Responding flexibly but not gullibly to drug addiction.
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Biomedical subjects
Publications and source records attributed to J Strang.
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The disposition and kinetics of paracetamol, dextropropoxyphene and their metabolites were investigated in an addict who claimed to be taking 80-100 Distalgesic tablets daily regularly. Plasma concentrations of paracetamol, dextropropoxyphene and their principal metabolites were measured after an oral dose of 15 Distalgesic tablets. The absorption of paracetamol and dextropropoxyphene was rapid with peak plasma concentrations at 15 and 30 min respectively. The elimination half-life for paracetamol was 2.3 h. Nordextropropoxyphene remained at steady state with very high plasma concentrations (5 mg/l). The urinary excretion of paracetamol and metabolites was not abnormal. The total recovery of paracetamol was only 31% of the dose. Apart from raised plasma gamma-glutamyltransferase activity there was no biochemical evidence for paracetamol-induced hepatocellular damage despite ingestion of 97.5 g of paracetamol over the 11 days of the withdrawal period.
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A study of the workload of trainers and their trainees in general practice, was undertaken throughout East Anglia. Thirty trainer/trainee pairs returned data over a two-week period and follow-up information was obtained from five pairs, eight months later. A simple encounter form was used.Trainee workloads were found to be similar to those of earlier studies, though there was considerable variation between the workloads. Trainees had little experience with elderly patients, and there was a lack of teamwork between members of the practices in providing care for the elderly.
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A group of 24 opiate addicts admitted to an in-patient drug dependence unit received either electrostimulation or graduated oral methadone withdrawal. Addicts treated with electrostimulation showed high levels of withdrawal symptoms during the first week of treatment: these reached a peak on Day 3. In this respect electrostimulation was markedly inferior to methadone withdrawal treatment. However, although progressive methadone withdrawal quickly reduced symptoms to a moderate or low level, there was no reduction in symptomatology as late as one month after admission (i.e. after ten days without methadone). The implications of these findings are discussed.
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On an inpatient drug dependency unit, the nursing role was recently extended to include structured individual interviews. Each new patient was allocated to a particular nurse. The success of the scheme is discussed and some of the difficulties encountered are described. A new framework, the Friend role and the Therapist role, is outlined and some benefits of the use of this framework are detailed.
A case of procyclidine abuse is described in which the clinical presentation was indistinguishable from mania. The patient was a long-standing poly-drug abuser and was obtaining the drugs from medical sources. Controlled exposure on the ward to drugs of abuse, including a double-blind comparison with placebo, confirmed that procyclidine caused a manic response in this patient.
Addicts who use illicit drugs despite receiving a maintenance prescription present a difficult management problem for drug dependence clinics. This study looks at a small group of such addicts and at their response to the provision of a temporary increase in their prescribed opiates. The results indicate that this increase led to a reduction in illicit drug use and to improvements in social functioning. These and other findings are discussed. It is suggested that clinics should be more prepared to consider such temporary increases, but the need for careful monitoring and for the involvement of more than one member of the treatment team is stressed.