Abstract: We conducted a pilot study (N = 22) comparing the efficacy of desipramine and amantadine for treatment of cocaine dependence in methadone maintenance clients. The study which lasted 12 weeks, was double-blind, randomly assigned, and placebo-controlled. Subjects met DSM-III-R criteria for active cocaine dependence. All three groups’ cocaine use, craving, and depressive symptoms declined significantly, but intergroup differences were not significant. Clients receiving desipramine were significantly more likely to remain in treatment and to be cocaine free at study completion. The results emphasize the importance of delivering comprehensive services to the cocaine user in methadone treatment. Further evaluations of these two medications as adjuncts in the treatment of cocaine dependence are needed.

Abstract: Results of needle and syringe exchange programmes (SEPs) in prisons based on 10 years experience in Switzerland, Germany, Spain and Moldova are presented. SEPs have been introduced in 46 European prisons, predominantly as pilot projects. Forty-three of these projects were still operating at the time of writing. In 11 prisons, SEPs were evaluated to assess feasibility and efficacy. Results did not support fears that commonly arise in the start-up of implementation of SEPs. Syringe distribution was not followed by an increase in drug use or injection drug use. Syringes were not misused, and disposal of used syringes was uncomplicated. Sharing of syringes among drug users reduced. Based on these experiences, it can be concluded that in these settings harm reduction measures, including syringe exchange, were not only feasible but efficient. Despite these positive results, syringe exchange in prison is far from general acceptance. However, a governmental decree released in Spain in 2001 that all prisons in the country are required to provide drug users with sterile injection equipment may lead to a breakthrough of this harm reduction measure in the future. The discrepancy concerning the success of SEPs in prisons on the one hand and its low acceptance on the other hand is striking. Suggestions for the installation of SEPs in prison are given to assist a more objective discussion.