The feasibility of abrupt methadone-buprenorphine transfer in British opiate addicts in an outpatient setting.

A study of 13 male opiate addicts was undertaken to investigate the feasibility of transferring abruptly from methadone maintenance treatment to buprenorphine in an outpatient setting. The mean age of subjects was 30 years (range 18-45) and all fulfilled DSM-III-R criteria for opioid dependence. All were maintained on a methadone dose of 20-30 mg mixture daily and were transferred for 3 days to 4 mg buprenorphine sublingually 24-26 hours after their last dose of methadone. On day 1 repeated measures of drug effects were performed, including agonist and withdrawal effects, and this was complemented by saccadic eye movements, a potential new measure of central opioid effects. These recordings were repeated once on days 2 and 3 and the subjects returned to their previous dose of methadone on day 4. Buprenorphine caused no detectable agonist effects or drug "high", but had "good" effects, was "liked" and well tolerated, suggesting that subjects would comply with buprenorphine treatment despite the lack of reinforcing effects. A mild increase in subjective withdrawal symptoms, which was not clinically significant, was seen in association with an increase in saccadic peak velocity on day 2 of the study but no withdrawal occurred on the other days, indicating that the abrupt transfer technique was acceptable.

Assessment of drinking patterns in general practice.

A study was undertaken in a north London general practice to see which questions and investigations were useful in assessing the drinking patterns of patients. In a 10-month period in 1984, 855 patients were interviewed by means of a questionnaire about quantity and frequency of drinking and the CAGE questionnaire to determine their drinking habits. They were also asked to blow into an alcolmeter. A blood sample was taken from 119 patients who said they drank more than 20 units of alcohol weekly or who scored more than two on the CAGE questionnaire or who had a positive alcolmeter reading, and gamma glutamyl transpeptidase levels and mean corpuscular volume were determined.The study showed that questions about quantity and frequency of drinking, taking under two minutes to administer in the consultation, are sufficient to raise suspicions about drinking problems. Detailed investigation can then be undertaken in patients who say they drink more than 20 units of alcohol weekly.

Clinical, biochemical, serological, histological and ultrastructural features of liver disease in drug abusers.

Heroin abusers are frequently found to have abnormal liver function tests and hepatic histology. Hepatitis viruses A, B, and NANB, other drugs or drug contaminants and excessive alcohol consumption are factors thought to contribute. One hundred and sixteen heroin abusers attending a London treatment centre were studied. Sixty two (53%) had a raised aspartate transaminase. This was not explained by current infection with hepatitis A and B, cytomegalo or Epstein-Barr viruses, excessive alcohol consumption (greater than 80 g/day) or concomitant drug taking. Abnormal liver function tests were as frequent in those with markers of current or past HBV infection as those without and there was evidence that both HBV infection and the cause of the abnormal liver function tests were acquired in the first few years of intravenous drug abuse. Liver biopsies from eight patients showed chronic hepatitis with a mild lobular and portal inflammatory infiltrate, fatty change and prominent sinusoidal cells. Electron microscopy showed cytoplasmic trilaminar tubular structures and dense fused membranes in dilated endoplasmic reticulum. These clinical, biochemical, serological, and histological features would suggest a major role for NANB virus infection in the aetiology of hepatitis in heroin abusers.

Evaluation of heroin maintenance in controlled trial.

Ninety-six confirmed heroin addicts requesting a heroin maintenance prescription were randomly allocated to treatment with injectable heroin or oral methadone. Progress was monitored throughout the next 12 months by research workers operating independently of the clinic. Heroin can be seen as maintaining the status quo, with the majority continuing to inject heroin regularly and to supplement their maintenance prescription from other sources; it was associated with a continuing intermediate level of involvement with the drug subculture and criminal activity. Refusal to prescribe heroin while offering oral methadone constituted a more confrontational response and resulted in a higher abstinence rate, but also a greater dependence on illegal sources of drugs for these who continued to inject. Those offered oral methadone tended to polarize toward high or low categories of illegal drug use and involvement with the drug subculture, and were more likely to be arrested during the 12-month follow-up. There was no difference between the two groups in terms of employment, health, or consumption of nonopiate drugs. Refusal to prescribe heroin resulted in a significantly greater drop out from regular treatment.

Alcoholism: a controlled trial of "treatment" and "advice".

Two groups of alcoholics received either one counseling session or several months of in- and outpatient treatment. One year later there were no significant differences in outcome between the two groups.

Abuse of methylamphetamine.

Seventy-four regular users of methylamphetamine injections were interviewed in four settings by use of a relatively structured standardized questionary. All but two had injected methylamphetamine within the previous 48 hours and had on average been using methylamphetamine continuously for 19 months.Significant features found in those interviewed were British nationality, single status, under 25 years of age, and a history of parental separation, absence, or bereavement. Educational standards were poor and a history of consistent truancy from secondary school was frequently reported.Comparison of their best and present occupations showed that downward drift had occurred. Forty-one per cent. of the sample had some definite or tentative evidence of neurotic disturbance in childhood. Twenty-three per cent. had been sentenced to detention centre, approved school, or Borstal training, and 20% had been sentenced to prison. Sixty-five per cent. had been charged with offences of one sort and 24% had been convicted of both drug and non-drug offences.A significant number had been heavy drinkers in the past, while most had been, and in many cases still were, multiple-drug users who had first started to use drugs between the ages of 16 and 20 years. They tended to have obtained methylamphetamine initially from people they knew or from sellers. While the majority were currently getting methylamphetamine from doctors, the fact that 40% gave non-medical agents as their major source of drugs suggests that a significant number were supplementing their supplies from illicit sources. More than one-half were rated as being continually involved in the "drug scene."Most of those interviewed accepted frequent psychotic episodes as a side-effect of their use of methylamphetamine. Malnutrition, weight loss, and sleep disturbance were frequent.