Search results

1 – 10 of over 1000
To view the access options for this content please click here
Article
Publication date: 4 September 2017

Clara Maria Schutte, Sunayna Sasikumar, Keorapetse Nchoe, Mandisa Kakaza, Veronica Ueckermann and Cornelius H. Van der Meyden

In South Africa, many illicit drugs have only recently been introduced and drug-related complications are often new to treating physicians. Heroin-induced…

Abstract

Purpose

In South Africa, many illicit drugs have only recently been introduced and drug-related complications are often new to treating physicians. Heroin-induced leukoencephalopathy has been reported elsewhere in patients who inhale heated heroin vapors, a method known as “chasing the dragon.” The purpose of this paper is to present two patients, known to have inhaled heroin a few weeks prior to presenting with progressive neurological deficits.

Design/methodology/approach

Case presentations: two young males presented independently within eight weeks of one another with progressive slurring of speech, incoordination and weakness of the limbs over a period of two to three weeks. Both were known heroin addicts, and were known to one another, and both had inhaled heroin prior to the onset of symptoms.

Findings

The patients presented with a pancerebellar syndrome with marked bilateral upper motor neuron signs. CT scans showed diffuse symmetrical hypodense lesions involving the cerebral and cerebellar white matter with normal CSF. Both patients deteriorated neurologically, became cardiovascularly unstable and demised. Postmortem in one of the patients showed a prominent spongiform leukoencephalopathy consistent with reports of heroin-inhalation injury to the brain.

Research limitations/implications

Toxic leukoencephalopathy due to heroin vapor inhalation was first described in the Netherlands in 1982. It has not been reported to occur with other modes of heroin use; an unknown toxin contained in heroin pyrolysate which forms when heroin is heated, may be causative. Brain MRI typically shows diffuse, symmetrical white matter hyperintensities on T2 and fluid-attenuated inversion recovery sequences in the cerebellum, posterior cerebrum and posterior limbs of the internal capsule with a posterior-anterior gradient. Pathologically, spongiform degeneration with relative sparing of subcortical U-fibers is seen. No treatment has been proven effective, but antioxidants and Vitamin E may be beneficial. Mortality is high at 23-48 percent.

Practical implications

This report emphasizes that spongiform leukoencephalopathy as a rare consequence of inhaling heroin vapors does occur in South Africa and clinicians should consider this disorder in their differential diagnosis of acutely developing leukoencephalopathy.

Social implications

An awareness program regarding this grave condition is planned.

Originality/value

The cardiovascular complications of patients inhaling heroin vapor has not been highlighted previously. These are the first patients from Africa described with this condition. A toxic component appears likely.

To view the access options for this content please click here
Article
Publication date: 17 June 2011

Salman Mushtaq, Joby Maucoli Easow, Vania Mendes and Jason Luty

Injectable opioid therapy (prescribing heroin for heroin addicts to inject) remains a highly controversial and expensive option. Recent research has shown significant…

Downloads
183

Abstract

Purpose

Injectable opioid therapy (prescribing heroin for heroin addicts to inject) remains a highly controversial and expensive option. Recent research has shown significant benefits for this therapy in otherwise refractory patients. The aim of this paper is to assess the public opinion regarding heroin prescribing to addicts and to determine what effect the cost of this might have on their opinions.

Design/methodology/approach

Participants were asked to complete a questionnaire after reading a vignette which described current opioid maintenance therapy. Two vignettes were generated and the experimental group was randomised to receive the additional information that the cost of heroin prescribing was £15,000 per addict, per year.

Findings

Questionnaires were received from 187 subjects (response rate 74 percent). For the control group, 23 percent agreed and 58 percent disagreed with prescribing heroin to addicts (23 vs 62). For the experimental group, where the additional cost of £15,000 per addict was introduced into the vignette, 10 percent agreed and 75 percent disagreed (10 vs 71). The difference was statistically significant (p<0.05; χ2). In total, 58 percent of people were opposed to the idea that heroin should be prescribed to heroin addicts on the National Health Service but this rises to 75 percent when the annual cost of prescribed heroin (£15,000) is included.

Originality/value

This study supports an earlier survey that showed over 80 percent of the general public opposed the prescription of diamorphine to addicts even to reduce crime. Heroin prescribing remains controversial and lacks public support.

Details

Journal of Public Mental Health, vol. 10 no. 2
Type: Research Article
ISSN: 1746-5729

Keywords

To view the access options for this content please click here
Article
Publication date: 21 June 2021

Marcelo Ribeiro, Rosana Frajzinger, Luciane Ogata Perrenoud and Benedikt Fischer

Brazil’s street-based drug use is mostly characterized by non-injection psychostimulant (e.g. crack-cocaine) drug use in Brazil, with limited interventions and service…

Abstract

Purpose

Brazil’s street-based drug use is mostly characterized by non-injection psychostimulant (e.g. crack-cocaine) drug use in Brazil, with limited interventions and service availability. Recently, an influx of multi-ethnic migrants within an urban drug scene in Sao Paulo was associated with heroin use, a drug normatively absent from Brazil. The purpose of this paper is to characterize and compare heroin use-related characteristics and outcomes for an attending sub-sample of clients from a large community-based treatment centre (“CRATOD”) serving Sao Paulo’s local urban drug scene.

Design/methodology/approach

All non-Brazilian patients (n = 109) receiving services at CRATOD for 2013–2016 were identified from patient files, divided into heroin users (n = 40) and non-heroin users (n = 69). Based on chart reviews, select socio-demographic, drug use and health status (including blood-borne-virus and other infections per rapid test methods) were examined and bi-variately compared. Multi-variate analyses examined factors independently associated with heroin use.

Findings

Most participants were male and middle-aged, poly-drug users and socio-economically marginalized. While heroin users primarily originated from Africa, they reported significantly more criminal histories, drug (e.g. injection) and sex-risk behaviors and elevated rates of BBV (e.g. Hepatitis C Virus and HIV). A minority of heroin users attending the clinic was provided methadone treatment, mostly for detoxification.

Originality/value

This study documented information on a distinct sample of mostly migration-based heroin users in Sao Paulo, Brazil. Based on the local experience, global migration dynamics can bring changes to established drug use cultures and services, including new challenges for drug use-related related behaviors and therapeutic interventions that require effective understanding and addressing.

Details

International Journal of Migration, Health and Social Care, vol. 17 no. 3
Type: Research Article
ISSN: 1747-9894

Keywords

To view the access options for this content please click here
Book part
Publication date: 1 September 2016

Lee D. Hoffer

To expand understandings of conflict, this chapter offers a detailed assessment of how exchange is enacted within local heroin markets. Addressing drug dealing and heroin

Abstract

Purpose

To expand understandings of conflict, this chapter offers a detailed assessment of how exchange is enacted within local heroin markets. Addressing drug dealing and heroin users’ buying drugs for their peers (i.e., brokering), this research expands how illegal drug markets are commonly understood. A generalized framework is presented that highlights patterns of exchange.

Approach

Findings come from a 36-month study of a demographically diverse sample of 38 heroin users in Cleveland, OH. Methods involved open-ended, semi-structured interviewing and participant observation, conducted by the author and a team of graduate students.

Findings

Instead of framing exchange as either an economic or social act, this chapter shows how trade in heroin markets is often both. Here Gudeman’s (2001) dialectic between market and community is embodied in inter-subjectivities of traders, promoting both trust and conflict. In this context, conflict is the result of perpetual ambiguity all market participants can experience.

Research implications

Applying a blended notion of exchange as both social and economic offers new insight on conflict and expands its orientation beyond narratives of political economy. Here, in addition to the economics that often promote conflict, the social elements of exchange (e.g., reciprocity) are emphasized.

Originality

Research has understood conflicts in drug market operations through trader characteristics (e.g., poverty, race, class, privilege). This chapter emphasizes opportunities for conflict irrespective of individualized characteristics by outlining structural elements of exchange.

Details

The Economics of Ecology, Exchange, and Adaptation: Anthropological Explorations
Type: Book
ISBN: 978-1-78635-227-9

Keywords

To view the access options for this content please click here
Article
Publication date: 11 December 2020

Toby Seddon

This extended review of Stimson and Oppenheimer’s classic book Heroin Addiction aims to highlight its contribution to the literature and consider its contemporary…

Abstract

Purpose

This extended review of Stimson and Oppenheimer’s classic book Heroin Addiction aims to highlight its contribution to the literature and consider its contemporary relevance for research, policy and practice.

Design/methodology/approach

The review examines the core themes of the longitudinal study that the book presents by bringing it in to dialogue with a recent “living history” project on John Marks’ radical heroin prescribing in the 1980s and 1990s.

Findings

The three core themes explored are treatment as containment; the balance between therapy and social control; and the benefits of heroin versus methadone.

Originality/value

The book is a “timeless classic” that still resonates with contemporary concerns and has much to tell us about heroin addiction and its treatment.

Details

Drugs and Alcohol Today, vol. 20 no. 4
Type: Research Article
ISSN: 1745-9265

Keywords

To view the access options for this content please click here
Article
Publication date: 1 December 2005

W. Rees Davis, Bruce D. Johnson, Doris Randolph, Hilary James Liberty and John Eterno

Comparisons between New York Police Department (NYPD) drug‐allegation data and data from users' and sellers' self‐reports about crack, powder cocaine and heroin provided…

Downloads
565

Abstract

Purpose

Comparisons between New York Police Department (NYPD) drug‐allegation data and data from users' and sellers' self‐reports about crack, powder cocaine and heroin provided useful insights about the allocation of police resources via drug‐allegation data.

Design/methodology/approach

Central Harlem was divided into 45 primary sampling units (PSUs) with two years of NYPD data organized in three strata, high, mid or low allegations/capita. In nine randomly selected PSUs (three/stratum), interviewers employed chain referral sampling, steered with a nomination technique.

Findings

NYPD drug‐allegation data concurred more often with self‐report data concerning crack use/sales, but underestimated use/sales of powder cocaine and heroin. Mid‐level PSUs had proportions of crack users/sellers similar to high‐level PSUs. Mid‐ and low‐level PSUs often had high proportions of powder cocaine and heroin users/sellers.

Research limitations/implications

The enumeration of crack users/sellers produced results similar to NYPD data because crack use/sales may be more easily detected and willingly reported by citizens, police informants and police officers. Powder cocaine and heroin use/sellers enumerated were less noted in the NYPD drug allegations.

Originality/value

Provides insights into a question not addressed in previous research – how much and what kinds of drug activity are indicated by NYPD drug‐allegation data.

Details

Policing: An International Journal of Police Strategies & Management, vol. 28 no. 4
Type: Research Article
ISSN: 1363-951X

Keywords

To view the access options for this content please click here
Article
Publication date: 1 March 2008

Susan Beckerleg, Ahmed Sadiq and Maggie Telfer

This paper reports on a questionnaire survey of 300 heroin users in Zanzibar town, in Tanzania. It was found that about 13% of respondents were current injectors of heroin

Abstract

This paper reports on a questionnaire survey of 300 heroin users in Zanzibar town, in Tanzania. It was found that about 13% of respondents were current injectors of heroin, but that 38% of respondents reported have ‘ever injected’ heroin. Many injectors reported hiding their needles and syringes and almost half of them had shared their equipment during the past four weeks. Most of the respondents reported that they had not had sexual intercourse during the past four weeks. Of those who were sexually active most reported not having used a condom the last time they had intercourse. These findings highlight the need for a wider recognition of the extent of heroin use in East Africa as well as the urgent need to provide harm reduction and treatment services.

Details

Drugs and Alcohol Today, vol. 8 no. 1
Type: Research Article
ISSN: 1745-9265

Keywords

To view the access options for this content please click here
Article
Publication date: 18 April 2008

Toby Seddon

The purpose of this paper is to review the research evidence on recent British trends in the use of heroin and/or crack‐cocaine by young people in order to appraise the…

Downloads
1127

Abstract

Purpose

The purpose of this paper is to review the research evidence on recent British trends in the use of heroin and/or crack‐cocaine by young people in order to appraise the scale and nature of the contemporary health problem they pose.

Design/methodology/approach

The approach consists of a narrative review of the main current data sources on young people's drug use.

Findings

Use of heroin or crack‐cocaine is rare in Britain in the general population of young people and is concentrated more amongst young adults than adolescents. There is some evidence for associations between use of these drugs and socio‐economic disadvantages, although the links are complex. There may be fruitful connections to be made between drug policy and public health strategies for tackling health inequalities.

Practical implications

Embedding responses to young people's heroin/crack use within mainstream strategies to tackle health inequalities may be mutually beneficial to both policy agendas.

Originality/value

Situating in its proper evidential context the emotive issue of young people's use of what are believed to be the most dangerous illicit drugs, and appraising these data from a public health perspective, may lead to a more realistic and appropriate research and policy response.

Details

Health Education, vol. 108 no. 3
Type: Research Article
ISSN: 0965-4283

Keywords

To view the access options for this content please click here
Article
Publication date: 5 December 2016

David Kingsley Payler

The purpose of this paper is to examine whether it is possible to switch patients from heroin or methadone to buprenorphine without needing to experience symptoms of withdrawal?

Abstract

Purpose

The purpose of this paper is to examine whether it is possible to switch patients from heroin or methadone to buprenorphine without needing to experience symptoms of withdrawal?

Design/methodology/approach

Review of author’s experience in 1980s where three patients transferred to 4 mg buprenorphine from 40 ml (1mg/ml) methadone without symptoms of withdrawal. Review of literature where patients were transferred to buprenorphine without waiting for withdrawal symptoms to occur. Presentation of six case histories in author’s clinic.

Findings

Provided the buprenorphine is commenced at a very low dosage, is gradually increased and the heroin/methadone is reduced over a period of time, it is possible to change from heroin or methadone without inducing withdrawal symptoms. It is not necessary to stop the heroin/methadone and wait for withdrawal symptoms to occur.

Research limitations/implications

Due to the author’s retirement in October 2015 further research into the production of a template which could be used universally has not yet been possible.

Practical implications

Transferring patients from heroin and methadone to buprenorphine has often been difficult. Waiting for withdrawal symptoms to occur has often resulted in treatment failure. The method described eliminates the problem for patients.

Social implications

Patients find the method is more acceptable and allows normal functioning.

Originality/value

Confirmation that the findings of the original case histories from 1980s were valid. The value to the treatment service should be considerable in simplifying the prescribing practice.

Details

Drugs and Alcohol Today, vol. 16 no. 4
Type: Research Article
ISSN: 1745-9265

Keywords

To view the access options for this content please click here
Article
Publication date: 1 July 2006

Susan Beckerleg, Ahmed Sadiq and Maggie Telfer

Heroin has been a street drug along the East African coast for 25 years (Beckerleg, 1995) but it has only recently been recognised and documented (Kilonzo et al, 2001;…

Abstract

Heroin has been a street drug along the East African coast for 25 years (Beckerleg, 1995) but it has only recently been recognised and documented (Kilonzo et al, 2001; Jones & Needle, 2005). Heroin use is risky and HIV transmission an increasing problem (McCurdy et al, 2005). Susan Beckerleg and colleagues uncover high rates of unprotected sex, excessive needle sharing and continued re‐use of old and dirty needles often kept in old tins, pockets, or as most do, hidden under rocks.

Details

Drugs and Alcohol Today, vol. 6 no. 2
Type: Research Article
ISSN: 1745-9265

1 – 10 of over 1000