Search PubMed⌕ Search

Biomedical subjects

M Gossop

Publications and source records attributed to M Gossop.

At least 91 records · Page 5Linked to original sources
PubMed1993

Severity of heroin dependence and HIV risk. I. Sexual behaviour.

The HIV risks associated with the sexual behaviour of drug injectors have sometimes been overshadowed by the more obvious risks of injection behaviour. In this study, 408 heroin users were interviewed in the community; 50% were not currently in treatment and 42% had never had any treatment contact. In addition to data on drug use, information was collected on sexual risk behaviour by means of a linked anonymous questionnaire (96% returned). Eighty-nine per cent of the sample had had at least one sexual partner in the previous year and 58% had a regular sexual partner at the time of interview. Drug users who had a sexual partner who was injecting drugs were more severely dependent upon heroin. Twenty-three per cent of the men and 20% of the women reported having had anal intercourse in the previous year. Seventeen per cent of the women and 6% of the men had engaged in some form of prostitution. Severity of heroin dependence was positively related to the occurrence and to the frequency of sex-for-money transactions and to the less well recognized phenomenon of sex-for-drugs; this association with severity of dependence applied to the women and to the men who have sex with men. The overall level of condom use was low in this sample, though condom use was more frequent among those involved in sex-for-money or sex-for-drugs transactions. Low levels of condom use were reported even for such high risk activities as anal sex.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Severity of heroin dependence and HIV risk. II. Sharing injecting equipment.

One of the most conspicuous risks of HIV transmission among drug injectors involves sharing injecting equipment which has been contaminated by infected blood. The present study investigates the relationship between severity of dependence upon heroin and the sharing of previously used injecting equipment (passive sharing). Four-hundred-and-eight heroin users were contacted and interviewed. Two-hundred-and-eighty-one (69% of the total heroin sample) had injected drugs on at least one occasion, and 204 of the 281 injectors (73%) had shared injecting equipment on at least one occasion after it had been used by someone else. The more severely dependent heroin injectors were more likely to have shared injecting equipment. As users become more dependent upon heroin, the types of factors which predispose them towards sharing may change. Less dependent users were more likely to use in public and 'social' settings, and they may be more likely to share injecting equipment with people they do not know well. The more dependent users appear to use heroin in private settings and to be at greater risk of sharing with dealers, perhaps because of the urgency of their need for drugs at times when they are in withdrawal. One of the most frequently cited reasons for sharing was that sterile injecting equipment was difficult to obtain. It is a matter for some concern that many of the sharers in our sample (24%) reported having shared used injecting equipment while in custody. There was good overall awareness of the risks of health problems associated with injecting among our subjects. However, awareness of risk was not associated with avoidance of sharing behaviour.

Adult↗
PubMed1993

Reaching hidden populations of drug users by privileged access interviewers: methodological and practical issues.

The methodological issues surrounding the use of a privileged access interviewer team to generate a network sample of drug users are examined. Traditionally network samples have tended to be used by qualitative researchers. Privileged access interviewing provides a mechanism for the application of a structured instrument to a network sampling model. In doing so some problematic issues in this area for structured methodology are overcome, reduced or standardized. The use of this method is appraised in terms of meeting the methodological requirements of the Drug Transitions study. The practical experiences of our group in using a privileged access interviewer team to interview more than 400 heroin users, many of whom were not in contact with treatment services, are discussed. This method is most appropriate for the quick collection of data, from diverse networks of drug users, by use of a structured instrument. Success is likely to be dependent on careful implementation. The ongoing monitoring of data quality is of particular importance, as is good management practice and the establishment of supportive and non exploitative relationships with the interviewer team.

Adult↗
PubMed1993

Does post-withdrawal cue exposure improve outcome in opiate addiction? A controlled trial.

A controlled trial studied whether cue exposure prevented relapse in opiate addiction. Subjects were randomly allocated to one of two inpatient treatment settings: a drug dependence unit with a special 10 week program and 4 weeks in a behavioural/general treatment unit without such a program. In each setting, following drug-withdrawal, subjects had either cue exposure for at least six sessions over 3 weeks, or a control condition. Subjects were followed up twice, at about 6 weeks and 6 months post-treatment. 186 subjects were randomly allocated; 69 were assessed post-detoxification, and of these 43 completed cue exposure or control treatments. Cue exposure and control subjects did not differ in cue reactivity. This was evaluated post-treatment for cue exposure subjects and at a comparable time point for controls. All groups showed a significant decrement in cue-elicited craving, withdrawal responses and negative mood. Cue exposure and control subjects did not differ at either of the two follow up interviews.

Adult↗
PubMed1992

Attributions and relapse in opiate addicts.

This study investigated whether attributions of opiate addicts would predict both their ability to abstain from future use and their reactions to abstinence violations. Measures of generalized beliefs about responsibility for positive and negative outcomes and specific attributions about relapse episodes were elicited from 80 addicts at the time of admission for inpatient detoxification and treatment. Addicts who at admission attributed to themselves greater responsibility for negative outcomes and who attributed relapse episodes to more personally controllable factors were subsequently (at 6-month follow-up) more likely either to be completely abstinent or to contain the effects of temporary lapses into opiate use.

Adaptation, Psychological↗
PubMed1992

'Horse trading': prescribing injectable opiates to opiate addicts. A descriptive study.

The clinical audit of 40 opiate-dependent individuals who were prescribed injectable drugs (heroin or methadone) between June 1987 and June 1989 is described. These subjects were characterized by the chronicity of their injecting and dependent opiate use, and by their refusal to comply with a treatment programme involving oral-only prescribing. The key aim was to attract entrenched injectors into contact with treatment services and to promote movement away from injecting drug use and reduce HIV risk behaviour. On review 35 of the original 40 were either still receiving an injectable prescription or injecting illicit drugs. Despite this 14 (35%) were rated as making positive life changes. Nine (22.5%) had been admitted to the in-patient unit and became drug free during their stay. The stability of the lives of eight (20%) had deteriorated. The benefits and drawbacks of this form of intervention are discussed with comparison to the other studies of injectable drug prescribing.

Journal Article↗
PubMed1992

The study of transitions in the route of drug use: the route from one route to another.

Route of administration of various drugs is an area of study to which specific attention must be paid in study of different HIV risks of drug use by various routes. If changes in route are seen in individuals or within populations, then study of these transitions in route may identify new approaches which could be developed in HIV prevention. The consideration in this paper is based around ten questions: (i) What is a transition? (ii) Do routes of administration vary by time and place? (iii) Is choice of route influenced by availability of drug paraphernalia? (iv) How does the context influence initial choice of administration, and possible subsequent transitions? (v) Are lapse and relapse meaningful concepts? (vi) Transitions: how much of it is going on? (vii) How much does change of route (with the same drug) signify a change of drug effect, its significance, or its relationship with other risk behaviour? (viii) Is change of route of use of one drug always accompanied by the same change of route of other drugs? (ix) Injectors/non-injectors and sharers/non-sharers: do these behavioural characteristics exist as categories or are they distributed along a continuum? (x) Are transitions reversible? This paper is accompanied by two research reports which describe explorations into the extent and nature of transitions amongst heroin users.

Cocaine↗
PubMed1992

Extent and nature of transitions of route among heroin addicts in treatment--preliminary data from the Drug Transitions Study.

Preliminary data are presented here from a study of drug transitions in the UK. These support the contention that differences in route of administration are likely to be reflected in differing patterns of drug use, and associated with differing health risks for the individual drug user. Heroin 'chasers' were found to have robust and long-term patterns of heroin use and could not merely be considered as pre-injectors. They were also younger. No differences were found in the typical daily doses prior to entering treatment between chasers and injectors. Subjects who usually 'chased the dragon' but who would also inject were less likely to have shared injecting equipment in the past. Transitions between different routes of use were found in most directions. However, changes from 'chasing' to injection were most common. Year of initiation into heroin use was also related to initial route of use.

Drug Administration Routes↗
PubMed1992

Severity of dependence and route of administration of heroin, cocaine and amphetamines.

This study investigates severity of dependence upon heroin, cocaine and amphetamines in a group of 200 heroin users, 75% of whom were not in contact with any treatment agency. For drug takers who were current users of more than one drug, heroin produced more severe dependence than either cocaine or amphetamine and many users of these stimulant drugs reported having experienced no problems of dependence. Severity of dependence was influenced by route of administration as well as type of drug. Heroin taken by injection was associated with more severe dependence than smoked heroin. For cocaine, injection and smoking were associated with equivalent dependence ratings, and both of these routes were associated with more severe dependence than cocaine used intranasally. For amphetamine, there were no differences in severity of dependence ratings for injection, intranasal or oral use. Severity of dependence was correlated with dose and duration of drug use; it was also associated with previous attendance at a drug treatment agency, though dependence problems were also common among heroin users who had never received treatment. Implications of these findings are discussed.

Adult↗
PubMed1992

Factors associated with relapse among opiate addicts in an out-patient detoxification programme.

Relapse is a central problem in the treatment of addictive behaviour, and a specific problem in the out-patient treatment of the opiate withdrawal syndrome. This study investigated factors associated with relapse among 42 opiate addicts receiving out-patient detoxification treatment at a London drug-dependence clinic. All subjects completed a questionnaire about their social, psychological, and environmental circumstances in the week before interview, and were interviewed within the first two weeks of the programme. Forty per cent had lapsed to illicit heroin abuse within the previous week. Interpersonal factors and drug-related cues were associated with lapse to opiate use. Most subjects encountered a range of high-risk situations, such as regularly meeting other drug users and being offered drugs, and persistent negative mood states.

Adult↗
PubMed1991

Should opiate addicts be involved in controlling their own detoxification? A comparison of fixed versus negotiable schedules.

This study compares the responses of opiate addicts at a London drug treatment centre to two outpatient methadone-based detoxification programmes. These involved either a fixed (non-negotiable) dose reduction schedule or a flexible, negotiable withdrawal schedule. In the negotiable condition, subjects were less likely to complete the detoxification programme and the mean reduction in dose achieved by the subjects in the negotiable condition was less than that in the fixed group. There was no difference between groups in programme retention at 6 weeks though subjects who remained in treatment in the negotiable group tended to extend their detoxification period beyond this point. The overall response of subjects in both groups was unsatisfactory. Only 13% of the subjects initially allocated to detoxification or 28% of those who actually started detoxification completed treatment; urine screening showed that heroin abuse was a continuing problem during treatment. The implications of these results for detoxification and drug treatment services are discussed.

Adult↗
PubMed1991

A six country survey of the content and structure of heroin treatment programmes using methadone.

The use of methadone in the treatment of drug dependence has provoked a good deal of controversy. However, it is clear that there is considerable variation between methadone treatment programmes and relatively little detail is available about the organization and operation of these programmes. This World Health Organization survey examines the content and structure of methadone treatment programmes, and particularly methadone maintenance programmes, in six countries. The six countries were Australia, Canada, France, the Netherlands, Thailand and the UK. The report presents information about the extent of national problems and about such issues as type of dispensing practices, dose- and time-limits for prescribing methadone, programme entry criteria, staffing, integration with other services, and urine testing. Developments and trends during the decade 1980-1990 are discussed and implications for further research and programme development are presented.

Cross-Cultural Comparison↗
PubMed1991

A comparison of the withdrawal responses of heroin and methadone addicts during detoxification.

This study compares the withdrawal responses of methadone and heroin addicts during a ten-day in-patient detoxification programme with methadone. Contrary to suggestions in the literature, the methadone group reported more severe withdrawal symptoms during both the acute withdrawal phase and the recovery phase. There were no differences between the two groups in onset or duration of symptoms. Whereas there may be reasons to favour methadone as a maintenance drug, its use may lead to difficulties during withdrawal.

Adult↗
PubMed1991

Self-detoxification by opiate addicts. A preliminary investigation.

A study of 50 opiate addicts attending a London service for treatment of drug dependence found that 47 subjects had previously made at least one attempt at self-detoxification. These subjects reported 212 previous attempts. Although 30 subjects reported having managed to complete at least one attempt, the success rate per episode was low (24%). One of the most commonly reported methods, used by 28 subjects, involved an abrupt cessation of opiates ('cold turkey'). Of the drugs used in their attempts at self-detoxification, benzodiazepines were reported by 24 subjects and opiates by 20. Practical strategies such as distraction and avoidance were also used. Self-help detoxification materials for opiate addicts might be useful.

Adult↗