LETTERS AND COMMENT
‘Prior to this
analysis we
were confident
that withdrawal
symptoms would
be primarily
physical, yet
psychological
withdrawal was
also evident.
Symptoms lasted
from 24 hours
to more than 72.
Patients respond
to prescribed
medicines in
different ways.’
including heroin, crack and alcohol.
The frequency that patients stated
that they smoked mamba was
variable – while three patients said
they would only smoke it at night to
induce sleep, nine said they smoked
it every 30 minutes. Fourteen
patients had been smoking the
substance for two years or more.
Prior to this analysis we
were confident that withdrawal
symptoms would be primarily
physical, yet psychological
withdrawal was also evident.
Symptoms lasted from 24 hours in
six cases to more than 72 in eight.
Patients respond to prescribed
medicines in different ways
dependent on a number of factors,
including age, weight, lifestyle and
not least the quantity, frequency
and length of time the substance
has been taken. During mamba
detoxification patients reported the
effect of their prescribed medicines
– seven said the medication was
‘very effective’, while 13 said it had
some effect.
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All patients at Edwin House are
encouraged to engage with the
recovery team and participate in
the group and individual sessions
on offer – of the 22, only 13
participated in recovery-focused
interventions. The nature of exit
was also variable – 11 patients left
in a planned and structured manner
after successfully completing
detox, while eight took their own
discharge against medical advice
for reasons including relationship
problems or being unable to cope
with the inpatient environment.
Three were discharged for a breach
of their terms of treatment – one for
suspicion of smoking mamba, and
two for disruptive and threatening
behaviour.
While this case study analysis
has proven to be a useful exercise
it has failed to identify any clear
and discernible patterns or trends
specific to synthetic cannabinoid
detoxification. A number of
variables have influenced this, not
least the additional substances
being taken by patients, along
with age and length of time
they’ve been engaged with
treatment services.
However, a successful
detoxification completion rate of 50
per cent indicates that the existing
treatment regimen offered can be
effective, especially if the patient is
prepared and has a robust aftercare
and follow-up plan in place. Only
one of the 22 had plans to relocate
to rehab, however.
The intention now is to refine
the analytical tool and embark on a
further live study with patients via
face-to-face interviews, perhaps on
a daily basis as they undertake the
process. This information could be
recorded during drug dispensing on
a pro-forma – data can be compiled
in real time to identify emerging
patterns, detect issues and pilot
changes. Bespoke pro-formas will
also allow us to capture useful
measures such as morbidity,
readmission rates, safety issues,
length of stay, patient satisfaction,
and waiting time to admission. It
would also be prudent to consider
a co-design for re-evaluation of our
detoxification protocol – this could
be achieved using live data, focused
debriefs and focus groups.
Dr Daniel Masud is a psychiatric
trainee based in the East Midlands
A MATTER OF TASTE
I’m very much in agreement with
Nick Goldstein’s assessment of
diamorphine prescribing. Nearly
two decades ago I used to buy
diamorphine dry ampoules from
someone who was prescribed
by my local DDU because
they preferred street heroin to
pharmaceutical diamorphine. I
also think he was probably not
prescribed an adequate dose.
And would you offer those who
smoke heroin a similar choice?
And in what form?
The cigarette injected with
diamorphine prescribed in
the ‘80s by Dr John Marks
failed as they did not deliver a
regular, measurable dose so a
lot literally went up in smoke.
Also heroin smokers are prone
to developing COPD, which is
as much a killer as overdose.
However I’m unsure if these
deaths would be recorded as
drug related.
Users have their own
particular taste for drugs across
the range of psychoactive
substances available. The
NHS is unlikely to treat opioid
dependent clients as a variation
on a wine appreciation club.
Peter Simonson, London
UNFAVOURABLE ODDS
I was encouraged to see that
the government has taken the
long-overdue step of stopping
businesses from allowing
people to use their credit cards
to gamble with money they
The cigarette
injected with
diamorphine
prescribed in the
‘80s by Dr John
Marks failed
as they did not
deliver a regular,
measurable dose
so a lot literally
went up in smoke.
don’t have (DDN, March, page
5). This, coupled with the recent
reduction in the maximum
stakes on the malign FOBT
machines suggests that things
are finally moving in the right
direction when it comes to
gambling, although it would
also be nice to see something
serious done about the levels of
advertising for this industry.
What is clearly needed now,
however, is a corresponding –
and substantial – increase in
treatment provision. I know
that budgets have been slashed
across the board, but for far
too long the level of available
gambling treatment has been
lamentable – calling it a ‘postcode
lottery’ doesn’t even cover it.
I’ve long believed that the levels
of problem gambling in this
country represent a public
health time bomb, and it’s vital
that provisions are put in place
accordingly.
Howard Pearce, by email
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MARCH 2020 • DRINK AND DRUGS NEWS • 15