First use of heroin: changes in route of administration over time.
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
M Gossop
Publications and source records attributed to M Gossop.
HIV among south London heroin users in 1991.
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HIV Infections↗
Attributions and relapse in opiate addicts.
This study investigated whether attributions of opiate addicts would predict both their ability to abstain from future use and their reactions to abstinence violations. Measures of generalized beliefs about responsibility for positive and negative outcomes and specific attributions about relapse episodes were elicited from 80 addicts at the time of admission for inpatient detoxification and treatment. Addicts who at admission attributed to themselves greater responsibility for negative outcomes and who attributed relapse episodes to more personally controllable factors were subsequently (at 6-month follow-up) more likely either to be completely abstinent or to contain the effects of temporary lapses into opiate use.
Adaptation, Psychological↗
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↗
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↗
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↗
Addiction: treatment and outcome.
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Health Behavior↗
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↗
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↗
A six country survey of the content and structure of heroin treatment programmes using methadone.
The use of methadone in the treatment of drug dependence has provoked a good deal of controversy. However, it is clear that there is considerable variation between methadone treatment programmes and relatively little detail is available about the organization and operation of these programmes. This World Health Organization survey examines the content and structure of methadone treatment programmes, and particularly methadone maintenance programmes, in six countries. The six countries were Australia, Canada, France, the Netherlands, Thailand and the UK. The report presents information about the extent of national problems and about such issues as type of dispensing practices, dose- and time-limits for prescribing methadone, programme entry criteria, staffing, integration with other services, and urine testing. Developments and trends during the decade 1980-1990 are discussed and implications for further research and programme development are presented.
Cross-Cultural Comparison↗
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↗
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↗
Chasing the dragon.
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Administration, Inhalation↗
The development of a Short Opiate Withdrawal Scale (SOWS).
In previous studies a 32-item Opiate Withdrawal Scale was found to provide a reliable and valid means of measuring the signs and symptoms of withdrawal among heroin (and other opiate) addicts. This paper describes the processes whereby a shorter 10-item version of the same scale was developed. The Short Opiate Withdrawal Scale (SOWS) is simple to understand and easy to administer, and it avoids the redundancy of items contained in the original scale. It is suggested that the SOWS provide a useful instrument which can be used both in research and clinical practice with opiate addicts.
Heroin↗
Comparison of linear versus inverse exponential methadone reduction curves in the detoxification of opiate addicts.
A linear methadone detoxification procedure is compared with an inverse exponential reduction curve in a double-blind study. The inverse exponential curve resulted in withdrawal symptomatology which was significantly greater during the acute phase of the opiate withdrawal curve and was not significantly different during the recovery phase. There was no difference between groups in the time course of the withdrawal syndrome, in peak symptom severity, nor in patient compliance. Separate analyses for high-dose and for low-dose addicts show variation in the suitability of the two curves according to dose. The implications for future research and treatment of the opiate withdrawal syndrome are discussed.
Adult↗
What do opiate addicts and cigarette smokers mean by "craving"? A pilot study.
There is general agreement that the term 'craving' requires clarification. This present report presents a pilot study in which groups of opiate addicts and cigarette smokers completed a brief rating scale to describe the frequency and intensity with which they had certain feelings while craving for their own drug of dependence. Craving was reported as being a dysphoric state and opiate addicts described more frequent and more intense dysphoric feeling while craving. Despite the difference in mean scores there were some similarities in the overall profile of scores in the two groups. Implications of these findings are discussed.
Adult↗
Social and drug-taking behaviour of 'maintained' opiate addicts.
The roles of the prescribing of maintenance methadone and prescribing injectable drugs in the management of opiate addicts have become subjects of active debate since the advent of HIV. Data are presented on the social circumstances and drug-taking behaviour of 26 opiate addicts who had been receiving maintenance methadone (24 of whom had been receiving at least part of the prescription as injectible methadone ampoules.
Adult↗
Crack and cocaine use in south London drug addicts: 1987-1989.
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.
Adult↗