ENDOCRINE PROFILE IN HEROIN ADDICTS

Abstract

A detailed study to determine the effects of chron ic heroin addiction was conducted on a group of adult male addicts routinely admitted to rehabilitation centers in the District of Rawalpindi, Pakistan. The effects of heroin and the extent of damage, if any, prior to and fol lowi ng subsequent withdrawal therapy (detoxification treatment) were examined on a variety of physio logical parameters especially the endocrine axes of pituitary with gonads, adrenal and thyroid. Determinat ions were carried out on serum levels of folli cle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), adrenocoliicotropic hormone (ACTI-f), growth hormone (GH), thyroid stimulating hormone (TSH), testosterone (T), dehydroxyepiandrosterone su lphate (DHE A-SO~ ) , estradiol (E2), sex hormone-binding globulin (SHBG), cOfiiso l, fi'ee thyroxine (FT~) , triiodothyronine (TJ), insulin and glucose, parathormolle (PTH) and gastrin. In addition , analys is was conducted to determine effects on vo lume of the ejacu late, sperm count, sperm motility and semen fructose level. Determinations were also made to measure act ivity ofNa,K-ATPase in eryt hrocytes and leucocytes of the heroin add ict. A total of 60 male addicts periodically brought to the Rawalpindi Genera l Hospital, Military Hospital Rawalpindi and Imran Detoxification Center, Rawalpindi for symptomatic detoxification were 3e lected for the study. A total of 30 healthy subjects, matched for age and sex, were used as co ntrol s. Prior to selection for the study, the patients consented voluntarily for par1icipation in the investigation. It was ascer1ained that none of the patients was critically ill. Information was obtained concerning route of drug intake, the amou nt of drug taken dai ly and that no drug other than hero in was L1 sed by them during the past six month s. The pati ents ranged between the ages of 25-30 yr (mean age: 27.7 ± 1.08 yr) and admitted use of the drug for the past 2- 16 yr (mean duration: 7.3 ± 0.46 yr). The daily intake of 30% pure street heroin was 3-5 g (mean 366 g/day). The mode of drug intake was inhalation of vapors (51 patients) smoking ( l:{ patients) and sn iffing (I patient). The last dose taken was 1-2 hours prior to ent ry in the rehabilitation centers. Blood, urin e and semen sa mpl es were taken soon after ent ry of the patients to the Centers. The urine samples were used to determine presence of heroin and its metabolites, The mean blood pressure of the patients at the time or entry was 112170± 1.06/1.03 mm Hg, Blood and semen samples were taken again following symptomatic detoxification treatment (withdrawal therapy) on the loth and the 30th day of drug withdrawal, The results show that the serum level of FSH increases while that of LH decreases signifi cant ly in the addicts, Prolactin also increases signi ficantly, Of the male gonadal hormones, serum T is depressed but neither DHEA-SO.l nor E2 undergo sign ifica nt change in the add icts, Increase in serum SHBG parallels the change in testosterone Both ACTH and cortisol levels in the serum also undergo sign ifi cant depression, The level of cortisol is altered both in the J1loJ rning and evening but the diurnal rhythm remaIns unaffected by heroin, Growth hormone, insulin, glu cose and gastrin also Increase significant ly Free thyroxine (FT.j) and PTH levels show decrease, In contrast, no change could be detected in serum T1 and TSH. DeterminRtion of the above parameters 10 and 30 days after drug withdrawal revealed that all of the above changes are reversible. Delayed recovery (30th day of detoxification) from the damaging effects of heroin was recorded for FSH, LH, T, SHBG, ACTH, cortisol and FT.j Early recovery ( l Oth day of deto:.;ification) was noted for PRL, GH, insulin, glucose and PTH. The most lasting alteration due to heroin addiction occurred In sperm count, moti lity of sperms and fructose level in the semen, A drastic decrease in these seminal factors was recorded, No modification could be detected in the volume of the ejaculate, The patients failed to recover from these effects of heroin even after 30 days of detoxifi cation therapy. Thus heroin exerted irreversib le influence on seminal integrity as far as can be argued on the basis of 30-day limit of detoxification treatment. The acti vity ofNa,K-ATPase in the addicts remained unaltered in the erythrocytes but showed a signifi cant increase in the leucocytes. The enzyme activity in the leucocytes was restored to the control level on the 15th day of withdrawal therapy , The data presented show that the majority of physiological aspects exa mined undergo significant alteration due to chronic heroin addiction, The endocrine system most noticeably affected by heroin is the pituitary-gonadal a\is apparently resu lting In irreversible alterations in sperm count, sperm motility and sem inal fructose. This observation provides affirmation of the self repOIied loss of libido by the majority of the addicts participating in this investigation. Ana lysis of the data by separating into short duration and long duration chronic addiction revealed that PRL, ACTH, cortisol and all semen parameters undergo far greater impairment due to heroin. Even recovery from the effects of the drug fo llowing detoxification is blocked in the longer duration addicts (9- 16 yr). It is important to note at the outset some of the unavoidable constraints of conducting a study on human subj ects like the one presently under consid erat ion. Among the most critical of these are ( I) the dosage of street hero in, (2) its purit y, and (3) the timing of the last dose taken. Admitted ly total reliance has been placed on the assurances given by the addicts regarding the timing of last dose, and on published information on the average purity of street hero in. Any further stand ardization of these co nditi ons could not be done in view of the ethical considerations. However, it is evident from reversibility of the changes In most of the phys iological parameters that time ly rehabilitation steps can resto re normalcy in the life orthe addicts.