Objective: In-treatment and post-treatment outcomes were compared for three detoxification procedures (lofexidine+naloxone, lofexidine+placebo naloxone, and methadone).Sample and design: The sample was 137 opiate dependent in-patients. Detoxification treatments were 6-day lofexidine+naloxone (n = 45), lofexidine+placebo naloxone (n = 46), or 10-day methadone reduction (n = 46). A cohort study design was, used with double-blind random allocation to lofexidine+naloxone versus lofexidine+placebo. Patients who did not consent to, or who were excluded from randomisation received methadone.Results: Outcome differences between treatment groups at follow-up were generally associated with length of stay post-detoxification rather than detoxification procedure. Among patients who were not opiate abstinent throughout follow-up (n = 85), those who received lofexidine+naloxone detoxification reported a longer interval to first heroin use, with an interaction between detoxification medication and subsequent retention in treatment also identified.Conclusions: Detoxification medication may influence medium-term opiate use outcomes via its effect upon retention in treatment. (c) 2006 Elsevier Ireland Ltd. All rights reserved.

The article uses a semi-structured interview method to assess the acquisition, preparation and use of heroin in a cohort of 114 drug users in contact with treatment services in south-east London. and examines the impact of the increase in crack availability on heroin use and preparation in this population. Seventy-six participants reported using heroin on a daily basis, involving an average of 2.8 hits and using a mean of 0.75 g on each using day. Although almost all of the sample bought their own heroin. very few were confident of assessing its quality, and the mean estimated purity level of heroin bought was 22.7%. Similarly, most of the sample believed that the heroin purchased was adulterated and, although most believed that the heroin quality was evident during the preparation stage, relatively few would ask about quality at the point of purchase. and it is apparent that the beliefs held by much of the sample about drug purity issues did not impact upon their behaviour. Seventy individuals reported the joint use of heroin and cocaine with 41 of these reporting that they used heroin to come down from the high of crack, although 17 of them reported simultaneous administration (either combined in the syringe or on the foil). The variations in patterns of behaviour identified and the lack of awareness of risk reported would suggest that there are significant implications for the development of both the harm reduction strategies for multiple drug users and for the treatment services for whom complex multiple drug use is increasingly the norm.

Sleep disturbance experienced during methadone or lofexidine opiate detoxification was investigated in 118 opiate-dependent patients receiving inpatient detoxification treatment. Sleep was assessed at four time-points during opiate detoxification using a self-report questionnaire. Maximum sleep disruption occurred at completion of detoxification and during the protracted withdrawal period, with patients in the methadone group reporting higher levels of withdrawal symptoms, lower overall sleep, longer sleep latencies and significantly longer periods of time awake than lofexidine patients. Regression analyses demonstrated a significant relationship between sleep disturbance, protracted withdrawal and retention in treatment, in addition to the major treatment benefit of reduced sleep disturbance conferred by lofexidine treatment.

The efficacy of lofexidine/naloxone was compared with lofexidine/placebo in a double-blind, randomized, placebo-controlled trial in 89 opiate-dependent patients. There were no significant differences between the two groups in the proportion of patients completing detoxification or in the length of stay. Patients in the active naloxone group demonstrated gradual reductions in levels of withdrawal and craving over the detoxification period. At completion of detoxification, patients who received naloxone maintained a level of withdrawal consistently lower than that in the placebo group; however, naloxone did not substantially accelerate the resolution of the withdrawal syndrome. Implications for future research are discussed.

to countries with better provision of intensive care units.However, for the United Kingdom, non-invasive ventilation for patients with mild to moderate acidosis due to decompensated chronic obstructive pulmonary disease is a highly effective technique that improves clinical outcomes, reduces demand for intensive care, and, from the hospital's perspective, reduces costs.We thank Professor Christine Godfrey, Centre for Health Economics at the University of York, for advice on methods; Amanda Farrin and Vicky Allgar for statistical advice; ResMed

One hundred and eight opiate addicts attending an in-patient opiate treatment unit were interviewed, using a mixed quantitative–qualitative approach, to investigate their experiences of witnessing overdoses, the associated interpretations and perceived cause of the overdose. Poly drug use and frequency of witnessed overdose was high among the sample. Use of 14 different combinations of drugs were reported, 8 of which involved the use of alcohol, and 7 benzodiazepines. Perceived cause of overdose involved attributions relating to the use of alcohol, in particular strong lager, small quantities of heroin and low levels of current opiate tolerance. Peer initiated resuscitation techniques revealed a range of responses from the probably valuable (recovery position, summon ambulance, administer naloxone) to the ineffective or frankly harmful (injecting with salt solution, immersing in a cold bath). The findings highlight the need for an overdose prevention program during in-patient detoxification and rehabilitation.

One hundred and sixteen opiate addicts attending treatment services in south London were interviewed about their drug use patterns. In the month before interview, 90% reported heroin use, while 60% had used crack cocaine and 58% alcohol. In the same period, 70% of participants reported multiple drug use, particularly concurrent heroin and crack cocaine use. Of the patients who reported using other drugs with heroin, two-third used crack cocaine, 11% diazepam, 9% methadone and 8% cocaine powder. Twenty-six per cent of crack users sample had injected crack cocaine, which provides confirmation of the increasing prevalence of this recent trend in studies using similar samples. Male participants were significantly more likely to use benzodiazepines with heroin, while women were more likely to use crack alongside heroin (and used larger quantities). These findings have implications for the treatment and management of multiple drug users, for whom opiates may be only a part of their drug-using repertoire.