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: Measures taken to reduce HIV risk by injecting drug users have been reported in many countries, but a minority of injectors continue to engage in risky practices. In an ongoing cohort study, 207 drug injectors were interviewed and anonymously tested for HIV antibodies in saliva in 1989. Injectors reporting recent syringe sharing were compared with those not recently sharing; injecting events where sharing did and did not take place were examined. Those recently sharing syringes differed significantly from the non-sharers on several factors, including: use of heroin, dihydrocodeine and temazepam; injection of heroin, temazepam and prescribed methadone; accommodation and contact with other injectors; means of financial support and recent involvement in crime; secondary sources of injecting equipment and unsafe disposal; employment of HIV protective strategies; treatment contact with general practitioners; number of sexual partners and injecting status of sexual partners. The two groups were not significantly different in terms of attendance at syringe-exchange schemes and self-reported HIV antibody status. Syringe sharing would appear to be related to social circumstances and life-style factors rather than just individual choices and motivation.

Abstract: Concern is increasing among surgeons and operating theatre staff about the risks of occupational exposure to HIV and hepatitis viruses.’-6 There has also been much public debate about the risk of patients who undergo invasive procedures acquiring these viruses from infected surgeons.7 Eminent bodies have published reports on the topic, yet views vary about the risk of transmission of HIV8-’4 and the level of precautions appropriate to British hospitals.’59 It was against this background that in October 1991 the Hospital Infection Society and the Surgical Infection Study Group convened a one day workshop at the Royal Society of Medicine, London, to review the degree of risk and prepare practical guidelines for surgeons, anaesthetists, and health care workers working in operating theatres. Its report forms the basis of the recommendations presented below. The incidence of nosocomially acquired hepatitis far exceeds that of HIV infection. Hepatitis B is preventable with immunisation and hence is discussed first.