Injecting drug users who want treatment.

This study examined characteristics of injecting drug users (IDUs) who want treatment and the features that differentiate them from IDUs who do not want treatment. Data were collected as part of a community-based HIV prevention project in San Antonio, Texas. Interviews were administered to 1,100 IDUs between February 1993 and May 1995. Interview topics included sociodemographics, drug use history, current drug use, treatment history, injection-related HIV risk behavior, sexual behavior, and previous contact related to HIV prevention. Multiple logistic regression analysis identified four factors independently associated with wanting treatment in the multivariate model. These were: (1) 30 or more injections per month; (2) being eligible for methadone maintenance; (3) 2 or more previous treatment admissions; and (4) being recruited after the first year of the project. Implications of these findings are discussed.

The relationship of methadone dose and other variables to outcomes of methadone maintenance.

The authors evaluated the relationship of methadone dose to retention in treatment and to urine tests for morphine and cocaine in a cohort of 610 opioid users admitted to methadone maintenance and followed for 1 year. Methadone dosing was flexible, with patient participation in dose decisions. The maximum dose during treatment ranged from 10 mg to 110 mg, with a mean of 52 mg. Higher doses were associated with increased retention through the dose range of 60 mg-69 mg. Dose was not related to the likelihood of a positive morphine test but was related to the likelihood of a positive cocaine test. In this study, with flexible dosing and patient participation in dose decisions, patients were retained on methadone about as well as was reported in a previous study with patients on a fixed dose of 80 mg.

The intravenous injection of illicit drugs and needle sharing: an historical perspective.

This study reviewed the literature on the history of needle sharing and intravenous drug abuse. Reports suggest that needle sharing was practiced by drug abusers as early as 1902 in China and 1914 in the United States. Intravenous drug abuse was first mentioned in the literature in 1925. However other references suggest that some opioid users were injecting intravenously prior to 1920. Outbreaks of malaria in Egypt, the United States, and China between 1929 and 1937 were attributed to needle sharing and intravenous injection of opioids. These reports suggest that both needle sharing and intravenous drug use were common by 1937. Factors such as medical use of intravenous injections, enactment and zealous enforcement of antinarcotic laws, and interactions among drug users in institutional settings such as regional hospitals and prisons may have contributed to the spread of both needle sharing and the intravenous technique among drug abusers.

Illicit drug injectors in three Texas cities.

In three Texas cities illicit drug injectors not in treatment were located by outreach and interviewed with a standard questionnaire. In all the cities the drug injectors were predominantly undereducated and unemployed young men from minority groups. In Dallas and Houston most were Black, while in San Antonio most were Hispanic. The most frequently reported primary drug in Houston was cocaine, but in Dallas and San Antonio it was heroin. The high needle risk for AIDS and the low rates of positive HIV antibody tests in these samples present a special window of opportunity for prevention of AIDS.

Methadone dose and urine morphine.

When methadone maintenance was introduced in 1965, daily doses of approximately 100 mg were advocated and used; later, doses under 50 mg became common; recently, doses between 50 and 100 mg have been recommended. In a historical study and a cross-section study in one program the authors found no relationship between methadone dose and urine morphine. Patients on methadone doses under 50 mg had nearly the same percentage of urine tests positive for morphine as did those on doses of 50 mg and more. Gender, ethnic background, and age were also unrelated to urine morphine. Time on methadone was inversely related to urine morphine. Patients maintained on methadone for 3 years or longer showed a marked decrease in urine tests positive for morphine. Increased urine morphine during one decade was associated with program and community changes that could have prompted increased heroin use. These findings suggest that variables other than methadone dose affect heroin use.

Designer drugs.

Designer drugs are synthetic analogs of substances with known psychoactive properties. These analogs are dangerous due to their direct pharmacological effects and the presence of toxic by-products that occur during synthesis. Three groups of designer drugs are reviewed (fentanyl, meperidine, and methamphetamine analogs), and their psychoactive effects and clinical presentations are described.

Patients who leave the hospital against medical advice: the role of the psychiatric consultant.

Previous studies have identified characteristics of patients who threaten to leave non-psychiatric units against medical advice, but few have described the role of the psychiatric consultant in the patient's decision. This study compared the medical records of 31 patients who threatened to leave the hospital against medical advice (AMA) and who were seen in consultation with the records of AMA-discharged patients who were not seen by a psychiatric consultant. Most patients who received consultations remained hospitalized or were discharged in regular fashion. Those seen soon after admission were most likely to stay. Patients were more likely to remain hospitalized if the consultant's recommendations had a practical, rather than a psychological, orientation.

Group psychotherapy for head and neck cancer patients.

The diagnosis of cancer has a profound emotional effect on the patient. We report the two-year experience of a weekly support group attended by 142 hospitalized head and neck cancer patients and 33 family members. The major goal for the group was to provide an open forum for discussion of any problems that faced the patient. Group size was usually four to eight patients and two to four therapists. Weekly data sheets documented attendance and major themes for the group. The most common theme was anticipation of and reaction to treatment. Initial difficulties with the group included ambivalence by the professional staff, low attendance, and logistical problems. Subjective impressions of the staff were that the group improved patients' morale, patient to patient support, compliance, and decreased the rate of discharge against medical advice.

Treatment outcomes of substance-abusing physicians.

Publications relating to outcome of physicians treated for substance abuse were obtained from a computerized literature search and a review of Cumulated Index Medicus for the years 1950-1982. The studies were reviewed regarding such factors as study location, sample size, presence of control groups, treatment modalities and setting, treatment duration, follow-up duration, method of determining outcome, and treatment outcome. Variations in these factors make comparisons of the studies difficult. Shortcomings in the methods of determining outcome raise questions concerning reliability of the data. Suggestions are made for further research for the assessment of treatment and outcome of substance-abusing physicians.