Among cohorts of cancer patients, we found wide variation in the use of surveillance care, including patterns of care receipt reflective of both underuse and overuse relative to guideline recommendations. Clinical reasons for these variations and the cost and health implications deserve further study.

Patterns of benzodiazepine abuse and dependence are not well known. Data on drug use and other demographic artd clinical characteristics vxre collected in 176 patients consecutively referred to the Addiction Research Foundation Clinical Institute for assessment and treatment of benzodiazepine abuse and/or dependence. Objective confirmation of benzodiazepine use was obtained in 95% of subjects screened Two groups of subjects emerged: patients who used only benzodiazepines (median daily dose: IS mg of diazepam or equivalent) for long periods of time (56%) and those who used benzodiazepines (median daily dose: 40 mg of diazepam or equivalent) in the context of multiple drug abuse (44%). Benzodiazepines were the primary drug of abuse in 23 (32%) of the multiple drug abusers. Patients using only benzodiazepines vxre significantly older, took lower daily doses and their life-time benzodiazepine exposure was lower. Diazepam was most frequently alleged in both groups, but relative preference for other benzodiazepines differed. The results have implications for recognition, assessment, management and treatment of benzodiazepine abuse and dependence.

Office visits and testing for local recurrence of cancer generally are performed for routine surveillance, regardless of recommendation by practice guidelines. Because procedures not recommended by practice guidelines were more often for diagnostic purposes, classification of patients as undergoing intensive surveillance may be misleading and may require record review to confirm.

We found evidence of potentially interacting concomitant medication dispensing among outpatients. An opportunity exists to better understand how such dispensing translates into adverse events and ultimately to improved medication safety.

SummaryThe extent of concurrent use and abuse of benzodiazepines and alcohol in chronic alcoholics is not known. Prospective data collected on 216 consecutive outpatient referrals between 1 June and 31 July 1981 (age range, 16 to 70 years, 75 per cent men) showed that benzodiazepines were detected in the urine of 33 per cent of patients undergoing medical assessment. Other drugs identified in urine were ethanol (5.0 %), codeine (1.99 %) and barbiturates (1.5 %). According to patient histories, the predictive value of benzodiazepine allegation was high for positive and negative allegation (0.87 and 0.83, respectively), indicating that patients reliably report benzodiazepine use if questioned. However, only one patient considered himself to be a benzodiazepine abuser. The proportion of women with a positive test for benzodiazepines (48%) was significantly higher than that of men (28%: X – 7.7; p <0.005). Among patients alleging use of benzodiazepines (n = 61), 54 per cent obtained the drug directly by prescription while 46 per cent obtained it indirectly (e.g. a relative, illicit source). Benzodiazepines were taken most frequently for anxiety (53%) and occasionally for alcohol withdrawal (10%). Forty‐seven (54%) of the patients could be considered abusers of benzodiazepines (i.e. indirect source and/or cumulative drug exposure of >2700 mg of diazepam or equivalent and a positive urine test). These results · indicate that benzodiazepines are very commonly used and abused by alcoholics. Treatment programmes for alcoholics should identify such patients, consider directing treatment toward control of benzodiazepine use, and monitor changes in benzodiazepine use during and after treatment.