Chronic use of prescription opioids and initiation of injecting drug use

24 Feb 2022Registered users

The risk of initiating injecting drug use is eight times higher for patients who receive long-term prescription opioid medication for non-cancer pain compared with that of opioid naïve patients, a large retrospective cohort study from Canada has found. However, the five-year cumulative probability of injecting drug use initiation in this group was only 4%.

Naltrexone lowers hospital admissions in alcohol use disorder

27 Oct 2021Registered users

The risk of hospitalisation for an alcohol-related or other cause is lower when patients with alcohol use disorder are treated with naltrexone alone or in combination with disulfiram or acamprosate, a nationwide Swedish study has found. However, acamprosate monotherapy was associated with an increased risk of hospital admission for an alcohol-related cause.

Increased risk of attempted suicide in young problem gamblers

21 Feb 2021Registered users

Men and women, under the age of 25, with problem gambling are at increased risk of trying to take their own lives, a UK study has found.

Which treatments are effective for maintaining abstinence from alcohol in primary care?

25 Jan 2021Registered users

Acamprosate was the only intervention with evidence that it was better than placebo in maintaining alcohol abstinence for up to 12 months, following detoxification, in a network meta-analysis.

Engagement with HCV therapy linked to lower deaths from all causes in injecting drug users

27 Oct 2020Registered users

Engagement with hepatitis C treatment by people who inject drugs is associated with a lower risk of all-cause mortality and drug-related death, a study set in Scotland has found.

Patient safety incidents in opioid substitution therapy analysed

24 Jul 2020Registered users

Errors in prescribing, supervised or non-supervised dispensing, and monitoring and communication were responsible for patient safety incidents in opioid substitution treatment, a study from England and Wales has shown.

Increased risk of fatal overdose or suicide associated with stopping opioids

25 May 2020Registered users

Ceasing treatment with opioids is associated with an increased risk of death from overdose and suicide, an observational study from the United States has found.

Most deaths in patients on methadone are not drug related

23 Jan 2020Paid-up subscribers

Non drug-related morbidities are the most common cause of death as methadone-treated opioid dependent patients age, a study from Scotland has found. The study authors used information from the Community Health Index and data on methadone prescriptions held within the Scottish National Prescribing Information System for 36,606 patients who had received one or more methadone prescriptions between 2009 and 2015.

Tramadol associated with longer use of opioids after surgery

24 Jun 2019Paid-up subscribers

A study from the United States has found that patients prescribed tramadol for postoperative pain have a higher risk of prolonged opioid use relative to those given other short-acting opioids.

Alcohol use disorder affects offspring’s behaviour in adulthood

25 Mar 2019Registered users

Parental alcohol use disorder is associated with an increased likelihood of marriage to a spouse with alcohol use disorder, a Swedish population-based study has found. In particular, daughters of affected mothers were more likely to have an affected spouse.

Deaths associated with opioid overdose increase

22 Feb 2019

A study from Ontario, Canada, has found that prescribed, diverted and illicit opioids all play an important role in the recent increase in opioid-related deaths.

Childhood trauma raises risk of drug misuse later on

23 Jan 2019Registered users

Individuals who suffer abuse as children are more likely to use marijuana or cocaine later in life, a study from the United States has found.

Patients prescribed opioids for analgesia at risk of dependence

25 Jul 2018Registered users

A systematic review and meta-analysis has estimated that the incidence of iatrogenic opioid dependence or abuse in patients prescribed opioids for pain is almost 1 in 20.

Marked regional variations identified in primary care opioid prescribing

23 Apr 2018Registered users

Opioid prescribing rates are increasing and show notable geographical variations across England. They are highest in the North and in areas of social deprivation, a study on primary care prescribing has shown. Virtually all the low prescribing areas were in the south of England and nine of the ten highest prescribing areas were northern clinical commissioning groups (CCGs).

Benzodiazepines and Z-drugs are being widely used long term

23 Jan 2018Registered users

A UK primary care survey has found that many patients are taking benzodiazepines or Z-drugs, recommended for short-term use, for at least a year.

Are differing emotional responses to alcohol associated with choice of drink?

20 Dec 2017Paid-up subscribers

Emotional responses to drinking appear to vary according to the type of drink imbibed and differ between men and women, an analysis of data from the Global Drug Survey (GDS) has found.

Mortality risk raised during induction with methadone in opioid substitution therapy

23 Nov 2017Paid-up subscribers

Patients undergoing opioid substitution treatment have an increased mortality risk during the induction phase with methadone but not with buprenorphine, a meta-analysis has found. Mortality risk is also raised in the period immediately after leaving treatment with both drugs.

Gambling linked to mental health problems

22 Jun 2017Registered users

Patients with depression and those who drink at risky levels are more than twice as likely to report gambling problems, a UK primary care study has shown.

Benzodiazepine and opioid co-prescribing raises risk of opioid overdose

24 Apr 2017Paid-up subscribers

Stopping concurrent benzodiazepine and opioid prescribing could reduce the risk of inpatient admissions for opioid overdose and attendance at emergency departments by 15%, a study from the US has found.

Drinking levels in young women are approaching those of men

15 Dec 2016Paid-up subscribers

The traditional gender difference in alcohol misuse and alcohol-related harm, where men have been at much higher risk than women is changing, a recent study has confirmed.

Continuing in methadone treatment associated with reduced risk of death

23 May 2016Registered users

Risk of mortality from all causes increases following cessation of methadone substitution treatment, a study in Addiction has confirmed. The risk was highest during the first four weeks after stopping treatment.

Alcohol sales and drinking related injuries presenting to A&E

22 Dec 2015Paid-up subscribers

Higher volume sales from off-premises and the number of local on-premises alcohol outlets were associated with increased risk of A&E attendance with drinking-related problems, in a study from Australia. The risk was substantially increased when extended hours trading was in place.

Benzodiazepine use raises risk of fatal overdose in patients treated with opioid analgesics

05 Aug 2015Registered users

The use of benzodiazepines is strongly associated with death from drug overdose in veterans receiving opioid analgesics, a large study from the USA has found.  The study applied to a mostly male cohort of veteran patients. GPs need to bear in mind that prescribed benzodiazepine use is a risk marker for death from overdose in their patients who are prescribed opioid analgesics. The authors suggest considering the option of providing naloxone for emergency use by carers in high-risk cases.

High rate of undiagnosed hepatitis C among current and former drug users

05 Aug 2015Registered users

More than half of those who have ever injected drugs (PWID) in Scotland have hepatitis C (HCV) and six out of ten remain undiagnosed, a modelling study has estimated. Case finding is essential both from the individual health and public health perspectives. Much of this will be undertaken in drug services. The study shows that a high proportion of undiagnosed cases are no longer injecting and are in an older age group, and so may no longer be in contact with drug services. Doctors working in primary care may need to take a more active role in case finding. ‘Targeting older individuals with a history of injecting drug use though primary care can also be an effective case-finding approach,’ the authors state.

Do anabolic steroids cause violent behaviour?

21 May 2015Paid-up subscribers

Violent offending appears to be associated with the combined misuse of multiple substances rather than anabolic androgenic steroids per se, a large study from Sweden has found.

Long working hours associated with increased drinking levels

23 Feb 2015Paid-up subscribers

People who work long hours are more likely to increase their drinking to levels that pose a health risk, a systematic review and meta-analysis published in the BMJ has found. Data were analysed from 36 published studies, of which 34 were cross sectional and two prospective, as well as unpublished individual participant data from 27 other cross-sectional studies.

Can hepatitis C infection be managed in primary care?

25 Jul 2014Registered users

With appropriate training and supervision GPs could treat patients with hepatitis C in the community, a systematic review has concluded.The researchers searched a range of medical databases (including Medline, Cinahl, PsycINFO, Cochrane, Web of Science and Embase) for studies that evaluated antiviral treatment for hepatitis C either initiated or maintained by GPs, published between 2000 and 2013.

Case finding for hepatitis C in general practice

23 Jun 2014Paid-up subscribers

Identifying, and testing, patients at risk of hepatitis C (HCV) infection by GPs mainly focuses on people who inject drugs (PWID) but migrants from medium- or high-prevalence countries are often overlooked, a UK study has found. Six GP practices in Bristol, serving a total population of 73,814 patients, took part in the study. Three had a high prevalence of PWID and three a low prevalence.

Exploring GPs’ views on prescribing opioids for chronic non-cancer pain

22 Apr 2014Paid-up subscribers

GPs have concerns about prescribing strong opioids for chronic non-cancer pain (CNCP), a qualitative study has shown. The issue most cited was the potential for development of tolerance and dependence. Seventeen GPs from the South West of England were interviewed individually about their current prescribing practices using semi-structured interviews. Information was supplemented through a focus group meeting involving another five GPs. Transcripts of the interviews and focus group were analysed by thematic analysis.

Overdose education programmes reduce death rates

20 Mar 2014Paid-up subscribers

Overdose education and nasal naloxone distribution (OEND) programmes can reduce mortality rates from opioid overdose, a study from the USA has shown. A controlled observational study of the implementation of OEND programmes was carried out in communities with a high prevalence of opioid overdose in Massachusetts. Communities with little or no OEND enrollment served as controls.

Improving outcomes in opiate substitution therapy

22 Jan 2014Paid-up subscribers

Continuous uninterrupted opiate substitution treatment for heroin users is the best predictor of drug-free discharge, a UK primary care-based study has shown. The prospective longitudinal cohort study was set in a GPwSI-led community drug service in Sheffield. Of 128 eligible patients entering treatment for opiate dependence in 1999, 123 were interviewed at baseline, with follow-up at one, five and 11 years. The Opiate Treatment Index was used as the primary assessment tool, and has outcome domains including drug use, BBV risk-taking behaviour, social functioning, criminal behaviour, health status and psychological wellbeing.

Liver checks could help reduce harmful drinking

05 Dec 2013Paid-up subscribers

Offering simple liver tests combined with feedback, information and advice, resulted in a significant reduction in problem drinking in at-risk patients. Patients aged 25-54 years from nine GP practices in the South West of England were sent an AUDIT questionnaire, the gold standard for identifying harmful and hazardous drinking.

Male injecting drug users who have sex with men at greater risk of HIV

24 Jun 2013Registered users

Men who inject drugs (IDUs) and have sex with men (MSM) have a four-fold higher risk of HIV than those who only have sex with women (MSW), a national survey has found. Prevalence of hepatitis C (HCV) was also a third higher in the former group. IDUs in England, Wales and Northern Ireland have been recruited into a voluntary unlinked anonymous cross-sectional survey annually since 1990. The survey includes an oral swab for HIV and HCV and a questionnaire on demographics and risk behaviours. A total of 8,671 male IDUs who reported having had sex and injecting drug use in the previous 12 months took part in the survey for the first time between 1998 and 2007. Median age was 29 and median period of injecting drug use seven years.

Comparing brief interventions to reduce harmful drinking

25 Apr 2013Paid-up subscribers

More detailed interventions for harmful drinking offer no advantage over simple feedback and written information, an English general practice study has found.

Use of opiate substitution linked to fall in HIV transmission

21 Feb 2013Registered users

Methadone treatment was associated with more than a 50% reduction in the risk of HIV transmission in injecting drug users, in a meta-analysis published in the BMJ.

Selecting first line treatment for opiate detoxification

28 Jan 2013Paid-up subscribers

Buprenorphine and methadone appear equally effective in achieving abstinence from opioids, a prison-based study has found.

Driving under the influence of cannabis doubles risk of fatal collisions

12 Dec 2012Paid-up subscribers

People who drive after using cannabis are twice as likely to be involved in a crash resulting in serious injury or death than those who drive while unimpaired, according to a meta-analysis in the BMJ.

Mildly raised ALT levels may point to hidden hepatitis C

12 Dec 2012Paid-up subscribers

Patients with slightly elevated alanine aminotransferase (ALT) levels are at increased risk of hepatitis C infection and should undergo further investigation, a study from the Netherlands has concluded.

Deaths from opioid pain killers soar

25 Feb 2012

The mortality rate from opioid analgesics has increased fourfold over the past decade in the United States, a national study, published in JAMA, has found. Reviewing the study, Dr Jez Thompson concludes, 'This paper clearly identifies rapid growth in the prescribing of opioid analgesics in the United States over the past decade, with a large parallel increase in related morbidity and mortality, leading the authors to claim that death from prescribed opioid pain relievers is now "an epidemic". Prescribers in the UK need to remain acutely aware of the dangers of prescribed opioid analgesics, while safeguarding legitimate access to treatment. This paper echoes current clinical guidance and recommends use of opioid analgesics only in carefully screened and monitored patients when non-opioid treatments have not been effective.

Cannabis use raises risk of incident psychotic symptoms

09 Aug 2011Registered users

The use of cannabis in young people is an independent risk factor for the development of incident psychotic symptoms, a prospective cohort study has found. Data were analysed on 1,923 subjects drawn from the Early Developmental Stages of Psychopathology Study in Germany. Participants were aged 14-24 years, mean 18.3, at entry and followed up for 10 years. Dr Jez Thompson writes: 'The authors conclude that cannabis is a risk factor for the development of incident psychotic symptoms and that continued use of cannabis might increase the risk of psychotic disorder by impacting on the persistence of normally transitory psychotic symptoms in young people.'

Deaths from methadone overdose fall

24 Jan 2011Registered users

The introduction of supervised methadone administration was followed by a reduction in deaths due to methadone overdose in England and Scotland. Deaths related to methadone declined four-fold in both countries, while methadone prescribing increased substantially, between 1993 and 2008.The past two decades have seen rapid growth in methadone prescribing for the management of heroin dependence and widespread adoption of supervised administration of methadone by pharmacists. The authors took the total quantity of methadone prescribed annually, and divided this by 60 mg (the approximate average daily dose) to give an estimate of the number of daily dispensed doses in a given year. This figure was then analysed with the number of deaths identified by coroners as involving methadone (both as the only drug involved, and when methadone was one of a number of substances), between 1993 and 2008. 'The study found that the OD4 index decreased substantially in both Scotland and England despite large increases in methadone prescribing. In England, for example, the OD4 for methadone-only deaths fell from 27.1 in 1993 to 5.8 in 2008, in a period when methadone prescribing increased seven-fold. In Scotland the respective values fell from 19.3 to 3.0 over the same period and methadone prescribing increased 18-fold. The study does not address any other potential cause for the decrease in fatal overdose rates apart from the introduction of supervised methadone dosing. However, it provides good evidence that methadone prescribing has become increasingly safe with the adoption of supervised administration. The OD4 provides a useful tool for monitoring any future changes.'

Abstinence from alcohol associated with anxiety and depression

15 Dec 2009Registered users

A large, prospective, population-based study has shown that people who drink no or little alcohol are at increased risk of anxiety and depression. Data on a sample of 38,390 people taking part in the HUNT study, in Norway, were analysed. Subjects filled in a questionnaire on alcohol intake which was based on the amount of alcohol consumed over the past two weeks. Anxiety and depression were measured using HADS. 'While the study demonstrates an association between low alcohol consumption and symptoms of anxiety and depression, limitations of the study mean that the causality of the relationship cannot be addressed. Possible causes discussed include a direct protective effect from moderate alcohol consumption, that mid-range drinking habits may be a consequence of psychological wellbeing in cultures where some alcohol consumption is the norm, and confounding from a range of social factors.'

Weigh up risks and benefits of buprenorphine and methadone

01 Oct 2009Registered users

Buprenorphine is safer during induction than methadone and, despite shorter retention in treatment, is not associated with a higher risk of death, a study from New South Wales has found. 'While treatment with methadone has been shown to reduce overall mortality in heroin users, both the early weeks of treatment and the period immediately after leaving treatment are associated with increased risk of death. Buprenorphine has been shown to be a safer option in some small studies.'

Prescription only analgesics widely available on the internet

21 May 2009Registered users

Patients can readily obtain controlled opioids and other POMs from internet pharmacies without a prescription, a research team from Edinburgh has shown. This study found that of 96 websites selling analgesics to customers in the UK, 46 provided POMs, and 35 of these did not require the customer to have a valid prescription. #Controlled analgesics with the potential for misuse and dependence are freely available in large amounts from internet pharmacies without prescription in the UK. Lack of regulation of online suppliers means that medication can be fake, may contain more, or less, active ingredient than advertised, and may contain harmful ingredients. This presents a risk to public health, and should be borne in mind when GPs prescribe.'

Giving up alcohol early on improves survival in cirrhosis

21 May 2009Registered users

Stopping drinking a month after the diagnosis of cirrhosis is the most important predictor of survival, a British study has found. The severity of cirrhosis found on biopsy had little impact on survival. The study followed 100 patients consecutively diagnosed with biopsy proven alcohol-induced cirrhosis at Southampton General Hospital. Patients with additional disease processes which were non-cirrhotic and patients without accurate mortality data were excluded from the study. Biopsies were scored for severity of cirrhosis by two independent observers. Data on drinking 30 days after diagnosis were available on all but four subjects.'This study clearly confirms that the single most important determinant of long-term prognosis in alcohol-induced cirrhosis is for the patient to stop drinking. For patients with cirrhosis, it is never too late.'

Buprenorphine detox more effective than dihydrocodeine

25 Apr 2009Registered users

Many opiate users entering prison require medication to aid detoxification. A study carried out at Leeds prison found buprenorphine to be significantly more effective than dihydrocodeine at producing opiate-negative urine samples at five days. 'The study supports the result of an earlier sister trial in the community in which buprenorphine was a more effective detoxification agent than dihydrocodeine. When choosing prescribed detoxification support in either community or secure environments GPs should not routinely use dihydrocodeine. GPs need to be aware of the high rate of relapse to opiate use following prison-based detoxification.'

High-dose methadone increases risk of neonatal syndrome

25 Apr 2009Registered users

In a large cohort study of infants born to mothers prescribed methadone for opioid dependence, 45.5% needed pharmacological treatment for neonatal abstinence syndrome. The syndrome was more likely in the babies of women taking high-dose methadone, whereas those who were breastfed were less likely to need pharmacological treatment. ' Substitute prescribing of methadone to opioid-dependent women in pregnancy helps stabilise aspects of lifestyle, reduces some drug-related risks, and reduces the risk of pre-term birth and intrauterine growth retardation. Higher doses of methadone may be associated with less risky patterns of illicit drug use. However, they are also associated with a greater risk of neonatal abstinence syndrome. Pregnant drug-misusing women should be maintained on the lowest dose of methadone compatible with stability and supported to breastfeed their infants.'

Tanning can be addictive

29 Mar 2009Registered users

A study from the USA has provided further evidence that some people who tan excessively are tanning dependent.The study recruited 400 volunteers from an American university, who were asked to complete an online questionnaire that had been modified to identify tanning dependence (modified CAGE and DSM-IV-TR scales). The mean age of participants was 21 years, 75% were women and 66% were white. 'Despite extensive public health education about the risks of excessive exposure to ultraviolet radiation, some people continue to tan excessively. Similarities between excessive tanning and substance use disorders are increasingly being discussed. Both are particularly common in the young, associated with pleasurable reinforcing experiences such as relaxation and socialisation and represent health risk behaviours that continue despite health warnings. A possible mechanism, linking tanning to endogenous opioid release during ultraviolet radiation exposure, has been mooted.The concept of tanning dependence may be new to many GPs and may  help them provide health education for those who continue to tan excessively.'

Families of addicts at increased risk of addiction and depression

29 Mar 2009Registered users

Much is known about the negative health effects of substance misuse for the individual. This paper set out to explore the morbidity and health costs for family members of those with a substance problem compared with relatives of people with asthma and diabetes. 'Disability and chronic illness of any kind affects the whole family. Having a family member with an alcohol or drug problem may have a negative effect on family functioning and dynamics and is associated with an increased risk of being diagnosed with a substance use disorder, depression, and trauma. GPs should bear this in mind when managing the families of those with problem substance abuse.'

Pattern of women's drug use alters in prison

29 Mar 2009Registered users

Pattern of women's drug use alters in prison Illegal drug use is reduced when women enter prison and their pattern of misuse changes from street drugs to prescription medicines. Prior to imprisonment, just over half of the women entered into the study had been using an illicit drug on a daily basis, and 38% were ever injectors. Following entry into custody, 14% of the sample continued to use an illicit drug daily, and 2% of women continued to inject. The study used participants from 13 women's prisons across England. 'This study highlights the many challenges facing prison-based primary care services. These include:
* providing adequate drug treatment services which are effective in reducing illicit drug use
* harm reduction initiatives to lower the prevalence of injecting use with its related risks
* policy and practice which minimise the opportunity for prescribed medication to be diverted as a source of illicit drugs
* prevention of post-release opiate overdose death in those who stop using heroin on admission to prison and lose opiate tolerance.'

Number of heavy smokers fall after smoking ban

29 Mar 2009Registered users

There was a significant drop in those smoking 20 cigarettes a day or more following the ban on smoking in public places in England, a survey has found. However, there was no change in the overall number who smoked. The authors carried out a postal survey of 3,500 people in Bury, Lancashire before, and three months after, the smoking ban came into force in 2007. Participants were randomly selected using the PCT database. 'Although primarily designed to reduce the health risks associated with second-hand smoke, it was also hoped that the 2007 legislation might motivate smokers to give up. It may disappoint GPs that the smoking ban did not bring about a significant reduction in the prevalence of smoking. However, it is encouraging that the number of heavy smokers fell.'

Piperazine as a drug of misuse

01 Oct 2007Paid-up subscribers


High hepatitis C prevalence in injecting drug users

01 Sep 2007Paid-up subscribers

Hepatitis C (HCV) infection is common in illicit drug users, and can lead to severe morbidity and mortality. Although all illicit drug users may put themselves at risk of acquiring HCV infection, a new study confirms that those with a long history of drug use and those who inject (particularly with shared needles or using preparation equipment such as spoons) are most at risk.