Do bipolar patients use street opioids to stabilize mood?

Introduction. The link between heroin addiction and bipolar disorder is generally accepted, both at the level of full-blown pathology and at the affective, temperamental level. Nevertheless, the nature of this relationship is still far from being elucidated. Aim. To verify whether the use of heroin in bipolar patients could lead to a faster progression of the illness or whether bipolar 1 drug addicts who use heroin are actually looking for the mood-stabilizing properties of the opiates. Methods. We compared the clinical characteristics and the natural history of heroin addiction between bipolar 1 and nondually diagnosed heroin-dependent patients at their first agonist opioid treatment; in fact, our starting point was that bipolar 1 heroin-dependent patients would show a more severe psychopathological condition and a shorter, less severe drug addiction history at treatment entry. This hypothesis would, if borne out, support a ‘self-medication’ approach to heroin use in bipolar 1 heroin-dependent patients. Results. Bipolar 1 heroin addicts showed faster progression of their illness, and a worse clinical presentation, both on the psychopathological and on the addictive plane. Conclusions. Even if the unprovable initial beneficial effect exerted by the substance on the emotional instability of bipolar patients were present to some degree, it would soon be followed by a mood-destabilizing action, which would then accelerate the course of the illness. © 2013, Heroin Addiction and Related Clinical Problems. All rights reserved.