Opiate addiction in China: current situation and treatments

Yunnan Baiyao Adjuvant Treatment for Patients with Hemoptysis: A Systematic Review and Meta-Analysis

Background

Yunnan Baiyao (YNBY) is a traditional Chinese medicine used to treat bleeding. We evaluated the efficacy of YNBY plus conventional pharmaceutical treatment (CPT) versus CPT alone in patients with hemoptysis.

Methods

A total of eight electronic databases were searched. The outcomes in the included studies were effective rate, hemoptysis volume, duration of hemoptysis and hospitalization, number of cases requiring endotracheal intubation, and adverse events (AEs). The studies were used to calculate risk ratios (RRs) or mean differences (MDs) with corresponding 95% confidence intervals. Risk of bias for included trials was assessed using the Cochrane risk of bias tool.

Results

Thirteen RCTs were analyzed consisting of a total of 1379 patients. Treatment with YNBY + CPT had a greater effective rate than CPT alone (RR: 1.18; 95% CI: 1.13 to 1.23; P < 0.001; I² = 0%), a lower hemoptysis volume (MD: −107.37; 95% CI: −121.69 to −93.06; P < 0.001; I² = 0%), a shorter duration of hemoptysis (MD: −2.70; 95% CI: −2.96 to 2.43; P < 0.001; I² = 0%) and hospitalization (MD: −2.38; 95% CI: −2.93 to −1.83; P < 0.001; I² = 9%), and a reduction in the incidence of AEs (RR: 0.34; 95% CI: 0.23 to 0.51; P < 0.001; I² = 0%). YNBY + CPT treatment provided no significant difference in reducing the number of cases requiring endotracheal intubation compared to CPT alone (RR: 0.49; 95% CI: 0.15 to 1.60; P=0.24; I² = 0%).

Conclusion

YNBY plus CPT showed better efficacy than CPT for patients with hemoptysis. Our study provides medical evidence for the efficacy and safety of YNBY for hemoptysis.

Environmental enrichment reduces heroin seeking following incubation of craving in both male and female rats

BACKGROUND

Contemporary treatments for heroin use disorder demonstrate only limited efficacy when the goals are long term abstinence and prevention of relapse. We have demonstrated that environmental enrichment (EE) reduces cue-induced heroin reinstatement in male rats. The present study is an attempt to extend the "anti-relapse" effects of EE to female rats and to periods where incubation of craving is hypothesized to occur.

METHODS

This experiment implemented a 3-phase procedure. In Phase 1, male and female rats were trained to self-administer heroin for 15 days. Phase 2 consisted of a 3- or 15-day forced abstinence (FA) period. In Phase 3 half of the rats were placed into EE and the other half in non-EE housing and subsequently tested for responding in extinction (no heroin or cues) for 15 days followed by a cue-induced reinstatement test.

RESULTS

We found that rats in the 15 days FA condition showed significantly enhanced drug seeking during extinction, irrespective of sex. We also found that EE significantly reduced this effect. During reinstatement, EE significantly reduced drug seeking in male and female rats and in both 3- and 15-day FA groups.

CONCLUSIONS

EE, with or without prolonged FA, effectively reduced heroin seeking in male and female rats. These findings indicate that EE can reduce drug-seeking in males and females and when putative incubation of craving (i.e., prolonged abstinence period) has occurred and suggest that it may aid in the development of future long-term behavioral treatments for individuals at risk for heroin relapse.

Spread the Word: There Are Two Opioid Crises!

Pain is associated with emotional and physical suffering that severely impacts quality of life. Many guidelines for the treatment of moderate to severe cancer pain indicate the use of opioids. For a small proportion of the global population, opioids are readily accessible, but are consequently also subject to risk of overuse and misuse. On the other hand, many regions provide limited access to licensed opioid therapeutics and patients struggle for better pain management. The use of prescription opioids for treatment of severe cancer and acute pain is well established, but opioid use in chronic non-cancer pain is controversial and not supported by the literature. The opioid crisis and the increasing overdose fatalities in some countries have resulted in a resurgence of opiophobia in these countries, but even worse, amplified opiophobia in countries with lower opioid consumption. In this narrative review, we highlight how the opioid crisis of overuse in some countries can negatively impact appropriate access to opioids elsewhere. The availability of opioids for clinical and recreational use differs between countries worldwide-this is an important factor in determining the occurrence of a 'crisis of recreational use of opioids' or a 'crisis of under-prescription of opioids' for pain management.

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

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.

Methods

Male patients with HUD who had been undergoing either PA (n=24) or MTT (n=21) for approximately 12 months, together with 20 demographically matched healthy controls, completed an event-related functional magnetic resonance imaging (fMRI) task. The subjective craving for heroin was evaluated using a visual analog scale.

Results

Compared to the healthy controls, the MMT and PA groups demonstrated significantly higher brain activation in the left pallidum, middle occipital gyrus, postcentral gyrus, anterior cingulate cortex, middle cingulate cortex, inferior parietal lobule, superior parietal lobule, amygdala, hippocampus, right inferior temporal gyrus, inferior frontal gyrus triangularis, and caudate during exposure to heroin-related cues. Compared to those undergoing PA, patients in the MMT group demonstrated significantly higher brain activation in all of these regions. Except for the left inferior parietal lobule and left superior parietal lobule, there were no statistically significant differences between the PA and healthy control groups. The MMT patients showed significantly higher subjective cravings before and after exposure to heroin cues than the PA group, but there was no significant difference in the change in subjective cravings between the 2 groups.

Conclusions

The results suggested that although the HUD patients receiving long-term MMT complied with the treatment, they still had higher subjective cravings and cue-induced brain activation than those undergoing PA. Therefore, long-term PA appears to be more beneficial than MMT in reducing the salience value of drug cues in patients with HUD.

Structural MRI and functional connectivity features predict current clinical status and persistence behavior in prescription opioid users

Prescription opioid use disorder (POUD) has reached epidemic proportions in the United States, raising an urgent need for diagnostic biological tools that can improve predictions of disease characteristics. The use of neuroimaging methods to develop such biomarkers have yielded promising results when applied to neurodegenerative and psychiatric disorders, yet have not been extended to prescription opioid addiction. With this long-term goal in mind, we conducted a preliminary study in this understudied clinical group. Univariate and multivariate approaches to distinguishing between POUD (n = 26) and healthy controls (n = 21) were investigated, on the basis of structural MRI (sMRI) and resting-state functional connectivity (restFC) features. Univariate approaches revealed reduced structural integrity in the subcortical extent of a previously reported addiction-related network in POUD subjects. No reliable univariate between-group differences in cortical structure or edgewise restFC were observed. Contrasting these mixed univariate results, multivariate machine learning classification approaches recovered more statistically reliable group differences, especially when sMRI and restFC features were combined in a multi-modal model (classification accuracy = 66.7%, p < .001). The same multivariate multi-modal approach also yielded reliable prediction of individual differences in a clinically relevant behavioral measure (persistence behavior; predicted-to-actual overlap r = 0.42, p = .009). Our findings suggest that sMRI and restFC measures can be used to reliably distinguish the neural effects of long-term opioid use, and that this endeavor numerically benefits from multivariate predictive approaches and multi-modal feature sets. This can serve as theoretical proof-of-concept for future longitudinal modeling of prognostic POUD characteristics from neuroimaging features, which would have clearer clinical utility.

Altered brain intrinsic functional hubs and connectivity associated with relapse risk in heroin dependents undergoing methadone maintenance treatment: A resting-state fMRI study

BACKGROUND

The neural substrates underlying the relapse behavior of heroin dependents (HD) who received long-term methadone maintenance treatment (MMT) have yet to be thoroughly expounded. This study investigated the relapse-related intrinsic functional hubs of HD and their functional integration feature at whole brain network level.

METHODS

57 male HD receiving MMT and 49 matched healthy controls (HC) were enrolled. All of the subjects received resting-state functional magnetic resonance imaging scan. And the 57 patients were assigned a 26-month follow-up for collecting illegal drug use information. Of them, 11 were non-relapsers and 46 relapsers. We analyzed the voxel-based degree centrality (DC) to reveal the differences in nodule centrality between HD and HC, conducted Pearson partial-correlation analysis to confirm the relationship between relapse frequency and DC value of the nodes with significant intergroup differences, and finally compared the functional connectivity (FC) of the relapse-related hubs between non-relapsers and relapsers.

RESULTS

We found the DC values of right insula and left nucleus accumbens (NAc) were negatively correlated with relapse frequency. Compared with the non-relapsers, the relapsers had a significant decreased FC between left NAc and inhibitory control circuitry, including left dorsolateral prefrontal cortex, left inferior frontal gyrus and motor regions.

CONCLUSIONS

These findings suggest that the neural substrates of relapse vulnerability in HD undergoing MMT are the intrinsic functional hubs of introceptive and reward systems and the latter modulates relapse behavior via interaction with inhibitory control circuit.

The Efficacy of Combined Electroacupuncture and Auricular Pressure on Sleep Quality in Patients Receiving Methadone Maintenance Treatment

BACKGROUND AND OBJECTIVES

Previous studies have revealed that the electroacupuncture or auricular-point pressure as a single treatment approach is beneficial for relieving insomniac symptoms among patients under methadone maintenance treatment (MMT). This study is designed to evaluate the clinical efficacy of combining two treatments.

METHODS

This study was a randomized, controlled, crossover trial. A total of 50 participants were recruited from the Linsen Chinese Medicine and Kunming Branches of Taipei City Hospital and randomly assigned to Groups A (25 participants) and B (25 participants). In Group A (electroacupuncture at the Hegu point (LI4) and Zusanli point (ST36) and auricular-point pressure on the Shenmen point) and Group B (only auricular-point), the interventions were implemented biweekly for 4 weeks. After a 1-week washout period, a crossover of the groups was performed. Sleep quality, according to the Pittsburgh Sleep Quality Index (PSQI), and daily attendance rate of MMT were evaluated.

RESULTS

Combined therapy significantly improved sleep quality, especially in the PSQI subscales of subjective sleep quality (60.91% vs 20.93%, P < 0.05) and sleep latency (42.59% vs 11.28%, P < 0.05). A significantly higher daily attendance rate was noted in combined therapy than single therapy (87% ± 2% vs 82% ± 2%, P < 0.001).

DISCUSSION AND CONCLUSIONS

The combination of the electroacupuncture with auricular-point pressure demonstrated high efficacy for improving sleep quality and increasing MMT adherence compared with single therapy of auricular-point pressure.

SCIENTIFIC SIGNIFICANCE

Combined therapy of the electroacupuncture and auricular-point pressing should be introduced as a routine, facilitating treatment for patients under methadone maintenance. (Am J Addict 2020;00:00-00).

Smuggling of drugs by body packing: Evidence from Chinese sentencing documents

BACKGROUND

In China, body packing as a means of transporting drugs was firstly found in Yunnan province in an area that shares a border with the Golden Triangle in late 1970s. Since then, drug trafficking cases that utilize body packing as the primary mode of transportation have increased substantially. Due to a scarcity of data, however, the scope and nature of such criminal activity is not thoroughly understood. This study provides a new approach to the analysis of body packing by digitizing and analyzing court sentencing documents in China from 2006-2016.

METHODOLOGY

This study implements network analysis and descriptive statistics to identify the structures of drug trafficking routes involving body packing in China and aims to provide a comprehensive examination of body packing activity, including the pattern of geographic routes and the characteristics of captured body packers. A generalized inflated negative binomial model is also used to investigate the effects of legal and extra-legal factors on the length of sentence for captured body packers.

RESULTS

We identified three types of trafficking routes involving body packing: intra-provincial, inter-provincial, and international. Our results showed that heroin and methamphetamine are the two primary drugs trafficked by captured body packers. Network analysis revealed that among body packing routes, there are three major hubs that serve as the primary origin for the trafficking -Yunnan, Sichuan, and Myanmar- and three potential authorities- Guangdong, Xinjiang, and Sichuan-which serve as the common destinations of the drug routes. Consistent with previous studies, our research also demonstrated that heavier punishments are given in cases that involve a larger quantity of drugs and repeat offenders. Offenders who fall into special groups, such as pregnant/lactating women, the disabled, or minors, receive more lenient sentences. In addition, our analysis further revealed that the logic behind longer sentences for those offenders who confessed as opposed to those who did not, is possibly due to the concentration of imprisonment values at fifteen years, as many of the confessed body packers are sentenced to the maximum fixed term of imprisonment.

CONCLUSION

By narrowing the gap in knowledge on the topic of body packing, our analysis provides evidence-based strategies for fighting against body packing, specifically by identifying geographical patterns and the profiles of captured body packers.

Efficacy of Electroacupuncture Combined with Auricular Point Pressing in Improving Mental Well-Being among Individuals with Heroin Use Disorder: A Randomized Controlled Crossover Trial and Pilot Study

Objective

To evaluate the clinical efficacy of combining electroacupuncture with auricular point pressing in improving quality of life of individuals with heroin use disorder undergoing methadone maintenance treatment.

Design

A randomized controlled crossover trial.

Subjects

50 participants were recruited from Taipei City Hospital, Linsen Chinese Medicine and Kunming branches, and randomly allocated to treatment groups.

Method

The 36-Item Short Form Health Survey (SF-36) was used. Group A received electroacupuncture at the Hegu (LI4) and Zusanli (ST36) and auricular point pressing on Ear Shenmen, and Group B received only auricular point pressing on Ear Shenmen biweekly for 4 weeks. After a 1-week washout period, crossover of the groups was performed.

Results

The SF-36 mental component scores of the combined treatment group improved relative to the single treatment group (11.09 vs. 10.33, p=0.023). Methadone dosage was reduced in both groups (combined therapy group: 8.58 ± 4.17/7.76 ± 4.11 (baseline/posttreatment) vs. single therapy group: 8.36 ± 4.20/8.30 ± .28, p=0.001).

Conclusion

Combined therapy of high-frequency electroacupuncture with auricular point pressing had better efficacy in enhancing quality of life, especially for mental well-being, and in gradually reducing methadone dosage.

Reasons of relapse and pattern of drug use among the substance users in Bangladesh: A nationwide study

This study aimed at investigating the reasons of relapse and patterns of drug use among the substance users in Bangladesh. We have conducted a descriptive type of cross-sectional study among the relapse cases of substances users in the whole of Bangladesh. Concerning the reasons for relapse after taking treatment; family unrest (29.5%), peer pressure (27.4%), to reduce depression (24.8%) and craving for drugs (24.3%) were the most frequent. Amphetamine was reported to be the most used drug (76.1%, n = 693), followed by cannabis (75%, n = 683) and alcohol (54.3%, n= 495). Further extensive studies are also needed to explore the association.

Decreased Relative Cerebral Blood Flow in Unmedicated Heroin-Dependent Individuals

Understanding the brain mechanisms of heroin dependence is invaluable for developing effective treatment. Measurement of regional cerebral blood flow (CBF) provides a method to visualize brain circuits that are functionally impaired by heroin dependence. This study examined regional CBF alterations and their clinical associations in unmedicated heroin-dependent individuals (HDIs) using a relatively large sample. Sixty-eight (42 males, 26 females; age: 40.9 ± 7.3 years) HDIs and forty-seven (34 males, 13 females; age: 39.3 ± 9.2 years) matched healthy controls (HCs) underwent high-resolution T1 and whole-brain arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) scans. Additionally, clinical characteristics were collected for neurocognitive assessments. HDIs showed worse neuropsychological performance than HCs and had decreased relative CBF (rCBF) in the bilateral middle frontal gyrus (MFG), inferior temporal gyrus, precuneus, posterior cerebellar lobe, cerebellar vermis, and the midbrain adjacent to the ventral tegmental area; right posterior cingulate gyrus, thalamus, and calcarine. rCBF in the bilateral MFG was negatively correlated with Trail Making Test time in HDIs. HDIs had limbic, frontal, and parietal hypoperfusion areas. Low CBF in the MFG indicated cognitive impairment in HDIs. Together, these findings suggest the MFG as a critical region in HDIs and suggest ASL-derived CBF as a potential marker for use in heroin addiction studies.

Reduced response inhibition after exposure to drug-related cues in male heroin abstainers

RATIONALE

Deficits in response inhibition associated with heroin use could last several months after abstinence in heroin users, and their response inhibition can also be interfered with task-irrelevant drug-related cues. However, it is unclear whether exposure to drug-related cues affects subsequent response inhibition in heroin users following abstinence.

OBJECTIVES

The present study aimed to investigate how drug-related cues with different durations between stimulus presentations, referred to as stimulus onset asynchronies (SOAs), affect subsequent response inhibition in heroin abstainers (HAs) with different length of abstinence.

METHODS

Sixty-seven male HAs performed a modified Go/NoGo task in which a motor response to frequent Go targets and no response to rare NoGo targets were required and a Go or NoGo target was displayed after either a heroin-related or a neutral picture presented for the 200 ms and 600 ms SOAs.

RESULTS

The HAs responded significantly faster to Go targets following the neutral pictures for the 600 ms SOA compared to other conditions. They also made more commission errors following heroin-related pictures compared to neutral pictures regardless of the SOAs. The shorter-term HAs made more commission errors compared to the longer-term HAs following the 200 ms SOA, and it was only a trend when the SOA was 600 ms. Additionally, negative correlations between the duration of current abstinence and commission errors were observed following cues with the 200 ms SOA.

CONCLUSIONS

Impaired response inhibition in HAs can be improved through protracted drug abstinence. However, that effect can be reduced by exposure to drug-related cues, which may increase the risk of relapse.

Smuggling of drugs by body packing: Evidence from Chinese sentencing documents

BACKGROUND

In China, body packing as a means of transporting drugs was firstly found in Yunnan province in an area that shares a border with the Golden Triangle in late 1970s. Since then, drug trafficking cases that utilize body packing as the primary mode of transportation have increased substantially. Due to a scarcity of data, however, the scope and nature of such criminal activity is not thoroughly understood. This study provides a new approach to the analysis of body packing by digitizing and analyzing court sentencing documents in China from 2006-2016.

METHODOLOGY

This study implements network analysis and descriptive statistics to identify the structures of drug trafficking routes involving body packing in China and aims to provide a comprehensive examination of body packing activity, including the pattern of geographic routes and the characteristics of captured body packers. A generalized inflated negative binomial model is also used to investigate the effects of legal and extra-legal factors on the length of sentence for captured body packers.

RESULTS

We identified three types of trafficking routes involving body packing: intra-provincial, inter-provincial, and international. Our results showed that heroin and methamphetamine are the two primary drugs trafficked by captured body packers. Network analysis revealed that among body packing routes, there are three major hubs that serve as the primary origin for the trafficking -Yunnan, Sichuan, and Myanmar- and three potential authorities- Guangdong, Xinjiang, and Sichuan-which serve as the common destinations of the drug routes. Consistent with previous studies, our research also demonstrated that heavier punishments are given in cases that involve a larger quantity of drugs and repeat offenders. Offenders who fall into special groups, such as pregnant/lactating women, the disabled, or minors, receive more lenient sentences. In addition, our analysis further revealed that the logic behind longer sentences for those offenders who confessed as opposed to those who did not, is possibly due to the concentration of imprisonment values at fifteen years, as many of the confessed body packers are sentenced to the maximum fixed term of imprisonment.

CONCLUSION

By narrowing the gap in knowledge on the topic of body packing, our analysis provides evidence-based strategies for fighting against body packing, specifically by identifying geographical patterns and the profiles of captured body packers.

Meeting the challenges of opioid dependence in China: experience of opioid agonist treatment

PURPOSE OF REVIEW

This article reviews the role of methadone maintenance treatment (MMT) clinics in minimizing the harms caused by opioid dependence, as well as China's current challenges in this area. In addition, we aim to discuss the treatment strategies for opioid dependence within the international community in the current global situation of serious abuse of opioids.

RECENT FINDINGS

Like other countries facing the opioid crisis, China is actively working on revising policy, improving the addiction treatment system and promotion of MMT clinics to cope with the risks of opioid abuse. As they provide one of the most effective opioid agonist treatments for opioid dependence, MMT clinics play an extremely important role in this campaign. The MMT programme in China has had a significant beneficial effect on reduction of opioid use and the prevalence rate of HIV/AIDS.

SUMMARY

The efficacy of MMT for patients with opioid dependence in China is confirmed by the present review. However, several important challenges still need to be resolved. China's treatment experience also provides a reference for other countries facing the danger of opioid dependence.

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.

An intervention to improve provider-patient interaction at methadone maintenance treatment in China

BACKGROUND

This study evaluated an intervention aiming to improve methadone maintenance therapy (MMT) service providers' interaction with their patients in China.

METHODS

Sixty-eight MMT clinics were randomized to either an intervention or a control condition. Providers in the intervention group attended three group training sessions to enhance their communication skills. Trained providers were encouraged to practice the taught communication skills through provider-initiated individual sessions with their patients. A total of 418 service providers completed assessments from baseline to 24-month. Linear mixed-effects regression models were used to compare self-reported short-term and sustained improvement in provider-patient interaction between the intervention and the control conditions.

RESULTS

The intervention group service providers perceived significantly greater short-term and sustained improvement in provider-patient interaction compared to the control group service providers (estimated difference (±SE): 1.20 (0.24) and 1.35 (0.33), respectively; p-values < 0.0001). Providers' baseline job satisfaction was significantly associated with a greater perceived improvement in provider-patient interaction for both periods (reg. coef. (±SE): 0.02 (0.01) and 0.04 (0.01) for short-term and sustained periods, respectively; p-values < 0.01).

CONCLUSION

Study findings suggest that the intervention could be beneficial for improving perceived provider-patient interaction in MMT programs. Service providers' job satisfaction should be addressed in training programs for the improvement of provider-patient interaction.

Causes and Consequences of Drug Abuse: A Comparison Between Synthetic Drug and Heroin Users in Urban China

This article examined the differences in causes and health consequences between synthetic drug and heroin abuse in urban China. Two-group comparisons were conducted to quantify differences in individual characteristics, causes of drug use, and HIV/STI risky sexual behavior between synthetic drug and heroin users; logistic regressions were employed to assess the net effect of synthetic drug use on risky sexual behavior. Results revealed that causes of synthetic drug use differed from those of heroin use; a combination of the knowledge gap concerning the harmful impact of synthetic drugs and the lesser punishment for their use appeared a main reason behind the shift from heroin to synthetic drugs; and synthetic drug use was a significant and powerful risk factor for HIV/STI risky sexual behavior. Educational and behavioral interventions are urgently needed to prevent the initiation of synthetic drug use among users to reduce their HIV/STI risky sexual behavior.

Chinese Female Drug Users' Experiences and Attitudes With Institutional Drug Treatment

With its rapid economic growth and the increased influence of Western culture, China has become a drug-consuming country. Forty-six semistructured interviews were conducted in a compulsory drug treatment institution to document Chinese female drug users' experiences with and attitudes toward two mandated treatment modalities: vocational training and educational activities. Detainees required to participate in first institutional treatment showed enthusiasm and had more positive attitudes; those who had entered the compulsory treatment facilities 2 or more times generally had a negative outlook on their pursuit of abstinence. Although female detainees achieved detoxification in the institution, many relapsed upon release to their community, indicating the institutional compulsory treatment model's failure to ensure long-term abstinence. By revealing four main flaws of the current institutional compulsory treatment, this study indicates the need for a comprehensive treatment system that combines improvements to institutional treatment and development of community-based treatment to address different stages of abstinence.

Poly-Drug Use of Prescription Medicine among People with Opioid Use Disorder in China: A Systematic Review and Meta-Analysis

BACKGROUND

Opioid use disorder (OUD) causes substantial public health and social problems worldwide. Poly-drug use is common in people with OUD and increases morbidity and mortality. Investigation of the patterns and characteristics of poly-drug use of prescription medicine among opioid users is needed to develop appropriate prevention and intervention strategies.

OBJECTIVES

To estimate the prevalence of poly-drug use of prescription medicine among people with OUD in China using meta-analysis.

METHODS

We searched relevant epidemiological studies published before February 2017 in English and Chinese databases. The quality of included studies was assessed using the Agency for Healthcare Research and Quality scale. The pooled prevalences of prescription medicine use among people with OUD were estimated.

RESULTS

We included 80 eligible studies in the meta-analysis. The main prescription medicines were benzodiazepines (BZDs) and prescription opioid analgesics. The pooled prevalence of unclassified BZDs and prescription opioids was 40.6% and 23.2%, respectively. Diazepam was the most frequently co-used BZD (32.6%), followed by triazolam (32.1%), and estazolam (9.2%). Tramadol was the most commonly used prescription opioid (27.3%), followed by methadone (16.8%), buprenorphine (12.6%), pethidine (8.9%), morphine (6.5%), dihydroetorphine (3.9%), and codeine-containing cough syrup (3.7%). BZDs were mainly used for self-medication (56.1%), whereas prescription opioids were primarily coused for nonmedical purposes (69.4%).

CONCLUSIONS

The results demonstrate that prescription medicine use is widespread among opioid users in China. There needs to be more consideration of poly-drug use, and early interventions and management strategies are needed to prevent poly-drug use among opioid users in China.

Feasibility of a Mobile Phone App to Support Recovery From Addiction in China: Secondary Analysis of a Pilot Study

Background

Mobile health technologies have been found to improve the self-management of chronic diseases. However, there is limited research regarding their feasibility in supporting recovery from substance use disorders (SUDs) in China.

Objective

The objective of this study was to examine the feasibility of a mobile phone-based ecological momentary assessment (EMA) app by testing the concordance of drug use assessed by the EMA, urine testing, and a life experience timeline (LET) assessment.

Methods

A total of 75 participants dependent on heroin or amphetamine-type stimulant (ATS) in Shanghai were recruited to participate in a 4-week pilot study. Of the participants, 50 (67% [50/75]) were randomly assigned to the experimental group and 25 (33% [25/75]) were assigned to the control group. The experimental group used mobile health (mHealth) based EMA technology to assess their daily drug use in natural environments and received 2 short health messages each day, whereas the control group only received 2 short health messages each day from the app. Urine tests and LET assessments were conducted each week and a post-intervention survey was administered to both groups. The correlations among the EMA, the LET assessment, and the urine test were investigated.

Results

The mean age of the participants was 41.6 (SD 8.0) years, and 71% (53/75) were male. During the 4 weeks of observation, 690 daily EMA survey data were recorded, with a response rate of 49.29% (690/1400). With respect to drug use, the percent of agreement between the EMA and the LET was 66.7%, 79.2%, 72.4%, and 85.8%, respectively, for each of the 4 weeks, whereas the percent of agreement between the EMA and the urine test was 51.2%, 65.1%, 61.9%, and 71.5%, respectively. The post-intervention survey indicated that 46% (32/70) of the participants preferred face-to-face interviews rather than the mHealth app.

Conclusions

This study demonstrated poor agreement between the EMA data and the LET and found that the acceptance of mHealth among individuals with SUDs in China was not positive. Hence, greater efforts are needed to improve the feasibility of mHealth in China.

A pilot study of a smartphone application supporting recovery from drug addiction

BACKGROUND

Mobile health (mHealth) technologies have the potential to facilitate self-monitoring and self-management for individuals with substance use disorders (SUD). S-Health is a bilingual smartphone application based on cognitive behavioral principles and is designed to support recovery from drug addiction by trigger recognition so as to allow practice in-the-moment coping to prevent relapse.

METHOD

For this pilot randomized controlled study, 75 participants were recruited from methadone maintenance treatment clinics and the social worker consortium in Shanghai, China. Participants in the control group (N=25) received text messages from S-Health (e.g., HIV prevention and other educational materials). Participants in the intervention group (N=50) received both text messages and daily surveys on cravings, affects, triggers, responses to triggers, and social contexts.

RESULTS

At the end of the 1-month study trial, 26.2% of the intervention group and 50% of the control group had positive urine test results (p=0.06). Also, the number of days using drug in the past week was significantly lower among participants in the intervention group (Mean=0.71, SD=1.87) relative to the control group (Mean=2.20, SD=3.06) (p<0.05). The two groups did not differ in slopes (i.e., rates of change in outcomes measured weekly) based on the mixed effects model. Participants in the intervention group also preferred answering questions on the cellphone (46.8%) relative to in-person interviews (36.2%).

CONCLUSIONS

This pilot demonstrated the feasibility and potential benefits to deliver mobile health intervention among participants with SUD. Further research with larger samples over a longer period of time is needed to test the effectiveness of S-Health as a self-monitoring tool supporting recovery from addiction.

Disrupted coupling of large-scale networks is associated with relapse behaviour in heroin-dependent men

BACKGROUND

It is unknown whether impaired coupling among 3 core large-scale brain networks (salience [SN], default mode [DMN] and executive control networks [ECN]) is associated with relapse behaviour in treated heroin-dependent patients.

METHODS

We conducted a prospective resting-state functional MRI study comparing the functional connectivity strength among healthy controls and heroin-dependent men who had either relapsed or were in early remission. Men were considered to be either relapsed or in early remission based on urine drug screens during a 3-month follow-up period. We also examined how the coupling of large-scale networks correlated with relapse behaviour among heroin-dependent men.

RESULTS

We included 20 controls and 50 heroin-dependent men (26 relapsed and 24 early remission) in our analyses. The relapsed men showed greater connectivity than the early remission and control groups between the dorsal anterior cingulate cortex (key node of the SN) and the dorsomedial prefrontal cortex (included in the DMN). The relapsed men and controls showed lower connectivity than the early remission group between the left dorsolateral prefrontal cortex (key node of the left ECN) and the dorsomedial prefrontal cortex. The percentage of positive urine drug screens positively correlated with the coupling between the dorsal anterior cingulate cortex and dorsomedial prefrontal cortex, but negatively correlated with the coupling between the left dorsolateral prefrontal cortex and dorsomedial prefrontal cortex.

LIMITATIONS

We examined deficits in only 3 core networks leading to relapse behaviour. Other networks may also contribute to relapse.

CONCLUSION

Greater coupling between the SN and DMN and lower coupling between the left ECN and DMN is associated with relapse behaviour. These findings may shed light on the development of new treatments for heroin addiction.

Traditional Chinese medicine-facilitated treatments may relieve anxiety symptoms during drug switching from methadone to buprenorphine/naloxone for treating opioid dependence

This study investigated a 51-year-old married man with a history of heroin dependence who underwent methadone maintenance treatment for 7 years. He received traditional Chinese medicine (TCM)-facilitated treatments and switched from methadone to buprenorphine/naloxone. Strong anxiety symptoms were observed during the initial stage; therefore, we prescribed a combination of Chaihu-Shugan-San, Zhi Bai Di Huang and Chin-Gin-Kuan-Ming decoction as the major herbal synergic regimen to relieve the symptoms of opioid withdrawal, anxiety and insomnia. During the treatment course, no precipitating withdrawal syndromes were noted, and the subject was gradually relieved of his anxiety symptoms through continual TCM treatments. In conclusion, TCM is effective in facilitating the switch from methadone to buprenorphine/naloxone and relieving anxiety symptoms. Therefore, focus on TCM-facilitated treatments for heroin dependence should be increased.

Reduction in N2 amplitude in response to deviant drug-related stimuli during a two-choice oddball task in long-term heroin abstainers

RATIONALE

Chronic heroin use can cause deficits in response inhibition, leading to a loss of control over drug use, particularly in the context of drug-related cues. Unfortunately, heightened incentive salience and motivational bias in response to drug-related cues may exist following abstinence from heroin use.

OBJECTIVES

The present study aimed to examine the effect of drug-related cues on response inhibition in long-term heroin abstainers.

METHODS

Sixteen long-term (8-24 months) male heroin abstainers and 16 male healthy controls completed a modified two-choice oddball paradigm, in which a neutral "chair" picture served as frequent standard stimuli; the neutral and drug-related pictures served as infrequent deviant stimuli of different conditions respectively. Event-related potentials were compared across groups and conditions.

RESULTS

Our results showed that heroin abstainers exhibited smaller N2d amplitude (deviant minus standard) in the drug cue condition compared to the neutral condition, due to smaller drug-cue deviant-N2 amplitude compared to neutral deviant-N2. Moreover, heroin abstainers had smaller N2d amplitude compared with the healthy controls in the drug cue condition, due to the heroin abstainers having reduced deviant-N2 amplitude compared to standard-N2 in the drug cue condition, which reversed in the healthy controls.

CONCLUSIONS

Our findings suggested that heroin addicts still show response inhibition deficits specifically for drug-related cues after longer-term abstinence. The inhibition-related N2 modulation for drug-related could be used as a novel electrophysiological index with clinical implications for assessing the risk of relapse and treatment outcome for heroin users.

Methadone maintenance-lessons from two systems in China

In Hong Kong, methadone maintenance treatment (MMT) was launched in the 1970s, almost 30 years before the counterpart programme’s inauguration in Mainland China. Both were established in response to perceived public crises—addiction-related crime and HIV outbreak, respectively—and both are now regular services under two systems in the same country. Effectiveness of MMT in achieving the stated goals was evident in each case and provides useful lessons on strategies for dealing with the varied concerns related to illicit drug use. Today, with changing patterns of drug addiction, increasing competition for resources, and changing attitudes towards addiction and its treatment, the two MMT systems are confronted with similar challenges to achieve sustainability.

Social-demographic shift in drug users at the first-ever- methadone maintenance treatment in Wuhan, China

The methadone maintenance treatment (MMT) has been initiated in Wuhan, China since early 2006. To understand the social-demographic, behavioral, and infectious diseases characteristics of drug users enrolled in their first-ever-MMT between 2006 and 2015, a retrospective observational study was implemented to also provide evidence for health policy-decisions to reduce harm and control disease. Pearson chi-square tests and t-tests were used to assess significant differences between two 5-year periods, 2006-2010 and 2011-2015. We observed increases in the mean age (38.65 vs. 42.43 years, P < 0.001), mean age of initial opioid drug use (28.18 vs. 31.07 years, P < 0.001), employment (11.9% vs. 30.7%, P < 0.001), married/co-habiting (42.4% vs. 47.8%, P < 0.001), and declines in higher education level (93.6% vs. 84.8%, P < 0.001), injection (82.3% vs. 75.1%, P < 0.001), syringe sharing (27.7% vs. 9.9%, P < 0.001), HCV infection rates (72.9% vs. 70.5%, P = 0.017). The number of drug users enrolling each year reduced following a continuous rapid growth in the first 3 years. The findings imply for adjusting in treatment services and allocation of resources to respond to emerging trends. In addition, the data will also be helpful for identifying needs and getting a baseline insight of the social-demographic and behavioral characteristics of the opioid abusers in the area.

Expression of protein kinase A and the kappa opioid receptor in selected brain regions and conditioned place aversion in morphine-dependent rats

This study examined adaptive changes in protein kinase A (PKA) and kappa opioid receptor (KOR) in selected addiction-related brain regions before and after conditioned place aversion (CPA). Seventy-two male SD rats were randomly assigned to an experimental group (morphine + naloxone, “MN”) and 2 control groups: MS (morphine + saline) and SN (saline + naloxone). MN rats were intraperitoneally injected with morphine twice per day for 6.5 days and naloxone once and trained to establish CPA model. MS and SN rats were injected with equivalent volumes of morphine plus saline and saline plus naloxone, respectively. PKA and KOR in AcbSH, CeA and VTA were measured by immunohistochemistry. Before CPA, there were no significant differences in PKA and KOR expression levels in the AcbSH, CeA and VTA between MN and 2 control groups. After CPA, significant differences in PKA expression were detected in the AcbSH (P<0.001) and VTA (P=0.018) between MN and 2 control groups. The average gray intensity of MN group (109.50±4.66) in AcbSH was significantly higher than that of MS (126.50±3.70, P<0.001) and MN (133.50±6.364, P<0.001) groups. Significant differences in KOR expression were also detected between MN and 2 control groups in CeA (P<0.001). In MN group, PKA and KOR expression levels showed adaptive changes at different points of CPA. These findings demonstrated that neuroadaptation mediated by PKA and KOR may be an important molecular neurobiology basis for CPA. The upregulation of AC-cAMP-PKA-CREB signaling pathway in AcbSH and VTA has some role in the neurobiological mechanism of CPA.

Granger causality reveals a dominant role of memory circuit in chronic opioid dependence

Resting-state magnetic resonance imaging has uncovered abnormal functional connectivity in heroin-dependent individuals (HDIs). However, it remains unclear how brain regions implicated in addictions are related in baseline state without conditioned cues in heroin dependent individuals during opioid maintenance treatment (HDIs-OMT). Previous connectivity analysis assessed the strength of correlated activity between brain regions but lacked the ability to infer directional neural interactions. In the current study, we employed Granger causality analysis to investigate directional causal influences among the brain circuits in HDIs-OMT and non-opioid users. The results revealed a weaker effective connectivity between the caudate nucleus implicated in mediating the reward circuit and other brain regions and also a weaker connectivity between the anterior cingulate cortex and medial prefrontal cortex implicated in mediating inhibitory control. Conversely, HDIs-OMT exhibited stronger effective connectivity between the hippocampus and amygdala implicated in mediating learning-memory, and the anterior cingulate cortex involved in mediating inhibitory control while the putamen mediated learned habits, suggesting that the hippocampus and amygdala may propel the memory circuit to override the control circuit and drive the learned habit in HDIs-OMT. Alterations in learning-memory and inhibitory control may contribute jointly and form a basis for relapse risk even after a period of heroin abstinence. Sustained neural effect of opioid dependence on methadone maintenance including hyperactivation in the memory circuit and impairment in the control circuit support the role of the memory circuitry in relapse and may help redefine targets for treatment.

Effect of drug-related cues on response inhibition through abstinence: A pilot study in male heroin abstainers

BACKGROUND

Chronic heroin use can cause a deficit of inhibitory function, leading to a loss of control over drug use. Exposure to drug-related cues is considered as one of the contributing factors. However, it is unclear whether there are dynamic changes on the effect of drug-related cues on response inhibition following prolonged abstinence.

OBJECTIVE

The present study investigated the effect of drug-related cues on response inhibition in heroin abstainers at different abstinent phases.

METHODS

26 shorter-term (2-6 months) and 26 longer-term (19-24 months) male heroin abstainers performed on a modified two-choice Oddball task, which included two conditions: in the cued condition, neutral pictures served as the background of standard stimuli (yellow frame) and heroin-related pictures served as the background of deviant stimuli (blue frame), reversed in the controlled conditions.

RESULTS

Compared to longer-term abstainers, mean reaction time (RT) for drug deviants in shorter-term abstainers was significantly longer. Shorter-term abstainers also showed markedly slower response to neutral deviants relative to drug deviants, but this tendency was not observed in longer-term abstainers. Nevertheless, both groups had similar RT for standard stimuli regardless of their paired background pictures.

CONCLUSION

Effect of drug-related cues on response inhibition remains at the early stage of abstinence; however, this effect may be reduced following a longer period of drug abstinence. Our findings highlight the importance of assessing and improving the ability of inhibiting drug-related cue reactivity during treatment.

"Overconfidence" versus "helplessness": A qualitative study on abstinence self-efficacy of drug users in a male compulsory drug detention center in China

Background

Compulsory drug detention is the most frequent way to control drug use in China; however, it has often been criticized. This qualitative study aimed to investigate abstinence self-efficacy and its sources of drug users in a compulsory male drug detention center in Shanghai, China, and the attitudes of the drug users to this form of rehabilitation.

Methods

Thirty-six participants were interviewed (semi-structured, in depth) about their history of drug use and rehabilitation, self-evaluation of addiction, motivations to abstain, plans for the future and attitudes toward rehabilitation. A thematic analysis was undertaken of the transcripts with responses to interview questions being coded for content.

Results

Two main types of self-efficacy were found – “overconfidence” (n = 16) and “helplessness” (n = 17). Overconfident participants underestimated their levels of addiction, overestimated their self-control and held external motivations and attributions. In contrast, helpless participants overestimated their levels of addiction, underestimated their self-control and had internal motivations and attributions. Compared to overconfident participants, helpless participants had more relapse history, and were more inclined to interpret relapse as a failure and attribute relapse to themselves. More helpless participants were abandoned by their family members, and received blame from the family members instead of encouragement, but their family members motivated them to abstain. Helpless participants experienced more negative emotions and had worse physical status. They said compulsory detention was a strong support for them and was the most effective way to abstain; while overconfident participants said compulsory detention was not necessary and not useful.

Conclusion

It is important to increase the motivation of overconfident drug users and the perceived control of helpless drug users. Compulsory drug detention has strengths in supporting drug users who feel helpless to resist drug use. Adjustments and improvements of compulsory drug detention are suggested.

Electronic supplementary material

The online version of this article (doi:10.1186/s13011-016-0073-2) contains supplementary material, which is available to authorized users.

Regional homogeneity changes between heroin relapse and non-relapse patients under methadone maintenance treatment: a resting-state fMRI study

Background

Methadone maintenance treatment (MMT) is recognized as one of the most effective treatments for heroin addiction but its effect is dimmed by the high incidence of heroin relapse. However, underlying neurobiology mechanism of heroin relapse under MMT is still largely unknown. Here, we took advantage of a resting-state fMRI technique by analysis of regional homogeneity (ReHo), and tried to explore the difference of brain function between heroin relapsers and non-relapsers in MMT.

Methods

Forty MMT patients were included and received a 12-month follow-up. All patients were given baseline resting-state fMRI scans by using a 3.0 T GE Signa Excite HD whole-body MRI system. Monthly self-report and urine test were used to assess heroin relapse or non-relapse. Subjective craving was measured with visual analog scale. The correlation between ReHo and the degree of heroin relapse was analyzed.

Results

Compared with the non-relapsers, ReHo values were increased in the bilateral medial orbitofrontal cortex, right caudate, and right cerebellum of the heroin relapsers while those in the left parahippocampal gyrus, left middle temporal gyrus, right lingual gyrus, and precuneus were decreased in heroin relapsers. Importantly, altered ReHo in the right caudate were positively correlated with heroin relapse rates or subjective craving response.

Conclusions

Using the resting-state fMRI technique by analysis of ReHo, we provided the first resting-state fMRI evidence that right caudate may serve as a potential biomarker for heroin relapse prediction and also as a promising target for reducing relapse risk.

Frontal Metabolite Concentration Deficits in Opiate Dependence Relate to Substance Use, Cognition, and Self-Regulation

OBJECTIVE

Proton magnetic resonance spectroscopy (1H MRS) in opiate dependence showed abnormalities in neuronal viability and glutamate concentration in the anterior cingulate cortex (ACC). Metabolite levels in dorsolateral prefrontal cortex (DLPFC) or orbitofrontal cortex (OFC) and their neuropsychological correlates have not been investigated in opiate dependence.

METHODS

Single-volume proton MRS at 4 Tesla and neuropsychological testing were conducted in 21 opiate-dependent individuals (OD) on buprenorphine maintenance therapy. Results were compared to 28 controls (CON) and 35 alcohol-dependent individuals (ALC), commonly investigated treatment-seekers providing context for OD evaluation. Metabolite concentrations were measured from ACC, DLPFC, OFC and parieto-occipital cortical (POC) regions.

RESULTS

Compared to CON, OD had lower concentrations of N-acetylaspartate (NAA), glutamate (Glu), creatine +phosphocreatine (Cr) and myo-Inositol (mI) in the DLPFC and lower NAA, Cr, and mI in the ACC. OD, ALC, and CON were equivalent on metabolite levels in the POC and γ-aminobutyric acid (GABA) concentration did not differ between groups in any region. In OD, prefrontal metabolite deficits in ACC Glu as well as DLPFC NAA and choline containing metabolites (Cho) correlated with poorer working memory, executive and visuospatial functioning; metabolite deficits in DLPFC Glu and ACC GABA and Cr correlated with substance use measures. In the OFC of OD, Glu and choline-containing metabolites were elevated and lower Cr concentration related to higher nonplanning impulsivity. Compared to 3 week abstinent ALC, OD had significant DLPFC metabolite deficits.

CONCLUSION

The anterior frontal metabolite profile of OD differed significantly from that of CON and ALC. The frontal lobe metabolite abnormalities in OD and their neuropsychological correlates may play a role in treatment outcome and could be explored as specific targets for improved OD treatment.

Abnormal white matter structural networks characterize heroin-dependent individuals: a network analysis

Neuroimaging studies suggested that drug addiction is linked to abnormal brain functional connectivity. However, little is known about the alteration of brain white matter (WM) connectivity in addictive drug users and nearly no study has been performed to examine the alterations of brain WM connectivity in heroin-dependent individuals (HDIs). Diffusion tensor imaging (DTI) offers a comprehensive technique to map the whole brain WM connectivity in vivo. In this study, we acquired DTI datasets from 20 HDIs and 18 healthy controls and constructed their brain WM structural networks using a deterministic fibre tracking approach. Using graph theoretical analysis, we explored the global and nodal topological parameters of brain network for both groups and adopted a network-based statistic (NBS) approach to assess between-group differences in inter-regional WM connections. Statistical analysis indicated the global efficiency and network strength were significantly increased, but the characteristic path length was significantly decreased in the HDIs compared with the controls. We also found that in the HDIs, the nodal efficiency was significantly increased in the left prefrontal cortex, bilateral orbital frontal cortices and left anterior cingulate gyrus. Moreover, the NBS analysis revealed that in the HDIs, the significant increased connections were located in the paralimbic, orbitofrontal, prefrontal and temporal regions. Our results may reflect the disruption of whole brain WM structural networks in the HDIs. Our findings suggest that mapping brain WM structural network may be helpful for better understanding the neuromechanism of heroin addiction.

Abnormal gray matter volume and resting-state functional connectivity in former heroin-dependent individuals abstinent for multiple years

Previous studies have suggested that heroin addiction is associated with structural and functional brain abnormalities. However, it is largely unknown whether these characteristics of brain abnormalities would be persistent or restored after long periods of abstinence. Considering the very high rates of relapse, we hypothesized that there may exist some latent neural vulnerabilities in abstinent heroin users. In this study, structural and resting-state functional magnetic resonance imaging data were collected from 30 former heroin-dependent (FHD) subjects who were drug free for more than 3 years and 30 non-addicted control (CN) volunteers. Voxel-based morphometry was used to identify possible gray matter volume differences between the FHD and CN groups. Alterations in resting-state functional connectivity in FHD were examined using brain areas with gray matter deficits as seed regions. Significantly reduced gray matter volume was observed in FHD in an area surrounding the parieto-occipital sulcus, which included the precuneus and cuneus. Functional connectivity analyses revealed that the FHD subjects showed reduced positive correlation within the default mode network and visual network and decreased negative correlation between the default mode network, visual network and task positive network. Moreover, the altered functional connectivity was correlated with self-reported impulsivity scores in the FHD subjects. Our findings suggest that disruption of large-scale brain systems is present in former heroin users even after multi-year abstinence, which could serve as system-level neural underpinnings for behavioral dysfunctions associated with addiction.

Beneficial effects of Bacopa monnieri extract on opioid induced toxicity

The present study examined the hepatotoxicity and nephrotoxicity of morphine and illicit street heroin and their amelioration by a standardized methanolic extract of Bacopa monnieri (L.) (mBME) in rats. Morphine or street heroin was administered at a dose of 20 mg/kg for 14 and 21 days. mBME (40 mg/kg) or ascorbic acid (50 mg/kg) was administered two hours before morphine or street heroin. High performance liquid chromatography (HPLC) was used for the standardization of bacoside-A major components in mBME. The antioxidant potential of mBME was evaluated by 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging assay. Administration of morphine and street heroin resulted in marked elevation of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and creatinine. Histopathological changes induced by morphine and street heroin after 14 days were of reversible nature while treatment for 21 days was associated with irreversible changes. Pretreatment with mBME or ascorbic acid restored the elevation of serum ALT, AST and creatinine and protected liver and kidneys from the toxicological influence of morphine and street heroin. HPLC analysis showed that mBME contained bacoside-A major components i.e. bacoside-A₃ (37.5 μg/mg), bacopaside-II (4.62 μg/mg) and bacopasaponin-C (1.91 μg/mg). The EC₅₀ for the DPPH free radical scavenging assay revealed that mBME possessed strong antioxidant potential. These results concluded that as compared to morphine, street heroin was associated with severe biochemical and histopathological changes in the liver and kidneys. Bacopa monnieri having strong antioxidant potential may provide a beneficial herbal remedy for the efficient management of opioid related hepatotoxicity and nephrotoxicity.

Brain white matter integrity in heroin addicts during methadone maintenance treatment is related to relapse propensity

INTRODUCTION

Cognitive deficits caused by heroin-induced white matter (WM) impairments hinder addicts' engagement in and benefit from treatment. The predictive value of WM integrity in heroin addicts during methadone maintenance treatment (MMT) for future relapse is unclear.

METHODS

Forty-eight MMT patients were given baseline diffusion tensor imaging scans and divided into heroin relapsers (HR, 25 cases) and abstainers (HA, 23 cases) according to the results of 6-month follow-up. Intergroup comparisons were performed for fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD). The correlation between diffusion tensor imaging indices and the degree of heroin relapse was analyzed.

RESULTS

Compared with HA group, HR group had reduced FA in the right retrolenticular part, left anterior and posterior limb of internal capsule, bilateral anterior corona radiata, and right external capsule. Three out of the six regions showed increased RD, with no changes in AD. The FA and AD values in the left posterior limb of internal capsule correlated negatively with the heroin-positive urinalysis rate within follow-up.

CONCLUSIONS

Lower WM integrity in MMT patients may add to neurobiological factors associated with relapse to heroin use. Strategies for improving WM integrity provide a new perspective to prevent future relapse to heroin abuse.

Scientific and conceptual flaws of coercive treatment models in addiction

In conceptual debates on addiction, neurobiological research has been used to support the idea that addicted drug users lack control over their addiction-related actions. In some interpretations, this has led to coercive treatment models, in which, the purpose is to 'restore' control. However, neurobiological studies that go beyond what is typically presented in conceptual debates paint a different story. In particular, they indicate that though addiction has neurobiological manifestations that make the addictive behaviour difficult to control, it is possible for individuals to reverse these manifestations through their own efforts. Thus, addicted individuals should not be considered incapable of making choices voluntarily, simply on the basis that addiction has neurobiological manifestations, and coercive treatment models of addiction should be reconsidered in this respect.

Compulsory treatment of drug users in Asia: designed to torture?

PURPOSE

- Injecting drug use is a global concern, with an estimated 16 million people who inject drugs (PWIDs) in over 148 countries. A number of Asian countries detain PWIDs for compulsory treatment. The paper aims to discuss this issue.

DESIGN/METHODOLOGY/APPROACH

- The authors reviewed the literature on compulsory drug treatment in seven Asian countries.

FINDINGS

- The authors identified 1,269 closed settings which held over 600,000 drug users in eight countries. The average detainee was aged from 20 to 30 years and was predominantly male. HIV risk behaviour continued in detention in some countries. In most countries treatment comprised physical labour, military drills. Methadone maintenance treatment and antiretroviral therapy were rarely available. No data were located to show detention in a closed setting treated drug dependency. Issues of concern were; no due legal process for the detention of drug users, lack of evidence-based drug treatment, lack of HIV prevention and treatment, abusive conditions, forced labour and exercise, arbitrary exit procedures and very high relapse rates.

RESEARCH LIMITATIONS/IMPLICATIONS

- The review of compulsory treatment of drug users failed to find any evaluation of effective drug treatment for detainees. Instead serious breaches in human rights conditions were evident. Prominent international organisations have called for the compulsory treatment of drug users to cease.

PRACTICAL IMPLICATIONS

- Many countries are spending vast amounts of funding on ineffective treatments for drug users.

SOCIAL IMPLICATIONS

- Funding should be directed to community-based drug treatments that have been shown to work.

ORIGINALITY/VALUE

- This is the largest review of compulsory treatment of drug users to date.

Evaluation of an implementation of methadone maintenance treatment in China

BACKGROUND

Methadone maintenance treatment (MMT) reduces the harms of opioid use disorder and is being rapidly scaled-up in China. This study evaluated the real-world implementation of MMT system in Wuhan, China.

METHODS

Data extracted from electronic medical records collected in 2010 on 8811 patients were used to compute for each patient indices of the prescribed and consumed daily methadone doses, an adherence index, dose adjustments following missed doses, the rates of opiate positive urine tests, self-reported drug use, injection drug use (IDU), and the duration of MMT exposure.

FINDINGS

The modal daily doses prescribed were 60 mg and above for 68.5% of patients. Adherence was variable: 51% of patients attended less than 60% and 26% attended 80-100% of their treatment days; and patients with long MMT exposure had significantly higher adherence rates than patients with short MMT exposure. The differences between doses dispensed immediately before and after the interruption in dosing days ranged from 0 to 7 mg, independently of the length of the interruption or the prescribed dosing level. The overall rate of opiate positive tests was 20%; 45% of patients had at least one opiate positive test; 29% reported past month drug use and 53% of them reported past month IDU. Adherence and MMT exposure duration correlated significantly with the proportion of opiate negative urine tests (r=0.355, p<0.001; r=0.351, p<0.001, respectively). Treatment for males and females was comparable.

CONCLUSIONS

Provision of safe methadone dosing after absences and improving daily attendance are identified as priority improvement areas.

A qualitative study of treatment-seeking heroin users in contemporary China

BACKGROUND

Heroin has emerged as the primary drug of concern in China, with as many as three million contemporary users. Once a Chinese citizen has been identified by Chinese law enforcement as a 'drug addict', that individual is 'registered' in an official government tracking system for the rest of his or her life, independent of verified rehabilitation and recovery. Most of what is known about heroin users in China is based on studies of registered heroin users participating, often involuntarily, in government-sponsored treatment.

METHODS

Using Grounded Theory Methodology, we collected and analyzed in-depth interviews of heroin users voluntarily seeking treatment at a new, non-government-sponsored, for-profit, addiction treatment hospital in Beijing, China.

RESULTS

We identified three major themes among our participants: (1) intense social stigma towards individuals with drug addiction; (2) a desire for anonymous, confidential treatment to avoid social stigma and the loss of personal freedom that accompanies participation in government-sponsored treatment; and (3) a deep mistrust of government-sponsored treatment and a search for more effective alternatives.

CONCLUSION

Despite a desire for treatment, our subjects were reluctant to access government-sponsored treatment facilities because of fear of a stigmatized identity, fear of loss of personal freedom, and lack of faith in the efficacy and safety of government-sponsored treatments. Their willingness to pay cash at a new, non-government-sponsored, addiction treatment facility illustrates the lengths to which they will go to remain 'unregistered' and to discover better alternatives. That the Chinese government allows such facilities to operate outside of government surveillance suggests a new openness to alternative options to combat China's rising drug epidemic. The efficacy of these alternative options, however, remains in question.

Neurobiological underpinnings of sensation seeking trait in heroin abusers

Neurobiological investigation of heroin revealed that abusers of this highly addictive substance show dysregulation in brain circuits for reward processing and cognitive control. Psychologically, personality traits related to reward processing and cognitive control differed between heroin abusers and non-abusers. Yet, there is no direct evidence on the relationship between these neurobiological and psychological findings on heroin abusers, and whether such relationship is altered in these abusers. The present study filled this research gap by integrating findings obtained via magnetic resonance imaging (structural volume and resting-state functional connectivity) and self-reported personality trait measures (Zuckerman׳s Sensation Seeking Scale and Barratt Impulsivity Scale) on 33 abstinent heroin users and 30 matched healthy controls. The key finding is a negative relationship between high sensation seeking tendency and midbrain structural volume in the heroin users. Importantly, there was stronger coupling between the midbrain and ventromedial prefrontal cortex and weaker coupling between the midbrain and dorsolateral prefrontal cortex in heroin users. Our findings offer significant insight into the neural underpinning of sensation seeking in heroin users. Importantly, the data shed light on a novel relationship between the mesolimbic-prefrontal pathway of the reward system and the high sensation seeking personality trait in heroin abusers.

Aberrant default-mode functional and structural connectivity in heroin-dependent individuals

BACKGROUND

Little is known about connectivity within the default mode network (DMN) in heroin-dependent individuals (HDIs). In the current study, diffusion-tensor imaging (DTI) and resting-state functional MRI (rs-fMRI) were combined to investigate both structural and functional connectivity within the DMN in HDIs.

METHODS

Fourteen HDIs and 14 controls participated in the study. Structural (path length, tracts count, (fractional anisotropy) FA and (mean diffusivity) MD derived from DTI tractography)and functional (temporal correlation coefficient derived from rs-fMRI) DMN connectivity changes were examined in HDIs. Pearson correlation analysis was performed to compare the structural/functional indices and duration of heroin use/Iowa gambling task(IGT) performance in HDIs.

RESULTS

HDIs had lower FA and higher MD in the tract connecting the posterior cingulate cortex/precuneus (PCC/PCUN) to right parahippocampal gyrus (PHG), compared to the controls. HDIs also had decreased FA and track count in the tract connecting the PCC/PCUN and medial prefrontal cortex (MPFC), as well as decreased functional connectivity between the PCC/PCUN and bilateral PHG and MPFC, compared to controls. FA values for the tract connecting PCC/PCUN to the right PHG and connecting PCC/PCUN to the MPFC were negatively correlated to the duration of heroin use. The temporal correlation coefficients between the PCC/PCUN and the MPFC, and the FA values for the tract connecting the PCC/PCUN to the MPFC were positively correlated to IGT performance in HDIs.

CONCLUSIONS

Structural and functional connectivity within the DMN are both disturbed in HDIs. This disturbance progresses as duration of heroin use increases and is related to deficits in decision making in HDIs.

A Multiple Indicators Multiple Causes (MIMIC) model of internal barriers to drug treatment in China

BACKGROUND

Although evidence exists for distinct barriers to drug abuse treatment (BDATs), investigations of their inter-relationships and the effect of individual characteristics on the barrier factors have been sparse, especially in China. A Multiple Indicators Multiple Causes (MIMIC) model is applied for this target.

METHODS

A sample of 262 drug users were recruited from three drug rehabilitation centers in Hunan Province, China. We applied a MIMIC approach to investigate the effect of gender, age, marital status, education, primary substance use, duration of primary drug use, and drug treatment experience on the internal barrier factors: absence of problem (AP), negative social support (NSS), fear of treatment (FT), and privacy concerns (PC).

RESULTS

Drug users of various characteristics were found to report different internal barrier factors. Younger participants were more likely to report NSS (-0.19, p=0.038) and PC (-0.31, p<0.001). Compared to other drug users, ice users were more likely to report AP (0.44, p<0.001) and NSS (0.25, p=0.010). Drug treatment experiences related to AP (0.20, p=0.012). In addition, differential item functioning (DIF) occurred in three items when participant from groups with different duration of drug use, ice use, or marital status.

CONCLUSIONS

Individual characteristics had significant effects on internal barriers to drug treatment. On this basis, BDAT perceived by different individuals could be assessed before tactics were utilized to successfully remove perceived barriers to drug treatment.

Investigating the factor structure of the Illness Perception Questionnaire-revised for substance dependence among injecting drug users in China

BACKGROUND

The Illness Perception Questionnaire-Revised (IPQ-R) has commonly been used to measure illness representations of various diseases. The present study examined whether the original factor structure of the IPQ-R could be confirmed or a new structure could be established on substance dependence among injecting drug users (IDU) in China.

METHODS

A total of 257 IDU completed the 38-item IPQ-R on substance dependence.

RESULTS

Results of confirmatory factor analysis (CFA) showed that the 7-factor structure as proposed by the original IPQ-R reported poor goodness-of-fit statistics. Although removal of 12 items improved the model fit, the goodness-of-fit statistics were still below acceptable standards. Furthermore, factors obtained from the exploratory factor analysis (EFA) of the IPQ-R were not interpretable.

CONCLUSIONS

The CFA found that the original IPQ-R factor structure fit the data poorly. Factors derived from EFA were also not interpretable. Use of the IPQ-R for assessment of illness representations of substance dependence among IDU in China is cautioned until further validation.