Chasing the dragon.
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Administration, Inhalation↗
Biomedical subjects
M Gossop
Publications and source records attributed to M Gossop.
The development of a Short Opiate Withdrawal Scale (SOWS).
In previous studies a 32-item Opiate Withdrawal Scale was found to provide a reliable and valid means of measuring the signs and symptoms of withdrawal among heroin (and other opiate) addicts. This paper describes the processes whereby a shorter 10-item version of the same scale was developed. The Short Opiate Withdrawal Scale (SOWS) is simple to understand and easy to administer, and it avoids the redundancy of items contained in the original scale. It is suggested that the SOWS provide a useful instrument which can be used both in research and clinical practice with opiate addicts.
Heroin↗
Comparison of linear versus inverse exponential methadone reduction curves in the detoxification of opiate addicts.
A linear methadone detoxification procedure is compared with an inverse exponential reduction curve in a double-blind study. The inverse exponential curve resulted in withdrawal symptomatology which was significantly greater during the acute phase of the opiate withdrawal curve and was not significantly different during the recovery phase. There was no difference between groups in the time course of the withdrawal syndrome, in peak symptom severity, nor in patient compliance. Separate analyses for high-dose and for low-dose addicts show variation in the suitability of the two curves according to dose. The implications for future research and treatment of the opiate withdrawal syndrome are discussed.
Adult↗
What do opiate addicts and cigarette smokers mean by "craving"? A pilot study.
There is general agreement that the term 'craving' requires clarification. This present report presents a pilot study in which groups of opiate addicts and cigarette smokers completed a brief rating scale to describe the frequency and intensity with which they had certain feelings while craving for their own drug of dependence. Craving was reported as being a dysphoric state and opiate addicts described more frequent and more intense dysphoric feeling while craving. Despite the difference in mean scores there were some similarities in the overall profile of scores in the two groups. Implications of these findings are discussed.
Adult↗
Social and drug-taking behaviour of 'maintained' opiate addicts.
The roles of the prescribing of maintenance methadone and prescribing injectable drugs in the management of opiate addicts have become subjects of active debate since the advent of HIV. Data are presented on the social circumstances and drug-taking behaviour of 26 opiate addicts who had been receiving maintenance methadone (24 of whom had been receiving at least part of the prescription as injectible methadone ampoules.
Adult↗
Crack and cocaine use in south London drug addicts: 1987-1989.
There has been great concern in recent years about the abuse of cocaine, particularly in its smokable form 'crack'. This paper presents data drawn from 441 patients seen by a South London Community Drug Team between 1987 and 1989. Only four (1%) cited cocaine abuse as the main drug problem. Heroin was the most common main drug. Detailed information was available on 355 of these subjects. During the study period 63 patients reported using cocaine and the proportion of subjects using cocaine increased from 13% to 29%. Within the sub-group of cocaine users, there was a marked increase in the use of smokable forms of cocaine from 15% in 1987 to 75% in 1989. In view of the increased dependence risk associated with smoking cocaine, this is seen as an ominous development.
Adult↗
Factors predicting outcome among opiate addicts after treatment.
Eighty opiate addicts who had been successfully withdrawn from drugs were followed up for a period of six months after leaving treatment. Variables which might have been expected to relate to subsequent abstinence or drug taking were regressed against measures of outcome. Two variables consistently emerged as predictors of outcome. The number of protective factors identified by the subject and a measure of confidence about being able to remain drug free were both related to frequency of drug use during the first two months after leaving treatment, to drug status at six months and to improvement during the six-month period. In addition, the length of previous periods of abstinence related to outcome at six months, as did time spent in treatment, though caution is urged in the interpretation of this latter effect. Although risk factors have been found to relate to relapse there was no relation between perceived risks and outcome. Also, the number of coping strategies identified at admission was only related to outcome during the immediate post-discharge period. The implications of these findings are discussed in terms of a model of relapse.
Adaptation, Psychological↗
Drug use, crime and the attitudes of magistrates.
In a study concerned with the views of magistrates' on crime related to drug use, a 27-item attitudinal questionnaire was sent to a random sample of 154 subjects drawn from all magistrates in the London area. The response rate was 72%. There was broad agreement on the seriousness of crime related to drug use but there were also interesting differences of opinion. A principal components analysis revealed three factors which accounted for 67% of the variance. Factor 1, labelled 'seriousness' relates to the attitude that the extent of drug use and drug-related crimes such as possession, are serious offences. Factor 2, labelled 'intervention', reflects the view that sentencing and treatment are valuable in dealing with drug-related crime. Factor 3, labelled 'responsibility' describes the attitude that drug users are responsible for their offences and for the contents of statements made when withdrawing from drugs. There were differences between the magistrates on items concerning cannabis, personal responsibility for drug-related crime and the value of sentencing options. Magistrates tended to value psychiatric court-reports but some found them unclearly worded and partial to the defendant. Implications for the legal and medical response to drug use and crime are discussed.
Attitude↗
Clonidine versus long- and short-term methadone-aided withdrawal from opiates. An uncontrolled comparison.
Twelve heroin addicts and one methadone addicts began withdrawal from street opiates, under clonidine cover, in a general psychiatric ward. Ten (80%) of them completed it within 6 days. Clonidine doses used were lower than in similar studies and all patients were alert and mobile throughout withdrawal. Two other groups of opiate addicts, of similar age and sex, were withdrawn on standard methadone regimens. Clonidine and methadone withdrawal had similar acceptability and attrition rates. Self-reports of subjective discomfort were higher in the clonidine group without affecting compliance with treatment. Withdrawal under clonidine cover deserves further study, in view of the need for postwithdrawal treatment to prevent relapse to opiate use.
Adult↗
Decriminalising possession of drugs.
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Crime↗
The detoxification of high dose heroin addicts in Pakistan.
Treatment services in Pakistan have been swamped by the recent appearance and rapid growth of heroin abuse, and there is an urgent need to initiate and strengthen effective responses. This paper presents the results of an exercise in national monitoring of heroin detoxification services in Pakistan. The study also offers the first systematic description of the withdrawal response of heroin addicts dependent upon doses greatly in excess of those reported in developed countries. The trial was conducted at four major treatment centres and looks at three of the most widely used detoxification procedures in Pakistan (symptomatic treatment only, opium reduction plus symptomatic treatment and clonidine). Data are presented on 118 addicts receiving inpatient detoxification from heroin. The results indicate that all three detoxification methods reduced peak levels of withdrawal symptoms to acceptable levels, and that all produced a return to baseline levels of symptomatology within 10 days or less. The three most persistent symptoms were aches and pains, restlessness and insomnia. Several differences were found between treatments, notably with regard to the number of drugs required to modify the withdrawal response. The implications of these and other results are discussed.
Adolescent↗
The Bethlem Study on NET: putting the record straight.
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Clinical Trials as Topic↗
The technology of dragon chasing.
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Acquired Immunodeficiency Syndrome↗
Lapse, relapse and survival among opiate addicts after treatment. A prospective follow-up study.
This paper presents data from the first British prospective study to investigate relapse among opiate addicts after treatment. Eighty subjects were followed up over the six-month period immediately after discharge from treatment and were interviewed on several occasions. Large numbers of subjects used opiates within a very short time after discharge; 71% used them within the first six weeks. However, this first lapse to opiate use did not herald a full-blown relapse to dependent use. There was a gradual increase in the number of abstinent subjects, with 45% abstinent and living in the community at the six-month point. The practical and theoretical implications may be regarded as broadly encouraging.
Adolescent↗
Circumstances surrounding the initial lapse to opiate use following detoxification.
Seventy-eight opiate abusers were followed up after successful in-patient detoxification in order to examine renewed opiate use. The greatest number of initial lapses occurred within a week of subjects leaving in-patient treatment. Eleven categories of lapse precipitant were identified: cognitive, mood, external, withdrawal, interpersonal, leaving a protected environment, drug availability, drug-related cues, craving, priming, and social pressure. Cognitions, negative moods and external events emerged as the most commonly mentioned factors; these often occurred together, either in clusters or in a sequence. Implications of these results for models of relapse and for treatment approaches are discussed.
Adolescent↗
Opiate withdrawal symptoms in response to 10-day and 21-day methadone withdrawal programmes.
This study investigates and compares the responses of 132 opiate addicts to a 10-day or a 21-day in-patient oral methadone withdrawal regime. For both groups, symptom severity (on the Opiate Withdrawal Scale) steadily increased through the methadone withdrawal phase, and peaked near the point of completion of the prescribed drug, declining slowly thereafter. Patients on the 10-day programme reported significantly higher peak withdrawal scores than those on the 21-day programme. Although the proportions who completed detoxification were similar, there was a significantly higher drop-out rate immediately after detoxification for the 10-day group. The possible benefits and handicaps of the two withdrawal schedules are considered and recommendations are proposed for further refinement of the present widely adopted approach.
Adult↗
Drug users, AIDS, and the government response.
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Acquired Immunodeficiency Syndrome↗
Clonidine and the treatment of the opiate withdrawal syndrome.
Clonidine is a central alpha adrenergic agonist which can be used to treat the opiate withdrawal syndrome. It has been used in many controlled trials and a substantial body of research evidence is available about its effectiveness in this role. This paper reviews the literature regarding its introduction in the Yale studies, its effectiveness relative to gradual methadone reduction treatments, its side effects, and touches briefly upon its use in conjunction with opiate antagonists. It is concluded that clonidine produces marked reduction of withdrawal symptoms but does not eliminate them; that the pattern of withdrawal symptoms differs from that associated with methadone reduction schemes; that there is some disagreement about the clinical significance of hypotensive and other side effects; and that the drug has interesting possibilities for rapid withdrawal programmes when combined with naltrexone.
Clonidine↗