Jane Fountain

Adverse effects of stimulant drugs in a community sample of drug users.

A sample of drug users (n = 158) were contacted and interviewed in non-clinical community settings about their use of Ecstasy, cocaine powder, and amphetamines and the adverse effects of these drugs. Subjects reported a wide range of adverse effects including anxiety problems, depression, mood swings, feelings of paranoia, and panic attacks. Sleep and appetite disturbances were the most commonly reported problems. About half of all subjects reported depression and paranoid feelings associated with their stimulant use. Many of those reporting problems stated that these were mild. However, for all drugs, a substantial minority of users reported adverse effects which they rated as severe. Between 30 and 55% of the sample reported having had at least one severe adverse effect (30% cocaine, 35% Ecstasy and 55% amphetamine). There were clear differences between the different drugs in the likelihood and reported severity of adverse effects. Amphetamine use was associated with significantly more adverse effects and with more severe adverse effects than Ecstasy or cocaine. Cocaine powder was associated with the least severe adverse effects. A common pattern of drug use involved the use of depressant drugs such as opiates and benzodiazepines in addition to stimulants. The stimulant and depressant users were more likely than the stimulants-only users to use stimulants by injection and more likely to report adverse effects associated with stimulant use. The stimulant and depressant users were also more likely to have been treated for a drug problem. Approximately a quarter of the sample stated that they had stopped using stimulants up to the point of interview as a result of their bad experiences.

What Influences Young People's Use of Drugs? A qualitative study of decision-making

Recent surveys in the UK indicate that approximately half of all young people aged 16-22 have used an illegal drug. Despite such observations, remarkably little research has been conducted in the UK about the motivating factors which shape the decisions that young people make to use drugs or alcohol. This paper reports on a qualitative study exploring the range of factors which young people reported to be influential over such decisions. Results are presented from in-depth interviews conducted with 50 16-21-year-olds. Analysis of the data revealed individual-level influences (the perceived functions of drug use (or specific purpose for using a particular substance), drug-related expectancies, physical/psychological state, commitments and boundaries) and social/contextual-level influences (environment, availability, finance, friends/peers and media) on decision-making. Of these, the perceived function for using a particular substance was identified as particularly influential. The findings are related to e...

Drug and Alcohol Use and the Link with Homelessness: Results from a Survey of Homeless People in London

A community survey using a structured questionnaire was used with 389 homeless<fnoteref rid=fn2>1</fnoteref> people currently or recently sleeping rough (on the streets) in London. Data were collected on respondents histories of homelessness and of substance use, and dependence on the main substance used in the last month was measured. In the month before the interview, 83% (324) of the sample had used a drug, 36% (139) were dependent on heroin and 25% (97) on alcohol. Sixty-three per cent (244) reported that their drug or alcohol use was one of the reasons they first became homeless, but the majority (80%, 310) had used at least one additional drug since then. Overall, drug and alcohol use, injecting, daily use and dependency increased the longer the respondents had been homeless. A clear link exists between substance use and homelessness: initiatives to tackle homelessness must simultaneously tackle the drug use of homeless people.

Why Say No? Reasons Given by Young People for Not Using Drugs

A combination of qualitative and quantitative methods has been employed in this study in order to assess the impact of a variety of factors on young peoples drug-using behaviour. The focus is on the responses to an enquiry with respondents who had never used heroin, methadone, other opiates, cocaine powder, crack cocaine, benzodiazepines, amphetamines, ecstasy, LSD, cannabis, and solvents who were asked for their reasons for this non-use. The data were also analysed to ascertain whether reasons for non-use varied according to age, what respondents thought the effects of the drugs they had never used would be, and how likely they thought it was that they would use them in the year following the interview. No single reason was given by the majority of respondents for the non-use of drugs, but the motive most frequently reported - particularly by older respondents - was a lack of interest in the effects. Younger respondentsreasons for non-use were, overall, related to a fear of drugs and their effects. Most...

Continuing drug risk behaviour: Shared use of injecting paraphernalia among London heroin injectors

The study investigates donor sharing and recipient sharing of different types of injecting equipment and the frequency of sharing activities with sexual partners, close friends and casual acquaintances. Structured interviews were conducted with 303 injectors recruited as part of a study of early and episodic opiate use. Subjects were contacted in non-clinical, community settings by a peer recruitment method (Privileged Access Interviews). Spoons and water containers were more frequently shared than needles and syringes. Significant differences were obtained between the frequency of sharing different types of injecting equipment. Many injectors had shared spoons or water containers, but had not shared needles or syringes. Frequency of sharing with others was also associated with intimacy of relationship to the subject. Almost two-thirds of the sample had shared some sort of injecting equipment during the previous year. The sharing of injecting paraphernalia presents a risk of infection with HIV hepatitis B and hepatitis C. Injectors and drug workers should be more clearly aware of the risks involved in such activities. Harm reduction advice given to drug injectors should target the sharing of injecting paraphernalia. Research into sharing should explicitly include questions about the use of different types of injecting equipment.

Which drugs cause overdose among opiate misusers? Study of personal and witnessed overdoses

Concern has been expressed at the widespread prescribing of methadone in view of its inherent toxicity. Commentators have opined that methadone is more toxic than heroin and causes more overdose deaths. However, data deficiencies and flawed analyses leave continuing uncertainty about this crucial policy issue. The relative contributions of heroin, other opiates (e.g. methadone) and non-opiate drugs to overdose and overdose deaths among drug misusers were examined in a community-recruited sample of 312 injecting drug misusers in London. Data were collected on last personal overdose (n=117), last witnessed overdose (n=167) and last witnessed fatal overdose (n=55), and on the different drugs that had been involved with these overdoses. Heroin was involved in 83% of last personal overdoses, 90% of last witnessed overdoses and 80% of last witnessed fatal overdoses, while other opiates were involved in only 18%, 8% and 26%, respectively. Methadone accounted for about half of these “other opiate” overdoses. Overdoses involving a combination of heroin and a non-opiate were common − 29%, 21% and 39%, respectively. Heroin was the drug most frequently involved in overdose across all three areas of study. However, combinations of heroin and a non-opiate were surprisingly frequent, especially in witnessed fatal overdoses (as reported recently by other investigators using different methodologies). Considering the wide extent of methadone prescribing to this group, methadone was remarkably infrequently reported as responsible (solely or in combination) for either personal overdoses, witnessed overdoses or witnessed fatal overdoses.

Diversion tactics: how a sample of drug misusers in treatment obtained surplus drugs to sell on the illicit market

This paper presents some findings from a qualitative study conducted during 1995 and 1996 amongst buyers and sellers of diverted prescription drugs in London. It details the tactics sellers employed to obtain drugs surplus to their own requirements in order to sell them on the illicit market: they acquired more than one prescription (‘multiple scripting’) and/or obtained a prescription for a higher dosage and/or a wider variety of drugs than they intended to use themselves (‘overscripting’). Informants exploited the lack of a standardised prescribing policy by ‘doctor shopping’, whereby they searched out those most likely to prescribe the drugs and the quantity they wanted. The methods most commonly used to acquire a surplus were to exaggerate a habit, bargain with prescribers, give a false identity, gain the sympathy of prescribers, feign addiction, and pretend to be a temporary resident. To conclude, some costs and benefits of diversion and its control are discussed.

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.

Benzodiazepines in polydrug-using repertoires: The impact of the decreased availability of temazepam gel-filled capsules

Reporting on a research project which used a qualitative methodology,this paper examines the role benzodiazepines played in the polydrug-using repertoires of a sample of long-term, polydrug-using, opiate addicts. The impact of a decrease in the availability of temazepam gel-filled capsules is monitored, showing the effect on both the illicit market for diverted prescription drugs and on the drug-using patterns of those who bought benzodiazepinesthere. The paper illustrates the complex factors which affect the substances polydrug users include in, or exclude from, their drug-using repertoires, and is an example of how measures aimed at harm reduction can have both positive and negative implications. It is argued that such measures must be evaluated in the context of their impact on a series of dynamic, interrelated changes.

Unmet Drug and Alcohol Service Needs of Homeless People in London: A Complex Issue

Little research has been conducted on the drug use of those who sleep rough (on the streets) in the United Kingdom (UK). During 2000, to fill in the gaps in the knowledge base, researchers at the National Addiction Centre, London, carried out a community survey using a structured questionnaire amongst 389 homeless people recently or currently sleeping rough, in order to investigate their met and unmet drug and alcohol service needs. In total, 265 (68%) had a need for drug services and 97 (25%) for alcohol services. Over half of the current drug users (170/324, 52%) and 88 (33%) of the 264 current alcohol users wanted help with their substance use, but few were currently accessing the appropriate services, other than needle exchanges. The challenge for services is to build these potential clients motivation to accept health-conferring intervention.