Medical use of cannabis: an addiction medicine perspective.

The use of cannabis for medical purposes, evident throughout history, has become a topic of increasing interest. Yet on the present medical evidence, cannabis-based treatments will only be appropriate for a small number of people in specific circumstances. Experience with cannabis as a recreational drug, and with use of psychoactive drugs that are prescribed and abused, should inform harm reduction in the context of medical cannabis.

Unusual presentations for pharmacotherapy-poppy seed dependence.

Two cases of patients presenting with opioid dependence who maintained their dependence with poppy tea are described. There appears to have been an increase in this practice in some groups, although dependent use is uncommon. These cases illustrate significant levels of dependence on a licit, and readily available, source of opiates requiring high doses of pharmacotherapy that match those typically required by individuals who are treated for heroin dependence.

Effects of carnitine supplementation on muscle metabolism by the use of magnetic resonance spectroscopy and near-infrared spectroscopy in end-stage renal disease.

BACKGROUND/AIM: A defect in skeletal muscle mitochondrial metabolism develops in patients with chronic renal failure on haemodialysis. Treatment with carnitine, a compound essential for normal mitochondrial function, has been suggested to have significant benefits in such patients, so we carried out a study to see if carnitine acts by improving muscle bioenergetics and function. METHODS: In a phase II randomised double-blind trial, patients with end-stage renal disease received placebo or intravenous L-carnitine (20 mg/kg dry body weight three times weekly after haemodialysis) for 16 weeks (n = 13 in each group). 31P magnetic resonance spectroscopy, 1H magnetic resonance imaging and near-infrared spectroscopy were used to measure muscle bioenergetics and function at baseline and at 16 weeks. RESULTS: There were no significant differences between groups at baseline. Mean plasma carnitine rose 10-fold in the carnitine group but was unchanged in the placebo group. L-carnitine had no statistically significant effect on any of the parameters measured. The rate of proton efflux from muscle, as a measure of tissue perfusion, was low in both groups and was not affected by treatment. CONCLUSIONS: The study failed to show any significant effect of 16 weeks' L-carnitine supplementation on these objective measures of muscle metabolism and function. Slow proton efflux from muscle provides evidence supporting low blood flow and, therefore, decreased oxygen availability, as an underlying mechanism for muscle mitochondrial dysfunction in this disorder.

Acute opioid withdrawal on accidental injection of naltrexone.

We report two 16-year-old female intravenous drug users who, after making purchases from street suppliers, both presented with symptoms of acute opioid withdrawal. Urine toxicology revealed naltrexone, a long-acting opioid antagonist used in detoxification and maintenance therapy in opioid dependence. While the safety and efficacy of opiate antagonist treatment is being debated, the present case highlights the vulnerability of this young population. The recent availability of non-prescribed opiate antagonists suggests that both health professionals and young people themselves need to be aware of their effects.

Adolescent alcohol and other substance use: sharing the Australian experience.

Substance use is common among adolescents. Although substance use may be a manifestation of experimentation in adolescent development, it may have more serious implications. It may be an indicator of emotional disturbance, or may be associated with several other health risk behaviours in adolescence. Substance use may also progress to harmful levels that can have a significant impact on a young person's health. Health professionals are increasingly being exposed to teenagers who use alcohol and drugs. The following article aims to provide, based on clinical and research experience in a number of institutions in Melbourne, Australia, an overview of the epidemiology of adolescent drug use, a clinical approach to assess substance use in young people and the principles of management of drug use in adolescence.

Adverse outcomes of alcohol use in adolescents.

AIMS: To compare the occurrence of behaviours occurring under the influence of alcohol in 16-17-year-olds and determine associated risk factors for the different behaviours. DESIGN/SETTING: Cross-sectional survey administered by laptop computers in secondary schools across the state of Victoria, Australia. MEASUREMENT/FINDINGS: The participation rate was 79%. Seventy per cent of participants drank alcohol; 17% of drinkers reported alcohol-related violence (accidents or injuries) and 15% reported problems relating to sex under the influence of alcohol (having sex and later regretting it or having had unsafe sex) in the previous 12 months. Males were more likely to report alcohol-related violence (20% compared to 14% females). Almost one in 10 young people reported having sex while under the influence of alcohol and later regretting it and 10% reported having had unsafe sex. There were no significant gender differences in the reporting rates of alcohol-related sexual risk taking (prop. cum. OR 1.1, 95% CI 0.68-1.9). For alcohol-related injuries, strong independent associations were found with dose of alcohol consumed (prop. cum. OR 2.3, 95% CI 1.3-4.0), frequency of alcohol consumption (prop. cum. OR 2.7, 95% CI 0.94-7.5), antisocial behaviour (prop. cum. OR 2.4, 95% CI 1.4-4.1) and peer drinking (prop. cum. OR 3.3, 95% CI 1.4-8.1). For alcohol-related sexual risk-taking, psychiatric morbidity (prop. cum. OR 4.1, 95% CI 1.9-9.0) and high frequency of alcohol consumption (prop. cum. OR 2.0, 95% CI 0.87-4.6) had strong independent associations. CONCLUSIONS: Physical injury and high-risk sexual behaviour under the influence of alcohol are common in teenagers. Alcohol-related physical injury appears closely related to patterns of alcohol consumption whereas alcohol-related sexual risk-taking is most closely associated with symptoms of depression and anxiety.

Putting harm reduction into an adolescent context.

Drug use is now widespread amongst Australian youth. Substance abuse and dependence are becoming increasingly significant health problems. Approximately 50% of 17-year-old Australians report regular consumption of alcohol and nearly 30% report tobacco smoking. The age of onset of substance use is reported to be decreasing. Between 1993 and 1995 the proportion of heroin users who had used the drug before the age of 16 years increased from 2% to 14%. The debate about youth substance use tends to be polarized between the views of Zero Tolerance and Legalization of drugs. The harm reduction approach spans between these two extremes. Examples of harm reduction strategies, such as education campaigns on safe injecting and needle exchange programs, have been effective in curbing the spread of blood-borne viruses such as HIV amongst intravenous drug using youth. The harm reduction approach, taking social context and developmental stage of the individual into account, may also be applied to adolescents at the less extreme end of the substance use spectrum. It is proposed that the harm reduction framework used in this way enables a rational, relevant and consistent response to contemporary youth substance use, aiming to minimize drug related harm.

Primary care assessment of a patient with an eating disorder.

Eating disorders have become commoner in young Australian women over the past two decades, making their presentation in general practice more likely. Eating disorders vary considerably in severity from brief single episodes to severe disorders with prominent weight loss or maladaptive behaviours. Assessment should therefore focus on estimating the severity of the disorder to indicate the most appropriate treatment approaches.