Breaking Worse: The Emergence of Krokodil and Excessive Injuries Among People Who Inject Drugs in Eurasia.

Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia.

Int J Drug Policy. 2013 May 30;
Grund JP, Latypov A, Harris M

BACKGROUND: Krokodil, a homemade injectable opioid, gained its moniker from the excessive harms associated with its use, such as ulcerations, amputations and discolored scale-like skin. While a relatively new phenomenon, krokodil use is prevalent in Russia and the Ukraine, with at least 100,000 and around 20,000 people respectively estimated to have injected the drug in 2011. In this paper we review the existing information on the production and use of krokodil, within the context of the region’s recent social history. METHODS: We searched PubMed, Google Advanced Search, Google Scholar, YouTube and the media search engine www.Mool.com for peer reviewed or media reports, grey literature and video reports. Survey data from HIV prevention and treatment NGOs was consulted, as well as regional experts and NGO representatives. FINDINGS: Krokodil production emerged in an atypical homemade drug production and injecting risk environment that predates the fall of communism. Made from codeine, the active ingredient is reportedly desomorphine, but – given the rudimentary ‘laboratory’ conditions – the solution injected may include various opioid alkaloids as well as high concentrations of processing chemicals, responsible for the localized and systemic injuries reported here. Links between health care and law enforcement, stigma and maltreatment by medical providers are likely to thwart users seeking timely medical help. CONCLUSION: A comprehensive response to the emergence of krokodil and associated harms should focus both on the substance itself and its rudimentary production methods, as well as on its micro and macro risk environments – that of the on-going syndemic of drug injecting, HIV, HCV, TB and STIs in the region and the recent upheaval in local and international heroin supply. The feasibility of harm reduction strategies for people who inject krokodil may depend more on political will than on the practical implementation of interventions. The legal status of opioid substitution treatment in Russia is a point in case. HubMed – addiction

Psychiatric comorbidity among adults with schizophrenia: A latent class analysis.

Psychiatry Res. 2013 May 30;
Tsai J, Rosenheck RA

Schizophrenia is a severe mental illness that often co-occurs with and can be exacerbated by other psychiatric conditions. There have not been adequate efforts to examine schizophrenia and psychiatric comorbidity beyond pairwise examination using clusters of diagnoses. This study used latent class analysis to characterize patterns of 5-year psychiatric comorbidity among a national sample of adults with schizophrenia. Baseline data from 1446 adults with schizophrenia across 57 sites in the United States were analyzed. Three latent classes were identified labeled Solely Schizophrenia, Comorbid Anxiety and Depressive Disorders with Schizophrenia, and Comorbid Addiction and Schizophrenia. Adults in the Solely Schizophrenia class had significantly better mental health than those in the two comorbid classes, but poorer illness and treatment insight than those with comorbid anxiety and depressive disorders. These results suggest that addiction and schizophrenia may represent a separate latent profile from depression, anxiety, and schizophrenia. More research is needed on how treatment can take advantage of the greater insight possessed by those with schizophrenia and comorbid anxiety and depression. HubMed – addiction

CREB Phosphorylation Regulates Striatal Transcriptional Responses in the Self-Administration Model of Methamphetamine Addiction in the Rat.

Neurobiol Dis. 2013 May 29;
Krasnova IN, Chiflikyan M, Justinova Z, McCoy MT, Ladenheim B, Jayanthi S, Quintero C, Brannock C, Barnes C, Adair JE, Lehrmann E, Kobeissy FH, Gold MS, Becker KG, Goldberg SR, Cadet JL

Neuroplastic changes in dorsal striatum participate in the transition from casual to habitual drug use and might play a critical role in the development of methamphetamine (METH) addiction. We examined the influence of METH self-administration on gene and protein expression that may form substrates for METH-induced neuronal plasticity in the dorsal striatum. Male Sprague-Dawley rats self-administered METH (0.1mg/kg/injection, i.v.) or received yoked saline infusions during eight 15-h sessions and were euthanized 2h, 24h, or 1month after cessation of METH exposure. Changes in gene and protein expression were assessed using microarray analysis, RT-PCR and Western blots. Chromatin immunoprecipitation (ChIP) followed by PCR was used to examine epigenetic regulation of METH-induced transcription. METH self-administration caused increases in mRNA expression of the transcription factors, c-fos and fosb, the neurotrophic factor, Bdnf, and the synaptic protein, synaptophysin (Syp) in the dorsal striatum. METH also caused changes in ?FosB, BDNF and TrkB protein levels, with increases after 2 and 24h, but decreases after 1month of drug abstinence. Importantly, ChIP-PCR showed that METH self-administration caused enrichment of phosphorylated CREB (pCREB), but not of histone H3 trimethylated at lysine 4 (H3K4me3), on promoters of c-fos, fosb, Bdnf and Syp at 2h after cessation of drug intake. These findings show that METH-induced changes in gene expression are mediated, in part, by pCREB-dependent epigenetic phenomena. Thus, METH self-administration might trigger epigenetic changes that mediate alterations in expression of genes and proteins serving as substrates for addiction-related synaptic plasticity. HubMed – addiction

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