864
colleagues (March 24, p 732). The dosage of penicillin used for the treatment of their patient, regarded as adequate in the past, was ineffective. Penicillin should still be regarded as first choice in the treatment of meningococcal infection with these strains, but in the light of this report the rather larger doses (eg, 1-2 MU 4-hourly) that are commonly used are probably essential. Manchester Regional Public Health Laboratory, Withington Hospital, Manchester M20 8LR, UK
D. M. JONES E. M. SUTCLIFFE
1. Sutcliffe EM, Jones DM, El-Sheikh S, Percival A. Penicillin-insensitive meningococci in the UK. Lancet 1988; i: 657-58. 2. Spratt BG, Qian-Yun Zhang, Jones DM, Hutchison A. Brannigan JA, Dowson CG. Recruitment of a penicillin-binding protein gene from Neisseria flavescens during the emergence of penicillin resistance m Neisseria meningitidis. Proc Natl Acad Sci
(USA) 1989; 86: 8988-992.
Prescribing smokable drugs SIR,-Drug dependency clinics see many clients who wish to stop using injectable drugs, but not to stop using drugs. Unfortunately, clients see no acceptable alternatives because often methadone syrup is all that is offered, usually as a reduction course. Methadone syrup has many advantages. It has a long half-life and can be given once in a daily dose that suppresses craving and provides stability throughout a 24 hour period, staving off any withdrawal symptoms. One of the drawbacks of the syrup is that, since it does not induce a "buzz", addicts will resort to black market supplies for their "entertainment", using the syrup only to keep themselves stable. In addition, methadone is very addictive and addicts have withdrawal effects long after stopping the drug. Many users complain of nausea, vomiting, tooth decay, and weight gain from long-term use and feel left with little alternative but to continue to take their drugs intravenously, either prescribed or from the black market. However careful and sterile the injection practices of the user may be, this is still by far the most hazardous route of administration. Widnes drug dependency clinic, with the approval of the Home Office drugs branch, has been prescribing an alternative to methadone mixture for clients who wish to try to stop injecting. It had been observed that several clients who had been prescribed only methadone mixture to try to curtail their intravenous drug use had returned to injectable drugs because they could not cope on methadone alone. Reefers—cigarettes—injected with 60 mg of diamorphine, 40 mg cocaine, or 20 mg amphetamine have been prescribed separately or in conjunction with methadone syrup and the injection practices of clients have been monitored. So far, this experiment has produced some encouraging results with respect to the reduction of intravenous use. Widnes has 30 clients, all of whom have long histories of intravenous drug use and are now maintained on either reefers or reefers and methadone syrup. They are monitored regularly for signs of intravenous use and urine samples are taken randomly to check that no other drugs are being used. The table shows the reduction of intravenous use since the introduction of reefers:
All clients seem to be coping well and none has returned to intravenous use. Their health has improved, relationships are now much more stable, and partners and families are relieved that worries about intravenous drug use have ceased. Several have found employment and, as a result of being freed from black market supplies, are no longer in trouble with the authorities and are away from the dangers of adulterated drugs. The main advantage of the reefers is that they provide an acceptable alternative to intravenous use and associated health risks.
The reefers also provide the buzz the user craves in a safer, more controlled format. Finally they are less addictive than methadone syrup and, therefore, easier to withdraw from. It is worth mentioning that clients registered at the Widnes clinic who have received prescriptions of injectable drugs for over ten years are exchanging ampoules for reefers on a trial basis. No pressure is placed on them to stop injecting in favour of reefers (such pressure may be misconstrued) and, if a client wishes, he or she may return to intravenous use.
J. A. MARKS
Drug Dependency Clinic, Widnes, Cheshire, WA8 7RP, UK
A. PALOMBELLA
Evening primrose oil
in
atopic eczema
SIR,-Dr Sharpe and Dr Farr (March 17, p 667) conclude that published trials of ’Epogam’ (evening primrose oil) in atopic eczema do not show a significant advantage over placebo. They claim that 311 patients entered trials but that information on only 128 had been published. However, the results on the 286 patients who completed the trials have appeared in the form of a meta-analysis. The claim that "no published trial yields a significant advantage of epogam over placebo" is also wrong. Wright and Burton2 stated, "the doctor’s assessment also showed a beneficial effect of the active treatment on the overall severity of the condition (p
colleagues (March 24, p 732). The dosage of penicillin used for the treatment of their patient, regarded as adequate in the past, was ineffective. Penicillin should still be regarded as first choice in the treatment of meningococcal infection with these strains, but in the light of this report the rather larger doses (eg, 1-2 MU 4-hourly) that are commonly used are probably essential. Manchester Regional Public Health Laboratory, Withington Hospital, Manchester M20 8LR, UK
D. M. JONES E. M. SUTCLIFFE
1. Sutcliffe EM, Jones DM, El-Sheikh S, Percival A. Penicillin-insensitive meningococci in the UK. Lancet 1988; i: 657-58. 2. Spratt BG, Qian-Yun Zhang, Jones DM, Hutchison A. Brannigan JA, Dowson CG. Recruitment of a penicillin-binding protein gene from Neisseria flavescens during the emergence of penicillin resistance m Neisseria meningitidis. Proc Natl Acad Sci
(USA) 1989; 86: 8988-992.
Prescribing smokable drugs SIR,-Drug dependency clinics see many clients who wish to stop using injectable drugs, but not to stop using drugs. Unfortunately, clients see no acceptable alternatives because often methadone syrup is all that is offered, usually as a reduction course. Methadone syrup has many advantages. It has a long half-life and can be given once in a daily dose that suppresses craving and provides stability throughout a 24 hour period, staving off any withdrawal symptoms. One of the drawbacks of the syrup is that, since it does not induce a "buzz", addicts will resort to black market supplies for their "entertainment", using the syrup only to keep themselves stable. In addition, methadone is very addictive and addicts have withdrawal effects long after stopping the drug. Many users complain of nausea, vomiting, tooth decay, and weight gain from long-term use and feel left with little alternative but to continue to take their drugs intravenously, either prescribed or from the black market. However careful and sterile the injection practices of the user may be, this is still by far the most hazardous route of administration. Widnes drug dependency clinic, with the approval of the Home Office drugs branch, has been prescribing an alternative to methadone mixture for clients who wish to try to stop injecting. It had been observed that several clients who had been prescribed only methadone mixture to try to curtail their intravenous drug use had returned to injectable drugs because they could not cope on methadone alone. Reefers—cigarettes—injected with 60 mg of diamorphine, 40 mg cocaine, or 20 mg amphetamine have been prescribed separately or in conjunction with methadone syrup and the injection practices of clients have been monitored. So far, this experiment has produced some encouraging results with respect to the reduction of intravenous use. Widnes has 30 clients, all of whom have long histories of intravenous drug use and are now maintained on either reefers or reefers and methadone syrup. They are monitored regularly for signs of intravenous use and urine samples are taken randomly to check that no other drugs are being used. The table shows the reduction of intravenous use since the introduction of reefers:
All clients seem to be coping well and none has returned to intravenous use. Their health has improved, relationships are now much more stable, and partners and families are relieved that worries about intravenous drug use have ceased. Several have found employment and, as a result of being freed from black market supplies, are no longer in trouble with the authorities and are away from the dangers of adulterated drugs. The main advantage of the reefers is that they provide an acceptable alternative to intravenous use and associated health risks.
The reefers also provide the buzz the user craves in a safer, more controlled format. Finally they are less addictive than methadone syrup and, therefore, easier to withdraw from. It is worth mentioning that clients registered at the Widnes clinic who have received prescriptions of injectable drugs for over ten years are exchanging ampoules for reefers on a trial basis. No pressure is placed on them to stop injecting in favour of reefers (such pressure may be misconstrued) and, if a client wishes, he or she may return to intravenous use.
J. A. MARKS
Drug Dependency Clinic, Widnes, Cheshire, WA8 7RP, UK
A. PALOMBELLA
Evening primrose oil
in
atopic eczema
SIR,-Dr Sharpe and Dr Farr (March 17, p 667) conclude that published trials of ’Epogam’ (evening primrose oil) in atopic eczema do not show a significant advantage over placebo. They claim that 311 patients entered trials but that information on only 128 had been published. However, the results on the 286 patients who completed the trials have appeared in the form of a meta-analysis. The claim that "no published trial yields a significant advantage of epogam over placebo" is also wrong. Wright and Burton2 stated, "the doctor’s assessment also showed a beneficial effect of the active treatment on the overall severity of the condition (p
