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Clinical reviews on addiction

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.

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.

 

Smoking cessation

E-cigarette use linked to successful quit attempts

22 Mar 2017Paid-up subscribers

The rise in the use of e-cigarettes in England has been associated with an improvement in the success of quit attempts, a study in the BMJ has found.

Smoking cessation services for inpatients could help more than a million smokers

15 Dec 2014Registered users

Offering smokers admitted to hospital behavioural support and pharmacotherapy could help reduce smoking rates significantly, a national audit in England has shown.

E-cigarettes help smokers to quit

23 Oct 2014Paid-up subscribers

Early evidence suggests that e-cigarettes help smokers interested in quitting to stop or cut down, a systematic review has found.

Stop smoking services helping significantly more smokers to quit

23 Sep 2013Paid-up subscribers

Smoking cessation services in England have trebled their impact in helping smokers to give up over the past decade, a study has found. However, a wide variation across local services was noted. The researchers analysed the performance of stop smoking services across England from 2001/02 to 2010/11, asking the questions: How has the performance of the services changed? How well have the services met the needs of different groups including economically disadvantaged smokers? How much local variation has there been in success rates?

 

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]