The impact of citrate introduction at UK syringe exchange programmes: a retrospective cohort study in Cheshire and Merseyside, UK

<p>Abstract</p> <p>Background</p> <p>In 2003, it became legal in the UK for syringe exchange programmes (SEPs) to provide citrate to injecting drug users to solubilise heroin. Little work has been undertaken on the effect of policy change on SEP function. Here, we examine whether the introduction of citrate in Cheshire and Merseyside SEPs has altered the number of heroin/crack injectors accessing SEPs, the frequency at which heroin/crack injectors visited SEPs and the number of syringes dispensed.</p> <p>Methods</p> <p>Eleven SEPs in Cheshire and Merseyside commenced citrate provision in 2003. SEP-specific data for the six months before and six months after citrate was introduced were extracted from routine monitoring systems relating to heroin and crack injectors. Analyses compared all individuals attending pre and post citrate and matched analyses only those individuals attending in both periods (defined as 'longitudinal attenders'). Non-parametric tests were used throughout.</p> <p>Results</p> <p>Neither new (first seen in either six months period) nor established clients visited SEPs more frequently post citrate. New clients collected significantly less syringes per visit post citrate, than pre citrate (14.5,10.0; z = 1.992, P < 0.05). Matched pair analysis showed that the median number of visits for 'longitudinal attenders' (i.e. those who attended in both pre and post citrate periods) increased from four pre citrate to five post citrate (z = 2.187, P < 0.05) but the number of syringes collected remained unchanged. These changes were not due to seasonal variation or other changes in service configuration.</p> <p>Conclusion</p> <p>The introduction of citrate did not negatively affect SEP attendance. 'Longitudinal attenders' visited SEPs more frequently post citrate, providing staff with greater opportunity for intervention and referral. As the number of syringes they collected each visit remained unchanged the total number of clean syringes made available to this group of injectors increased very slightly between the pre and post citrate periods. However, new clients collected significantly less syringes post citrate than pre citrate, possibly due to staff concerns regarding the amount of citrate (and thus syringes) to dispense safely to new clients. These concerns should not be allowed to negatively impact on the number of syringes dispensed.</p

High drug related mortality rates following prison release: Assessing the acceptance likelihood of a naltrexone injection and related concerns

Background and aims. High drug related mortality amongst former prisoners in the 4 weeks following release is an internationally recognised problem. Naltrexone injections at release could diminish this by blockading opioid receptors, but naltrexone is not licenced for injection for treating opiate misuse in the United Kingdom and some other countries. This study examined the likelihood of accepting a naltrexone injection at release, and the relationship of this likelihood to other relevant variables. Method. Sixty-one male prisoners with a history of heroin use, who were approaching release from two prisons in the north-west of England, provided likelihood ratings for accepting a naltrexone injection if it were to have been available. Additional data was gathered regarding demographic and drug use histories, and also from psychometric instruments relevant to drug misuse and treatment preparedness. Results. Maximum likelihood ratings for accepting a naltrexone injection were recorded by 55.7% of the sample with only 9.8% indicating no likelihood of accepting an injection. Likelihood ratings were positively related to serving a current sentence for an acquisitive offence compared to drug related or violence offences, and negatively related to peak methadone dosages during the current sentence. Conclusions. Although naltrexone injections were not available to participants in this study, the findings suggest that the potential uptake for this intervention is sufficient to warrant a clinical trial with this population of British prisoners, with a view to potential changes to its current licencing statu

Self-reported patterns of MDMA use and their related beliefs.:Symposium abstracts: Society for the Study of Addiction: from biology to sociology: evidence base and implementation strategies for alcohol, drugs and tobacco policies.

Self-reported patterns of MDMA use and their related beliefs

Executive Working Memory Deficits in Abstinent Ecstasy/MDMA Users: A Critical Review

Aims: This review examined studies of executive functioning in abstinent ecstasy (3,4-methylenedioxymethamphetamine, MDMA) users on tasks which had been empirically mapped onto updating, shifting, inhibition and accessing long-term memory executive processes. Studies of some aspects of visuospatial memory performance were also included because of the investment of executive resources in such tasks. Methods: Thirty-three studies were identified for the review following searches of the Psychinfo and Medline databases. Inclusion criteria were the reporting of new empirical findings from participants drug free at the time of testing, in peer-reviewed journals in the English language. Results: Evidence for ecstasy-related performance deficits was strongest for the updating of verbal material, and for visuospatial memory tasks requiring additional processing beyond storage and retrieval. Such processing suggested that the overall level of executive demand was an important consideration. Executive shifting showed little evidence of ecstasy-related impairment, whilst examination of inhibition and long-term memory access presented an unclear picture. Conclusions: All but one of the studies had a cross-sectional design. Although this is a potential weakness with regard to confounds, the necessity of such designs was acknowledged. Studies were generally aware of the need to control for potential confounds, especially the effects of other drugs, through a mixture of group designs and statistical techniques. It was recommended that future studies of executive functioning in ecstasy users should detail the relationship of the tasks and dependent variables reported to specific executive processes and consider the level of executive demand imposed by such tasks. Copyright (C) 2009 S. Karger AG, Basel

Reasoning deficits in ecstasy (MDMA) polydrug users

Rationale/objectives: Previous research has shown that ecstasy users are impaired in thinking and reasoning. The present study sought to explore the possibility that syllogistic reasoning errors in ecstasy users were due to an inability to construct a model of the premises due to working memory limitations. Methods: Twenty-nine ecstasy users and 25 nonecstasy user controls completed abstract syllogistic reasoning problems varying in difficulty. Pairs of premises were provided, and participants were required to generate conclusions that followed necessarily from them. Results: On the easier problems, both groups performed at well above chance although nonusers achieved significantly more correct responses. Consistent with existing research, on the more difficult problems, errors by nonusers were characterised by incorrect conclusions suggesting that while nonusers have the working memory capacity to construct a single model of the premises, this is not an exhaustive representation and usually results in an erroneous conclusion. On the other hand, for all problem types, ecstasy users, rather than produce incorrect responses, were more likely to fail to generate a conclusion. Conclusions: The present results are consistent with the possibility that ecstasy users with their reduced working memory capacity may experience difficulty in constructing even a single model of the premises. While this might be attributable to the effects of 3,4-methlylenedioxymethamphetamine neurotoxicity, many of the ecstasy users in the present study were polydrug users. Thus, the possibility that other drugs including cannabis and cocaine might contribute to the present results cannot be excluded