Comparison of drug abuse in Germany and China

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.

Patterns of childhood trauma and psychological distress among injecting heroin users in China

Background

Childhood trauma has been reported as a possible cause of future substance abuse in some countries. This study reports the prevalence of childhood trauma and examines its association with psychological distress among injecting drug users from mainland China.

Methodology

The study was conducted in three government-operated drug rehabilitation facilities in Shanghai, China in 2007. The Early Trauma Inventory Self Report-Short Form (ETISR-SF) was used to evaluate 4 types (general, emotional, physical and sexual) and severity of childhood trauma, and the Symptom Checklist-90-Revised (SCL-90-R) to evaluate psychological distress.

Principal Findings

Among 341 injecting drug users who completed the study, about 80% reported one or more types of childhood trauma, specifically 53% general trauma, 56% physical abuse, 36% emotional abuse and 26% sexual abuse. Compared to female injecting drug users, males reported significantly higher scores of general trauma and physical abuse, but lower sexual abuse scores. Hierarchical linear regression analyses showed that greater physical and emotional abuse in childhood predict greater current psychopathological distress among these injecting drug users in China.

Conclusions

The results reveal a high prevalence of childhood trauma among injecting drug users in China, and it is comparable to other similar studies in Western countries. It is important to consider the role of childhood trauma in the prevention and treatment of substance abuse.

[Burden of disease and level of patient's medical care in substitution treatment for opiates]

BACKGROUND AND PURPOSE

Within the framework of an interdisciplinary cooperation, the authors set up an on-site medical service provider in a specialized methadone substitution center in Germany. Here, they report on the prevalence of infectious and noninfectious diseases, and the vaccination status of substituted heroin-dependent patients.

PATIENTS AND METHODS

All patients who visited the medical care service provider between February 2008 and December 2008 were included in this study.

RESULTS

Ten patients (7%) were seropositive for the hepatitis A virus. Two patients (1.3%) suffered from chronic hepatitis B; 40 patients (27%) were cured after a hepatitis B infection. Additionally, 99 patients (68%) were infected with hepatitis C virus (HCV), and 41 patients (28%) had active hepatitis C. Furthermore, 48 hepatitis C patients (33%) were cured. Of those, 25 patients (17%) cleared the virus spontaneously and 23 (16%) after ribavirin/interferon combination therapy. Ten (7%) of 146 patients were infected with the human immunodeficiency virus (HIV). Of those, four patients had active hepatitis C, and five patients were cured after a hepatitis C infection. 18 patients (12%) were vaccinated against hepatitis A and 28 (19%) against hepatitis B. Two of the 41 patients with chronic hepatitis C were vaccinated against hepatitis A. The most frequent noninfectious diagnoses were arterial hypertension (n = 28), bronchial asthma (n = 8), and diffuse liver parenchymal damage (n = 12).

CONCLUSION

These results emphasize that i.v. drug users on substitution therapy are an underserved collective with a high prevalence of disease. The challenge consists in facilitating this population access to internistic and infectious disease service. The offer of an on-site medical service was well accepted. This is essential for an ongoing reduction of HIV and HCV prevalence in the drug users.

Consequences of drug abuse and HIV/AIDS in China: recommendations for integrated care of HIV-infected drug users

Drug abuse is a complicated social phenomenon rather than a neural disease. It especially fuels the HIV/AIDS epidemic. Researchers have shown interest in HIV-infected drug users as the socially and medically marginalized population, but they did not provide good enough care. Based on published English and Chinese journal articles and official reports, this integrated literature review summarizes the epidemic of drug abuse and HIV/AIDS, and comments on the clinical and psychosocial consequences, and harm reduction measures in China. Officially registered drug users have reached more than 1 million recently. A little under half of the people living with HIV/AIDS are injection drug users, as they transmit the disease through needle sharing and unprotected sexual behavior. The main consequences of drug abuse and HIV/AIDS included high prevalence of hepatitis viruses and tuberculosis co-infections, severe mental problems and extreme poverty. Even health professionals hold discriminative attitude toward drug users because of condemnation of drug abuse behavior and fear of HIV infection. Although interventions for drug addiction and harm reduction have been scaled up quickly, such as methadone maintenance treatment and needle syringe programs, the measures should be further revised, and the effectiveness needs to be evaluated appropriately. To enhance HIV-infected drug users' quality of life and the utility of medical services, improving health care providers' attitude is the first step. Then securing good quality of integrated medical care services with multidisciplinary cooperation will be essential.

Effects of cannabinoid CB1 receptor antagonist rimonabant in consolidation and reconsolidation of methamphetamine reward memory in mice

RATIONALE

Previous studies have shown that cannabinoid CB1 receptors play an important role in specific aspects of learning and memory, yet there has been no systematic study focusing on the involvement of cannabinoid CB1 receptors in methamphetamine-related reward memory.

OBJECTIVES

The purpose of this study was to examine whether rimonabant, a cannabinoid CB1 receptor antagonist, would disrupt the consolidation and reconsolidation of methamphetamine-related reward memory, using conditioned place preference paradigm (CPP).

MATERIALS AND METHODS

Separate groups of male Kunming mice were trained to acquire methamphetamine CPP. Vehicle or rimonabant (1 mg/kg or 3 mg/kg, i.p.) was given at different time points: immediately after each CPP training session (consolidation), 30 min before the reactivation of CPP (retrieval), or immediately after the reactivation of CPP (reconsolidation). Methamphetamine CPP was retested 24 h and 1 and 2 weeks after rimonabant administration.

RESULTS

Rimonabant at doses of 1 and 3 mg/kg significantly inhibited the consolidation of methamphetamine CPP. Only high-dose rimonabant (3 mg/kg) disrupted the retrieval and reconsolidation of methamphetamine CPP. Rimonabant had no effect on methamphetamine CPP in the absence of methamphetamine CPP reactivation.

CONCLUSIONS

Our findings suggest that cannabinoid CB1 receptors play a major role in methamphetamine reward memory, and cannabinoid CB1 receptor antagonists may be a potential pharmacotherapy to manage relapse associated with drug-reward-related memory.

Drug addiction in China

Drug addiction in China began with the importation of Indian opium by the British in the 16th century and brought severe social and health problems. While drug abuse abated following the establishment of People's Republic of China, modernization and Westernization in the 1980s led to the reemergence of this problem. Drug abuse in China became epidemic, facilitating the spread of HIV/AIDS. The Chinese government has made great efforts to address these problems, focusing both on treatments of drug addiction and on harm-reduction programs. Although the new trends of drug addiction in China pose great public health challenges, these government interventions are likely to successfully stem the problem of drug abuse in the future.