Heroin

21. Global Seizures of Heroin and Illegal Morphine

"The total quantity of heroin seized globally reached a record high in 2016, while the quantities of opium and morphine seized reached the second highest level ever reported. The largest quantities of opiates seized were of opium (658 tons), followed by seizures of heroin (91 tons) and morphine (65 tons). Overall seizures of opiates, expressed in heroin equivalents, increased by almost 50 per cent from 2015 to 2016, of which the quantity of heroin seized exceeded that of opium and morphine.

"As most seizures of opiates are made in, or close to, the main opium production areas, Asia, which is responsible for more than 90 per cent of global illicit opium production, accounted for 86 per cent of the total quantity of heroin and morphine seized in 2016. This is primarily a reflection of the increasing concentration of opium production in Afghanistan and the consequent increase in seizures by neighbouring countries.

"Similarly to the distribution of heroin and morphine seizures, overall, 90 per cent of the total quantity of opiates (including opium), expressed in heroin equivalent, was seized in Asia, the vast majority in the Near and Middle East/South-West Asia (83 per cent), while 6 per cent was seized in East and South- East Asia."

World Drug Report 2018. United Nations publication, Sales No. E.18.XI.9.
https://www.unodc.org/wdr2018/
https://www.unodc.org/wdr2018/...

22. HIV and Injection Drug Use in Eastern Europe, Russia, and Central Asia

"By far the highest prevalence of HIV among PWID [People Who Inject Drugs] is in South-West Asia and in Eastern and South-Eastern Europe, with rates that are, respectively, 2.4 and 1.9 times the global average. Together, those two subregions account for 49 per cent of the total number of PWID worldwide living with HIV. Although the prevalence of HIV among PWID in East and South-East Asia is below the global average, 24 per cent of the global total of PWID living with HIV reside in that subregion. An estimated 53 per cent of PWID living with HIV worldwide in 2016 (662,000 people) resided in just three countries (China, Pakistan and the Russian Federation), which is disproportionately large compared with the percentage of the world’s PWID living in those three countries (35 per cent)."

World Drug Report 2018. United Nations publication, Sales No. E.18.XI.9.
https://www.unodc.org/wdr2018/
https://www.unodc.org/wdr2018/...

23. Heroin Toxicity and Opiate Overdose

"A striking finding from the toxicological data was the relatively small number of subjects in whom morphine only was detected. Most died with more drugs than heroin alone 'on board', with alcohol detected in 45% of subjects and benzodiazepines in just over a quarter. Both of these drugs act as central nervous system depressants and can enhance and prolong the depressant effects of heroin."

Zador, Deborah, Sunjic, Sandra, and Darke, Shane, "Heroin-related deaths in New South Wales, 1992: toxicological findings and circumstances," The Medical Journal of Australia, 1996; 164 (4): 204-207.
https://www.mja.com.au/journal...

24. Overdose - Opiates

"The disadvantage of continuing to describe heroin-related fatalities as 'overdoses' is that it attributes the cause of death solely to heroin and detracts attention from the contribution of other drugs to the cause of death. Heroin users need to be educated about the potentially dangerous practice of concurrent polydrug and heroin use."

Zador, Deborah, Sunjic, Sandra, and Darke, Shane, "Heroin-related deaths in New South Wales, 1992: toxicological findings and circumstances," The Medical Journal of Australia, 1996; 164 (4): 204-207.
https://www.mja.com.au/journal...

25. Effectiveness of Heroin-Assisted Treatment Compared With Methadone Maintenance

"Diacetylmorphine was found to be a dominant strategy over methadone maintenance treatment in each time horizon studied (Table 2). Over a lifetime horizon, people in the methadone cohort lived 14.54 years on average following entry into the model, spending 8.79 years (60% of their remaining life) in treatment and 5.52 years in relapse. They accumulated 7.46 discounted QALYs and generated a societal cost of $1.14 million. People in the diacetylmorphine cohort lived 15.45 years on average, spending 10.41 years (67% of their remaining life) in treatment (2.34 years of which was in post-diacetylmorphine methadone treatment) and 4.05 years in relapse. They accumulated 7.92 discounted QALYs and generated a societal cost of $1.10 million. Based on these findings in the baseline model, over a lifetime horizon the provision of diacetylmorphine in the hypothetical cohort provided greater incremental health benefits and reduced the total costs to society compared with methadone maintenance treatment."

Bohdan Nosyk PhD., et al., "Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment," Canadian Medical Association Journal, April 3, 2012, 184(6):E317-E328.
http://www.ncbi.nlm.nih.gov/pm...
http://www.ncbi.nlm.nih.gov/pm...

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