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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
PubMed2000

Peer-initiated overdose resuscitation: fellow drug users could be mobilised to implement resuscitation.

Research interviews about overdose experiences were conducted with 115 patients attending a methadone maintenance clinic in south London, UK. While almost half (49.6%) reported having experienced overdose personally (on an average of four occasions each), almost all (97.4%) reported that they had witnessed overdoses (on an average of six occasions each). This represents a total of 706 overdoses witnessed, of which 106 had resulted in fatalities. The vast majority of patients (86/97) reported that they had taken actions when they had witnessed overdoses with those acting taking an average of nearly threee different actions on the last occasion on which they had seen someone overdosing. Most respondents reported that they would be willing to act, even if they did not know the overdose victim personally and that they had not been deterred from acting by the previous response from the emergency services. Fear of punishment was not a strong deterrent from acting certainly not for this sample, with many participants also expressing an interest in expanding their repertoire of overdose interventions, for example through training in resuscitation techniques and by keeping naloxone at home for use in overdose emergency.

Journal Article↗
PubMed2000

Drinking and smoking as concurrent predictors of illicit drug use and positive drug attitudes in adolescents.

The study investigates the relationship between smoking and drinking, and the use of illicit drugs in a cohort of London adolescents. A high prevalence of drug experimentation and positive attitudes to illicit drug use were characteristic of those who both drank alcohol and smoked cigarettes on a regular basis. There was then a clear hierarchy in which lower prevalence of use and more negative attitudes marked those who only smoked, then those who only drank, while non-smokers and non-drinkers (the largest group) had lowest lifetime and recent drug use prevalence and the most negative attitudes about drug use.

Adolescent↗
PubMed2000

Naltrexone and lofexidine combination treatment compared with conventional lofexidine treatment for in-patient opiate detoxification.

This study compares a naltrexone/lofexidine combination treatment with a 7-day course of lofexidine alone in the treatment of opiate withdrawal in 22 opiate-dependent patients. Withdrawal symptoms were significantly less severe on days 4-7, and 9-13, in the naltrexone/lofexidine combination group. There were no significant differences in the percentage of patients completing detoxification or in the mean length of stay for the two groups. Both treatments had similar, minimal effects on blood pressure. The naltrexone/lofexidine combination was associated with a more rapid resolution of the opiate withdrawal syndrome than a 7-day lofexidine-only treatment schedule, without substantial increases in withdrawal symptoms or hypotensive side-effects.

Adult↗
PubMed2000

Illicit drugs and driving: prevalence, beliefs and accident involvement among a cohort of current out-of-treatment drug users.

Drug-driving behaviour among out-of-treatment dependent drug users has not been investigated while a theoretical perspective on the propensity of certain drug users to drive while impaired has not been suggested. This paper examines illicit drugs and driving behaviour and accident involvement among out-of-treatment current drug users. Psychological evidence of belief-based mechanisms to account for the decision to drive while impaired by drugs are provided. A total of 210 out-of-treatment current drug users were interviewed in a non-clinical setting by privileged access interviewers. Questionnaire measures were: current illicit drug use, severity of dependence, illicit drugs and driving behaviour, impaired and unimpaired accident involvement and beliefs and perceptions about the impairing effects of a number of illicit drugs. Analyses are restricted to participants who reported driving during the previous 12 months (n = 71). Fifty-eight participants (81.7%) reported driving immediately after consuming illicit drugs, primarily heroin and cannabis. Of these 41.4% (n = 24) had at least one road accident as a driver, 15 of whom (62.4%) reported accident involvement following recent drug consumption. Belief-based results showed that participants who reported never driving after using illicit drugs perceived heroin, methadone and alcohol to be greater significance for accident risk and driving skills impairment than other drugs. Those drivers who reported drugs and driving behaviour believed only alcohol to be significantly more impairing than other drugs. Findings indicated that illicit drugs and driving behaviour is common among out-of-treatment drug users. Accident involvement among this cohort is characterised by the previous consumption of illicit substances. Differential beliefs about the effects of drugs on driving performance and accident risk were shown to be dependent upon frequency of drugs and driving behaviour. Results are discussed in terms of experiential factors and consistency theories of attitude formation and change.

Accidents, Traffic↗
PubMed2000

National survey of hepatitis testing and vaccination services provided by drug services in England and Wales.

Since viral hepatitis among intravenous drug users continues to be a major cause of morbidity and mortality, the present study was conducted to survey drug agencies in England and Wales in order to identify the prevalence of hepatitis B and C testing and vaccination being provided. A postal survey of all 539 drug agencies in England and Wales was thus conducted to assess their current treatment provisions and practices. An analysis of the responses provided by the 373 agencies that returned usable data (69.2% response rate) revealed that only one-quarter (26.6%) of the drug agencies conducted routine hepatitis B testing, and 26.9% did not offer it at all. Just over half (55.7%) of the agencies provided hepatitis B vaccination, but only 21.7% did so routinely. Seventy percent provided hepatitis C testing, but only 24% did so routinely. Nevertheless, the majority of respondents, of whom 40.3% were nurses and 25.1% drug workers, believed that clients and their partners should be offered hepatitis B and C screening. The paucity of hepatitis testing and vaccination services being offered to injecting drug users is unacceptable, with users, their partners and children being needlessly exposed to continued risk. The disparity between recommended policy and current practice needs to be urgently addressed.

Delivery of Health Care↗
PubMed2000

Pharmacy-based needle exchange (PBNX) schemes in south east England: a survey of service providers.

AIMS: To describe the activities of service providers with regard to (i) the business operation and policies defining pharmacy-based needle exchange (PBNX) in South East England; (ii) the day-to-day work of PBNX outlets from the provider perspective; and (iii) problems encountered by PBNX providers. DESIGN: (i) Postal self-completion questionnaire to all participating PBNX community pharmacies in South East England; and (ii) postal self-completion questionnaire to needle exchange coordinators. SETTING: Community pharmacy needle exchanges. PARTICIPANTS: Pharmacists in charge of needle exchange; and needle exchange coordinators. FINDINGS: Data were collected (i) from 381/440 (86.7%) participating community pharmacists, and (ii) 32/36 (88.9%) of coordinators. The study found that PBNX was reaching injecting drug users (many of whom used PBNX regularly), and providing a wide range of injecting equipment. Although pharmacists reported that problems such as shoplifting occurred relatively frequently, more serious problems such as violence were relatively rare. However, PBNX pharmacists reported needing further training for themselves and their staff. Suggested improvements included better advertising of services and improving returns rates for used injecting equipment. CONCLUSION: Needle exchange can reasonably be provided by non-specialist health care professionals such as community pharmacists. However, attention should to be paid to the educational needs of service providers who also require adequate support.

Education, Pharmacy↗
PubMed2000

Randomized trial of supervised injectable versus oral methadone maintenance: report of feasibility and 6-month outcome.

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.

Administration, Oral↗
PubMed2000

Diversion of prescribed drugs by drug users in treatment: analysis of the UK market and new data from London.

AIMS: To review the available knowledge about the diversion to the illicit market of drugs prescribed to drug users in treatment in the United Kingdom, and to identify aspects of the London market in more detail. METHOD: An analysis of the literature and new data in terms of the extent and nature of the market, the practicalities of trade, motives for selling, reasons for demand and the influence of variations in prescribing practice on diversion. Prices of diverted prescription drugs and details of their availability in London are presented. FINDINGS: The size of the market is substantial and appears to involve a large number of individuals, each diverting small amounts of their own prescribed drugs. Major motives for selling prescribed drugs are to raise funds to buy other, preferred, drugs and/or to pay for a private prescription. Buyers in treatment appear to be motivated by a desire to supplement their own prescriptions because they are dissatisfied with the particular drug prescribed, dosage and formulation. Drug users in treatment can exploit the variations in prescribing practice--such as how much 'take-home' medication they are allowed and whether tests are conducted to ascertain if they are using it themselves--and divert their prescribed drugs. Prices of prescription drugs on the illicit market can fluctuate on a daily basis according to supply and demand. CONCLUSIONS: The results suggest that, to be effective, diversion control must simultaneously involve deterrents from prescribers, drug treatment services, law enforcement agencies and dispensing pharmacists. Finally, some suggestions for further research on this under-studied issue are suggested.

Benzodiazepines↗
PubMed2000

Measuring met and unmet need of drug misusers: integration of quantitative and qualitative data.

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.

Adult↗
PubMed2000

Variation between and within drug treatment modalities: data from the National Treatment Outcome Research Study (UK).

This paper describes treatment practices in 54 drug treatment programmes taking part in the National Treatment Outcome Research Study (NTORS). Programmes were representative of the 4 main treatment modalities in the UK: in-patient, residential rehabilitation, methadone maintenance and methadone reduction. Distinguishing features of these forms of treatment were identified. Substantial variations in treatment practices were also observed within each modality, particularly for detoxification and prescribing arrangements, counselling and non-drug treatment services, and planned duration of treatment. Many programmes reported extensive waiting lists. These findings are discussed in the context of the growing international evidence of the association between patient outcome and the manner in which programme services are delivered.

Ambulatory Care↗
PubMed2000

Pathways to abstinence: two-year follow-up data on 60 abstinent former opiate addicts who had been turned away from treatment.

Structural changes in the organization of drug treatment services in the northwest of England during the early 80s provided a unique opportunity to study a group of opiate addicts who were turned away from treatment. This paper reports on 60 opiate addicts who were abstinent at follow-up (2-3 years after their original referral). For the majority of subjects, any treatment received in the intervening period had been from a range of local, non-specialist treatment providers, including: general practices (n = 24) and local hospitals (n = 32). The subjects had also received assistance from non-statutory agencies (n = 35). Informal sources of support were drawn upon in the form of friends, family, and voluntary agencies. Social acceptance, legal problems, financial difficulties, and imprisonment were frequently cited as motivational factors that led to abstinence. At follow-up, improvements were reported in personal relationships and family circumstances, although there was less progress in relation to employment, finances, and housing. Increased involvement with the criminal justice system was significantly associated with a greater use of treatment services at follow-up. This paper presents the treatment and non-treatment pathways that led to abstinence amongst this group of opiate addicts. It also points to the importance of including non-treatment samples in evaluations of treatment interventions.

Adolescent↗
PubMed2000

Price, cost and value of opiate detoxification treatments. Reanalysis of data from two randomised trials.

BACKGROUND: Treatments in different settings have different costs. A dilemma arises if expensive treatments lead to better outcomes. AIMS: To investigate conflicts between the priorities of cost minimisation, clinical effectiveness, and cost-effectiveness in the detoxification of opiate addicts. METHOD: Cost and clinical effectiveness were examined using published outcome data. The main outcome measures were: achieving a drug-free state on completion of detoxification; the economic costs of treatment. RESULTS: In terms of simple cost, in-patient detoxification is much more expensive than out-patient treatment (ratio, 24:1). With adjustment for successful outcome, the costs are almost identical (ratio, 0.9:1). Comparison of specialist and general psychiatry in-patient settings showed that even when adjusted for clinical outcomes, the specialist setting is more costly (ratio, 1.9:1), although the outcomes are better. CONCLUSIONS: Naïve adherence to cost and cost-containment considerations is dangerous. Discussion of treatment costs is misleading if not informed by, and adjusted for, evidence of effectiveness. This is especially important where marked differences in outcome between treatment options exist.

Ambulatory Care↗