... of their role it may be more appropriate to talk of the doctor±receptionist± patient triad ra... more ... of their role it may be more appropriate to talk of the doctor±receptionist± patient triad rather than just the dyadic doctor± patient relationship (Arber and Sawyer 1985 ... 1998, Bennett and Wright 1986), although this is less clear for alcohol misusing patients (Thom 1987, Thom et al ...
Reports have consistently shown that non-specialist drug workers (whose working role is not speci... more Reports have consistently shown that non-specialist drug workers (whose working role is not specifically concentrated on dealing with drug-related issues) are reluctant to work with drug users. A number of explanations have been offered to account for this unwillingness including attitudinal factors, occupational constraints and a lack of motivation to learn about drug-related issues. Previously, it has been shown that training affects commitment to working with substance misusers, although failure to attract particular professional groups (e.g. general practitioners) into training courses has also been reported. No previous research has examined the views of trainers about training primary health care and health-related workers. This study of a (non-probability) sample of UK drug trainers (n = 145) assessed training activity for different health care workers, and trainers' differential perceptions of training needs and methods. GPs were the group least likely to become trained about drug issues. Training in attitudes towards drug using individuals was perceived to be more important than either skills or knowledge training for GPs, practice nurses, other nurses and probation officers. Experiential training methods were perceived to be more important than a didactic approach for training all health groups except GPs for whom lecture type instruction was believed to be equally appropriate. Seventy-nine percent of subjects reported providing training across drugs in alcohol or drugs, alcohol and tobacco. Most trainers who stated that certain professions required independent training believed that GPs should be trained separately from other groups.
This exploratory research was conducted in response to concern about prevalences of illicit drugs... more This exploratory research was conducted in response to concern about prevalences of illicit drugs in drivers killed in motor vehicle accidents in Victoria, Australia. Five focus groups (36 participants in all) and a field survey (160 participants) were used to investigate the perceptions and behaviours of drivers who use illicit opiates, stimulants and cannabis. The participants were aware of many drug effects which may impair driving ability, but believed they were not at significantly increased risk of accidents. For many participants, drug use was closely linked to driving; most of the heroin and amphetamine users drove to purchase their drugs and frequently used drugs inside a car. Some of the amphetamine users who deliberately drug-drove reported alarming attitudes and behaviour. Few participants were concerned about the illegality of their driving behaviour, and nearly 10% were driving unlicensed. Heroin users perceived drug-induced tiredness as an accident risk, and reported frequently experiencing this condition. Altering drug-driving behaviour is likely to be difficult, given drug dependence for some users and heavy reliance on private motor vehicles for transport in Melbourne, but also because of conflicting scientific evidence linking impairment to the use of most illicit drugs.
ABSTRACT Government policy encourages primary care involvement with opiate misusers. The Consulta... more ABSTRACT Government policy encourages primary care involvement with opiate misusers. The Consultancy Liaison Addiction Service (CLAS) was set up to help support increased primary care involvement. From 18 study practices, 133 of the 156 staff (85.3%) completed the interviews or self-completion questionnaires. Many general practitioners had a considerable involvement and seemed to have met their basic role requirements, although there appeared to be room for improvement in some areas of management. Other general practitioners had less involvement and could potentially benefit from input from CLAS. However, they expressed strong feelings against this sort of work, which could make such input difficult. Practice nurses had less involvement than general practitioners and expressed an interest in being trained. In their position of initial screening, practice nurses might be in a good position to offer preventative health measures to opiate misusers. Practice managers and receptionists described difficulties they had had with opiate misusers and might benefit from additional training and support. Some practices were treating many opiate misusers. National policy to rely more on primary care runs the risk of overstretching a small number of highly active practices, rather than spreading the load across a broad base of practices.
ABSTRACT Large numbers of individuals use illicit drugs (e.g. cannabis, heroin, cocaine). The num... more ABSTRACT Large numbers of individuals use illicit drugs (e.g. cannabis, heroin, cocaine). The number of people driving vehicles has also increased. There is an increasing overlap between populations of illicit drug users and drivers. This paper describes the magnitude and nature of an illicit drugs and driving problem. The relationship between the consumption of illicit substances and driving skills, accident involvement and driving behaviour are examined using epidemiological data, injury and fatality statistics, empirical/behavioural evidence and survey research. Problems for the interpretation of such data are identified, and a number of questions remain unanswered for characterizing the magnitude and nature of the problem. Measures designed to counter the drugs and driving issue (e.g. secondary enforcement) are discussed. Proposals are made for further countermeasures based on current evidence.
A reluctance of nonspecialists to work with drug and alcohol misusers have focused upon belief-ba... more A reluctance of nonspecialists to work with drug and alcohol misusers have focused upon belief-based systems, including therapeutic commitment (TC) and situation-specific constraints. This paper describes the development and assessment of a theoretical model for nonspecialist drug workers, characterised as a synthesis of attitudinal and constraints explanations. A cohort of 189 nonspecialist drug workers completed self-report measures of overall TC and situational constraints scales. Predictive analysis of associations between TC, role security (RS), role requirements, and situational constraints was performed to explore direct and indirect effects. Such assessment allowed for the identification of a predictive process by which TC may be established, manipulated, and maintained. Levels of TC were found to be explained by the direct effects of self-esteem (SE), situational constraints, role support, and RS. Role support and situational constraints were also found to have indirect effects. Experience with working with drug users and education on drug-related issues were found to have predominantly indirect effects on TC via situational constraints and RS. Findings show the synthesised model to be partially supported. Implications for the development of a process-driven theoretical understanding of TC and situational constraints are discussed, and applied recommendations for training intervention are presented.
Drug-driving behaviour among out-of-treatment dependent drug users has not been investigated whil... more Drug-driving behaviour among out-of-treatment dependent drug users has not been investigated while a theoretical perspective on the propensity of certain drug users to drive while impaired has not been suggested. This paper examines illicit drugs and driving behaviour and accident involvement among out-of-treatment current drug users. Psychological evidence of belief-based mechanisms to account for the decision to drive while impaired by drugs are provided. A total of 210 out-of-treatment current drug users were interviewed in a non-clinical setting by privileged access interviewers. Questionnaire measures were: current illicit drug use, severity of dependence, illicit drugs and driving behaviour, impaired and unimpaired accident involvement and beliefs and perceptions about the impairing effects of a number of illicit drugs. Analyses are restricted to participants who reported driving during the previous 12 months (n= 71). Fifty-eight participants (81.7%) reported driving immediately after consuming illicit drugs, primarily heroin and cannabis. Of these 41.4% (n= 24) had at least one road accident as a driver, 15 of whom (62.4%) reported accident involvement following recent drug consumption. Belief-based results showed that participants who reported never driving after using illicit drugs perceived heroin, methadone and alcohol to be greater significance for accident risk and driving skills impairment than other drugs. Those drivers who reported drugs and driving behaviour believed only alcohol to be significantly more impairing than other drugs. Findings indicated that illicit drugs and driving behaviour is common among out-of-treatment drug users. Accident involvement among this cohort is characterised by the previous consumption of illicit substances. Differential beliefs about the effects of drugs on driving performance and accident risk were shown to be dependent upon frequency of drugs and driving behaviour. Results are discussed in terms of experiential factors and consistency theories of attitude formation and change.
This study examines the cost-effectiveness of contingency-management (CM) for stimulant dependenc... more This study examines the cost-effectiveness of contingency-management (CM) for stimulant dependence among community mental health patients with serious mental illness (SMI) METHODS: Economic evaluation of a 12-week randomized controlled trial investigating the efficacy of CM added to treatment-as-usual (CM+TAU), relative to TAU without CM, for treating stimulant dependence among patients with a SMI. The trial included 176 participants diagnosed with SMI and stimulant dependency who were receiving community mental health and addiction treatment at one community mental health center in Seattle, Washington. Participants were also assessed during a 12-week follow-up period. Positive and negative syndrome scale (PANSS) scores were used to calculate quality-adjusted life-years (QALYs) for the primary economic outcome. The primary clinical outcome, the stimulant-free year (SFY) is a weighted measure of time free from stimulants. Two perspectives were adopted, those of the provider and the p...
Health technology assessment (Winchester, England), Nov 1, 2017
Opioid substitution therapy and needle exchanges have reduced blood-borne viruses (BBVs) among pe... more Opioid substitution therapy and needle exchanges have reduced blood-borne viruses (BBVs) among people who inject drugs (PWID). Some PWID continue to share injecting equipment. To develop an evidence-based psychosocial intervention to reduce BBV risk behaviours and increase transmission knowledge among PWID, and conduct a feasibility trial among PWID comparing the intervention with a control. A pragmatic, two-armed randomised controlled, open feasibility trial. Service users were Steering Group members and co-developed the intervention. Peer educators co-delivered the intervention in London. NHS or third-sector drug treatment or needle exchanges in Glasgow, London, Wrexham and York, recruiting January and February 2016. Current PWID, aged ≥ 18 years. A remote, web-based computer randomisation system allocated participants to a three-session, manualised, psychosocial, gender-specific group intervention delivered by trained facilitators and BBV transmission information booklet plus tre...
The time post-release from prison involves elevated mortality, especially overdose deaths. Variat... more The time post-release from prison involves elevated mortality, especially overdose deaths. Variations in overdose mortality both by time since release from prison and time of release has not been investigated sufficiently. Our aims were to estimate and compare overdose death rates at time intervals after prison release and to estimate the effect on overdose death rates over calendar time. This 15-year cohort study includes all individuals (n = 91 090) released from prison (1 January 2000 to 31 December 2014) obtained from the Norwegian prison registry, linked to the Norwegian Cause of Death Registry (2000-14). All-cause and cause-specific mortality were examined during different time-periods following release: first week, second week, 3-4 weeks and 2-6 months, and by three different time intervals of release. We calculated crude mortality rates (CMRs) per 1000 person-years and estimated incidence rate ratios (IRR) by Poisson regression analysis adjusting for time intervals after pri...
See Articles page e133 JS reports grants and consultancy payments from Martindale Pharma, Mundiph... more See Articles page e133 JS reports grants and consultancy payments from Martindale Pharma, Mundipharma, and Braeburn Pharmaceuticals, outside the submitted work. JS has a patent with Euro-Celtique issued, and a patent with King's College London pending. WH declares no competing interests.
Background The UK heroin market is the biggest in Europe and~70% of heroin deaths are due to fata... more Background The UK heroin market is the biggest in Europe and~70% of heroin deaths are due to fatal poisoning. Methadone treatment for heroin addiction in the UK, the 'British system', is unique as it is largely provided by General Practitioners. Methods The Office for National Statistics provided data on deaths, the Home Office provided law enforcement data on drug seizures and the Department of Health data on prescriptions. For methadone treatment we calculated the death rate per 1000 patient years. We used Spearman's rank correlation to assess the association between illicit drug seizures for heroin and methadone and deaths. Results Between 1993 and 2004 there were 7072 deaths involving heroin/morphine (86% males) and 3298 deaths involving methadone (83% male). From 1993-1997, directly age-standardized mortality rates for males were similar for both drugs, increasing from~5 to 15 per million. Mortality rates for heroin continued to increase until 2000, subsequently decreasing from 30 to 20 per million by 2003, and rising again to 24 per million in 2004. In contrast, mortality rates for methadone decreased between 1997 and 2004 to just above 1993 levels. Among females the mortality rate for both drugs was lower than for males throughout the study period, remaining relatively stable. Methadone deaths per 1000 patient years remained similar between 1993 and 1997, after which they fell by three quarters. For both heroin/morphine and methadone, deaths were strongly associated with seizures (Spearmans' coefficient for males: heroin, P 5 0.95, P , 0.001 and methadone, P 5 0.83, P 5 0.0013). Conclusions Our study suggests the 'British System' can deliver substantial expansion of treatment without increased mortality risk. The fall in heroin/morphine deaths since 2000 may also be an indication of success of increasing methadone treatment. Data on mortality risk is needed to determine whether increased methadone treatment has reduced drug-related deaths.
For letters on scientific subjects we normally reserve our correspondence columns for those relat... more For letters on scientific subjects we normally reserve our correspondence columns for those relating to issues discussed recently (within six weeks) in the BMJ'. * We do not routinely acknowledge letters. Please send a stamped addressed envelope ifyou would like an acknowledgment. * Because we receive many more letters than we can publish we may shorten those we do print, particularly when we receive several on the same subject.
See Articles page e133 JS reports grants and consultancy payments from Martindale Pharma, Mundiph... more See Articles page e133 JS reports grants and consultancy payments from Martindale Pharma, Mundipharma, and Braeburn Pharmaceuticals, outside the submitted work. JS has a patent with Euro-Celtique issued, and a patent with King's College London pending. WH declares no competing interests.
Formal experiments are underused in criminal justice. Disposals matter. Are they effective? And h... more Formal experiments are underused in criminal justice. Disposals matter. Are they effective? And how much do they cost for what they deliver? Good intentions are not evidence of effectiveness.1 2 The same standards of evidence1 3 4 5 6 7 8 9 should apply for judges prescribing a sentence as for doctors prescribing drugs. Given the benefits of good quality research, and the cost of ignoring it, health scientists should advocate for randomised controlled trials in the criminal justice system and confront common objections.
... of their role it may be more appropriate to talk of the doctor±receptionist± patient triad ra... more ... of their role it may be more appropriate to talk of the doctor±receptionist± patient triad rather than just the dyadic doctor± patient relationship (Arber and Sawyer 1985 ... 1998, Bennett and Wright 1986), although this is less clear for alcohol misusing patients (Thom 1987, Thom et al ...
Reports have consistently shown that non-specialist drug workers (whose working role is not speci... more Reports have consistently shown that non-specialist drug workers (whose working role is not specifically concentrated on dealing with drug-related issues) are reluctant to work with drug users. A number of explanations have been offered to account for this unwillingness including attitudinal factors, occupational constraints and a lack of motivation to learn about drug-related issues. Previously, it has been shown that training affects commitment to working with substance misusers, although failure to attract particular professional groups (e.g. general practitioners) into training courses has also been reported. No previous research has examined the views of trainers about training primary health care and health-related workers. This study of a (non-probability) sample of UK drug trainers (n = 145) assessed training activity for different health care workers, and trainers' differential perceptions of training needs and methods. GPs were the group least likely to become trained about drug issues. Training in attitudes towards drug using individuals was perceived to be more important than either skills or knowledge training for GPs, practice nurses, other nurses and probation officers. Experiential training methods were perceived to be more important than a didactic approach for training all health groups except GPs for whom lecture type instruction was believed to be equally appropriate. Seventy-nine percent of subjects reported providing training across drugs in alcohol or drugs, alcohol and tobacco. Most trainers who stated that certain professions required independent training believed that GPs should be trained separately from other groups.
This exploratory research was conducted in response to concern about prevalences of illicit drugs... more This exploratory research was conducted in response to concern about prevalences of illicit drugs in drivers killed in motor vehicle accidents in Victoria, Australia. Five focus groups (36 participants in all) and a field survey (160 participants) were used to investigate the perceptions and behaviours of drivers who use illicit opiates, stimulants and cannabis. The participants were aware of many drug effects which may impair driving ability, but believed they were not at significantly increased risk of accidents. For many participants, drug use was closely linked to driving; most of the heroin and amphetamine users drove to purchase their drugs and frequently used drugs inside a car. Some of the amphetamine users who deliberately drug-drove reported alarming attitudes and behaviour. Few participants were concerned about the illegality of their driving behaviour, and nearly 10% were driving unlicensed. Heroin users perceived drug-induced tiredness as an accident risk, and reported frequently experiencing this condition. Altering drug-driving behaviour is likely to be difficult, given drug dependence for some users and heavy reliance on private motor vehicles for transport in Melbourne, but also because of conflicting scientific evidence linking impairment to the use of most illicit drugs.
ABSTRACT Government policy encourages primary care involvement with opiate misusers. The Consulta... more ABSTRACT Government policy encourages primary care involvement with opiate misusers. The Consultancy Liaison Addiction Service (CLAS) was set up to help support increased primary care involvement. From 18 study practices, 133 of the 156 staff (85.3%) completed the interviews or self-completion questionnaires. Many general practitioners had a considerable involvement and seemed to have met their basic role requirements, although there appeared to be room for improvement in some areas of management. Other general practitioners had less involvement and could potentially benefit from input from CLAS. However, they expressed strong feelings against this sort of work, which could make such input difficult. Practice nurses had less involvement than general practitioners and expressed an interest in being trained. In their position of initial screening, practice nurses might be in a good position to offer preventative health measures to opiate misusers. Practice managers and receptionists described difficulties they had had with opiate misusers and might benefit from additional training and support. Some practices were treating many opiate misusers. National policy to rely more on primary care runs the risk of overstretching a small number of highly active practices, rather than spreading the load across a broad base of practices.
ABSTRACT Large numbers of individuals use illicit drugs (e.g. cannabis, heroin, cocaine). The num... more ABSTRACT Large numbers of individuals use illicit drugs (e.g. cannabis, heroin, cocaine). The number of people driving vehicles has also increased. There is an increasing overlap between populations of illicit drug users and drivers. This paper describes the magnitude and nature of an illicit drugs and driving problem. The relationship between the consumption of illicit substances and driving skills, accident involvement and driving behaviour are examined using epidemiological data, injury and fatality statistics, empirical/behavioural evidence and survey research. Problems for the interpretation of such data are identified, and a number of questions remain unanswered for characterizing the magnitude and nature of the problem. Measures designed to counter the drugs and driving issue (e.g. secondary enforcement) are discussed. Proposals are made for further countermeasures based on current evidence.
A reluctance of nonspecialists to work with drug and alcohol misusers have focused upon belief-ba... more A reluctance of nonspecialists to work with drug and alcohol misusers have focused upon belief-based systems, including therapeutic commitment (TC) and situation-specific constraints. This paper describes the development and assessment of a theoretical model for nonspecialist drug workers, characterised as a synthesis of attitudinal and constraints explanations. A cohort of 189 nonspecialist drug workers completed self-report measures of overall TC and situational constraints scales. Predictive analysis of associations between TC, role security (RS), role requirements, and situational constraints was performed to explore direct and indirect effects. Such assessment allowed for the identification of a predictive process by which TC may be established, manipulated, and maintained. Levels of TC were found to be explained by the direct effects of self-esteem (SE), situational constraints, role support, and RS. Role support and situational constraints were also found to have indirect effects. Experience with working with drug users and education on drug-related issues were found to have predominantly indirect effects on TC via situational constraints and RS. Findings show the synthesised model to be partially supported. Implications for the development of a process-driven theoretical understanding of TC and situational constraints are discussed, and applied recommendations for training intervention are presented.
Drug-driving behaviour among out-of-treatment dependent drug users has not been investigated whil... more Drug-driving behaviour among out-of-treatment dependent drug users has not been investigated while a theoretical perspective on the propensity of certain drug users to drive while impaired has not been suggested. This paper examines illicit drugs and driving behaviour and accident involvement among out-of-treatment current drug users. Psychological evidence of belief-based mechanisms to account for the decision to drive while impaired by drugs are provided. A total of 210 out-of-treatment current drug users were interviewed in a non-clinical setting by privileged access interviewers. Questionnaire measures were: current illicit drug use, severity of dependence, illicit drugs and driving behaviour, impaired and unimpaired accident involvement and beliefs and perceptions about the impairing effects of a number of illicit drugs. Analyses are restricted to participants who reported driving during the previous 12 months (n= 71). Fifty-eight participants (81.7%) reported driving immediately after consuming illicit drugs, primarily heroin and cannabis. Of these 41.4% (n= 24) had at least one road accident as a driver, 15 of whom (62.4%) reported accident involvement following recent drug consumption. Belief-based results showed that participants who reported never driving after using illicit drugs perceived heroin, methadone and alcohol to be greater significance for accident risk and driving skills impairment than other drugs. Those drivers who reported drugs and driving behaviour believed only alcohol to be significantly more impairing than other drugs. Findings indicated that illicit drugs and driving behaviour is common among out-of-treatment drug users. Accident involvement among this cohort is characterised by the previous consumption of illicit substances. Differential beliefs about the effects of drugs on driving performance and accident risk were shown to be dependent upon frequency of drugs and driving behaviour. Results are discussed in terms of experiential factors and consistency theories of attitude formation and change.
This study examines the cost-effectiveness of contingency-management (CM) for stimulant dependenc... more This study examines the cost-effectiveness of contingency-management (CM) for stimulant dependence among community mental health patients with serious mental illness (SMI) METHODS: Economic evaluation of a 12-week randomized controlled trial investigating the efficacy of CM added to treatment-as-usual (CM+TAU), relative to TAU without CM, for treating stimulant dependence among patients with a SMI. The trial included 176 participants diagnosed with SMI and stimulant dependency who were receiving community mental health and addiction treatment at one community mental health center in Seattle, Washington. Participants were also assessed during a 12-week follow-up period. Positive and negative syndrome scale (PANSS) scores were used to calculate quality-adjusted life-years (QALYs) for the primary economic outcome. The primary clinical outcome, the stimulant-free year (SFY) is a weighted measure of time free from stimulants. Two perspectives were adopted, those of the provider and the p...
Health technology assessment (Winchester, England), Nov 1, 2017
Opioid substitution therapy and needle exchanges have reduced blood-borne viruses (BBVs) among pe... more Opioid substitution therapy and needle exchanges have reduced blood-borne viruses (BBVs) among people who inject drugs (PWID). Some PWID continue to share injecting equipment. To develop an evidence-based psychosocial intervention to reduce BBV risk behaviours and increase transmission knowledge among PWID, and conduct a feasibility trial among PWID comparing the intervention with a control. A pragmatic, two-armed randomised controlled, open feasibility trial. Service users were Steering Group members and co-developed the intervention. Peer educators co-delivered the intervention in London. NHS or third-sector drug treatment or needle exchanges in Glasgow, London, Wrexham and York, recruiting January and February 2016. Current PWID, aged ≥ 18 years. A remote, web-based computer randomisation system allocated participants to a three-session, manualised, psychosocial, gender-specific group intervention delivered by trained facilitators and BBV transmission information booklet plus tre...
The time post-release from prison involves elevated mortality, especially overdose deaths. Variat... more The time post-release from prison involves elevated mortality, especially overdose deaths. Variations in overdose mortality both by time since release from prison and time of release has not been investigated sufficiently. Our aims were to estimate and compare overdose death rates at time intervals after prison release and to estimate the effect on overdose death rates over calendar time. This 15-year cohort study includes all individuals (n = 91 090) released from prison (1 January 2000 to 31 December 2014) obtained from the Norwegian prison registry, linked to the Norwegian Cause of Death Registry (2000-14). All-cause and cause-specific mortality were examined during different time-periods following release: first week, second week, 3-4 weeks and 2-6 months, and by three different time intervals of release. We calculated crude mortality rates (CMRs) per 1000 person-years and estimated incidence rate ratios (IRR) by Poisson regression analysis adjusting for time intervals after pri...
See Articles page e133 JS reports grants and consultancy payments from Martindale Pharma, Mundiph... more See Articles page e133 JS reports grants and consultancy payments from Martindale Pharma, Mundipharma, and Braeburn Pharmaceuticals, outside the submitted work. JS has a patent with Euro-Celtique issued, and a patent with King's College London pending. WH declares no competing interests.
Background The UK heroin market is the biggest in Europe and~70% of heroin deaths are due to fata... more Background The UK heroin market is the biggest in Europe and~70% of heroin deaths are due to fatal poisoning. Methadone treatment for heroin addiction in the UK, the 'British system', is unique as it is largely provided by General Practitioners. Methods The Office for National Statistics provided data on deaths, the Home Office provided law enforcement data on drug seizures and the Department of Health data on prescriptions. For methadone treatment we calculated the death rate per 1000 patient years. We used Spearman's rank correlation to assess the association between illicit drug seizures for heroin and methadone and deaths. Results Between 1993 and 2004 there were 7072 deaths involving heroin/morphine (86% males) and 3298 deaths involving methadone (83% male). From 1993-1997, directly age-standardized mortality rates for males were similar for both drugs, increasing from~5 to 15 per million. Mortality rates for heroin continued to increase until 2000, subsequently decreasing from 30 to 20 per million by 2003, and rising again to 24 per million in 2004. In contrast, mortality rates for methadone decreased between 1997 and 2004 to just above 1993 levels. Among females the mortality rate for both drugs was lower than for males throughout the study period, remaining relatively stable. Methadone deaths per 1000 patient years remained similar between 1993 and 1997, after which they fell by three quarters. For both heroin/morphine and methadone, deaths were strongly associated with seizures (Spearmans' coefficient for males: heroin, P 5 0.95, P , 0.001 and methadone, P 5 0.83, P 5 0.0013). Conclusions Our study suggests the 'British System' can deliver substantial expansion of treatment without increased mortality risk. The fall in heroin/morphine deaths since 2000 may also be an indication of success of increasing methadone treatment. Data on mortality risk is needed to determine whether increased methadone treatment has reduced drug-related deaths.
For letters on scientific subjects we normally reserve our correspondence columns for those relat... more For letters on scientific subjects we normally reserve our correspondence columns for those relating to issues discussed recently (within six weeks) in the BMJ'. * We do not routinely acknowledge letters. Please send a stamped addressed envelope ifyou would like an acknowledgment. * Because we receive many more letters than we can publish we may shorten those we do print, particularly when we receive several on the same subject.
See Articles page e133 JS reports grants and consultancy payments from Martindale Pharma, Mundiph... more See Articles page e133 JS reports grants and consultancy payments from Martindale Pharma, Mundipharma, and Braeburn Pharmaceuticals, outside the submitted work. JS has a patent with Euro-Celtique issued, and a patent with King's College London pending. WH declares no competing interests.
Formal experiments are underused in criminal justice. Disposals matter. Are they effective? And h... more Formal experiments are underused in criminal justice. Disposals matter. Are they effective? And how much do they cost for what they deliver? Good intentions are not evidence of effectiveness.1 2 The same standards of evidence1 3 4 5 6 7 8 9 should apply for judges prescribing a sentence as for doctors prescribing drugs. Given the benefits of good quality research, and the cost of ignoring it, health scientists should advocate for randomised controlled trials in the criminal justice system and confront common objections.
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Papers by John Strang