Drunk, drowsy, doped: skiers' and snowboarders' injury risk perceptions regarding alcohol, fatigue and recreational drug use.

The objective was to investigate perceptions of snowfield resort visitors about injury risk regarding alcohol, fatigue and recreational drug use. Visitors to a resort village in a large Australian snowfield region completed a brief survey about fatigue, alcohol and recreational drug use and injury risk perception. Participants stated their ability to ski or snowboard and drive safely following a lack of sleep, alcohol and recreational drug use. Intoxicated snowfield resort visitors were compared with non-intoxicated visitors. Safety beliefs across snow sport and transport were compared. Participants reported that they generally slept less than usual and 30% reported both drinking alcohol and using drugs more than usual while visiting the snowfields. Participants perceived driving as a greater injury risk than skiing/snowboarding (p < 0.001). Fatigue was perceived as a relatively weak injury risk factor, particularly whilst skiing and snowboarding. Awareness needs to be raised among snowfield resort visitors about the contribution of alcohol, fatigue and recreational drug use to snow sport and transport-related injury risk.

Methadone maintenance patients are cross-tolerant to the antinociceptive effects of morphine.

We have previously shown that methadone maintenance patients are hyperalgesic. Very little is known about the antinociceptive effects of additional opioids in these patients. This study (1) compared the intensity and duration of antinociceptive responses, at two pseudo-steady-state plasma morphine concentrations (C(SS1) and C(SS2)), between four patients on stable, once daily, doses of methadone and four matched control subjects; and (2) determined, in methadone patients, whether the antinociceptive effects of morphine are affected by changes in plasma R(-)-methadone concentration that occur during an inter-dosing interval. Two types of nociceptive stimuli were used: (1) a cold pressor test (CP), (2) electrical stimulation (ES). Morphine was administered intravenously to achieve the two consecutive plasma concentrations. Blood samples were collected, concurrently with nociceptive responses, to determine plasma morphine concentrations. Methadone patients achieved mean C(SS1) and C(SS2) of 16 and 55 ng/ml respectively; those of controls were 11 and 33 ng/ml. Methadone patients were hyperalgesic to pain induced by CP but not ES. Despite significantly greater plasma morphine concentrations, methadone patients experienced minimal antinociception in comparison with controls. Furthermore in methadone patients, the antinociception ceased when the infusion ended. In comparison, the duration of effect in control subjects was 3 h. The fluctuations that occurred in plasma R(-)-methadone concentration during an inter-dosing interval had little effect on patients' responses to morphine. Our findings suggest that methadone patients are cross-tolerant to the antinociceptive effects of morphine, and conventional doses of morphine are likely to be ineffective in managing episodes of acute pain amongst this patient group. Further research is needed to determine whether other drugs are more effective than morphine in managing acute pain in this patient population.