title: The impact of diacetylmorphine on hypothalamic-pituitary-adrenal axis activity and heroin craving in heroin dependence.
abstract: OBJECTIVE
  Heroin dependence is a chronic relapsing disorder characterized by the compulsion to seek and use heroin. Stress and craving are seen as key factors for heroin use. Moreover, altered hypothalamic-pituitary-adrenal (HPA) axis function has been frequently reported. However, the acute effects of diacetylmorphine (DAM) on HPA axis activity and craving have not been investigated in a controlled study. The present randomized controlled study examined whether DAM administration differs from placebo (saline) administration with regard to HPA axis response and heroin craving.
  
  
  METHODS
  In a crossover experiment, 28 DAM-maintained heroin-dependent patients were first injected with DAM and then saline, or the converse. Plasma adrenocorticotropic hormone (ACTH) and cortisol in saliva and serum were measured at baseline and 20 and 60 min after both injections. Heroin craving was measured at baseline and 60 min after both injections, by means of the Heroin Craving Questionnaire.
  
  
  RESULTS
  Compared to saline, DAM administration induced a significant decrease in plasma ACTH (p < 0.01), serum cortisol (p < 0.0001) and saliva cortisol (p < 0.01), as well as in craving (p < 0.0001), over time.
  
  
  CONCLUSIONS
  Since acute DAM administration suppresses the stress response, DAM-assisted treatment may be an effective alternative to methadone maintenance in stress-sensitive heroin-dependent patients.
authors.affiliation: Psychiatric Hospital, University of Basel, Basel, Switzerland. hana.gerber @ upkbs.ch
authors.forename: Hana
authors.initials: H
authors.lastname: Gerber
authors.forename: Stefan J
authors.initials: SJ
authors.lastname: Borgwardt
authors.forename: Otto
authors.initials: O
authors.lastname: Schmid
authors.forename: Urs
authors.initials: U
authors.lastname: Gerhard
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Joechle
authors.forename: Anita
authors.initials: A
authors.lastname: Riecher-Rössler
authors.forename: Gerhard A
authors.initials: GA
authors.lastname: Wiesbeck
authors.forename: Marc
authors.initials: M
authors.lastname: Walter
mesh_terms: D000328:Adult; D016739:Behavior, Addictive / Q000188:drug therapy* / Q000378:metabolism; D018592:Cross-Over Studies; D005260:Female; D003932:Heroin / Q000494:pharmacology / Q000627:therapeutic use*; D006556:Heroin Dependence / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000187:drug effects* / Q000378:metabolism; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D003932:Heroin