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  • 1
    Electronic Resource
    Electronic Resource
    Methadone prescribing to opiate addicts by private doctors: comparison with NHS practice in south east England (2001)
    Oxford, UK : Carfax Publishing, part of the Taylor & Francis Group
    Addiction 96 (2001), S. 0 
    Details
    ISSN: 1360-0443
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Psychology
    Notes: Aims. To compare National Health Service (NHS) and private practice in prescribing methadone to opiate addicts. Design and participants. Survey of community pharmacies during 1995 (one in four random sample) and during 1997 (one in two random sample) in which data were collected on all methadone prescriptions currently being dispensed to opiate addicts. Setting. Dispensing community pharmacies in south east England. Units measured. 829 methadone prescriptions (785 NHS and 44 private) from 1995, and 761 (703 NHS and 58 private) from 1997. Measurements. (i) The prescribed daily dose of methadone; (ii) the form (oral mixture, tablets or ampoules); and (iii) the pick-up duration (daily collection of prescribed dose, through to weekly or fortnightly collection in a single pick-up). Findings. Private methadone prescriptions issued to addicts typically give twice the daily dose, are more than four times as likely to give the methadone in injectable form, and most commonly give prescriptions to be collected in a single large weekly or fortnightly instalment instead of through daily dispensing, compared with NHS methadone prescriptions. Conclusions. The disparity between private and NHS methadone prescriptions is striking. The much higher doses, the lack of arrangements for instalment collection and the frequent choice of injectable forms of methadone increase greatly the risk of abuse and diversion to the black market. Regulatory scrutiny of this private practice in the United Kingdom is currently minimal. Independent research is required to explore more fully the different nature of such private methadone prescribing.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1360-0443.2001.9645675.x
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  • 2
    Electronic Resource
    Electronic Resource
    Substance use among young people: the relationship between perceived functions and intentions (1999)
    Oxford, UK : Carfax Publishing, Taylor & Francis Ltd
    Addiction 94 (1999), S. 0 
    Details
    ISSN: 1360-0443
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Psychology
    Notes: 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.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1360-0443.1999.94710439.x
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  • 3
    Electronic Resource
    Electronic Resource
    Self-reported overdose among injecting drug users in London: extent and nature of the problem (1999)
    Oxford, UK : Carfax Publishing, Taylor & Francis Ltd.
    Addiction 94 (1999), S. 0 
    Details
    ISSN: 1360-0443
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Psychology
    Notes: 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.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1360-0443.1999.9444712.x
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  • 4
    Electronic Resource
    Electronic Resource
    Preventing opiate overdose fatalities with take-home naloxone: pre-launch study of possible impact and acceptability (1999)
    Oxford, UK : Carfax Publishing Limited
    Addiction 94 (1999), S. 0 
    Details
    ISSN: 1360-0443
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Psychology
    Notes: 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 samplemainly 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.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1360-0443.1999.9421993.x
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  • 5
    Electronic Resource
    Electronic Resource
    Deterioration over time in effect of Motivational Interviewing in reducing drug consumption and related risk among young people (2005)
    Oxford, UK : Blackwell Science Ltd
    Addiction 100 (2005), S. 0 
    Details
    ISSN: 1360-0443
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Psychology
    Notes: Aim  To test whether beneficial effects of a single session of Motivational Interviewing (MI) on alcohol, tobacco and illicit drug use apparent after 3 months were maintained until 12 months.Design  Cluster randomized trial, allocating 200 young people in the natural groups in which they were recruited to either MI (n = 105) or to an assessment-only control condition (n = 95).Setting  Ten further education colleges across inner London.Participants  Two hundred young people who were current users of illegal drugs (age range 16–20 years) with whom contact was established through peers trained for the project.Intervention  The intervention was adapted from MI in the form of a topic-based 1-hour single-session discussion.Measurements  Changes in cigarette, alcohol, cannabis and other drug use and perceptions of risk and harm between the time of recruitment and follow-up interviews after 3 and 12 months.Findings  A satisfactory follow-up rate (81%) was achieved. After 12 months, 3-month differences between MI and assessment-only groups have disappeared almost entirely. Unexpected improvements by the assessment-only control group on a number of outcomes suggest the possibility of reactivity to the research assessment at 3-month follow-up.Conclusion  In the terms of the original experiment, there is little evidence of enduring intervention effectiveness shown by between-group differences after 12 months. Deterioration of effect is the most probable explanation, although reactivity to 3-month assessment, a late Hawthorne effect, cannot be ruled out.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1360-0443.2005.01013.x
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  • 6
    Electronic Resource
    Electronic Resource
    HIV prevention and drug treatment services for drug misusers: a national study of community pharmacists' attitudes and their involvement in service specific training (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Addiction 92 (1997), S. 0 
    Details
    ISSN: 1360-0443
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Psychology
    Notes: Aims. To investigate the attitudes of community pharmacists towards HIV prevention services for drug misusers and the relationship between these and their involvement in service provision. Design. Postal survey of a one in four random sample of community pharmacies (N = 2654) in England and Wales, stratified by Family Health Service Authority, in 1995, using up to four mailshots. Setting. Community pharmacies in England and Wales. Participants. The community pharmacist in charge of the dispensary at the random sample of community pharmacies. Measurements. Information on attitudes and behaviour were collected through self-completion and postal return of structured questionnaires using questions with both category responses and Likert scales. Findings. A 74.8% response rate was achieved. Community pharmacists were positive about their role in HIV prevention and the provision of clean injecting equipment to injecting drug users—positive attitudes that were more evident among those pharmacists already providing these services. However, they had concerns over the effect drug misusers may have on business and indicated a need for more training and for more role support. Only a minority had taken pan in training on drug misuse and HIV prevention (34.7% and 21.3%, respectively). Many community pharmacists supported the proposal that there should be extensions of their involvement, to include services such as supervising the consumption of methadone in the pharmacy (38.6%) and collecting used prescribed ampoules front patients (33.8%). Positive relationships were identified between training and attitude, and between attitude and service provision. Changes in attitude responses between this 1995 survey and the earlier 1988 survey are also presented. Conclusions. Recommendations are made for further training and greater communication between prescriber/carer and the community pharmacists, for involvement of community pharmacies in new possible forms of service provision, and for there to be greater attention to the value of role support.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1360-0443.1997.tb02894.x
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  • 7
    Electronic Resource
    Electronic Resource
    The Maudsley Addiction Profile (MAP): a brief instrument for assessing treatment outcome (1998)
    Oxford, UK : Carfax Publishing Limited
    Addiction 93 (1998), S. 0 
    Details
    ISSN: 1360-0443
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Psychology
    Notes: Aim. To develop a brief, multi-dimensional instrument for assessing treatment outcome for people with drug and/or alcohol problems. The Maudsley Addiction Profile (MAP) is the first instrument to be developed in the United Kingdom for this purpose. Design. Field testing with quota-recruitment of problem drug users and problem alcohol users in treatment with researcher and clinician-administered test-retest interviews. Setting. Two community and two inpatient services at the Bethlem Royal and Maudsley Hospital, London. Participants. Subjects (160 drug users and 80 alcohol users) interviewed by eight interviewers (four researchers and four clinicians), each of whom interviewed 30 subjects on two occasions. Measures. Sixty items across substance use, health risk, physical/psychological health and personal/social functioning domains. Findings. Average completion time of the MAP was 12 minutes. The questionnaire was acceptable to a majority of subjects and performed well with both researcher and clinician interviewers. Internal reliability and feasible concurrent validity assessments of the scales and items were highly satisfactory. Test-retest reliability was good, average intraclass correlation coefficients across eight substances were 0.94 and 0.81 across health risk, health problems, relationship conflict, employment and crime measures. Conclusions. The MAP can serve as a core research instrument with additional outcome measures added as required. The collection of a set of reliable quantitative measures of problems among drug and alcohol users by research or treatment personnel for outcome evaluation purposes need not be time-consuming.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1360-0443.1998.9312185711.x
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  • 8
    Electronic Resource
    Electronic Resource
    Heroin smoking by ‘chasing the dragon’: origins and history (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Addiction 92 (1997), S. 0 
    Details
    ISSN: 1360-0443
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Psychology
    Notes: The history of heroin smoking and the subsequent development and spread of ‘chasing the dragon’ are examined. The first heroin smoking originated in Shanghai in the 1920s and involved use of porcelain bowls and bamboo lubes, thereafter spreading across much of Eastern Asia and to the United States over the next decode. ‘Chasing the dragon’ was a later refinement of this form of heroin smoking, originating in or near Hong Kong in the 1950s, and refers to the ingestion of heroin by inhaling the vapours which result when the drug is heated-typically on tin-foil above aflame. Subsequent spread of ‘chasing the dragon’ included spread to other parts of South East Asia during the 1960s and 1970s, to some pans of Europe during the late 1970s and early 1980s, and to much of the Indian sub-continent during the 1980s. At the time of writing, ‘chasing the dragon’ has now been reliably reported from many parts of the world but no: from others with an established heroin problem-such as the United States and Australia. The significance of this new form of heroin use is examined, including consideration of the role of the different effect with this new form of use, the different types of heroin, and changing public attitudes to injecting.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1360-0443.1997.tb02927.x
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  • 9
    Electronic Resource
    Electronic Resource
    Chasing the elusive dragon: the need for better definition (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Addiction 92 (1997), S. 0 
    Details
    ISSN: 1360-0443
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Psychology
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1360-0443.1997.tb02935.x
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  • 10
    Electronic Resource
    Electronic Resource
    Are practice nurses an unexplored resource in the indentification and management of alcohol misuse? Results from a study of practice nurses in England and Wales in 1995 (1998)
    Oxford, UK : Blackwell Science Ltd
    Journal of advanced nursing 28 (1998), S. 0 
    Details
    ISSN: 1365-2648
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Changes in the health promotional work undertaken in primary care, including the work needed to meet the ‘Health of the Nation’ alcohol targets, have led to a rapid expansion of the number of practice nurses in England and Wales. However, there has been little evaluation of this role. This study provides data, for the first time at a national level, about practice nurses’ work in identifying and managing patients drinking above recommended sensible guidelines. Data were collected by postal questionnaire from all nurses in a 50% random sample of 1852 practices (drawn from a general practitioner (GP) national study, undertaken at the same time). 43% of nurses responded from 62% of the targeted practices. Respondents reported identifying a mean of 3·1 patients per month who were drinking above recommended sensible guidelines. These patients tended to be male, above 40 years of age and in contact with the nurse for the first time about this problem. Most patients were categorized as having a potential alcohol problem; few were classified as currently dependent. Very little intervention work was undertaken by nurses except for referral to the GP. If real progress is to be made in meeting the ‘Health of the Nation’ targets on population alcohol consumption, then primary care work in identifying alcohol misusing patients needs to be developed as a matter of urgency. The patients identified by practice nurses are those patients relevant to the ‘Health of the Nation’ alcohol targets. More emphasis needs to be placed on the valuable contribution practice nurses can make, particularly through the use of screening instruments and brief interventions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2648.1998.00694.x
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