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Aims. This study examined overdose deaths involving benzodiazepines and prescription opioids, and studied associated factors.Methods. In a retrospective registry study of drug-overdose deaths (n= 167) with post-mortem toxicological findings of benzodiazepines and/or opioids/carisoprodol (strong analgesics) in Oslo, Norway, from 2006 to 2008, prescribing and dispensing patterns were investigated, and factors associated with benzodiazepines and/or strong analgesics in post-mortem toxicology where these medications were not prescribed were identified.Results. Among deceased with toxicological findings of only benzodiazepines, 28.1% (20.7–36.9) had been dispensed benzodiazepines four weeks prior to death; only strong analgesics, 33.3% (13.0–61.3) had been dispensed strong analgesics; both benzodiazepines and strong analgesics, 58.3% (36.9–77.2) had been dispensed benzodiazepines and/or strong analgesics. Also, 33.0% of the deceased had five or more different prescribing physicians of either benzodiazepines or strong analgesics in the year prior to death. Doses of both dispensed benzodiazepines and strong analgesics were higher than recommended. Younger age and residing outside Oslo were associated with having benzodiazepines and/or strong analgesics in the toxicological findings when these medications had not been dispensed (p= 0.006 andp= 0.039, respectively).Conclusion. The majority of benzodiazepines and strong analgesics detected in overdose deaths were non-prescribed and/or associated with less than optimal prescribing practices by some treating physicians. [ABSTRACT FROM AUTHOR]

A sample of 110 drug-involved offenders from two prisons was assessed regarding drug and alcohol consumption, problem awareness, ambivalence and treatment readiness. Of these, 56% reported hazardous alcohol consumption and 53% highly problematic drug use. Highly problematic users reported more problem awareness and more cognitive dissonance regarding change. Treatment readiness was rated higher by problematic users as compared to users reporting fewer problems. The influence of prison environment on ambivalence needs to be studied longitudinally after imprisonment. Identification of drug-involved prisoners should be done systematically, including assessment of alcohol consumption. Opportunities for substance misuse treatment in prisons should be increased. [ABSTRACT FROM AUTHOR]

This study, based on data from the MANIF 2000 cohort study, investigates the relationship between the lending of injecting equipment, drug use, and experience with HIV care. The sample comprised 224 HIV–HCV co-infected patients who reported having injected drugs in the previous six months and their 538 visits to clinical services. Longitudinal data were collected for medical status, and self-reported risk behaviors. A logistic regression GEE model was used to identify correlates of distributive sharing. After multiple adjustment, patients who reported trust in physicians were significantly less likely to report lending injection equipment while cocaine users were at increased risk. Promoting dialog between physicians and injecting drug users (IDUs) may play an important role in HIV–HCV positive prevention. [ABSTRACT FROM PUBLISHER]

Background: Estimates of psychoactive substance use among acutely admitted psychiatric patients vary among studies, and few have used comprehensive laboratory methods. Aims: This study used chromatography-based analyses of blood and urine to identify the rates of substance use among acute psychiatric admissions, and to study the associations with socio-demographic variables, clinical characteristics and patients'' reports of symptoms, substance use and need for treatment. Methods: A cross-sectional study was conducted in 2006/2007 in Oslo, Norway. Blood and urine samples were collected from 298 acute psychiatric admissions and extensively analysed for alcohol, medicinal and illicit drugs. Psychotic symptoms were assessed with the positive subscale of the Positive and Negative Syndrome Scale. Patient self-report questionnaires included the Alcohol and Drug Use Disorder Identification Tests. Patients were also asked if they needed professional help for substance use. Results: Psychoactive substances were detected in 63% of the 298 admissions, medicinal drugs in 46%, alcohol in 12% and illicit drugs in 28%. Patients using alcohol had a high suicidal risk score at admission and the shortest length of stay (median 1 day). Use of illicit drugs was associated with psychotic symptoms and readmission. Self-report questionnaires indicated harmful use of alcohol for half of the patients and of other substances for one-third. A need for professional help for substance use was reported by one-third of patients. Conclusion: Given the high rates of substance use and the important clinical associations, drug screening seems warranted in acute psychiatric settings. Interventions designed for substance-using patients should be developed and integrated. [ABSTRACT FROM AUTHOR]

Introduction and aims: The present study compared the types and severity of physical health problems among patients with drug or alcohol dependence. Design and methods: A total of 252 patients from one inpatient and two outpatient units were interviewed. Data were collected at the start of treatment using a structured research protocol to assess nine health domains, and ratings were made by a medically qualified physician following physical examination of the patient. Results: Physical health problems were common-76% of the sample had at least one problem and 51% had two or more problems. Health problems were often serious and required treatment with the overall level of severity significantly higher ( p < .001) in alcohol dependent patients and specifically for neurological, gastrointestinal and liver, and dermatological problems. Among alcohol dependent patients, both quantity of drinking prior to treatment and age ( p < .001) were associated with increased physical morbidity. For drug dependent patients, injection of drugs ( p < .001) and homelessness ( p = .037) were associated with poorer physical health. For both groups physical health was poorer among those treated in inpatient than in outpatient settings ( p < .001). Discussion and Conclusions: The high prevalence of physical health problems among patients who are dependent on alcohol or other drugs emphasizes the importance of a thorough health screening at admission to treatment with provision for, or referral to, appropriate treatment for any problems identified [ABSTRACT FROM AUTHOR]

There is evidence that treatment for opiate addiction is effective in reducing drug use and offending (Prendergast et al. 2002; Gossop et al. 2003), based on effective combinations of substitution prescribing and evidenced psychosocial treatments (McLellan et al. 1993), yet concerns that few structured interventions are delivered in ‘real life’ settings. The current study assessed what keyworkers perceive as going on in drug working sessions in the criminal justice system. To assess what is actually delivered, cross-sectional case reviews were undertaken of 344 files of drug-using offenders in treatment, and interviews with the 35 keyworkers delivering case management and psychosocial interventions to the clients in these cases. This constituted all the active cases in the Drug Intervention Programme (DIP) in Birmingham, UK. Clients were typically seen for a mean of 44.3 min per session, in which time a range of tasks were undertaken, and workers estimating that evidenced interventions accounted for an average of 10 minutes per session. There was marked variability in session length and content, with some of this variability predicted by client characteristics, and by worker and team factors. The study provides little support for the delivery of evidence-based psychosocial interventions in mandated drug treatment services. [ABSTRACT FROM AUTHOR]

Aims: The study investigates differences in dual diagnosis disorders among patients in psychiatric and in substance use treatment services. Method: The sample (n = 159) comprised patients from four treatment settings: community mental health service, inpatient psychiatric ward, drug treatment service, alcohol treatment service. Patients who screened positive for dual diagnosis received a detailed multi-axial assessment of substance use and mental health problems. Results: Important clinical differences were found between dual diagnosis patients in psychiatry and substance use treatment services. Dual diagnosis patients in psychiatry services were more likely to have a psychotic illness: those in the inpatient psychiatry service had the most severe mental health problems, and were exposed to the greatest risks to their safety. Psychiatric outpatients were least likely to have an alcohol dependence disorder, although a high rate of drug use disorders (mainly involving cannabis) was found among the psychiatric inpatients. High rates of affective disorders and suicide risk were found among patients in all treatment services. Conclusions: The term 'dual' diagnosis can be misleading. Dual diagnosis patients present with complex mental health, physical health, psychosocial disability, and safety needs, and the pattern of problems presented by dual diagnosis patients varies across different treatment services. [ABSTRACT FROM AUTHOR]

Patients and staff from an in-patient drug and alcohol dependence treatment service were surveyed regarding their attitudes towards a proposed smoking ban. Data were collected using a semi-structured questionnaire. The sample (n = 77) comprised 38 patients and 39 staff. Patients generally held negative attitudes towards a no smoking policy on the wards: almost three-quarters reported that they would be unlikely to accept treatment with such a policy. While staff members recognized the health benefits of a no smoking policy, they expressed concern that such a policy would lead to increased difficulties for patients and increase the likelihood of early discharge from treatment. Although about a quarter of patients expressed a desire to quit smoking, it was generally felt that stopping smoking was not an attractive proposition during treatment. Overall, both patients and staff felt that the introduction of a no smoking policy would be unattractive and potentially disruptive to treatment. [ABSTRACT FROM AUTHOR]

The increase in cocaine use in young people has been reflected in an increase in the number of deaths in which cocaine is identified post mortem. This increase is evident in relation to police custody deaths. In the current analysis, 43 drug-related deaths in custody are considered with cocaine identified in 24 of the post mortem examinations. The article examines the characteristics of these deaths, with particular attention paid to tire method and related reasons for drug consumption. Crucially, these deaths contrast with national drug mortality data as they generally involve cocaine consumed by swallowing at the point of arrest. A total of 18 of 24 cocaine deaths involved oral ingestion with at least 15 of these possible attempts at drug concealment occurring at the point of arrest. There is likely to he a considerable risk of loss of life among street-level drug dealers who swallow to avoid drug detection; the article examines the risks associated with this behaviour and possible preventative strategies. INSETS: Case Study 1;Case Study 2. [ABSTRACT FROM AUTHOR]

The study assessed prevalence of volatile substance abuse (VSA), and its link to other forms of psychoactive substance use and to other problem behaviours among 14-15 year olds recruited from sixteen secondary schools in south-west London. Lifetime use of volatile substances was reported by 126 young people (6% of the sample) whose mean age of first use was 12.6 years. Using logistic regression analysis, lifetime use of volatile substances was found to be associated with more frequent cigarette smoking and more frequent drinking in the previous month, with higher levels of anxiety, greater involvement in delinquent acts, and lower levels of educational aspirations. Among volatile substance abusers, more frequent use was associated with higher levels of psychological distress and greater delinquent activity. Volatile substance abuse may be a marker for other forms of substance use and for other behaviour problems. This issue remains inadequately explored by researchers and clinicians. [ABSTRACT FROM AUTHOR]

Focuses on the importance of identifying alcohol problems among methadone maintenance patients. Use of multiple strategies for assessing alcohol consumption, alcohol dependence and liver function tests; Provision of useful and satisfactory indicator of drinking behavior through self-reported alcohol consumption.

The Consultancy Liaison Addiction Service (CLAS) is a GP-led service to provide support and training to primary health care staff in South London. Data on 136 out of 153 staff (85.3%) were obtained at the start of the project. Generally the service was well received. However, the study failed to show any statistically significant changes in behaviour or attitudes as a result of CLAS. Possible reasons for this are explored. CLAS did little training and, in those practices where it was active, the CLAS workers mainly worked directly with substance-misusing patients. Individuals from a clinical background may find it hard to move into a consultative role, given their background and in the face of a demand from GPs to see the patients. CLAS had little involvement with staff other than GPs. Although training and support for other staff could be advantageous, the training and consultancy functions of a service like CLAS are unlikely to be used appropriately without the therapeutic commitment of the whole practice and especially the backing of the GPs. However, by engaging GPs, CLAS may have been making the necessary first step of building trust as a foundation for more substantial change. [ABSTRACT FROM AUTHOR]

The study investigates developmental associations in the relationship between drug use and crime among 100 treatment-seeking opiate addicts. While 56% of the sample report having committed 2,785 acquisitive crimes in the previous month, there are strong developmental patterns. Those who have committed crimes before age 14 have earlier onset of tobacco, alcohol, cannabis and cocaine use and a lower first age of heroin problems. This relates to perceptions - those who believe drug use caused crime before the age of 14 have lower age of onset for tobacco and cocaine use and for heroin problems. The developmental patterns suggest strong associations between drug use and crime, but provide no support for a casual model in which drug use leads to crime. [ABSTRACT FROM AUTHOR]

This cross-sectional study investigates patterns of drug use and associated problems among 332 cocaine users from treatment and community samples in São Paulo, Brazil. Data were collected using a structured questionnaire and the Severity of Dependence Scale (SDS). The majority were regular users of high doses of smoked cocaine. After controlling for severity of cocaine use, users in the community were found to be more involved in illegal activities, more likely to report adverse effects of cocaine, to be involved in prostitution, and to have lived on the streets. Better methods are required to provide interventions to tackle the problems and risk behaviors of these cocaine users. [ABSTRACT FROM AUTHOR]

Assesses client satisfaction with treatment for substance use problems with the use of treatment perceptions questionnaire (TPQ). Predictors of treatment satisfaction; Measures for personal and social functioning, treatment processes and perceptions; Outcome evaluation from oral and injectable methadone maintenance treatment; Validity and reliability of TPQ.

Identifies the factors and reasons cited by young people in Great Britain for not using drugs. Lack of interest in the effects of the drugs by older adults; Fear of the effect of drugs; Fear of addiction; Fear of physical harm; Absence of peer influence.

Central policy has increasingly encouraged general practitioners to be involved in treating patients with problems of substance misuse. A postal questionnaire was sent to all 416 general practitioners in the South East London Health Authority area to explore the extent of their identification and management of patients who smoke, or misuse alcohol or illicit opiates. A high response rate (78%) was achieved over three waves. Most doctors reported asking their patients about smoking and drinking and offering advice where a problem is found. Two-thirds of the general practitioners reported having seen at least one opiate misusing patient in the previous four weeks. More than a quarter reported always or often prescribing medication such as methadone for opiate misusing patients. Our findings differ from previous surveys and suggest that general practitioners may be becoming more active in the treatment of patients with problems of substance misuse. [ABSTRACT FROM AUTHOR]

The interrogation of drug addicts in custody presents a problem. The reliability of confessions made either under the influence of drugs or during drug withdrawal may be adversely affected. This study explores the effect of drug use and drug withdrawal on interrogative suggestibility and compliance. These two psychological factors are relevant to erroneous testimony. The interrogative suggestibility and compliance of heroin addicts on an inpatient drug unit were measured on opiates, whilst withdrawing from opiates and drug free. The interrogative suggestibility and compliance of the group of subjects as a whole did not differ significantly in these three conditions. However the results did suggest that a subgroup of vulnerable individuals may have been more suggestible when under the influence of opiates. Further work is needed to clarify these results and to aid professionals assessing fitness for interview and cases of retracted confessions. [ABSTRACT FROM PUBLISHER]

Examines the levels of alcohol and tobacco consumption and diet in a cohort of methadone maintenance addicts in London, England. Effectiveness of methadone substitution treatment for opiate addicts; Differences in diet and smoking between drinkers and non-drinkers; Relationship between eating and drinking patterns.

Identifies the benefits of first-month use of methadone treatment for opiate addiction in Great Britain. Reduction in the amount of heroine and cocaine drug use; Percent reduction of injection drug users; Improvement of physical health; Reduction of shoplifting behavior among drug users.

Examines the effect of benzodiazepine use among long-term polydrug-using, opiate addicts in London, England. Impact of the decrease in the availability of temazepam gel-filled capsules; Emphasis on the effect on both the illicit market for diverted prescription drugs and drug-using patterns.

Presents a qualitative study on the perception of clients regarding inpatient treatment programs for drug and alcohol dependence in England. Description on the positive aspect of the treatment; Positive effect of the studies to the clients; Views of the clients on the therapeutic aspect of the treatment.