Incidence and prevalence of illegal drug use in Switzerland in the 1980s and early 1990s: an analytical study

The Swiss registry of charges concerning illegal trade and consumption of narcotics offers the possibility of monitoring the incidence and prevalence of illegal drug use in Switzerland. Of course, the relation between the number of charges against users of illegal drugs and the number of users is unknown and may vary in time and space. This makes it difficult to estimate the prevalence of consumption from law enforcement data, but it does not hinder the estimation of incidence if the numbers of first and subsequent charges are known. This is demonstrated by employing a dynamic model with two compartments which represent the not yet charged and the charged users. In contrast to methods which rely on treatment admission data, the new method can detect changes of incidence without time lag. Prevalence estimates can be obtained if the charge frequency distribution is known, as it is for Switzerland from 1990 to 1994. A theoretical distribution is fitted to the data which are available for all illegal drugs as well as for heroin and/or cocaine. This leads to estimates of the populations of users of illegal drugs in general and of heroin and/or cocaine.     

Two successful surgical cases of total left anomalous pulmonary venous connection with intact atrial septum--a report on their operative procedures and approaches

A seroepidemiological survey of a group of drug abusers has been carried out to determine the prevalence of hepatitis C virus and hepatitis B virus, hepatitis D virus, hepatitis A virus infection markers in sera, as well as to evaluate the role of potential risk factors. A total of 645 symptomless subjects with a history of injecting heroin were recruited as volunteers from methadone maintenance centres in Rome. For all hepatitis viruses the total figures showed high prevalence rates giving considerable viral circulation in this group. Among heroin addicts the prevalence was 63.4% for HCV, 65% for HBV, 13.3% for HDV and 50.9% for HAV. Anti-HCV prevalence correlated with serological evidence of HBV infection. A significant correlation was also found between presence of HCV antibodies and exposure time to drug addiction > 5 years earlier. The data reveal the important role played by needle sharing in the spreading of multiple infections among intravenous drug abusers (IVDA).     

Differential diagnosis of pulmonary circular focusses by means of analytic-synthetical picture evaluation (author''s transl)]

Hyperamylasemia was noted in 17 (19%) of a group of 91 hospitalized heroin addicts. Thirteen of the 17 were in acute respiratory distress (12 with so-called "heroin lung" syndrome and one with status asthmaticus). Isoamylase analysis in the hyperamylasemic patients demonstrated S-type isoamylase dominance in 15, P-type isoamylase dominance in one and essentially equivalent P- and S-type isoamylase elevations in one. It would appear from these data that the hyperamylasemia after heroin in most persons addicted to the use of this drug arises from the sources other than the pancreas. Changes in the lungs occurring in association with heroin addiction seem to have an important role among the possible contributory factors.     

Personality differences and sociopathy in heroin addicts and nonaddict prisoners.

Examined measurable personality differences between carefully selected samples of 40 heroin addicts and 40 nonaddict prisoners. Composite mmpi profiles were compared for statistical differences between groups, and individual mmpi profiles were classified using a system of differential diagnosis reported by P. E. Meehl. Results suggest that there are measurable personality differences between heroin addicts and nonaddict prisoners, especially with respect to the incidence and extent of sociopathy. The 2 samples did not differ from each other in terms of age, educational level, intellectual level, or chronicity of antisocial behavior as indicated by time served in prison. (16 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Death from heroin overdose: findings from hair analysis

BACKGROUND: Morphine analysis of hair is used in forensic toxicology to study the addiction history of heroin addicts. To clarify the features underlying fatal heroin intake, we measured hair morphine content in a group of deceased heroin addicts, to verify a possible correlation between fatal heroin overdoses and the addiction behaviour of these individuals before death. METHODS: 91 deaths were attributed to heroin overdose in Verona, Italy, in 1993-96. We analysed the hair of 37 of these individuals, and of 37 active heroin addicts, 37 former heroin users abstinent from the drug for several months, and 20 individuals with no evidence of exposure to opioids. From each individual, a hair sample of about 150 mg was analysed by RIA and high-performance liquid chromatography, to measure the morphine content. FINDINGS: The mean morphine content in the hair of the addicts who had died was 1.15 ng/mg (SD 2.35 ng/mg; range 0-12.25 ng/mg) compared with 6.07 ng/mg (4.29; 1.15-17.0) in the active heroin addicts, 0.74 ng/mg (0.93; 0.10-3.32) in the abstinent former addicts, and values below the detection limit in the non-exposed group. Hair morphine content among those who had died was significantly lower than that in active heroin consumers (p<.00001), but not significantly different from that in the former addicts (p=0.978). INTERPRETATION: Although our findings may be subject to selection bias, since suitable hair samples were available for only 37 of the 91 addicts who had died, these findings support the theory of high susceptibility to opioid overdose after periods of intentional or unintentional abstinence, due to loss of tolerance. Medical staff running detoxification programmes should be aware of the risk inherent in relapse to heroin after a period of abstinence. Moreover, occasional heroin use without a build-up of tolerance could also give a high risk of overdose.     

Heroin addiction: Its relation to sexual behavior and sexual experience.

Describes a study in which 31 17-60 yr. old male drug-free heroin addicts, residents of a therapeutic community, were questioned individually by a nonaddict male interviewer as to 7 sexual variables. Results show that during addiction periods, "sexuality" was suppressed; most Ss reported decreased frequencies of intercourse, masturbation, and nocturnal emissions. Proportion of orgasm dropped, ratings of desire and the quality of orgasm were low, and all Ss reported that time to ejaculation was long. In the postaddiction residential phase in the program, sexuality recovered and resembled or was higher than that reported for preaddiction periods. A relationship between changes in sexuality and heroin addiction appears firmly established. A reinforcement hypothesis is discussed. (21 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stationary phase and the cell cycle of Dictyostelium discoideum in liquid nutrient medium

In a study of social interaction during an experimental addiction cycle, male narcotic addicts expressed more hostility after higher doses of heroin. No consistent role variations were observed in dominance, friendliness, or therapeutic-orientation.     

Immunoassayable beta-endorphin level in the plasma and CSF of heroin addicted and normal subjects before and after electroacupuncture

The present study was undertaken to evaluate if plasma or CSF beta-endorphin level can be induced to rise during the treatment of heroin addiction by electroacupuncture. Based on the examination of 30 addicts, we obtained no evidence indicating an increase of beta-endorphin level in either the plasma or the CSF after 30 min of acupuncture. In spite of this, the majority of the addicts experienced a reduction of withdrawal symptoms during treatment. Since electroacupuncture may only induce a highly localized secretion of beta-endorphin in the brain, our results cannot unequivocally exclude the possibility that this peptide is involved in mediating the action of acupuncture.     

Alterations of immune functions in heroin addicts and heroin withdrawal subjects

Conflicting results, both decreased and increased, have been reported concerning the function of T-lymphocytes in heroin addicts. We investigated the alterations of T-lymphocyte proliferative responses and immunophenotypic markers on lymphoid cells in heroin addicts and during different periods of heroin withdrawal in addicted subjects. This study has demonstrated a decrease in the response of T-lymphocytes to 1.2, 2.5, 5 and 10 microg/ml of phytohemagglutinin stimuli in heroin addicts and 1- to 5-day heroin withdrawal subjects compared with controls. Similarly, in an in vitro study, 10(-4), 10(-6) and 10(-8) M concentrations of morphine were shown to suppress 0.6 and 2.5 microg/ml of PHA-stimulated T-lymphocyte obtained from naive subjects. This inhibitory effect of morphine on PHA stimulation was completely abolished by 100 microM naloxone. The immunological parameters of total T-lymphocytes (CD3), T-helper cells (CD4), cytotoxic T-cells (CD8), B-cells and natural killer cells that are the immunophenotypic markers studied by flow cytometric analysis were altered in heroin addicts, 15- to 21-day and 6- to 24-month heroin withdrawal subjects, when compared with controls. These results suggest that heroin addicts and short period (15 to 21 days and 6 to 24 months) of heroin withdrawal have decreases in their immune system functioning and that the heroin withdrawal subjects seem to gradually reverse their immunological parameters to normal levels when withdrawal was sustained >/=2 years. This is the first report examining immune function in heroin withdrawal subjects using the "cold turkey" method. The results are beneficial for further study of the mechanism responsible for the opioid-induced changes in immune function.     

Opiate dependence, comorbidity and seasonality of birth

OBJECTIVE: In contrast with the non-opiate dependent population, persons biologically-dependent upon opioids display an excess life-time prevalence of affective and anxiety disorders. Many of these addicts state that opiates, particularly methadone, relieve or diminish the severity of their dysphoria. The purpose of this study is to explore this phenomena by analyzing how a specific population of long-term addicts (mean years of addiction 16.9, SD 3.8) differs from a non-opiate dependent population regarding seasonality of birth. METHODS: Birth months were determined for 457 opiate dependent patients, placed onto methadone maintenance for intractable opiate dependence, born between 1930-1970 (sorted by sex, race, year and place of birth), and compared to normal US birth statistics. Affective and anxiety disorders were screened for using psychometric testing, verified by structured clinical intervals. RESULTS: A significant difference was noted when comparing monthly births rates for patients and normals. Grouping the monthly data into birth trimesters (Oct-Jan; Feb-May; Jun-Sep) clearly shows this difference: opioid dependent persons--38.5/29.8/31.8%; normals--33.4/32.0/34.7%. As a group, intractable, opioid dependent patients demonstrate an increased life-time prevalence, relative to normals, of anxiety (27.8 vs. 13.9%), dysthymia (23.4 vs. 6.4%) and combined anxiety + dysthymia (17.9 vs. 1.5%); opioid dependent persons born between Oct-Jan demonstrated more anxiety (32.0 vs. 25.1%), dysthymia (29.3 vs. 19.5) and combined anx + dys (23.3 vs. 14.4) than those born in the other two trimesters. CONCLUSION: Persons entering methadone maintenance for opiate dependence with comorbid anxiety, dysthymia or combined anxiety + dysthymia are more likely to have been born in the period of Oct-Jan. This may be due to a higher risk of developmental aberrations occurring in infants born during the light-limited portion of the year creating a later propensity for intractable, opiate dependence.     

Alcohol and drug abuse: a retrospective analysis of incidence in a regional hospital 1993-1994

This retrospective study analyzes and compares the incidence of admissions for alcohol and drug (i.e.: heroin and cocaine) induced diseases to the internal medicine service of Locarno Regional Hospital (61 beds plus intensive care unit) between January 1, 1993 and December 31, 1994. Of 4038 admissions, 298 (7.4%) were related to alcoholism and drug addiction. 4.2% of all hospital days were due to alcohol abuse, whereas 3.2% were related to drug abuse (of these 1.8% were for HIV-associated diseases and 0.9% for withdrawal treatment). The male/female ratio was 3:1 in both groups, the average age of women being significantly lower in the alcoholic group (50.5 +/- 14.4 years vs. 58.1 +/- 12.9; p = 0.003). Over 90% of the patients with alcohol-induced conditions continued to consume alcohol. On the contrary, only 16% of the HIV-positive patients were still drug-addicted. The in-hospital mortality was 6% (5% in the alcoholic group; 1.6% and 12%, respectively, in the HIV-negative and HIV-positive groups of drug addicts). This study confirms the high prevalence of diseases related to alcohol and drug abuse. Women are less affected, but show complications of alcohol abuse earlier. Despite the HIV epidemic in our area, the admissions of alcoholics to the hospital are more frequent than those of drug addicts. Most of the drug addicts with an HIV-associated condition are in remission, whereas alcoholics with alcohol-induced diseases continue, for the most part, to be alcohol-dependent.     

Withdrawal in opiate addicts in an internal medicine hospital unit

Withdrawal of opiates drug addicts in Internal Medicine is unusual in France. Four main preliminary conditions are requested: 1--Drug addict preparation and self motivation, 2--Inter and intra institution team collaboration, 3--Opening the hospital towards community agencies, 4--Hospital staff recruited on volunteer basis. Within two years (1992-1993), 210 opiates drug addicts were hospitalized for withdrawal. Two third were males, median age was 27, median years of addiction was 7. Thirty percent were seropositive for HIV, 70% for HCV. Hospitalisation lasted 7 days for heroin addicts and 10 days for morphin, codein or buprenorphin addicts. Successful withdrawn was observed for 70% patients but six months after withdrawal, only 15% remained abstinent.     

Infective endocarditis as a complication of heroin use

Infective endocarditis in heroin addicts has been reported to have a mortality as high as 85% and reports have varied widely regarding predominant valvular involvement and infecting microorganisms. A retrspective study was done and 61 cases of heroin-associated infective endocarditis were identified at Freedmen's Hospital and the District of Columbia General Hospital, Washington, DC between January 1969 and January 1973. Our results indicate that staphylococcal infection of the tricuspid valve has a much higher incidence in this population than has generally been believed and that it is the predominant presentation of infective endocarditis in these patients. The outcome of patients in our series compares favorably with previous reports and suggests that early diagnosis and prompt institution of appropriate antimicrobial therapy are important and may lead to improved survival in addicts with tricuspid endocarditis.     

A theoretical note on personality characteristics of heroin addicts.

Contends that P. B. Sutker's (see record 1972-09270-001) finding that heroin addicts produced a more elevated MMPI profile than a comparable sample of nonaddicts may have been due to the fact that heroin addicts were "volunteers" for treatment, unlike the nonaddict sample. The present study provided a demonstration of the effect of the "volunteer" factor on addict and nonaddict MMPI profiles. More elevated MMPI profiles were found both for volunteer addict and nonaddict Ss (n = 17) when compared to MMPI profiles of nonvolunteer addicts and nonaddicts (n = 33). The MMPI profiles of addicts and nonaddicts were quite similar when the volunteer factor was controlled. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Direct and indirect estimates of HIV-1 incidence in a high-prevalence population

While the worldwide AIDS epidemic continues to expand, directly measured incidence data are difficult to obtain. Methods to reliably estimate human immunodeficiency virus type 1 (HIV-1) incidence from more easily available data are particularly relevant in those parts of the world where prevalence is rising in heterosexually exposed populations. The authors set out to estimate HIV-1 incidence in a population of heterosexual sexually transmitted disease clinic attendees in Trinidad who had a known high prevalence of HIV-1 subtype B. Over the period 1987-1995, HIV-1 incidence estimates from serial cross-sectional studies of HIV-1 prevalence, passive follow-up of clinic recidivists, modeling of early markers of HIV-1 infection (p24 antigen screening), and a cohort study of seronegative genital ulcer disease cases were compared. Measuring incidence density in the genital ulcer disease cases directly gave the highest estimate, 6.9% per annum. Screening for the detection of early HIV-1 markers yielded an incidence of 5.0% per annum, while estimating incidence from serial cross-sectional prevalence data and clinic recidivists gave estimates of 3.5% and 4.5% per annum, respectively. These results were found to be internally consistent. Indirect estimates of incidence based on prevalence data can give accurate surrogates of true incidence. Within limitations, even crude measures of incidence are robust enough for health planning and evaluation purposes. For planning vaccine efficacy trials, consistent conservative estimates may be used to evaluate populations before targeting them for cohort studies.     

Insulin-dependent diabetes in the county of Funen 1970-2020. An epidemiological description

We present an epidemiological model applicable to insulin-dependent diabetes mellitus (IDDM), based on which prevalence rates are estimated from assumed rates of incidence and mortality of diabetes. The model is illustrated by analysing epidemiological data on IDDM in Fyn County, Denmark for the period 1970-1990, with predictions of prevalence rates during 1990-2020. The epidemiological model assumes known prevalence rates as well as incidence rates and mortality at a given point of time. Under assumed rates of incidence and mortality of IDDM and its complications, the prevalence rate is the dependent variable which is estimated as a function of calendar time. We used epidemiological data on IDDM (operationally defined as insulin-treated diabetes with onset before age 30 years), blindness and nephropathy as well as mortality as reported for the years 1973 and 1987 in Fyn County, Denmark. During 1970-1990 the prevalence of IDDM increased steadily, due to increasing incidence and decreasing risk of complications and mortality. The relative prevalence of patients with nephropathy increased whereas that of blind patients decreased considerably. Under specified assumptions regarding the future levels of incidence of disease, complications and of mortality, it is estimated that the prevalence rate of IDDM in the year 2020 will be 45-60% higher than the level in 1990. The relative prevalence of patients with nephropathy will increase further, whereas the relative prevalence of blind patients will remain constant at a low level. We conclude that IDDM will represent an increasing public health problem in Denmark over the next decades, with increasing overall prevalence rates and a rising proportion of patients with nephropathy. The major determinants of this trend are increasing incidence, combined with declining mortality and declining risk of complications. It is recommended that epidemiological modelling techniques be further developed to provide improved data for the planning of the future diabetes care.     

Opiate addiction: The case for an adaptive orientation.

Reviews the 2 views of addiction to heroin and other opiate drugs: The exposure orientation (including metabolic and conditioning theories) views addiction as a condition engendered by prior opiate use; the adaptive orientation depicts it as a continuing attempt to reduce distress (be it social, cognitive, or genetic) that existed before opiate use began. Recent data indicate that the exposure orientation may have outlived its usefulness because it implies that addiction is interminable since each dose strengthens the habit. The strongest evidence against the exposure view has come from the low rate of Vietnam veterans who relapsed into addiction after detoxification. The authors recommend a major shift of emphasis toward the adaptive orientation, which would benefit science, psychotherapy, and public policy. However, they also discuss 4 problems of the adaptive orientation (and their resolutions): explanation of the self-destructive nature of addiction; the plethora of retrospective, rather than experimental, evidence; the hesitancy of psychologists to reject the long-standing exposure hypothesis; and the lack of large-scale success in using this psychotherapeutic view to cure addicts. (128 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Estimating HIV incidence from age-specific prevalence data: comparison with concurrent cohort estimates in a study of male factory workers, Harare, Zimbabwe

OBJECTIVE: To compare HIV incidence estimates from cross-sectional age-specific prevalence data with concurrent cohort estimates and to examine the sensitivity of the estimates to changes in age-categorization and survivorship assumptions. METHODS: Two previously described methods of estimating HIV incidence from cross-sectional prevalence data - the cumulative incidence and survival (CIS) and constant prevalence (CP) methods - are applied using data from a study of male factory workers in Harare, Zimbabwe. The methods are applied under two alternative groupings of the HIV prevalence data and under alternative survivorship assumptions: (a) Weibull distribution providing the best fit to the HIV prevalence data using the CIS method; (b) Weibull distribution matching data from an HIV natural history cohort study in Uganda; and (c) survivorship pattern as in (b) with survival periods reducing with increasing age at infection. Age-specific, age-standardized and cumulative HIV incidence estimates are calculated. The results are compared with concurrent longitudinal estimates from 3 years of follow-up of the Harare cohort (1993-1995). RESULTS: Age-standardized HIV incidence was estimated at 2.02 per 100 man years (95% CI, 1.57-2.47) in the cohort study. There was evidence of recent variability in HIV incidence in these data. Estimates from the cross-sectional methods ranged from 1.98 to 2.74 per 100 man years and were sensitive to changes in age-categorization of the HIV prevalence data and changes in survivorship assumptions. The cross-sectional estimates were higher at central ages and lower at older ages than the cohort estimates. The age-specific estimates from the CIS method were less sensitive to changes in age grouping than those from the CP method. CONCLUSIONS: HIV incidence remains high in Harare. Incidence estimates broadly consistent with cohort estimates can be obtained from single-round cross-sectional HIV prevalence data in established epidemics - even when the underlying assumption of stable endemic prevalence is not fully met. Estimates based on cross-sectional surveys should therefore be explored when reliable longitudinal estimates cannot be obtained. More data on post-HIV infection survivorship distributions in sub-Saharan Africa would facilitate the improvement of estimates of incidence based on cross-sectional surveys.     

Drug abusers on the job

Drug abusers in the working population range from the functional to the dysfunctional. Functional drug-abusing employees may work as productive members of a company for years without incident or detection. Cases have been documented of long-term heroin addicts with stable 10- and 20-year work histories., Studies of drug addicts in treatment with known work histories reveal that such persons can, and do, hold a broad range of jobs in the work force. In a study by Levy of 95 former addicts with histories of simultaneous employment and undetected drug abuse (including on-the-job use by 91 of the 95 addicts), the following occupations were found: bank teller; mail clerk; secretary; delivery man; stock clerk; college registrar; typist; baker; nurses aide; medical supply clerk; messenger; pharmacy clerk; receptionist; teletype operator; men's clothing salesman; truck driver; busboy; telephone installer; roofer; clothing designer; assembly line worker; waitress; auto mechanic; security officer; postal worker; credit collector; plant manager; and rigger. Reports from CODAP, a Federal statistical system covering drug treatment programs, indicate that about 20% of opiate users admitted to treatment were employed full time at the time of admission. Caplovitz found that the stable worker-addict is more similar in basic characteristics to other workers than to nonworking addicts.     

Asymptomatic incidence and duration of prostate cancer

Prostate cancer is known as a disease with an extremely high prevalence relative to its clinical incidence in the population. The combination of preclinical incidence and duration that could yield this phenomenon is of tremendous interest to researchers trying to understand the natural history of the disease and to develop efficient screening strategies. In this article, the authors present estimates of the age-specific asymptomatic incidence and average preclinical duration of prostate cancer. The methodological approach is to first estimate the age-specific incidence of new (stage AI) prostate cancers using preclinical prevalence data from autopsy studies performed between 1941 and 1964 and clinical incidence data for the years 1960-1986 from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. Then, the preclinical prevalence estimates are divided by the derived preclinical incidence estimates to yield estimates of the average duration of asymptomatic disease. The estimated mean duration among white men is between 11 and 12 years and appears to be approximately 1 year shorter for blacks than for whites. Comparison of the lifetime risks of preclinical and clinical disease suggests that approximately 75% of prostate cancers will never become diagnosed if clinical incidence remains at levels observed in 1984-1986, prior to the introduction of prostate-specific antigen (PSA) screening in the population.