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Substance Abuse during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Studies of heroin use during pregnancy are of illicit use only. The health effects of heroin use are confounded because users often abuse other drugs (alcohol, cocaine), use tobacco, and have poor health and nutritional status. Heroin purity, dose, frequency, duration, and trimesters of use are usually unknown in studies of drug use during pregnancy. Notably, prescription use of opioids during pregnancy was significantly associated with birth defects (Chapter 8).
Lifestyle and Diet
Published in Chuong Pham-Huy, Bruno Pham Huy, Food and Lifestyle in Health and Disease, 2022
Chuong Pham-Huy, Bruno Pham Huy
Short-term administration of heroin or morphine produces euphoria, sedation, and a feeling of tranquility. Repeated administration rapidly produces tolerance and intense physical dependence. Overdose can cause lethal respiratory depression (125). Heroin is usually used as an illegal drug of abuse. Heroin, also known as diacetylmorphine, is a semi-synthetic compound obtained by acetylation of morphine, and is more potent than morphine (129). Heroin can be sniffed, smoked, or injected. Heroin is a strong agonist of opioid receptors. It has a short half-life of three minutes in blood after intravenous administration, requiring drug abusers to use it several times per day to maintain the desired effect (129). Heroin is rapidly metabolized into morphine and totally absent in urine. Common side effects of heroin include respiratory depression, sleepiness, dizziness, confusion, nausea, sedation, and impaired coordination. The health risks of heroin intake are addiction, constipation, endocarditis, hepatitis, HIV, and fatal overdose. Injection of heroin can cause infection and HIV due to the transmission of virus or bacteria from contaminated syringes. In the event of overdose death, this can include signs of pulmonary edema in lung tissue sections and rhabdomyolysis, including myocardial injury (129).
Care of opiate users: maintenance treatment
Published in Berry Beaumont, David Haslam, Care of Drug Users in General Practice, 2021
Where heroin is used by injection, the preferred route for heavy users because of the relative efficiency of this method of delivery, the health risks encountered include deep vein thrombosis, pulmonary embolus and sepsis both local and systemic. Where injecting equipment is shared, there are the attendant risks of transmission of bloodborne viruses, with an estimated 20–70% of injecting drug users being positive for hepatitis C antibodies.2 Although the proportion of injecting drug users who have evidence of hepatitis B and HIV is lower, the risk is nevertheless significant. General unwanted side-effects of heroin use include low salivary flow, leading to severe dental decay, severe constipation and adverse effects on pregnancy outcomes. Death associated with heroin use is common, with injecting drug users experiencing approximately 14 times the mortality rate compared with their non-drug using peers.3 Death is usually the result of coma and respiratory depression from heroin overdose, often in conjunction with other respiratory and CNS depressants such as alcohol, other opiates and benzodiazepines.
Estimating the impact of drug addiction causes heart damage
Published in Drug and Chemical Toxicology, 2023
Sheng-Huang Chang, Pei-Ying Pai, Chiung-Hung Hsu, Shibu Marthandam Asokan, Bruce Chi-Kang Tsai, Wen-Tsan Weng, Wei-Wen Kuo, Tzu-Ching Shih, Hui-Chuan Kao, William Shao-Tsu Chen, Chih-Yang Huang
Amphetamine and heroin rank first and second among the drugs seized by various judicial units in Taiwan (Administration 2018). The impact of dangerous behaviors of drug abusers on public safety is more difficult to estimate. The pharmacological properties of amphetamine are due to aniline, a central stimulator of sympathetic nerves, promoting the release of dopamine, norepinephrine, and epinephrine. It causes the excessive release of these neurotransmitters, thus promoting nerve overexcitation and inducing neurological symptoms. The impact of amphetamines on the cardiovascular system is mainly due to the increased release of norepinephrine (Robertson et al.2009). Heroin is obtained by acetylation from morphine and acetic anhydride. The main side effect of heroin use is respiratory depression, which causes death after intravenous injection. Heroin also causes severe cardiovascular problems, including arrhythmias, non-cardiac pulmonary edema, and reduction of cardiac output (Frishman et al. 2003). Chronic heart failure caused by heroin abuse may also be related to the production of TNF-α (Chen et al. 2012).
Preliminary attitudes on medications for opioid use disorders (MOUDs) in Southeastern Switzerland and New York City
Published in Journal of Addictive Diseases, 2023
Felipe Castillo, Daniel Scalise, David Hernandez, Rahul Gupta, Cale N. Basaraba, Thomas Corbeil, Sandra D. Comer, Andres R. Schneeberger
The current opioid epidemic in the US calls for increasing efforts to curtail the number of preventable early deaths, decrease the morbidity associated with drug use, and increase the quality of life for those suffering from substance use disorders. Many interventions in the US in the past 10 years have only moved the dial slightly in the previously mentioned goals and have not prevented subsequent “waves” of the crisis from surging. At this stage, it is important to accurately identify factors such as attitudes and beliefs toward treatment options. This study assessed attitudes and beliefs in two separate samples in affluent countries in the developed world by means of a novel survey instrument. Based on this survey, attitudes on the role of Heroin-Assisted Treatment appear independent of competence in treating psychiatric disorders, how comfortable providers are with SUDS, and with the principles of addiction science. The most salient difference was seen in the attitudes toward this singular modality used in the treatment of OUD that is available as medical treatment by prescription in Switzerland and is listed by the Drug Enforcement Administration in Schedule I (no accepted medical use, a lack of accepted safety for use under medical supervision, and a high potential for abuse) in the United States. From a regulatory point of view, there are multiple barriers that would need to be addressed before HAT could be implemented in the US.
Polysubstance use and adherence to antiretroviral treatment in the Miami Adult Studies on HIV (MASH) cohort
Published in AIDS Care, 2022
Abraham Degarege, Karl Krupp, Javier Tamargo, Sabrina Sales Martinez, Adriana Campa, Marianna Baum
About one-third of the 1.2 million people living with HIV (PLHIV) in the United States abuse drugs or alcohol (NIDA, 2020). Substance misuse has been associated with lower acceptance and adherence to antiretroviral therapy (ART), poorer engagement with healthcare, and lower rates of persistence in care (Montgomery et al., 2019; Rowell-Cunsolo & Hu, 2020; Socias & Milloy, 2018). Examined as composite exposures, Kader and associates found that hazardous or harmful alcohol use and problematic drug use predicted missing and discontinuing ART (Kader et al., 2015). Differing substances, routes of administration, and patterns of drug abuse have been shown to have unique associations with compliance and adherence to prescribed treatment (Azar et al., 2015; Garin et al., 2017). Injecting heroin and cocaine, for instance, have been associated with poorer overall adherence and a lower likelihood of achieving viral suppression (Azar et al., 2015; Feldman et al., 2019). Interestingly, the use of recreational marijuana among PLHIV was associated with improved adherence to ART (Mannes et al., 2018). Others have also found that while heroin use impairs adherence, methadone maintenance therapy improves it (Azar et al., 2015; Culbert et al., 2019). Alcohol abuse appears to have one of the most complex relationships with ART adherence. Research suggests that the risk of nonadherence is differentially associated with problem drinking, alcohol use disorders, binge drinking, and moderate alcohol use (Molina et al., 2018; Paolillo et al., 2017).