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Biomedical subjects

J Strang

Publications and source records attributed to J Strang.

At least 37 records · Page 2Linked to original sources
PubMed1992

The study of transitions in the route of drug use: the route from one route to another.

Route of administration of various drugs is an area of study to which specific attention must be paid in study of different HIV risks of drug use by various routes. If changes in route are seen in individuals or within populations, then study of these transitions in route may identify new approaches which could be developed in HIV prevention. The consideration in this paper is based around ten questions: (i) What is a transition? (ii) Do routes of administration vary by time and place? (iii) Is choice of route influenced by availability of drug paraphernalia? (iv) How does the context influence initial choice of administration, and possible subsequent transitions? (v) Are lapse and relapse meaningful concepts? (vi) Transitions: how much of it is going on? (vii) How much does change of route (with the same drug) signify a change of drug effect, its significance, or its relationship with other risk behaviour? (viii) Is change of route of use of one drug always accompanied by the same change of route of other drugs? (ix) Injectors/non-injectors and sharers/non-sharers: do these behavioural characteristics exist as categories or are they distributed along a continuum? (x) Are transitions reversible? This paper is accompanied by two research reports which describe explorations into the extent and nature of transitions amongst heroin users.

Cocaine↗
PubMed1992

Extent and nature of transitions of route among heroin addicts in treatment--preliminary data from the Drug Transitions Study.

Preliminary data are presented here from a study of drug transitions in the UK. These support the contention that differences in route of administration are likely to be reflected in differing patterns of drug use, and associated with differing health risks for the individual drug user. Heroin 'chasers' were found to have robust and long-term patterns of heroin use and could not merely be considered as pre-injectors. They were also younger. No differences were found in the typical daily doses prior to entering treatment between chasers and injectors. Subjects who usually 'chased the dragon' but who would also inject were less likely to have shared injecting equipment in the past. Transitions between different routes of use were found in most directions. However, changes from 'chasing' to injection were most common. Year of initiation into heroin use was also related to initial route of use.

Drug Administration Routes↗
PubMed1992

Establishment of a liaison service for pregnant opiate-dependent women.

A pregnancy liaison and outreach service was developed as part of a community drug team to attract pregnant drug-dependent women into treatment. Women were provided with information on harm reduction, safer drug use and offered treatment for drug dependence. In total, 43 women (45 pregnancies) presented to the service over a 30-month period. Thirty-four women began out-patient treatment of opiate dependence. There was a significant reduction in maternal methadone dose by delivery. Of the 45 pregnancies, four women had therapeutic abortions, two first trimester and two second trimester spontaneous abortions and 34 live births (three women remained untraceable). All the pregnancies that continued to the third trimester proceeded uneventfully with a consequent live birth. Mean gestational age was 37.9 +/- 3.7 weeks, mean birth weight was 2863 +/- 526 g, 10 of the babies were small for gestational age. Fifteen babies required medication for neonatal withdrawal symptoms; mothers whose babies exhibited withdrawal symptoms were using significantly higher doses of methadone at delivery than mothers whose babies did not withdraw. The importance of providing this type of service for women drug users in the 1990s is discussed.

Adolescent↗
PubMed1992

Severity of dependence and route of administration of heroin, cocaine and amphetamines.

This study investigates severity of dependence upon heroin, cocaine and amphetamines in a group of 200 heroin users, 75% of whom were not in contact with any treatment agency. For drug takers who were current users of more than one drug, heroin produced more severe dependence than either cocaine or amphetamine and many users of these stimulant drugs reported having experienced no problems of dependence. Severity of dependence was influenced by route of administration as well as type of drug. Heroin taken by injection was associated with more severe dependence than smoked heroin. For cocaine, injection and smoking were associated with equivalent dependence ratings, and both of these routes were associated with more severe dependence than cocaine used intranasally. For amphetamine, there were no differences in severity of dependence ratings for injection, intranasal or oral use. Severity of dependence was correlated with dose and duration of drug use; it was also associated with previous attendance at a drug treatment agency, though dependence problems were also common among heroin users who had never received treatment. Implications of these findings are discussed.

Adult↗
PubMed1992

The community drug team.

The creation of a network of nearly 100 community drug teams (CDTs) across the UK stands as the most significant expansion to occur within drug services during the 1980s. Key characteristics include the narrowly defined geographical focus, the community emphasis, the multi-disciplinary composition and the promotion of generic contribution through 'consultancy'--as with Community Alcohol Teams. Subsequent adaptations have extended from the base of the CDT with outreach strategies and harm-minimization techniques. However, the extent of collaboration from generic colleagues (especially general practitioners) has been initially poor and is only slowly improving. An unplanned abandonment of the original consultancy role for the CDT is widely evident, as CDT workers have become more actively involved in the delivery of care--either directly or on a 'shared care' basis. It is proposed that separate consideration should be given to short- and long-term development strategies, including re-examination of the target populations, staffing composition, and methods of work through consultancy and/or direct provision of care.

Community Mental Health Centers↗
PubMed1992

The Fifth Thomas James Okey Memorial Lecture: research and practice: the necessary symbiosis.

What relationship should exist between research and practice in the field of addictive behaviour? Are the perspectives essentially independent, or is there a necessary interaction? The extent of productive interaction is considered in three examples; (i) detoxification, (ii) stable abstinence, and (iii) goals other than abstinence. Changes are occurring in the drugs being used, the extents and types of associated co-morbidity, the levels of public and professional concern, and the explanatory paradigms which are dominant; and so it will be increasingly important for both practitioners and researchers to be sensitive and reactive to these changing circumstances. The most productive state for both research and practice will exist when they both feed off, and feed into each other--when there is indeed a necessary symbiosis.

Combined Modality Therapy↗
PubMed1992

Factors associated with relapse among opiate addicts in an out-patient detoxification programme.

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.

Adult↗
PubMed1991

Liposomal amphotericin B (AmBisome) in the treatment of fungal infections in neutropenic patients.

The use of high-dose chemotherapy and the subsequent prolonged neutropenia in patients with haematological diseases has resulted in an increased incidence of fungal infections. The diagnosis and treatment of these infections in neutropenic patients pose major therapeutic problems. The only drug with proven efficacy in the treatment of deep-seated fungal infections, including invasive aspergillosis, is amphotericin B. Unfortunately, this drug has adverse side effects, most importantly dose-dependent nephrotoxicity; furthermore, some patients fail to show a response to amphotericin B. We have treated 20 patients undergoing myeloablative chemotherapy and/or bone marrow transplantation for haematological diseases with liposomal amphotericin (AmBisome) for proven or suspected aspergillosis. Eighteen patients had diffuse interstitial pneumonitis and two patients had suspected fungal liver abscesses. Five patients had mycologically proven fungal infection and of these, three patients (60%) showed a complete response to liposomal amphotericin. Eleven patients received liposomal amphotericin because of the failure of conventional amphotericin B to eradicate proven or suspected fungal infection. Five of these 11 patients (45%) showed a complete clinical response to liposomal amphotericin. Eight patients received liposomal amphotericin because of pre-existing renal impairment or nephrotoxicity caused by conventional amphotericin B. Four of these patients (50%) showed a response to liposomal amphotericin. Recovery from probable fungal infection in this group of patients occurred when there was complete remission of underlying disease and recovery of neutrophil counts, when they were concurrently treated with liposomal amphotericin.

Adolescent↗
PubMed1991

Should opiate addicts be involved in controlling their own detoxification? A comparison of fixed versus negotiable schedules.

This study compares the responses of opiate addicts at a London drug treatment centre to two outpatient methadone-based detoxification programmes. These involved either a fixed (non-negotiable) dose reduction schedule or a flexible, negotiable withdrawal schedule. In the negotiable condition, subjects were less likely to complete the detoxification programme and the mean reduction in dose achieved by the subjects in the negotiable condition was less than that in the fixed group. There was no difference between groups in programme retention at 6 weeks though subjects who remained in treatment in the negotiable group tended to extend their detoxification period beyond this point. The overall response of subjects in both groups was unsatisfactory. Only 13% of the subjects initially allocated to detoxification or 28% of those who actually started detoxification completed treatment; urine screening showed that heroin abuse was a continuing problem during treatment. The implications of these results for detoxification and drug treatment services are discussed.

Adult↗
PubMed1991

A comparison of the withdrawal responses of heroin and methadone addicts during detoxification.

This study compares the withdrawal responses of methadone and heroin addicts during a ten-day in-patient detoxification programme with methadone. Contrary to suggestions in the literature, the methadone group reported more severe withdrawal symptoms during both the acute withdrawal phase and the recovery phase. There were no differences between the two groups in onset or duration of symptoms. Whereas there may be reasons to favour methadone as a maintenance drug, its use may lead to difficulties during withdrawal.

Adult↗
PubMed1991

Self-detoxification by opiate addicts. A preliminary investigation.

A study of 50 opiate addicts attending a London service for treatment of drug dependence found that 47 subjects had previously made at least one attempt at self-detoxification. These subjects reported 212 previous attempts. Although 30 subjects reported having managed to complete at least one attempt, the success rate per episode was low (24%). One of the most commonly reported methods, used by 28 subjects, involved an abrupt cessation of opiates ('cold turkey'). Of the drugs used in their attempts at self-detoxification, benzodiazepines were reported by 24 subjects and opiates by 20. Practical strategies such as distraction and avoidance were also used. Self-help detoxification materials for opiate addicts might be useful.

Adult↗