John Strang
King's College London, Addictions, Faculty Member
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... 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...
Research Interests: Information Systems, Family Medicine, Risk Taking, Medicine, United Kingdom, and 15 moreLibrary and Information Studies, Humans, Female, Feasibility Studies, Male, Psychological Intervention, Young Adult, Psychosocial, Health Technology Assessment, Middle Aged, Adult, Public health systems and services research, Randomized Controlled Trial, Virus diseases, and Blood Borne Pathogens
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... 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...
Research Interests: Demography, Addiction, Medicine, Norway, Prospective studies, and 15 moreHumans, Female, Prison, Male, Poisson regression, Risk factors, Registries, Prisoners, Adult, Risk Factors, Confidence Interval, Mortality rate, Cohort Studies, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Research Interests: Computer Science, Medicine, British medical history, Drug, London, and 11 moreHumans, Male, Public health systems and services research, BMJ, Illicit Drugs, Street Drugs, Illicit Drug Use, Substance-Related Disorders, Ambulatory Care, Acquired immunodeficiency syndrome, and Community health services
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Treatment of people with drug problems requires a consideration of those inviduals in their personal and social context, while being mindful of the complex interaction of genetic and developmental influences. Approaches to treatment... more
Treatment of people with drug problems requires a consideration of those inviduals in their personal and social context, while being mindful of the complex interaction of genetic and developmental influences. Approaches to treatment should reflect this often complex aetiology and phenomenology, and the totality of treatment will typically include social, psychological, educational and pharmacological therapies. Treatment should result in a health benefit; consequently the goals of treatment should be tailored to the health care needs of the individual. Thus, with many patients, treatment will include abstinence as an explicit objective, whereas with other patients, intermediate goals, such as reduction of harmful injecting, may be more realistic and achievable.
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The time available to act is a crucial factor affecting the probable success of interventions to manage opiate overdose. We analyse opiate users' accounts of non-fatal overdose incidents to (i) construct a proto-typology of non-fatal... more
The time available to act is a crucial factor affecting the probable success of interventions to manage opiate overdose. We analyse opiate users' accounts of non-fatal overdose incidents to (i) construct a proto-typology of non-fatal opiate overdose onset and (ii) assess the implications for overdose management and prevention of fatalities. Re-analysis of a subset of data from a large qualitative study of non-fatal opiate overdose conducted from 1997 to 1999. Data were generated from semi-structured interviews undertaken with opiate users who had experienced a non-fatal overdose in the previous 24 hours. Forty-four participants (30 men; 14 women; aged 16-47 years) provided sufficient information for in-depth analysis. Data relating to 'memory of the moment of overdose', 'time to loss of consciousness' and 'subjective description of the overdose experience' were scrutinised using iterative categorization. Four types of overdose onset were identified: type ...
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To assess the impact of femoral ultrasonography accompanied by explanation of the findings (UFV) on groin-injecting behaviour. 348 heroin-addicted groin injectors (GIs) on opioid substitution treatment (OST) were included in the study:... more
To assess the impact of femoral ultrasonography accompanied by explanation of the findings (UFV) on groin-injecting behaviour. 348 heroin-addicted groin injectors (GIs) on opioid substitution treatment (OST) were included in the study: 174 received UFV (cases), 174 did not (controls). Injecting behaviour among cases and matched controls were compared for both 'persistent GIs' (patients who had injected via the femoral vein in the 28-day period preceding the baseline) and 'former GIs' (patients with a history of previous groin injecting). There were no significant between-group differences in gender, mean age, time in treatment, substitute medication and mean dose at baseline or injecting behaviour prior to baseline. After baseline, reduction by a third in the proportion still groin injecting was immediately evident among UFV cases versus controls (number needed to treat: 3, 95% CI: 2, 8; p < 0.001). Marked reduction in groin-injecting behaviour among UFV cases was...
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... Bulsara Chapter 8 Drug users and pharmacists: the clients&amp;#x27; perspective 85 Catriona Matheson Chapter 9 ... drugs: supervised consumption of methadone 137 Laurence Gruer and Kay Roberts Chapter 13 ... and addiction: the... more
... Bulsara Chapter 8 Drug users and pharmacists: the clients&amp;#x27; perspective 85 Catriona Matheson Chapter 9 ... drugs: supervised consumption of methadone 137 Laurence Gruer and Kay Roberts Chapter 13 ... and addiction: the talking therapies 173 Tara Rado and Robert Hill Chapter ...
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Background Worldwide, opioid use causes more than 100,000 overdose deaths annually. Naloxone has proven efficacy in reversing opioid overdoses and is approved as an emergency antidote to opioid overdose. Take home naloxone (THN)... more
Background Worldwide, opioid use causes more than 100,000 overdose deaths annually. Naloxone has proven efficacy in reversing opioid overdoses and is approved as an emergency antidote to opioid overdose. Take home naloxone (THN) programmes have been introduced to provide ‘community members’, who are likely to observe opioid overdoses, with naloxone kits and train them to recognise an overdose and administer naloxone. The acceptability and feasibility of THN programmes has been demonstrated, but the real-life effectiveness of naloxone administration by community members is not known. In recent years, the approval of several concentrated naloxone nasal-spray formulations (in addition to injectable formulations, eg.prenoxad) potentially increases acceptability and scope for wider provision. This study aims to determine the effectiveness of THN (all formulations) in real-world conditions. Methods A European, multi-country, prospective cohort study, to assess the use of THN by community ...
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Background People recovering from heroin addiction need better treatments than are currently offered. The chronic relapsing nature of drug dependence means that helping a patient to achieve abstinence is often difficult. Naltrexone blocks... more
Background People recovering from heroin addiction need better treatments than are currently offered. The chronic relapsing nature of drug dependence means that helping a patient to achieve abstinence is often difficult. Naltrexone blocks the effects of ingested heroin; however, evidence is conflicting regarding the best delivery method. Objectives The primary purpose of the trial was to evaluate the clinical effectiveness and cost-effectiveness of extended-release naltrexone versus standard oral naltrexone versus relapse prevention therapy without medication for opioid use disorder (OUD). Design This was a 3-year, definitive, three-centre, three-arm, parallel group, placebo-controlled, double-blind, double-dummy, randomised controlled trial. Setting Two specialist NHS outpatient addiction clinics: one in London and one in Birmingham. Participants Planned study sample – 300 adult patients with OUD who had completed detoxification. Interventions One iGen/Atral-Cipan Extended Release ...
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The genetic component of Cannabis Use Disorder may overlap with influences acting more generally on early stages of cannabis use. This paper aims to determine the extent to which genetic influences on the development of cannabis... more
The genetic component of Cannabis Use Disorder may overlap with influences acting more generally on early stages of cannabis use. This paper aims to determine the extent to which genetic influences on the development of cannabis abuse/dependence are correlated with those acting on the opportunity to use cannabis and frequency of use. A cross-sectional study of 3303 Australian twins, measuring age of onset of cannabis use opportunity, lifetime frequency of cannabis use, and lifetime DSM-IV cannabis abuse/dependence. A trivariate Cholesky decomposition estimated additive genetic (A), shared environment (C) and unique environment (E) contributions to the opportunity to use cannabis, the frequency of cannabis use, cannabis abuse/dependence, and the extent of overlap between genetic and environmental factors associated with each phenotype. Variance components estimates were A = 0.64 [95% confidence interval (CI) 0.58-0.70] and E = 0.36 (95% CI 0.29-0.42) for age of opportunity to use can...
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Issues. Non‐injectable naloxone formulations are being developed for opioid overdose reversal, but only limited data have been published in the peer‐reviewed domain. Through examination of a hitherto‐unsearched database, we expand public... more
Issues. Non‐injectable naloxone formulations are being developed for opioid overdose reversal, but only limited data have been published in the peer‐reviewed domain. Through examination of a hitherto‐unsearched database, we expand public knowledge of non‐injectable formulations, tracing their development and novelty, with the aim to describe and compare their pharmacokinetic properties. Approach. (i) The PatentScope database of the World Intellectual Property Organization was searched for relevant English‐language patent applications; (ii) Pharmacokinetic data were extracted, collated and analysed; (iii) PubMed was searched using Boolean search query ‘(nasal OR intranasal OR nose OR buccal OR sublingual) AND naloxone AND pharmacokinetics’. Key Findings. Five hundred and twenty‐two PatentScope and 56 PubMed records were identified: three published international patent applications and five peer‐reviewed papers were eligible. Pharmacokinetic data were available for intranasal, subling...
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The prison-based N-ALIVE pilot trial had undertaken to notify the Research Ethics Committee and participants if we had reason to believe that the N-ALIVE pilot trial would not proceed to the main trial. In this paper, we describe how... more
The prison-based N-ALIVE pilot trial had undertaken to notify the Research Ethics Committee and participants if we had reason to believe that the N-ALIVE pilot trial would not proceed to the main trial. In this paper, we describe how external data for the third year of before/after evaluation from Scotland's National Naloxone Programme, a related public health policy, were anticipated by eliciting prior opinion about the Scottish results in the month prior to their release as official statistics. We summarise how deliberations by the N-ALIVE Trial Steering-Data Monitoring Committee (TS-DMC) on N-ALIVE's own interim data, together with those on naloxone-on-release (NOR) from Scotland, led to the decision to cease randomization in the N-ALIVE pilot trial and recommend to local Principal Investigators that NOR be offered to already-randomized prisoners who had not yet been released.
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To test the safety of new buprenorphine oral lyophilisate wafer ("bup-lyo") versus standard sub-lingual buprenorphine ("bup-SL"). Randomised (2:1) open-label study; opioid-dependent subjects; subsequent partial... more
To test the safety of new buprenorphine oral lyophilisate wafer ("bup-lyo") versus standard sub-lingual buprenorphine ("bup-SL"). Randomised (2:1) open-label study; opioid-dependent subjects; subsequent partial cross-over. Specialised clinical trials facility and addictions treatment facility. Opioid-dependent subjects (n = 36) commencing buprenorphine maintenance (personalised dose-titration) including patients co-using alcohol, cocaine and benzodiazepines (below thresholds). Respiratory function (respiratory rate, pulse-oximetry); medication hold and dose adequacy; opiate withdrawal signs and symptoms; tablet disintegration times; treatment retention. Pharmacokinetics (PK) for plasma buprenorphine and norbuprenorphine (n = 11). Oral lyophilised buprenorphine ("bup-lyo") completely dissolved within 2 min for 58 vs. 5% for "bup-SL." Dose titration resulted in similar maintenance dosing (10.8 vs. 9.6 mg). There were no significant between-group...
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While opiate substitution therapy and injecting equipment provision (IEP) have reduced blood-borne viruses (BBV) among people who inject drugs (PWID), some PWID continue to share injecting equipment and acquire BBV. Psychosocial... more
While opiate substitution therapy and injecting equipment provision (IEP) have reduced blood-borne viruses (BBV) among people who inject drugs (PWID), some PWID continue to share injecting equipment and acquire BBV. Psychosocial interventions that address risk behaviours could reduce BBV transmission among PWID. A pragmatic, two-armed randomised controlled, open feasibility study of PWID attending drug treatment or IEP in four UK regions. Ninety-nine PWID were randomly allocated to receive a three-session manualised psychosocial group intervention and BBV transmission information booklet plus treatment as usual (TAU) (n = 52) or information booklet plus TAU (n = 47). The intervention was developed from evidence-based literature, qualitative interviews with PWID, key stakeholder consultations, and expert opinion. Recruitment rates, retention in treatment, follow-up completion rates and health economic data completion measured feasibility. Fifty-six percent (99/176) of eligible PWID w...
Research Interests: Psychotherapy, Family Medicine, Risk Taking, Medicine, Harm Reduction, and 15 moreHumans, Transmission, Female, Feasibility Studies, Male, Psychological Intervention, Psychosocial, Middle Aged, Adult, Focus Group Research, Public health systems and services research, Randomized Controlled Trial, Psychosocial Interventions, People Who Inject Drugs, and Blood Borne Pathogens
Background: Six recent randomised control trials (RCTs) have suggested that supervised injectable heroin (SIH) can be effective in patients who persist in street heroin use during methadone treatment. However, short-term randomised... more
Background: Six recent randomised control trials (RCTs) have suggested that supervised injectable heroin (SIH) can be effective in patients who persist in street heroin use during methadone treatment. However, short-term randomised control trials have limitations in assessing the effectiveness of treatments for addictive disorders, which are chronic and relapsing disorders of motivation. These RCTs particularly fail to capture the process of the SIH treatment and the diversity of influence and change over time. Method: This narrative review is based on the analysis of published data. Conclusions are drawn from a process of reflection informed by experience in delivering one of the published trials, subsequent experiences in varying the way SIH is delivered, and through consideration of possible mechanisms of action of SIH. Observations: Many long-term, socially marginalised and demoralised people who are addicted to heroin experience few rewards from the stability afforded by methad...
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Risk assessments are widely used, but their ability to predict outcomes in opioid use disorder (OUD) treatment remains unclear. Therefore, the aim was to investigate if addiction-specific brief risk screening is effective in identifying... more
Risk assessments are widely used, but their ability to predict outcomes in opioid use disorder (OUD) treatment remains unclear. Therefore, the aim was to investigate if addiction-specific brief risk screening is effective in identifying high mortality risk groups and if subsequent clinical actions following risk assessment impacts on mortality levels. Opioid use disorder (OUD) patients were identified in the South London and Maudsley Case Register. Deaths were identified through database linkage to the national mortality dataset. Cox and competing-risk regression were used to model associations between brief risk assessment domains and all-cause and overdose mortality in 4488 OUD patients, with up-to 6-year follow-up time where 227 deaths were registered. Data were stratified by admission to general mental health services. All-cause mortality was significantly associated with unsafe injecting (HR 1.53, 95% CI 1.10-2.11) and clinically appraised likelihood of accidental overdose (HR ...
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There is a developing body of research looking at cannabis use opportunity, but little research examining timing of opportunity to use cannabis. Identify factors associated with (1) earlier opportunity to use cannabis and (2) faster... more
There is a developing body of research looking at cannabis use opportunity, but little research examining timing of opportunity to use cannabis. Identify factors associated with (1) earlier opportunity to use cannabis and (2) faster progression from opportunity to cannabis dependence. Cross-sectional study of 3824 Australian twins and siblings, measuring age of onset of cannabis use opportunity and DSM-IV cannabis dependence. Survival analysis identified factors associated with faster progression to opportunity or dependence. Factors associated with both speed of progression to opportunity and dependence were conduct disorder (opportunity HR 5.57, 95%CI 1.52-20.47; dependence HR 2.49, 95%CI 1.91-3.25), parental drug problems (opportunity HR 7.29, 95%CI 1.74-30.62; dependence HR 3.30, 95%CI 1.63-6.69), weekly tobacco use (opportunity HR 8.57, 95%CI 3.93-18.68; dependence HR 2.76, 95% CI 2.10-3.64), and female gender (opportunity HR 0.69, 95%CI 0.64-0.75; dependence HR 0.44, 95%CI 0.3...
Research Interests: Pharmacology, Australia, Medicine, Humans, Female, and 15 moreMale, Opportunity, Dependence, Etiology, Registries, Cannabis, Middle Aged, Adult, Disease Progression, Cannabis Dependence, Cross Sectional Studies, Age of Onset, Marijuana abuse, Psychology and Cognitive Sciences, and Medical and Health Sciences
Publisher Summary This chapter explores the associations between social class, binge drinking, and other risk behaviors among Brazilian young people. In developing countries such as Brazil, there is still very little information about... more
Publisher Summary This chapter explores the associations between social class, binge drinking, and other risk behaviors among Brazilian young people. In developing countries such as Brazil, there is still very little information about alcohol use among young people, and its causes and consequences. The purpose of this chapter is to contribute to the fuller understanding of alcohol use among young people in Recife, Northeast Brazil. This study has explored binge drinking in a sample of young people (10–19 years) in Recife, Brazil. Data collection focused on a range of social factors potentially associated with this risky pattern of alcohol use such as social class, age, gender, use of other drugs, sexual relationships and involvement in criminal activities. Within this sample (n=336), 23% had had at least one episode of binge drinking, 23% had smoked cigarettes and 26% had tried other drugs (illegal or legal). In addition, 24% had had sexual relationships, of which 24% had had unprotectes sex, and 7% had been involved in criminal activities. Social class emerged as significantly related to binge drinking, with greater likelihood of this event among poor class older adolescents, after adjusting for gender, age and social variables. One could argue that reverse causality could explain the association between binge drinking and poor class. However, reverse causality is unlikely since social mobility because of personal behaviour could not be considered with subjects at such a young age.
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Research Interests: Medicine, Humans, Prison, Heroin Dependence, Great Britain, and 5 moreMedical Emergency, BMJ, Emergencies, Heroin, and Naloxone
Research Interests: Psychiatry, Addiction, Mental Health, Family Medicine, Medicine, and 15 moreMotivation, London, Library and Information Studies, Humans, Smoking Cessation, Smoking, Female, Male, Prevalence, Middle Aged, Questionnaires, Adult, Public health systems and services research, Cross Sectional Studies, and attitude to health
... REFERENCES Best D, Gossop M, Harris J, Farrell M, Finch E, Noble A and Strang J (2000) Use of non-prescribed methadone and other illicit drug during methadone maintenance treatment. Drug and Alcohol Review 19: 9-16. ...