Buprenorphine in Overdose?

Fellow devotees of "Addiction" magazine will have shared my fascination for a case report in this month's edition of a heroin addict whose life was apparently saved by the timely administration of buprenorphine by his mate..... as we all know, most injecting heroin users have themselves experienced overdose or been with someone else who has, and the majority of most overdoses that end up dead are witnessed long before calling an ambulance. This has led many to distribute naloxone injection with education to those in treatment, so that they can identify signs of overdose in others, and administer it before emergency services arrive.
But this is the first time I know of where a resourceful user (on take-out bupenrorphine) recognised the state of his friend with the blue lips, crumbled up one of his tablets and placed it under the tongue of his unrousable colleague. The subject woke up "all angry" within 10 minutes....
We all know of the paradoxical antagonism of buprenorphine at dose initiation, and this of course makes sense.... I wonder if we can make better use of this "off piste" use of buprenorphine?

“Recovery” – what’s in a name?

Some of you will have been bored by me banging on from various platforms, about the idiotic mud slinging that goes on between the ultra orthodox abstentionists, and the similarly entrenched harm reductionists. The slurs of danger and ineffectiveness have reached the public whose knee jerk take on all this, is that treatment of drug misuse simply doesn’t work.
In an attempt at some sort of mutually agreeable interpretation of the word “recovery”, Professor John Strang and various professionals and service users from ALL across the divided treatment spectrum got together in a smoke filled room for two days to thrash it out. Known as the UKDPC Consensus group, this is what they came up with:

Recovery is a process, characterised by voluntarily maintained control over substance use, leading towards health and well-being and participation in the rights, roles and responsibilities of society.

And I rather like it. It means that recovery, being a continuous process of accruing benefits, may begin well before abstinence (indeed abstinence may never occur in some cases, despite big recovery gains), and similarly, there may be further recovery to take place after abstinence has been achieved.

So that’s the end of the arguments then………..!

Ketamine

Either I am just looking for it, or there really is a phenomenon going on out there.... I seem to hear of more and more people using ketamine. What was once just one of many chemicals used occasionally at raves seems to be becoming much more widely used. You will recall that it was popular with anaesthetists as a safe short acting anaesthetic that didnt depress respiration - but because many people found the onset of anaesthesia very frightening, reporting hallucinations, nightmares and out of body experiences, it fell from favour but was taken up by vets, presumably because either animals like dissociative experiences, or more likely, they can't tell us about them afterwards.

But clearly some of our patients love the stuff: usuall snorted, it can cause an unpleasant inflammatory sinusitis, and if injected, getting the dose right is tricky or anaesthesia follows rapidly and you can injure yourself. Long term heavy use often causes a painful and non infective cystitis. But noone seems to know what more harms can follow the use of this drug, and perhaps websites such as this can help. So if you have come accross any stories of ketamine related harms, please let me know and I will spread the word.

More on QT

Since my last posting on the subject of higher dose methadone and cardiac arrythmias, there has been a growing volume of whispers on the subject. My sense of the present consensus is that on balance of risk, the benefits of effective methadone treatment far outweighs any theoretical (and very small) risk of methadone itself contributing to ventricular tacchyarrythmias. The advice remains (in the BNF) to exclude a prolonged QT interval by means of an ECG in those taking 100mg methadone daily or more, and if you see a prolonged QT interval, then seek a cardiologist's advice, don't stop the methadone.

But in the current issue of Network, Martin Wilkinson has written a nice and concise account on the subject... you can read it here. Which gives me a chance to plug Network, which you should all read - it contributes to your CPD, is delivered free if you ask for it, or is of course available to read on line.

Hard to Reach or Easy to Ignore?

I have returned from the Brighton conference - it was good to see many old friends there. This year's events were themed around meeting the needs of diverse and disadvantaged populations - not just the BEMs, but also sex workers, those with learning difficulties, mental health problems and so forth. No matter how sensitive we think we are, we need to be constantly reminded of just how awkward some of our services are to access, by certain corners of the population.

There were many excellent presentations too numerous to mention here. Some will be available on the Healthcare Events website in the near future. And speaking of which, ALL of the presentations at the Exchange Supplies Drug Treatment Conference in Glasgow are available by clicking here - I have mentioned this excellent facility in the past but it is worth repeating: you can see and hear presentations in real time on this web site - if it weren't that you would be missing out on meeting all your friends and sharing in the atmosphere of the event, this is almost as good as being there!

Both of these conferences are always stimulating, educational and provide unique opportunities to relax, unwind, and spend some well earned time out with like minded professionals and clients. You owe it to yourself and your CPD to go to one (or both!) every year.

Important Conference comes to the South West

Those marvellous people at SMMGP (and if you don't access their web site regularly with all its resources, you should) have chosen the South West to host their Third annual (one day)conference. The theme this year is to be "End of The Line, or Part of The Journey? - How to Optimise Patient Choice and Opportunity". This will be an important event for the hitherto neglected South West, and will appeal to GP and all practice staff, as well as Shared Care workers, patients, carers and all those involved in services. It's at The Bristol Marriott on Friday September 26th - stick it in your diaries NOW! it's a day of CPD, and a chance for us all to get together to show the rest of the UK how things should be done! You can go to the SMMGP conference and events page by clicking here and scroll down to the Bristol event....but look at all the others as well.....

Addiction and The Family

Here is an interesting looking local conference: "Addiction and The Family" - a one day event in Bristol at The Marriot Royal Hotel on Friday November 21st. Speakers include the eminent pioneers of Family Therapy and SBNT, Professors Orford, Copello and Velleman, as well as Prof Moira Plant included in a stellar cast. Details available from Jan.Green@uwe.ac.uk