ORCID Profile
0000-0002-5413-2725
Current Organisations
Institute of Psychiatry Psychology and Neuroscience
,
King's College London
,
National Addiction Centre
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Publisher: Elsevier BV
Date: 12-1997
DOI: 10.1016/S0376-8716(97)00138-5
Abstract: One hundred clients receiving methadone substitution treatment participated in an investigation of the relationship between methadone dose, time of daily self-administration and reported illicit heroin and other drug use. The study was conducted at two outpatient clinics operating from a single site at the Maudsley Hospital, London. Forty-seven per cent of clients reported using illicit heroin on one or more occasions in the week before interview. Multivariate analysis of methadone dose, time of methadone administration and duration of treatment indicated that the time of methadone administration was the most important predictor of illicit heroin use. Clients who took their methadone before 1500 h were less likely to use heroin than those who consumed methadone later in the day. This finding suggests the possibility of reducing illicit heroin use by methadone maintenance clients through the structuring of treatment programmes so that supervision of methadone consumption occurs during the early part of the day.
Publisher: Wiley
Date: 11-01-2010
Publisher: Wiley
Date: 11-10-2023
DOI: 10.1111/ADD.16353
Publisher: Wiley
Date: 11-2000
DOI: 10.1046/J.1360-0443.2000.951116314.X
Abstract: To assess the feasibility of a randomized clinical trial of supervised injectable versus oral methadone maintenance and to assess medium-term treatment outcomes. Randomized clinical trial of supervised injectable versus supervised oral methadone maintenance treatment (MMT). Trial participants were dependent illicit opiate injectors allocated at intake to supervised injectable or oral methadone maintenance treatment. Specialist addictions treatment centre in South London. Forty dependent illicit opiate injectors seeking methadone maintenance treatment. Daily supervised injectable and oral methadone maintenance, delivered at the treatment centre. Frequency of illicit heroin use and frequency of illicit drug injecting during 30 days before intake to treatment and prior to 6-month follow-up. frequency of use of illicit methadone, crack cocaine, benzodiazepines and alcohol, physical and psychological health symptoms and acquisitive crime. Injectable and oral MMT were both generally acceptable to the study participants: there was a high level of agreement to enter the randomized trial, and subsequent retention in treatment was good. The average number of days of illicit heroin use reduced from 22.2 to 7.6 for the injectable MMT group and from 22.4 to 8.7 for the oral MMT group. The average number of days of illicit injecting reduced from 25.7 to 10.8 days for the injectable group and from 20.1 to 11.9 days for the oral group. Patients' physical and psychological health symptoms and involvement in acquisitive crime also reduced in both groups. Treatment satisfaction ratings at follow-up were higher among patients in the injectable MMT group. The ratio for the actual medication costs between injectable and oral MMT was 6.8:1, and for the direct operational costs was 4.7:1. There was some evidence of a differential patient response with greater reductions in heroin use occurring among patients who were daily illicit injectors and had poorer psychological and physical health (at entry) who were allocated to injectable MMT. Conduct of the trial has demonstrated that it is feasible to implement supervised injectable methadone maintenance treatment in the context of (although separate from) a specialist oral methadone maintenance service. Patients assigned to receive either supervised injectable or oral MMT had broadly equivalent, positive during-treatment outcomes at 6-month follow-up. Future studies should seek to identify patient characteristics which are linked to good outcome in injectable MMT. Practical evidence-based guidance to physicians about determining which patients are more suitable for injectable MMT is urgently needed.
Publisher: Wiley
Date: 24-01-2018
DOI: 10.1111/ADD.14131
Publisher: BMJ
Date: 12-03-1994
DOI: 10.1136/BMJ.308.6930.718C
Abstract: We report the case of a healthy 59-year-old woman who presented with an acute abducens nerve palsy 2 days after receiving the Pfizer-BioNTech COVID-19 vaccine. In adults, such palsies are typically caused by microvascular disease or compressive tumors, although they have also been described after routine vaccinations. Given the temporal relationship between vaccination and the onset of symptoms, the lack of preexisting medical conditions, and unremarkable magnetic resonance imaging, the patient's abducens nerve palsy was felt to be related to her vaccination. This case highlights the importance of recognizing the potential of a COVID-19 vaccine to have neurologic sequelae similar to those that as have been reported with the virus itself as well as with other vaccines.
Publisher: Elsevier BV
Date: 10-2009
DOI: 10.1016/J.SCHRES.2009.05.020
Abstract: Cognitive impairment has been found independently among in iduals with schizophrenia and in iduals with alcohol use disorders. Less is known about the nature and severity of cognitive impairment in patients with a dual diagnosis, though the co-occurrence of these disorders may further exacerbate cognitive impairment. The study investigates the possible additive effect of alcohol use disorder and schizophrenia on cognitive impairment among patients diagnosed with schizophrenia. Participants were inpatients with schizophrenia (n=30), inpatients with a dual diagnosis of schizophrenia and alcohol use disorder (n=30), and matched controls (n=30): all completed a comprehensive neuropsychological battery. Both patient groups were significantly impaired, relative to controls, across the battery. Dual diagnosis patients were significantly more impaired than schizophrenia patients on delayed verbal memory, and executive functioning, primarily set-shifting, working memory, and planning, and had higher psychiatric morbidity scores. The findings provide support for an additive effect of the two disorders on cognitive impairment. These cognitive deficits may affect capacity to engage in treatment, increase risk of relapse, and adversely affect treatment outcomes. An understanding of the cognitive profile of people with dual diagnosis may help to tailor treatment delivery to meet their specific needs, enhance cognitive strengths, accommodate deficits and improve treatment outcomes.
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.ANNEPIDEM.2013.07.012
Abstract: This study compares polydrug use in national and inner city s les to (1) examine patterns of use underlying different prevalence rates and (2) identify how inner city polydrug use needs targeting in ways not suggested by national research. Latent class analyses on indicators of illicit drug use in the last year, hazardous alcohol use, and cigarette smoking were compared between the inner city 2008-2010 South East London Community Health study (n = 1698) and the nationally representative 2007 Adult Psychiatric Morbidity Survey in England (n = 7403). Multinomial logistic regressions then examined latent class solutions with demographic and socioeconomic factors. Both s les revealed three notably similar classes of polydrug users: a "high-drug" group using multiple substances a "moderate-drug" group using cannabis, alcohol, and cigarettes and a "low-drug" group reporting minimal alcohol and cigarette use. However, South East London Community Health reported lower risks of polydrug use for ethnic minorities but not for more educated participants. Despite higher polydrug use prevalence in the inner city, latent classes of polydrug users were similar between s les. Some demographic and socioeconomic factors differed between the s les, suggesting the need for inner city services to use both local and national data for policy planning.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.DRUGALCDEP.2014.12.025
Abstract: Opioid misusers have recognized high mortality but the influence of psychiatric comorbidity in excess cause-specific mortality is unclear. Opioid use disorder (OUD) patients were identified in the South London and Maudsley Case Register. Deaths were identified through database linkage to the national mortality dataset. Standard mortality ratios were calculated to compare mortality risk with the general population. Cox and competing risk regression models were used to investigate the effect of psychiatric comorbidity and psychological health on all-cause and cause-specific mortality (respectively) in OUD patients. Of 4837 OUD patients, 176 had died. Mortality rates were substantially higher than the general population (SMR 4.23 95%CI 3.63-4.90). Among those with OUD, comorbid personality disorder (PD) and comorbid alcohol use disorder (AUD) was associated with increased all-cause mortality in all models, including the fully adjusted model, controlling for socio-demographic factors, severity of drug use, risk behaviours and physical health (HR2.15, 95%CI 1.17-3.95 HR2.28, 95%CI 1.54-3.36). AUD was associated with increased risk of fatal overdose (HR2.57, 95%CI 1.26-5.26) and hepatic-related deaths (HR7.26, 95%CI 2.79-18.86). In iduals with OUD and comorbid PD had almost four times greater risk of liver related deaths compared to those without PD (HR3.76, 95%CI 1.21-11.74). Comorbid severe mental illness and poor psychological health were not associated with increased mortality. This study highlights the importance of assessment for PD and AUD in OUD patients in order to identify in iduals at substantially elevated mortality risk to enable a more personalized approach to their medical care.
Publisher: S. Karger AG
Date: 2008
DOI: 10.1159/000141646
Abstract: i Background/Aims: /i The femoral region (‘groin’) appears to be increasingly commonly used by injecting drug users in the UK. With the advent of Britain’s first supervised prescribed injectable opioid treatment clinic, unprecedented decisions and judgements were required about the safe supervision of this practice, or whether to permit this behaviour on site at all. This paper reports the reasons for, and outcome of, development of a clinical policy on injecting into the deep femoral vein (groin injecting). i Method: /i A small in-depth audit of the complications of femoral injecting was undertaken in a supervised injecting clinic. i Results: /i All femoral injectors had had either local site-related medical complications or other health problems which could potentially be worsened by ongoing injection. This finding along with the personal and professional issues raised by staff for supervision of femoral injecting led to a revised policy focussing on achieving a shift towards lower-risk peripheral venous and intramuscular sites. i Conclusion: /i While the clinic staff’s training may be more compatible with professional duties of care by encouraging cessation of femoral injecting, this does not tell us what advice harm reduction workers in the field should offer groin injectors. More research is needed into this high-risk, controversial injecting practice.
Publisher: Wiley
Date: 02-2019
Abstract: 'Take-home naloxone' refers to a life-saving intervention in which a drug (naloxone) is made available to nonmedically trained people for administration to other people experiencing an opioid overdose. In Australia, it has not been taken up as widely as would be expected, given its life-saving potential. We consider the actions of take-home naloxone, focusing on how care relations shape its uses and effects. Mobilising Science and Technology Studies insights, we suggest that the uses and effects of naloxone are co-produced within social relations and, therefore, this initiative 'affords' multiple outcomes. We argue that these affordances are shaped by a politics of care, and that these politics relate to uptake. We analyse two complementary case studies, drawn from an interview-based project, in which opioid consumers discussed take-home naloxone and its uses. Our analysis maps the ways take-home naloxone can afford (i) a regime of care within an intimate partnership (allowing a terminally ill man to more safely consume opioids) and (ii) a political process of care (in which a consumer takes care of others treated with the medication by administering it 'gently'). We conclude by exploring the political affordances of a politics of care approach for the uptake of take-home naloxone.
Publisher: Oxford University Press (OUP)
Date: 12-08-2003
Abstract: This study investigates the relationship between attendance at Alcoholics Anonymous (AA) meetings prior to, during, and after leaving treatment, and changes in clinical outcome following inpatient alcohol treatment. A longitudinal design was used in which participants were interviewed at admission (within 5 days of entry), and 6 months following departure. The s le comprised 150 patients in an inpatient alcohol treatment programme who met ICD-10 criteria for alcohol dependence. The full s le was interviewed at admission to treatment. Six months after departure from treatment, 120 (80%) were re-interviewed. Significant improvements in drinking behaviours (frequency, quantity and reported problems), psychological problems and quality of life were reported. Frequent AA attenders had superior drinking outcomes to non-AA attenders and infrequent attenders. Those who attended AA on a weekly or more frequent basis after treatment reported greater reductions in alcohol consumption and more abstinent days. This relationship was sustained after controlling for potential confounding variables. Frequent AA attendance related only to improved drinking outcomes. Despite the improved outcomes, many of the s le had alcohol and psychiatric problems at follow-up. The importance of aftercare has long been acknowledged. Despite this, adequate aftercare services are often lacking. The findings support the role of Alcoholics Anonymous as a useful aftercare resource.
Publisher: Wiley
Date: 28-08-2013
DOI: 10.1111/ADD.12304
Publisher: BMJ
Date: 05-03-1994
Abstract: Volume changes in subcortical structures and cerebella have been associated with localization-related epilepsy and psychiatric illnesses. This study evaluated the effect of handedness and sex on the volumes of selected subcortical structures and cerebellar hemispheres in normal persons. Volumetric measurements were performed of the caudate heads, thalami, and cerebellar hemispheres in 34 (20 right- and 14 left-handed, 19 female and 15 male) normal persons. Amygdalar and hippoc al volumes were reported previously for these persons. All study participants completed a 10-item handedness questionnaire. The MR imaging sequence was a 3D T1-weighted gradient-echo acquisition of the whole brain (24/6 [TR/TE] flip angle, 25 degrees). MR images were spatially normalized, and volumes were painted with a 1.0 mm(3) resolution cursor on an SGI workstation. The effects of handedness and sex on standardized volumes and right-to-left volume ratios were calculated, and volumes were compared between right and left sides for each structure. Handedness did not affect standardized volumes or asymmetries of the caudate heads, thalami, or cerebellar hemispheres. The volumes of subcortical structures were bilaterally larger in women than in men. Right-to-left asymmetries were significant for the caudate head and cerebellum but not for the thalamus. These findings show that women have significantly larger subcortical structures than do men after spatial normalization to account for differences in brain size. Sex-specific normal ranges may be needed for evaluating volume changes related to epilepsy or other disease processes.
Publisher: Informa UK Limited
Date: 1999
Publisher: Wiley
Date: 06-1998
DOI: 10.1080/09595239800187001
Abstract: Route of administration has a profound, but often overlooked, influence on the actual experience of the drug use itself, on the risk of resulting development of dependence, and on the nature of the harms to which drug users are exposing themselves. These three areas are reviewed. The influence of route of administration on drug effect is considered first with regard to overall effectiveness of absorption, and also with regard to speed of onset of effect. The implications for risk of dependence cover animal and human laboratory studies of reinforcement schedules, epidemiological studies, the attitudes of drug users themselves to the different routes of possible drug use and associated dependence risk and the postulated influences on progression to dependence. Finally, the relationship between route of drug use and health sequelae is explored for the three most widely used routes of administration of illicit drugs-snorting, smoking and injecting.
Publisher: Wiley
Date: 12-10-2011
DOI: 10.1111/J.1360-0443.2011.03577.X
Abstract: To provide controlled data on direct induction with buprenorphine/naloxone (BNX) versus indirect buprenorphine (BPN)-to-BNX induction. Phase 4, prospective, randomized, active-drug controlled, parallel-group trial consisting of a 2-day, double-blind, double-dummy induction phase followed by 26 days of open-label treatment with BNX. Nineteen sites in 10 European countries from March 2008 to December 2009. A total of 187 opioid-dependent men and women ≥ 15 years of age. The primary objective was assessment of patient response to direct and indirect BNX induction [proportion of patients receiving the scheduled 16-mg BNX dose on day 3 (i.e. first day post-induction)]. Secondary assessments included illicit drug use, treatment retention and compliance, withdrawal scale scores, and safety. Patient response to direct- versus indirect-BNX induction was similar [direct 91.4% (85/93) versus indirect 90.4% (85/94) 95% confidence interval (CI): -7.3%, 9.2%]. Rapid dose induction (16 mg of BPN equivalent on day 2) was acceptable and 72% of patients completed treatment (day 28). There were no significant differences in secondary measures across groups. An average BNX maintenance dose of 15.3 mg across groups was associated with substantial reductions in illicit opioid use and no self-reported intravenous misuse. Treatment compliance and retention rates were similar (98.5% and 81.3%, respectively). Treatment-emergent adverse event rates were comparable: 75% versus 74% for direct- versus indirect-induction groups, respectively. Direct buprenorphine/naloxone induction was a safe and effective strategy for maintenance treatment of opioid dependence. Response to high-dose direct buprenorphine/naloxone induction appears to be similar to indirect buprenorphine-to-buprenorphine/naloxone induction and was not associated with reports of intravenous buprenorphine/naloxone misuse.
Publisher: Informa UK Limited
Date: 2008
Publisher: Wiley
Date: 1991
Publisher: Informa UK Limited
Date: 08-12-2009
Publisher: Elsevier BV
Date: 11-2000
DOI: 10.1016/S0376-8716(00)00113-7
Abstract: The study investigates the relationship between smoking and drinking, and the use of illicit drugs in a cohort of London adolescents. A high prevalence of drug experimentation and positive attitudes to illicit drug use were characteristic of those who both drank alcohol and smoked cigarettes on a regular basis. There was then a clear hierarchy in which lower prevalence of use and more negative attitudes marked those who only smoked, then those who only drank, while non-smokers and non-drinkers (the largest group) had lowest lifetime and recent drug use prevalence and the most negative attitudes about drug use.
Publisher: BMJ
Date: 27-05-1995
DOI: 10.1136/BMJ.310.6991.1408
Abstract: Apart from eccentric exercises (EE), isometric exercises (ISO) might be a treatment option for Achilles tendinopathy. Shear wave elastography (SWE) provides information for diagnosis and for monitoring tissue elasticity, which is altered in symptomatic tendons. Isometric exercises will have a beneficial effect on patients' outcome scores. Based on SWE, insertional and midportion tendon parts will differ in their elastic properties according to current symptoms. Randomized clinical trial. Level 2. Group 1 (EE n = 20 12 males, 8 females mean age, 52 ± 8.98 years) and group 2 (EE + ISO n = 22 15 males, 7 females mean age, 47 ± 15.11 years) performed exercises for 3 months. Measurement points were before exercises were initiated as well as after 1 and 3 months using the Victorian Institute of Sports Assessment-Achilles (VISA-A) score, American Orthopaedic Foot & Ankle Society score, and SWE (insertion and midportion). Both groups improved significantly, but there were no significant interin idual differences (VISA-A Isometric exercises do not have additional benefit when combined with eccentric exercises, as assessed over a 3-month intervention period. SWE is able to distinguish between insertional and midportion tendon parts in a symptomatic and asymptomatic state. The present study shows no additional effect of ISO when added to baseline EE in treating Achilles tendinopathy. Different elastic properties of the insertional and midportion tendon have to be taken into consideration when rating a tendon as pathologic.
Publisher: Elsevier BV
Date: 2011
DOI: 10.1016/J.DRUGPO.2010.09.008
Abstract: Opioid overdose has a high mortality, but is often reversible with appropriate overdose management and naloxone (opioid antagonist). Training in these skills has been successfully trialled internationally with opioid users themselves. Healthcare professionals working in substance misuse are in a prime position to deliver overdose prevention training to drug users and may themselves witness opioid overdoses. The best method of training dissemination has not been identified. The study assessed post-training change in clinician knowledge for managing an opioid overdose and administering naloxone, evaluated the 'cascade method' for disseminating training, and identified barriers to implementation. A repeated-measures design evaluated knowledge pre-and-post training. A sub-set of clinicians were interviewed to identify barriers to implementation. Clinicians from addiction services across England received training. Participants self-completed a structured questionnaire recording overdose knowledge, confidence and barriers to implementation. One hundred clinicians were trained initially, who trained a further 119 clinicians (n=219) and thereafter trained 239 drug users. The mean composite score for opioid overdose risk signs and actions to be taken was 18.3/26 (±3.8) which increased to 21.2/26 (±4.1) after training, demonstrating a significant improvement in knowledge (Z=9.2, p<0.001). The proportion of clinicians willing to use naloxone in an opioid overdose rose from 77% to 99% after training. Barriers to implementing training were clinician time and confidence, service resources, client willingness and naloxone formulation. Training clinicians how to manage an opioid overdose and administer naloxone was effective. However the 'cascade method' was only modestly successful for disseminating training to a large clinician workforce, with a range of clinician and service perceived obstacles. Drug policy changes and improvements to educational programmes for drug services would be important to ensure successful implementation of overdose training internationally.
Publisher: Wiley
Date: 10-10-2007
DOI: 10.1111/J.1360-0443.2007.02016.X
Abstract: In England, the role of community pharmacy in service provision to drug misusers was studied in 1995. Extensive involvement was identified, and considerable underused capacity was noted. This study explores these and potential new roles 10 years on. Cross-sectional national study. Postal survey (three mailshots), plus a fourth telephone follow-up using a structured questionnaire based on the 1995 questionnaire. Community pharmacies in England. Involvement in opioid substitution therapy services (e.g. methadone, buprenorphine) and related activities. Attitudes towards service provision and novel services. A 95% response rate was obtained. This was higher than in 1995, due largely to the use of a telephone follow-up. There had been an increase in the proportion providing substitution therapy dispensing services from 51% to 63% and in the average current case-load (from 5.9 to 9.2) and consequently a large increase in the numbers being treated (approximately x 1.9). Similarly, supervised consumption of methadone and buprenorphine was being provided more widely (increasing from 0 to 59% of all responding pharmacists). Attitudes towards existing roles were more positive than in 1995, and providers tended to be more positive than non-providers. For newer roles (e.g. supervise medications for comorbidity provide hepatitis B vaccination), there was support from around one-quarter of respondents. Community pharmacy continues to play an important role in delivering treatment, including prescribing services, to drug misusers. There still appears to be untapped capacity, and moderate support for newer roles.
Publisher: Elsevier BV
Date: 03-2016
Publisher: Elsevier BV
Date: 08-2004
Publisher: Informa UK Limited
Date: 02-2001
Abstract: The study examines stages of drinking and smoking careers and transitions from initiation to regular use among adolescents, as a function of ethnic status and gender. The data were collected using a confidential, self-completion questionnaire assessing onset and frequency of drinking and smoking. The s le consisted of 1777 adolescents, between the ages of 11 and 14, drawn from eight secondary schools in south-west London. For both smoking and drinking, white children were more likely to have ever smoked tobacco and drunk alcohol, and were also more likely to progress from initiation to regular use than were either black or Asian children. Asian children reported the latest onset and the lowest prevalence rates for both drinking and smoking. Males reported experimenting with both cigarettes and alcohol at an earlier age than females, although a lower proportion of males report regular and lifetime involvement with both alcohol and tobacco. Furthermore, a significantly higher proportion of females who try smoking go on to do so regularly. The importance of sociocultural factors in relation to race and gender in predicting onset and escalation of substance use is discussed. The fact that age of onset does not appear to be a significant determinant of transition rate from initiation to regular use is also explored.
Publisher: Routledge
Date: 02-08-2004
Publisher: Wiley
Date: 11-2005
DOI: 10.1080/09595230500292920
Abstract: The study uses a school-based s le to test the social and familial risk and protective factors relating to cannabis use. Based on a self-completion survey of 2078 14-16-year-olds (mean age of 15 years) attending seven standard state-run secondary schools in south London, an assessment was made of rates and risk factors for cannabis use. Twenty-four per cent of the total s le had ever used cannabis, with 15% having done so in the month prior to assessment. In addition to greater likelihood of illicit drug use, lifetime cannabis users were less likely to spend time regularly with both their mothers and fathers, but more likely to spend free time with friends who smoked, drank alcohol and used illicit drugs, and with friends involved in criminal activities. Among those who had ever used cannabis, frequency of cannabis use was predicted (using linear regression) by two onset factors (earlier initiation of drinking and cannabis use were both linked to more frequent use) and two social factors (more time spent with drug-using friends and less time spent with the mother). Overall, the study showed that early onset, itself predicted by social networks, is linked to more frequent use of cannabis and that this appears to be sustained by less time spent with parents and more with drug-using peers.
Publisher: Elsevier BV
Date: 08-2006
DOI: 10.1016/J.ADDBEH.2005.12.002
Abstract: The study investigates excessive drinking and associations with other problem behaviours in 2078 school students aged 14-16 years in seven London secondary schools. Using a cross-sectional design, a self-completion questionnaire assessed lifetime and recent (past month) alcohol and drug consumption, attitudes to alcohol use education, alcohol-related problems, psychological problems, educational aspirations, truancy, and delinquent behaviour. Excessive drinking was operationally defined as 10 or more units of alcohol per drinking occasion. At least one episode of excessive drinking was reported by 32% of the s le, with 10% reporting five or more episodes. Excessive drinking was positively associated with frequency of cigarette smoking, use of cannabis, positive attitudes towards illicit drugs, low educational aspirations, higher depression scores, frequent truancy, and involvement in delinquent behaviours. Excessive drinking is a problematic behaviour in its own right but it is also a marker for other problem behaviours, including illicit drug misuse and delinquency. Understanding and responding to alcohol misuse among adolescents requires attention to psychological, social and developmental factors other than alcohol consumption alone.
Publisher: Elsevier BV
Date: 12-2017
Publisher: Informa UK Limited
Date: 12-2004
Publisher: Wiley
Date: 10-01-2018
DOI: 10.1111/ADD.14114
Abstract: To investigate clustering of all-cause and overdose deaths after a transfer of patients and their care to alternative treatment provider and after the end of opioid substitution therapy (OST) in opioid-dependent in iduals in specialist addiction treatment. Mortality data were identified within a s le of 5335 patients with opioid use disorder who had received OST treatment between 1 April 2008 and 31 December 2013 from a large mental health-care provider in the United Kingdom. We investigated the circumstances and distribution of the 332 deaths identified within the observation window with a specific focus on overdose deaths (n = 103) after a planned discharge, dropout and transfer between services. Crude mortality rates for overdose mortality 14 days, 28 days and more than 1 month after the end of treatment/transfer for overdose mortality. Of 47 in iduals who died from overdose after having been transferred between services, nine died during the first 2 weeks [crude mortality rate (CMR) = 136.4, 95% confidence interval (CI) = 64.3-243.1] and a further five died during the first month post-transfer (CMR= 79.5, 95% CI = 44.2-129.7). Of the 32 in iduals who died from overdose after planned OST cessation, five died during the first 2 weeks (CMR = 151.5, 95% CI = 51.1-319.0) and a further four died during the first month post-discharge (CMR = 82.6, 95% CI = 38.4-151.0). In the United Kingdom, opioid-dependent people who are transferred to an alternative treatment provider for continuation of their opioid substitution therapy experience high overdose mortality rates, with substantially higher rates during the first month (especially during the first 14 days) following transfer.
Publisher: Routledge
Date: 14-10-2016
Publisher: Emerald
Date: 09-12-2011
Publisher: Wiley
Date: 02-1993
Publisher: BMJ
Date: 08-1998
DOI: 10.1136/EBMH.1.3.81
Publisher: Wiley
Date: 09-03-2007
DOI: 10.1111/J.1360-0443.2007.01762.X
Abstract: To assess changes in opiate prescribing (1995-2005) following a decade of national guidelines to address substandard opiate substitution prescribing for heroin addiction. A repeat national survey (1995 and 2005) using random one-in-four s les of all community pharmacies in England, achieving response rates of 75% (1847/2475) in 1995 and 95% (2349/2473) in 2005. Data were obtained on 3732 (1995 data) and 9620 (2005 data) prescriptions dispensed in the preceding month from the 936 and 1463 pharmacies who were currently dispensing. We have measured impact on practice for seven specific recommended changes. Between 1995 and 2005 the number of substitute opiate prescriptions doubled (x 2.03). By 2005, methadone still dominated (down from 97% to 83%), buprenorphine increased (from 1% to 16%) and other opiate medications virtually disappeared. Changes in the direction of national guidelines included: increased daily dose of methadone (from 47.3 mg to 56.3 mg), more frequent dispensing (from 38% to 60% as daily installments), more supervised consumption (from 0% to 36%) and fewer methadone tablets (from 10.9% to 1.8%). Nevertheless, despite the increased mean daily dose, only 41.0% of prescriptions for methadone were for daily doses in the recommended 60-120 mg dose range. Only one change was not in the direction of the national guidelines--the proportion of prescriptions from GPs fell from 41% to 30%, although this still represented an approximate 50% increase in the extent of GP prescribing. Doubling in provision of opiate substitute treatment has occurred, alongside significant improvements in the nature of this treatment. These positive changes have occurred in the direction of six out of seven of the UK national guidelines.
Publisher: Wiley
Date: 05-09-2008
DOI: 10.1111/J.1360-0443.2008.02314.X
Abstract: To examine the impact of training in overdose management and naloxone provision on the knowledge and confidence of current opiate users and to record subsequent management of overdoses that occur during a 3-month follow-up period. Repeated-measures design to examine changes in knowledge and confidence immediately after overdose management training retention of knowledge and confidence at 3 months and prospective cohort study design to document actual interventions applied at post-training overdose situations. A total of 239 opiate users in treatment completed a pre-training questionnaire on overdose management and naloxone administration and were re-assessed immediately post-training, at which point they were provided with the take-home emergency supply of naloxone. Three months later they were re-interviewed. Significant improvements were seen in knowledge of risks of overdose, characteristics of overdose and appropriate actions to be taken and in confidence in the administration of naloxone. A 78% follow-up rate was achieved (186 of 239) among whom knowledge of both the risks and physical/behavioural characteristics of overdose and also of recommended management actions was well retained. Eighteen overdoses (either experienced or witnessed) had occurred during the 3 months between the training and the follow-up. Naloxone was used on 12 occasions (a trained client's own supply on 10 occasions). One death occurred in one of the six overdoses where naloxone was not used. Where naloxone was used, all 12 resulted in successful reversal. With overdose management training, opiate users can be trained to execute appropriate actions to assist the successful reversal of potentially fatal overdose. Wider provision may reduce drug-related deaths further. Future studies should examine whether public policy of wider overdose management training and naloxone provision could reduce the extent of opiate overdose fatalities, particularly at times of recognized increased risk.
Publisher: S. Karger AG
Date: 2004
DOI: 10.1159/000076117
Abstract: i Objective: /i To determine the preference of substance misusers for the terms ‘patient’, ‘client’ and ‘service user’ in the context of their contact with health professionals, if they consider substance misuse problems to exist appropriately under the category of mental health problems and if they consider themselves to have mental health problems. i Methods: /i A self-completion questionnaire was administered to 150 National Health Service and private in- and outpatients with alcohol, drug and smoking problems. i Results: /i The majority (54%) preferred the term ‘patient’, felt substance misuse problems was a category of mental health problems (59%), even though the majority (62%) did not consider themselves to have a mental health problem. Broadly similar preferences were found for those attending drug services and alcohol services whilst those attending the smoking cessation service were less likely to consider it an appropriate location or description. i Discussion: /i The majority of substance misusers preferred to be called ‘patients’. The location of substance misuse services within mental health provision was widely tolerated.
Publisher: Wiley
Date: 09-1999
DOI: 10.1046/J.1360-0443.1999.94912792.X
Abstract: 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. The review process involved an examination of key reference texts and literature from the scientific fields of analytical and clinical toxicology. 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 s ling which can provide a much longer time frame for assessment. Breath, saliva, sweat or breast milk remain possibilities in the future. Accurate interpretation of the screening tests within a clinical setting alongside other relevant information remains the key to the usefulness of any test.
Publisher: Wiley
Date: 1990
Publisher: National Institute for Health and Care Research
Date: 2019
DOI: 10.3310/HTA23030
Abstract: People recovering from heroin addiction need better treatments than are currently offered. The chronic relapsing nature of drug dependence means that helping a patient to achieve abstinence is often difficult. Naltrexone blocks the effects of ingested heroin however, evidence is conflicting regarding the best delivery method. The primary purpose of the trial was to evaluate the clinical effectiveness and cost-effectiveness of extended-release naltrexone versus standard oral naltrexone versus relapse prevention therapy without medication for opioid use disorder (OUD). This was a 3-year, definitive, three-centre, three-arm, parallel group, placebo-controlled, double-blind, double-dummy, randomised controlled trial. Two specialist NHS outpatient addiction clinics: one in London and one in Birmingham. Planned study s le – 300 adult patients with OUD who had completed detoxification. One iGen/Atral-Cipan Extended Release Naltrexone device (iGen/Atral-Cipan, Castanheira do Ribatejo, Portugal) (765 mg naltrexone or placebo) at day 0 of study week 1. Three weekly directly observed active or placebo oral naltrexone tablets (2 × 50 mg, Monday and Wednesday 3 × 50 mg, Friday) at day 0 of study week 1 (for 4 weeks) and then an 8-week regimen of patient-administered dosing at the same dosing level. The primary outcome measure was the proportion of heroin-negative urine drug screen (UDS) results at the end of the 12-week post-randomisation time point. Six patients were recruited and randomised to receive study interventions. Two patients had no positive UDS s les for heroin during the 12-week treatment period, one patient had only one positive UDS s le and the remaining patients had two, six and eight positive UDS results for heroin. All patients had at least one missed clinic visit (range 1–14). Considerable problems were encountered with (1) the stipulated requirement of a validated ‘detoxified’ status prior to the initiation of the study naltrexone, (2) the requirement for a consent cooling-off period and (3) delays awaiting the surgical implant procedure. Major upheaval to the organisation and delivery of NHS community treatment services across England led to extremely poor levels of actual entry of patients into the trial. Research-vital clinical and procedural requirements were, therefore, more challenging to implement. The potential therapeutic value of the opioid antagonist naltrexone still needs clear investigation, including comparison of the established oral form with the new ultra-long-acting depot implant formulations (for which no licensed products exist in Europe). Despite the small number of study participants, some tentative conclusions can be reached, relevant to potential future work. The blinding of the active lacebo medications appeared to be good. Self-report was not sufficient to detect instances of heroin use. Self-report plus UDS information provided a fuller picture. Instances of lapsed heroin use were not necessarily followed by full relapse, and future work should consider the lapse–relapse relationship. The prison release setting also warrants special consideration. In future, investigators should consider seeking ethics approval for studies in which clinical procedures to accelerate the treatment process are permitted, even if outside orthodox clinical practice, if they address a clinical need at the time of challenge and clinical risk. In addition, it may be appropriate to seek exemption from the ordinary requirement of a cooling-off period after securing consent because it is often essential to initiate treatment promptly. Current Controlled Trials ISRCTN95809946. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment Vol. 23, No. 3. See the NIHR Journals Library website for further project information.
Publisher: Wiley
Date: 03-06-2019
DOI: 10.1111/ADD.14636
Publisher: Elsevier BV
Date: 09-1994
Publisher: S. Karger AG
Date: 2008
DOI: 10.1159/000156479
Abstract: This study investigates changes in neuropsychological functioning during early abstinence from alcohol. 30 alcohol-dependent inpatients were tested at intake (day 4 of admission) and post detoxification (day 26), using a test-retest design. The neuropsychological battery included measures of pre-morbid IQ, full-scale IQ, verbal and non-verbal measures of memory and executive function. IQ was within the normal range at intake and comparable with age-adjusted normative values and there were some impairments in memory and executive function. There were significant increases in performance scores post detoxification in working memory, verbal fluency and verbal inhibition but not in non-verbal executive function tasks (mental flexibility and planning ability). Despite increased scores on tests of verbal and memory skills after 3 weeks of abstinence, complex executive abilities showed little change. These may have a negative impact on engagement and response to treatment and compromise clinical outcomes, heightening the risk of relapse.
Publisher: Wiley
Date: 10-1990
Publisher: Wiley
Date: 19-05-2020
DOI: 10.1111/ADD.15087
Publisher: Wiley
Date: 10-1992
DOI: 10.1111/J.1360-0443.1992.TB01916.X
Abstract: Of 178 patients with sclerosing cholangitis treated since 1950, 88 patients had associated inflammatory bowel disease, 72 had no such history, and 18 had iatrogenic injury or stone disease. A total of 233 biliary operations were performed, with a 75% rate of temporary improvement after initial operation. Subsequent operations resulted in a lower success rate and a higher mortality rate. Radiologic findings included predominant extrahepatic, intrahepatic, and diffuse disease in 29%, 28%, and 43% of patients, respectively no survival differences were noted. Seventy-five of one hundred three deaths (73%) were related to liver failure, bleeding, or sepsis. Of 14 patients undergoing portosystemic shunt, 13 died of surgical complications or related disease. Orthotopic liver transplantation was performed in 16 patients and resulted in eight deaths, mainly in patients who had previously undergone extensive surgical treatment. No survival differences were seen between the patients with inflammatory bowel disease, those without the condition, or those who had colectomy. Surgical treatment in patients with sclerosing cholangitis should be minimized. Orthotopic liver transplantation should be offered as the treatment of choice for patients with portal hypertension, refractory cholangitis, advanced cirrhosis, or progressive liver failure.
Publisher: Elsevier BV
Date: 08-2016
Publisher: Informa UK Limited
Date: 02-11-2015
Publisher: BMJ
Date: 04-11-2014
DOI: 10.1136/BMJ.G6580
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-1989
Publisher: Informa UK Limited
Date: 04-08-2014
Publisher: Wiley
Date: 12-1990
DOI: 10.1111/J.1360-0443.1990.TB01656.X
Abstract: Hepatitis B vaccines are now available for people at high risk of infection. Injecting drug users are at particular risk. A UK national survey of statutory drug treatment facilities was conducted to assess what screening and vaccination procedures were offered to drug takers. Of the respondents 64% did not screen for hepatitis B and 71% did not offer vaccination to hepatitis B negative in iduals. However, 63% respondents said they would advise vaccination for injecting drug users who continued to share. Fifty-eight per cent thought that the partners of hepatitis B positive clients should be screened and 50% thought that vaccination of partners was advisable. A policy of screening and vaccination for hepatitis B is recommended.
Publisher: Wiley
Date: 06-05-2018
DOI: 10.1111/ADD.14226
Publisher: Informa UK Limited
Date: 09-2010
Publisher: Informa UK Limited
Date: 15-05-2014
Publisher: Wiley
Date: 07-1994
Publisher: BMJ
Date: 15-10-1994
Abstract: Non healing wounds of the lower limb continue to be a significant issue for both practitioners and patients. Failure of gold-standard management demands a creative response. This article describes the development of a novel and intuitive strapping technique overlying the compression bandage that appears to have an influence in healing complex lower limb ulcers. A retrospective audit of 17 patients with 25 ulcers allows further analysis and discussion. The strapping technique uses cohesive inelastic compression bandaging narrow strips of bandages are layered in a fan distribution over the ulcer and oedema. This approach seems to offer an intuitive response to these complex wounds, allowing management to be tailored to the site of the ulcer and oedema. Tolerance for this less bulky compression therapy regime is excellent, thereby aiding healing and reducing all costs associated with non healing leg ulcers.
Publisher: Wiley
Date: 03-2000
DOI: 10.1046/J.1360-0443.2000.95339310.X
Abstract: To review the available knowledge about the ersion to the illicit market of drugs prescribed to drug users in treatment in the United Kingdom, and to identify aspects of the London market in more detail. An analysis of the literature and new data in terms of the extent and nature of the market, the practicalities of trade, motives for selling, reasons for demand and the influence of variations in prescribing practice on ersion. Prices of erted prescription drugs and details of their availability in London are presented. The size of the market is substantial and appears to involve a large number of in iduals, each erting small amounts of their own prescribed drugs. Major motives for selling prescribed drugs are to raise funds to buy other, preferred, drugs and/or to pay for a private prescription. Buyers in treatment appear to be motivated by a desire to supplement their own prescriptions because they are dissatisfied with the particular drug prescribed, dosage and formulation. Drug users in treatment can exploit the variations in prescribing practice--such as how much 'take-home' medication they are allowed and whether tests are conducted to ascertain if they are using it themselves--and ert their prescribed drugs. Prices of prescription drugs on the illicit market can fluctuate on a daily basis according to supply and demand. The results suggest that, to be effective, ersion control must simultaneously involve deterrents from prescribers, drug treatment services, law enforcement agencies and dispensing pharmacists. Finally, some suggestions for further research on this under-studied issue are suggested.
Publisher: BMJ
Date: 05-1998
DOI: 10.1136/EBMH.1.2.63
Publisher: BMJ
Date: 06-07-1996
Publisher: Informa UK Limited
Date: 2007
Publisher: Informa UK Limited
Date: 22-02-2022
Publisher: Informa UK Limited
Date: 27-02-2019
Publisher: Informa UK Limited
Date: 1999
Publisher: SAGE Publications
Date: 12-06-2020
Abstract: Opioid overdose deaths are a major health issue in Australia and around the world. Programmes to provide opioid consumers with ‘take-home’ naloxone to reverse overdose exist internationally, but uptake by mainstream health services and consumers remains inconsistent. Researchers have identified a range of important educational, training and logistical impediments to take-home naloxone uptake and distribution, yet they have focused less on the social dynamics that can enhance or limit access, such as stigma. In this article, we also explore impediments to uptake, drawing on qualitative interview data gathered for an Australian research project on take-home naloxone. Mobilising a performative approach to stigma, we argue that overdose and prevention are shaped by the social dynamics of stigma and, as such, responsibility for dealing with overdose, as with take-home naloxone, should also be considered social (i.e. shared among peers, the public, communities and governments). Our interview data illuminate the various ways in which addiction stigma limits the possibilities and capacities of take-home naloxone and overdose prevention. First, we focus on how stigma may impede professional information provision about take-home naloxone by limiting the extent to which it is presented as a matter of interest for all opioid consumers, not just those who consume opioids illicitly. Second, we explore how stigma may limit the scale-up and expansion of programmes and access points. From here, we focus on how stigma co-constitutes the politics of overdose and prevention, rendering take-home naloxone ill-suited to many social settings of overdose. In closing, we point out that stigma is not just a post hoc impediment to access to and use of take-home naloxone but is central to opioid overdose production itself, and to effective prevention. While take-home naloxone is an excellent life-saving initiative, uncritically valorising it may ert attention from broader goals, such as the de-stigmatisation of drug consumption through decriminalisation, and other ambitious attempts to reduce overdose.
Publisher: Informa UK Limited
Date: 1999
Publisher: S. Karger AG
Date: 2001
DOI: 10.1159/000050719
Abstract: The present study is a cross-sectional interview-based investigation comparing experiences of and attitudes towards Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) in a s le of 200 patients attending inpatient substance misuse detoxification services. Two hundred consecutive admissions were recruited 100 each from one drug and one alcohol in-patient treatment service in which attendance at AA/NA was a voluntary adjunct to a generic treatment programme. Although there were no differences in the history of AA/NA attendance, the drug users (who were on average younger) reported significantly more positive attitudes towards AA/NA, more willingness to attend during their in-patient treatment and greater intention to attend following completion of their detoxification. In particular, despite no differences in spiritual/religious orientation, the drug users reported more positive views of the Twelve Steps. As AA/NA remain popular and accessible forms of substance misuse support, it is critical that we develop a clearer understanding of their impact and of the scope for their integration with generic forms of substance misuse treatment.
Publisher: SAGE Publications
Date: 07-1995
DOI: 10.1177/026988119500900414
Abstract: The oral opiate antagonist naltrexone is in regular use in clinical practice with abstinent opiate-dependent in iduals. Acute opioid withdrawal is a well-recognised consequence of consuming naltrexone while opiate dependent. Two cases of naltrexone-induced opiate withdrawal are reported. The compressed nature of the withdrawal syndrome in both of these cases and the implications for the management of protracted withdrawal symptoms are discussed. The theoretical implications of this experimental and clinical phenomenon are reviewed.
Publisher: Oxford University Press (OUP)
Date: 12-2005
Abstract: Over the past 20 years there has been a steady rise in mortality associated with opioid misuse in several Western countries. We aimed to examine trends in opioid-related mortality over a 20-year period in the Republic of Ireland. Retrospective analysis of deaths attributed to ICD-9 codes 304.0 (morphine-type dependence) and E850.0 (accidental poisoning by opiates and related narcotics) in the Republic of Ireland between 1980 and 1999. The Republic of Ireland has seen a rapid increase in the number of opioid-related deaths over the 20-year period studied, from 0.01% of total deaths in 1980 to 0.15% in 1999. This is most marked in the younger age groups where, for ex le, it rose to 23% of 15-19 year old male deaths for 1997. The opioid-related mortality rate in the 15-44 years age range increased by nearly 14 times between 1980-1984 and 1995-1999. Over the whole period, 87% of opioid-related deaths were amongst males. Outside Dublin there has been a considerable increase in opioid-related mortality, nearly doubling the percentage of the total from 6% in the 1980s to 11% in the 1990s. Opioid-related mortality is an increasing problem in the Republic of Ireland, as in other Western countries. Today, young people have a very low mortality rate, and hence this rapid increase may need specific targeted interventions. The spread of opioid-related mortality outside Dublin to rural and other urban areas will have implications for service planning and provision.
Publisher: Wiley
Date: 2002
DOI: 10.1080/135562101200100607
Abstract: One hundred and twenty-three treatment-seeking substance misusers were recruited to a study assessing the early impact of treatment. Participants were interviewed at treatment entry and 3 and 6 months later, regardless of their treatment status (i.e. including those who had dropped out of treatment), while additional data were obtained from the two assessment interviews carried out prior to the initiation of treatment. Three consistent observations can be applied to both the opiate misuser (n = 61) and problem drinker s les (n = 62): (1) the period of pre-treatment wait (mean of 8 weeks) was characterized by stable patterns of substance misuse with no significant 'spontaneous' improvement in indices of severity of drug or alcohol problems (2) the period immediately following initiation of treatment was associated with substantial reductions in the quantity and frequency of substance use, an effect not influenced by the length of time for treatment initiation (3) these benefits are maintained to 6 months after treatment initiation. The waiting period for treatment initiation does not seem to be characterized by significant changes in drug or alcohol use patterns, at least among those who made it into treatment, with clear and sustained improvements irrespective of the length of treatment wait.
Publisher: Elsevier BV
Date: 12-2016
Publisher: Elsevier BV
Date: 2006
Publisher: Wiley
Date: 1992
DOI: 10.1080/09595239200185061
Abstract: The clinical audit of 40 opiate-dependent in iduals 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.
Publisher: Elsevier BV
Date: 11-2012
DOI: 10.1016/J.DRUGALCDEP.2012.05.004
Abstract: Active engagement in 12-Step self-help groups (SHG) is associated with improvements in substance use outcomes during and after treatment, yet levels of participation in SHG meetings in the U.K. remain low. An RCT investigating the impact of active referral to SHG, delivered by doctors or 12-Step peers during inpatient treatment on both inpatient and post-treatment meeting attendance was conducted. 151 inpatients with alcohol, opiate, crack-cocaine or benzodiazepine dependence undergoing detoxification, received one of two active referral interventions: 12-Step peer intervention (PI), doctor intervention (DI), or no intervention (NI). 83% of the s le was followed up, 2-3 months following discharge. Active referral interventions significantly increased attendance at 12-Step meetings during inpatient treatment (88% versus 73%, p<.05). Rates of post-discharge meeting attendance were PI=64%, DI=48%, NI=33%, with those in the PI group significantly (OR=3.6 CI=1.3, 9.8) more likely to have attended. Inpatient meeting attenders were three times as likely to have attended meetings post-discharge (59% versus 20%, p<.01), and post-discharge meeting attenders reported significantly higher abstinence rates (60.8% versus 39.2%, p<.05) at follow-up. However, abstinence rates did not differ significantly across intervention groups (44% [PI], 41% [DI] and 36% [NI]). Attendance at 12-Step SHGs is associated with greater rates of abstinence and active referral, especially by 12-Step peers, increases 12-Step SHG attendance rates. However, improved clinical outcomes among attendees might not occur until stronger recovery peer support networks are established. These results show promise for the benefit of incorporating Twelve Step Facilitation into U.K. treatment settings.
Publisher: Wiley
Date: 1990
Publisher: Wiley
Date: 03-06-2015
DOI: 10.1111/ADD.12910
Abstract: This paper reviews the early work of Griffith Edwards and his colleagues on alcohol in the criminal justice system and outlines the direction of research in this area in the Addiction Research Unit in the 1960s and 1970s. The paper outlines the link between that work and work undertaken in the more recent past in this area. The key papers of the authors are reviewed and the impact of this work on policy and practice is discussed. There is a rich seam of work on deprived and incarcerated populations that has been under way at the Addiction Research Unit and subsequently the National Addiction Centre, Institute of Psychiatry, London. Griffith Edwards initiated this work that explores the risks and problems experienced by people moving between the health and criminal justice system, and demonstrated the need for better care and continuity across this system.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for John Strang.