Hugh Williams

Depressive symptoms in opiate addicts on methadone maintenance.

A number of studies have shown association between drug dependence and other psychiatric disorders. This study reported on the level of depressive symptomatology reported by a sample of opiate addicts, who were receiving methadone maintenance therapy and attending the Drug Treatment Centre in Dublin. A high level of depressive symptoms was found after completion of the Beck Depression Inventory (BDI). The clinical implications of depressive symptoms in opiate addicts were discussed.

Buprenorphine detoxification treatment for heroin dependence: a preliminary experience in an outpatient setting

OBJECTIVES The aim of the study was to evaluate buprenorphine as a detoxification agent for heroin dependence in an outpatient setting. Specifically we sought to establish the rate of completion of detoxification and retention in treatment, the duration of successful detoxification and dose requirements. METHODS The study was an open prospective evaluation of routinely collected clinical data on the first 60 consecutive heroin dependent patients who underwent buprenorphine detoxification. A flexible dosing regime was adopted with the dose of buprenorphine being adjusted daily against the previous days withdrawal symptoms. RESULTS The majority of patients (40 (67%)) completed detoxification. The median duration of treatment for completers was 17 days (range 9-30 days) with 90% of detoxification episodes completed within 21 days. Patients were commenced on initial median dose of 4mg buprenorphine (range 2mg-6mg) and the median stabilisation dose for the sample was 10mg daily (range 6mg-14mg). The median final dosage of buprenorphine required by patients retained in treatment was 1.2mg (range 0.4mg-2mg). We found older patient age to be a significant predictor of treatment completion. CONCLUSIONS Buprenorphine was an acceptable and a feasible outpatient detoxification treatment option for heroin dependent patients. Based on the study findings we propose a standard 21-day fixed-dose detoxification schedule.

Fatal antidepressant overdose among drug abusers and non-drug abusers.

Objective: This study examined the predictors, extent and patternof fatal antidepressant overdose (FAO) in all psychoactivedrug‐related deaths and compared these in drug abusers and non‐drugabusers.

Prevalence and Pattern of Benzodiazepine Abuse and Dependence Among Patients in a Methadone Detoxification Programme: A Repeated Cross-Sectional Analysis (Benzodiazepine Abuse Among Opiate Addicts)

This study was a repeated cross-sectional analysis of records of admissions to an in-patient methadone detoxification programme in two twelve-month matched periods, four years apart. The objectives were to identify changes in prevalence and pattern of benzodiazepine abuse and dependence among opiate addicts between the first (baseline) and second (follow-up) study periods. Prevalence rate of benzodiazepine abuse increased from 11.8% at baseline to 36% at follow-up, and the rates for benzodiazepine dependence at baseline and follow-up were 4.5% and 15.4% respectively. The following significant changes between the two study periods were also observed: Age of first benzodiazepine use, temazepam use, combined use of multiple benzodiazepines, injecting behaviour, use of barbiturates and cannabis, severity of dependence, and rate of treatment completion. The need to routinely assess methadone detoxification patients for benzodiazepine abuse and dependence on admission is underscored.

A coordinated response to the high drug death rate in Brighton & Hove

Concern about the increasing number of drug related deaths in Brighton & Hove prompted a Confidential Inquiry into 69 deaths. This led to recommendations concerning better data collection, identifying vulnerable populations, improving responses to overdose, and modifying service organization. Heroin-related deaths were halved between 2000 and 2003, but the rate for total drug deaths remained the highest at 25.3 per 100,000 (2003) in participating coroners’ jurisdictions. In a subsequent Capture Recapture study, the prevalence of intravenous drug use in Brighton & Hove was estimated at 2 per cent of people aged 15-44, higher than Liverpool or London. The proportion of opiate drug users dying from opiate overdose was also highest in Brighton & Hove, at 2.1 per cent. A network of interlocking services was established within strong multi-agency partnerships, supplemented by: increasing the numbers in treatment; fast tracking hospital discharges and prison releases into treatment; new specialist posts in the local prison, the accident and emergency department and police custody suite; and participation by pharmacists and primary care services. This was underpinned by good liaison with the coroner.

Nalbuphine dependence: a brief report from the UK

Objectives : Nalbuphine (Nubain) is a synthetic opioid analgesic with agonist-antagonist properties. This study describes a characteristic patient profile, pattern of use and treatment outcome for a series of nalbuphine dependent subjects. Method : Retrospective systematic case-note review of uniformly collected clinical data on 11 cases of nalbuphine dependence presenting to a substance misuse service. Results : There were nine males and two females with a mean age of 31 years of whom nine were currently employed. At presentation the mean duration of nalbuphine use was three years, the average daily dosage was 60mg (range lOmg-lOOmg) and all subjects reported injecting between two and eight times daily (mean five times daily). All subjects met opioid dependence criteria (ICD-10). Drug-related problems were multiple and varied while forensic history was uncommon. Exposure to nalbuphine occurred exclusively within the gymnasium environment and was used by bodybuilders to enhance weight training and bodybuilding. Eight subjects admitted previous anabolic steroid use, and seven current cocaine use. Eleven subjects represented 14 separate treatment episodes of which 11 treatment episodes involved the use of methadone substitution therapy. The mean stabilisation dose of methadone was 29mg (range 15mg-40mg) and in eight episodes (73%) patients were successfully retained in treatment to completion of detoxification. Conclusions : Dependence on nalbuphine, an agonist-antagonist opioid previously believed to have low abuse potential, does occur and may be particularly associated with bodybuilders who use its analgesic properties to facilitate pain free training. Its use appears linked not only with other performance enhancing drugs (viz. anabolic steroids) but may also be associated with other psychoactive drugs such as cocaine. Methadone substitution therapy appears to be a viable treatment option.

Oedipism and ocular self-mutilation

Self-enucleation is a rare and disturbing form of self-mutilation. A case is reported in which a schizophrenic patient simultaneously attempted the three main forms of major self-mutilation, that is self-enucleation, amputation of the penis and of the right hand. The historical background, underlying psychiatric factors and possible complications are discussed.

Service response to benzodiazepine use in opiate addicts: a national postal survey

OBJECTIVES The study reports on benzodiazepine use among opiate dependent patients attending National Health Service community prescribing services and examines current practice in the clinical management of benzodiazepine dependence. METHOD A postal questionnaire survey of 174 NHS substance misuse services in England and Wales. RESULTS A 71% response rate was achieved. Services estimated the prevalence of benzodiazepine use to be 40% and the prevalence of benzodiazepine dependence to be less than 25% among opiate dependent patients in treatment. Illicit supplies (street) and general practitioners were regarded as the most common source of benzodiazepines. The most commonly reported reasons for benzodiazepine use were for the direct intoxicating effects and for the treatment of anxiety/insomnia. The majority of services (93,75%) reported prescribing benzodiazepines to patients for benzodiazepine detoxification while 43 (35%) reported prescribing for benzodiazepine maintenance treatment. The variations in benzodiazepine prescribing practices across services are described. CONCLUSIONS Benzodiazepine use remains common among opiate addicts in contact with treatment services. The majority of services surveyed reported prescribing benzodiazepines but there was much variation in clinical practice nationally. There is need for further research to identify effective treatment approaches for comorbid benzodiazepine dependence in opiate misusers.