The case for other substitute drugs

More than methadone The case for other substitute drugs 

Further situations in which methadone can seem an unsatisfactory substitution agent are towards the other end of the treatment spectrum. In uncomplicated maintenance treatment or for detoxification, the criticisms which are levelled at methadone relate not so much to the subjective effects, but to the aspects of addictiveness, abuse potential and toxicity. The issue of whether methadone is too addictive to be really suitable for detoxification is considered in detail in Chapter 3, and the controversial subject of methadone risks and deaths in Chapter 1. It is in the relatively milder cases of heroin dependence that buprenorphine treatment as an alternative to methadone has risen to great prominence in several countries, although, importantly, the condition definitely does not have to be mild for this medication to be used. Undoubtedly the introduction of buprenorphine is one of 

Amanda is a 33-year-old woman whose case we inherited after she had been prescribed diamorphine in controversial circumstances. She had previously been a patient of the methadone clinic but her progress had generally been unsatisfactory, and eventually she had obtained treatment with diamorphine from a doctor in private practice. Unfortunately the doctor did not have the licence required to prescribe the drug, but by the time the situation was discovered treatment had been established for several months. It was agreed that we would take her back into our service, where diamorphine could be prescribed on a legal footing while her case was being reassessed. 

Reviewing her history, it appeared that she had used heroin by injection for five years before being first prescribed methadone. She was from a relatively isolated small town where the limited network of users had few links with treatment services. She used heroin with her then husband, and both were eventually referred to the clinic after he had been charged with supplying the drug. They separated soon afterwards, and while he remained in treatment for only a short period before leaving the area, Amanda has been receiving prescribed medication since that time. 

Because diamorphine is converted to morphine in the body, prescribing the two drugs may be considered broadly similar. However, the initial subjective effects of diamorphine are crucial, and morphine is often a less attractive proposition. In the early major trial of injectable drugs in Switzerland (Uchtenhagen et al. 1996), in which the morphine protocol was based on previous experience in the Netherlands, two of the morphine-prescribing groups were curtailed because of poor acceptability by participants. Of side-effects, histamine-like reactions on intravenous injection were most frequently reported. 

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Other toxic effects of the ergot alkaloids include drowsiness and, in the case of methysergide, occasional instances of central stimulation and hallucinations. In fact, methysergide was sometimes used as a substitute for LSD by members of the "drug culture."... 

Many applications have been reported in the field of biomolecular NMR spectroscopy which use RDCs for the refinement of three-dimensional structures. The approach is quite powerful and can also be applied to smaller molecules whenever the conformation of a molecule is important, as for example in the case of rational drug design. Traditionally, NMR in liquid crystals is applied on a multitude of small organic compounds to obtain their fully characterized structure. Most examples are measured on all kinds of aromatic systems as reported in refs. 204—212 other recent examples deal with substituted alkanes, aldehydes216,217 or bridged systems like norbomadiene.218 In general, these very detailed studies can be applied to molecules with up to 12 protons. 

Today, the abuse of inhalants is still a major problem. Inhalants are within easy reach, much as they were in the past. Additionally, in many cases they are still used as substitutes for other drugs that are illegal to purchase or too expensive to buy. These ties with the past use of inhalants makes further exploration of today s trends all the more interesting. 

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