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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 present study represents the first large-scale test of the capacity to predict illicit drug treatment outcomes of an instrument [Stages of Change and Treatment Eagerness Scale (SOCRATES)] purporting to measure processes underlying stages of change. The main hypothesis was that ‘taking steps’ should be predictive of less frequent use of illicit opiates (heroin and non-prescribed methadone) at follow-up. Design The sample comprised 1075 people seeking treatment for drug abuse problems in 54 treatment agencies in England. The study uses a longitudinal, prospective cohort design. Structured interviews were conducted at treatment intake and at 1-year follow-up. Data were collected about illicit drug use (frequency of use of heroin, non-prescribed methadone, cocaine and amphetamines, and non-prescribed benzodiazepines) and other problems. Findings Results failed to support the hypothesis that taking steps should be associated with less frequent use of illicit opiates at follow-up. No statistically significant associations of any kind were found between readiness for change measures and use of opiates or stimulants at follow-up. A negative association was found between taking steps and benzodiazepine misuse. Readiness for change measures were correlated with heroin use and psychiatric symptom scores at treatment intake. Conclusions Readiness for change measures were not associated with illicit drug use outcomes. Of the 12 hypothesized relationships between readiness for change measures and outcomes, our results show only one ‘hit’ and 11 ‘misses’. [ABSTRACT FROM AUTHOR]

The study uses a school-based sample 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 sample 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. [Best D, Gross S, Manning V, Gossop M, Witton J, Strang J. Cannabis use in adolescents: the impact of risk and protective factors and social functioning . Drug Alcohol Rev 2005;24:483–488] [ABSTRACT FROM AUTHOR]

Abstract: Changes in caseload and in the provision of counseling and comprehensive services were examined among 27 outpatient methadone programs across England between 1995 and 1999. The number of patients treated at the programs doubled during this time and average waiting times increased. More patients presented for treatment with alcohol and stimulant problems, dual diagnosis, and involvement in the Criminal Justice System. Provision of individual counseling and comprehensive services was high at both points, although services for family/relationship problems were reduced at followup. Changes were reported in disciplinary procedures. Drug positive urine tests were more likely to result in loss of patient privileges, and there was a significant increase in discharges for breaking program rules, missing appointments, and consuming alcohol. The study allows only tentative conclusions to be drawn, but these changes may be indicative of increased pressures placed on the programs and their staff. [Copyright &y& Elsevier]

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]

This paper investigates alcohol outcomes and heavy drinking among 418 drug misusers from the National Treatment Outcome Research Study who completed followup interviews at 1, 2, and 4–5 years. About a quarter of the sample were drinking heavily at intake. Alcohol consumption at followup was predicted by drinking prior to intake, and about a quarter of those who were classified as alcohol abstainers, medium-level drinkers, or heavy drinkers at intake, remained in the same drinking category at all assessment points. Drinking outcomes were not related to opioid use. Heavy drinkers at followup were more likely to be using non-opioid drugs. The poor drinking outcomes are a matter for concern. Drug misusers with concurrent alcohol problems may require special treatment provision. The extent of heavy drinking among drug misusers both before and after treatment indicates a need to develop and strengthen programs and interventions to tackle alcohol-related problems in this patient group. [Copyright &y& Elsevier]

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]

Two weeks after the start of a major police initiative targeting drug dealing in London (described by the Metropolitan Police as a ‘spectacular success’), 174 street drug users were interviewed about drug price, availability and purity. Only seven users reported price increases for any drug, with the majority stating that there had been no change in any market features. This basic pattern was not influenced by whether the users were aware of the operation, whether they lived in the areas directly affected or by the number of different dealers that they used to purchase their drugs. Paradoxically, any perceived changes were more likely to be ‘improvements’ in the market than deterioration (i.e. lower price, greater availability and higher levels of purity). There is limited evidence from the current study to support the assertion that targeted policing will impact on the accessibility, price or quality of heroin, cannabis or crack cocaine. [ABSTRACT FROM AUTHOR]

The study investigates patterns of criminal activity and drug use in a cohort of 100 new entrants to a drug treatment service in south London. While 78 subjects reported heroin use in the month prior to treatment and 52 reported crack cocaine use, only 56 reported involvement in acquisitive crime in this period. Forms of crime most commonly engaged in were shoplifting, receiving stolen goods and theft. The patterns of criminal involvement varied as a function of the extent and profile of drug activity in the preceding month with crack users reporting the highest levels of drug expenditure and the most crime. There was no clear relationship between current methadone prescribing (or methadone dose) and levels of criminal involvement. [ABSTRACT FROM AUTHOR]

The study investigated overdose attitudes and experiences among 155 attenders at an out-patient drug clinic in south London. Almost half the sample (46.8%) had ever overdosed while 82.6% had witnessed overdoses, of whom 43 had witnessed overdose fatalities. However, this does not appear to have been a consequence of inaction, with most users reporting that they had attempted to resuscitate or assist the victim in a number of ways. Most participants also reported a reasonable awareness of the appropriate actions to take, were not deterred by fear of police sanction and managing reported that they would be willing to intervene in the future. Over a third were keen to receive training on managing overdose and that the majority would be willing to keep naloxone at home. This evidence supports previous research suggesting that addicts may be a valuable resource in strategies for reducing overdose fatalities through training and the dissemination of new drug technologies such as naloxone. [ABSTRACT FROM AUTHOR]

Aim. To assess the feasibility of a randomized clinical trial of supervised injectable versus oral methadone maintenance and to assess medium-term treatment outcomes. Design. 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. Setting. Specialist addictions treatment centre in South London. Subjects. Forty dependent illicit opiate injectors seeking methadone maintenance treatment. Interventions. Daily supervised injectable and oral methadone maintenance, delivered at the treatment centre. Main outcome measures. 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. Secondary outcome measures: frequency of use of illicit methadone, crack cocaine, benzodiazepines and alcohol, physical and psychological health symptoms and acquisitive crime. Results. 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. Conclusions. 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. [ABSTRACT FROM AUTHOR]

Aims. To investigate regional variations across England in routes of administration for heroin, nonprescribed methadone, non-prescribed benzodiazepines, cocaine powder, crack cocaine and amphetamines. Design, setting, participants. A survey of 1053 clients recruited to 54 residential and community drug misuse programmes. Measurements. Structured face-to-face interviews conducted with clients at admission to treatment. Findings. Routes of administration included injecting, smoking, snorting and oral use. For some drugs (methadone and benzodiazepines) one main route of administration was used. For other drugs (heroin, amphetamines and cocaine powder) there were marked variations in route. For all drugs except benzodiazepines, there were regional differences in routes of administration. Heroin injectors were more likely also to use other drugs by injection. Conclusions. The differences in routes of administration of different drugs, and the regional differences in routes of use, have implications for the provision of preventive and treatment services. Interventions to prevent transitions to injecting may be especially appropriate in areas where injecting is not prevalent. Hepatitis B vaccination continues to be advisable in both areas of high and low injecting prevalence. Needle exchange schemes and interventions targeted at drug overdose may be more suitable in areas of high injecting prevalence. Further research into regional differences in routes of drug use should be conducted with non-clinical samples. [ABSTRACT FROM AUTHOR]

This paper reports on the combination of qualitative and quantitative methods which were used to record the attitudes to, and perceptions of, drug treatment services by current, ex-, and potential clients in south-east London. Three research instruments were employed: a structured current client satisfaction survey (n = 333); a questionnaire which included open-ended questions, administered to drug users not currently in treatment (n = 88), and focus groups for young drug users not in treatment (n = 14), women in treatment (n = 7) and men in treatment (n = 11). The data thus collected were used to construct a picture of local met and unmet need and obstacles to the uptake of health care, which is supported by more than one perspective, and which can reasonably be used as the basis for the planning of local health care purchase. Three major concerns were revealed by the data: the inadequacy of existing GP drug services; the deterrent effect of long waiting lists for methadone treatment, and the role of treatment services in relation to those drug users who acknowledge that their drug use is problematic, but believe that treatment services have nothing to offer them.Copyright © 2000 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Concern has been expressed at the widespread prescribing of methadone in view of its inherent toxicity. Commentators have opined that methadone is more toxic than heroin and causes more overdose deaths. However, data deficiencies and flawed analyses leave continuing uncertainty about this crucial policy issue. The relative contributions of heroin, other opiates (e.g. methadone) and non-opiate drugs to overdose and overdose deaths among drug misusers were examined in a community-recruited sample of 312 injecting drug misusers in London. Data were collected on last personal overdose (n=117), last witnessed overdose (n=167) and last witnessed fatal overdose (n=55), and on the different drugs that had been involved with these overdoses. Heroin was involved in 83% of last personal overdoses, 90% of last witnessed overdoses and 80% of last witnessed fatal overdoses, while other opiates were involved in only 18%, 8% and 26%, respectively. Methadone accounted for about half of these "other opiate" overdoses. Overdoses involving a combination of heroin and a non-opiate were common - 29%, 21% and 39%, respectively. Heroin was the drug most frequently involved in overdose across all three areas of study. However, combinations of heroin and a non-opiate were surprisingly frequent, especially in witnessed fatal overdoses (as reported recently by other investigators using different methodologies). Considering the wide extent of methadone prescribing to this group, methadone was remarkably infrequently reported as responsible (solely or in combination) for either personal overdoses, witnessed overdoses or witnessed fatal overdoses. [ABSTRACT FROM AUTHOR]

Presents information on a study which estimated the extent and nature of overdose and factors associated with overdose among injecting drug users in London, England. Characteristics of the study participants; Frequency of non-fatal overdose; Factors associated with non-fatal overdose.

"Chasing the dragon" has spread rapidly as a method of use of heroin in many countries over the last quarter of a century, and is now the most widely used method of heroin use worldwide. However, little examination has been made of the differences in characteristics and drug-taking patterns between heroin chasers and injectors. In this study, a comparison is made of the personal, social and drug-taking characteristics of heroin users in a community sample (i.e., not drawn from treatment services, contacted through a range of non-treatment access routes), according to whether the heroin user was currently a heroin chaser or injector, and according to whether or not they had ever injected. Data were examined on 400 heroin users contacted and interviewed in South London by privileged access interviewers using a structured interview schedule. Severity of dependence was measured using the Severity of Dependence Scale (SDS). Heroin chasing and injecting were almost equally prevalent among this community sample. Of the 400 heroin users, 178 (44.5%) identified "chasing the dragon" as their current route of heroin use, and 222 (55.5%) injecting. Heroin chasers were younger, though they had first used at an older age, had a larger proportion of non-using friends, and contained larger proportions of women and people of Afro-Caribbean origin. Injectors were using higher daily doses and were significantly more likely to be using on a daily basis. Those who had never injected were more likely to be women and to have friends who did not use drugs. Severity of Dependence (SDS) scores were greater amongst injectors, with scores for injectors almost all being above the informal clinical threshold of greater than 5; while one third of the chasers had SDS scores below this level. Heroin chasing had been a longstanding pattern of behavior for a large proportion of the study sample. Chasers were generally less deeply involved in a heroin-using culture and were less likely to be using heroin daily. Almost all low scores for severity of dependence were seen among the chasers, though a significant number of chasers had dependence scores at the most extreme. Heroin chasers display distinctly different personal and drug-taking characteristics and will need to be the subject of separate research studies and clinical programs. (Am J Addict 1999;8:148-160). [ABSTRACT FROM AUTHOR]

Deals with the research conducted by the Drug Dependence Clinical Research and Treatment Unit at Maudsley and Bethlem Royal Hospitals in London, England. Psychological and psychiatric characteristics of addicts admitted to the unit; Approaches to detoxification; Development of clinical and research assessment procedures.

This study looks at the processes whereby individuals with drug problems were referred to a London drug dependence clinic during a seven month period, and at the responses of the clinic to such referrals. One hundred and ninety four cases were referred, mainly from G.P.s. Of the referrals, almost half (44 %) failed to attend the clinic. Most of the people who did attend were opiate addicts. The movement of these people through the various procedures of the clinic is described. There were substantial waiting periods between each stage of treatment, though this was not found to be related to attendance or failure to attend. The results are discussed in terms of problems associated with the referral process and the issue of access to treatment facilities. The results provide basic information about the operation of one clinic but raises several important issues that deserve further empirical investigation. [ABSTRACT FROM AUTHOR]

Presents a study on patterns if drug-taking and sexual behavior among a group of women working as prostitutes in south London, England. Reason for starting as prostitute; Sex for drugs; Sexual practices; regular sexual partners; Heroin and cocaine use; Drug treatment history; Drug use and prostitution; Alcohol use and prostitution.

There has been great concern in recent years about the abuse of cocaine, particularly in its smokable form 'crack'. This paper presents data drawn from 441 patients seen by a South London Community Drug Team between 1987 and 1989. Only four (1%) cited cocaine abuse as the main drug problem. Heroin was the most common main drug. Detailed information was available on 355 of these subjects. During the study period 63 patients reported using cocaine and the proportion of subjects using cocaine increased from 13% to 29%. Within the sub-group of cocaine users, there was a marked increase in the use of smokable forms of cocaine from 15% in 1987 to 75% in 1989. In view of the increased dependence risk associated with smoking cocaine, this is seen as an ominous development. [ABSTRACT FROM AUTHOR]

Background: This study investigates patterns of qat use among 207 Somalis living in London.Method: Subjects were recruited using privileged access interviewing. Somalian interviewers were recruited who shared the same culture as the subjects. Data were collected by means of a structured interview.Results: One hundred and sixty-two subjects (78%) had used qat. The majority (76%) used more qat than in Somalia. Some users reported moderate dependence; a minority reported severe problems. Adverse psychological effects included sleep problems, anxiety and depression. Medical problems associated with qat use were rare.Conclusions: Qat users who continue to use this drug when it is transplanted from a traditional context may experience difficulties. Qat use can also be seen as playing a positive role in supporting the cultural identity of the Somalian community. Severe problems were rarely reported. Qat consumption should be considered when addressing health-related topics with patients from those communities in which qat use is common. [ABSTRACT FROM AUTHOR]

We contacted and interviewed 150 cocaine users in south London community settings. Most were taking cocaine regularly, but not daily, and in substantial doses. Three main routes of administration were used: smoking (40%), intranasal (32%), and injecting (24%). Injectors reported having used cocaine more frequently, in higher doses and for longer periods of time. Despite their frequent and extensive use of cocaine, the overall level of dependence was low for the great majority of the sample. Two-thirds (66%) of the full sample (and two-thirds (65%) of the crack smokers) reported only minor signs of dependence during the year prior to interview. Route of drug administration was related to severity of dependence. Cocaine taken by injection was associated with the highest levels of dependence; intranasal use was associated with the lowest levels, and crack smoking was intermediate between the two. There had been substantial changes in the initial route by which cocaine was used, with a clear trend away from injection on the first occasion of use. Those who first used cocaine before 1986 were more likely to have used the drug either intranasally or by injection. Cocaine users who first tried the drug after 1987 were increasingly likely to take it by smoking crack. Women and black (predominantly Afro-Caribbean) subjects were more evident in this sample of cocaine users than has previously been reported in many UK studies. [ABSTRACT FROM AUTHOR]

This study investigates sex differences in patterns of drug taking and related injecting and sexual behaviour among 355 patients attending a London community drug team. The majority of cases attending the service presented with heroin problems. Men were more likely to use heroin by injection and women were more likely to use heroin by inhaling/smoking ('chasing the dragon'); there was no sex difference in the overall incidence of needle sharing. The delay between first use of the problem drug and first presentation to services was the same for both men and women. Women were more likely to have a sexual partner who was a drug user and to be living with another user than men. This closer social attachment to other drug users was seen as presenting a high risk factor for women with regard to prognosis and treatment. [ABSTRACT FROM AUTHOR]

Relapse is a central problem in the treatment of addictive behaviour, and a specific problem in the out-patient treatment of the opiate withdrawal syndrome. This study investigated factors associated with relapse among 42 opiate addicts receiving out-patient detoxification treatment at a London drug-dependence clinic. All subjects completed a questionnaire about their social, psychological, and environmental circumstances in the week before interview, and were interviewed within the first two weeks of the programme. Forty per cent had lapsed to illicit heroin abuse within the previous week. Interpersonal factors and drug-related cues were associated with lapse to opiate use. Most subjects encountered a range of high-risk situations, such as regularly meeting other drug users and being offered drugs, and persistent negative mood states. [ABSTRACT FROM AUTHOR]

This paper presents data from the first British prospective study to investigate relapse among opiate addicts after treatment. Eighty subjects were followed up over the six-month period immediately after discharge from treatment and were interviewed on several occasions. Large numbers of subjects used opiates within a very short time after discharge; 71% used them within the first six weeks. However, this first lapse to opiate use did not herald a full-blown relapse to dependent use. There was a gradual increase in the number of abstinent subjects, with 45% abstinent and living in the community at the six-month point. The practical and theoretical implications may be regarded as broadly encouraging. [ABSTRACT FROM AUTHOR]

In a study of male addicts attending a London drug dependence unit, it was found that convicted addicts tended to score more highly on measures of hostility than non-convicted subjects. The differences in hostility between the convicted and non-convicted groups were most clearly seen on the violent crimes variable, although addicts convicted of drug-possession and of non-drug crimes were also more hostile than non-convicted subjects. It is suggested that hostility acts as a personality factor which predisposes the individual towards criminal behaviour, and that the more hostile subjects may also be more likely to be apprehended and convicted. [ABSTRACT FROM AUTHOR]

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.

Introduction and Aims: The effect of heroin administration route on speed of transition to regular use is unknown. This paper aims to determine whether the speed of transition from initiation of heroin use to daily heroin use differs by route of administration (injecting, chasing/inhaling or snorting).Design and Methods: Privileged access interviewer survey of purposively selected sample of 395 current people who use heroin (both in and not in treatment) in London, UK (historical sample from 1991). Data on age and year of initiation, time from initiation to daily use and routes of administration were collected by means of a structured questionnaire. Generalised ordered logistic models were used to test the relationship between route of initial administration of heroin and speed of transition to daily heroin use. Analyses were adjusted for gender, ethnicity, daily use of other drug(s) at time of initiation, year of initiation and treatment status at interview.Results: After adjustment, participants whose initial administration route was injecting had a 4.71 (95% confidence interval 1.34-16.5) increase in likelihood of progressing to daily use within 1-3 weeks of initiation, compared to those whose initial administration route was non-injecting.Discussion and Conclusions: The speed of transition from first use to daily heroin use is faster if the individual injects heroin at initiation of use. Those who initiate heroin use through injecting have a shorter time frame for intervention before drug use escalation. [Hines LA, Lynskey M, Morley KI, Griffiths P, Gossop M, Powis B, Strang J. The relationship between initial route of heroin administration and speed of transition to daily heroin use. Drug Alcohol Rev 2017;00:000-000]. [ABSTRACT FROM AUTHOR]

Compares effectiveness between inpatient and outpatient withdrawal programs for opiate addicts in London, England. Likelihood of inpatient addicts to achieve complete withdrawal; Implication of study for treatment of opiate addicts; Effect of psychological and social condition on withdrawal effectiveness.

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.

Aim: To investigate the persistence of use of heroin, cocaine and amphetamine drugs during imprisonment, and to identify factors associated with increased levels of persistence., Design: The use of heroin, cocaine and amphetamine by current prison inmates has been examined and, in particular, the relationship between drug use within prison and the type of drug used prior to imprisonment, recency of use and severity of dependence., Setting and Participants: A randomly selected sample of 1009 adult male prisoners in 13 prisons in England and Wales during 1994/95; structured confidential interviews conducted by independent research staff. Enquiry about prior use of heroin, cocaine or amphetamine focused on three time-periods (ever, last year and last month pre-prison) and the use of these drugs during the first month of imprisonment., Findings: A total of 557 (55%) of the 1009 prisoners had used previously one of the three drugs selected for study: 58% had used heroin, 69% cocaine and 75% amphetamine. More than half (59%; 327/557) had used these drugs in the month before the current imprisonment. Drug use in prisons was most likely to occur among those who had used in the month prior to imprisonment. The persistence of heroin use in prison occurred more frequently (70%) than use of cocaine (20%) or amphetamine (15%). Of those using heroin pre-imprisonment, 67% considered they were dependent, compared to 15% and 22%, respectively, for cocaine and amphetamine users., Conclusions: Changes in the drug-taking behaviour of drug users after imprisonment vary according to the type of drug being taken. Prisoners were much more likely to continue to use heroin than either cocaine or amphetamines while in prison. Heroin was most likely to be used by those who had been using heroin during the immediate pre-imprisonment period, and particularly by the two-thirds of heroin users who considered themselves dependent. In view of the high prevalence of prior use of these drugs by individuals currently imprisoned, continuing attention is required to study of their behaviour and of the impact of interventions that may be introduced during or following their incarceration.

Changes in criminal convictions were investigated among 1075 clients admitted to 54 drug misuse treatment services across England as part of the National Treatment Outcome Research Study (NTORS). Convictions data during the year prior to treatment, and at 1 year, 2 years, and 5 years after treatment intake were collected from the Home Office Offenders' Index, a national database of all convictions in adult and youth courts. Clinical data were collected by face-to-face interviews at intake to treatment, and at follow-up 1 year, 2 years, and 4-5 years after admission to treatment. During the year prior to treatment, 34% of the sample had been convicted of at least one offence. Conviction rates at all follow-up points were significantly lower than at intake. During the year prior to the 5-year follow-up, 18% of the sample had been convicted of at least one offence. Statistically significant reductions in the mean number of convicted offences were also found between treatment intake and 5-year follow-up. Reductions in convictions were found for acquisitive, drug selling, and violent crimes. Reductions in crime were associated with reductions in regular heroin use, age, and with stable housing. The results replicate previously reported findings of crime reductions among the NTORS cohort as indicated by self-reported measures of offending behaviour. The observed reductions in crime among drug misusers after treatment represent substantial changes in behaviour and have considerable personal, social and clinical significance. Reduced criminality also provides substantial economic benefits to society.

Aims: Some economic costs and consequences of drug misuse and treatment were investigated among clients recruited to the National Treatment Outcome Research Study (NTORS)., Design: This was a longitudinal prospective cohort design comprising 549 clients recruited from 54 residential and community treatment programmes: data were collected from interviews conducted at treatment intake, at 1 year and at 2-year follow-ups., Measurements: Treatment costs included index and other drug treatments. Costs were estimated for use of health and social care services, criminal activity and the use of criminal justice resources. Costs were based upon self-reported data collected by structured face-to-face interviews combined with unit cost estimates taken from a variety of sources., Findings: Addiction treatment was costed at pound 2.9 million in the 2 years prior to index treatment, and a further pound 4.4 million in the subsequent 2 years. Economic benefits were largely accounted for by reduced crime and victim costs of crime. Crime costs fell by pound 16.1 million during the first year, and by pound 11.3 million during the second year. Health-care costs were relatively small but approximately doubled during the course of the study. The ratio of consequences to net treatment investment varied from 18 : 1 to 9.5 : 1, depending on assumptions. This is likely to be a conservative estimate of the benefit-cost ratio because many potential benefits were not estimated., Conclusions: The data showed clear economic benefits to treating drug misusers in England.

Aims: The National Treatment Outcome Research Study (NTORS) is the first prospective national study of treatment outcome among drug misusers in the United Kingdom. NTORS investigates outcomes for drug misusers treated in existing services in residential and community settings., Design, Setting and Participants: The study used a longitudinal, prospective cohort design. Data were collected by structured interviews at intake to treatment, 1 year, 2 years and at 4-5 years. The sample comprised 418 patients from 54 agencies and four treatment modalities., Measurements: Measures were taken of illicit drug use, injecting and sharing injecting equipment, alcohol use, psychological health and crime., Findings: Rates of abstinence from illicit drugs increased after treatment among patients from both residential and community (methadone) programmes. Reductions were found for frequency of use of heroin, non-prescribed methadone, benzodiazepines, injecting and sharing of injecting equipment. For most variables, reductions were evident at 1 year with outcomes remaining at about the 1 year level or with further reductions. Crack cocaine and alcohol outcomes at 4-5 years were not significantly different from intake., Conclusions: Substantial reductions across a range of problem behaviours were found 4-5 years after patients were admitted to national treatment programmes delivered under day-to-day conditions. The less satisfactory outcomes for heavy drinking and use of crack cocaine suggest the need for services to be modified to tackle these problems more effectively. Despite differences between the United Kingdom and the United States in patient populations and in treatment programmes, there are many similarities between the two countries in outcomes from large-scale, multi-site studies.

Crack cocaine outcomes at 4-5 years are reported for 496 drug users recruited from UK treatment programmes. About one-third used crack at intake and at 4-5 years. The results show different outcome profiles. For crack users at intake, use was more than halved at follow-up. Among non-crack-users at intake, about a quarter used crack during follow-up, of whom about two-thirds had never used crack before. Polydrug use and use of other stimulants were associated with using crack. Crack users reported worse acquisitive crime and psychological health outcomes. About 10% reported injecting crack. The reductions in crack use are encouraging, but the onset of crack use among many non-users at intake suggests the need to develop more effective treatment interventions.