[HIV-1 prevalence in deaths caused by drug overdose in various large cities of West Germany and West Berlin between 1985 and 1988]. / HIV-1-Prävalenz bei Drogentoten in verschiedenen Grossstädten der Bundesrepublik Deutschland und in Westberlin zwischen 1985 und 1988.

The development of the HIV-1-prevalence among drug deaths (n = 753) in several German cities (West Berlin, Frankfurt, Munich, Hamburg, Bremen, Cologne and Stuttgart) from 1985 to 1988 was evaluated; in 1988 43% of 674 deceased drug addicts were examined. The regional prevalence rate was between 15 and 25%; only in Berlin 42% of the drug deaths were HIV-infected (cumulated data of all cities over the 4-year-period: 26%). There was no uniform or steady regional development of HIV-1-prevalence in the different cities. The ratio men/women among drug deaths was 3:1. The HIV-1-prevalence among males was 22%, among females 40%. HIV-infected individuals were 2-3 years older than seronegatives. Predictions concerning the trend of prevalence rates are not possible up to now. Continuous monitoring of the HIV-status of drug deaths seems to be a worthful method to evaluate the spread of this disease among the risk group of intravenous drug addicts.

[Suicidal carbon monoxide poisoning in an automobile with the engine switched off]. / Suizidale Kohlenmonoxid-Vergiftung in einem Pkw bei ausgeschalteter Zündung.

Report is made on a suicidal carbon monoxide poisoning through entrance of exhaust fumes into the interior of the vehicle. The situation of discovery (switched-off engine) occasioned experimental examinations. The result showed that fatal carbon monoxide concentrations can obviously remain in the interior of a vehicle over a long period of time.

[Risks and perspectives of drug dependence. Catamnestic results in 100 opiate addicts during the access years 1969-1974]. / Risiken und Perspektiven der Drogenabhängigkeit.Katamnese- Ergebnisse bei 100 Opiatabhängigen dr Zugangsjahre 1969-1974.

The further development of 100 young drug addicts of the opiate type (72 males, 28 females) who had been medically assessed by court or police order between 1969 and 1974 was evaluated over 10 to 15 years. Until the end of 1983 20 clients had died, 14 males and 6 females. The state of the survivors was separated into 5 categories according to drug dependency, rate of delinquency and assurance of income. 39 clients were free from injectable drugs. The abstinence rate was equal in males and females. The major part of these abstinent clients was fully rehabilitated, drug-independent for years, not delinquent and integrated into work. A minor part depended on external help. Three clients were not able to earn a living. Half of the 80 survivors had to be considered at risk. International comparison shows that the increased mortality among opiate addicts is only slightly different among western industrial nations. Perspectives of survivors are also similar. Despite different treatment and intervention strategies the abstinence ratio approaches 40% after the 30th year of life with an increasing tendency with increase of age. As the now already older clients usually decline in-patient care, however accept out-patient help promoting rehabilitation successfully ("path of rehabilitation"), promotion of ambulatory care decisively involving doctors is urgently required.

[Survival rate of drug addicts. Longitudinal analysis of 530 outpatient clients for the admissions years 1969 to 1977]. / Zur Uberlebensquote Drogenabhängiger. Langzeitanalyse bei 530 Ambulanzklienten der Zugangsjahre 1969 bis 1977.

The mortality amongst 530 out-patient drug-addicts, dependent mainly on opiates and being first registered between 1969 and 1977, was analysed. This grand total (27% females, median age 19 years, 73% males, median age 20 years) was subdivided into three groups with variable observation follow-up according to the time-shift of consumed main drugs. Until the demarcation day 31 December 1982 81 clients (15%) died. Mortality rates were determined according to the death cases for the three groups. In comparison with the mortality of the age-matched whole population male heroin addicts had a twelve-fold and females a 29-fold death rate. Survival curves of all three groups showed a rather linear course indicating a surprisingly long period of danger. For optimisation of advice methods and for treatment of drug-addicts long-term analyses of larger unselected groups involving further parameters are required.

[Treatment of drug addicts under the aspect of medicoprofessional ethics (author's transl)]. / Therapie Drogenabhängiger unter dem Aspekt berufsgerechten ärztlichen Handelns.

The problem of an effective treatment of drug addicts is getting more and more important. This applies in particular to youngsters who have become addicted to opiate drugs. The medical profession is confronted by the question to what extent they can contribute towards tackling this task. It is becoming evident that success can be achieved if physicians join hands with skilled social workers. Insofar as drug-free methods are applied, the realization of such co-operation does not involve any obvious legal or ethical difficulties linked to a professional code. However, there is an obstacle to the development and critical testing of new methods in the field of addiction, namely, the scholastic tendency to recognize definite therapeutic methods only as being in line with professional ethics, whereas other methods, especially those supported by the use of pharmaceuticals, are rejected or discriminated right away as erroneous or illegal. It is suggested to gradually come away from this scholastic position and to utilize the criteria normally applicable and well-tried in the medico-scientific field. Differentiation between methods in line with professional ethics and questionable methods can be effected only against the background of empirical results.

[Recognizing and treating drug addicts. Part 2. Differential diagnosis, therapy]. / Erkennung und Behandlung von Drogen-Abhängigen. Teil 2: Differentialdiagnose, Therapie.

Persons addicted to opiates often have fresh injection scars on the skin directly above the veins in the arms and legs. These appear as well as scars from abscesses and burns, tattoos, advanced tooth decay and signs of chronic hepatitis. An intensive consumption of hallucinogens is often connected to an inclination toward apathy and a loss of contact to reality (amotivational syndrome). It is necessary to have a sufficiently wide spectrum of therapeutic and rehabilitation measures being offered, due to the wide range of variants one can expect in the personality structure and the primary disturbance. The slogan of "therapy instead of punishment" leads nowhere. Long-term in-patient programmes, still presently favoured in our country, are not sufficient and are being increasingly more frequently rejected by the addicts themselves. Out-patient therapy trends, which are both extremely necessary and promising, are to be found in the close co-operation between physicians and specialists in social therapy while utilizing community resources. Two examples for such a programme are discussed (Hesse, Marx). A more concentrated improvement of out-patient therapy and rehabilitation of drug addicts is only possible when the chemical-toxicological diagnosis of addicting substances in urine becomes a routine process in the medical laboratory, e.g. by enzyme immunological methods.

[The effectiveness of the criminal justice system in cases of opiate addiction (author's transl)]. / Zur Frage der Wirksamkeit strafrechtlicher Massnahmen bei Drogenabhängigen vom Opiattyp

On the 63 deliquent youth drug addicts examined by the author as a court-appointed expert during the years 1970-1973, an attempt was made in the summer of 1975 to ascertain their actual current condition. This was indeed possible with 58 of the subjects in question (43 male, 15 female--average age at the time of examination.: 21). On the day the sample was taken (August 15, 1975) 23 of them were in penal confinement, 13 had again become dependent on illegal opiates, 2 were dependent on surrogate drugs, and 1 person was in the hospital. 3 members of the sample population who had overcome their dependency on drugs, 4 were unemployed, 2 were living in therapeutic communities and the remaining 10 were either re-integrated into occupations or training programs. A comparative analysis of the cases indicates that penal care measures are predominantly effective in those cases where the delinquents are subjected to intensive expert diagnosis, therapeutic care and vocational counselling and vocational aidmeasures at the commencement, during and subsequent to their respective periods of confinement.