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Practice corner: Sleepless in Sydney—is valerian an effective alternative to benzodiazepines in the treatment of insomnia?

University of Sydney School of Public Health
Sydney, New South Wales, Australia

Key Words: insomnia • valerian • homeless persons

The first 150 words of the full text of this article appear below.

This practice corner considers a clinical question that arose at the author’s outreach clinic at a soup kitchen in urban Sydney. It highlights some of the practical issues that affect the equitable application of evidence with disadvantaged patients.

THE PROBLEM
Jason dropped by the clinic looking fidgety and agitated. He is 32 years old with a history of substance abuse that includes paint sniffing and narcotic abuse. On a previous visit, he told me that he injects crushed and filtered morphine tablets twice a week "to relax," and I suspect that he has harmed himself in the past.

He sleeps "rough" in parks, railway stations, and squats and presented to the clinic asking for something to help him sleep. He says it is "noisy" on the streets and he hasn’t had a decent night’s sleep for a long time, yet he refuses to access emergency shelter accommodation. I’m very reluctant to prescribe . . . [Full text of this article]