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Natural History of Addiction in Psychotic Heroin-addicted Patients at Their First Agonist Opioid Treatment

Maremmani, Angelo Giovanni Icro MD; Bacciardi, Silvia MD; Rovai, Luca MD; Rugani, Fabio MD; Dell’Osso, Liliana MD; Maremmani, Icro MD

Addictive Disorders & Their Treatment: March 2013 - Volume 12 - Issue 1 - p 31–39
doi: 10.1097/ADT.0b013e31824c5d1b
Original Articles

Psychoses correlated with substance abuse prove to be more common in cases involving cannabinoids, stimulants, hallucinogens, and polyabuse. Among substance abusers, it has not been ascertained whether opioids exert a psychotic effect; some authors have supported the view that opioids exert antidepressant and antipsychotic effects. To clarify the relationships between opioids and psychosis, 23 psychotic heroin-dependent patients, at their first agonist opioid treatment, were compared with 209 nonpsychotic individuals in terms of their demographic and clinical characteristics. Psychotic heroin-dependent patients presented for agonist opioid treatment with more severe psychopathologic aspects and a shorter, less severe addiction history (except for polyabuse) than their nonpsychotic peers. The fact that our psychotic patients requested agonist opioid treatment earlier, and with a less severe addiction history, suggests that these patients may mainly benefit from an opioid medication through the improvement of their psychopathology, rather than through the alleviation of their heroin dependence. These data indirectly support the antipsychotic effects of opioid and Khantzian’s self-medication hypothesis for psychotic heroin-dependent patients.

*Vincent P. Dole Dual Diagnosis Unit, Santa Chiara University Hospital, Department of Psychiatry, NPB, University of Pisa

G. De Lisio Institute of Behavioural Sciences, Pisa, Italy

AU-CNS, Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Lucca, Italy.

The authors declare no conflict of interest.

Reprints: Icro Maremmani, MD, Vincent P. Dole Dual Diagnosis Unit, Santa Chiara University Hospital, Department of Psychiatry, University of Pisa, 67 via Roma, 56100 Pisa, Italy (e-mail:

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