Martin Luther King declared that a riot is the language of the unheard. I don't think he meant this particular RIOTT but it’s good to see the Lancet paper on injectable heroin in the UK finally make it into print given the rather hasty pre-publication presentation at press conference in September 2009. This post is a follow up to 'I predict a RIOTT' I blogged back when the NAOMI study in Canada was published in the NEJM.

Hangovers offer rich pickings for complementary therapists. It's the perfect fodder for alternative medicine. Give them an affliction almost completely characterised by a progressive recovery and they will be tumbling over themselves to offer 'cures'. Staring bleary-eyed at the Sunday supplements the recommended homeopathic regime of nux vomica suddenly seem like a good idea. Rational individuals try to reason through the fog of hangover and decide to take one pill (sorry pillule – don't want to sound too allopathic) and then wait 24 hours. Hangover cured. Personally, I’d like to see a decent double-blind RCT looking at homeopathic nux vomica versus a bacon butty.

"Akmal Shaikh was convicted and sentenced to death penalty for serious drug trafficking on solid evidence. In fact, 150mg of heroin of high degree of purity would be lethal. The amount of heroin he carried was 4030g, enough to cause 26800 deaths."

On Christmas Eve this was part of the Chinese statement about the impending execution of Akmal Shaikh.

Of course, this is misleading claptrap and anyone with a firing neurone will raise an eyebrow at these numbers. It is possible to do a 'back of an envelope' calculation of how many deaths 4kg of heroin might cause.

Smoking kills millions of people every year and yet the medical community seems pathologically opposed to any measure to tackle the issue other than through the promotion of total abstinence. Carl Phillips suggests in his paper in the Harm Reduction Journal this month that smoking for just one month is more dangerous than switching to a smokeless nicotine product for a lifetime.

I have to confess that a few years ago I was advising patients to go and get glucosamine for their dodgy knees. There can't be many GPs that haven't dropped it into the discussion with a patient with intractable osteoarthritic pain. The therapeutic options for worsening osteoarthritis seem to dwindle rapidly. Unfortunately, the evidence for any effect from glucosamine has been eroded nearly as quickly as the joints involved.