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Some heroin addicts persistently fail to benefit from conventional treatments. We aimed to compare the effectiveness of supervised injectable treatment with medicinal heroin (diamorphine or diacetylmorphine) or supervised injectable methadone versus optimised oral methadone for chronic heroin addiction.

Indigenous workers were employed to conduct a community survey of crack cocaine use in Trafford, Manchester, and to discover attitudes to drug services. This revealed increasing use, and considerable personal and social problems caused by crack use. Users did not consider services useful, even though 30% were already attending drug services for help with coexistent opiate dependence. Three groups are considered: those in touch with services, those worried about their use but not seeking help, and those who are not worried about their use. Many of those reporting the worst crack-related problems were already attending services. Specific strategies are proposed for dealing with each of these groups. Peer-education has an important role in encouraging safer cocaine use.

All GPs in three neighbouring districts were sent a questionnaire concerning attitudes towards drug raisusers and their treatment beliefs. 79 % (270) returned completed questionnaires. Two of the districts showed similar attitude scores towards opiate users and their treatment but the third district contained significantly more GPs with negative attitudes. Social deprivation scores did not appear important. GPs who had experience of prescribing for drug users and were of younger age were more likely to have positive opinions. This study demonstrates an apparent positive shift in opinion and attitude of GP's and provides indications for purchasers wishing to develop "shared care" of drug misusers. However they must first assess local conditions before they can set targets and allocate resources.

Two cases of zolpidem tolerance and dependence are reported. The literature is reviewed for other reported cases, and the potential for abuse of zolpidem is discussed.