Drug dependence with oestrogen replacement therapy.

Dependence on some drugs can be hard to recognize. Hormone replacement therapy (HRT) has been widely prescribed only in the past two decades, and the indications for treatment and the risk/benefit ratio are still disputed. Oestrogens are psychoactive: they lift mood, can be given by injection, and their use has powerful psychological effects. Reports of women with supraphysiological oestradiol concentrations may represent tolerance and withdrawal. Dependence on substances occurring naturally in the body has been reported before. We propose that HRT dependence occurs.

In-patient treatment for drug abuse.

During 1984 there were 253 admissions to the in-patient drug dependence treatment unit at Tooting Bec Hospital. Of the 198 patients responsible for these admissions, 60% were male and 43% were over the age of 30 years. There were 151 patients admitted for opiate detoxification, and 75% completed the withdrawal schedule. However, only 15 out of 25 patients admitted for benzodiazepine withdrawals were found to be physically dependent. Other reasons for admission included stabilisation of the dose of opiate (24%) and the treatment of physical complications of addiction.

Mydriatic response to topical naloxone in opiate abusers.

Naloxone hydrochloride eyedrops 1 mg/ml dilated the pupils of 36 out of 47 opiate addicts on methadone maintenance treatment, without precipitation of acute withdrawal effects, but not those of healthy unmedicated subjects. The response in addicts was attenuated by certain ancillary treatments and by withdrawal of methadone treatment. The size of the response suggests some potential clinical use for topical naloxone as a diagnostic test of current opioid influence and possibility of physical dependence. The local mydriatic response, which was restricted to the treated eye, indicates that the effect of opiates on the pupil in man is determined, at least in part, by a peripheral action.

"New chronic" patients.

A five-year follow-up of 1467 mental hospital patients showed that 501 had died, 449 had been discharged, and 517 were still resident. During this period 81 "new chronic" patients aged under 65 were admitted: 49 were readmissions and 15 of 32 first admissions had had previous periods in other psychiatric hospitals. Many new chronic patients were old chronic with intervals of community care, and one-third of them were likely to require permanent care. These findings provide no comfort for those who believe that present DHSS plans for mental health services can ever be realised.

Patients working out from a psychiatric hospital.

Outside employment was obtained by 630 resident male patients who had 1447 admissions to a South London Hospital between 1963 and 1969. This "working out" group were compared with all male patients admitted to the hospital during the same period and with a national sample from the Mental Health Enquiry for 1969. The working patients had 827 spells of employment working for 742 employers, 75% of whom had employed only 1 patient for 1 spell of employment. A quarter of all male patients under 65 had worked out from the hospital over the seven years, approximately 90 out of 320 new admissions annually. This group were the younger patients admitted. The most frequent length of employment before discharge was 1--4 weeks. Patients with the diagnosis of alcoholism (the largest group in the sample) had shorter admissions and working out period than those with schizophrenia. The value of "working out" is discussed.

Delinquency by opiate addicts treated at two London clinics.

455 male and 120 female opiate addicts were treated at two London drug dependence clinics between 1968 and 1975. The delinquency pattern of 117 female addicts and of a systematic sample of 119 male addicts was analysed in relation to stages of their addiction career and outcome. Treatment had no effect on overall crime rate but there was a significant increase in the proportion of drug offences during the treatment stage. Comparisons between the sexes showed that the outcome of treatment was worse in women. In male addicts a history of delinquency had no prognostic significance, but in females convictions for non-drug offences before entering treatment might predict poor response to treatment of drug dependence.

Outcomes of 575 British opiate addicts entering treatment between 1968 and 1975.

Five hundred and seventy-five opiate addicts (455 male, 120 female) who were treated at two clinics in London between 1968 and 1975 had their current situation reviewed in October 1975. Fifty-two per cent were still in treatment (258 at the clinics, 42 elsewhere), 28 per cent were not in treatment and not known to be using opiates, 11 per cent had died, 6 per cent were in custody and 3 per cent had left the country. Sixty-one per cent of the patients in treatment had remained so continuously. Twenty-eight per cent had also had in-patient hospital treatment. Some patients were very unstable and those treated as in-patients in hospital two or more times for drug abuse had an average of nine hospitalizations. Forty-six per cent of patients in clinic treatment said they were working regularly at the end of the study (23 per cent at entry). Some 7-8 per cent of patients left treatment each year and the death rate remained between 2 and 3 per cent each year. The prescribing of heroin for addicts was gradually superseded by the prescribing of injectable methadone. The authors concluded that a methadone maintenance programme probably had some value in the treatment of opiate dependence.

Conning the general practitioner--how drug-abusing patients obtain prescriptions.

A sample of 100 patients attending drug dependence clinics was questioned about the methods they used to obtain psychotropic drugs from general practitioners. Sixty-one per cent said they were obtaining psychotropic drugs and 39 per cent said they had obtained psychotropic drugs from this source during the preceding 12 months. Drugs obtained included minor tranquillisers, barbiturates, amphetamines, and methylphenidate (;Ritalin'). Some degree of deception of the general practitioner by the patient was almost always clear. Three recommendations to help prevent this are suggested.

Hospital doctors' career structure and misuse of medical womanpower.

Biological and culturel differences between men and women lead to severe discrimination against women doctors who bear the burdens of pregnancy, child-rearing, and housework. These lead, from equality within medical school and at qualification, to increasing failure to obtain posts commensurate with their innate abilities. Women doctors who temporarily and partially drop out of full-time practice have been studied frequently, but men (who are equally expensive to train) have not, despite their disappearing from National Health Service practice through emigration, death, alcoholism, suicide, or removal from the Medical Register. In a working lifetime of forty years, a woman doctor with an average family is likely to do seven-eighths of the work of a doctor who has not had to carry the primary responsibility of bearing and rearing children. Doctors with dependants are handicapped, and a separate career structure might be set up for them. Supernumerary consultant posts are proposed.