1/153. mortality associated with new south wales methadone programs in 1994: lives lost and saved.OBJECTIVES: To estimate the effects of methadone programs in new south wales on mortality. DESIGN AND CASES: Retrospective, cross-sectional study of all 1994 new south wales coronial cases in which methadone was detected in postmortem specimens taken from the deceased. Cases were people we identified as patients in NSW methadone maintenance programs or those whose deaths involved methadone syrup diverted from maintenance programs. OUTCOME MEASURES: Relative risks of fatal, accidental drug toxicity in the first two weeks of treatment and later; the number of lives lost as a result of maintenance treatment; preadmission risks and the number of lives saved by maintenance programs, calculated from data from a previous study. RESULTS: There was very close agreement between this study's classifications and official pathology reports of accidental drug toxicity. The relative risk (RR) of fatal accidental drug toxicity for patients in the first two weeks of methadone maintenance was 6.7 times that of heroin addicts not in treatment (95% CI RR, 3.3-13.9) and 97.8 times that of patients who had been in maintenance more than two weeks (95% CI RR, 36.7-260.5). Despite 10 people dying from iatrogenic methadone toxicity and diverted methadone syrup being involved in 26 fatalities. In 1994, NSW maintenance programs are estimated to have saved 68 lives (adjusted 95% CI, 29-128). CONCLUSIONS: In 1994, untoward events associated with NSW methadone programs cost 36 lives in NSW. To reduce this mortality, doctors should carefully assess and closely monitor patients being admitted to methadone maintenance and limit the use of takeaway doses of methadone.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/153. Intravenous injection of talc-containing drugs intended for oral use. A cause of pulmonary granulomatosis and pulmonary hypertension.Clinical and morphologic features are described in two patients known to have repeatedly injected intravenously talc-containing drugs intended for oral use. In one patient severe pulmonary hypertension developed; the talc granulomas in him were located predominantly within the pulmonary arteries. The second patient had normal pulmonary arterial pressures, and the talc granulomas in him were located predominantly in the pulmonary interstitium. Of 19 previously described patients with pulmonary talc granulomas, 12 had morphologic evidence of pulmonary hypertension (in three of severe degree); in each, talc granulomas were located predominantly within the pulmonary arteries. In those without signs of pulmonary hypertension, granulomas were located predominantly in the pulmonary interstitium. Why there are differences in the distribution of the talc granulomas is unclear. It is clear, however, as demonstrated by one of our patients, that severe pulmonary hypertension may be a consequence of intravenous injection of drugs intended for oral use.- - - - - - - - - - ranking = 2keywords = drug (Clic here for more details about this article) |
3/153. Working and "drugging" in the city: economics and substance use in a sample of working addicts.employment status is often treated as a "risk factor" in epidemiologic studies of drug use. The process that underlies the supposed relationship has remained, however, essentially unexamined. This article uses life history data to look at the relationship between work and drug use in a sample of addicts from baltimore City, maryland. The narratives constructed by these individuals demonstrate that the processes involved in creating and maintaining drug- and nondrug-related identities are neither linear nor straightforward. Rather, managing complex, emergent identities is a product of the economic situation, the organization of the drug scene, and the larger milieu in which these addicts operate.- - - - - - - - - - ranking = 3keywords = drug (Clic here for more details about this article) |
4/153. Inhaled heroin-induced status asthmaticus: five cases and a review of the literature.We report five cases of status asthmaticus (four requiring mechanical ventilation) that were triggered by inhaled heroin and review the pertinent literature. These cases share common features of sudden and severe asthma exacerbations temporally related to heroin use, stress the importance of considering illicit drug use in like cases, and call attention to a public health issue.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
5/153. Managing addiction in advanced cancer patients: why bother?The management of addiction in patients with advanced cancer can be time-consuming, labor-intensive, and difficult. Some clinicians believe that it is not worth the effort, due in part to a failure to appreciate the deleterious impact of addiction on palliative care efforts and a view of addiction as intractable in any case. Indeed, it is possible that some clinicians perceive addiction not only fatalistically but, because of common misconceptions, believe that managing or attempting to decrease the patient's use of alcohol or illicit substances would be tantamount to depriving a dying patient of a source of pleasure. In this paper, we argue that managing addiction is an essential aspect of palliative care for chemically-dependent and alcoholic patients. The goal of such efforts is not complete abstinence, but exerting enough control over illicit drug and alcohol use to allow palliative care interventions to decrease suffering. To illustrate this view, we describe two patients with chemical-dependency. We highlight the impact of unchecked substance abuse on patients' perpetuation of their own suffering, the complication of symptom management, the diagnosis and treatment of mood/anxiety disorders, and the effect on the patients' family and caregivers.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
6/153. Disciplining addictions: the bio-politics of methadone and heroin in the united states.Biomedical understanding of methadone as a magic-bullet pharmacological block to the euphoric effects of heroin is inconsistent with epidemiological and clinical data. An ethnographic perspective on the ways street-based heroin addicts experience methadone reveals the quagmire of power relations that shape drug treatment in the united states. The phenomenon of the methadone clinic is an unhappy compromise between competing discourses: A criminalizing morality versus a medicalizing model of addiction-as-a-brain-disease. Treatment in this context becomes a hostile exercise in disciplining the unruly misuses of pleasure and in controlling economically unproductive bodies. Most of the biomedical and epidemiological research literature on methadone obscures these power dynamics by technocratically debating dosage titrations in a social vacuum. A foucaultian critique of the interplay between power and knowledge might dismiss debates over the Swiss experiments with heroin prescription as merely one more version of biopower disciplining unworthy bodies. Foucault's ill-defined concept of the specific intellectual as someone who confronts power relations on a practical technical level, however, suggests there can be a role for political as well as theoretical engagement with debates in the field of applied substance abuse treatment. Meanwhile, too many heroin addicts who are prescribed methadone in the united states suffer negative side effects that range from an accentuated craving for polydrug abuse to a paralyzing sense of impotence and physical and emotional discomfort.- - - - - - - - - - ranking = 0.66666666666667keywords = drug (Clic here for more details about this article) |
7/153. Fatal falciparum malaria among narcotic injectors.Eleven narcotic injectors from a prison in Saigon were hospitalized with falciparum malaria. coma and intense parasitemia were common and eight patients died soon after admission. Two of three autopsied cases also had purulent pulmonary infections. No non-addicted prisoners were hospitalized for malaria. Nine more unsuspected falciparum infections were found among 29 other addicts in the prison. The clustering of malaria infections among narcotic injectors who had not been in malarious areas indicates that the malaria was transmitted by the common use of needles and syringes. Cerebral malaria in an addict may be misdiagnosed as drug intoxication. malaria surveillance is recommended for the increasing addict population in the cities of Southeast asia.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
8/153. Benefits of linking primary medical care and substance abuse services: patient, provider, and societal perspectives.Individuals with alcohol and drug use problems may receive health care from medical, mental health, and substance abuse providers, or a combination of all three. Systems of care are often distinct and separate, and substantial opportunities for benefit to patient, provider, and payer are missed. In this article, we outline (1) the possible benefits of linking primary care, mental health, and substance abuse services from the perspective of the major stakeholders-medical and mental health providers, addiction clinicians, patients, and society-and (2) reasons for suboptimal linkage and opportunities for improving linkage within the current health care system. We also review published models of linked medical and substance abuse services. Given the potential benefits of creating tangible systems in which primary care, mental health, and substance abuse services are meaningfully linked, efforts to implement, examine, and measure the real impact should be a high priority.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
9/153. Hepatitis after intravenous buprenorphine misuse in heroin addicts.BACKGROUND: Sublingual buprenorphine is used as a substitution drug in heroin addicts. Although buprenorphine inhibits mitochondrial function at high concentrations in experimental animals, these effects should not occur after therapeutic sublingual doses, which give very low plasma concentrations. case reports: We report four cases of former heroin addicts infected with hepatitis c virus and placed on substitution therapy with buprenorphine. These patients exhibited a marked increase in serum alanine amino transferase (30-, 37-, 13- and 50-times the upper limit of normal, respectively) after injecting buprenorphine intravenously and three of them also became jaundiced. Interruption of buprenorphine injections was associated with prompt recovery, even though two of these patients continued buprenorphine by the sublingual route. A fifth patient carrying the hepatitis c and human immunodeficiency viruses, developed jaundice and asterixis with panlobular liver necrosis and microvesicular steatosis after using sublingual buprenorphine and small doses of paracetamol and aspirin. CONCLUSIONS: Although buprenorphine hepatitis is most uncommon even after intravenous misuse, addicts placed on buprenorphine substitution should be repeatedly warned not to use it intravenously. Higher drug concentrations could trigger hepatitis in a few intravenous users, possibly those whose mitochondrial function is already impaired by viral infections and other factors.- - - - - - - - - - ranking = 0.66666666666667keywords = drug (Clic here for more details about this article) |
10/153. clonidine abuse among opiate addicts.OBJECTIVE: To determine if clonidine abuse among non-pregnant opiate dependent individuals is common and the reason for such use. METHOD: self report of personal use or knowledge of others' use of this drug. RESULTS: Fourteen of fifteen treatment seeking individuals with opiate dependence knew of clonidine abuse. Ten had used it personally to decrease the amount of heroin necessary to achieve a desired effect and to prolong the length of the opiate's action. CONCLUSION: clonidine abuse among opiate addicts may be more common than previous studies have suggested. Opiate addicts should be screened for abuse of this substance, especially in view of its widespread use for the purpose of opiate withdrawal. Further, such patients should be warned of potential health hazards attendant upon clonidine use and abrupt cessation.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
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