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Clinical reviews on addiction

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.

 

Smoking cessation

Benefits of quitting smoking outweigh the risks of weight gain

24 Jun 2019Paid-up subscribers

The cardiovascular and overall mortality benefits of stopping smoking far outweigh the risks of weight gain and acquiring type 2 diabetes, a study from the United States has shown.

Are e-cigarettes more effective than nicotine replacement therapy to help smokers quit?

25 Mar 2019Registered users

One year smoking cessation rates were significantly higher in those who used e-cigarettes compared with those using traditional nicotine replacement therapy (NRT) products, in a UK prospective study. However, many more of those on e-cigarettes who had quit ordinary cigarettes still used the substitute while most of those who quit using NRT were free from treatment.

Rise in vaping accompanied by fall in youth smoking

22 Feb 2019

An increase in the use of e-cigarettes (vaping) has been associated with a drop in smoking by teenagers and young adults, a time trend analysis from the United States has found.

What factors influence uptake of smoking in children?

23 Jan 2019Registered users

Living in a smoking household and having peers who smoke are key factors associated with children smoking, a cohort study has found. The investigators analysed data on 11,577 teenagers in the Millenium Cohort Study, a birth cohort of children born between September 2000 and January 2002 in the UK.

Can nicotine preloading help smokers quit?

25 Jul 2018Registered users

The use of a nicotine patch before quitting may have a modest effect on abstinence, a large pragmatic randomised trial has found. A total of 1,792 adults were enrolled from Nottingham, Birmingham, Bristol, and London.

 

Editorials

Identifying at-risk drinkers in primary care

23 Sep 2014Registered users

It has been estimated that around 20% of patients attending their GP are at risk from their drinking or have an alcohol use disorder. Without using specific screening tools GPs may typically detect about 40% of cases they see, but miss the majority. The study authors suggest a single or two question approach to initial screening, followed by either the CAGE or AUDIT test for those who are positive, and onward referral for those who test positive on the more in-depth questionnaire.

 

Hepatitis infection

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.

Should men who have sex with men be screened for hepatitis C?

21 Feb 2013Paid-up subscribers

Reports of acute HCV infection in HIV-positive men who have sex with men (MSM) have emerged where sexual exposure was the only risk factor. In a systematic review, HIV-positive MSM had approximately four times the risk of acquiring acute HCV infection compared with HIV-negative MSM. The data suggest it would be reasonable to consider routine screening for HCV in HIV-positive MSM.

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.

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.

 

HIV infection

Which indicator conditions predict HIV?

25 Jul 2013Registered users

A UK study using The Health Improvement Network (THIN) database to identify symptoms and clinical diagnoses associated with HIV infection has assessed their predictive value in diagnosing HIV in primary care. The THIN database contains anonymised patient records from 386 UK general practices; these include sociodemographic data, diagnoses, treatments, clinical measurements, laboratory results, secondary care referrals and hospital diagnoses. [With external links to current evidence]

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.

Should men who have sex with men be screened for hepatitis C?

21 Feb 2013Paid-up subscribers

Reports of acute HCV infection in HIV-positive men who have sex with men (MSM) have emerged where sexual exposure was the only risk factor. In a systematic review, HIV-positive MSM had approximately four times the risk of acquiring acute HCV infection compared with HIV-negative MSM. The data suggest it would be reasonable to consider routine screening for HCV in HIV-positive MSM.

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.

Which GP and patient characteristics influence HIV testing?

19 Sep 2011Paid-up subscribers

GPs who are under 35 and working in metropolitan areas are more likely to offer HIV tests, a study from Australia has found. Patients deemed to be at risk by their GP or who present for screening are most likely to be tested. The study used data from a cross-sectional, national survey of GP activity called BEACH (Bettering the Evaluation and Care of Health). This database has been running since 2000; each year, approximately 1,000 GPs from a national, rolling sample are recruited. [With external links to current evidence]