%0 Journal Article %@ 1708-0428 %A Yoder, Ruth %A MacNeela, Padraig %A Conway, Ronan %A Heary, Caroline %D 2017 %F ndc:28007 %I Springer %J Obesity Surgery %T How do individuals develop alcohol use disorder after bariatric surgery? A grounded theory exploration. %U http://www.drugsandalcohol.ie/28007/ %V Early online %X BACKGROUND: Bariatric surgery is the most effective treatment for severe obesity. However, following Roux-en-Y gastric bypass (RYGB) surgery, a small minority of patients develop new-onset alcohol use disorder (AUD), the aetiology of which is poorly understood. AIM: The aim is to construct a theory to explain the development of AUD among a sample of individuals who reported problematic drinking following RYGB. METHOD: Semi-structured interviews were conducted with eight RYGB patients diagnosed with AUD attending a multi-disciplinary outpatient weight management service at a public hospital in the Republic of Ireland. A constructivist grounded theory methodology was used to analyse interview transcripts. RESULTS: Participants' main concern was identified as 'unresolved psychological issues' which were managed by 'external coping mechanisms', namely, 'eating to cope'. After RYGB, comfort eating was no longer possible to the same extent. Following a 'honeymoon period', participants' need for an external coping mechanism resurfaced. 'Filling the void' provides a framework to explain how participants managed the symptoms of their unresolved psychological issues through 'behavioural substitution', that is, drinking alcohol instead of eating. CONCLUSION: The theoretical framework of 'filling the void' adds to contemporary research that conceptualises AUD behavioural substitution as 'addiction transfer' by describing the process by which the phenomenon occurs as well as the characteristics of participants. The clinical implication of this research is to advocate for a reshaping of treatment of RYGB patients, with increased psychological input following surgery. %0 Generic %A Drug and Alcohol Findings, %C London %D 2017 %F ndc:28035 %I Drug and Alcohol Findings %N October-December 2017 %T Substance use treatment as part of a ‘wrap-around’ package of care. %U http://www.drugsandalcohol.ie/28035/ %X In the ‘austere’ UK financial climate, it seems unclear whether treatment services will be forced to bunker down and focus on substance use objectives, or instead be supported to expand into holistic providers of, or gateways to, the range of psychosocial services demanded by government reintegration and recovery agendas. Given the typically multiple, severe, and overlapping problems presented by treatment caseloads, it seems obvious that a holistic approach would help get patients back on a stable (recovery) footing, and similarly obvious that just focusing on substance use objectives would be setting some patients up to fail. Could ‘wrap-around’ care be the answer, and should treatment services have the flexibility to determine the extent to which this would be implemented in practice, or would this risk a lottery of comprehensive care? %0 Generic %A Drug and Alcohol Findings, %C London %D 2017 %F ndc:22467 %I Drug and Alcohol Findings %T Drug Matrix cell C1: management/supervision - reducing harm. %U http://www.drugsandalcohol.ie/22467/ %0 Journal Article %A O'Driscoll, Colin %A Foy, Sean %D 2017 %F ndc:27973 %I Psychological Society of Ireland %J The Irish Psychologist %N 12 %P 16-20 %T Working with clients with addiction: what psychologists need to know. %U http://www.drugsandalcohol.ie/27973/ %V 43 %X Addiction is a common problem that practitioner psychologists face with their clients. It is however, the view and experience of the authors that specialised training in addiction treatment for psychologists is sparse, inconsistent and incomprehensive. As a consequence, psychologists may feel unskilled in this regard, referring clients onto specialist community based services where they may or may not be seen, or specialist residential (tier 4) services where they may or may not be accepted, or be able to afford (in time or cost). This article aims to give some context to the nature of these issues and the challenges facing practitioners, offer an overview of evidence in the treatment of addiction, and finally conclude with some guidance to psychologists in the treatment of these issues in the psychotherapeutic context. %0 Generic %A Public Health England, %C London %D 2017 %F ndc:27951 %I Public Health England %T Health Matters: preventing ill health from alcohol and tobacco use. %U http://www.drugsandalcohol.ie/27951/ %0 Generic %A Ryan, Sara %A Hislop, Jenny %A Ziebland, Sue %D 2017 %F ndc:27903 %I Wiley %N 5 %P 878-885 %T Do we all agree what "good health care" looks like? Views from those who are "seldom heard" in health research, policy and service improvement. %U http://www.drugsandalcohol.ie/27903/ %V 20 %X Context: The aim of this study was to ask whether there are shared ideas about what good health care looks like that apply across different populations and conditions. Do priorities among "seldom heard" groups differ from mainstream views and, if so, how might we understand these differences? Design: Focus groups were recruited with the help of our study patient representatives. Participants discussed and prioritized a set of eight "core components" of good care. We recorded and transcribed the data for thematic analysis. Setting and participants: We recruited people who are seldom heard in health and policy research for separate focus group discussions (one each with illegal drug users, Irish Travellers, migrant workers, young men and learning disabled people). We also ran a reference group of educated, older adults and an online group with people with long-term conditions. Results: There were few differences in what participants thought was important in health care but considerable differences in their expectations that they might personally receive good care. Differences related to participants' previous experiences. The drug users group reported particularly poor experiences and low expectations of good care. Discussion: Differences in what is regarded as an entitlement or privilege in health care underline the persistence of structural and relational differences in how services are experienced. While we can be reassured that core aspects of care are similarly prioritized across different patient groups, including those who are seldom heard, a more intractable challenge remains: how to provide equitable health care for marginalized groups in an unequal society. %0 Generic %A WHO Regional Office for Europe, %C Copenhagan %D 2017 %F ndc:28029 %I WHO Regional Office for Europe %T WHO alcohol brief intervention training manual for primary care. %U http://www.drugsandalcohol.ie/28029/ %X Alcohol contributes significantly to the disease and mortality burden in the WHO European Region, and primary health care systems play an important role in reducing the impact of harmful alcohol use. Screening and brief interventions (SBIs) for alcohol are an evidence-informed approach to addressing the needs of the many patients presenting in primary care who may benefit from reducing their alcohol consumption. This manual provides information to plan training and support for primary care practitioners to confidently deliver SBI for alcohol problems to their patients. The manual outlines the background and evidence base for SBI, and gives practical advice on establishing an implementation programme as well as detailed educational materials to develop the knowledge and skills of participants in organized training sessions. Unit 1. Introduction, course overview and group agreement p.22 Unit 2. Attitudes to alcohol p.26 Unit 3. Impact, consumption and harms of alcohol p.34 Unit 4. ABIs: goals, skills and practice change .p.44 Unit 5. Beginning a conversation about alcohol p.53 Unit 6. Screening and feedback using AUDIT p.57 Unit 7. Brief intervention core skills .p.68 Unit 8. Brief interventions – practice session p.77 Post training materials - Evaluation and monitoring p.93 %0 Journal Article %@ 1465-3362 %A Ivers, Jo-Hanna %A Zgaga, Lina %A Sweeney, Brion %A Keenan, Eamon %A Darker, Catherine %A Smyth, Bobby P %A Barry, Joe %D 2017 %F ndc:27911 %I Wiley %J Drug and Alcohol Review %T A naturalistic longitudinal analysis of post-detoxification outcomes in opioid-dependent patients. %U http://www.drugsandalcohol.ie/27911/ %V Early online %X Introduction and aims: To provide an assessment of outcomes in a cohort of opioid-dependent patients post-detoxification. Design and methods: This study employed an observational longitudinal cohort design. Patients who completed detoxification in the three major Drug Dependency Units in Ireland during a 14-month period were included in the study (n = 143). Patients opting for one of the three pathways post-detoxification (inpatient aftercare, outpatient aftercare or no formal aftercare) were assessed in the final week of detoxification and followed up after 3, 6 and 9 months. The primary outcome was abstinence following detoxification. Results: A Cox (adjusted) model indicated participants who opted for outpatient aftercare treatment lapsed/relapsed at a rate of 52% higher than the inpatient aftercare group (hazard ratio = 1.52, 95% confidence interval 0.75-3.08, P = 0.24). Moreover, time to lapse/relapse was considerably shorter for the no formal aftercare group (hazard ratio = 7.68, 95% confidence interval 4.30-13.73, P = 5.75 × 10(-12) ). Abstinence rates for outpatient aftercare and inpatient aftercare are about equal after 9 months. Discussion and conclusion: Patients who opt for aftercare post-detoxification have significantly better outcomes at follow up when compared to no formal aftercare. In addition, patients' intention to attend aftercare affected their outcomes regardless of eventual treatment path. %0 Generic %A Nugent, Shannon M %A Morasco, Benjamin J %A O'Neil, Maya E %A Freeman, Michele %A Low, Allison %A Kondo, Karli %A Elven, Camille %A Zakher, Bernadette %A Motu'apuaka, Makalapua %A Paynter, Robin %A Kansagara, Devan %D 2017 %F ndc:27823 %I American College of Physicians %N 5 %P 319-331 %T The effects of cannabis among adults with chronic pain and an overview of general harms: a systematic review. %U http://www.drugsandalcohol.ie/27823/ %V 167 %0 Generic %A Drug and Alcohol Findings, %C London %D 2017 %F ndc:22466 %I Drug and Alcohol Findings %T Drug Matrix cell B1: practitioners - reducing harm. %U http://www.drugsandalcohol.ie/22466/ %Z From Drug Treatment Matrix, copyright Drug and Alcohol Findings and the Substance Misuse Skills Consortium. %0 Report %A Department of Health, %B %C Dublin %D 2017 %F ndc:27729 %I Department of Health %T Hepatitis C screening. National clinical guideline no. 15. Summary. %U http://www.drugsandalcohol.ie/27729/ %X This Summary National Clinical Guideline is relevant to all healthcare professionals, healthcare managers and policy makers working with those at increased risk of hepatitis C virus (HCV) infection. The guideline will also be of value to both statutory and voluntary bodies providing services to those groups at increased risk of HCV infection. It may also be used by those with HCV or in a risk group for HCV and by members of the public. Hepatitis C virus (HCV) is a major cause of liver disease worldwide. Globally, it is estimated that there are 115 million people who have had HCV infection, and 80 million with chronic infection. Transmission of HCV occurs through contact with the blood of an infected person. Risk factors for HCV differ globally. In developed countries like Ireland, injecting drug use (IDU) is the major risk factor. (3.1.4 People who use unprescribed or illicit drugs - page 15) %0 Journal Article %A Lyons, Suzi %D 2017 %F ndc:27752 %I Health Research Board %J Drugnet Ireland %P 27-30 %T New clinical guidelines for opioid substitution treatment. %U http://www.drugsandalcohol.ie/27752/ %V Issue 62, Summer 2017 %0 Journal Article %A Lyons, Suzi %D 2017 %F ndc:27754 %I Health Research Board %J Drugnet Ireland %P 31 %T Updated community detoxification protocols for methadone and benzodiazepines. %U http://www.drugsandalcohol.ie/27754/ %V Issue 62, Summer 2017 %0 Journal Article %A Millar, Sean %D 2017 %F ndc:27758 %I Health Research Board %J Drugnet Ireland %P 36-37 %T Healthcare in Irish prisons. %U http://www.drugsandalcohol.ie/27758/ %V Issue 62, Summer 2017 %0 Journal Article %@ 1747-597X %A Ayu, Astri Parawita %A El-Guebaly, Nady %A Schellekens, Arnt %A De Jong, Cor %A Welle-Strand, Gabrielle %A Small, William %A Wood, Evan %A Cullen, Walter %A Klimas, Jan %D 2017 %F ndc:27667 %I Taylor & Francis %J Substance Abuse %P 0 %T Core addiction medicine competencies for doctors, an international consultation on training.. %U http://www.drugsandalcohol.ie/27667/ %V Early online %X BACKGROUND: Despite the high prevalence of substance use disorders, associated comorbidities and the evidence-base upon which to base clinical practice, most health systems have not invested in standardised training of healthcare providers in addiction medicine. As a result, people with substance use disorders often receive inadequate care, at the cost of quality of life and enormous direct health care costs and indirect societal costs. Therefore, we undertook this study to assess the views of international scholars, representing different countries, on the core set of addiction medicine competencies that need to be covered in medical education. METHODS: We interviewed 13 members of the International Society of Addiction Medicine (ISAM), from 12 different countries (37% response rate), over Skype, email survey or in-person - at the annual conference. We content-analysed the interview transcripts, using constant comparison methodology. RESULTS: We identified recommendations related to the core set of the addiction medicine competencies at three educational levels: (i) undergraduate (ii) postgraduate and (iii) continued medical education (CME). The participants described broad ideas, such as knowledge / skills / attitudes towards addiction to be obtained at undergraduate level, or knowledge of addiction treatment to be acquired at graduate level, as well as specific recommendations, including the need to tailor curriculum to national settings and different specialties. CONCLUSIONS: While it is unclear whether a global curriculum is needed, a consensus on a core set of principles for progression of knowledge, attitude and skills in addiction medicine to be developed at each educational level amongst medical graduates would likely have substantial value. %0 Journal Article %@ 1471-244X %A Peckham, Emily %A Brabyn, Sally %A Cook, Liz %A Tew, Garry %A Gilbody, Simon %D 2017 %F ndc:27601 %I BioMed Central %J BMC psychiatry %N 1 %P 252 %T Smoking cessation in severe mental ill health: what works? an updated systematic review and meta-analysis. %U http://www.drugsandalcohol.ie/27601/ %V 17 %X BACKGROUND: People with severe mental ill health are more likely to smoke than those in the general population. It is therefore important that effective smoking cessation strategies are used to help people with severe mental ill health to stop smoking. This study aims to assess the effectiveness and cost -effectiveness of smoking cessation and reduction strategies in adults with severe mental ill health in both inpatient and outpatient settings. METHODS: This is an update of a previous systematic review. Electronic databases were searched during September 2016 for randomised controlled trials comparing smoking cessation interventions to each other, usual care, or placebo. Data was extracted on biochemically-verified, self-reported smoking cessation (primary outcome), as well as on smoking reduction, body weight, psychiatric symptom, and adverse events (secondary outcomes). RESULTS: We included 26 trials of pharmacological and/or behavioural interventions. Eight trials comparing bupropion to placebo were pooled showing that bupropion improved quit rates significantly in the medium and long term but not the short term (short term RR = 6.42 95% CI 0.82-50.07; medium term RR = 2.93 95% CI 1.61-5.34; long term RR = 3.04 95% CI 1.10-8.42). Five trials comparing varenicline to placebo showed that that the addition of varenicline improved quit rates significantly in the medium term (RR = 4.13 95% CI 1.36-12.53). The results from five trials of specialised smoking cessation programmes were pooled and showed no evidence of benefit in the medium (RR = 1.32 95% CI 0.85-2.06) or long term (RR = 1.33 95% CI 0.85-2.08). There was insufficient data to allowing pooling for all time points for varenicline and trials of specialist smoking cessation programmes. Trials suggest few adverse events although safety data were not always reported. Only one pilot study reported cost effectiveness data. CONCLUSIONS: Bupropion and varenicline, which have been shown to be effective in the general population, also work for people with severe mental ill health and their use in patients with stable psychiatric conditions. Despite good evidence for the effectiveness of smoking cessation interventions for people with severe mental ill health, the percentage of people with severe mental ill health who smoke remains higher than that for the general population. %0 Report %@ HRB Drug and Alcohol Evidence Review 5 %A Bates, Geoff %A Jones, Lisa %A Cochrane, Madeleine %A Pendlebury, Marissa %A Sumnall, Harry %B %C Dublin %D 2017 %F ndc:27253 %I Health Research Board %T The effectiveness of interventions related to the use of illicit drugs: prevention, harm reduction, treatment and recovery. A ‘review of reviews’. %U http://www.drugsandalcohol.ie/27253/ %0 Generic %A Bonnie, Richard J %A Ford, Morgan A %A Phillips, Jonathan K %A Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse, %C Washington %D 2017 %F ndc:27587 %I National Academies Press %T Pain management and the opioid epidemic: balancing societal and individual benefits and risks of prescription opioid use. %U http://www.drugsandalcohol.ie/27587/ %X Summary s-1 1 introduction 1-1 PART I Pain management and research 2 Pain management and the intersection of pain and opioid use disorder 2-1 • The scope of the problem of pain, 2-1 • Opioid analgesics, 2-4 • Nonopioid pharmacologic treatments, 2-16 • Interventional pain therapies, 2-25 • Nonpharmacologic treatments, 2-27 • Differences in pain experiences and treatment effectiveness among • Subpopulations, 2-33 • The intersection between pain and opioid use disorder, 2-36 • References, 2-36 3 Progress and future directions in research on pain and opioid use disorder 3-1 • Basic pain research, 3-1 • The neurobiology of the reward pathway and the intersection of pain and opioid • Use disorder, 3-10 • Preclinical and translational research, 3-13 • Clinical research, 3-18 • Intersection of pain and opioid use disorder, 3-26 • Support for research, 3-33 • Summary and recommendation, 3-34 • References, 3-34 PART II Addressing the opioid epidemic 4 Trends in opioid use, harms, and treatment 4-1 • Trends in prescription opioid use and misuse, 4-1 • Heroin use and its relation to prescription opioid use, 4-15 • Illicit opioid markets, 4-25 • The current state of surveillance systems, 4-32 • Recent developments in pharmaceutical treatment of opioid use disorder, 4-35 • Trends in treatment of opioid overdose with naloxone, 4-46 • Summary and recommendations, 4-48 • References, 4-49 5 Evidence on strategies for addressing the opioid epidemic 5-1 • Nature of the Evidence, 5-2 • The Need for a Systems Approach, 5-4 • Strategies for Restricting Supply, 5-10 • Strategies for Influencing Prescribing Practices, 5-21 • Strategies for Reducing Demand, 5-39 • Strategies for Reducing Harm, 5-46 • Summary and Recommendations, 5-58 • References, 5-60 6 Opioid approval and monitoring by the U.S. Food and drug administration 6-1 • Overview of the FDA’s regulatory process for prescription drugs and its application to opioids, 6-2 • Public health dimensions of FDA drug regulation, 6-17 • Key elements of an integrated decision-making framework for opioid • Regulation,6-22 • Implementation of an integrated framework for opioid regulation, 6-25 • Summary and recommendations, 6-40 • References, 6-44 • Annex table 6-1: extended-release(er)/long-acting (la) opioid post-marketing • Study requirements, 6-49 Appendixes A Data sources and methods a-1 B Biographical sketches of committee members and consultants b-1 C Existing data sources on opioid use, misuse, overdose, and other harms c-1 [Note: Download from NAP site if free, but may require guest registration with your email.] %0 Generic %A Nielsen, Suzanne %C Sydney %D 2017 %F ndc:27709 %I National Drug and Alcohol Research Centre %T Frequently asked questions on opioid agonist treatment for pharmaceutical opioid dependence: An evidence summary. %U http://www.drugsandalcohol.ie/27709/ %X This evidence summary from Australia comes from a program of work that aimed to build the evidence base for the treatment of pharmaceutical opioid dependence, or dependence on opioid pain medications such as oxycodone, morphine and codeine. Many of the original trials examining methadone and buprenorphine (+/- naloxone) were conducted in people dependent on heroin. In recent years new studies and revised analysis from older studies have aimed to provide information on the use of methadone and buprenorphine (+ naloxone) for those dependent on pharmaceutical opioids such as codeine, morphine and oxycodone. This document is a summary of key findings in a ‘frequently asked questions’ format. %0 Generic %A Clinical Guidelines on Drug Misuse and Dependence Update 2017 Independent Expert Working Group, %C London %D 2017 %F ndc:27595 %I Department of Health %T Drug misuse and dependence. UK guidelines on clinical management. %U http://www.drugsandalcohol.ie/27595/ %X Contents Chapter 1: Introduction 9 Chapter 2: Essential elements of treatment provision 15 2.1 Key points 15 2.2 Assessment, planning care and treatment 15 2.3 Delivery of treatment 27 2.4 Drug testing 28 2.5 General health assessment at presentation and in treatment 31 2.6 Effective communication with primary and secondary care services 35 2.7 Organisational factors for effective drug treatment 35 2.8 Intimate partner violence and domestic abuse 43 2.9 Planning and contracting or commissioning services 44 Chapter 3: Psychosocial components of treatment 47 3.1 Key points 47 3.2 Introduction 47 3.3 Core elements underpinning effective delivery 51 3.4 Making psychosocial interventions effective 52 3.5 Interventions focused on social network and family, friends and carers 56 3.6 Medication and psychosocial interventions 57 3.7 Delivering psychosocial interventions 58 3.8 Resources and further reading 81 3.9 References 81 Chapter 4: Pharmacological interventions 83 4.1 Key points 83 4.2 Prescribing 84 4.3 Choosing an appropriate opioid substitute 88 4.4 Induction onto methadone and buprenorphine substitution treatment 90 4.5 Supervised consumption 101 4.6 Assessing and responding to progress and failure to benefit 104 4.7 Opioid maintenance prescribing 110 4.8 Opioid detoxification 115 4.9 Naltrexone for relapse prevention 118 4.10 Pharmacological management of dependence on other drugs 119 4.11 Resources and further reading 124 4.12 References 125 Chapter 5: Criminal justice system 127 5.1 Key points 127 5.2 Introduction 128 5.3 Criminal justice systems in the community 130 5.4 Prisons and other secure environments 133 5.5 References 160 Chapter 6: Health considerations 163 6.1 Key points 163 6.2 Blood-borne viruses and other infections 163 6.3 Preventing drug-related deaths 174 6.4 Naloxone 178 6.5 Alcohol in drug treatment 183 6.6 Smoking and respiratory function 187 6.7 Oral health 190 6.8 References 194 Chapter 7: Specific treatment situations and populations 197 7.1 General key points 197 7.2 Pain management 197 7.3 Dependence on prescribed and over-the-counter opioids 205 7.4 Misuse of or dependence on gabapentinoids 208 7.5 Hospitalisation 209 7.6 Pregnancy and neonatal care 220 7.7 New psychoactive substances and club drugs 225 7.8 Image and performance enhancing drugs 229 7.9 Coexisting problems with mental health and substance use 231 7.10 Young people 240 7.11 Older people 247 7.12 References 252 Annexes 255 A1: Working group members and other contributors 257 A2: Governance 263 A3: Marketing authorisations 271 A4: Writing prescriptions 277 A5: Interactions 293 A6: Travelling abroad with controlled drugs 303 A7: Drugs and driving 305 A8: Glossary 311 %0 Journal Article %@ 1049-7323 %A Van Hout, Marie Claire %A Horan, A %A Santlal, K %A Rich, E %A Bergin, M %D 2017 %F ndc:24912 %I Sage %J Qualitative Health Research %N 3 %P 341-350 %T ‘Codeine is my companion’: misuse and dependence on codeine containing medicines in Ireland. %U http://www.drugsandalcohol.ie/24912/ %V 27 %X Objectives: Global concern around over the counter availability of codeine containing products and risk of misuse, dependence and related harms are evident. A phenomenological study of lived experiences of codeine misuse and dependence was undertaken in Ireland, following the Pharmaceutical Society of Ireland’s 2010 guidelines for restricted supply of non-prescription codeine containing products. Methods: In-depth interviews were conducted with a purposive sample of adult codeine misusers and dependents (n=21), both actively using, in treatment and in recovery. The narratives were analysed using the Empirical Phenomenological Psychological five-step method (Karlsson, 1995). A total of 10 themes with 82 categories were identified. Two concepts at a higher level of abstraction above the theme-level emerged during the final stage of analysis. The concepts identified were ‘emotional pain and user self-legitimization of use’ and ‘entrapment into habit-forming and invisible dependent use’. These concepts were reported in different ways by a majority of participants. Results: Findings are presented under the following themes: (1) profile and product preferences; (2) awareness of habit forming use and harm; (3) negotiating pharmacy sales; (4) alternative sourcing routes; (5) the codeine feeling; (6) the daily routine; (7) acute and chronic side effects; (8) social isolation; (9) withdrawal and dependence and (10) help-seeking and treatment experiences. Conclusions: There is a public health and regulatory imperative to develop proactive responses tackling public availability of codeine containing medicines, risk minimisation in consumer self-treatment for pain, enhanced patient awareness of potential for habit forming use and its consequences and continued health professional pharmacovigilence. %0 Generic %A Ward, Matt %A Jones, Andrew %D 2017 %F ndc:27658 %I Springer %T Elevated alcohol consumption following alcohol cue exposure is partially mediated by reduced inhibitory control and increased craving. %U http://www.drugsandalcohol.ie/27658/ %V Early online %X Rationale: Exposure to alcohol-related cues leads to increased alcohol consumption, and this may be partially attributable to momentarily impaired impulse control. Objectives: We investigated if exposure to alcohol cues would impair inhibitory control and if the extent of this impairment would partially mediate the effect of alcohol cues on subsequent voluntary alcohol consumption. Methods: We recruited 81 heavy drinkers (50 female) who completed baseline measures of inhibitory control (stop-signal task) and subjective craving before random allocation to an alcohol cue exposure or control group. The alcohol cue exposure group then completed a second stop-signal task (with embedded alcohol cues) with concurrent exposure to olfactory alcohol cues, in an alcohol context. The control group completed a second stop-signal task (with embedded water cues), accompanied by exposure to water cues, in a neutral context. Then, subjective craving and ad libitum alcohol consumption were measured in all participants. Results: Inhibitory control worsened (compared to baseline) to a greater extent in the alcohol cue exposure group compared to the control group. Craving and ad libitum alcohol consumption were elevated in the alcohol cue exposure group compared to the control group, although the group difference in alcohol consumption fell short of statistical significance. In support of our hypotheses, multiple mediation analyses demonstrated that elevated ad libitum alcohol consumption following alcohol cue exposure was partially mediated by both impaired inhibitory control and increased craving. Conclusions: These findings suggest that state fluctuations in inhibitory control are a potential mechanism through which alcohol cues increase drinking behaviour. %0 Journal Article %@ 2450-131X %A Crowley, Des %A Cullen, Walter %A Laird, Eamon %A Lambert, John S %A Mc Hugh, Tina %A Murphy, Carol %A Van Hout, Marie Claire %D 2017 %F ndc:27666 %I De Gruyter %J Journal of Translational Internal Medicine %N 2 %P 112-119 %T Exploring patient characteristics and barriers to hepatitis C treatment in patients on opioid substitution treatment attending a community based fibro-scanning clinic. %U http://www.drugsandalcohol.ie/27666/ %V 5 %X BACKGROUND AND OBJECTIVES: Hepatitis C virus (HCV) infection is a major public health issue. There is substandard uptake in HCV assessment and treatment among people who inject drugs (PWID). Community fibroscanning is used to assess disease severity and target treatment. METHODS: A survey was administered to a cohort of chronically HCV infected patients attending a community fibroscanning clinic. Questions targeted diagnosis of HCV, suitability, willingness and barriers to engagement in treatment. Descriptive and regression analysis, with thematic analysis of open-ended data was conducted. RESULTS: There was high acceptance of community fibroscanning among this cohort with over 90% (68) attending. High levels of unemployment (90%) and homelessness (40%) were identified. Most patients were on methadone treatment and had been HCV infected for greater than 10 years with length of time since HCV diagnosis being significantly longer in patients with fibroscan scores > 8.5 kPa (P = 0.016). With each unit increase in methadone dose, the odds of the >8.5 fibroscan group increased by 5.2%. Patient identified barriers to engagement were alcohol and drug use, fear of HCV treatment and liver biopsy, imprisonment, distance to hospital and early morning appointments. CONCLUSION: The study highlights the usefulness of community fibroscanning. Identifying barriers to treatment in this cohort affords an opportunity to increase the treatment uptake. The availability of afternoon clinics and enhanced prison linkage are warranted. %0 Generic %A Drug and Alcohol Findings, %C London %D 2017 %F ndc:23732 %I Drug and Alcohol Findings %T Alcohol matrix cell C5: Management/supervision - safeguarding the community. %U http://www.drugsandalcohol.ie/23732/ %0 Generic %A National Institute for Health and Care Excellence, %C London %D 2017 %F ndc:27483 %I National Institute for Health and Care Excellence %T Liver disease. Quality standard. %U http://www.drugsandalcohol.ie/27483/ %0 Generic %A National Institute for Health and Care Excellence, %C London %D 2017 %F ndc:27705 %I NICE %T Multimorbidity: quality standard. %U http://www.drugsandalcohol.ie/27705/ %X This quality standard covers clinical assessment, prioritising and managing healthcare for adults aged 18 years and over with 2 or more long-term health conditions (multimorbidity). At least 1 of these conditions must be a physical health condition. It describes high-quality care in priority areas for improvement. (It does not cover care for people who have multiple mental health problems and no physical health conditions because their care is largely delivered by psychiatric services.) Improving outcomes: This quality standard is expected to contribute to improvements in the following outcomes: • health-related quality of life for adults with multimorbidity • adults with multimorbidity feeling involved in decisions about their care • effects of health problems and treatment on day-to-day activities of adults with multimorbidity. %0 Generic %A Webster, Russell %D 2017 %F ndc:27317 %I Russell Webster %T What do prisoners think of drug treatment? %U http://www.drugsandalcohol.ie/27317/ %X A very mixed picture By way of a change today, I am actually summarising a piece of research undertaken by myself. Over the last two months I’ve been researching the experiences of opiate using offenders seeking substitute prescribing (methadone or buprenorphine – usually known as Subutex or “Subbies”) in prison and on release. Interestingly, service users had very mixed experiences with some finding access to a script easier than in the community while others received no help despite being on a prescription in the community prior to being sent to prison. I used two main methods to gain service user views. First, an online survey was completed by 102 opiate users who had been in an English or Welsh prison in the last two years. Opiate using prisoners were identified and recruited by 10 peer researchers trained, supervised and supported by the Revolving Doors Agency. Analysis of the survey data informed the second stage of the research study; a focus group with nine individuals with recent experience of Opioid Substitute Treatment (OST) in prison........... %0 Generic %A Drug and Alcohol Findings, %C London %D 2017 %F ndc:23731 %I Drug and Alcohol Findings %T Alcohol matrix cell B5: Practitioners - safeguarding the community. %U http://www.drugsandalcohol.ie/23731/ %0 Report %A National Office for Traffic Medicine, %B %C Dublin %D 2017 %F ndc:27226 %I Road Safety Authority %T Sláinte agus Tiomáint. Medical fitness to drive guidelines (Group 1 and Group 2 Drivers). %U http://www.drugsandalcohol.ie/27226/ %X Sláinte agus Tiomáint provides guidance on medical fitness to drive and is aimed primarily at medical professionals and those working at the interface between road safety and health e.g. On-road Driving Assessors, the National Driver Licence Service. It supports clinicians in providing guidance to patients who may have medical fitness to drive issues. The guidelines highlight the need for all of us to appreciate that the state of our health impacts, to a greater or lesser degree, on our ability to drive safely. Driver fitness is governed by EU law and regulations made in Ireland under the Road Traffic Acts. Sláinte agus Tiomáint is an interpretation of these laws; however, the Directive/regulations form the overriding legal basis for driver medical fitness in Ireland. One of the objectives of Sláinte agus Tiomáint is to promote mobility and to do this in a way that is consistent with safety on our roads. Once a driver is aware of any health aspects that impact on driving and follows the advice of their doctor, they can continue to drive in most cases. P.15 3.9 Medications and driving P.84 Chapter 6: Drug misuse and dependence %0 Generic %A Saulle, Rosella %A Vecchi, Simona %A Gowing, Linda %C London %D 2017 %F ndc:25451 %I John Wiley & Sons, Ltd %N 4 %T Supervised dosing with a long acting opioid medication in the management of opioid dependence. %U http://www.drugsandalcohol.ie/25451/ %X Take-home medication strategies are attractive to treatment services due to lower costs, and place less restrictions on clients, but it is unknown whether they may be associated with increased risk of diversion and unsanctioned use of medication. There is uncertainty about the effects of supervised dosing compared with unsupervised medication due to the low and very low quality of the evidence for the primary outcomes of interest for this review. Data on defined secondary outcomes were similarly limited. More research comparing supervised and take-home medication strategies is needed to support decisions on the relative effectiveness of these strategies. The trials should be designed and conducted with high quality and over a longer follow-up period to support comparison of strategies at different stages of treatment. In particular, there is a need for studies assessing in more detail the risk of diversion and safety outcomes of using supervised OST to manage opioid dependence. %0 Generic %A Drug and Alcohol Findings, %C London %D 2017 %F ndc:22525 %I Drug and Alcohol Findings and the Substance Misuse Skills Consortium %T Alcohol Matrix cell B4: Practitioners - psychosocial therapies. %U http://www.drugsandalcohol.ie/22525/ %0 Generic %A Laporte, Catherine %A Vaillant-Roussel, Hélène %A Pereira, Bruno %A Blanc, Olivier %A Eschalier, Bénédicte %A Kinouani, Shérazade %A Brousse, Georges %A Llorca, Pierre-Michel %A Vorilhon, Philippe %D 2017 %F ndc:27052 %I n/a %N 2 %P 131-139 %T Cannabis and young users- a brief intervention to reduce their consumption (CANABIC): a cluster randomized controlled trial in primary care. %U http://www.drugsandalcohol.ie/27052/ %V 15 %X PURPOSE: Brief intervention to reduce cannabis is a promising technique that could be adapted for use in primary care, but it has not been well studied in this setting. We tested the efficacy of a brief intervention conducted by general practitioners among cannabis users aged 15 to 25 years. METHODS: We performed a cluster randomized controlled trial with 77 general practitioners in France. The intervention consisted of an interview designed according to the FRAMES (feedback, responsibility, advice, menu, empathy, self-efficacy) model, while the control condition consisted of routine care. RESULTS: The general practitioners screened and followed up 261 young cannabis users. After 1 year, there was no significant difference between the intervention and control groups in the median number of joints smoked per month among all users (17.5 vs 17.5; P = .13), but there was a difference in favor of the intervention among nondaily users (3 vs 10; P = .01). After 6 months, the intervention was associated with a more favorable change from baseline in the number of joints smoked (-33.3% vs 0%, P = .01) and, among users younger than age of 18, smoking of fewer joints per month (12.5 vs 20, P = .04). CONCLUSIONS: Our findings suggest that a brief intervention conducted by general practitioners with French young cannabis users does not affect use overall. They do, however, strongly support use of brief intervention for younger users and for moderate users. %0 Generic %A Parkman, Tom %A Neale, Joanne %A Day, Ed %A Drummond, Colin %D 2017 %F ndc:26869 %I BioMed Central %N 140 %T Qualitative exploration of why people repeatedly attend emergency departments for alcohol-related reasons. %U http://www.drugsandalcohol.ie/26869/ %V 17 %X Background: Understanding why people repeatedly attend Emergency Departments (EDs) for alcohol-related reasons is an important prerequisite to identifying ways of reducing any unnecessary demands on hospital resources. We use Andersen’s Behavioural Model of Health Services Use to explore factors that contributed to repeat ED attendances. Methods: Qualitative interviews were conducted with 30 people who repeatedly attended EDs for alcohol-related reasons (≥10 attendances in the past 12 months). We recruited participants from 6 EDs in London, United Kingdom. Data on socio-demographic characteristics, substance use, contact with specialist addiction and other health services, most recent ED attendance, and previous ED attendances were analysed. Results: Participants reported long-standing health problems, almost all were unemployed, and many had limited education and unstable housing. Most held positive health beliefs about EDs, despite some negative experiences. They reported limited community resources: poor social support, inaccessible primary care services, dislike or lack of information about specialist addiction services, and difficulties travelling to services. In contrast, EDs offered immediate, sympathetic care and free transport by ambulance. Participants’ perceived need for care was high, with physical injury and pain being the main reasons for ED attendance. Conclusions: Push’ and ‘pull’ factors contributed to repeated ED use. ‘Push’ factors included individual-level problems and wider community service failings. ‘Pull’ factors included positive experiences of, and beliefs about, ED care. Community services need to better engage and support people with complex drinking problems, whilst ED staff can be more effective in referring patients to community-based services. %0 Journal Article %A Galvin, Brian %D 2017 %F ndc:26707 %I Health Research Board %J Drugnet Ireland %P 15-17 %T HRB drug and alcohol evidence review on case management. %U http://www.drugsandalcohol.ie/26707/ %V Issue 60, Winter 2017 %0 Generic %A Koivula, Riitta %A Tigerstedt, Christoffer %A Vilkko, Anni %A Kuussaari, Kristiina %A Pajala, Satu %D 2016 %F ndc:26624 %I De Gruyter %N 5-6 %T How does older people’s drinking appear in the daily work of home care professionals? %U http://www.drugsandalcohol.ie/26624/ %V 33 %X AIMS - In this article the authors ask how the alcohol use of elderly home care clients affects the daily work of home care professionals and how the professionals act to support the drinking client. METHODS - Semi-structured interviews with 10 home care professionals were conducted from December 2014 to February 2015 in the Helsinki metropolitan area of Finland. Everyday situations during home visits related to the clients’ alcohol use were analysed according to modalities of agency of the home care professionals. RESULTS - The results focus on three themes raised in the interviews: supporting life management of the client, the lack of qualifications in tackling clients’ drinking and the need for multi-professional collaboration. Intoxicated clients complicated the home care nurses’ work and obstructed the implementation of recommendations set out to guide the professionals’ operations. Care work with alcohol-using clients was particularly demanding, and the professionals were concerned about not having enough training in how to encounter elderly clients’ drinking. Multi-professional collaboration with substance abuse services and emergency department personnel was called for to remedy this problem. CONCLUSIONS - More extensive and detailed research is needed for a better picture of how clients’ drinking influences home care nurses’ working conditions and what kind of skills nurses need in different alcohol-related situations. Such research would have the potential to benefit clients and improve the well-being of the employees. %0 Generic %A Drug and Alcohol Findings, %C London %D 2016 %F ndc:22519 %I Drug and Alcohol Findings and the Substance Misuse Skills Consortium %T Alcohol Matrix cell A3: Interventions - medical treatment. %U http://www.drugsandalcohol.ie/22519/ %0 Generic %A Drug and Alcohol Findings, %C London %D 2016 %F ndc:22520 %I Drug and Alcohol Findings and the Substance Misuse Skills Consortium %T Alcohol Matrix cell B3: Practitioners - medical treatment. %U http://www.drugsandalcohol.ie/22520/ %0 Generic %A World Health Organization, %C Geneva %D 2016 %F ndc:26313 %I World Health Organization %T Global report on access to hepatitis C treatment - Focus on overcoming barriers. %U http://www.drugsandalcohol.ie/26313/ %X This is the first-ever global report on treatment access to hepatitis C medicines. The report provides the information that countries and health authorities need to identify the appropriate HCV treatment, and procure it at affordable prices. The report uses the experience of several pioneering countries to demonstrate how barriers to treatment access can be overcome. It also provides information on the production of new hepatitis C drugs and generic versions worldwide, including where the drugs are registered, where the drugs are patented and where not, and what opportunities countries have under the license agreements that were signed by some companies as well as current pricing of all recommended direct-acting antivirals (DAAs), including by generic companies all over the world. P.12 - People who inject drugs (PWID) are the group with the highest HCV prevalence, an estimated 67%. Injections among PWID with unsterilized syringes or shared injecting equipment are the major transmission mode in high-income countries and are increasingly being reported in LMICs (low- and middle-income countries). The major route of transmission in LMICs is through the reuse of syringes and needles, and through substandard infection control practices in health-care settings. %0 Generic %A Drug and Alcohol Findings, %C London %D 2016 %F ndc:26057 %I Drug and Alcohol Findings %T Alcohol Matrix cell B2: Practitioners; generic and cross-cutting issues. %U http://www.drugsandalcohol.ie/26057/ %0 Generic %A Drug and Alcohol Findings, %C London %D 2016 %F ndc:26614 %I Drug and Alcohol Findings %T Alcohol Matrix cell D2: Organisational functioning; Generic and cross-cutting issues. %U http://www.drugsandalcohol.ie/26614/ %0 Generic %C London %D 2016 %F ndc:15185 %I National Institute for Health and Clinical Excellence %T Alcohol-use disorders overview. %U http://www.drugsandalcohol.ie/15185/ %X NICE Pathways is an online tool for health and social care professionals that brings together all related NICE guidance and associated products in a set of interactive topic-based diagrams. Visually representing everything NICE has said on a particular topic, the pathways enable you to see at a glance all of NICE's recommendations on a specific clinical or health topic. In this pathway,click on the information,implementation and guidance links for details. %0 Journal Article %@ 1530-0277 %A Cousins, Gráinne %A Mongan, Deirdre %A Barry, Joe %A Smyth, Bobby %A Rackard, Marion %A Long, Jean %D 2016 %F ndc:25734 %I Wiley-Blackwell %J Alcoholism Clinical and Experimental Research %N 8 %P 1700-1706 %T Estimating risk of alcohol dependence using empirically validated ordinal risk zones versus recommended binary risk zones of the RAPS4: a validation study using stratum-specific likelihood ratio analysis. %U http://www.drugsandalcohol.ie/25734/ %V 40 %X BACKGROUND: Effective treatment options for alcohol dependence exist; yet, only 10% of people with alcohol dependence receive treatment. The objective of the current study was to examine the performance of previously recommended Rapid Alcohol Problem Screen 4 (RAPS4) risk zones, based on single binary cut-points (RAPS4 ≥ 1; RAPS4 ≥ 2), and empirically identified RAPS4 risk zones to identify people with alcohol dependence so that further diagnostic assessment or interventions can be offered. METHOD: Stratum-specific likelihood ratio (SSLR) and receiver operating characteristic analyses were used to compare the screening performance of empirically identified "risk zones" on the RAPS4 to previously recommended binary cut-points in a general population sample of current drinkers in Ireland (N = 4,267). SSLRs were also used along with the pretest prevalence of alcohol dependence to estimate posttest probabilities of alcohol dependence for the recommended and empirically identified risk zones. RESULTS: The weighted prevalence estimate of alcohol dependence among current drinkers was 6.9% (9.3% men; 4.5% women). The SSLR analysis identified multiple risk zones in the RAPS4, with each of the individual scores (0, 1, 2, 3, 4) retained as 5 separate ordinal risk zones for both men and women. A comparison of the area under the receiver operating characteristic curve showed that the ordinal RAPS4 risk zones performed better than recommended binary thresholds for both men and women. Based on the pretest probability of 9.3% and the identified SSLRs for the ordinal risk zones, the posttest probability of alcohol dependence for men ranged from 1.6% for those in the lower risk zone (RAPS4 = 0) to 86.7% for those in the highest risk zone (RAPS4 = 4). The posttest probability of alcohol dependence for women ranged from 0.4% for those in the lower risk zone to 80% for those in the higher risk zone. CONCLUSIONS: The detection of alcohol dependence may be improved using the empirically identified ordinal RAPS4 risk zones for both men and women. The application of the identified SSLRs, particularly if integrated into a clinical decision support system, may be helpful for clinicians in providing feedback to patients regarding their risk of alcohol dependence. %0 Generic %A Medicines and Healthcare products Regulatory Agency, %D 2016 %F ndc:25822 %I n/a %N 12 %T Citalopram: suspected drug interaction with cocaine; prescribers should consider enquiring about illicit drug use. %U http://www.drugsandalcohol.ie/25822/ %V 9 %X The UK Medicines and Healthcare products Regulatory Agency received a Coroner’s report that raised concerns about a suspected drug interaction between citalopram and cocaine after the death of a man due to subarachnoid haemorrhage. The case was discussed by the UK Commission on Human Medicine’s Pharmacovigilance Expert Advisory Group. There are plausible mechanisms for an interaction between cocaine and citalopram that could lead to subarachnoid haemorrhage, including hypertension related to cocaine and an additive increased bleeding risk in combination with citalopram. Enquiring about potential illicit drug use: Guidance from the General Medical Council states that, together with the patient, healthcare professionals should make an assessment of the patient’s condition before deciding to prescribe a medicine. The professional must have, or take, an adequate history, which considers recent use of other medicines—including non-prescription medicines, herbal medicines, illegal drugs, and medicines purchased online. In particular, when prescribing selective serotonin reuptake inhibitors (SSRIs), prescribers are reminded to enquire about cocaine use when considering drug–drug interactions and the need to avoid concurrent use of multiple serotonergic drugs. In light of this Coroner’s case, we remind prescribers to note the potential increased risk of bleeding when citalopram is prescribed to patients who are taking cocaine. More generally, the possibility of illicit drug use and interactions should be considered when prescribing any medicines that have the potential to interact adversely. Possible interactions with illicit drugs should also be considered in patients who present with suspected adverse reactions to a medicine. %0 Generic %A Kendrick, Tony %A El-Gohary, Magdy %A Stuart, Beth %A Gilbody, Simon %A Churchill, Rachel %A Aiken, Laura %A Bhattacharya, Abhishek %A Gimson, Amy %A Brutt, Anna L %A de Jong, Kim %A Moore, Michael %C London %D 2016 %F ndc:25806 %I John Wiley & Sons, Ltd %T Routine use of patient reported outcome measures (PROMs) for improving treatment of common mental health disorders in adults. %U http://www.drugsandalcohol.ie/25806/ %V 7 %X What questions does this review aim to answer? • Does the use of PROMs to monitor progress in people with CMHDs improve health outcomes, including symptoms, quality of life, and social functioning? • Does the use of PROMs in people with CMHDs change the way their problems are managed, including drug therapy and referrals for specialist help? Which studies were included in the review? Trial databases were searched to find all high-quality studies of the use of PROMs to monitor the treatment of CMHDs published up to May 2015. Included studies had to be randomised controlled trials in adult participants, where the majority diagnosed had a CMHD. Seventeen studies involving 8787 participants were included in the review, nine from mental health, six from psychological therapy, and two from primary care settings. The quality of the studies was rated ‘low’ to 'moderate'. What does the evidence from the review tell us? Routine outcome monitoring of CMHDs using PROMs was not shown conclusively to be helpful in analyses combining study results, either in terms of improving patient symptom outcomes (across 12 studies), or in changing the duration of treatment for their conditions (across seven studies). It was not possible to analyse changes in drug treatment or referrals for further treatment as only two studies reported these. Similarly, health-related quality of life, social functioning, adverse events, and costs were reported in very few studies. What should happen next? More research of better quality is required, especially in primary care where most CMHDs are treated. Studies should include people treated with drugs as well as psychological therapies, and should follow them for longer than six months. As well as symptoms and length of treatment, studies should measure possible harms, quality of life, social functioning, and the costs of monitoring. %0 Generic %A Drug and Alcohol Findings, %C London %D 2016 %F ndc:22483 %I Drug and Alcohol Findings %T Alcohol Matrix cell B1: Practitioners - screening and brief intervention. %U http://www.drugsandalcohol.ie/22483/ %0 Generic %A Drug and Alcohol Findings, %A Substance Misuse Skills Consortium, %C London %D 2016 %F ndc:20066 %I Drug and Alcohol Findings and the Consortium %T Alcohol Matrix: Evidence for effective treatment. %U http://www.drugsandalcohol.ie/20066/ %X The Alcohol Matrix is concerned with the treatment of alcohol-related problems among adults (a similar table deals with drug-related problems). It maps the terrain within which relevant evidence may be found and for each location tries to find the most important UK-relevant research and guidance. In widening contextual circles, across the top of the matrix the columns move from specific interventions through how their impacts are affected by staff, the management of the service, and the nature of the organisation, to the impact of whole local area treatment systems. Down the rows are the major intervention types implemented at these levels. At the intersections, inside each cell is our pick of the most important documents relevant to the impact of that intervention type at that contextual level. %0 Report %A HSE Mental Health Division, %B %C Dublin %D 2016 %F ndc:25702 %I Health Service Executive %T Partnership for change. Report of the Mental Health Reference Group. %U http://www.drugsandalcohol.ie/25702/ %X The HSE Mental Health Division established a mental Health Reference Group in August 2014, consisting of 13 service users, family members and carers. The group submitted recommendations to the HSE national mental health management team that were accepted in full. The recommendations outline the key structures that will be used to engage service users, their families and carers and service providers at local and national level. In line with the recommendations, Liam Hennessy was appointed as the new Head of Service User Engagement in February and will be leading on the development of the engagement structures. A user of the mental health services himself, Liam has a background in teaching and has worked as a senior civil servant, a management consultant and, most recently, as the Service User, Assistant Inspector of Mental Health Services at the Mental Health Commission. Liam was Chair of St Patrick’s University Hospital Consumer and Carers’ Council and joint Chair of REFOCUS (Recovery Experience Forum of Carers and Users of Services), a committee of the College of Psychiatrists of Ireland. The next stages in the development of the service will include the recruitment of nine Area Leads for Engagement who will work in their designated areas, with service users and their supporters, to establish local and area forums. These forums will work in partnership with the local services to ensure that service user, family members and carer experiences and views will be taken into account in the planning and delivery of services. %0 Journal Article %@ 0790-9667 %A Rowntree, R %A Sweeney, J %A Crumlish, N %A Flynn, G %D 2016 %F ndc:25715 %I Medmedia Group %J Irish Journal of Psychological Medicine %T How do we compare with best practice? A completed audit of benzodiazepine and z-hypnotic prescribing. %U http://www.drugsandalcohol.ie/25715/ %V Early online %X Objectives. To compare benzodiazepine and z-hypnotic prescribing practices in an inpatient psychiatric unit to best practice standards. Methods. Medication charts of all inpatients in the psychiatric unit, over a 1-week period, were reviewed. Details of current benzodiazepine and z-hypnotic prescriptions were collected. Information collected included the substance prescribed, duration and administration instructions. Feedback was communicated to medical practitioners through a presentation and email. A re-audit was completed 4 months later. Results. There were increases in total benzodiazepine and z-hypnotic prescribing despite intervention. A reduction of 2mg occurred in the mean regular dose of benzodiazepine prescribed. Lorazepam was the most prescribed benzodiazepine throughout. In both data sets, at least 50% of regular z-hypnotics and benzodiazepines were initiated before admission. There was an increase of 14% in regular benzodiazepines initiated in hospital exceeding 4 weeks in duration. In neither data collection did regular z-hypnotics initiated in hospital exceed this cut off. A greater number of individuals were in the process of being withdrawn from regular benzodiazepine or z-hypnotic prescriptions in the re-audit. There were minimal improvements in ‘as required’ prescribing as regards documentation of an indication, time limit and maximum dose. Conclusion. The increase in overall prescribing, despite intervention, maybe because these medications continued to be indicated in the acute presentations needing inpatient treatment. The small improvements in ‘as required’ prescribing patterns suggest that the intervention was limited in effecting change in this area. %0 Generic %A Neale, Joanne %A Parkman, Tom %A Day, Ed %A Drummond, Colin %C London %D 2016 %F ndc:25471 %I Alcohol research UK %T Frequent attenders to accident and emergency departments: a qualitative study of individuals who repeatedly present with alcohol-related health conditions. %U http://www.drugsandalcohol.ie/25471/ %X Key findings • People who frequently attend Accident and Emergency (A&E) departments for alcohol-related reasons tend to experience alcohol dependence associated with multiple and complex needs, but also report diverse patterns of drinking and other substance use, and varied health and social problems. • Although A&E staff are generally sympathetic to the needs of people with complex drinking and related problems, they do not have the resources or training to provide the kind of personalised support that people who frequently attend A&E for alcohol-related reasons often need. • Assertive outreach – a treatment model that offers intensive, individualised, caseworker support for patients in the community – seems to offer good potential for helping people who frequently attend A&E for alcohol-related reasons. %0 Generic %A Drug and Alcohol Findings, %A Substance Misuse Skills Consortium, %C London %D 2016 %F ndc:22482 %I Drug and Alcohol Findings and the Substance Misuse Skills Consortium %T Alcohol Matrix cell A1: Interventions - screening and brief intervention. %U http://www.drugsandalcohol.ie/22482/ %0 Journal Article %@ 1471-244X %A Simpson, Alan %A Hannigan, Ben %A Coffey, Michael %A Barlow, Sally %A Cohen, Rachel %A Jones, Aled %A Všetečková, Jitka %A Faulkner, Alison %A Thornton, Alexandra %A Cartwright, Martin %D 2016 %F ndc:25552 %I BioMed Central %J BMC Psychiatry %N 1 %P 147 %T Recovery-focused care planning and coordination in England and Wales: a cross-national mixed methods comparative case study. %U http://www.drugsandalcohol.ie/25552/ %V 16 %X BACKGROUND: In the UK, concerns about safety and fragmented community mental health care led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require service users to have a care coordinator, written care plan and regular reviews of their care. Processes are required to be collaborative, recovery-focused and personalised but have rarely been researched. We aimed to obtain the views and experiences of stakeholders involved in community mental health care and identify factors that facilitate or act as barriers to personalised, collaborative, recovery-focused care. METHODS: We conducted a cross-national comparative study employing a concurrent transformative mixed-methods approach with embedded case studies across six service provider sites in England and Wales. The study included a survey of views on recovery, empowerment and therapeutic relationships in service users (n = 448) and recovery in care coordinators (n = 201); embedded case studies involving interviews with service providers, service users and carers (n = 117) and a review of care plans (n = 33). Quantitative and qualitative data were analysed within and across sites using inferential statistics, correlations and framework method. RESULTS: Significant differences were found across sites for scores on therapeutic relationships. Variation within sites and participant groups was reported in experiences of care planning and understandings of recovery and personalisation. Care plans were described as administratively burdensome and were rarely consulted. Carers reported varying levels of involvement. Risk assessments were central to clinical concerns but were rarely discussed with service users. Service users valued therapeutic relationships with care coordinators and others, and saw these as central to recovery. CONCLUSIONS: Administrative elements of care coordination reduce opportunities for recovery-focused and personalised work. There were few common understandings of recovery which may limit shared goals. Conversations on risk appeared to be neglected and assessments kept from service users. A reluctance to engage in dialogue about risk management may work against opportunities for positive risk-taking as part of recovery-focused work. Research to investigate innovative approaches to maximise staff contact time with service users and carers, shared decision-making in risk assessments, and training designed to enable personalised, recovery-focused care coordination is indicated. %0 Journal Article %@ 0955-3959 %A Van Hout, Marie Claire %A Norman, Ian %D 2016 %F ndc:26338 %I Elsevier %J International Journal of Drug Policy %P 17-22 %T Misuse of non-prescription codeine containing products: Recommendations for detection and reduction of risk in community pharmacies. %U http://www.drugsandalcohol.ie/26338/ %V 27 %X Misuse of opioid analgesics is an emergent global public health concern. Codeine has an identified abuse liability, given its effect and development of tolerance within a short timeframe on regular or excessive use. Estimation and management of misuse of over the counter (OTC) codeine containing products are hampered by widespread and easy availability and the heterogeneous and hidden nature of misuse. Continued debate around availability centre on increasing evidence of misuse, dependence and adverse health effects associated with presence of non-opioid agents (paracetamol, ibuprofen) in combination products, and lack of evidence of a significant clinical analgesic benefit of combining low dose codeine in OTC products. Limited up scheduling that still enables purchase of codeine products without a prescription, and varied measures of pharmacist intervention at point of sale have not succeeded in curtailing therapeutic and non-therapeutic forms of misuse. This commentary broadly discusses the concepts of medication misuse, codeine's potential for misuse and dependence, characteristics of codeine misuse in general, harms from OTC codeine products in particular, 'unique issues' with OTC codeine products, the problems with scheduling solutions and pharmacy based interventions targeting users, along with the supports needed for these interventions. The recent introduction of new OTC combinations of non-opioid agents which provide greater analgesic efficacy than OTC codeine combination analgesics with no risk of opioid dependence provides a satisfactory alternative to these widely misused products. %0 Generic %A Bhui, Kamaldeep S %D 2016 %F ndc:25864 %I Sage %N 7 %T Smuggling compassion into care: is the NHS destined for system D? %U http://www.drugsandalcohol.ie/25864/ %V 50 %X Editorial: Compassion requires emotional connection, role exchange, empathy, experimentation and exploration of people’s world views and experiences, their perspectives on what troubles them beyond the illness label, and a shift of the professional gaze to the person’s location in a social world of relationships and a life-course legacy of risks which include genetics and life events, and current contextual impacts. A remarkable positive consequence is that the practitioner feels that they can perform their professional role with their full range of skills, and without a conveyor-belt culture of processing and outcome measurement, before and after unthinking intervention. The sense that the system we work in is not socially inclusive, and transmits inequity, as only the most able remain engaged and effective consumers, erodes the ethos of professionals. The skill of exploring the personal biographies and narratives of patients requires flexible and reflexive awareness by professionals of their own histories, and therefore connection with the true self rather than alienation from one’s ethos and values. The notion of smuggling ideas, of commodities, of geopolitical and imperial conquests, of romantic piracy all come together to reveal that smuggling is a pretty ordinary part of the informal economy of organisations and societies (Harvey, 2016). All organisations have creative spaces in which people negotiate and resolve shortages of resources, conflicting interests and avoid scrutiny in order to realise what is not attended to or seen as important in formal economies and structures, alternatively known as System D. Should compassion be relegated to the System D in NHS practice, or health care in any country? Surely not. %0 Journal Article %@ 1433-9285 %A Carroll, R %A Corcoran, Paul %A Griffin, E %A Perry, I %A Arensman, Ella %A Gunnell, D %A Metcalfe, C %D 2016 %F ndc:25875 %I Springer %J Social Psychiatry and Psychiatric Epidemiology %N 11 %P 1485-1493 %T Variation between hospitals in inpatient admission practices for self-harm patients and its impact on repeat presentation. %U http://www.drugsandalcohol.ie/25875/ %V 51 %X PURPOSE: Self-harm patient management varies markedly between hospitals, with fourfold differences in the proportion of patients who are admitted to a medical or psychiatric inpatient bed. The current study aimed to investigate whether differences in admission practices are associated with patient outcomes (repeat self-harm) while accounting for differences in patient case mix. METHODS: Data came from the National Self-Harm Registry Ireland. A prospective cohort of 43,595 self-harm patients presenting to hospital between 2007 and 2012 were included. As well as conventional regression analysis, instrumental variable (IV) methods utilising between hospital differences in rates of hospital admission were used in an attempt to gain unbiased estimates of the association of admission with risk of repeat self-harm. RESULTS: The proportion of self-harm patients admitted to a medical bed varied from 10 to 74 % between hospitals. Conventional regression and IV analysis suggested medical admission was not associated with risk of repeat self-harm. Psychiatric inpatient admission was associated with an increased risk of repeat self-harm in both conventional and IV analyses. This increased risk persisted in analyses stratified by gender and when restricted to self-poisoning patients only. CONCLUSIONS: No strong evidence was found to suggest medical admission reduces the risk of repeat self-harm. Models of health service provision that encourage prompt mental health assessment in the emergency department and avoid unnecessary medical admission of self-harm patients appear warranted. Psychiatric inpatient admission may be associated with a heightened risk of repeat self-harm in some patients, but these findings could be biased by residual confounding and require replication. %0 Journal Article %@ 1532-2491 %A Darker, Catherine D %A Sweeney, Brion %A Keenan, Eamon %A Whiston, Lucy %A Anderson, Rolande %A Barry, Joseph %D 2016 %F ndc:25507 %I Informa healthcare %J Substance Use & Misuse %N 9 %P 1104-1115 %T Screening and brief interventions for illicit drug use and alcohol use in methadone maintained opiate-dependent patients: results of a pilot cluster randomized controlled trial feasibility study. %U http://www.drugsandalcohol.ie/25507/ %V 51 %X BACKGROUND AND OBJECTIVES: The present study evaluated the effectiveness of a single clinician delivered brief intervention (BI) to reduce problem alcohol use and illicit substance use in an opiate-dependent methadone maintained cohort of patients attending for treatment. METHODS: Four addiction treatment centers were randomly assigned to either treatment as usual (TAU; control group) or BI (intervention group). Clinicians screened patients using the alcohol, smoking, and substance involvement screening test (ASSIST) screening tool at baseline and again at three-month follow up. Fidelity checks were performed to ensure that training was delivered effectively and uniformly across all study sites. Feasibility of administering a BI within daily practice was assessed through intervention fidelity checks, patient satisfaction questionnaires and process evaluation. RESULTS: A total of 465 patients were screened (66% of the overall eligible population) with a total of 433 (93%) ASSIST positive cases. Randomization was effective, with no differences in the control versus the intervention arms at baseline for key demographic or clinical indicators including substance us. There was a statistically significant difference between global risk score for the intervention (x = 39.36, sd = 25.91) group and the control group (x = 45.27, SD = 27.52) at 3-month follow-up (t(341) = -2.07, p < .05). CONCLUSIONS: This trial provides the first evidence that a single clinician delivered BI can result in a reduction in substance use within a methadone maintained opiate-dependent cohort, and this effect is sustained at three month follow up. %0 Report %@ HRB drug and alcohol evidence review 3 %A Nic Gabhainn, Saoirse %A D'Eath, M %A Keane, Martin %A Sixsmith, Jane %B %C Dublin %D 2016 %F ndc:26681 %I Health Research Board %T Scoping review of case management in the treatment of drug and alcohol misuse, 2003–2013. %U http://www.drugsandalcohol.ie/26681/ %X This is the final report of a scoping review commissioned by the HRB National Drugs Library. The objective of the review was to examine the peer-reviewed non-experimental literature on case management and substance use published between 2003 and 2013, and to answer specific research questions based on the literature. These comprised questions on the nature of case management, the outcomes that have been studied, and gaps in the literature. %0 Generic %A Friedrichs, Anke %A Spies, Maren %A Härter, Martin %A Buchholz, Angela %D 2016 %F ndc:26334 %I National Library for Public Health %N 1 %P e0145817 %T Patient preferences and shared decision making in the treatment of substance use disorders: a systematic review of the literature. %U http://www.drugsandalcohol.ie/26334/ %V 11 %X BACKGROUND: Shared Decision Making (SDM) as means to the involvement of patients in medical decision making is increasingly demanded by treatment guidelines and legislation. Also, matching of patients' preferences to treatments has been shown to be effective regarding symptom reduction. Despite promising results for patients with substance use disorders (SUD) no systematic evaluation of the literature has been provided. The aim is therefore to give a systematic overview of the literature of patient preferences and SDM in the treatment of patients with SUD. METHODS: An electronic literature search of the databases Medline, Embase, Psyndex and Clinical Trials Register was performed. Variations of the search terms substance use disorders, patient preferences and SDM were used. For data synthesis the populations, interventions and outcomes were summarized and described according to the PRISMA statement. Methodological quality of the included articles was assessed with the Mixed Methods Appraisal Tool. RESULTS: N = 25 trials were included in this review. These were conducted between 1986 and 2014 with altogether n = 8.729 patients. Two studies found that patients with SUD preferred to be actively involved in treatment decisions. Treatment preferences were assessed in n = 18 studies, where the majority of patients preferred outpatient compared with inpatient treatment. Matching patients to preferences resulted in a reduction on substance use (n = 3 studies), but the majority of studies found no significant effect. Interventions for SDM differed across patient populations and optional therapeutic techniques. DISCUSSION: Patients with substance use disorders should be involved in medical treatment decisions, as patients with other health conditions. A suitable approach is Shared Decision Making, emphasizing the patients' preferences. However, due to the heterogeneity of the included studies, results should be interpreted with caution. Further research is needed regarding SDM interventions in patient populations with substance use disorders. %0 Generic %A Harris, Jane %A Khatri, Rose %D 2015 %F ndc:24881 %I Liverpool John Moores University %T Late diagnosis of HIV in the United Kingdom: An evidence review. %U http://www.drugsandalcohol.ie/24881/ %X •Late diagnosis of HIV remains an important public health issue in the UK, with 40% of newly diagnosed individuals in 2014 diagnosed late •Reducing the number of people presenting to care at a late stage of HIV infection is a key public health priority in the United Kingdom. It is one of only three sexual health indicators included on the Public Health Outcomes Framework for England and a key ambition of the Framework for Sexual Health Improvement in England •Late diagnosis of HIV is defined as having a CD4 count of less than 350 cells per mm3 within 3 months of diagnosis and is associated with significantly heightened levels of HIV related morbidity and mortality, increased risk of onward HIV transmission (Halve it, 2011) and higher healthcare costs •Evidence suggests that certain groups are disproportionally affected by late diagnosis, namely older adults, heterosexuals and non-national populations, in particular black Africans •Evidence suggest that the majority of individuals have lowered perceptions of their risk of acquiring HIV and for those who have recent high risk behaviour, fear of disease is an important barrier to testing. Amongst black African populations, there are additional barriers to testing including a heightened fear of disclosure due to stigma •Amongst healthcare professionals, missed diagnostic opportunities are well documented and are linked to clinician’s own perceptions of risk and a lack of knowledge of HIV and testing procedures •Interventions to expand testing beyond routine settings have been shown as both acceptable and feasible to patients and staff and, cost effective. Pilots to expand testing in hospital and primary care settings have found varying levels of testing activity among clinicians suggesting that support and training for healthcare staff is necessary and effective in increasing testing •Community outreach testing has been found particularly effective among MSM and black African populations. Research suggests that effective interventions must be: grounded in community mobilisation and outreach settings; normalise both testing and treatment for HIV and, address HIV related stigma. Emerging evidence also suggests that new home sampling and home testing methods will be particularly effective in accessing harder to reach groups particularly among MSM %0 Journal Article %A Calami, Alvise %A Dowdall, Deirdre %D 2015 %F ndc:24915 %I Irish College of General Practitioners %J Forum %N 11 %P 39-42 %T The challenge of opioid-induced hyperalgeisa. %U http://www.drugsandalcohol.ie/24915/ %V 32 %X Long-term exposure to opiates or synthetic opioids has been shown to sensitise subjects to painful stimuli. This is of significances in the areas of chronic pain management (as patients receiving opioid analgesia can actually become more sensitive to pain) and in managing acute and chronic pain in people on the methadone replacement programme for addiction to opiates, %0 Generic %A Williams, Janet F %A Smith, Vincent C %D 2015 %F ndc:26067 %I American Academy of Pediatrics %N 5 %T Fetal Alcohol Spectrum Disorders. Clinical report: Guidance for the clinician in rendering pediatric care. %U http://www.drugsandalcohol.ie/26067/ %V 136 %X Prenatal exposure to alcohol can damage the developing fetus and is the leading preventable cause of birth defects and intellectual and neurodevelopmental disabilities. In 1973, fetal alcohol syndrome was first described as a specific cluster of birth defects resulting from alcohol exposure in utero. Subsequently, research unequivocally revealed that prenatal alcohol exposure causes a broad range of adverse developmental effects. Fetal alcohol spectrum disorder (FASD) is the general term that encompasses the range of adverse effects associated with prenatal alcohol exposure. The diagnostic criteria for fetal alcohol syndrome are specific, and comprehensive efforts are ongoing to establish definitive criteria for diagnosing the other FASDs. A large and growing body of research has led to evidence-based FASD education of professionals and the public, broader prevention initiatives, and recommended treatment approaches based on the following premises: ▪ Alcohol-related birth defects and developmental disabilities are completely preventable when pregnant women abstain from alcohol use. ▪ Neurocognitive and behavioral problems resulting from prenatal alcohol exposure are lifelong. ▪ Early recognition, diagnosis, and therapy for any condition along the FASD continuum can result in improved outcomes. ▪ During pregnancy: ◦no amount of alcohol intake should be considered safe; ◦there is no safe trimester to drink alcohol; ◦all forms of alcohol, such as beer, wine, and liquor, pose similar risk; and ◦binge drinking poses dose-related risk to the developing fetus. %0 Generic %A BMA Board of Science, %C London %D 2015 %F ndc:24620 %I British Medical Association %T Prescribed drugs associated with dependence and withdrawal – building a consensus for action. Analysis report. %U http://www.drugsandalcohol.ie/24620/ %X Prescribing is a major clinical activity and a key therapeutic tool for influencing the health of patients. When certain psychoactive drugs are inappropriately prescribed there is potential for patients to become dependent or suffer withdrawal symptoms, leading to a range of health and social harms. The prescription of a number of these drugs continues to rise mainly because of longer term use, and this issue is becoming increasingly ingrained with complex medical, political and ethical challenges. Too little is known about prescribing patterns, the levels of dependence and withdrawal, and the level of harm that is being caused. There is also too little research about the long-term effects of these drugs. This analysis report has been developed following the board of science’s call for evidence undertaken in March 2014. It aims to provide a platform for action to improve the prevention, identification and management of dependence and withdrawal associated with prescribed drugs, and has a particular focus on the prescribed use of benzodiazepines, z-drugs, opioids and antidepressants. %0 Generic %A Dolan, Kate %A Mehrjerdi, Zahra Alam %C Sydney %D 2015 %F ndc:24580 %I Australian National Council on Drugs %T Medication-assisted treatment of opioid dependence information toolkit. %U http://www.drugsandalcohol.ie/24580/ %X This information kit developed by researchers at the National Drug and Alcohol Research Centre at UNSW provides a step by step guide to the evidence for medically assisted treatment for heroin dependence as well as answering commonly asked questions. Heroin or opioid dependence can be treated with medication and psychosocial support, also known as medication-assisted treatment of opioid dependence (MATOD). The most common medicines used for MATOD in Australia are methadone, buprenorphine and naltrexone. There is a strong body of research that underpins the use of these and other medicines, but NDARC’s Professor Kate Dolan says often people are uncertain about the role of MATOD in treating heroin or opioid use and dependence. “Heroin dependence can lead to serious health, social and economic consequences for users, their families and society,” said Professor Dolan. “The more information and easy to understand research evidence we can provide for affected people and for the wider community, the better outcomes for those seeking help.” This Information Kit includes two booklets. The first booklet answers some of the most frequently asked questions about MATOD and addresses common misunderstandings, while the second booklet provides a review of evidence of MATOD. %0 Generic %A The Royal Australian College of General Practitioners, %C Melbourne %D 2015 %F ndc:24381 %I The Royal Australian College of General Practitioners %T Prescribing drugs of dependence in general practice, Part A – Clinical governance framework. %U http://www.drugsandalcohol.ie/24381/ %X This guide on clinical governance is a starting place for general practice to be a solution to problematic prescription drug use. The guide is a living document and will be regularly updated. %0 Report %9 Government Publication %A Ireland. Department of Health, %B %C Dublin %D 2015 %F ndc:24311 %I Department of Health %T Public health plan for the pharmaceutical treatment of Hepatitis C. %U http://www.drugsandalcohol.ie/24311/ %0 Generic %A Public Health England, %C London %D 2015 %F ndc:24291 %I Public Health England %T Improving access to, and completion of, hepatitis C treatment. %U http://www.drugsandalcohol.ie/24291/ %X New treatments for hepatitis C virus (HCV) infection have shorter, easier, oral regimens with fewer side effects and better outcomes. These represent a real opportunity to reduce the incidence of HCV-related cirrhosis and liver cancer among people already infected with HCV and to remove the virus from the ‘infection pool’, resulting in reduced transmission among people who inject drugs and the general population. Treating hepatitis C infection is an effective and cost-effective way to substantially reduce prevalence, especially in areas where it is high. Compliance with the new treatments is easier and can be further improved by well-planned support for patients. Needle and syringe programmes (NSP) and opioid substitution treatment (OST) have been effective in capping English hepatitis C virus (HCV) rates at an average of around 50% among people who inject drugs.* There are wide geographical variations, with prevalence much higher in some cities and metropolitan areas. Sustained long-term increases in the coverage of NSP and OST could further reduce the virus’s prevalence. The rate of treatment for hepatitis C in people who inject drugs is extremely low (just 3% of people estimated to be infected with chronic infections access treatment each year) but it can be improved by attention to assessment and engagement pathways, peer and other support, improved staff awareness and attitudes, and better access. Evidence also shows that addressing people’s healthcare needs, such as hepatitis, can help them progress in their drug recovery. This briefing provides an overview of the key issues that local providers and commissioners of drug and hepatitis treatment should consider. %0 Generic %A Strang, John %C London %D 2015 %F ndc:24341 %I Public Health England %T Naloxone – preliminary advice from the working group updating Drug misuse and dependence: UK guidelines on clinical management. %U http://www.drugsandalcohol.ie/24341/ %X The working group updating the 2007 UK national clinical guidelines on drug treatment has published some preliminary advice on naloxone before addressing its supply and use more fully in the published update in 2016. The advice covers naloxone dosing in overdose situations, take-home naloxone products that can be supplied and training that should be provided. An open letter from Professor John Strang, chair of the clinical guidelines update working group. Naloxone and its use: Across Europe, illicit opioid users are 10 times more likely to die than their peers of the same age group and gender, and 6,100 deaths were attributed directly to opioid overdose in 2012. Naloxone is a potentially life-saving medicine when used in settings associated with opiate misuse and overdose. There is evidence that take-home naloxone given to service users, and training family members or peers in how to administer naloxone, can be effective in reversing heroin overdoses. Its legal status means that anyone can administer naloxone for the purpose of saving a life, and it has been supplied by some drug treatment services since 2005. However naloxone is only licensed for use in injectable form and remains a prescription-only medicine. This means that at present it can only be distributed to patients with a prescription or via an alternative mechanism (patient group direction (PGD) or patient specific direction (PSD)). Naloxone is an opioid/opiate antagonist and is already licensed for use in: 1. complete or partial reversal of central nervous system depression and especially respiratory depression, caused by natural or synthetic opioids; and 2. treatment of suspected acute opioid overdose or intoxication. An NHS England Patient Safety Alert in November 2014 highlighted risks associated with the use of naloxone in patients where it is not indicated, or in larger than recommended doses...... %0 Generic %A Barth, Jürgen %A Jacob, Tiffany %A Daha, Ioana %A Critchley, Julia A. %C London %D 2015 %F ndc:16602 %I John Wiley & Sons, Ltd %N 7 %T Psychosocial interventions for smoking cessation in patients with coronary heart disease. %U http://www.drugsandalcohol.ie/16602/ %X Smoking is a risk factor for heart attacks and stopping smoking is recommended for patients after a heart attack. Psychosocial smoking cessation interventions like counseling can help such patients to stop smoking, if they are provided for over one month. Psychosocial interventions can help such patients to quit within 6 months but studies about the long term effects did not support the beneficial short-term findings. Most trials used a mixture of different intervention strategies, therefore no single strategy showed superior efficacy. %0 Generic %A Abercrombie, Rob %A Harries, Ellen %A Wharton, Rachel %C London %D 2015 %F ndc:24178 %I New Philanthropy Capital %T Systems change: a guide to what it is and how to do it. %U http://www.drugsandalcohol.ie/24178/ %X We have produced this guide to plug a gap in the systems change literature—providing accessible material and recommendations for action. It introduces the basic concepts, maps out the different perspectives in the systems change landscape and suggests good practice for systemic social action. It has been written as a resource for those working or supporting the social sector—namely charities and funders, but also those in the public sector or in social enterprises. In summary, this guide: • clarifies what is meant by systems and systems change • describes the main perspectives on systems change • outlines good practice for systems change • identifies what is and is not agreed upon by experts in the field • provides recommendations for charities, funders and the public sector on how to act systemically. %0 Generic %A The Royal Australian College of General Practitioners, %C Victoria %D 2015 %F ndc:24380 %I The Royal Australian College of General Practitioners %T Prescribing drugs of dependence in general practice, Part B - benzodiazepines. %U http://www.drugsandalcohol.ie/24380/ %X Drugs of dependence have important therapeutic uses, but there is a need to ensure the supply of these medicines is clinically appropriate. A key measure is accountable prescribing that can be supported by a range of strategies at the practice level. Please refer to RACGP’s Prescribing drugs of dependence in general practice, Part A – Clinical governance framework for information about these strategies. Since 2002, approximately 7 million prescriptions for benzodiazepines have been dispensed in Australia each year, for conditions such as anxiety and insomnia. There is concern a portion of these prescriptions is causing or contributing to patient harm. This is a practical guide general practitioners (GPs) can use to minimise harm and maximise benefits to patients. Evidence-based recommendations are collated here and there is further information in the body of the guide. %0 Generic %A The Royal College of Emergency Medicine, %C London %D 2015 %F ndc:24281 %I The Royal College of Emergency Medicine %T Alcohol: a toolkit for improving care. %U http://www.drugsandalcohol.ie/24281/ %X The aims of the toolkit are: 1. Promotion of best practice in the area of alcohol management - methods of screening and complete management of the patient with alcohol related illness and injury in EDs. 2. Advancement of safe and effective care in this area - advising on approaches on how to care for this subset of patients and sharing best practice with the use of medications. 3. Education and training of Emergency Medicine doctors - by provision of guidelines and advocating training. %0 Generic %A Abdulrahim, D %A Bowden-Jones, O %A Novel Psychoactive Treatment UK Network, %C London %D 2015 %F ndc:24292 %I NEPTUNE %T Guidance on the clinical management of acute and chronic harms of club drugs and novel psychoactive substances. %U http://www.drugsandalcohol.ie/24292/ %X For the purposes of this document, ‘club drugs’ is a short-hand term used for convenience to refer to a group of psychoactive substances typically used in dance venues, house parties, music festivals and sometimes in a sexual context. The term therefore describes a diverse group of substances with different actions. They include substances with primarily stimulant effects, those with primarily hallucinogenic effects, as well as some central nervous system depressants and synthetic cannabinoids. Club drugs include substances well established in the UK such as MDMA (ecstasy), as well as the rapidly expanding range of novel psychoactive substances (NPS) such as synthetic cannabinoids, synthetic cathinones and a range of other amphetamine-type stimulants. Some club drugs are sold on the illicit market, whilst others are sold as so-called ‘legal highs’. This document provides guidance on the clinical management of harms resulting from acute intoxication and from the harmful and dependent use of club drugs and NPS. It categorises club drugs broadly according to their clinical effects: depressant; stimulant; hallucinogenic. In addition, the synthetic cannabinoids are treated as a separate category, largely for reasons relating to their clinical management but also because they do not fit neatly into that threefold categorisation. The guidance is based on available evidence and clinical consensus. It is a response to the current gap in knowledge and experience in the management of these drugs across the UK and beyond. Guidance is aimed in particular at clinicians in a range of settings, specifically: • specialist drug treatment services • hospital emergency departments (EDs) • general practice/ primary care • sexual health clinics This document provides guidance, not guidelines. Together with the recommendations of its reviews, technical appraisals and standards, national guidelines produced by the National Institute for Health and Care Excellence (NICE) determine the wider principles within which treatment and care should be provided within drug services, EDs, primary care, sexual health and mental health services in the UK. However, these guidelines do not relate specifically to NPS. NEPTUNE guidance must be used within the wider principles of national guidelines. Non-UK readers of this document should contact their local, regional or national poisons information service for up–to-date advice and guidance on the management of acute club drug intoxication and withdrawal. %0 Report %A Higgins, A %A Morrissey, J %A Doyle, L %A Bailey, J %A Gill, A %B %C Dublin %D 2015 %F ndc:25683 %I Health Service Executive %T Best practice principles for risk assessment and safety planning for nurses working in mental health services. %U http://www.drugsandalcohol.ie/25683/ %X The clinical role and responsibilities of the nurse has developed significantly to meet the changing nature and context of mental health care. Risk assessment and safety planning constitutes a significant component of the role of every nurse working in a recovery focused way in contemporary services and is particularly significant for those working in specialist and advanced practice roles in areas such as Liaison, Self Harm, Suicide Crisis Assessment and Community Mental Health. These principles are a resource for all nurses and provide a benchmark for the delivery of care. This document and these principles relate to the specific area of risk assessment and safety planning of an individual’s care. It is internationally accepted that risk and safety planning is an integral part of a standardised, comprehensive mental health bio psychosocial assessment of care which every individual will have when accessing mental health services. However, the profession requires a more in-depth knowledge and expertise in the area of risk assessment and safety planning. How risk is defined, classified and responded to needs to be evidence-based and consistent across all clinical settings and locations where care is being delivered nationally. %0 Generic %A National Institute for Health and Care Excellence, %C London %D 2015 %F ndc:24144 %I National Institute for Health and Care Excellence %T Psychosis with coexisting substance misuse overview (Dual diagnosis). %U http://www.drugsandalcohol.ie/24144/ %0 Report %9 Other %A O'Brien, Tom %A Webb, Margaret %A Stynes, Greg %A Cosgrave, Gavin %A Ardis, Jennifer %B %C Dublin %D 2015 %F ndc:24967 %I Health Service Executive %T Evaluating the implementation of the RCI in Irish mental health services. %U http://www.drugsandalcohol.ie/24967/ %X The Recovery Context Inventory has been designed as a profiling and outcome tool to support personal mental health recovery and recovery-oriented service development and represents an innovation in e-mental health. The measure allows people to comprehensively assess the presence of contextual factors in their lives which they consider important to their wellbeing and recovery, under the main headings of Personal Supports and Service Supports. In this way, the structure of the RCI adopts a whole life approach in facilitating a personal evaluation of a broad range of factors in a person’s life, including mental health services, that impact upon the personal recovery process %0 Journal Article %A Ohakim, Adanna %A Mellon, Lisa %A Jafar, Bedour %A O'Byrne, Caroline %A McElvaney, NG %A Cormican, Liam %A McDonnell, Ronan %A Doyle, Frank %D 2015 %F ndc:24023 %I n/a %J Health Psychology and Behavioral Medicine %N 1 %P 142-153 %T Smoking, attitudes to smoking and provision of smoking cessation advice in two teaching hospitals in Ireland: do smoke-free policies matter? %U http://www.drugsandalcohol.ie/24023/ %V 3 %0 Journal Article %@ 0332-3102 %A Tuite, Helen %A Horgan, M %A Mallom, PWG %A McConkey, SJ %A Mooka, B %A Mulcahy, F %A Walsh, C %A O'Hora, Aidan %A O'Flanagan, D %A Bergin, C %A Fleming, C %D 2015 %F ndc:24348 %I Irish Medical Organisation %J Irish Medical Journal %N 7 %T Patients accessing ambulatory care for HIV-infection: epidemiology and prevalence assessment. %U http://www.drugsandalcohol.ie/24348/ %V 108 %0 Generic %A Public Health England, %C London %D 2014 %F ndc:23131 %I Public Health England %T Young people’s hospital alcohol pathways. Support pack for A&E departments. %U http://www.drugsandalcohol.ie/23131/ %X This document shows how local pathways can work for young people who present to A&E with alcohol-related conditions. It builds on similar publications by the National Institute for Health and Care Excellence (NICE)1 and Alcohol Concern. The pack includes a set of key questions for local professionals in the UK to help them develop effective care pathways within A&E and into other relevant services. It will be most relevant for A&E clinicians, hospital managers, substance misuse and young people’s commissioners. It may also have wider interest for local authority children’s services and organisations that are part of the pathway, such as substance misuse services and other young people’s support agencies. %0 Generic %A Boyle, Raymond %A Solberg, Leif %A Fiore, Michael %C London %D 2014 %F ndc:16619 %I John Wiley & Sons, Ltd %N 12 %T Use of electronic health records to support smoking cessation. %U http://www.drugsandalcohol.ie/16619/ %X Objective: To assess the effectiveness of electronic health record-facilitated interventions on smoking cessation support actions by clinicians and on patient smoking cessation outcomes. Conclusions: At least in the short term, documentation of tobacco status and increased referral to cessation counseling do appear to increase following the introduction of an expectation to use the EHR to record and treat patient tobacco use at medical visits. There is a need for additional research to further understand the effect of EHRs on smoking treatment in healthcare settings. %0 Generic %A Drug and Alcohol Findings, %A Substance Misuse Skills Consortium, %C London %D 2014 %F ndc:23725 %I Drug and Alcohol Findings %T Drug matrix cell B5: Practitioners - safeguarding the community. %U http://www.drugsandalcohol.ie/23725/ %0 Generic %A Drug and Alcohol Findings, %A Substance Misuse Skills Consortium, %C London %D 2014 %F ndc:23726 %I Drug and Alcohol Findings and the Substance Misuse Skills Consortium %T Drug matrix cell C5: Management/supervision - safeguarding the community. %U http://www.drugsandalcohol.ie/23726/ %0 Generic %A Drug and Alcohol Findings, %A Substance Misuse Skills Consortium, %C London %D 2014 %F ndc:22718 %I Drug and Alcohol Findings and the Substance Misuse Skills Consortium %T Drug Matrix cell B4: Practitioners - psychosocial therapies. %U http://www.drugsandalcohol.ie/22718/ %0 Journal Article %@ 1863-4362 %A McMahon, A %A Brohan, J %A Donnelly, M %A Fitzpatrick, GJ %D 2014 %F ndc:20696 %I Springer %J Irish Journal of Medical Science %N 3 %P 391-395 %T Characteristics of patients admitted to the intensive care unit following self-poisoning and their impact on resource utilisation. %U http://www.drugsandalcohol.ie/20696/ %V 183 %X Background: Self-poisoning accounts for up to 10 % of hospital admissions, some of whom require admission to ICU. Few studies have looked at the epidemiology of these patients in an Irish setting. Aims: To quantify the proportion of ICU admissions attributable to self-poisoning, to examine the characteristics and outcome of these patients, and to assess their ICU resource utilisation. Methods: Retrospective review of ICU admissions from 2006 to 2010. Data were collected on patient age, sex, admission diagnosis, substances involved, APACHE II score, length of stay, organ support, and outcome. Results: There were 80 admissions to ICU following self-poisoning accounting for 3.8 % of ICU admissions and 13 % of all hospital admissions for self-poisoning. M:F ratio was 0.9:1. Mean age 35 (range 16–75), APACHE II score 14 (2–36). Commonest substances involved were benzodiazepines, opioids, tricycle antidepressants. Median ICU stay was 2 days (IQR 0.96–4.5). 84 % of patients were ventilated, 27.5 % required inotropic support, 14 % renal replacement therapy. When opioids were involved requirement for inotropes and CRRT were higher. ICU mortality was 6.3 %. These patients consumed 280 bed days. Conclusion: Self-poisoning accounted for 3.8 % of ICU admissions. Patients tend to require a short period of ventilation, with a minority requiring additional organ support. The cost of ICU care is calculated based on previously published methodology to be €7,717 per patient. Extrapolated nationally the annual cost for ICU care for self-poisoning is estimated to be in the order of €5 m. %0 Generic %A Scottish Health Action on Alcohol Problems, %C Edinburgh %D 2014 %F ndc:21807 %I Scottish Health Action on Alcohol Problems %T Alcohol and cancer risks: a guide for health professionals. %U http://www.drugsandalcohol.ie/21807/ %X This guide has been produced to summarise for Health Professionals the links between alcohol consumption and cancers, so that they can use opportunities in their work to intervene to reduce the risks. It was produced following an expert workshop which was convened by SHAAP. Public and professional awareness of the links between alcohol and cancer is low in Scotland. Elsewhere in Europe and in North America and Australia professional and public awareness of cancer risks from alcohol is higher. The role of health professionals Some clinicians can feel uncomfortable about raising the issue of alcohol consumption with patients. However, evidence from many sources suggests that patients are accepting of tactful or empathetic inquiry about aspects of their lifestyle which may have an impact on their health. Health professionals are well placed to raise the level of awareness with their patients and clients as part of a comprehensive review of health and lifestyle. Most patient and clients welcome guidance and support to help them find the motivation to improve their health and wellbeing. Reducing alcohol consumption is often only one of a number of changes that could be made to improve quality of life but it is one that is achievable. %0 Generic %A Drug and Alcohol Findings, %A Substance Misuse Skills Consortium, %C London %D 2014 %F ndc:22480 %I Drug and Alcohol Findings and the Substance Misuse Skills Consortium %T Drug Matrix cell A3: Interventions - medical treatment. %U http://www.drugsandalcohol.ie/22480/ %0 Generic %A Drug and Alcohol Findings, %A Substance Misuse Skills Consortium, %C London %D 2014 %F ndc:22470 %I Drug and Alcohol Findings and the Substance Misuse Skills Consortium %T Drug Matrix cell A2: interventions - generic and cross-cutting issues. %U http://www.drugsandalcohol.ie/22470/ %0 Generic %A Drug and Alcohol Findings, %A Substance Misuse Skills Consortium, %C London %D 2014 %F ndc:22476 %I Drug and Alcohol Findings and the Substance Misuse Skills Consortium %T Drug Matrix cell B2: practitioners: generic and cross-cutting issues. %U http://www.drugsandalcohol.ie/22476/ %0 Generic %A National Substance Misuse Non-Medical Prescribing Forum, %C London %D 2014 %F ndc:22366 %I Public Health England %T Non-medical prescribing in the management of substance misuse. %U http://www.drugsandalcohol.ie/22366/ %X Non-medical prescribing (NMP) – namely, the prescribing of medicines by health professionals who are not doctors – allows for increased availability and responsiveness of prescribing interventions. The non-medical management of substance misuse in the UK was revolutionised by 2012’s change to allow non-media prescribers to independently prescribe for the treatment of drug dependence. PHE’s new document is intended for non-medical prescribers and all those with an interest in NMP including aspiring non-medical prescribers, consultants and clinical leads, service managers, NMP leads, colleagues from different professions (eg, doctors, psychologists, and social workers) and service commissioners. Non-medical prescribing in the management of substance misuse was prepared by an expert group convened by PHE alcohol, drugs and tobacco and the National Substance Misuse Non-Medical Prescribing Forum (NSMNMPF). The document defines clear parameters within which non-medical prescribing can be delivered safely and effectively within recovery-orientated drug and alcohol treatment systems. %0 Generic %A Drug and Alcohol Findings, %A Substance Misuse Skills Consortium, %C London %D 2014 %F ndc:20065 %I Drug and Alcohol Findings and the Consortium %T Drug Matrix: Evidence for effective treatment. %U http://www.drugsandalcohol.ie/20065/ %X The Drug Matrix is concerned with the treatment of problems related to the use of illegal drugs by adults (a similar table deals with alcohol-related problems). It maps the terrain within which relevant evidence may be found and for each location tries to find the most important UK-relevant research and guidance. In widening contextual circles, across the top of the matrix the columns move from specific interventions through how their impacts are affected by staff, the management of the service, and the nature of the organisation, to the impact of whole local area treatment systems. Down the rows are the major intervention types implemented at these levels. At the intersections, inside each cell is our pick of the most important documents relevant to the impact of that intervention type at that contextual level. %0 Journal Article %@ 1432-1041 %A Galvin, Rose %A Moriarty, Frank %A Cousins, Gráinne %A Cahir, Caitriona %A Motterlini, Nicola %A Bradley, Marie %A Hughes, Carmel M %A Bennett, Kathleen %A Smith, Susan M %A Fahey, Tom %A Kenny, Rose-Anne %D 2014 %F ndc:22502 %I Springer %J European Journal of Clinical Pharmacology %N 5 %P 599-606 %T Prevalence of potentially inappropriate prescribing and prescribing omissions in older Irish adults: findings from The Irish longitudinal study on ageing study (TILDA). %U http://www.drugsandalcohol.ie/22502/ %V 70 %X PURPOSE: We sought to estimate the prevalence of potentially inappropriate prescriptions (PIP) and potential prescribing omissions (PPOs) using a subset of the STOPP/START criteria in a population based sample of Irish adults aged ≥ 65 years using data from The Irish LongituDinal Study on Ageing (TILDA). METHODS: A subset of 26 PIP indicators and 10 PPO indicators from the STOPP/START criteria were applied to the TILDA dataset. PIP/PPO prevalence according to individual STOPP/START criteria and the overall prevalence of PIP/PPO were estimated. The relationship between PIP and PPOs and polypharmacy, age, gender and multimorbidity was examined using logistic regression. RESULTS: The overall prevalence of PIP in the study population (n=3,454) was 14.6 %. The most common examples of PIP identified were NSAID with moderate-severe hypertension (200 participants; 5.8 %) and aspirin with no history of coronary, cerebral, or peripheral vascular symptoms or occlusive event (112 participants; 3.2 %). The overall prevalence of PPOs was 30 % (n=1,035). The most frequent PPO was antihypertensive therapy where systolic blood pressure consistently >160 mmHg (n=341, 9.9 %), There was a significant association between PIP and PPO and polypharmacy when adjusting for age, sex and multimorbidity (adjusted OR 2.62, 95 % CI 2.05-3.33 for PIP and adjusted OR 1.46, 95 % CI 1.23-1.75 for prescribing omissions). CONCLUSION: Our findings indicate prescribing omissions are twice as prevalent as PIP in the elderly using a subset of the STOPP/START criteria as an explicit process measure of potentially inappropriate prescribing and prescribing omissions. Polypharmacy was independently associated with both PPO and PIP. Application of such screening tools to prescribing decisions may reduce unnecessary medication, related adverse events, healthcare utilisation and cost. %0 Report %9 Other %A Health Information and Quality Authority, %B %C Cork %D 2014 %F ndc:21862 %I Health Information and Quality Authority %T Guidance for health and social care providers. Principles of good practice in medication reconciliation. %U http://www.drugsandalcohol.ie/21862/ %X Medication management refers to the safe, clinically effective and economic use of medicines to ensure that people using health and social care services get the maximum benefit from the medicines they need, while at the same time minimising potential harm. Medication safety involves giving the right person the right medication in the right dose at the right time and by the correct route. In line with the relevant national standards, service providers are expected to have arrangements in place to ensure the safe and effective use of medicines, including assessing, prescribing, dispensing, administering, documenting, reconciling, reviewing and assisting people with their medications. The Authority has produced this guidance to aid service providers in achieving this. In Ireland, the medication incidents most commonly reported to the Clinical Indemnity Scheme (CIS) in 2012 were medication reconciliation incidents. %0 Journal Article %@ 1938-9116 %A McVeigh, T %A Hynes, N %A Tawfick, W %A Sultan, S %D 2014 %F ndc:22963 %I Sage %J Vascular and endovascular surgery %N 3 %P 277-280 %T Endovascular aneurysm repair for multiple aneurysms as a sequel of hypereosinophilic syndrome. %U http://www.drugsandalcohol.ie/22963/ %V 48 %X This case represents the first report of multiple arterial aneurysms including aortic, iliac, visceral, and coronary aneurysms associated with hypereosinophilic syndrome. It presents an interesting case of epinephrine abuse and the unfortunate sequelae. This case illustrates novel approaches in emergency repair of internal iliac artery aneurysm rupture and the management of visceral artery aneurysms and exemplifies how multiple endovascular technologies can be utilized even in the high-risk polymorbid patient. %0 Report %9 Other %A Barry, Joseph %A Ivers, Jo-Hanna H %B %C Dublin %D 2014 %F ndc:21600 %I Health Service Executive %T Evaluation report of the National Drugs Rehabilitation Framework pilot. %U http://www.drugsandalcohol.ie/21600/ %0 Journal Article %A Meagan, Geraldine %D 2014 %F ndc:21508 %I Irish College of General Practitioners %J Forum %N 3 %P 23 %T Novel approach to tackle alcohol problems. %U http://www.drugsandalcohol.ie/21508/ %V 31 %X A recent survey shows that many GPs still feel unsure about their ability to effectively help patients who have issues with alcohol. Results of this survey will be published in 2014. Although a high proportion of GPs think that they are not effective in helping patients to change their drinking habits, the survey is pointing to a large proportion using structured brief intervention in their practices and providing some form of counselling to help patients to reduce their drinking. %0 Journal Article %@ 0790-9667 %A Twomey, C %A Byrne, M %A Leahy, T %D 2014 %F ndc:21419 %I Medmedia Group %J Irish Journal of Psychological Medicine %N 1 %P 51-59 %T Steps towards effective teamworking in community mental health teams. %U http://www.drugsandalcohol.ie/21419/ %V 31 %0 Generic %A Drug and Alcohol Findings, %A Substance Misuse Skills Consortium, %C London %D 2014 %F ndc:22524 %I Drug and Alcohol Findings and the Substance Misuse Skills Consortium %T Alcohol Matrix cell A4: Interventions - psychosocial therapies. %U http://www.drugsandalcohol.ie/22524/ %0 Journal Article %A Nfila, G %A Lee, S %A Binchy, J %D 2014 %F ndc:21455 %I Irish Medical Organisation %J Irish Medical Journal %N 2 %P 47 %T Impact of new UK paracetamol overdose guidelines on patients presenting to the emergency department. %U http://www.drugsandalcohol.ie/21455/ %V 107 %X Paracetamol is involved in a large proportion of overdoses that present to the Emergency Department (ED), either as lone or mixed overdoses. Non-treatment of toxic levels can lead to fulminant liver failure. This study is to determine the impact the new UK treatment guidelines1 will have on patients presenting with paracetamol overdose. A retrospective review was performed on all patients who had paracetamol levels done in the ED between September 2011 and August 2012. A total of 523 patients were identified, 95(18%) of whom had detectable paracetamol levels. 74 patients from the 95 were evaluated. 18(24%) patients were treated with N-acetylcysteine as per the then paracetamol overdose guidelines. Using the new guidelines would have resulted in 3 more patients being admitted. Our study shows that most patients who present following paracetamol overdose do not require treatment with N-acetylcysteine and suggests that the introduction of the new UK treatment guidelines is likely to result in only a small increase in the number of patients requiring treatment. %0 Generic %A Health and Safety Authority, %C Dublin %D 2014 %F ndc:24476 %I Health and Safety Authority %T Guide to the European Union (Prevention of Sharps Injuries in the Healthcare Sector) Regulations 2014. %U http://www.drugsandalcohol.ie/24476/ %X The purpose of this guide is to provide practical information on the implementation of the European Union (Prevention of Sharps Injuries in the Healthcare Sector) Regulations 2014, hereafter referred to as ‘’the Regulations’’. The information is aimed at employers, managers, employees, safety representatives, health and safety practitioners and other interested parties in the healthcare sector. %0 Generic %A National Institute for Health and Care Excellence, %C London %D 2014 %F ndc:24143 %I National Institute for Health and Care Excellence %T Drug misuse overview. %U http://www.drugsandalcohol.ie/24143/ %0 Generic %A Public Health England, %C London %D 2014 %F ndc:22793 %I Department of Health %T A framework for personalised care and population health for nurses, midwives, health visitors and allied health professionals. %U http://www.drugsandalcohol.ie/22793/ %X This framework has been developed to underpin the UK national programme to maximise nurses, midwives, health visitors (HVs) and allied health professionals (AHPs) impact on improving health outcomes and reducing inequalities. The framework supports and shapes health promoting practice and embeds personalised care and population health across all ages, care places and with individuals, families and communities. It is a resource to support practitioners’ access to best evidence for practice and to support nurse managers and commissioners to develop services which use the knowledge and skills that nurses, midwives, HVs and AHPs use to deliver the best health outcomes for the populations they serve. There are six key areas of population health activity in the framework. In each population health activity area are one or more worked examples on national health priority areas that illustrate how the framework should be used. • Wider determinants of health • Health improvement • Health protection • Healthcare public health • Health, wellbeing & independence • Lifecourse [Alcohol section on page 32-36; also contains references to smoking throughout the document] %0 Generic %A Recovery Orientated Drug Treatment Expert Group, %C London %D 2013 %F ndc:21100 %I Public Health England %T Medications in recovery: best practice in reviewing treatment. %U http://www.drugsandalcohol.ie/21100/ %X In 2012, the Recovery Orientated Drug Treatment Expert Group published its report, Medications in recovery: re-orientating drug dependence treatment. The report supports a radical ambition to place prescribing within a fully recovery-orientated system of care, with changes at system, service and individual levels. The report makes clear that this involves treatment services continuing to re-orient their delivery of care to provide active and visible support for recovery from the point of entry to treatment, during treatment and after exit, and that successful recovery also relies on support from others, including mutual aid, employment and housing services. In the summer of 2013, the Chief Medical Officer (CMO) asked for further advice from the expert group on: • the frequency at which an individual receiving treatment for addiction should be reviewed (to determine the benefit of the treatment and thus whether alternative treatments should be tried) • the structure of the review meetings (what should be considered, how to assess the benefit a patient is receiving, tools for decision making, etc) The group responded to CMO in September 2013 and, following her review of their advice, she has agreed with the group that PHE should publish the advice for the benefit of the field. The group’s advice makes clear that: • care planning, with its ongoing and planned reviews of specific goals and actions, should be part of a phased and layered treatment programme • a strategic review of the client’s recovery pathway will normally be necessary within three months (and no later than six months) of treatment entry, and will then usually be repeated at six-monthly intervals • a strategic review should always revisit recovery goals and pathways (to support clients to move towards a drug-free lifestyle) • drug treatment should be reviewed based on an assessment of improvement (or preservation of benefit) across the core domains of successful recovery. %Z Supplementary advice from the Recovery Orientated Drug Treatment Expert Group. %0 Generic %A Health Protection Surveillance Centre, %A Health Service Executive, %C Dublin %D 2013 %F ndc:20671 %I Health Protection Surveillance Centre %T Infection with Bacillus anthracis - Injecting drug users potential presentations and case definitions. %U http://www.drugsandalcohol.ie/20671/ %X In Scotland in December 2009, an outbreak of anthrax was identified among injecting drug user (IDUs) centred in Glasgow. The initial Scottish cluster of infection in IDUs began in 2009 and resulted in 119 patients being classed as having anthrax, with 47 of these being confirmed. Fourteen of these cases died. In addition, there were three related cases in England. The responsible isolates had an indistinguishable genetic signature (Ba4599 single-nucleotide polymorphism genotype). In investigating strain origin, it was subsequently determined that this clone was prevalent in Turkey. Initial UK police and Europol investigations suggested that hide bags used to transport raw opium from production areas in Afghanistan to processing plants (most likely in Turkey) were the source of the anthrax spores. After a lull, in summer 2012, a cluster of five anthrax bloodstream infection cases was identified in Germany, Denmark and France (this cluster was suspected as being caused by illegal importation of heroin from Scotland to Germany). This low-grade outbreak is continuing; to date (March 2013) 13 cases now identified since early June 2012. Seven cases have been affected in the UK – five in England (including four fatalities), one in Scotland and one in Wales. The causative strain of this cluster was again indistinguishable from that responsible for the Scottish cluster. To date, there have been no similar cases in Ireland. The aim of this guidance is to assist clinicians in Ireland in clinical and microbiological assessment of suspected cases of infection with B. anthracis in IDUs. %0 Journal Article %@ 1471-2296 %A Field, Catherine-Anne %A Klimas, Jan %A Barry, Joseph %A Bury, Gerard %A Keenan, Eamon %A Smyth, Bobby P %A Cullen, Walter %D 2013 %F ndc:20447 %I BioMed Central %J BMC Family Practice %P 98 %T Problem alcohol use among problem drug users in primary care: a qualitative study of what patients think about screening and treatment. %U http://www.drugsandalcohol.ie/20447/ %V 14 %X Background: Problem alcohol use is common and associated with considerable adverse outcomes among patients who attend primary care in Ireland and other European countries for opiate substitution treatment. This paper aims to describe patients’ experience of, and attitude towards, screening and therapeutic interventions for problem alcohol use in primary care. Methods: This qualitative study recruited problem drug users (N = 28) from primary care based methadone programmes in the Ireland’s Eastern region, using a stratified sampling matrix to include size of general practice and geographical area. Semi-structured interviews were conducted and analysed using thematic analysis, and audited by a third reviewer. Results: We identified three overarching themes relevant to the purpose of this paper: (1) patients’ experience of, and (2) attitude towards, screening and treatment for problem alcohol use in primary care, as well as their (3) views on service improvement. While most patients reported being screened for problem alcohol use at initial assessment, few recalled routine screening or treatment. Among the barriers and enablers to screening and treatment, patients highlighted the importance of the practitioner-patient relationship in helping them address the issue. Nevertheless, patients felt that healthcare professionals should be more proactive in the management of problem alcohol use at a primary care level and that primary care can play an important role in their treatment. Conclusions: Problem alcohol use is an important challenge in the care of problem drug users. While primary care is well placed to address this issue, little data has reported on this topic. The development of interventions which promote screening and brief interventions in practice are likely to benefit this at-risk group and further research and education, that help achieve this goal, are a priority. Strategies such as dissemination of clinical guidelines, educational videos, academic detailing and practice visits, should be explored. %0 Generic %A Finnegan, Loretta %C Ottawa %D 2013 %F ndc:20862 %I Canadian Centre on Substance Abuse %T Licit and illicit drug use during pregnancy: maternal, neonatal and early childhood consequences. %U http://www.drugsandalcohol.ie/20862/ %X Introduction p.5 1.0 Epidemiology of maternal drug use p.8 2.0 Medical and obstetrical consequences of drug use in women p.14 3.0 Psychosocial issues and victimization in pregnant women using drugs p.26 4.0 Outcomes of newborns of pregnant women using drugs p.34 5.0 Comprehensive treatment approaches for pregnant women using drugs p.62 6.0 Early childhood outcomes p.90 7.0 A Call to action by Franco Vaccarino and Colleen Dell p.106 Appendices p.112 %0 Generic %C Glasgow %D 2013 %F ndc:19944 %I Institute for Research and Innovation in Social Services %T Leading for outcomes integrated working. %U http://www.drugsandalcohol.ie/19944/ %X This guide forms part of the IRISS Leading for Outcomes series. The guides are designed to support team leaders, managers and trainers to lead teams in the adoption and implementation of personal outcomes-focused approach. • The guide is aimed at those committed to leading an outcomes-focused approach to integrated working, including team leaders, managers and those in training roles. It should be relevant to those from a range of health, housing and social care backgrounds. • The guide provides a framework for training and is designed to be adapted to the time and resources available and to the specific needs of your team. The guide builds on the material offered in the parent guide. We suggest you familiarise yourself with this guide before leading with this more specialist guide. Cross-references are made to the parent guide as appropriate in this document. The guide includes a range of training materials and exercises and is divided into three parts. Part one focuses on understanding what is meant by integrated working. Part two focuses on understanding and promoting a personal outcomes approach within integrated working across health, housing and social care and beyond. Part three focuses on putting the approach into practice and on ensuring it is sustained. %0 Journal Article %A Maguire, Aideen %A Hughes, Carmel M %A Cardwell, Chris %A O'Reilly, Dermot %D 2013 %F ndc:19335 %I n/a %J Journal of the American Geriatrics Society %P 215-221 %T Psychotropic medications and the transition into care: a national data linkage study. %U http://www.drugsandalcohol.ie/19335/ %V 61 %X Objectives To determine whether excessive and often inappropriate or dangerous psychotropic drug dispensing to older adults is unique to care homes or is a continuation of community treatment. Design Population-based data-linkage study using prescription drug information. Setting Northern Ireland's national prescribing database and care home information from the national inspectorate. Participants Two hundred fifty thousand six hundred seventeen individuals aged 65 and older. Measurements Prescription information was extracted for all psychotropic drugs included in the British National Formulary (BNF) categories 4.1.1, 4.1.2, and 4.2.2 (hypnotics, anxiolytics, and antipsychotics) dispensed over the study period. Repeated cross-sectional analysis was used to monitor changes in psychotropic drug dispensing over time. Results Psychotropic drug use was higher in care homes than the community; 20.3% of those in care homes were dispensed an antipsychotic in January 2009, compared with 1.1% of those in the community. People who entered care had higher use of psychotropic medications before entry than those who did not enter care, but this increased sharply in the month of admission and continued to rise. Antipsychotic drug dispensing increased from 8.2% before entry to 18.6% after entering care (risk ratio (RR) = 2.26, 95% confidence interval (CI)=1.96–2.59) and hypnotic drug dispensing from 14.8% to 26.3% (RR=1.78, 95% CI=1.61–1.96). Conclusion A continuation of high use before entry cannot wholly explain the higher dispensing of psychotropic drugs to individuals in care homes. Although drug dispensing is high in older people in the community, it increases dramatically %0 Report %9 Other %A O'Heaire, Gary %B %C Dublin %D 2013 %F ndc:22061 %I Bawnogue Youth and Family Support Group %T Urine Analysis, an exploratory case study from the perspective of participants in a rehabilitation day programme. %U http://www.drugsandalcohol.ie/22061/ %X Urine analysis has been the preferred screening method used by many drug treatment agencies for a considerable time now. However this particular screening method has been viewed by some to be an intrusion of their human rights and its effectiveness in reducing illicit drug use has come in to question in recent times. This exploratory case study focused on the views of participants from the Bawnogue Youth and Family Support Group Rehabilitation Day Programme “Station One” in relation to their perspective of urine analysis. What is clear from the findings presented in this study is that urine analysis is viewed to be an important part of the participant’s recovery. If given the choice the majority of the participants would choose to continue to give urine samples as part of their recovery plan. This study includes the participant’s individual responses in relation to their perspective of urine analysis in the context of a rehabilitation day programme. %0 Journal Article %A Pike, Brigid %D 2013 %F ndc:20726 %I Health Research Board %J Drugnet Ireland %P 3-4 %T BYAP values individuality and people’s potential for change. %U http://www.drugsandalcohol.ie/20726/ %V Issue 47, Autumn 2013 %0 Generic %A European Monitoring Centre for Drugs and Drug Addiction, %C Lisbon %D 2012 %F ndc:16942 %I European Monitoring Centre for Drugs and Drug Addiction %T Standards and guidelines for practices. Web resource. %U http://www.drugsandalcohol.ie/16942/ %X This page contains a listing of national drug prevention guidelines and standards in Europe. The title, the methodological basis and the types of treatment covered by each guideline are provided, along with a download link where available. %0 Generic %A National Institute for Health and Clinical Excellence, %C London %D 2012 %F ndc:18809 %I National Institute for Health and Clinical Excellence %T Quality standard for drug use disorders. %U http://www.drugsandalcohol.ie/18809/ %X This quality standard defines clinical best practice within this topic area. It provides specific, concise quality statements, measures and audience descriptors to provide the public, health and social care professionals, commissioners and service providers in the UK with definitions of high-quality care. This quality standard covers the treatment of adults (18 years or over) who misuse opioids, cannabis, stimulants or other drugs in all settings in which care is received, in particular inpatient and specialist residential and community-based treatment settings. This includes related organisations such as prison services and the interface with other services, for example those provided by the voluntary sector. List of quality statements Statement 1. People who inject drugs have access to needle and syringe programmes in accordance with NICE guidance. Statement 2. People in drug treatment are offered a comprehensive assessment. Statement 3. Families and carers of people with drug use disorders are offered an assessment of their needs. Statement 4. People accessing drug treatment services are offered testing and referral for treatment for hepatitis B, hepatitis C and HIV and vaccination for hepatitis B. Statement 5. People in drug treatment are given information and advice about the following treatment options: harm-reduction, maintenance, detoxification and abstinence. Statement 6. People in drug treatment are offered appropriate psychosocial interventions by their keyworker. Statement 7. People in drug treatment are offered support to access services that promote recovery and reintegration including housing, education, employment, personal finance, healthcare and mutual aid. Statement 8. People in drug treatment are offered appropriate formal psychosocial interventions and/or psychological treatments. Statement 9. People who have achieved abstinence are offered continued treatment or support for at least 6 months. Statement 10. People in drug treatment are given information and advice on the NICE eligibility criteria for residential rehabilitative treatment. %0 Generic %A Drug and Alcohol Findings, %D 2012 %F ndc:18557 %I Drug and Alcohol Findings %T Effectiveness Bank Bulletin [Strategies for improving outcomes of services] %U http://www.drugsandalcohol.ie/18557/ %V 8 Octo %X A policy-oriented review of strategies for improving the outcomes of services for substance use disorder patients. Humphreys K., McLellan T. Addiction: 2011, 106, p.2058–2066. Improving performance of substance use disorder treatment systems is no easy matter and one prone to unintended consequences. All the more welcome then is guidance from leading US experts with top-level experience in the UK and the USA; their favourite tactic, rewarding services for patient progress during treatment, is featured in UK payment-by-results schemes. Summary Two US experts who worked at top levels on drug policy for the current US president and have advised the UK government draw on scientific literature and their experiences to offer policy makers an overview of system-level strategies to improve the outcomes of services for substance use disorder patients. Their aim was to stimulate discussion rather than conduct a systematic and comprehensive review of the evidence. Though they may be used together, the review divides the strategies in to process-focused quality improvement strategies which change how treatment staff work in the expectation that this will improve patient outcomes, and patient-focused strategies which concentrate on outcomes without specifying how those are to be achieved. Also reviewed in this bulletin (click on URL link above): • A randomized controlled study of a web-based performance improvement system for substance abuse treatment providers. Crits-Christoph P., Ring-Kurtz S., McClure Bridget. et al. Journal of Substance Abuse Treatment: 2010, 38, p. 251–262. It should have improved relationships between counsellors and clients and between counsellors and their clinics, but a sophisticated system for feeding back client progress made no positive difference on any of these measures. A later study helped establish why: counsellors were not told which patient the feedback related to and what they might do about it. • A preliminary study of the effects of individual patient-level feedback in outpatient substance abuse treatment programs. Crits-Christoph P., Ring-Kurtz S., Hamilton J.L. et al. Journal of Substance Abuse Treatment: 2012, p. 301–309. Confirmation that the failure to improve outcomes of a system for feeding back client progress to counsellors was probably due to aggregating outcomes across the counsellor's caseload rather than enabling them to identify and take recommended actions in respect of individuals doing poorly. Remedying these deficits significantly improved outcomes. • Does meeting the HEDIS substance abuse treatment engagement criterion predict patient outcomes? Harris A.H.S , Humphreys K., Bowe T. et al. Journal of Behavioral Health Services and Research: 2010, 37(1), p. 25–39. This first major multi-modality test of a treatment engagement indicator widely used as a quality control yardstick in the USA found it was only very weakly related to patient improvement seven months after starting treatment, confirmation that simple measures of what happens during treatment struggle to capture what really makes treatment effective. • Performance-based contracting within a state substance abuse treatment system: a preliminary exploration of differences in client access and client outcomes. Brucker D.L., Stewart M. Journal of Behavioral Health Services and Research: 2011, 38(3), p. 383–397. In 2007–08 the US state of Maine introduced a new scheme directly linking funding for outpatient treatment services to performance in terms of waiting times and retention, but financial and service delivery impacts were negligible. Were the incentives too weak, or were services already doing as well as they could? • Advancing recovery: implementing evidence-based treatment for substance use disorders at the systems level. Schmidt L.A., Rieckmann T., Abraham A. et al. Journal of Studies on Alcohol and Drugs: 2012, 73(3), p. 413–422. In the US homeland of competition and private health care, it was cooperation and coordination which led to the introduction of new medications and innovations to promote continuing care – plus the exercise of regulatory and financial muscle and the salutary experience of senior staff who placed themselves in the patient's shoes. %0 Generic %D 2012 %F ndc:18232 %I Drug and Alcohol Findings %T Effectiveness Bank Bulletin [Community drug team prescribing and client views] %U http://www.drugsandalcohol.ie/18232/ %V 09 Aug %X A survey of community drug team prescribing policies and client views. Luty J., O'Gara C., Sessay M. et al. Journal of Substance Use: 2010, 15(1), p. 51–59. Contrary to national guidelines, in the mid-2000s in England and Wales, prescribed doses of the heroin substitute methadone were generally low, and often even new patients were not required to take it under supervision at the pharmacy. Patients in Essex also generally favoured low doses and opposed supervised consumption. Summary: Based on data from the mid-2000s, this report relates the findings of a survey of usual prescribing practices at NHS community drug teams in England and Wales (which treat addiction to drugs including heroin) to a companion survey of the opinions on these policies of patients from one area. %0 Generic %D 2012 %F ndc:18124 %I Drug and Alcohol Findings %T Effectiveness Bank Bulletin (Heart screening in methadone maintenance treatment). %U http://www.drugsandalcohol.ie/18124/ %V 18 Jul %X 1. QT interval screening in methadone maintenance treatment: report of a SAMHSA expert panel. Martin J.A., Campbell A., Killip T. et al. Journal of Addictive Diseases: 2011, 30, p. 283–306. Concerned that this might on balance cause more deaths by limiting an effective treatment for opiate addiction, an expert panel convened by the US government has changed its mind on whether the risk of a fatal heart attack potentially posed by methadone justifies routine electrocardiogram screening of patients. Summary: The QT interval (or QTc as corrected for the heart rate) is an indicator of heart function derived from electrocardiogram measures. It refers to the delay between two phases of the electrical activity of the heart which drives it in pumping blood round the body. The health risks associated with a prolonged interval are not clear. It can lead to torsades de pointes, a potentially life threatening heart attack, but some medications prolong the interval yet rarely cause this condition, and it can occur even when the interval is normal. The risk threshold has been set variously at for example 450ms (0.45 seconds) for men and 460ms to 470ms for women or 450ms for both, though it is generally accepted that intervals greater than 500ms pose a significant risk of torsades de pointes. Some studies have reported that methadone may contribute to the elongation of the QT interval, heightening the risk of torsades de pointes. In response the US government convened an expert panel to assess the risk to patients and make recommendations to enhance their cardiac safety. The featured article is the latest report of that panel, superseding an earlier version. The panel framed its recommendations on the understanding that methadone must remain widely available because it has been associated with an overall reduction in deaths, there are few therapeutic alternatives, and it is cost-effective. Treatment providers are encouraged to consider the report and take action to the extent that they are clinically, administratively, and financially able to do so, but nothing in the report is intended to create a legal standard of care or accreditation requirement, or to interfere with the judgment of the clinicians treating the patients. 2. Methadone maintenance, QTc and torsade de pointes: who needs an electrocardiogram and what is the prevalence of QTc prolongation? Mayet S., Gossop M., Lintzeris N. et al. Drug and Alcohol Review: 2011, 30(4), p. 388–396. British guidelines suggest electrocardiogram screening of methadone patients at heightened risk of a form of possibly methadone-aggravated cardiac disorder which can result in sudden death. But a London clinic found this would still mean testing most patients, with huge resource implications yet uncertain benefits. Summary: The QTc interval is an indicator of heart function derived from electrocardiogram measures. It refers to the delay between two phases of the electrical activity of the heart which drives it in pumping blood round the body. Extended intervals may lead to torsades de pointes, a potentially life threatening irregular heartbeat. Several studies have reported that methadone may contribute to the elongation of this interval, heightening the risk. The risk threshold has been variously set at 450ms (0.45 seconds) for men and 470ms for women or 450ms for both, though it is generally accepted that intervals greater than 500ms constitute a significant risk of abnormal heart function. UK addiction treatment guidance dating from 2007 says that electrocardiograms "might be considered before induction onto methadone or before increases in methadone dose and subsequently after stabilisation – at least with doses over 100mg per day and in those with substantial risk factors". According to UK medicines regulators, these factors include "heart or liver disease, electrolyte abnormalities, concomitant treatment with CYP 3A4 inhibitors, or other drugs with the potential to cause QT interval prolongation". An addiction clinic in London assessed 155 methadone patients stabilised on their doses for at least four weeks to determine what proportion would qualify for electrocardiogram monitoring according to these criteria, and conducted electrocardiograms on 83 of the patients who attended for testing to determine whether they were at risk according to the readings of their QT intervals. 3. Onsite QTc interval screening for patients in methadone maintenance treatment. Fareed A., Vayalapalli S., Byrd-Sellers J. et al. Journal of Addictive Diseases: 2010, 29(1), p. 15–22. Does the small risk of fatal heart attack potentially posed by methadone justify routine electrocardiogram screening of patients, or will this cause more deaths by limiting an effective treatment for opiate addiction? A US clinic tried it and found three at-risk patients in three years. Summary: The QTc interval is an indicator of heart function derived from electrocardiogram measures. It refers to the delay between two phases of the electrical activity of the heart which drives it in pumping blood round the body. Extended intervals may lead to torsades de pointes, a potentially life threatening heart attack. Several studies have reported that methadone may contribute to the elongation of this interval, heightening the risk. The risk threshold has been variously set at 450ms (0.45 seconds) for men and 470ms for women or 450ms for both, though it is generally accepted that intervals greater than 500ms constitute a significant risk of abnormal heart function. Given the risk, an expert US panel recommended electrocardiogram screening of all methadone patients when they start treatment and then a month and a year later, with extra tests as indicated. A medical clinic for former US military personnel instigated such screening at the clinic itself to identify high risk patients. Alongside it offered brief on-site counselling for patients about the risks of cardiac arrhythmias associated with methadone and how to spot the symptoms of any impending problems. Electrocardiogram results were reviewed by the clinic's psychiatrist, who provided feedback for each patient and arranged for appropriate referrals as needed. Patients with automated readings between 450ms and 500ms received more education and further electrocardiogram monitoring. If the interval reading exceeded 500ms, methadone dose was reduced and the patient was referred to a cardiology clinic. The featured article reports on the feasibility and effectiveness of these procedures instigated in 2007 based on the records of 55 patients treated between 2002 and 2009 who were among the clinic's established caseload and had been retained in methadone treatment for at least six months and not dropped out. These patients averaged 90mg methadone daily. %0 Generic %C London %D 2012 %E Gilvarry, Eilish %E McArdle, Paul %E O’Herlihy, Anne %E Mirza, Kah %E Bevington, Dickon %E Malcolm, Norman %F ndc:17885 %I Royal College of Psychiatrists %T Practice standards for young people with substance misuse problems. %U http://www.drugsandalcohol.ie/17885/ %X Drug and alcohol misuse among young people is a major problem, although overall use is starting to decline. The UK has one of the highest rates of young people’s cannabis use and binge drinking in Europe, with some 13,000 hospital admissions linked to young people’s drinking each year. In recent years the number of specialist services for drug and alcohol misuse has increased so that young people can get the treatment they need. In 2010-2011 the number of under-18s accessing these services was 21,955. The new standards have been developed by the Royal College of Psychiatrists’ Centre for Quality Improvement (CCQI) in partnership with substance misuse organisations, paediatricians, psychologists and nurses.They are aimed at all staff in contact with young people aged 18 or under (in universal, targeted and specialist services) across health, social care, education, youth justice system, and the voluntary and community sector. The standards propose that services invest in the psychosocial development and well-being of young people with substance misuse problems to give them the best chance of a normal life through:  engagement of the young person, and their family where possible  skilled initial analysis of the young person’s difficulties, including mental disorders and developmental problems such as learning disability, and life circumstances  engaging local systems so that they work together  co-ordinated, well-led interventions that mobilise the resources of local communities as required, including safeguarding, education, training, mental health and accommodation  active follow-up to detect further episodes of support or intervention  prioritising and delivering the training and support of staff Dr Dickon Bevington, of the Royal College of Psychiatrists, said: "Many of our most vulnerable young people have their lives further blighted by substance misuse. From a position just a decade ago of having minimal evidence for effectiveness, substance use disorder services for young people are now guiding many young people toward fuller lives. These standards should be read as the next chapter in a conversation that has been gathering pace, where genuine collaboration between experts, agencies, and different professional groupings has been a founding principle." Martin Barnes, chief executive of DrugScope, said: "These practice standards have a vital role to play in supporting the development of procedures, interventions and services that are both efficient and effective. I hope they will become a key reference resource for everyone working with young people affected by substance misuse problems, and will be used to inform workforce development, strategic planning and development, and delivery of care and treatment." %0 Generic %A Rigotti, Nancy A. %A Clair, Carole %A Munafo, Marcus R %A Stead, Lindsay F %C London %D 2012 %F ndc:16600 %I John Wiley & Sons, Ltd %N 5 %T Interventions for smoking cessation in hospitalised patients. %U http://www.drugsandalcohol.ie/16600/ %X Objectives: To determine the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients. Conclusion: High intensity behavioural interventions that begin during a hospital stay and include at least one month of supportive contact after discharge promote smoking cessation among hospitalised patients. The effect of these interventions was independent of the patient's admitting diagnosis and was found in rehabilitation settings as well as acute care hospitals. There was no evidence of effect for interventions of lower intensity or shorter duration. This update found that adding NRT to intensive counselling significantly increases cessation rates over counselling alone. There is insufficient direct evidence to conclude that adding bupropion or varenicline to intensive counselling increases cessation rates over what is achieved by counselling alone. %0 Generic %D 2012 %F ndc:17805 %I Drug and Alcohol Findings %T Effectiveness Bank Bulletin. [Care management & employment] %U http://www.drugsandalcohol.ie/17805/ %V 10 Jan %X Does coordinated care management improve employment for substance-using welfare recipients? Morgenstern J., Hogue A., Dauber S. et al. Journal of Studies on Alcohol and Drugs: 2009, 70, p. 955–963. In New York intensive case management coordinating multiple sources of support helped resolve the substance use problems of welfare applicants, but only among the women – who faced the greatest barriers to working – did this promote employment. Perhaps men would have done better being helped to rapidly enter the job market. Summary Focusing on employment and training outcomes, the featured report complements an earlier report from the same US study which focused on substance use treatment participation and substance use outcomes. The study tested whether relatively intensive case management support helps welfare applicants overcome substance use problems and gain employment. A particular issue was whether welfare recipients who despite recent reforms have yet to find work can be helped to do so, or whether this caseload faces barriers too great to overcome, even with intensive help. Implemented in New York's Bronx district in partnership with the city's welfare agency, it was designed to be a practical trial which maximised real-world applicability while maintaining research integrity. Participants were 421 substance using single adults and adults with dependent children applying for welfare benefits. They were selected from 1519 such applicants on the basis of their reporting a substance use problem and being motivated to receive treatment. Initially they had been identified by welfare workers using a short questionnaire which screened applicants for substance use problems. Depending solely on where the next assessment slot was available, the workers transferred substance users for further assessment at one of the two offices in the study. One of the offices offered usual assessment and care services: assessment by an addiction counsellor focused on substance use problems in relation to employability, followed by allocation to a generic welfare worker whose role was to assess eligibility for welfare payments and deal with non-compliance with the welfare system's requirements. They also referred the beneficiary to services, but only during infrequent meetings limited by a large caseload. At the other office, more rounded and detailed assessments were conducted by a multidisciplinary team. After referring applicants to a range of services to meet identified needs, they transferred them to case managers. Their role was to maintain intensive contact with the beneficiary and with the agencies providing them with services, and to ensure that these agencies matched the individual's needs and performed acceptably. In the usual care option, quarterly reassessments focused on welfare system requirements, but in the case management option the focus was on client progress and adjusting the service mix accordingly. All 108 applicants who were in methadone maintenance treatment during the study were already in this treatment at the time they applied for benefits, and generally simply continued. Beyond these existing methadone patients, there were few if any heroin dependent applicants who might benefit from initiating treatment. Welfare case workers had more latitude to initiate or change other sorts of substance use treatments. Diagnostic interviews found that about 6 in 10 of the sample met criteria for substance dependence, mainly in respect of cocaine, alcohol or heroin, and another fifth for substance abuse. Psychological problems and criminal justice involvement were common. About 1 in 6 had some degree of responsibility for dependent children. %0 Generic %A Health Information and Quality Authority, %C Dublin %D 2012 %F ndc:24404 %I Health Information and Quality Authority %T National standards for safer better healthcare. %U http://www.drugsandalcohol.ie/24404/ %X The National Standards for Safer Better Health will provide the building blocks for a standards-driven health service, creating a common understanding of quality and safety. The standards will give healthcare providers a structure to systematically and continuously improve the safety and quality of services delivered. The National Standards will: • place patients at the heart of the care process • be a benchmark for change for safety • give patients a clear expectation of the standard of care they can expect to receive • ensure services will be clear on what is expected of them • provide a strategic approach to improving safety, quality and reliability in our health service %0 Journal Article %@ 1863-4362 %A Kenny, Kevin %A O'Carroll, Austin %D 2012 %F ndc:15788 %I Springer %J Irish Journal of Medical Science %N 1 %P 43-48 %T The use of psychotherapeutic interventions by primary care GPs in Ireland in the treatment of their methadone patients: a grounded theory study. %U http://www.drugsandalcohol.ie/15788/ %V 181 %X BACKGROUND: The methadone protocol placed responsibility on general practitioners (GPs) for the methadone treatment of stabilised drug-addicted patients. The protocol emphasised a medico-pharmacological model with minor reference to psychotherapeutic treatment. AIM: This qualitative study investigated how primary care GPs in Ireland use psychotherapeutic interventions in the treatment of methadone patients. METHOD: A grounded theory methodology was used. FINDINGS: There is a wide variation in the beliefs and knowledge of methadone-prescribing GPs regarding the efficacy of psychotherapeutic interventions for patients on methadone maintenance. GPs do not formally integrate psychotherapeutic interventions into methadone patient treatment. Accessing psychotherapeutic services raises concerns for GPs in terms of availability, location and quality. Primary care GPs who offer methadone maintenance view opiate abuse as a health issue similar to other such issues within their community. They take a holistic view of their methadone patient and, without formal guidelines, develop individual approaches to the use of psychotherapeutic interventions. The absence of a framework for the use of psychotherapeutic interventions in primary care methadone treatment in Ireland militates against the development of a basis for improving practice. %0 Journal Article %A Kiernan, Claire %A Ni Fhearail, Aislinn %A Coyne, Imelda %D 2012 %F ndc:17679 %I MA Healthcare %J British Journal of Nursing %N 8 %P 474-478 %T Nurses' role in managing alcohol misuse among adolescents. %U http://www.drugsandalcohol.ie/17679/ %V 21 %X Over the past decade, there has been an increase in the amount of alcohol consumed by young people, aged 11-17 years, in the UK and Ireland, which has implications for all health professionals caring for adolescents. Alcohol misuse is increasingly common among adolescents and is a significant concern for families, communities and society. Health professionals need to be aware of the dangers involved with underage drinking, how to recognise the signs of alcohol misuse, and how to intervene appropriately. Over the past few years, there has been a noticeable increase in the number of adolescents presenting to emergency departments (EDs) owing to alcohol-related injuries. This increase means that all nurses and other health professionals are suitably placed to provide education and support to adolescents who are consuming excessive alcohol. Regular alcohol misuse can lead to adverse health outcomes, and therefore nurses need to take an active role in health promotion to ensure that adolescents are aware of the associated dangers. This article summarises the harmful effects of underage drinking, the influencing factors and outlines the current guidelines on alcohol misuse in young people. It discusses strategies that nurses can use in the ED setting, and all healthcare settings, to motivate adolescents to change health-damaging behaviours. %Z PMID: 22585075 %0 Generic %A Epidemiology and Research Branch, %C Sydney %D 2012 %F ndc:18991 %I NSW Department of Health %T Mental health, drug and alcohol - emergency department and ambulance monitoring. %U http://www.drugsandalcohol.ie/18991/ %X This guideline relates to increases in Emergency Department visits or NSW Ambulance Service calls for mental health, drug and alcohol problems identified by the Public Health Real-time Emergency Department Surveillance System (PHREDSS). It describes the flow of information via a situation report, from PHREDSS to the Office of the Chief Health Officer and the Mental Health and Drug and Alcohol Office. It identifies the situations in which each of these bodies has primary responsibility for deciding how to respond to the increase. %0 Journal Article %@ 0332-3102 %A Ní Chróinín, D %A Gaine, S %D 2012 %F ndc:17444 %I Irish Medical Organisation %J Irish Medical Journal %N 4 %P 118-119 %T Crack-ing the case: a patient with persistent delirium due to body packing with cocaine. %U http://www.drugsandalcohol.ie/17444/ %V 105 %X A 36-year-old male presented acutely with encephalopathy, following his return to Ireland from a visit to West Africa. Clinical findings included confusion, agitation and tonic-clonic seizures. Difficulties in weaning sedation prompted repeat urine toxicology screening at day 8, which was positive for cocaine. Work-up for a source of continued cocaine exposure led to the discovery of cocaine-containing packages in the gastrointestinal tract. An index of suspicion should be maintained in patients presenting with drug toxicity following cross-border travel. %0 Journal Article %A O'Riordan, Margaret %A Finegan, Pearse %D 2012 %F ndc:19882 %I Irish College of General Practitioners %J Forum %N 12 %P 21-22 %T College ready to tackle alcohol-related problems. %U http://www.drugsandalcohol.ie/19882/ %V 30 %X The ICGP's primary aim is to serve the patient and the GP by encouraging and maintaining the highest standards of general medical practice. It is the representative organisation for education, training and standards in general practice. Excessive consumption of alcohol in Irish society has generated well-documented problems for individuals, families and society. The ICGP supports an evidence-based approach to the prevention of alcohol-related problems. It will continue to educate its members on skills related to alcohol screening and brief intervention in providing an accessible, effective, timely and efficient service to patients and their families experiencing alcohol-related problems. %0 Journal Article %A Perk, Joep %A De Backer, Guy %A Gohlke, Helmut %A Graham, Ian %A Reiner, Aeljko %A Verschuren, WM Monique %A Albus, Christian %A Benlian, Pascale %A Boysen, Gudrun %A Cifkova, Renata %A Deaton, Christi %A Ebrahim, Shah %A Fisher, Miles %A Germano, Guiseppe %A Hobbs, Richard %A Hoes, Arno %A Karadeniz, Sehnaz %A Mezzani, Alessandro %A Prescott, Eva %A Ryden, Lars %A Scherer, Martin %A Syvanne, Mikko %A Scholte Op Reimer, Wilma JM %A Vrints, Christian %A Wood, David %A Zamorano, Jose Luis %A Zannad, Faiez %D 2012 %F ndc:18001 %I American Heart Association %J European Heart Journal %P 1635-1701 %T European guidelines on cardiovascular disease prevention in clinical practice (version 2012). %U http://www.drugsandalcohol.ie/18001/ %V 33 %X Examines Cardiovascular disease:  Prevention  Risk assessment  Risk management  Smoking  Nutrition  Physical activity  Psychosocial factors %0 Generic %A Substance Abuse and Mental Health Services Administration, %C Rockville, MD %D 2012 %F ndc:17228 %I Substance Abuse and Mental Health Services Administration %T Managing chronic pain in adults with or in recovery from substance use disorders. Treatment Improvement Protocol (TIP) Series 54. %U http://www.drugsandalcohol.ie/17228/ %X Chronic noncancer pain (CNCP) is common in the general population as well as in people who have a substance use disorder (SUD. Chronic pain is not harmless; it has physiological, social, and psychological dimensions that can seriously harm health, functioning, and well-being. As a multidimensional condition with both objective and subjective aspects, CNCP is difficult to assess and treat. Although CNCP can be managed, it usually cannot be completely eliminated. When patients with CNCP have comorbid SUD or are recovering from SUD, a complex condition becomes even more difficult to manage. This Treatment Improvement Protocol (TIP) is for primary care providers who treat or are likely to treat adult patients with or in recovery from SUDs who present with CNCP. Given the prevalence of CNCP in the population, this audience includes virtually all primary care providers. Addiction specialists, psychiatrists, nurses, and other clinicians may find information here that will help them ensure that their patients with CNCP receive adequate pain treatment. By providing a shared basic understanding of and a common language for these two chronic conditions, this TIP facilitates cooperation and communication between healthcare professionals treating pain and those treating addiction. This TIP equips clinicians with practical guidance and tools for treating CNCP in adults with histories of SUDs. It does not describe how to treat SUDs or other behavioural health disorders in patients with CNCP; however, it provides readers with information about SUD assessments and referrals for further evaluation. For patients with histories of SUDs, the most controversial and possibly hazardous pain treatment in widespread use is opioid treatment. For this reason, this topic receives significant attention in Chapters 3 and 4. %0 Generic %A Bize, Raphaël %A Burnand, Bernard %A Mueller, Yolanda %A Rège Walther, Miriam %A Camain, Jean Yves %A Cornuz, Jacques %C London %D 2012 %F ndc:16609 %I John Wiley & Sons, Ltd %N 12 %T Biomedical risk assessment as an aid for smoking cessation. %U http://www.drugsandalcohol.ie/16609/ %X Objective: To determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation. Conclusion: There is little evidence about the effects of most types of biomedical tests for risk assessment. Spirometry combined with an interpretation of the results in terms of 'lung age' had a significant effect in a single good quality trial. Mixed quality evidence does not support the hypothesis that other types of biomedical risk assessment increase smoking cessation in comparison to standard treatment. Only two pairs of studies were similar enough in term of recruitment, setting, and intervention to allow meta-analysis. %0 Generic %A Substance Abuse and Mental Health Services Administration, %C Rockville, MD %D 2011 %F ndc:17229 %I Substance Abuse and Mental Health Services Administration %T Addressing viral hepatitis in people with substance use disorders. Treatment Improvement Protocol (TIP) series 53. %U http://www.drugsandalcohol.ie/17229/ %X The main objective of this Treatment Improvement Protocol (TIP) is to improve care for clients with SUDs by increasing knowledge of viral hepatitis among staff in behavioral health programs that provide substance abuse treatment. Some surveys have shown that substance abuse treatment providers are not well informed about viral hepatitis (Strauss et al., 2006). Clients often perceive that counselors do not have the information they need (Munoz-Plaza, Strauss, Astone, Des Jarlais, & Hagan, 2004). With up-to-date information, counselors, health professionals, and administrators in SUD treatment settings can encourage clients to understand the serious nature of hepatitis, risk factors, the importance of liver wellness, screening, treatment options, and ways to avoid spreading— or contracting—hepatitis. Other behavioral health treatment providers (e.g., counselors in mental health treatment settings, nurses, mid-level providers) will also find useful information in this TIP. Information is provided in lay terms so that it can be understood by readers who do not have medical training. %0 Generic %9 Other %A National Drugs Rehabilitation Implementation Committee, %C Kildare %D 2011 %F ndc:16717 %I Health Service Executive %T National protocols & common assessment guidelines: to accompany the National Drugs Rehabilitation Framework. %U http://www.drugsandalcohol.ie/16717/ %X This document aims to align the National Drugs Rehabilitation Framework document’s model of integrated care pathways with common assessment guidelines and national protocols to enable the implementation of this model. The guidelines detail criteria which should be included in any assessment a service provider undertakes with a service user, across the four tier model of service interventions. %0 Report %9 Other %@ 978-0-9559351-0-7 %A National Immunisation Advisory Committee of the Royal College of Physicians of Ireland, %B %C Dublin %D 2011 %F ndc:12920 %I Royal College of Physicians of Ireland %T Immunisation guidelines for Ireland, 2008 edition. Online only update September 2011. %U http://www.drugsandalcohol.ie/12920/ %X Chapters of particular relevance to care of drug users: • Chapter 5 Hepatitis A p.49 • Chapter 6 Hepatitis B p.57 • Chapter 15 Tetanus p.149 Alcoholics and smokers: Chapter 12 Pneumococcal Infection %0 Journal Article %A Braden, Marina %A McGowan, Iain W %A McLaughlin, Derek Francis %A McKenna, Hugh %A Keeney, Sinead %A Quinn, Breige %D 2011 %F ndc:16653 %I Informa healthcare %J Journal of Substance Use %N 6 %P 452-463 %T Users, carers and professionals experiences of treatment and care for heroin dependency: implications for practice. A preliminary study. %U http://www.drugsandalcohol.ie/16653/ %V 16 %X Aim: This paper reports on the treatment and care experiences for heroin dependency in a Northern Ireland Healthcare Trust. Background: There is a dearth of multi-dimensional heroin dependency treatment perspectives in background qualitative peer-reviewed literature. This is surprising given the influence of 'consumer evaluation' in service development. Method: Focus groups were undertaken with separate purposive samples of ex//current heroin users ( n == 7), carers of ex//current heroin users ( n == 4) and professionals involved in heroin dependency service provision ( n == 4). Non-directive question schedules elicited collective phenomenological experiences. Focus groups were transcribed verbatim and content analyzed. Findings: Study participants shared mainly dehumanizing experiences of treatment and care provision often characterized by non-communicative and judgemental health professional conduct. Unpredictable prescribing protocol and limited treatment resources have overshadowed any beneficial experiences of substitute prescribing in our pilot study. Findings also showed that participants requested treatment choice and holistic care provision. Conclusions: Incoherent drug treatment policy and communication breakdown between treatment stakeholders has influenced a cyclical blame culture in this study. %0 Generic %A Handford, Curtis %A Kahan, Meldon %A Srivastava, Anita %A Cirone, Sharon %A Palda, Valerie %C Toronto %D 2011 %F ndc:16240 %I Centre for Addiction and Mental health %T Buprenorphine/Naloxone for opioid dependence: clinical practice guideline. %U http://www.drugsandalcohol.ie/16240/ %X • The objective of this guideline is to provide clinical recommendations for the initiation, maintenance and discontinuation of buprenorphine/naloxone maintenance treatment in the ambulatory treatment of adults and adolescents with opioid dependence in Ontario. • The guideline intends to contribute to education of practitioners regarding opioid prescribing, improved patient access to treatment for opioid dependence, and safe prescribing and dispensing of buprenorphine/naloxone. • This evidence-based clinical practice guideline was developed by a multidisciplinary committee, and included specialists in the field of addiction medicine, family medicine and pharmacy. • A systematic review of the literature formed the evidence base for this guideline, and recommendations were assigned levels of evidence and grades of recommendations based on those developed by the Canadian Task Force on Preventive Health Care. %0 Report %9 Other %A Gannon, Maria %A McKeganey, Neil %A Hay, Gordon %B %C Dublin %D 2011 %F ndc:16724 %I National Advisory Committee on Drugs %T Protocol for national substance misuse rehabilitation cohort study. %U http://www.drugsandalcohol.ie/16724/ %X The National Advisory Committee on Drugs (NACD) commissioned the Centre for Drug Misuse Research at the University of Glasgow to design a protocol for a cohort study examining rehabilitation among Irish substance misusers. This report has two key elements; a review of the literature and the proposed study designs. The literature review focuses on previous cohort studies involving samples of substances misusers from representative treatment modalities. These key longitudinal studies examined treatment effectiveness through the measurement of various outcomes related to recovery. The review also examines duration of treatment; its relationship with positive outcomes and the identification of optimum length of stay for different treatment modalities as well as examining rehabilitation focussed studies. The second section of the report discusses the definition of rehabilitation and how best to evaluate rehabilitation in Ireland. The research team have presented a number of possible cohort study designs: -Enhanced version of ROSIE focussing on rehabilitation outcomes -Sample ex‑clients and assess their progress to rehabilitation -Systemic evaluation of rehabilitation -Combined systemic evaluation and ex‑client assessment -Multiple mini‑cohorts focussing on rehabilitation oriented services -Virtual mapping The advantages and challenges related to each possible design are discussed in turn. Following discussions with the NACD the most promising study design was selected and is discussed in the conclusion of the report. %0 Generic %A HIV and AIDS Asia Regional Program, %C Canberra %D 2011 %F ndc:16033 %I Commonwealth of Australia %T Management of substance use-related disorders and common mental health problems among people who use drugs. %U http://www.drugsandalcohol.ie/16033/ %X People who use drugs often present to health workers at drop-in centres (DICs) with health conditions that are consequences of drug use and dependence. People using substances usually have multiple medical problems that need to be assessed comprehensively to plan and implement appropriate treatment. The key objective of these guidelines is to assist health workers in making a comprehensive assessment of drug use–related disorders and to promote the rational use of medication to treat conditions such as withdrawal symptoms, intoxication and common mental health problems within a harm reduction context. The guidelines have two sections. The first section is for use by health workers in HAARP service sites. The second section is for use by trained mental health and advanced practitioners only. They were designed to be used to help service providers in Myanmar and across South-East Asia to deal with drug use– related physical and mental health issues in outpatient settings. %0 Journal Article %A Keane, Martin %D 2011 %F ndc:16166 %I Health Research Board %J Drugnet Ireland %P 17-18 %T UK expert group reports on recovery-oriented treatment. %U http://www.drugsandalcohol.ie/16166/ %V Issue 39, Autumn 2011 %0 Journal Article %A Lyons, Suzi %D 2011 %F ndc:15009 %I Health Research Board %J Drugnet Ireland %P 22-24 %T External review of methadone treatment protocol makes wide-ranging recommendations. %U http://www.drugsandalcohol.ie/15009/ %V Issue 37, Spring 2011 %0 Generic %A National Institute for Health and Clinical Excellence, %C London %D 2011 %F ndc:15833 %I National Institute for Health and Clinical Excellence %T Alcohol dependence and harmful alcohol use quality standard. %U http://www.drugsandalcohol.ie/15833/ %X This NICE quality standard defines clinical best practice within this topic area. It provides specific, concise quality statements, measures and audience descriptors to provide the public, health and social care professionals, commissioners and service providers with definitions of high-quality care. Scope of the quality standard This quality standard covers the care of children (aged 10-15 years), young people (aged 16-17 years) and adults (aged 18 years and over) drinking in a harmful way and those with alcohol dependence in all NHS-funded settings. It also includes opportunistic screening and brief interventions for hazardous and harmful drinkers. The quality standard addresses the prevention and management of Wernicke's encephalopathy but does not cover the separate management of other physical and mental health disorders associated with alcohol use. %0 Journal Article %@ 0790-9667 %A O'Reilly, Fiona %A O'Connell, David %A O'Carroll, Austin %A Whitford, David L %A Long, Jean %D 2011 %F ndc:16016 %I Medmedia Group %J Irish Journal of Psychological Medicine %N 3 %P 129-133 %T Sharing control: user involvement in general practice based methadone maintenance. %U http://www.drugsandalcohol.ie/16016/ %V 28 %X Objective: This study assessed patients' views of a methadone programme in a Dublin general practice including the degree to which the patients were involved in decisions about their treatment. Conclusions: Most patients receiving methadone in general practice were listed to and had a say in deciding their methadone dose but did not have an opportunity to engage in more structured or contractual forms of involvement in treatment such as written care plans. In line with a patient centred approach, treatment providers should set their sights beyond the safe delivery of methadone, to provide a service which is centred on patient goals, expectations and choice. %0 Journal Article %@ 1049-9091 %A Rowley, Dominic %A McLean, Sarah %A O'Gorman, Aisling %A Ryan, Karen %A McQuillan, Regina %D 2011 %F ndc:15789 %I Sage %J American Journal of Hospice & Palliative Medicine %N 3 %P 183-187 %T Review of cancer pain management in patients receiving maintenance methadone therapy. %U http://www.drugsandalcohol.ie/15789/ %V 28 %X Methadone is commonly used in the treatment of heroin addiction. Patients with a history of opioid misuse or on methadone maintenance therapy (MMT) with cancer often have difficult to manage pain. We studied 12 patients referred to the palliative care service with cancer pain who were on MMT. All had difficult to control pain, and a third required 5 or more analgesic agents. Two patients had documented ''drug-seeking'' behavior. Methadone was used subcutaneously as an analgesic agent in 1 patient. We explore why patients on MMT have difficult to manage pain, the optimal management of their pain, and the increasing role of methadone as an analgesic agent in cancer pain. %0 Journal Article %A Xiao, Liang %A Cousins, Grainne %A Courtney, Brenda %A Hederman, Lucy %A Fahey, Tom %A Dimitrov, Borislav D. %D 2011 %F ndc:15051 %I BioMed Central %J BMC Medical Informatics and Decision Making %N 5 %T Developing an electronic health record (EHR) for methadone treatment recording and decision support. %U http://www.drugsandalcohol.ie/15051/ %V 11 %X BACKGROUND: In this paper, we give an overview of methadone treatment in Ireland and outline the rationale for designing an electronic health record (EHR) with extensibility, interoperability and decision support functionality. Incorporating several international standards, a conceptual model applying a problem orientated approach in a hierarchical structure has been proposed for building the EHR. METHODS: A set of archetypes has been designed in line with the current best practice and clinical guidelines which guide the information-gathering process. A web-based data entry system has been implemented, incorporating elements of the paper-based prescription form, while at the same time facilitating the decision support function. RESULTS: The use of archetypes was found to capture the ever changing requirements in the healthcare domain and externalises them in constrained data structures. The solution is extensible enabling the EHR to cover medicine management in general as per the programme of the HRB Centre for Primary Care Research. CONCLUSIONS: The data collected via this Irish system can be aggregated into a larger dataset, if necessary, for analysis and evidence-gathering, since we adopted the openEHR standard. It will be later extended to include the functionalities of prescribing drugs other than methadone along with the research agenda at the HRB Centre for Primary Care Research in Ireland. %0 Journal Article %A Duggan, Michelle %A Kavanagh, Brian P %D 2010 %F ndc:17927 %I Elsevier %J Best Practice & Research: Clinical Anaesthesiology %N 2 %P 145-155 %T Perioperative modifications of respiratory function. %U http://www.drugsandalcohol.ie/17927/ %V 24 %X Postoperative pulmonary complications contribute considerably to morbidity and mortality, especially after major thoracic or abdominal surgery. Clinically relevant pulmonary complications include the exacerbation of underlying chronic lung disease, bronchospasm, atelectasis, pneumonia and respiratory failure with prolonged mechanical ventilation. Risk factors for postoperative pulmonary complications include patient-related risk factors (e.g., chronic obstructive pulmonary disease (COPD), tobacco smoking and increasing age) as well as procedure-related risk factors (e.g., site of surgery, duration of surgery and general vs. regional anaesthesia). Careful history taking and a thorough physical examination may be the most sensitive ways to identify at-risk patients. Pulmonary function tests are not suitable as a general screen to assess risk of postoperative pulmonary complications. Strategies to reduce the risk of postoperative pulmonary complications include smoking cessation, inspiratory muscle training, optimising nutritional status and intra-operative strategies. Postoperative care should include lung expansion manoeuvres and adequate pain control. %0 Report %9 Other %A Farrell, Michael %A Barry, Joseph %A Health Service Executive. Social Inclusion Unit, %B %C Dublin %D 2010 %F ndc:14458 %I Health Service Executive %T The introduction of the opioid treatment protocol. %U http://www.drugsandalcohol.ie/14458/ %X This is the first external review of the Methadone Treatment Protocol in Ireland. It seeks to examine the regulatory process and oversight of methadone and opiate dependence treatment, focusing on both the 1998 protocol and the processes by which treatment is implemented and delivered. %0 Generic %A International Research for Research on Cancer, %C Geneva %D 2010 %F ndc:26599 %I World Health Organization %T Alcohol consumption and ethyl carbamate. %U http://www.drugsandalcohol.ie/26599/ %V 96 %X Consumption of Alcoholic Beverages 1. Exposure Data 2. Studies of Cancer in Humans 2.1 Description of cohort studies 2.2 Cancer of the oral cavity and pharynx 2.3 Cancer of the larynx 2.4 Cancer of the oesophagus 2.5 Cancer of the liver 2.6 Breast cancer 2.7 Cancer of the stomach 2.8 Cancers of the colon and/or rectum 2.9 Cancer of the pancreas 2.10 Cancer of the lung 2.11 Cancer of the urinary bladder 2.12 Cancer of the endometrium 2.13 Cancer of the ovary 2.14 Cancer of the uterine cervix 2.15 Cancer of the prostate 2.16 Cancer of the kidney 2.17 Cancer of the lymphatic and haematopoietic system 2.18 Cancer at other sites 3. Studies of Cancer in Experimental Animals 4. Mechanistic and Other Relevant Data 5. Summary of Data Reported 6. Evaluation and Rationale Ethyl Carbamate 1. Exposure Data 2. Studies of Cancer in Humans 3. Studies of Cancer in Experimental Animals 4. Mechanistic and Other Relevant Data 5. Summary of Data Reported 6. Evaluation and Rationale %0 Journal Article %A McCreaddie, May %D 2010 %F ndc:18095 %I Blackwell %J Journal of Clinical Nursing %P 2730-2740 %T Routines and rituals: a grounded theory of the pain management of drug users in acute care settings. %U http://www.drugsandalcohol.ie/18095/ %V 19 %X Aim. This study reviewed the perceptions and strategies of drug users and nurses with regard to pain management in acute care settings. Background. Drug users present unique challenges in acute care settings with pain management noted to be at best suboptimal, at worst non-existent. Little is known about why and specifically how therapeutic effectiveness is compromised. Design. Qualitative: constructivist grounded theory Method. A constructivist grounded theory approach incorporating a constant comparative method of data collection and analysis was applied. The data corpus comprised interviews with drug users (n = 11) and five focus groups (n = 22) of nurses and recovering drug users. Results. Moral relativism as the core category both represents the phenomenon and explains the basic social process. Nurses and drug users struggle with moral relativism when addressing the issue of pain management in the acute care setting. Drug users lay claim to expectations of compassionate care and moralise via narration. Paradoxically, nurses report that the caring ideal and mutuality of caring are diminished. Drug users’ individual sensitivities, anxieties and felt stigma in conjunction with opioid-induced hyperalgesia complicate the processes. Nurses’ and hospitals’ organisational routines challenge drug user rituals and vice versa leading both protagonists to become disaffected. Consequently, key clinical issues such as preventing withdrawal and managing pain are left unaddressed and therapeutic effectiveness is compromised. Conclusion. This study provides a robust account of nurses’ and drug users’ struggle with pain management in the acute care setting. Quick technological fixes such as urine screens, checklists or the transient effects of (cognitive-based) education (or training) are not the answer. This study highlights the need for nurses to engage meaningfully with this perceptibly ‘difficult’group of patients. Relevance to clinical practice. The key aspects likely to contribute to problematic interactions with this patient cohort are outlined so that they can be prevented and, or addressed. %0 Generic %A National Institute for Health and Clinical Excellence, %C London %D 2010 %F ndc:13918 %I National Institute for Health and Clinical Excellence %T Pregnancy and complex social factors: A model for service provision for pregnant women with complex social factors. %U http://www.drugsandalcohol.ie/13918/ %X The care that women should be offered during pregnancy is outlined in NICE clinical guideline 62 ('Antenatal care'). However, pregnant women with complex social factors may need additional support to use antenatal care services. This guideline describes how access to care can be improved, how contact with antenatal carers can be maintained, the additional support and consultations that are required and the additional information that should be offered to pregnant women with complex social factors. Examples of complex social factors include: • substance misuse; • recent arrival as a migrant; • asylum seeker or refugee status; • difficulty speaking or understanding English; • age under 20; • domestic abuse; • poverty; • homelessness %0 Journal Article %@ 1351-0126 %A Nash, M J %A Romanos, M T %D 2010 %F ndc:24336 %I Wiley-Blackwell %J Journal of Psychiatric and Mental Health Nursing %N 8 %P 683-691 %T An exploration of mental health nursing students' experiences and attitudes towards using cigarettes to change client's behaviour. %U http://www.drugsandalcohol.ie/24336/ %V 17 %X There are ethical and moral dilemmas around using lifestyle risk factors as rewards or using client's nicotine addiction as a means of controlling behaviour. The question of whether this intervention should ever be used, given its associated health risk, requires more critical debate in clinical practice. %0 Report %9 Other %A National SATU Guidelines Development Group, %B %C Dublin %D 2010 %F ndc:15550 %I National SATU Guidelines Development Group %T Recent rape/sexual assault: National guidelines on referral and forensic clinical examination in Ireland. %U http://www.drugsandalcohol.ie/15550/ %X The purpose of this document is to facilitate all aspects of a responsive and coordinated service for men and women over the age of 14 years who have been raped or sexually assaulted. This is the second edition of the ‘Recent Rape/Sexual Assault: National Guidelines on Referral and Forensic Clinical Examination in Ireland’ and the updates to the various sections emphasise the many positive developments in the service over the past 4 years. The interagency nature of these guidelines will enable consistent provision of high quality care at all stages of the journey, regardless of the circumstances of the assault or the person’s involvement with criminal justice agencies. This document also ensures that clearly defined referral pathways exist, so that men and women can access appropriate individualised care that is responsive to their needs. It is important to highlight that people respond to instances of sexual violence in different ways, and while this document provides guidance for compassionate and effective care it does not represent the only medically or legally acceptable response. There may be circumstances where personal or clinical factors may mandate appropriate deviation from these guidelines. Quick reference pages have been devised in order to enable practitioners to access information quickly. The quick reference pages are: • Pathway options: Recent history Of rape/sexual assault (p. 13) • Referral pathway: To a sexual assault treatment unit (p. 14) • Contact details for SATUs (p. 14) • Guide to help preserve forensic evidence which may be available. (p. 15) %0 Generic %A World Health Organization, %C Geneva %D 2010 %F ndc:13984 %I WHO %T mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings. %U http://www.drugsandalcohol.ie/13984/ %X The mhGAP Intervention Guide (mhGAP-IG) for mental, neurological and substance use disorders for non-specialist health settings, is a technical tool developed by WHO to assist in implementation of mhGAP. The Intervention Guide has been developed through a systematic review of evidence followed by an international consultative and participatory process. The mhGAP-IG presents integrated management of priority conditions using protocols for clinical decision-making. The priority conditions included are: depression, psychosis, bipolar disorders, epilepsy, developmental and behavioural disorders in children and adolescents, dementia, alcohol use disorders, drug use disorders, self-harm/suicide and other significant emotional or medically unexplained complaints. The mhGAP-IG is a model guide and has been developed for use by health-care providers working in non-specialized health-care settings after adaptation for national and local needs. For access to the mhGAP Evidence Centre please click the related URL link below.