Adenekan Oyefeso

Trapped in the "K-hole": overview of deaths associated with ketamine misuse in the UK (1993-2006).

Medical use of ketamine has a good safety record, but recent increase of misuse is worrying. We focussed on ketamine misuse mortality figures (UK; 1993-2006), extracted both from St George‟s np-SAD database and from published mortality statistics. The 23 victims (typically males, in the 25-44 age group) self-administered themselves with a miscellany of psychoactive compounds and alcohol. Ketamine was detected in 4 cases on its own. Although drug identification does not necessarily imply direct contribution to death, the suggested ketamine high safety profile is here questioned. Coroners/ procurators fiscal should consider more routine screening for ketamine in unexpected deaths.

Review of deaths related to taking ecstasy, England and Wales, 1997-2000

The lack of data about the lethal consequences of taking ecstasy has led to high profile reports of deaths in the media and also the idea that ecstasy is safe. The United Kingdom accounts for most of the ecstasy tablets—normally containing methylenedioxymethamphetamine (MDMA) or 3,4-methylenedioxyamphetamine (MDA)—seized in the European Union.1 The rate of deaths related to taking ecstasy in people aged 15–24 during 1995 and 1996 in England was 18 and between 1995 and 1997 in Scotland was 11.2 The risk of using ecstasy varies between one death in 2000 first time users to one death in 50 000 first time users.2nnThe National Programme on Substance Abuse Deaths was established after the …

Subjective sleep-wake parameters in treatment-seeking opiate addicts.

We investigated subjective sleep parameters and sleep difficulties of opiate addicts undertaking methadone detoxification and identified their sleep profile. Using the St Marys Sleep Questionnaire, we compared the subjective sleep parameters of 27 consecutively consenting patients (16 males, 11 females) with a mean age of 33 years (S.D. = 7.5) undertaking in-patient methadone detoxification with those of 26 drug-free controls (9 males, 17 females) with a mean age of 35 years (S.D. = 8.0). Our findings reveal that subjective sleep parameters of opiate addicts and controls are quantitatively and qualitatively different. The patients are more likely than controls to report difficulty initiating sleep (OR = 5.42; 95% CI = 1.43, 20.47); difficulty maintaining sleep (OR = 16.50; 95% CI = 3.81, 71.47); inadequate sleep quality (OR = 8.56; 95% CI = 2.04, 35.81); and inadequate sleep quantity (OR = 9.00; 95% CI = 2.49, 32.57).

Drug abuse-related mortality: a study of teenage addicts over a 20-year period

Background: There is growing concern about increase in illicit drug use and associated fatalities in young people. Method: This longitudinal analysis of successive cohorts of addicts in England and Wales aged 15–19 years followed up over a 20-year period covering 1974 to 1993 (1) investigated trends in all-causes mortality; (2) examined teenage-specific mortality, i.e. deaths during ages 15–19 years; (3) determined excess teenage-specific mortality; and (4) identified the main underlying causes of teenage-specific death in this population. The main outcome measures were overall mortality rates, teenage-specific mortality and standardised mortality ratios calculated for four 5-year (period) successive cohorts. Results: Overall mortality rate in the study population (Nu2009=u20099491) was 4.7/1000 person-years. The median age at death was 23 years (semi interquartile rangeu2009=u20093), with the majority (91.3%) of deaths occurring between ages 15 and 29 years. Excess teenage-specific mortality in the population was 10.7 in males and 21.2 in females (general populationu2009=u20091), and increase in excess mortality in both sexes was evident in the last 5-year period of study. The majority of deaths (64.3%) resulted from accidental poisoning. Methadone and heroine/morphine accounted for about two-thirds of accidental poisoning deaths, while suicide accounted for 11.4% of teenage-specific deaths. Conclusions: It is strongly recommended that treatment services should be more responsive to the need for careful prescribing, dispensing and administration of substitute medication to teenage addicts in their care. The development of needs-led, case-sensitive treatment services for young addicts is indicated.

Cause and manner of death in drug-related fatality: an analysis of drug-related deaths recorded by coroners in England and Wales in 2000

This study investigated causes and manner of drug-related fatalities recorded in 2000 in the United Kingdom, measuring the masked manner of death in cases typically recorded as overdose. A retrospective cohort study was used of 1037 cases of accidental drug-related fatalities reported by coroners in England and Wales to the National Programme of Substance Abuse Deaths. Whilst 802 cases were identified as direct acute overdose, representing 77% of the total accidental deaths, 23% of overdose fatalities were caused by asphyxiation (7%), drug-related medical conditions (7%), non-drug-related conditions (4%), traumatic accidents (3%) and infections (2%). Younger people show higher risk of overdose and asphyxiation; older people show higher risk from pre-existing medical conditions. This study not only confirmed the high risk of overdose associated with heroin and polydrug use, but it also identified other high fatality risk factors for heroin/morphine users such as contracting an acute infection leading to septicaemia or endocarditis, or contracting a chronic infection such as HIV, HBV or HCV. In contrast, stimulants particularly featured in traumatic accidents, with amphetamine use most associated with cardio-vascular fatality. These findings highlight the masked manner of death in cases commonly recorded as overdose and demonstrate the need for a more-detailed and systematic method of recording drug-related deaths in order to inform drug education and harm reduction strategies.

Treating an opiate-dependent inpatient population: a one-year follow-up study of treatment completers and noncompleters.

INTRODUCTIONnThe aim of this study was to compare the characteristics of patients who completed (completers) inpatient treatment of drug dependence with those who failed to complete this programme (noncompleters).nnnMETHODnParticipants were assessed at admission using the Substance Abuse Assessment Questionnaire (SAAQ) to obtain information about the sociodemographic background, history of drug and alcohol use, physical health, mental health, offending behaviour, and interpersonal relationships. Follow-up interviews were carried out 3, 6, 9, and 12 months after discharge using the SAAQ-Follow-up. To form the three comparison groups, participants were divided on the basis of completion of detoxification and receipt of aftercare.nnnRESULTS AND CONCLUSIONSnSignificantly better treatment outcome was observed amongst those who completed detoxification and went on to spend at least 6 weeks in a recovery and/or residential rehabilitation unit. In contrast, there were no significant differences between noncompleters and completers who had no aftercare on the majority of measures of drug use during follow-up.

The need for substance misuse education in health studies curriculum: a case for nursing education.

The sharp increase, in recent years, in the use and misuse of psychoactive substances necessitates greater involvement of non-specialist health care workers in the management of problems associated with substance misuse. The need to expand the health studies curriculum in line with current trends in substance use and misuse is recommended.

Attitudes Towards the Work Behaviour of Ex-Mental Patients in Nigeria

Attitudes towards the work behaviour of ex-mental patients were examined in a random sample of 480 senior federal civil servants in Nigeria. The results revealed: pervasive negative attitudes towards ex-mental patients and their work behaviour; inadequate provision for the needs of ex-mental patients by government; lack of awareness of and/or non-existence of welfare policies for rehabilitating ex-mental patients; and a need for a social welfare policy to cater for ex-mental patients in the workplace.

Methadone-Related Deaths: Data from 18 Coroners' Jurisdictions in England

This paper examines the methadone-related deaths (MRD) among entire cases of inquest on drug-related cases in 18 coroners jurisdictions in England which were entered on the National Programme on Substance Abuse Deaths during a six-month period in 1997. In 154 deaths methadone, either prescribed or not prescribed, was reported to be the substance directly implicated in the death of 40 individuals. The MRD between the prescribed and non-prescribed cases were compared in respect to various demographic variables and associated risks. The main findings reported are that the majority of deaths in this sample were in cases where methadone had not been prescribed (72%) and that there was a significant difference in age between the methadone prescribed (median = 22 years) and non-prescribed groups (median = 37 years) (Mann-Whitney U = 57.5, p = 0.01). Also significant differences amongst the two groups in respect of the coroners verdicts are reported. The authors suggest more stringent controls around the prescription and dispensing of methadone, along with measures to alert the population at risk of the hazards of using methadone in a non-controlled fashion.

Mapping the role of nurses in Methadone Substitution Therapy (MST) programmes across Europe: core competencies

The World Health Organisation and the International Council of Nurses (WHO/ICN, 1991) broadly define addiction nurses roles into eight domains that suggest a set of core competencies required to work effectively within this challenging area of nurse practice. This paper reports on a survey of addiction centres across eight European countries. The survey explored the role of the nurse specifically within methadone substitution therapy programmes, with the intention of mapping perceived key roles against the ICN/WHO domains. While many of WHO/ICN domains were evident (provider of care; educator; counsellor; advocate) significant limitations were revealed in other domains.