An Uncertain Dominion: Irish Psychiatry, Methadone, and the Treatment of Opiate Abuse

This paper investigates some productive ambiguities around the medical administration of methadone in the Republic of Ireland. The tensions surrounding methadone maintenance therapy (MMT) are outlined, as well as the sociohistorical context in which a serious heroin addiction problem in Ireland developed. Irish psychiatry intervened in this situation, during a time of institutional change, debates concerning the nature of addiction, moral panics concerning heroin addiction in Irish society and the recent boom in the Irish economy, known popularly as the Celtic Tiger. A particular history of this sort illuminates how technologies like MMT become cosmopolitan, settling into, while changing, local contexts

Psychosis and recreational use of MDMA ("ecstasy").

In Dublin there has been an increase in the use of Methylene dioxy methamphetamine (MDMA) or ecstasy among young people. In this case a seventeen-year-old unemployed male attended a drug treatment centre in Dublin with his mother, who had become increasingly worried about his bizarre behaviour. He admitted to taking MDMA over a five-month period, taking approximately 1-2 tablets per week at rave parties. There was evidence of disturbance throughout adolescence, as indicated by behavioural problems and suspensions at school. He had last used MDMA five days previously and almost immediately complained of shivers, cold, sweats, vomiting, and disturbing thoughts. On prior occasions, the patient suffered no adverse affects after using Ecstasy. The patient appeared frightened and had slow, deliberate speech. He exhibited paranoid delusions regarding family members and strangers. He experienced visual hallucinations and third person auditory hallucinations. Routine blood investigation and hepatitis screen were normal, as was the magnetic resonance imaging of the brain

Heroin smoking by 'chasing the dragon' in young opiate users in Ireland.

This paper is based on a study of the use of heroin to counter the adverse side affects of Ecstasy use. The authors explored the frequency of commencing opiate use by "chasing the dragon" to "come down" off Ecstasy and the stability of heroin smoking in young opiate takers by assessing 102 subjects in Dublin using a semistructured interview. Ninety-two subjects had used Ecstasy. Of these, 68 reported "chasing" to "come down" off Ecstasy at some point in their history and were found to have used Ecstasy more frequently and in larger amounts. Thirty-six reported that their first experience of using opiates was to "come down" off Ecstasy, 28 citing this as their main reason for commencement.Eighty-six of the 102 commenced opiates by "chasing" heroin, 61 of whom progressed to injecting after a mean of 2.9 years. This was associated with starting illicit drug use earlier, starting heroin earlier, and a history of using Ecstasy. Implications for service planners in developing responses to illicit drug use among adolescents are discussed

Chasing the Dragon: experience in Ireland and associations with ecstasy.

This letter to the editor responded to an article by J. Strang, P. Griffiths and M. Gossop ('Heroin smoking by "chasing the dragon" origins and history', Addiction, 92 (1997), 673-683). The authors disputed Strang et al.'s comment on reported preferences for injecting heroin in Ireland, pointing to evidence that heroin smoking had become increasingly prevalent in Ireland in recent years, with 'chasing the dragon' being the main method used. They quoted figures found by O'Higgins & Duff (1997) in relation to this assertion, and made reference to a pilot study on heroin smoking they had conducted themselves. The authors also made reference to the smoking of heroin as a method of 'coming down' off ecstasy, a context that they said did not appear to have been noted previously and which they believed merited further attention and research

The prevalence of comorbid substance misuse and its influence on suicidal ideation among in-patients with schizophrenia.

The objective of this article was to estimate the prevalence, and identify the clinical correlates of comorbid substance misuse (abuse or dependence) among readmissions with schizophrenia, and particularly to establish whether comorbid substance misuse is associated with higher rates of depressive symptoms and suicidal ideation. Over 12 months, consecutive readmissions to an Irish psychiatric service with DSM-IV schizophrenia/schizoaffective disorder were assessed using clinical assessments of symptomatology including depression, insight and compliance. Comorbid substance misuse was diagnosed using DSM-IV criteria. Results: Of 102 readmissions 40% had lifetime, while 20% had current comorbid substance misuse and were predominately young males. Comorbid substance misuse had no statistically significant impact on positive, negative or depressive symptomatology. However, those currently misusing substances reported more suicidal ideation compared with past or non-substance misusers. The conclude that readmissions with comorbid substance misuse were more likely to report suicidal ideation, and may represent a group of individuals who are at higher risk of suicide

Insight and comorbid substance misuse and medication compliance among patients with schizophrenia.

The authors examined levels of noncompliance with oral antipsychotic medication regimens and factors influencing it among 87 Ss consecutively readmitted to a hospital with an acute psychotic relapse of schizophrenia or schizoaffective disorder. Compliance was assessed using a structured clinical interview. Ss also completed a self-report questionnaire to measure insight (M. Birchwood et al, 1994) and the Drug Attitude Inventory to assess attitudes toward medication. Of the 87 Ss, the 21 Ss taking depot medication (DM) were significantly more likely than the 66 Ss (mean age 37.3 yrs) taking only oral medication (OM) to be regularly compliant. Only 22 of the 66 OM Ss were compliant vs 12 of the 21 DM Ss. 15 of the OM Ss had comorbid substance use or dependence disorders, 14 of who were irregularly compliant. Excluding Ss with current comorbid substance misuse, the 21 regularly compliant Ss had a significantly higher mean insight score than the irregularly compliant Ss. Overall, results suggest that comorbid substance misuse, negative subjective response to neuroleptics, and lack of insight contribute to noncompliance

Lifetime history of substance misuse in first-episode psychosis: Prevalence and its influence on psychopathology and onset of psychotic symptoms.

Substance misuse (SM) (drug/alcohol dependence or abuse) in psychotic illness is an increasingly recognized problem. The authors aimed to estimate the prevalence and examine the influence of substance misuse on age at onset of psychosis and psychopathology among patients with first-episode psychosis. One hundred seventy-one consecutive patients with first-episode psychosis were assessed. Substance misuse, age of onset of psychosis and psychopathology were determined using valid instruments. Results: Seventy-seven (46%) patients had a lifetime history of substance misuse and were predominately males, had more positive symptoms, and in the majority of cases (84%), started misusing substances before the onset of psychosis (SM-BP). There was no difference in age of onset between patients with SM-BP and the rest of the sample. Conclusion: Lifetime history of substance misuse is common and may influence psychopathology, but does not appear to influence or bring forward the age at onset of psychotic symptoms