Amphetamine and Other Non-opioid Drug Users Attending a Special Drug Dependence Clinic

Gardner, R; Connell, P. H.

doi:10.1136/bmj.2.5809.322

Cited by 21 publications

(9 citation statements)

References 13 publications

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“…The original formulation of the DA hypothesis of schizophrenia was based on evidence that the therapeutically effective antipsychotic drugs act, at least in part, by blocking DA receptors, especially the DA D2 receptor (D2R) subclass (Van Rossum 1966;Carlsson 1974;Meltzer and Stahl 1976;Snyder 1976;Seeman 1987Seeman , 2006. Further support for this hypothesis has been yielded by the findings that DAstimulating drugs can induce psychosis-like behavior in non-psychotic human subjects (Angrist and Gershon 1970;Gardner and Connell 1972;Bell 1973) and aggravate the symptoms in patients with schizophrenia (Lieberman et al 1987;Laruelle et al 1999). This has led to the original hypothesis that the psychotic symptoms in schizophrenia are associated with a hyperdopaminergic state, especially in mesolimbic structures, and that normalizing enhanced mesolimbic DA activity by DAreceptor blocking agents is critical for the therapeutic efficacy of antipsychotic drugs.…”

Section: Altered Da Functions In Schizophreniamentioning

confidence: 97%

Prenatal exposure to infection: a primary mechanism for abnormal dopaminergic development in schizophrenia

Meyer

Feldon

2009

Psychopharmacology

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Dopaminergic mal-development in general, and following prenatal immune activation in particular, may represent a primary etiopathological mechanism in the development of schizophrenia and related disorders. This hypothesis differs from the view that dopaminergic abnormalities in schizophrenia may be secondary to abnormalities in other brain structures and/or neurotransmitter systems. The existence of primary dopaminergic mechanisms may have important implications for the identification and early treatment of individuals prodromally symptomatic for schizophrenia.

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Section: Altered Da Functions In Schizophreniamentioning

confidence: 97%

Prenatal exposure to infection: a primary mechanism for abnormal dopaminergic development in schizophrenia

Meyer

Feldon

2009

Psychopharmacology

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“…A survey of heroin addicts at a London clinic during 1968 and 1969 found that all of them had started heroin use by injecting [1]. Today, the situation has changed considerably [2], and virtually all heroin users in London start to use heroin by 'chasing the dragon' ( fig.…”

Section: Chasing the Dragonmentioning

confidence: 99%

Chasing the Dragon: Research into Heroin Smoking in Britain

Gossop¹

1995

Eur Addict Res

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There have been important changes in the ways in which British drug users have used heroin in recent years. In the 1960s, nearly all heroin users in the UK used their drugs by injection. During the late 1970s and throughout the 1980s, there has been an increase in heroin smoking. The issue of transition between different routes of heroin administration, e.g. moving from chasing to injection, was identified as an important research question. In addition, obtaining access to the hidden population, i.e. people who use illegal drugs and are not in contact with treatment services, has proved to be a major challenge. The Privileged Access Interviewers (PAI) team has proven to be a particularly suitable and effective research method. With the PAI method a large number of drug users from different social networks could be approached in a short period of time. In this sample, two main routes of heroin administration were observed: 54% of the sample used injection as a route of administration and 44% used by chasing the dragon. Only 8% did not have a single primary route of administration. The preferred route of administration changed at least once in more than a third of heroin users. Multiple transitions in route were uncommon. Different groups of heroin users were identified: stable injectors, stable chasers, those who moved from chasing to injection and those who had previously been injectors and had now moved to chasing. Stable chasers characteristically have little contact to the heroin subcultures. A survival analysis indicated a small but continuing risk of moving to injection. Our results show that there are positive associations between drug dose, the route by which the drug is taken and the severity of dependence. Potential relationships between the severity of dependence and the following factors have been studied: drug dose, the route of administration, diversity of drug rates of passive sharing, circumstances in which heroin was used and differences in types of sharing partners.

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“…Most ... accepted frequent psychotic episodes as a side effect of their use of me@amphetamine. Gardner & Connell [24] studied 104 non-opioid (mainly amphetamine) users and concluded, without citing any supporting data, that prescribing was inappropriate. Some doctors had prescribed methytamphetamine as a drug substitute for cocaine.…”

Section: Outcome Studies Of Amphetamine Substitutionmentioning

confidence: 99%

“…• Similar negative comments were made elsewhere about the impact on illicit drug use of the early attempts prescribing amphetamine to amphetamine users. Gardner & Connell [24] studied 104 non-opioid (mainly amphetamine) users and concluded, without citing any supporting data, that prescribing was inappropriate.…”

Section: Outcome Studies Of Amphetamine Substitutionmentioning

confidence: 99%

Drug replacement treatments: is amphetamine substitution a horse of a different colour?

Mattick

Darke

1995

Drug and Alcohol Review

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Advocates of amphetamine substitution therapy argue that needle sharing by amphetamine users, and associated infectious disease risk, outweigh the risks associated with oral dexamphetamine substitution prescribing, and that substitution can allow stabilization and gradual withdrawal of patients, or maintenance. Others note that amphetamine users are not generally physically dependent, dexamphetamine prescribing can lead to increased drug use and psychosis, and that there are possible neurotoxic effects from prolonged chronic exposure to amphetamines. Research on the impact of amphetamine and cocaine prescribing on drug use, injecting, social adjustment and criminal involvement is lacking apart from a small number of retrospective case reports. Early experience in the United Kingdom leads to the view that amphetamine maintenance was a therapeutic failure. More recently, clinicians have expressed confidence that the approach has merit, and while their claims should not be discounted there remains no empirical basis to support them. Although dexamphetamine substitution therapy has been heralded as an important intervention to reduce injecting behaviour and associated infectious disease risk, there is very little research which attests to its success in reaching this goal. Indeed, what is known regarding patterns of amphetamine use and the effects of prolonged use of the drug raise serious doubts as to the efficacy of amphetamine maintenance. There is an urgent need for randomized or case-controlled trails of the efficacy of these procedures. Until such empirical comparative research is available, the benefits to be gained from dexamphetamine substitution therapy remain speculative and opinion-based.

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Amphetamine and Other Non-opioid Drug Users Attending a Special Drug Dependence Clinic

Cited by 21 publications

References 13 publications

Prenatal exposure to infection: a primary mechanism for abnormal dopaminergic development in schizophrenia

Prenatal exposure to infection: a primary mechanism for abnormal dopaminergic development in schizophrenia

Chasing the Dragon: Research into Heroin Smoking in Britain

Drug replacement treatments: is amphetamine substitution a horse of a different colour?

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