Scottish cocaine users: wealthy snorters or delinquent smokers?

Ninety-two cocaine users were interviewed in Scotland. Most were middle-class nasal users, also used other drugs and generally gave cocaine a positive rating. One half of them had at some time used cocaine more than once a week. For some, this period lasted some months, when as much as 30 'lines' of cocaine were used per day of cocaine use. More of these heavy users reported adverse effects of cocaine than was the case for light users. Nonetheless, most heavy users had reduced their use by themselves to the point that their current cocaine use was no different from that of light users. Possible explanations for this apparently spontaneous reduction are discussed.

Femoral nerve blockade in the multidisciplinary management of intractable localized pain due to metastatic tumor: a case report.

This report describes the management of a 39-year-old man with intractable metastatic femoral bone pain managed by femoral nerve blockade, first via a percutaneously tunneled catheter and later via an implanted Port-A-Cath system. Analgesia was maintained by repeated injections of bupivacaine. The multitherapeutic approach utilizing surgical fixation, radiotherapy, opioid analgesics and adjuvants, transcutaneous electrical nerve stimulation, physiotherapy, and neural blockade to the management is emphasized.

Hair testing for "ecstasy" (MDMA) in volunteer Scottish drug users.

The aim of the study was to compare self reported "ecstasy" use with the results of the analysis of hair harvested from the same users. Subjects were recruited by multisite chain-referral sampling within the 1994-95 "dance scene" in Glasgow. One hundred subjects donated hair after completing a lengthy interviewer-administered questionnaire. Overall gross concordance between self reported "ecstasy" use and discovery of MDMA (or related compounds) in analysed hair did not surpass 59%, and no relationship had a Cohen's kappa of more than 0.08. Within the positive concordant dataset (n = 52), scatter was considerable, with no correlation being significant, and none more strongly positive than -0.0518. The results presented here indicate that, as far as MDMA is concerned, if judged by self-report, hair does not reach a level of apparent accuracy that would permit its use as a general population estimator. However, hair testing is probably more reliable than self-report, and its accuracy could be verified independently if large-scale inter- and intra-laboratory comparative research is conducted.

Hair analysis: self-reported use of "speed" and "ecstasy" compared with laboratory findings.

Drug use histories were collected from 100 subjects recruited from the "dance scene" in and around Glasgow, Scotland. In addition, each subject donated a hair sample which was analyzed by gas chromatography/mass spectrometry (GC/MS) for amphetamine (AP), methamphetamine (MA), 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MD MA) and 3,4-methylenedioxyethylamphetamine (MDEA). The hair samples were analyzed in two 6 cm segments or in full, ranging from 1.5 to 12 cm depending on the length of the hair. Approximately 10 mg of hair was ground to a fine powder before treatment with beta-glucuronidase/aryl sulfatase. A solid-phase extraction procedure was carried out followed by derivatization with pentafluoropropionic anhydride (PFPA). All extracts were analyzed by gas chromatography/mass spectrometry (GC/MS). Of the 139 segments analyzed, 77 (52.5%) were positive for at least one of the five amphetamines. The drug concentrations found in the hair were compared with the self-reported drug histories. A concordance of greater than 50% was found between the self-report data and levels detected in hair. However, no correlation was found between the reported number of "ecstasy" tablets consumed and the drug levels detected in hair. An increase in the average drug levels measured was observed from low to high use (number of "ecstasy" tablets/month). A large number of false negatives and a low number of false positives were observed.

Computerized projection of future heroin epidemics: a necessity for the 21st century?

Although U.K. has seen significant advances in knowledge since the onset of its last major heroin epidemic in the early 1980s, it is still the case that most assessments of the extent of drug misuse are based on old data. Recognition of this problem is evidenced by the many attempts elsewhere to reduce the lag between data collection and data use in such programs as DAWN, ADAM, and PULSE CHECK. Such programs are an improvement, but they are nevertheless still estimates of unknown reliability, and still about the past rather than about the future. Building on the pioneering work of Hunt and Chambers in the 1970s, the authors present the output of a computerized model that attempts to forecast the heroin epidemics of the future.

The 1990s: decade of the stimulants?

Does the media fan fake panics, forecast possible issues, create real problems, or detect problems at an earlier stage than treatment resources? A study of the relationship of tabloid news coverage of MDMA (Ecstasy) to drug treatment service demand found that treatment agencies were more concerned about amphetamine use but conversely tabloid coverage centred on ecstasy. Casual enquiries to a few drug agencies one year later discovered reports of increased numbers of clients presenting for ecstasy and reports of the drug's increased availability. The relationship between media coverage and changing drug availability and drug use is unclear. Short-term studies are unreliable, and interpretation of the relationship between drug use and media coverage runs a permanent risk of generating contradictory conclusions. The need for long-term serious study of the relationship between the media and drug use is stressed.

Variations in needle sharing practices among intravenous drug users in Possil (Glasgow).

Glasgow has an intravenous drug using (IVDU) population which is probably larger but hitherto less infected with the human immunodeficiency virus (HIV) than IVDUs elsewhere in Scotland. This 1988 study of 50 Glasgow IVDUs reports disturbingly high rates of sharing injecting equipment, and points to imprisonment as a possible factor in increasing such risk taking behaviour.

When the diagnosis of deafness is wrong.

OBJECTIVE: To describe three children in whom there had been major errors in the diagnosis of hearing loss. CLINICAL FEATURES: In three children (two developmentally delayed, one not developmentally delayed) hearing thresholds obtained by behavioural testing were later proven wrong. This resulted in significant family distress and inappropriate educational approaches. INTERVENTION AND OUTCOME: Electrocochleography and brainstem audiometry were performed, demonstrating normal cochlear function. Simultaneous microinspection of the ears gave information about current or old middle ear disease and the likelihood of past conductive hearing loss. In each case hearing aids could be discarded, enabling parents and teachers to concentrate on one rather than multiple problems. CONCLUSION: Electrocochleography and brainstem audiometry should be used more frequently to check the diagnosis of hearing loss in children who are developmentally delayed, hyperactive or autistic and who do not give consistent responses to behavioural testing. It should also be considered if parents are firmly convinced that the diagnosis of deafness is wrong.