THE OPIATE-DEPENDENT PATIENT - INCREASE O F USERS

Heroin can still be considered the illegal drug number one among illic it opioid addicts, Data from the first quarter of 1995 and 1996 report s that cocaine use has stabilized or slightly decreased across the nat ion while heroin comparatively is still much higher, especially among young low and middle-income adults, teens and particularly middle-clas s suburbanites, Ethnographers indicate that cocaine use is not as popu lar among adolescents and young adults as it once was, it is not seen as fashionable and the preference of heroin over cocaine is thought to be because the drug makes the user calm, Thus an increasing number of sources are reporting ''double-breasted'' dealing or ''one plus one'' sales, in which cocaine and heroin are sold by the same person, This deviation from the traditional single drug market has already had noti cable effects on heroin quality, Individuals who have not previously d ealt with heroin may not know enough about the drug to cut and package it properly, Inexperienced dealers often cut the heroin inconsistentl y and purity may range from 2% to 30%, In addition, new heroin dealers may adulterate the heroin with a large variety of pharmacologically a ctive and non active compounds which often result in a variable toxici ty of the drug, Also, designer drugs of the fentanyl series and that o f pethidine are appearing more frequently on the market, compounds whi ch are characterized by a high purity and a high toxicity when compare d to their mother compound, Such practices result in an increased numb er of opioid overdoses and users appearing at emergency rooms for prob lems related to the substance with which heroin is mixed have to be tr eated accordingly, While the final aim in the treatment of drug addict s is abstinence from the drug, various techniques are available to fre e a user from the opioid, Among these the ''ultra-rapid detoxification technique'' in anaesthesia has raised interest as many addicts are wi lling to give up their drug career but are incapable of coping with th e abstinence syndrome, Similar to maintenance programmes with methadon e, however, detoxification does not guarantee no relapse unless a psyc hosocial stablization is initiated in highly motivated individual acco mpanied by a maintenance programme with the opioid antagonist naltrexo ne.