Drug Dependence Clinics

Fraser, A. and Leighton, K.M. (1984) Characteristics of attenders at a Scottish drug dependence clinic, British Journal of Psychiatry, 144 307-... 

Drug-dependence clinics need to develop full assessment procedures and be very familiar with the changing local drug scenes so that needs can be identified early and met. Knowledge of other local services provided by both statutory and voluntary bodies is essential to avoid duplication of services and to link the facilities available. If possible the size and nature of the local drug problem should be ascertained. Surveys in East Dorset have been used to involve probation and social services and to emphasise the important needs of comprehensive school children (Pritchard et al. 1985,1986). 

Due to a combination of increasing concern about the implications of AIDS/HIV for the treatment of drug takers, and increasing polarisation of attitudes and treatment policies between the Drug Dependence Clinics and private doctors in addiction, the past year has witnessed a renewal of the debate about appropriate prescribing. However, although this debate tends to focus on the currently fashionable concept of flexible prescribing , it has frequently been characterised by the adoption of rather inflexible and extreme positions. 

Two opioids are used in the treatment and management of opiate dependence levomethadyl and methadone. Levomethadyl is given in an opiate dependency clinic to maintain control over the delivery of the drug. Because of its potential for serious and life-threatening proarrhythmic effects, levomethadyl is reserved for use in the treatment of addicted patients who have no response to other treatments. Levomethadyl is not taken daily the drug is administered three times a week (Monday/Wednesday/Thursday or Tuesday/Thursday/ Saturday). Daily use of the usual dose will cause serious overdose. 

Each time the patient visits the outpatient clinic, the nurse evaluates the patient s response to therapy and looks for any signs that drug dependency might again be a problem. 

Jaffe JH Drug dependence opioids, nonnarcotics, nicotine (tobacco), and caffeine, in Comprehensive Textbook of Psychiatry, 5th Edition, Vol 1. Edited by Kaplan HI, Sadock BJ. Baltimore, Williams c Wilkins, 1989, pp 642-686 Jaffe J, Knapp CM, Ciraulo DA Opiates clinical aspects, in Substance Abuse A Comprehensive Textbook. Edited by Lowinson JH, Ruiz P, Millman RB, et al. New York, Lippincott Williams and Wilkins, 2004, pp 158—165 Jarvis MA, Schnoll SH Methadone use dming pregnancy. NIDA Res Monogr 149 58— 77, 1995... 

Appropriate empiric anti-infective therapy decreases 28-day mortality compared to inappropriate empiric therapy (24% versus 39%).22 23,30 Additionally, appropriate therapy administered within 1 hour of sepsis recognition also decreases complications and mortality.22-23,30 Empiric anti-infective therapy should include one, two, or three drugs, depending on the site of infection and causative pathogens (Table 79-3). Anti-infective clinical trials in sepsis and septic shock patients are scarce and have not demonstrated differences among agents therefore, factors that determine selection are ... 

Fudala P., Johnson R., Jaffe J. Outpatient comparison of buprenorphine and methadone maintenance. II. Effects of cocaine usage, retention time in study and missed clinical visits. In Harrison L., Ed. Problems of Drug Dependence. Natl. Inst. Mental Health Res. Monogr. 105 587, 1991. 

Medical scientists mainly rely on the measurement of bioavailability of a drug as a positive indicator of therapeutic equivalence, because clinical efficacy for orally administered drugs depends on the degree of absorption and the presence of the active ingredient in the blood stream. 

Blum K, Futterman SL, Pascarosa P. (1977). Peyote, a potential ethnopharmacologic agent for alcoholism and other drug dependencies possible biochemical rationale. Clinical Toxicol. 11(4) 459-72. 

Tennant FS, Tarver AL, Rawason RA (1983) Clinical evaluation of mecamylamine for withdrawal from nicotine dependence. In Harris LS (ed) Problems of drug dependence, NIDA Research Monograph 49. USDHHS publication no, 84-1316, pp 239-246 Tercyak KP, Herman C, Audrain J (2002) Association of attention-deficit/hyperactivity disorder symptoms with levels of cigarette smoking in a community sample of adolescents, J Am Acad Child Adolesc Psychiatry 41 799-805... 

Define objectives of treatment before initiation of a drug Note frequency and severity for a drug Dependant on age, disease, and individual patient factors Include drug action, absorption, elimination, and protein binding Are they clinically significant ... 

V. Clinical guidelines on the diagnosis of drug dependence arising in therapeutic situations 270... 

V CLINICAL GUIDELINES ON THE DIAGNOSIS OF DRUG DEPENDENCE ARISING IN THERAPEUTIC SITUATIONS... 

The clinical diagnosis of drug dependence arising during therapy with drugs acting directly or indirectly on control nervous system receptors is always... 

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