Addictive disordersThe medical complications of heroin useTheodorou, Stana; Haber, Paul SbAuthor Information aDrug Health Services, Concord Hospital bDrug Health Services, Royal Prince Alfred Hospital, and Discipline of Medicine, University of Sydney, Sydney, Australia Correspondence to Dr Stan Theodorou, Senior Staff Specialist and Director, Drug Health Services, c/o Concord Hospital, Hospital Road, Concord, NSW 2139, Australia Tel: +612 97678320; fax: +612 97678327; e-mail: [email protected] Current Opinion in Psychiatry: May 2005 - Volume 18 - Issue 3 - p 257-263 doi: 10.1097/01.yco.0000165595.98552.d9 Buy Metrics Abstract Purpose of review Heroin use is associated with numerous adverse sequelae. As clinical services develop, addiction psychiatrists will increasingly be called upon to help identify and manage the complications of heroin use. This review focuses on recent research into the medical complications of heroin use and looks at strategies to minimize harm associated with this practice. Recent findings Mortality associated with heroin overdose has increased substantially in many countries. Parenteral use of opioid drugs is a central factor and other risk factors include polydrug use, particularly benzodiazepines and alcohol, mental health issues and environmental factors not conducive to resuscitation. Unravelling the determinants of blood-borne virus transmission continues, the focus shifting from needle sharing to inadvertent sharing of other injecting equipment. Trials addressing the challenges of antiviral therapy in injecting drug users are emerging. A greater understanding of the effects of opioids on immune functioning complements our knowledge of infection in the heroin-using group as well as possibly explaining the reduced response to vaccination in this group. Summary Medical complications of heroin affect a number of different organ systems. The role of the addiction specialist is to be aware of these so that early diagnosis and appropriate management is instituted. The latter will generally be done in collaboration with other specialists. The addictions specialist can play a significant role in the development of clinical systems to minimize these complications. © 2005 Lippincott Williams & Wilkins, Inc.