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Biomedical subjects

J Strang

Publications and source records attributed to J Strang.

At least 109 records · Page 6Linked to original sources
PubMed1994

Sex differences in patterns of drug taking behaviour. A study at a London community drug team.

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.

Adult↗
PubMed1994

Cocaine: patterns of use, route of administration, and severity of dependence.

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.

Adolescent↗
PubMed1994

A ratio estimation method for determining the prevalence of cocaine use.

This paper presents an approach to estimating the prevalence of cocaine use, based upon a new ratio estimation technique. This method can be applied to random samples of overlapping populations for which no sampling frames exist. When the ratio estimation method is applied to the two study samples (drawn from populations of people using cocaine and people using heroin) the ratio of cocaine users to heroin users (C/H) was 1.55, with a 95% confidence interval of +/- 0.48. Such estimates should be applied with caution. However, if used with reference to national estimates of about 75,000 heroin users, application of the present estimate suggests that there may be about 116,000 cocaine users in the UK.

Adult↗
PubMed1993

Severity of heroin dependence and HIV risk. I. Sexual behaviour.

The HIV risks associated with the sexual behaviour of drug injectors have sometimes been overshadowed by the more obvious risks of injection behaviour. In this study, 408 heroin users were interviewed in the community; 50% were not currently in treatment and 42% had never had any treatment contact. In addition to data on drug use, information was collected on sexual risk behaviour by means of a linked anonymous questionnaire (96% returned). Eighty-nine per cent of the sample had had at least one sexual partner in the previous year and 58% had a regular sexual partner at the time of interview. Drug users who had a sexual partner who was injecting drugs were more severely dependent upon heroin. Twenty-three per cent of the men and 20% of the women reported having had anal intercourse in the previous year. Seventeen per cent of the women and 6% of the men had engaged in some form of prostitution. Severity of heroin dependence was positively related to the occurrence and to the frequency of sex-for-money transactions and to the less well recognized phenomenon of sex-for-drugs; this association with severity of dependence applied to the women and to the men who have sex with men. The overall level of condom use was low in this sample, though condom use was more frequent among those involved in sex-for-money or sex-for-drugs transactions. Low levels of condom use were reported even for such high risk activities as anal sex.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Severity of heroin dependence and HIV risk. II. Sharing injecting equipment.

One of the most conspicuous risks of HIV transmission among drug injectors involves sharing injecting equipment which has been contaminated by infected blood. The present study investigates the relationship between severity of dependence upon heroin and the sharing of previously used injecting equipment (passive sharing). Four-hundred-and-eight heroin users were contacted and interviewed. Two-hundred-and-eighty-one (69% of the total heroin sample) had injected drugs on at least one occasion, and 204 of the 281 injectors (73%) had shared injecting equipment on at least one occasion after it had been used by someone else. The more severely dependent heroin injectors were more likely to have shared injecting equipment. As users become more dependent upon heroin, the types of factors which predispose them towards sharing may change. Less dependent users were more likely to use in public and 'social' settings, and they may be more likely to share injecting equipment with people they do not know well. The more dependent users appear to use heroin in private settings and to be at greater risk of sharing with dealers, perhaps because of the urgency of their need for drugs at times when they are in withdrawal. One of the most frequently cited reasons for sharing was that sterile injecting equipment was difficult to obtain. It is a matter for some concern that many of the sharers in our sample (24%) reported having shared used injecting equipment while in custody. There was good overall awareness of the risks of health problems associated with injecting among our subjects. However, awareness of risk was not associated with avoidance of sharing behaviour.

Adult↗
PubMed1993

Reaching hidden populations of drug users by privileged access interviewers: methodological and practical issues.

The methodological issues surrounding the use of a privileged access interviewer team to generate a network sample of drug users are examined. Traditionally network samples have tended to be used by qualitative researchers. Privileged access interviewing provides a mechanism for the application of a structured instrument to a network sampling model. In doing so some problematic issues in this area for structured methodology are overcome, reduced or standardized. The use of this method is appraised in terms of meeting the methodological requirements of the Drug Transitions study. The practical experiences of our group in using a privileged access interviewer team to interview more than 400 heroin users, many of whom were not in contact with treatment services, are discussed. This method is most appropriate for the quick collection of data, from diverse networks of drug users, by use of a structured instrument. Success is likely to be dependent on careful implementation. The ongoing monitoring of data quality is of particular importance, as is good management practice and the establishment of supportive and non exploitative relationships with the interviewer team.

Adult↗
PubMed1993

Does post-withdrawal cue exposure improve outcome in opiate addiction? A controlled trial.

A controlled trial studied whether cue exposure prevented relapse in opiate addiction. Subjects were randomly allocated to one of two inpatient treatment settings: a drug dependence unit with a special 10 week program and 4 weeks in a behavioural/general treatment unit without such a program. In each setting, following drug-withdrawal, subjects had either cue exposure for at least six sessions over 3 weeks, or a control condition. Subjects were followed up twice, at about 6 weeks and 6 months post-treatment. 186 subjects were randomly allocated; 69 were assessed post-detoxification, and of these 43 completed cue exposure or control treatments. Cue exposure and control subjects did not differ in cue reactivity. This was evaluated post-treatment for cue exposure subjects and at a comparable time point for controls. All groups showed a significant decrement in cue-elicited craving, withdrawal responses and negative mood. Cue exposure and control subjects did not differ at either of the two follow up interviews.

Adult↗
PubMed1993

Cocaine in the UK--1991.

More than 100 years after Freud's original endorsement of the drug, the use of cocaine is a problem for both users and for society, which struggles to organise effective responses to the epidemic of the last decade. During the 1980s the rapid spread of smokeable cocaine (including 'crack') was seen in the Americas (particularly the US). The initial simple predictions of an identical European epidemic were mistaken. The available data on the extent of cocaine use and of cocaine problems in the UK are examined. New forms of cocaine have been developed by black-market entrepreneurs ('freebase' and 'crack'), and new technologies have emerged for their use; with these new technologies have come new effects and new problems. The general psychiatrist now needs a knowledge of directly and indirectly related psychopathology which has an increasing relevance to the diagnosis and management of the younger patient.

Cocaine↗
PubMed1993

Poppy tea dependence.

A patient presenting with dependence on opium poppy tea infusion is reported. Poppy tea drinking, although previously described in certain parts of the UK, rarely presents in the form of a dependence syndrome. Issues relating to the management of poppy tea dependence are discussed, including the results of existing laboratory urinalysis for drugs of abuse, the calculation of opiate dose equivalence, and the likelihood of transition (or not) from use of poppy tea to use of other opiates.

Adult↗
PubMed1993

Do general practitioners and general psychiatrists want to look after drug misusers? Evaluation of a non-specialist treatment policy.

A new means of monitoring drug misuse which was developed in the north west of England, but is now widely used throughout the United Kingdom, is described and evaluated. Report forms which had been specially designed and ensured the anonymity of drug misusers were widely distributed among doctors and non-medical health workers who may have had contact with drug misusers. The forms were returned post-free to a centre where they were entered on a customized drug misuse database. There were 2127 reports from the north west of England (population 3.99 million) relating to 1792 individuals over a 15-month period. However, despite intensive promotion of the project among doctors, the number of reports from doctors remained virtually unchanged over the 15 months despite a 33% increase in the overall number of reports. When the reports from three health districts, selected so as to be representative of the region demographically (total population 658,500, population aged 15-44 years 292,200), were considered there was a substantial fall (70%) in reports from general practitioners which was considerably greater than the 2% fall in all reports. In a linked study all the psychiatrists, 30% of probation officers and a one in six sample of general practitioners from the three selected health districts were approached for interview at the beginning of the 15-month period and again a year later. This structured enquiry about caseloads, treatment, and attitudes also revealed a fall in the number of drug misusers attended by general practitioners and general psychiatrists and a reduction in the services provided for them by general practitioners.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗