Sell, L.A., Cowen, P.J., Robson, P.J. (1995) Ondansetron and opiate craving A novel
pharmacological approach to Addiction. British Journal of Psychiatry,166, 511-514.
Conclusion Our current findings do not support a role for 5-HT3 receptor agonists
in the reduction of craving in opiate addicts.
Strang, J., Marks, I., Dawe, S., et al. (1997) Type of hospital setting and treatment
outcome with heroin addicts Results from a randomised trial. British Journal of Psychiatry,
Conclusions From pre-treatment onwards significant differences in process and outcome
were found after allocation to treatment on either DDU or GEN. Further randomised
studies are required to replicate and explain these findings.
Seoane, A., Carrasco, G., Cabre, L., et al (1997) Efficacy and safety of two new
methods of rapid intravenous detoxification in heroin addicts previously treated
without success. British Journal of Psychiatry, 171, 340-345.
Conclusions Successful rapid intravenous detoxification can be achieved using relatively
light levels of sedation.
Heroin is More Than Just Diamorphine
Authors: John Stranga; Les Kingb
Affiliations: a Professor of the Addictions and Director, National Addiction Centre,
the Maudsley Hospital/Institute of Psychiatry, London
b Head of Drugs Intelligence Laboratory, the Forensic Science Service, Lambeth Road,
Publication Frequency: 6 issues per year
Published in:Addiction Research & Theory, Volume 5, Issue 1 April 1997 , pages iii
Heroin isn't just heroin anymore. Over the last two decades, there has been diversification
in the forms and 'brands' of heroin which exist in both the domestic as well as international
marketplaces. Closer examination reveals important differences between these 'brands'.
Black market heroin may now be obtained in either the form of salt (hydrochloride)
or the separated base. Importantly, the different forms have different suitabilities
for use by injection or by 'chasing the dragon', with the salt form being most suitable
for injecting, whilst many of the base forms are either used by 'chasing' or are
chemically transformed to the salt before injection. Country of origin and obvious
physical characteristics such as colour are strong predictors of 'salt' or 'base'
status. When consideration is given to the more recent technique of chasing the dragon,
a new interpretation can be attached to some of the other drugs found in samples
of black market heroin (often described as 'impurities'). New data have identified
that several of these additional drugs increase substantially the proportion of heroin
which sublimates and can successfully be recovered by the heroin 'chaser', and these
increases can be seen in the extent of recovery of both salt and base forms of heroin.
Finally, new policy options are explored in the light of this new evidence-options
that include the proposed development and promotion of NIROAs (non-injectable routes
of administration), and the possible constructive manipulation of the heroin marketplace
through differential application of interdiction efforts so as to promote the move
from injecting to 'chasing' as the chosen method of heroin use.
Keywords: Heroin; black market; route; policy; control. UK; chasing the dragon
Perneger, T.V., Giner, F., del Rio, M. et al (1998) Randomised trial of heroin maintenance
programme for addicts who fail in conventional drug treatments. British Medical Journal,
Ghodse, A.H., Greaves, J.L., Lynch, D., (1999) Evalutation of the opioid addiction
test in an out-patient drug dependency unit. British Journal of Psychiatry,175,
Conclusions The opioid addiction test proved to be a very useful tool for the rapid
diagnosis of opioid dependence in the out-patient clinic. Specialist pupillometric
equipment increases the number of patients correctly identified as opioid dependent
on the first visit, but is not essential.
Smyth, B.P., Barry, J., Lane, A., et al (2005) In-patient treatment of opiate dependence:
medium-term follow-up outcomes. British Journal of Psychiatry, 187, 360-365.
Conclusions Abstinence remains an attainable goal. As the principal influence on
outcome was treatment adherence, in-patient services should seek to enhance rates
of programme completion. After-care should be provided to patients. We caution against
use of pre-treatment patient characteristics as criteria for prioritising access
to in-patient treatment.
Rathod, N.H., Addenbrooke, W.M., Rosenbach, A.F. (2005) Heroin dependence in an English
town: 33-year follow up. British Journal of Psychiatry, 187, 421-425.
Conclusions Results proved favourable in the above three parameters (percentage abstinent
for 10 years, percentage taking methadone and classified as addicted and percentage
mortality) compared with other long-term studies.
Whitty, M., O’Connor, J. (2007) Opiate dependence and pregnancy: 20 year follow up
study. Psychiatric Bulletin, 31, 450-453.
Clinical Implications Mortality was higher in our group than in other long-term follow
up samples. These findings suggest that such participants and their offspring require
intensive long-term support and treatment.
Haasen, C., Verthein, U., Degkwitz, P., et al (2007) Heroin-assisted treatment for
opioid dependence. British Journal of Psychiatry, 191, 55-62.
Conclusions Heroin-assisted treatment is more effective for people with opioid dependence
who continue intravenous heroin while on methadone or maintenance or who are not
enrolled in treatment. Despite a higher risk, it should be considered for treatment
resistance under medical supervision.