A study of methadone in fatalities in the Strathclyde Region, 1991-1996.

There was a substantial increase in the percent of drug screens testing positive for methadone between 1991 and 1996 in the Strathclyde region of Scotland. Seventy-nine per cent (n = 136) of these deaths were drug-related, involving methadone either alone or in combination with other drugs such as diazepam, temazepam, alcohol and morphine. The involvement of methadone in the majority of these fatalities was due to diversion of legitimate supply. This paper highlights the dangers of resuming methadone consumption following a period of abstinence or when taken in combination with other drugs.

A confidential enquiry into methadone-related deaths.

AIM: To assess the acceptability and usefulness of the "confidential enquiry" process in examining methadone-related deaths. DESIGN: An audit of patient care. SETTING: Glasgow, Scotland, UK (population 915,000) Participants. All doctors who, in the final 14 days of the patient's life, had attended a patient who suffered a methadone-related death. MEASUREMENTS: The medical care of each case was assessed by peer review and the results of these assessments returned to the responsible clinician(s). FINDINGS: (1) The audit cycle was completed in 32 of the 34 reported cases (94%). (2) Twenty-eight of 33 doctors (85%) found the audit to be helpful. (3) As a result of the enquiry, the majority of doctors whose patient management had attracted criticism intended to amend their practice. (4) Shortcomings in clinical care were identified in 18 cases (56%) and problems in the organization of services in 22 (69%). CONCLUSIONS: (1) The model of audit piloted here was found to be highly acceptable to participants. (2) The episodes of substandard care that were uncovered provided useful opportunities to improve the future management of patients who were being prescribed methadone.

Hepatitis virus infection and liver disease in injecting drug users who died suddenly.

AIM: To determine the extent of liver damage resulting from infection with hepatitis B, C and D viruses (HBV, HCV and HDV) in intravenous drug users (IDUs). METHODS: Liver sections taken at necropsy performed to investigate the cause of sudden death in 48 IDUs were scored for necroinflammatory activity and fibrosis. Evidence of infection was by detection of viral antibodies in serum, hepatitis B surface antigen (HBsAg) and HCV RNA by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Evidence of HCV infection was present in 43 (90%) of 48 serum samples. Six (12%) HBsAg positive serum samples had markers indicative of chronic HBsAg carriage, including three with antibody directed against HDV. Evidence of past HBV infection was found in 27 (69%) of 39 HBsAg negative serum samples. HIV was detected in one (2%) of 48 samples. In five (10%) of 48 samples there was no evidence of current or past infection with HCV, HBV or HIV. All 43 liver sections from HCV positive IDUs scored > or = 1 for necroinflammatory activity, whereas three IDUs without HCV scored 0. Scores for stage of fibrosis were > or = 1 in 15 (35%) of 43 and zero of five IDUs, respectively. Fibrosis scores of > or = 3 were seen only in three IDUs positive for HBV, HDV and HCV. CONCLUSION: Inflammatory activity in the liver is present in a high proportion of IDUs in Glasgow and is strongly associated with HCV infection. Severe chronic liver damage was limited to HBsAg carriers superinfected with HDV and HCV.

Drugs associated with drug-related deaths in Edinburgh and Glasgow, November 1990 to October 1992.

Between 1991 and 1992 there was a four-fold increase in drug-related deaths in Glasgow. Comparing records of the drug-related deaths for November 1990-October 1991 and November 1991-October 1992 in Edinburgh and Glasgow, it was found that the increase in Glasgow was statistically significant and that heroin, often mixed with other drugs, which most often included temazepam, diazepam and alcohol, was implicated in the increase in deaths in Glasgow. A number of the deceased had been prescribed temazepam or diazepam. Discussed are the hazards of drug mixing and the possibility that the use of buprenorphine by drug injectors previously had kept the number of overdoses relatively low.

Drug abuse deaths in Glasgow in 1992--a retrospective study.

A survey of 62 drug deaths in Glasgow showed a wider age range than expected (16-49), a high male to female ratio (44:18) and, where mode of employment had been recorded, a high degree of unemployment (91%). The majority of deaths occurred near centres of known supply. Although a number occurred in the family home, a large proportion were not at the place of residence. In only two cases was morphine detected alone. The majority of the deaths were from combinations of drugs, primarily with benzodiazepines.

Fournier's gangrene and urethral problems.

Fournier's classical description of infective genital gangrene has been frequently amplified. We present seven patients in whom the exact site of gangrene was related to the origin of the infection, either from the urethra or from the anorectum. A sixth case of diabetes presenting as Fournier's gangrene is described. The need for urological assessment in this condition is discussed.