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Biomedical subjects

J Strang

Publications and source records attributed to J Strang.

At least 37 records · Page 2Linked to original sources
PubMed2000

Pathways to abstinence: two-year follow-up data on 60 abstinent former opiate addicts who had been turned away from treatment.

Structural changes in the organization of drug treatment services in the northwest of England during the early 80s provided a unique opportunity to study a group of opiate addicts who were turned away from treatment. This paper reports on 60 opiate addicts who were abstinent at follow-up (2-3 years after their original referral). For the majority of subjects, any treatment received in the intervening period had been from a range of local, non-specialist treatment providers, including: general practices (n = 24) and local hospitals (n = 32). The subjects had also received assistance from non-statutory agencies (n = 35). Informal sources of support were drawn upon in the form of friends, family, and voluntary agencies. Social acceptance, legal problems, financial difficulties, and imprisonment were frequently cited as motivational factors that led to abstinence. At follow-up, improvements were reported in personal relationships and family circumstances, although there was less progress in relation to employment, finances, and housing. Increased involvement with the criminal justice system was significantly associated with a greater use of treatment services at follow-up. This paper presents the treatment and non-treatment pathways that led to abstinence amongst this group of opiate addicts. It also points to the importance of including non-treatment samples in evaluations of treatment interventions.

Adolescent↗
PubMed2000

Price, cost and value of opiate detoxification treatments. Reanalysis of data from two randomised trials.

BACKGROUND: Treatments in different settings have different costs. A dilemma arises if expensive treatments lead to better outcomes. AIMS: To investigate conflicts between the priorities of cost minimisation, clinical effectiveness, and cost-effectiveness in the detoxification of opiate addicts. METHOD: Cost and clinical effectiveness were examined using published outcome data. The main outcome measures were: achieving a drug-free state on completion of detoxification; the economic costs of treatment. RESULTS: In terms of simple cost, in-patient detoxification is much more expensive than out-patient treatment (ratio, 24:1). With adjustment for successful outcome, the costs are almost identical (ratio, 0.9:1). Comparison of specialist and general psychiatry in-patient settings showed that even when adjusted for clinical outcomes, the specialist setting is more costly (ratio, 1.9:1), although the outcomes are better. CONCLUSIONS: Naïve adherence to cost and cost-containment considerations is dangerous. Discussion of treatment costs is misleading if not informed by, and adjusted for, evidence of effectiveness. This is especially important where marked differences in outcome between treatment options exist.

Ambulatory Care↗
PubMed1999

Continued heroin use during methadone treatment: relationships between frequency of use and reasons reported for heroin use.

Seventy-seven (71%) of a group of 109 attenders at an out-patient drug treatment service reported that they had used heroin in the 90 days before interview, of whom 24 (31%) had used every day. Daily users were more likely to explain their use in terms of needing to curb withdrawals than were occasional heroin users. The latter group were more likely to report availability as a reason for use. From a clinical perspective, it is likely that those who use opportunistically are less likely to change their use as a function of clinical responses (e.g. higher methadone dose) than are those whose use is motivated by the attempt to curb withdrawal symptoms.

Adult↗
PubMed1999

Preventing opiate overdose fatalities with take-home naloxone: pre-launch study of possible impact and acceptability.

AIMS: Before proceeding with the introduction of an overdose fatality prevention programme including teaching in cardio-pulmonary resuscitation and distribution of naloxone, a pre-launch study of treatment and community samples of injecting drug misusers has been undertaken to establish (i) the extent of witnessing overdoses, (ii) the acceptability of naloxone distribution and training; and (iii) the likely impact of such measures. DESIGN AND SETTING: Structured interview of two samples: (a) a community sample of injecting drug misusers recruited by selected privileged access interviewers (PAI) and interviewed by them in community settings and (b) a treatment sample of opiate addicts recruited from our methadone maintenance clinic (interviewed by in-house research staff). PARTICIPANTS: (a) Three hundred and twelve injecting drug misusers with a history of having injected and currently still using injectable drugs; and (b) 142 opiate addicts in treatment at our local catchment area methadone maintenance clinic in South London. FINDINGS: History of personal overdose was found with 38% of the community sample and 55% of the treatment sample--mainly involving opiates and in the company of friends. Most (54% and 92%, respectively) had witnessed at least one overdose (again mostly involving opiates), of whom a third had witnessed a fatal overdose. Only a few (35%) already knew of the existence and effects of naloxone. After explanation to the treatment sample, 70% considered naloxone distribution to be a good proposal. Of the 13% opposed to the proposal, half thought it may lead them to use more drugs. Eighty-nine per cent of those who had witnessed an overdose fatality would have administered naloxone if it had been available. We estimate that at least two-thirds of witnessed overdose fatalities could be prevented by administration of home-based supplies of naloxone. CONCLUSIONS: Substantial proportions of both community and treatment samples of drug misusers have witnessed an overdose death which could have been prevented through prior training in resuscitation techniques and administration of home-based supplies of naloxone. Such a new approach would be supported by most drug misusers. On the basis of these findings, we conclude that it is appropriate to proceed to a carefully constructed trial of naloxone distribution.

Adult↗
PubMed1999

Self-reported overdose among injecting drug users in London: extent and nature of the problem.

AIMS: To estimate the extent and nature of overdose and factors associated with overdose among injecting drug users in London. DESIGN: Three hundred and twelve current injecting drug users were recruited and interviewed in community settings by a team of "privileged access interviewers". MEASUREMENTS: A structured questionnaire was used that covered the following areas: demographic characteristics, drug use, injecting behaviour, sharing practices, severity of drug dependence, experience of overdose, injecting-related health problems and treatment history. FINDINGS: The results showed that experience of overdose was common (38%). A majority (54%) had witnessed someone else overdose. Overdosing was not a solitary experience; over 80% of subjects who had overdosed had done so in the presence of someone else, but only 27% reported ambulances having been called. Factors found to be associated with overdose were: age at which injecting began; gender (women being more likely to experience overdose); use of alcohol; and polydrug injection. The overall rate of overdosing was one per 6 years of injecting; however, once an individual had an overdose the chance of having another increased. The risk of experiencing a first overdose fell with years of injecting. CONCLUSIONS: Harm-reduction interventions with drug injectors should educate users on the risk factors associated with overdose and actions that should be taken when someone has overdosed. Interventions designed to reduce the risk of overdose may be more effective if they are differentially targeted on drug injectors who have already experienced an overdose.

Adolescent↗
PubMed1999

Substance use among young people: the relationship between perceived functions and intentions.

AIMS: To explore the relationship between young people's use of psychoactive substances, perceived functions for using, the experience of negative effects, and the influences of these variables on their intention to use substances again. DESIGN: Cross-sectional survey in which respondents were purposively recruited using snowballing techniques. SETTING: Interviews were conducted in informal community settings. PARTICIPANTS: One hundred young drug and alcohol users (45 females) aged between 16 and 21 years. MEASUREMENTS: Life-time prevalence, current frequency and intensity of substance use and intentions to use again were assessed for four target substances (alcohol, cannabis, amphetamines and ecstasy) together with measures of the perceived functions for their use and peer substance involvement. FINDINGS: The life-time experience of negative effects from using the assessed substances was not found to correlate with current consumption patterns. Statistically significant associations were observed between the reported frequency of taking substances and the perceived social/contextual and/or mood altering functions cited for their consumption. The substance use function measures together with the reported extent of peer use were significant predictors of intentions to use again. CONCLUSIONS: If these findings are confirmed in larger studies, educational and preventative efforts may need to acknowledge the positive personal and social functions which different substances serve for young people. The results also call into question the extent to which the experience of negative effects influences future patterns of use.

Adolescent↗
PubMed1999

A review of biological indicators of illicit drug use, practical considerations and clinical usefulness.

AIMS: To examine a range of biological indicators of illicit drug use, including blood, urine, hair and saliva, addressing both technological and practical issues relating to their application and interpretation. METHODS: The review process involved an examination of key reference texts and literature from the scientific fields of analytical and clinical toxicology. FINDINGS: Urine remains the biological tool of choice for qualitative detection of illicit drug use in a clinical setting, while quantitative accuracy remains strictly the domain of blood. The growing sophistication of laboratory analysis may additionally make possible the routine use of hair sampling which can provide a much longer time frame for assessment. Breath, saliva, sweat or breast milk remain possibilities in the future. CONCLUSIONS: Accurate interpretation of the screening tests within a clinical setting alongside other relevant information remains the key to the usefulness of any test.

Biomarkers↗
PubMed1999

Lofexidine for opiate detoxification: review of recent randomised and open controlled trials.

The objective of this article was to review the data from recently published trials of lofexidine in the treatment of opiate withdrawal, with particular attention to evidence on efficacy, side-effects (particularly hypotension), and the acceptability of this new treatment to the patient population. The authors reviewed data contained within peer-reviewed published reports of clinical trials of lofexidine compared with detoxification using reducing doses of the opiate agonist methadone or the alpha-adrenergic agonist clonidine. Five published reports of clinical trials of lofexidine have been identified from peer-reviewed journals in the eight years between 1990 and 1998--all published within the last three years. Three of the reports compare lofexidine with clonidine, while the remaining two compare it with methadone detoxification. The three comparisons with clonidine find lofexidine to be similar in its moderating effect on the withdrawal syndrome, but without the same extent of problems with hypotension. Comparisons with methadone show a more rapid resolution of withdrawal symptoms with lofexidine--particularly with the accelerated 5-day lofexidine protocol. Such problems of hypotension as were encountered with lofexidine were adequately managed with dose reduction. Acceptability of the treatment to the patient (as measured by retention in treatment) appears to be greater with lofexidine than clonidine, although possibly less than with methadone. Lofexidine is an alpha-2 adrenergic agonist that is increasingly used in the management of opiate withdrawal--notably in the UK. The available data indicate that it is a useful new addition to the armamentarium of the clinician. Future studies should explore its application with improved protocols and in new treatment settings. This article reviews the recent advances in the study of lofexidine as a new treatment for opiate detoxification. It examines the background of the development and introduction of lofexidine into the U.K., with data on the extent to which it is now used in the U.K. in the treatment of opiate addiction. A review is then provided of the published evidence on the use of lofexidine in the management of opiate detoxification, mainly concentrating on the data from recent double-blind randomised trials. Finally, the possible future role of lofexidine in this field is considered.

Clonidine↗
PubMed1999

Heroin chasers and heroin injectors: differences observed in a community sample in London, UK.

"Chasing the dragon" has spread rapidly as a method of use of heroin in many countries over the last quarter of a century, and is now the most widely used method of heroin use worldwide. However, little examination has been made of the differences in characteristics and drug-taking patterns between heroin chasers and injectors. In this study, a comparison is made of the personal, social and drug-taking characteristics of heroin users in a community sample (i.e., not drawn from treatment services, contacted through a range of non-treatment access routes), according to whether the heroin user was currently a heroin chaser or injector, and according to whether or not they had ever injected. Data were examined on 400 heroin users contacted and interviewed in South London by privileged access interviewers using a structured interview schedule. Severity of dependence was measured using the Severity of Dependence Scale (SDS). Heroin chasing and injecting were almost equally prevalent among this community sample. Of the 400 heroin users, 178 (44.5%) identified "chasing the dragon" as their current route of heroin use, and 222 (55.5%) injecting. Heroin chasers were younger, though they had first used at an older age, had a larger proportion of non-using friends, and contained larger proportions of women and people of Afro-Caribbean origin. Injectors were using higher daily doses and were significantly more likely to be using on a daily basis. Those who had never injected were more likely to be women and to have friends who did not use drugs. Severity of Dependence (SDS) scores were greater amongst injectors, with scores for injectors almost all being above the informal clinical threshold of greater than 5; while one third of the chasers had SDS scores below this level. Heroin chasing had been a longstanding pattern of behavior for a large proportion of the study sample. Chasers were generally less deeply involved in a heroin-using culture and were less likely to be using heroin daily. Almost all low scores for severity of dependence were seen among the chasers, though a significant number of chasers had dependence scores at the most extreme. Heroin chasers display distinctly different personal and drug-taking characteristics and will need to be the subject of separate research studies and clinical programs.

Adolescent↗
PubMed1999

Therapeutic drug monitoring for methadone: scanning the horizon.

The initial assessment and subsequent monitoring of compliance in methadone treatment programmes are excessively reliant on the accuracy of self-report from opiate addicts themselves. Given the central position of methadone treatment in the therapeutic options currently available and with the increasing number of opiate addicts requiring treatment, improved methods of judging optimal methadone treatment are required. This paper explores the possible future options for assessing the adequacy of methadone prescribing from the analysis of methadone levels in urine, blood, hair and saliva. The particular promise of plasma therapeutic drug monitoring for methadone is explored, accompanied by an account of the state of the art at the time of writing.

Heroin↗
PubMed1999

Alternative ways of using and abusing drugs and complicity of doctors.

Many drugs that have been prescribed by doctors are not taken as directed. Altered dose, frequency and route of administration may lead to misuse of drugs that have been prescribed in good faith. Awareness of the abuse potential of prescribed and over-the-counter drugs is the first point of intervention, followed by monitoring of each doctor's practice.

Drug Administration Routes↗
PubMed1999

Methadone treatment practices and outcome for opiate addicts treated in drug clinics and in general practice: results from the National Treatment Outcome Research Study.

BACKGROUND: General practitioners (GPs) are increasingly urged to become more involved in the care and treatment of drug misusers. Little information is available about the effectiveness of treatments delivered in primary health care or specialist settings. The impact of treatment setting is investigated as part of the National Treatment Outcome Research Study (NTORS). This is the largest study of treatment outcome for drug misusers ever conducted in the United Kingdom (UK). AIM: This paper presents six-month treatment outcomes for patients who received community-based methadone treatment in either a specialist drug clinic or a general practice setting. METHOD: A prospective, multisite follow-up study of treatment outcome was conducted with 452 opiate addicts who had been given methadone treatment in primary health care and specialist clinic settings. Outcome data are presented for substance use behaviours, health, and crime. RESULTS: Improvements at follow-up were found among both the GP and the clinic-treated groups in drug-related problems, health, and social functioning. Problems at intake were broadly comparable among the clinic-based and the GP patients. Similar levels and types of improvement were found for both groups at six-month follow-up. CONCLUSIONS: Results demonstrate the feasibility of treating opiate addicts using methadone in primary health care settings, and show that treatment outcomes for such patients can be as satisfactory as for patients in specialist drug clinics. The GPs in our study are unrepresentative in their willingness to be actively involved with problem drug users; moreover, several services treated relatively large numbers of drug users. Issues surrounding the growth of 'GP specialists' are discussed.

Adolescent↗