A case of needle fixation.

Needle fixation is frequently missed and dismissed by clinicians and patients. However, ignoring this condition can have severe consequences, such as septicaemia, thrombosis, blood borne viruses, and is associated with an overall poor prognosis of drug dependence.Here we describe a 37-year-old man who presented with 20-year history of polydrug dependence, drug-induced psychosis and antisocial personality disorder. He was found to also have a 5-year history of intermittent needle fixation. His injecting behaviour and drug use improved significantly with fluoxetine while being on methadone maintenance.At present there is little evidence for any effective treatment strategies for needle fixation. The current recommended treatment consists of cognitive behavioural therapy and cue exposure. Whether fluoxetine constitutes an effective management strategy remains to be seen.

Substance use among medical students: time to reignite the debate?

BACKGROUND: Substance use among medical students could impact on the conduct, safety and efficiency of future doctors. Despite serious medicolegal, ethical and political ramifications, there is little research on the subject, especially from the Indian subcontinent. We aimed to explore the patterns of substance use among a sample of medical students from the Indian subcontinent. METHODS: An opportunistic, cross-sectional survey of medical students from 76 medical schools attending an inter-medical school festival. A brief self-reported questionnaire was used to identify current and lifetime use of tobacco, alcohol, cannabis, heroin and non-prescription drugs. Multivariable logistic regression analysis was used to identify factors associated with illicit substance use. RESULTS: Responses from 2135 medical students were analysed. Current alcohol and tobacco (chewable or smoked) use was reported by 7.1% and 6.1% of the respondents, respectively. Lifetime use of illicit substances was reported by 143 (6.7%) respondents. Use of illicit substances was strongly associated with use of tobacco, alcohol and non-prescription drugs. CONCLUSION: This study provides a snapshot of the problem of substance use among medical students from the Indian subcontinent. The reported prevalence of alcohol and illicit substance use in our sample was lower, while tobacco use was similar, when compared with data from western studies. Further research is needed from the Indian subcontinent to study nationwide patterns of substance use among medical students, and to identify important determinants and reinforce protective factors. Strategies need to be developed for supporting students with a substance use problem.

Effect of buprenorphine on psychomotor functions in patients on buprenorphine maintenance.

OBJECTIVE: Patients on buprenorphine maintenance for opioid dependence often abuse its additional doses over and above the maintenance dose. Being a psychoactive agent, it may affect psychomotor performance with all its consequences, for example, effect on quality of life. This study was conducted to assess the effects of its additional doses on psychomotor performance in patients who are maintained on it. DESIGN AND SETTING: This was an interventional study, carried out in an in-patient setting in a tertiary care national drug dependence treatment center. PARTICIPANTS: It included 19 subjects maintained on buprenorphine, 4 mg/d (s/L) for at least a month. INTERVENTION: Maintenance dose was followed by three administrations of buprenorphine, 2 mg, at two hourly intervals (cumulative dose design). MAIN OUTCOME MEASURES: Subjects were assessed on digit symbol substitution test, trail making, digit span, and delayed recall, after each administration and the next morning. RESULTS: Performance of subjects on Digit Symbol Substitution Test (chi2 = 52.98, p < 0.000) and Trail Making Test-A (chi2 = 26.29, p < 0.000) and B (chi2 = 42.08, p < 0.000) improved significantly with each assessment while other tests were unaffected. CONCLUSIONS: Improvement in psychomotor performance (which could be true effect of drug itself or a result of other factors, eg, inadequate maintenance dose or practice effect) though contrasting with some of the earlier findings, does have significant clinical implications regarding the long-term use of buprenorphine. It would be worthwhile repeating this type of study in a placebo controlled design to further verify the results.

Pattern of tobacco use among school children in National Capital Territory (NCT).

OBJECTIVE: To study the prevalence, consumption patterns and correlates of tobacco use among adolescent SZI children in Government schools in the National Capital territory of Delhi. METHODS: Thirty schools in National Capital Territory (NCT) of Delhi, India, were selected by two stage cluster random design and population proportionate to size sampling (PPS) methodology. A sample of 3,422 children in the age group of 10-18 years studying in the 30 middle and senior secondary Government schools in NCT of Delhi were studied. Each student was administered a pre-tested, semi-structured questionnaire. RESULTS: Overall 9.8% of the study children had at least once experimented with any form of tobacco in their lifetime. The proportion of children who were current users of tobacco products was 5.4% (boys: 4.6%, Girls: 0.8%). Current users differed from abstainers in location of their schools, category of school, class, gender, hobbies, not having friends, having tobacco users in family and school etc. CONCLUSION: Consumption of tobacco amongst adolescents is an emerging health problem in Delhi. A number of variables seem to differentiate between the current users and abstainers. Tobacco use in family and school environment is a mutable factor that should be focused in tobacco reduction campaigns. Encouraging friendship has a protective influence. There is a need for similar studies in other metropolitan cities of the country.

Tobacco consumption and awareness of their health hazards amongst lower income group school children in National Capital Territory of Delhi.

Consumption of tobacco is a complex and multidimensional problem faced by the country. It is the main culprit behind oral cancer. The present study was undertaken to assess the prevalence of consumption of tobacco amongst adolescent school children of low-income group in National Capital Territory (NCT) of Delhi and to study the perception of the children regarding the health hazards of tobacco. A cross-sectional study was conducted amongst 3,422 children in the age group of 10-18 years studying in government schools in NCT of Delhi. About 9.8% of the study children had at least once experimented with any form of tobacco in their lifetime. The proportion of children who were "current users" of tobacco products was 5.4% (boys: 4.6%, Girls: 0.8%). Nearly eighty percent of the study subjects knew that, tobacco consumption is injurious to health. The parents of 59% of the children discussed the harmful effects of tobacco consumption with their children.

A comparison of brief intervention versus simple advice for alcohol use disorders in a North India community-based sample followed for 3 months.

AIM: To examine the change in alcohol use parameters following a brief intervention (BI) based on the FRAMES protocol, compared to simple advice (SA), in a community setting in North India. METHOD: Ninety male subjects, 20-45 years old, with an AUDIT score between 8 and 24, consented to participate in this study. They were recruited from an earlier study on treatment, non-seeking, and allocated alternatively to the BI or SA protocols. The subjects were compared on drinking parameters, Addiction Severity Index (ASI), WHO Quality of Life (WHOQOL_Bref) and readiness to change (RCQ) after 1 month and 3 months post intervention. The assessments were made by an investigator blind to the intervention status of the subject. RESULTS: Of the 90 subjects, 87 (96.7%) were available for follow up in the first month and 86 (95.6%) in the third month. There was significant improvement across many drinking and QOL parameters in both the BI and SA groups, Significant differences were noticed across interventions, with a decrease in severity of dependence as measured by alcohol use in the last 30 days, composite ASI scores & improvement in physical and psychological quality of life, in those who received BI compared to those who received SA. Changes in motivation toward action were documented at first follow up, but were not sustained in either of the interventions. CONCLUSIONS: BI had a slight advantage over SA in excessive users of alcohol in this community setting in India. It is probable that booster sessions would be needed to achieve sustained effect.

Validation of the Alcohol Use Disorders Identification Test (AUDIT) in urban community outreach and de-addiction center samples in north India.

OBJECTIVE: The Alcohol Use Disorders Identification Test (AUDIT) developed by the World Health Organization for screening disorders related to alcohol use has been shown to have robust psychometric properties. This study compared the performance of AUDIT with that of the Short Michigan Alcoholism Screening Test (SMAST) in a region of North India. METHOD: A total of 297 consecutive subjects who had used alcohol in the past year were recruited from a de-addiction center (DAC) (n = 97) and a community outreach setting (n = 200) in West Delhi. Using International Classification of Diseases, Tenth Edition (ICD-10) criteria, the relative effectiveness of the AUDIT and the SMAST in identifying alcohol-use-related disorders was assessed and compared. Internal consistency and interscale correlations were evaluated, along with sensitivity, specificity and ROC curve analyses. RESULTS: The AUDIT had very high internal reliability (alpha 0.92) in this Indian sample. There was, in general, good correlation between the total and factor scores of the AUDIT and SMAST (ranging from 0.28 to 0.97), which were higher in the community than in the DAC sample. The AUDIT (area under the curve [AUC] = 0.883) and SMAST (AUC = 0.870) were similar in detecting harmful use of alcohol. The AUDIT optimal cutoff score was 16 (sensitivity 85.3, specificity 89.4) for ICD-10 harmful use and 24 (sensitivity 69.4, specificity 87.5) for ICD-10 alcohol dependence. CONCLUSIONS: The AUDIT and SMAST seem to be comparable in their ability to screen subjects with alcohol use disorders. The AUDIT score for screening harmful use in the sample appears to be higher than previously reported. The utility of such high cutoff for screening subjects for intervention is obvious, but it is quite likely that some positive cases might be missed.

Treatment nonseeking in alcohol users: a community-based study from North India.

OBJECTIVE: This study examined the reasons given for not seeking treatment by problem alcohol users who live close to a community outreach de-addiction center. METHOD: Consecutive households in the community were contacted, and inquiry identified 495 male family members who were using alcohol, 163 of whom reported use of alcohol in the previous year. Of these 163 subjects, the 79 who scored above the cut-off of > or = 8 on the Alcohol Use Disorders Identification Test were further evaluated using a semistructured interview schedule to determine their reasons for not seeking treatment. RESULTS: The majority (n = 40) considered alcohol use a "social" problem. Among the reasons for not seeking treatment, the two most commonly cited were "ashamed to admit problems" and "treatment does not help" in 26.5% (n = 21) and 22.8% (n = 18), respectively. CONCLUSIONS: The reasons for not seeking treatment for alcohol problems in this sample of Indian men resemble those cited in the literature. The data highlight the need for action to improve outreach to problem alcohol users.

Coping behaviors and relapse precipitants in opioid dependence: a study from North India.

This study was undertaken to evaluate the reasons for lapse, relapse and the coping behaviors in a group of recently abstinent subjects with opioid dependence. Retrospective qualitative and quantitative evaluation of the reasons for lapse, relapse and coping behaviors were done using structured questionnaires and semi-structured interviews. Eighty-four subjects from inpatient and outpatient settings of a Drug Dependence Treatment Centre, who had used illicit opioids after at least 3 weeks abstinence in the last 6-month period, were included. Coping behaviors, reasons for lapse and relapse were assessed and it was found that environmental factors are important for first use and physiological experiences related to drug use for regular use. There were significant differences in the use of coping behaviors by the currently abstinent and currently using subjects in the index abstinence. The study provides information about coping behaviors and reasons for lapse/relapse in an Indian setting.