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Drug addicts very often present with vascular complications. A great number of these lesions require medical care. Vascular problems are diverse and multiple affecting both veins and arteries, the latter being often the most dramatic. This article attempt to describe the most frequent lesions observed in drug addicts considering two different mechanisms; traumatic versus drug induced complications.
Drug addiction which entails cardiovascular risks unknown or misknown to physicians, currently involves an increasing number of miscellaneous drugs, existing in manifold forms. There appears to be no bounds on the way of intake. All territories of the body may be affected with more or less severity. In young people, the cardiac, coronary, cerebral and peripheral vascular systems are generally involved. Two illicit drugs, cannabis and cocaine, showing a permanent increase in misuse, prevail. This drug addiction comes along with intercurrent pathologies which have their own vascular toxicity, especially HIV infection. Moreover, the advent of new illicit substances emphasizes the complexity of the clinical presentations. These complex situations have a real social and medical impact. We are currently in a phase of permanently increasing risk of cardiovascular complications. The pathophysiological mechanisms involved are intertwined and complicated by the frequent association of polytoxicomania or by the effects excipients added to these drugs: direct vascular toxicity, angeitis, arterial and venous thrombosis. Arsenic, a common component of these drugs, is also found in cigarettes; arsenic toxicity mainly affects the lower limbs. Treatment of these complications is non-specific; the ideal solution being weaning which, unfortunately in this peculiar population of patients, may entail serious complications due to the misuse of substitution products.
Altogether 240 unselected intravenous drug addicts were tested for the presence of infection with delta virus (HDV). Anti-delta were found in 16 (16%) out of 100 drug addicts tested in the years 1988-1989 and in only one drug addict (0.7%) out of 140 tested in the years 1985-1986. It seems that delta virus has been introduced to Warsaw drug community in the mid-eighties and has spread enormously since that time.
The condition of teeth was studied in 30 drug addicts aged 21-34 years (drug addiction duration 3-16 years) comparing the results with those obtained in a similar group of 30 age-matched subjects without drug addiction. The needs for stomatological treatment were determined also. It was found that drug addicts had twice the number of teeth with active caries and missing teeth, and four times less filled teeth as compared with controls. Most drug addicts had lost 45-100% chewing ability, and loss of teeth included all anatomical groups. The mean number of teeth requiring treatment per one addict was 8, and 2.8 teeth required removal. Only 3 addicts were not in need of prosthetic treatment, the remaining ones (90%) should have been given permanent of removable replacements (including complete denture). Drug addiction was found to produce intensification of caries and mutilation of the stomatognathic system.
Attempts by young drug addicts to decrease or quit drug consumption were studied by means of a series of interviews. Interest was focused on volitional problems arising due to difficulties in living up to commitments in the face of temptations and various types of emotional stress. It was found that relapses occurred mostly under the influence of emotional stress and that they were preceded by various forms of twisted reasoning, a finding similar to those for other types of addictive behaviors such as smoking and alcoholism. The techniques used by the drug addicts to fight temptations were similar to those reported by other patients. Knowledge of techniques seemed to be rather scarce. There was a correlation between knowledge of technique and success in quitting drug habits. Strong stimulus pull factors were evident in some cases and were apparently counteracted by more or less successful attempts by the patients to escape the tempting situation.
There is a need to define the field of drug addiction from both the theoretical and the practical point of view, but any attempt to do so encounters difficulties that are inherent in the many types of approach as well as in the polymorphism of drug addiction. The difficulties are also due to the present day consumption of pills which is very high both among members of our "square" society and in the marginal fringes, and occurs in and outside the field of drug addiction proper -- the guide being here the progressive increase of doses. The modes of use are not sufficient to determine the presence of drug addiction: the drug substance must have a psychism-oriented tropism; the increase in the dose of a non-psychotropic product is therefore a matter of hypochondria and not of drug addiction. The means of administering a drug also occupies a privileged place, in so far as the intravenous method suffices alone to label non-medical use as drug addiction. It is the hallucinogens that, despite the absence of physical dependence, most frequently pose the question of the definition of drug addiction, in view of the ritual dimension and the transgressive significance of the absorption of these products, even at relatively moderate doses, and hallucinogens pose this question all the more since their use emerges from a sub-cultural environment that produces typical drug addiction, namely intravenous heroin addiction. The latter does not raise the question of definition, but is used as the basis for a drug addiction referential system.
In 22 drug addicts, the clinical diagnosis of osteomyelitis and/or septic arthritis was suspected because of symptoms of sepsis and pain in various locations. All patients underwent bone scintigraphy with 17-20 mCi of 99mTc labeling either pyrophosphate or methylene diphosphonate. Whole body and spot scans located the area of disease in most patients. This permitted biopsy of the affected area when the pathogen recurs. One of the two patients whose scintigrams were normal was on adequate treatment before the bone scintigram and the other was on oxacillin. Radiographs of the affected areas were normal, which indicates bone scintigraphy should be preferred to radiography in the early diagnosis of osseous infections.
Spleen and portal lymphnode sections from 86 drug addicts submitted for medico-legal autopsy at the Institute of Forensic Medicine in Copenhagen in the year 1979 were studied together with tissue sections from 24 "normal" persons. In 70% of the drug addicts the spleen weight was more than 200 g, and in 71% portal lymphnode hyperplasia was found. Birefringent foreign material was found in spleen tissue of drug addicts in 72% and in portal lymphnode tissue in 44%. Signs of antigen stimulation in both spleen and portal lymphnode tissue evaluated by the number of germinal centre and plasma cells were found in more than 80% of the drug addicts compared with about 20% of the "normal" persons. The results were related to anamnestic information of duration of drug abuse, to the spleen weight, to the occurrence of birefringent material and to the liver changes. Examination of lysozyme and immunoglobulin containing cells using the indirect preoxidase technique was performed in a total of 72 cases of spleen tissue, 59 cases of portal lymphnode tissue from drug addicts, 24 cases of spleen tissue and 18 of portal lymphnode tissue from "normal" persons. Lysozyme, IgM and IgG containing cells were found significantly more often among drug addicts than "normal" persons. The results indicate that the splenomegalia and the portal lymphnode hyperplasia often found in drug addicts are caused by continuous antigen stimulation due to repeated injections of various antigens.
Infective endocarditis (IE) in drug addicts is characterized by the involvement of the right heart with evolving septic pulmonary thromboembolism. Staphylococcus aureus is the causative agent of IE in 71.8% of cases. The specific feature of the course of IE in drug addicts is a relatively low hospital mortality rate (35.5%). The main cause of death was generalized infection with a developing multiple organ dysfunction. Pyonecrotic foci in the organs and tissues and septic vasculitis were histologically detected along with pronounced dystrophic changes. The presence of morphological signs of HIV infection at early stages, as well as viral hepatitis C do not affect mortality rates in drug addicts with IE.
The sexual life style, drug habit and socio-demographic status of 253 male hospitalized drug addicts were investigated. This study was conducted during the period June 1997 to July 1998, and each case was selected by the random sampling method. The research instrument was an interviewer-administered questionnaire, the sexual habits, number and quality of sex partners, use of condoms, sexually transmitted diseases, etc., were considered as indicators of the sexual life style of the drug addicts. Eighty-eight percent (n=233) of the addicts were heterosexual. Bisexuality was found only in 7% (n=18) of the addicts. Eighty-seven percent (n=240) of the addicts have multiple sex partners of either commercial or residential category. Most of the drug addicts (72%,n=181) did not use condoms. Fifty-seven percent (n=145) of the addicts were observed to have sexual diseases. As indicators of a drug habit, starting drug, choice of drug, period of addiction, sharing of needles, etc., were included. Cannabis was the starting substance for 59% (n=149) of the addicts. Heroin was the drug of choice for 60% (n=157) addicts. A single drug was taken only by 8% (n=20) of the addicts and the remaining 92% (n=233) took multiple drugs. The drug addicts (n=97) who used mostly injection (87%,n=84) shared needles. Education, occupation, income, age, marital status, influencing factors for addiction were considered as socio-demographic characteristics. Young adults (79%,n=199), secondary educated (46%,n=116), low-mid income (60%,n=150), businessmen (46%,n=150) and married (60%,n=151) people were found highly involved in addiction. Self-curiosity and a friend's incitement were revealed as the most important influencing factors for taking drugs.
OBJECTIVE: 21 drug addicts' reasons for attending (RA) primary care clinics were studied. DESIGN: A six-month long prospective study. SITE: An attendance group, as in Insalud's traditional model, from an area of Madrid with a high level of drug use. PARTICIPANTS: Everybody known to be dependent on drugs and who could be followed up. 9 out of 21 drug addicts were HIV+. MEASUREMENTS AND MAIN RESULTS: Out of the 51 RA's established, the most common one was high temperature (27.4%), even when the HIV+ (37.5%) and HIV- (26.3%) groups were considered separately, though the number of consultations for high temperature was significantly higher (p < 0.01) among HIV+ patients. Other important RA's were those arising from drug abuse (efforts to give up; request for substitution therapy etc.) (25%). The total number of consultations with drug addicts represented 2.8% of the total number of consultations with the population as a whole during the same period of time. CONCLUSIONS: The high demand placed by drug addicts on the Primary Care network is confirmed by this study. High temperature and problems arising from drug abuse were the most common RA's. High temperature was the main RA both in HIV+ and HIV- patients.
Intravenous drug users (IVDUs) account for more than 64% of the total AIDS cases in Italy. The IVDUs' seropositivity rate is greater than 70% in Milan and greater than 50% in the main cities of Italy. The first evidence of seropositivity in this population dates back to 1979. In a cohort study performed in Milan the rate of progression to overt AIDS among IVDUs was 6% in 3 years (1984-1987). At presentation, more than 75% of the subjects had CD4+ cell counts higher than 400/mm3 (mean 631, median 528, mode 465). These values are significantly higher than those observed in the same population in New York, the only American city with HIV-infection spread comparable to that observed in Milan. The probability of having CD4+ cell counts lower than 400, 300, and 200/mm3 in relation to the length of follow-up was, respectively, 50, 40, and 2% after 36 months from presentation. At the same end point, subjects presenting less than 400 CD4+ cells at entry had 30% probability of falling under 200 cell/mm3. The pattern of CD4+ cells, as much as the low percentage of yearly progression to overt AIDS, is probably related to the recent, even if rapid, spread of infection among IVDUs in Italy. The clinical features of overt AIDS present some differences between IVDUs and other at-risk groups. Among U.S. IVDUs with AIDS, Kaposi's sarcoma is infrequent (2.9% vs 27.7% in homosexual men) while mycotic infections such as deep candidiasis and cryptococcosis are significantly more frequent. The same pattern has been observed in our case file in Milan: esophageal candidiasis represents the most frequent cause of diagnosis of overt AIDS. Mycotic infections, overall, are more frequent than in U.S. IVDUs. The increased rate of mycotic infections among IVDUs might be justified by altered functions of nonspecific immunity, such as PMNL killing and phagocytosis of Candida albicans spores, impaired in HIV-infected IVDUs, but generally normal in infected subjects belonging to the other at-risk groups.
The results of the work on the Program "Bus" supported by the Charitable Fund "Vozvrashchenie" and the French organization Doctors of the World [correction of Word] are presented. The Program "Bus", in contrast to a number of other programs aimed at the "decrease of harm", extended the project by providing the possibility of organizing, within this program, contacts between specialists and drug addicts, as well as the possibility of carrying out diagnostic procedures. As revealed in the process of the work, a half of those who applied to the "Bus" for help sought advice, psychological support, etc. 70% of the drug addicts asking for clean syringes had never applied for help. Among 900 persons who underwent testing, 90% were found to have markers of hepatitis C virus and 76%, markers of hepatitis B virus. Among those drug addicts who applied to the "Bus" for help 11% were found to have syphilis and 1 person proved to be HIV-infected. The results of the work on this project are indicative of the expediency of using such programs in other regions.
Hedonic and reinforcing properties of drugs of abuse are closely related to brain dopamine neuron activity. All these drugs increase dopamine release in the shell of the nucleus accumbens, a brain region in which neurons co-express the D1 (D1R) and D3 (D3R) dopamine receptor subtypes, that converging pharmacological, human post-mortem and genetic studies suggest to be implicated in drug addiction. The D3R through a cross-talk with the D1R, is involved in induction and expression of behavioral sensitization to levodopa in rats bearing unilateral lesions of dopamine neurons. Behavioral sensitization, a cardinal feature of addiction arises from repeated administration of drugs of abuse thought to play a role in intensification of reinforcing efficacy of these drugs observed under certain conditions. Stimulation of the D3R also appears to enhance the reinforcing effect of cocaine in rats. By interacting with these processes, D3R agents have potential therapeutic applications for treating drug addiction. BP 897 (N-[4-(4-(2-methoxyphenyl)piperazin-1-yl) butyl] naphtalen 2-carboxamide dichlorhydrate), a partial and highly selective D3R agonist in vitro, behaves as an agonist or an antagonist in vivo depending on the response considered. BP 897 has the unprecedented property to reduce cocaine-seeking behavior induced by presentation of a cocaine-associated cue, without having any intrinsic reinforcing effect. As drug-associated cues maintain drug-seeking in animals and elicit craving and relapse in humans, D3R agents like BP 897 may represent new medications for drug addiction, with minimal liability to maintaining dependence.
Basic aspects of drug abuse are discussed, from a semantic and physiopathologic point of view: drug definition; drug abuse and drug addiction; drug as a tool, that produces adverse or beneficial effects according to its use, rather than its intrinsic features. Simple and complicated drug-related problems are discussed in some depth, the former being associated with external factors, the latter with organic or mental disease. Practical implications of this concept are exposed. Similarities of drug abuse and suicide are underlined. It is concluded that ethical judgments and measures require an additional evaluation of these aspects, with particular reference to the medical component of drug abuse.
In this article the authors propose: 1) a typology of drug addiction cases consisting of four main classes: A. traumatic drug addiction, B. drug addiction from actual neuroses, C. transitional drug addiction, and D. sociopathic drug addiction; 2) a clinical study (with 18 months of follow-up data) involving 131 heroin addicts mostly treated with structural or counterparadoxical family therapy in the same psychotherapy center and in the same year; and 3) some preliminary conclusions emerging from an examination of the four-class typology with respect to the effectiveness of family therapy interventions. If, for example, structural family therapy techniques seem more suitable in type-B cases (similar to cases described by Haley in his Leaving Home), the counterparadoxical techniques are likely to be more effective in type-C cases (similar to the anorectics described by Selvini-Palazzoli).
Abuse of drugs can elicit compulsive drug seeking behaviors upon repeated administration, and ultimately leads to the phenomenon of addiction. We developed a procedure for the standardization of microarray gene expression data of rat brain in drug addiction and stored them in a single integrated database system, focusing on more effective data processing and interpretation. Another characteristic of the present database is that it has a systematic flexibility for statistical analysis and linking with other databases. Basically, we adopt an intelligent SQL querying system, as the foundation of our DB, in order to set up an interactive module which can automatically read the raw gene expression data in the standardized format. We maximize the usability of this DB, helping users study significant gene expression and identify biological function of the genes through integrated up-to-date gene information such as GO annotation and metabolic pathway. For collecting the latest information of selected gene from the database, we also set up the local BLAST search engine and nonredundant sequence database updated by NCBI server on a daily basis. We find that the present database is a useful query interface and data-mining tool, specifically for finding out the genes related to drug addiction. We apply this system to the identification and characterization of methamphetamine-induced genes' behavior in rat brain.
BACKGROUND: Treatment of drug addiction is complex; hence there is a debate in the field of what is the best approach. An honest desire to stop using drugs is the entry ticket into the self-help programmes Alcoholics Anonymous (AA) and Narcotics Anonymous (NA); these groups are a possible supplement to ordinary treatment. They employ the twelve-step programme and are found in most large cities in Norway and around the world. The usefulness of these groups has been disputed, and few Norwegian treatment facilities have developed a systematic cooperation with them. The purpose of this study was to examine whether the use of self-help groups is associated with higher rates of abstinence two years after participants started attending groups. MATERIALS AND METHODS: 114 patients, 59 with alcohol addiction and 55 with drug addiction, who started in self-help groups after a drug treatment, were approached two years later with a questionnaire. The response rate was 66%; 6 (5%) patients were dead. RESULTS: Intention to treat analysis showed that 38% participated in self-help programmes two years after treatment. Of regular participants, 81% had been abstinent over the previous 6 months, compared with only 26% among non-participants. Logistic regression analysis showed odds ratio = 12.6, 95% CI (4.1-38.3), p < 0.001, for participation and abstinence. CONCLUSION: The study has several methodological problems; particularly that correlation does not necessarily indicate causality. These problems are discussed here; the conclusion is that the probability of a positive effect is strong enough to recommend participation in self-help groups as a supplement to drug addiction treatment.