings demonstrate significant racial and ethnic differences in the route of administration. This work expands on the understanding of the complex nature of polysubstance use in the evolving opioid crisis and the secondary substance use of clients on routes of administration of opioids and heroin, highlighting the need for tailored interventions to address the treatment needs of under-represented minorities.


Assuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Humanos , Masculino , Feminino , Adulto , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/etnologia , Estados Unidos/epidemiologia , Heroína/administração & dosagem , Pessoa de Meia-Idade , Hispânico ou Latino/estatística & dados numéricos , Adulto Jovem , Vias de Administração de Medicamentos , População Branca/estatística & dados numéricos , Adolescente , Negro ou Afro-Americano/estatística & dados numéricos , Etnicidade/estatística & dados numéricos
8.
Addiction ; 119(7): 1301-1309, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38593992

RESUMO

BACKGROUND AND AIMS: Xylazine is a non-opioid sedative which has spread rapidly throughout the US illicit drug supply. This study aimed to describe the spread of xylazine throughout the UK illicit drug supply. METHODS: Xylazine detections in human biological samples were collated from toxicology laboratories operating in the United Kingdom with the date, location, case type, xylazine concentration and co-detected drugs (with quantifications where performed) detailed, where permitted, by the corresponding coroner. Drug-testing cases positive for xylazine were collated from the Welsh Emerging Drugs and Identification of Novel Substances (WEDINOS) drug-testing postal service with the date, location, purchase intent and co-detected drugs detailed. Drug seizures made by UK law enforcement were communicated by the Office for Health Improvement and Disparities with the date and location detailed. RESULTS: By the end of August 2023, xylazine was detected in 35 cases from throughout toxicology, drug-testing and drug seizure sources covering England, Scotland and Wales. There were no cases reported from Northern Ireland. Xylazine was detected in biological samples from 16 people. In most cases where full toxicology results were provided, xylazine was detected with heroin and/or a strong opioid (n = nine of 11), but this polydrug use pattern was not evident in all cases (n = two of 11), suggesting a wider circulation of xylazine in the UK illicit drug market beyond heroin supplies. Evidence from WEDINOS supports this claim, as all 14 drug samples (100%) submitted from across the UK contained xylazine; however, in none of these cases was heroin the purchase intent but rather counterfeit prescription medication tablets (n = 11 of 14), tetrahydrocannabinol (THC) vapes (n = two of 14) or white powder (n = one of 14). Additional evidence for the spread of illicit xylazine comes from five drug seizures made by law enforcement. CONCLUSIONS: Xylazine has penetrated the UK illicit drug market and is not limited to heroin supplies.


Assuntos
Heroína , Drogas Ilícitas , Detecção do Abuso de Substâncias , Xilazina , Humanos , Drogas Ilícitas/provisão & distribuição , Drogas Ilícitas/análise , Reino Unido , Heroína/provisão & distribuição , Detecção do Abuso de Substâncias/métodos , Aplicação da Lei , Hipnóticos e Sedativos/provisão & distribuição , Hipnóticos e Sedativos/análise
9.
Eur J Neurosci ; 59(10): 2502-2521, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38650303

RESUMO

The emergence of compulsive drug-seeking habits, a hallmark feature of substance use disorder, has been shown to be predicated on the engagement of dorsolateral striatal control over behaviour. This process involves the dopamine-dependent functional coupling of the anterior dorsolateral striatum (aDLS) with the nucleus accumbens core, but the mechanisms by which this coupling occurs have not been fully elucidated. The striatum is tiled by a syncytium of astrocytes that express the dopamine transporter (DAT), the level of which is altered in individuals with heroin use disorder. Astrocytes are therefore uniquely placed functionally to bridge dopamine-dependent mechanisms across the striatum. Here we tested the hypothesis that exposure to heroin influences the expression of DAT in striatal astrocytes across the striatum before the development of DLS-dependent incentive heroin seeking habits. Using Western-blot, qPCR, and RNAscope™, we measured DAT protein and mRNA levels in whole tissue, culture and in situ astrocytes from striatal territories of rats with a well-established cue-controlled heroin seeking habit and rats trained to respond for heroin or food under continuous reinforcement. Incentive heroin seeking habits were associated with a reduction in DAT protein levels in the anterior aDLS that was preceded by a heroin-induced reduction in DAT mRNA and protein in astrocytes across the striatum. Striatal astrocytes were also shown to be susceptible to direct dopamine- and opioid-induced downregulation of DAT expression. These results suggest that astrocytes may critically regulate the striatal dopaminergic adaptations that lead to the development of incentive heroin seeking habits.


Assuntos
Astrócitos , Corpo Estriado , Proteínas da Membrana Plasmática de Transporte de Dopamina , Dopamina , Comportamento de Procura de Droga , Heroína , Animais , Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Astrócitos/metabolismo , Astrócitos/efeitos dos fármacos , Corpo Estriado/metabolismo , Corpo Estriado/efeitos dos fármacos , Masculino , Ratos , Comportamento de Procura de Droga/fisiologia , Comportamento de Procura de Droga/efeitos dos fármacos , Heroína/farmacologia , Heroína/administração & dosagem , Dopamina/metabolismo , Motivação/efeitos dos fármacos , Motivação/fisiologia , Dependência de Heroína/metabolismo , Ratos Sprague-Dawley
10.
11.
Cult. cuid ; 28(68): 179-188, Abr 10, 2024. ilus
Artigo em Espanhol | IBECS | ID: ibc-232321

RESUMO

Introducción: Maria José Bezerra, Maria Soldado, mujernegra nacida en la ciudad de Limeira, São Paulo, heroína ysímbolo de la Revolución Constitucionalista de 1932, fueuna enfermera de guerra reconocida por su fuerza, valor,patriotismo y abnegación.Objetivo: historiar la trayectoria vital personal y profesionalde Maria José Bezerra. Metodología: Investigación biográficarealizada a partir de registros bibliográficos y documentales.Resultados: Maria José Bezerra sirvió como enfermeramiembro de la Legión Negra en la Guerra Civil de la RevoluciónConstitucionalista de 1932, destacando por sus logros, con unacontribución activa a la construcción de la historia del país.Conclusión: La invisibilidad negra traduce la injusticia, laincoherencia de los derechos y también los actos que tratande deshonrar al individuo en sus aspectos individuales ycolectivos. El estudio de la trayectoria de esta mujer luchadorase constituye como una estrategia para dar voz, fuerza ysentido a hacer pública la historia de una representantede la población negra, y también debería incluirse en loscurrículos académicos.(AU)


Introduction: Maria José Bezerra, a black woman born inthe city of Limeira, São Paulo, hero and symbol of the 1932Constitutionalist Revolution, was a war nurse recognized forher strength, courage, patriotism and abnegation.Objective: To historicize Maria José Bezerra's personal andprofessional life trajectory. Methodology: Biographical research based on bibliographicand documentary records.Results: Maria José Bezerra acted as a nurse member ofthe Black Legion in the Civil War of the ConstitutionalistRevolution of 1932, stood out for her achievements, withactive contribution in the construction of the country's history.Conclusion: Black invisibility translates as injustice, inconsistencyof rights, and even acts that try to discredit the individualin their individual and collective aspects. The study of thetrajectory of this woman fighter constitutes a strategy togive voice, strength and meaning to make public the historyof a representative of the black population, and the themeshould also be included in academic curricula.(AU)


Introdução: Maria José Bezerra, a Maria Soldado, uma mulhernegra nascida na cidade de Limeira, São Paulo, heroína esímbolo da Revolução Constitucionalista de 1932, foi umaenfermeira de guerra reconhecida pela força, coragem,patriotismo e abnegação.Objetivo: Historicizar a trajetória de vida pessoal e profissionalde Maria José Bezerra.Metodologia: Pesquisa biográfica realizada a partir de registrosbibliográficos e documentais.Resultados: Maria José Bezerra atuou como enfermeiramembro da Legião Negra na Guerra Civil da RevoluçãoConstitucionalista de 1932, destacou-se pelos seus feitos,com contribuição ativa na construção da história do país.Conclusão: A invisibilidade negra traduz a injustiça, incoerênciade direitos e, ainda, atos que tentam desabonar o indivíduoem seus aspectos individuais e coletivos. O estudo da trajetóriadessa mulher lutadora constitui-se como estratégia de darvoz, força e sentido de tornar público a história de umarepresentante da população negra, devendo ainda ser inclusaa temática nos currículos acadêmicos.(AU)


Assuntos
Humanos , Feminino , História da Enfermagem , Papel do Profissional de Enfermagem , Militares , Racismo , Brasil , Enfermagem
12.
Front Public Health ; 12: 1346109, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38481848

RESUMO

Opioid-induced respiratory depression (OIRD) deaths are ~80,000 a year in the US and are a major public health issue. Approximately 90% of fatal opioid-related deaths are due to synthetic opioids such as fentanyl, most of which is illicitly manufactured and distributed either on its own or as an adulterant to other drugs of abuse such as cocaine or methamphetamine. Other potent opioids such as nitazenes are also increasingly present in the illicit drug supply, and xylazine, a veterinary tranquilizer, is a prevalent additive to opioids and other drugs of abuse. Naloxone is the main treatment used to reverse OIRD and is available as nasal sprays, prefilled naloxone injection devices, and generic naloxone for injection. An overdose needs to be treated as soon as possible to avoid death, and synthetic opioids such as fentanyl are up to 50 times more potent than heroin, so the availability of new, higher-dose, 5-mg prefilled injection or 8-mg intranasal spray naloxone preparations are important additions for emergency treatment of OIRDs, especially by lay people in the community. Higher naloxone doses are expected to reverse a synthetic overdose more rapidly and the current formulations are ideal for use by untrained lay people in the community. There are potential concerns about severe withdrawal symptoms, or pulmonary edema from treatment with high-dose naloxone. However, from the perspective of first responders, the balance of risks would point to administration of naloxone at the dose required to combat the overdose where the risk of death is very high. The presence of xylazines as an adulterant complicates the treatment of OIRDs, as naloxone is probably ineffective, although it will reverse the respiratory depression due to the opioid. For these patients, hospitalization is particularly vital. Education about the benefits of naloxone remains important not only in informing people about how to treat emergency OIRDs but also how to obtain naloxone. A call to emergency services is also essential after administering naloxone because, although the patient may revive, they may overdose again later because of the short half-life of naloxone and the long-lasting potency of fentanyl and its analogs.


Assuntos
Overdose de Drogas , Naloxona , Humanos , Naloxona/uso terapêutico , Analgésicos Opioides/efeitos adversos , Antagonistas de Entorpecentes/uso terapêutico , Fentanila/uso terapêutico , Heroína , Overdose de Drogas/tratamento farmacológico
13.
Molecules ; 29(5)2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38474628

RESUMO

The analysis of heroin samples, before use in the protected environment of user centra, could be a supplementary service in the context of harm reduction. Infrared spectroscopy hyphenated with multivariate calibration could be a valuable asset in this context, and therefore 125 heroin samples were collected directly from users and analysed with classical chromatographic techniques. Further, Mid-Infrared spectra were collected for all samples, to be used in Partial Least Squares (PLS) modelling, in order to obtain qualitative and quantitative models based on real live samples. The approach showed that it was possible to identify and quantify heroin in the samples based on the collected spectral data and PLS modelling. These models were able to identify heroin correctly for 96% of the samples of the external test set with precision, specificity and sensitivity values of 100.0, 75.0 and 95.5%, respectively. For regression, a root mean squared error of prediction (RMSEP) of 0.04 was obtained, pointing at good predictive properties. Furthermore, during mass spectrometric screening, 10 different adulterants and impurities were encountered. Using the spectral data to model the presence of each of these resulted in performant models for seven of them. All models showed promising correct-classification rates (between 92 and 96%) and good values for sensitivity, specificity and precision. For codeine and morphine, the models were not satisfactory, probably due to the low concentration of these impurities as a consequence of acetylation. For methacetin, the approach failed.


Assuntos
Heroína , Heroína/análise , Calibragem , Espectrofotometria Infravermelho , Análise dos Mínimos Quadrados
14.
Neuron ; 112(5): 689-691, 2024 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-38452736

RESUMO

Failure in behavioral suppression is a key feature in substance use disorders, potentially leading to compulsive drug seeking and relapse. In this issue of Neuron, Paniccia et al.1 elucidated a heroin-damaged paraventricular nucleus of the thalamus (PVT)-accumbal circuit and how recovery of PVT function could prevent heroin relapse.


Assuntos
Analgésicos Opioides , Heroína , Tálamo/fisiologia , Neurônios/fisiologia , Comportamento de Procura de Droga
15.
Math Biosci Eng ; 21(2): 3165-3206, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38454724

RESUMO

A leading crisis in the United States is the opioid use disorder (OUD) epidemic. Opioid overdose deaths have been increasing, with over 100,000 deaths due to overdose from April 2020 to April 2021. This paper presents a mathematical model to address illicit OUD (IOUD), initiation, casual use, treatment, relapse, recovery, and opioid overdose deaths within an epidemiological framework. Within this model, individuals remain in the recovery class unless they relapse back to use and due to the limited availability of specialty treatment facilities for individuals with OUD, a saturation treatment function was incorporated. Additionally, a casual user class and its corresponding specialty treatment class were incorporated. We use both heroin and all-illicit opioids datasets to find parameter estimates for our models. Bistability of equilibrium solutions was found for realistic parameter values for the heroin-only dataset. This result implies that it would be beneficial to increase the availability of treatment. An alarming effect was discovered about the high overdose death rate: by 2046, the disorder-free equilibrium would be the only stable equilibrium. This consequence is concerning because it means the epidemic would end due to high overdose death rates. The IOUD model with a casual user class, its sensitivity results, and the comparison of parameters for both datasets, showed the importance of not overlooking the influence that casual users have in driving the all-illicit opioid epidemic. Casual users stay in the casual user class longer and are not going to treatment as quickly as the users of the heroin epidemic. Another result was that the users of the all-illicit opioids were going to the recovered class by means other than specialty treatment. However, the change in the relapse rate has more of an influence for those individuals than in the heroin-only epidemic. The results above from analyzing this model may inform health and policy officials, leading to more effective treatment options and prevention efforts.


Assuntos
Overdose de Drogas , Overdose de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Humanos , Estados Unidos , Heroína , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/terapia , Analgésicos Opioides/uso terapêutico , Overdose de Drogas/epidemiologia , Overdose de Drogas/terapia , Modelos Teóricos , Recidiva
16.
Int J Drug Policy ; 126: 104367, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38460217

RESUMO

BACKGROUND: The UK is experiencing its highest rate of drug related deaths in 25 years. Poor and inconsistent access to healthcare negatively impacts health outcomes for people who use drugs. Innovation in models of care which promote access and availability of physical treatment is fundamental. Heroin Assisted Treatment (HAT) is a treatment modality targeted at the most marginalised people who use drugs, at high risk of mortality and morbidity. The first service-provider initiated HAT service in the UK ran between October 2019 and November 2022 in Middlesbrough, England. The service was co-located within a specialist primary care facility offering acute healthcare treatment alongside injectable diamorphine. METHODS: Analysis of anonymised health records for healthcare costs (not including drug treatment) took place using descriptive statistics prior and during engagement with HAT, at both three (n=15) and six (n=12) months. Primary outcome measures were incidents of wound care, skin and soft tissue infections (SSTIs), overdose (OD) events, unplanned overnight stays in hospital, treatment engagement (general and within hospital care settings) and ambulance incidents. Secondary outcome measures were costs associated with these events. RESULTS: A shift in healthcare access for participants during HAT engagement was observed. HAT service attendance appeared to support health promoting preventative care, and reduce reactive reliance on emergency healthcare systems. At three and six months, engagement for preventative wound care and treatment for SSTIs increased at the practice. Unplanned emergency healthcare interactions for ODs, overnight hospital stays, serious SSTIs, and ambulance incidents reduced, and there was an increase in treatment engagement (i.e. a reduction in appointments which were not engaged with). There was a decrease in treatment engagement in hospital settings. Changes in healthcare utilisation during HAT translated to a reduction in healthcare costs of 58% within six months compared to the same timeframe from the period directly prior to commencing HAT. CONCLUSION: This exploratory study highlights the potential for innovative harm reduction interventions such as HAT, co-located with primary care services, to improve healthcare access and engagement for a high-risk population. Increased uptake of primary healthcare services translated to reductions in emergency healthcare use and associated costs. Although costs of HAT provision are substantial, the notable cost-savings in health care should be an important consideration in service implementation planning.


Assuntos
Custos de Cuidados de Saúde , Acessibilidade aos Serviços de Saúde , Dependência de Heroína , Atenção Primária à Saúde , Humanos , Atenção Primária à Saúde/economia , Dependência de Heroína/economia , Dependência de Heroína/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Feminino , Masculino , Adulto , Reino Unido , Heroína/economia , Heroína/administração & dosagem , Overdose de Drogas/prevenção & controle , Pessoa de Meia-Idade , Atenção à Saúde/economia , Inglaterra , Tratamento de Substituição de Opiáceos/economia
17.
Neuroreport ; 35(7): 486-498, 2024 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-38526939

RESUMO

This study aimed to investigate the effects of SIRT1 modulation on heroin addiction-like behavior and its possible biological mechanisms. Wild-type C57BL/6J and Sirt1loxp/loxp D1-Cre mice were used in this experiment, and Sirt1 loxp/loxp D1-Cre(-) mice were used as a control for conditional knockout mice. Mice were divided into saline control and heroin-dependent groups. Behavioral methods were used to record the withdrawal response, conditioned place preference (CPP) changes, and open field test results. Transmission electron microscopy (TEM) was used to observe the structure of autophagosomes in nucleus accumbens (NAc) neurons. The expression of SIRT1 and autophagy-related proteins and genes, such as LC3Ⅱ, ATG5 , and ATG7 , was detected in the NAc of each mouse group via western blot, real-time quantitative PCR (qPCR) analyzes, and immunofluorescence. The results of this experiment showed that compared with the saline group, mice in the wild-type heroin-dependent group showed marked withdrawal symptoms, with more autophagosomes observed in NAc via TEM. Compared with wild-type and Sirt1loxp/loxp D1-Cre(-) heroin-dependent groups, CPP formation was found to be reduced in the conditional knockout mouse group, with a significant decrease in spontaneous activity. Western blot, qPCR, and immunofluorescence results indicated that the expression of LC3Ⅱ, ATG-5, and ATG-7 was significantly reduced in the NAc of the Sirt1loxp/loxp D1-Cre(+) group. It was still, however, higher than that in the saline control group. These results suggest that inhibition of Sirt1 expression may prevent heroin-induced addiction-related behaviors via reducing D1 neuronal autophagy.


Assuntos
Dependência de Heroína , Núcleo Accumbens , Camundongos , Animais , Dependência de Heroína/metabolismo , Heroína , Sirtuína 1/metabolismo , Camundongos Endogâmicos C57BL , Camundongos Knockout , Autofagia
18.
Forensic Sci Int ; 357: 111992, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38518570

RESUMO

Substance misuse is a major problem among individuals involved in forensic-correctional mental health services. Urine drug screening detects substance use and deters the entry of contraband into forensic-correctional units, albeit with limitations. For example, a point-of-care urine sample may not be possible and patients can alter or substitute samples to avoid detection, highlighting the role of ancillary tools to detect contraband substances. This study describes the pattern and types of substances detected from environmental samples using a gas chromatographic analyzer (TeknoScan TSI3000) in forensic-correctional populations to model the benefits of similar tools in similar settings. Samples collected over 18 months (January 2020 to June 2021) by trained staff members using the machine were reviewed. During this period, 217 environmental samples were recorded, and 66 (30%) samples were positive for contraband substances, including tetrahydrocannabinol (25%), methamphetamines (19%), and cocaine (16%). Other substances detected include methylene-dioxymethamphetamine, heroin, morphine, lysergic acid diethylamide, tramadol, and methyl-benzoate. Fewer positive samples were detected, especially during the time corresponding with the COVID-19 restriction on the forensic units. TeknoScan was beneficial as an ancillary tool to detect and deter contraband substances. It also provided evidence for risk management. Adequate training is needed for the successful implementation of the tool.


Assuntos
Serviços de Saúde Mental , Transtornos Relacionados ao Uso de Substâncias , Humanos , Heroína , Morfina , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Cromatografia Gasosa
19.
Brain Behav Immun ; 118: 210-220, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38452987

RESUMO

In opioid use disorder (OUD) patients, a decrease in brain grey matter volume (GMV) has been reported. It is unclear whether this is the consequence of prolonged exposure to opioids or is a predisposing causal factor in OUD development. To investigate this, we conducted a structural MRI longitudinal study in NIH Heterogeneous Stock rats exposed to heroin self-administration and age-matched naïve controls housed in the same controlled environment. Structural MRI scans were acquired before (MRI1) and after (MRI2) a prolonged period of long access heroin self-administration resulting in escalation of drug intake. Heroin intake resulted in reduced GMV in various cortical and sub-cortical brain regions. In drug-naïve controls no difference was found between MRI1 and MRI2. Notably, the degree of GMV reduction in the medial prefrontal cortex (mPFC) and the insula positively correlated with the amount of heroin consumed and the escalation of heroin use. In a preliminary gene expression analysis, we identified a number of transcripts linked to immune response and neuroinflammation. This prompted us to hypothesize a link between changes in microglia homeostasis and loss of GMV. For this reason, we analyzed the number and morphology of microglial cells in the mPFC and insula. The number of neurons and their morphology was also evaluated. The primary motor cortex, where no GMV change was observed, was used as negative control. We found no differences in the number of neurons and microglia cells following heroin. However, in the same regions where reduced GMV was detected, we observed a shift towards a rounder shape and size reduction in microglia, suggestive of their homeostatic change towards a reactive state. Altogether these findings suggest that escalation of heroin intake correlates with loss of GMV in specific brain regions and that this phenomenon is linked to changes in microglial morphology.


Assuntos
Substância Cinzenta , Heroína , Humanos , Ratos , Animais , Heroína/efeitos adversos , Microglia , Estudos Longitudinais , Encéfalo , Imageamento por Ressonância Magnética
20.
Biomed Pharmacother ; 173: 116414, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38460374

RESUMO

Drug-associated long-term memories underlie substance use disorders, including heroin use disorder (HUD), which are difficult to eliminate through existing therapies. Addictive memories may become unstable when reexposed to drug-related cues and need to be stabilized again through protein resynthesis. Studies have shown the involvement of histone acetylation in the formation and reconsolidation of long-term drug-associated memory. However, it remains unknown whether and how histone acetyltransferases (HAT), the essential regulators of histone acetylation, contribute to the reconsolidation of heroin-associated memories. Herein, we investigated the function of HAT in the reconsolidation concerning heroin-conditioned memory by using a rat self-administration model. Systemic administration of the HAT inhibitor garcinol inhibited cue and heroin-priming induced reinstatement of heroin seeking, indicating the treatment potential of garcinol for relapse prevention.


Assuntos
Heroína , Histonas , Terpenos , Ratos , Animais , Heroína/farmacologia , Histonas/metabolismo , Ratos Sprague-Dawley , Acetilação
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