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Abstract
Ulcerated and inflammatory lesions of the oral mucosa are not rare. A detailed patient medical and social history including habits and abuses, as well as the duration, location, focality and presence, or lack of local and/or systemic symptoms is critical in establishing a proper diagnosis. This article discusses the clinical presentation, management, and histopathologic characteristics of a variety of ulcerative and inflammatory lesions seen in the oral cavity.
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Affiliation(s)
- Elizabeth M Philipone
- Division of Oral and Maxillofacial Pathology, Columbia University Irving Medical Center, New York, NY 10032, USA.
| | - Scott M Peters
- Division of Oral and Maxillofacial Pathology, Columbia University Irving Medical Center, New York, NY 10032, USA
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Zisman-Ilani Y, Smith WR, Morris NP. Addressing Substance Use in Psychiatric Care: An Old Problem With Renewed Urgency. Psychiatr Serv 2023; 74:201-203. [PMID: 35833255 DOI: 10.1176/appi.ps.202100724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Patients, clinicians, researchers, and policy makers have long called for greater integration of services for people with co-occurring mental and substance use disorders. Decades later, these services remain fragmented in psychiatry across much of the United States. Mounting deaths from drug-related overdoses call for renewed focus on bringing substance use into the center of psychiatric services. This Open Forum explores factors within the field of psychiatry, including insufficient training related to substance use, prevalent stigma surrounding substance use, and limited availability of co-occurring disorder specialists, that reinforce this divide and offers solutions for better addressing substance use disorders in psychiatric care.
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Affiliation(s)
- Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia (Zisman-Ilani); Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani); Department of Psychiatry, University of Pennsylvania, Philadelphia (Smith); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Morris)
| | - William R Smith
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia (Zisman-Ilani); Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani); Department of Psychiatry, University of Pennsylvania, Philadelphia (Smith); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Morris)
| | - Nathaniel P Morris
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia (Zisman-Ilani); Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani); Department of Psychiatry, University of Pennsylvania, Philadelphia (Smith); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Morris)
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Dunham CM, Huang GS, Chance EA, Hileman BM, Han JS. Trauma activation patient preinjury toxicology-positive proportions and associated risk conditions: A retrospective study. Injury 2023; 54:1334-1341. [PMID: 36737270 DOI: 10.1016/j.injury.2023.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/13/2022] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Unlike prior guidelines for a positive toxicology screen, the 2022 national trauma data bank dictionary requires the exclusion of postinjury drugs. We aimed to (1) investigate the proportion of drugs in the toxicology screen that were given postinjury; (2) determine preinjury toxicology-positive associations with smoking, psychiatric, and drug abuse histories in an activation patient (ACT-Pt) cohort; and (3) explore whether ACT-Pt varied toxicology testing rates would produce similar preinjury toxicology-positive results. METHODS In this retrospective study, the historic parent database included consecutive trauma center admissions where toxicology testing was discretionary. A supplementary electronic medical record audit of ACT-Pts age 18-60 years assessed smoking, psychiatric, and drug abuse histories. Subsequently, ACT-Pt age 18-100 years testing was encouraged by attending surgeons and, later routine testing was implemented. RESULTS Of 2,076 patients in the historic parent database, discretionary toxicology testing occurred in 23.9% (n = 496) and the positive proportion was 58.9% (n = 292). However, 23.6% (n = 69) of the positive screens had the drug given postinjury. The preinjury positive-toxicology proportion was 45.0% (223/496). Preinjury toxicology positivity was greater in ACT-Pts age 18-60 years (52.3%) than in other patients (activations >60 years of age or consultations) (33.7%; p < 0.0001; odds ratio [OR] = 2.2). Smoking, psychiatric, and drug abuse histories were more common in ACT-Pts age 18-60 years preinjury toxicology-positive patients (74.4%, 51.3%, and 98.7%) than in negative patients (36.6%, 25.2%, and 25.2%; p < 0.0001). In ACT-Pts age 18-100 years, when compared to historic discretionary testing (32.7%), testing was increased with encouraged testing (62.1%; p < 0.0001; OR = 3.4) and routine testing (73.1%; p < 0.0001; OR = 5.6). ACT-Pt preinjury toxicology positivity was similar for historic discretionary (47.9%), encouraged (57.6%), and routine (51.3%) (p = 0.3670) testing. The meta-analytic toxicology-positive proportion for the three testing strategies was 49.8%. CONCLUSIONS Substantial toxicology-positive findings are due to postinjury drug administration. Toxicology positivity is associated with ACT-Pts age 18-60 years and smoking, psychiatric, and drug abuse histories. ACT-Pt age 18-100 years preinjury toxicology positivity is 50% and does not vary with different testing proportions and strategies.
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Affiliation(s)
- C Michael Dunham
- Trauma, Critical Care, and General Surgery Services, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., St. Elizabeth Youngstown Hospital, Youngstown, OH 44501, United States.
| | - Gregory S Huang
- Trauma, Critical Care, and General Surgery Services, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., St. Elizabeth Youngstown Hospital, Youngstown, OH 44501, United States
| | - Elisha A Chance
- Trauma and Neuroscience Research Department, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH 44501, United States
| | - Barbara M Hileman
- Trauma and Neuroscience Research Department, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH 44501, United States
| | - Jane S Han
- Department of Surgery, St Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH 44501, United States
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Pepper D. The Entanglements of Substance Use Disorders and Emergency Departments. Focus (Am Psychiatr Publ) 2023; 21:52-53. [PMID: 37205033 PMCID: PMC10172536 DOI: 10.1176/appi.focus.20220075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- David Pepper
- Institute of Living, Hartford Hospital, Hartford, Connecticut
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Nourafkan A, Amini Z. Relation of Social Support Status and Social Health in People with Drug Abuse. Adv Biomed Res 2023; 12:63. [PMID: 37200743 PMCID: PMC10186042 DOI: 10.4103/abr.abr_85_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 05/20/2023] Open
Abstract
Background The aim of this study was to investigate the status of social support in people with drug abuse and its relationship with social health in patients referring to addiction treatment centers in Isfahan. Materials and Methods This cross-sectional study was performed in Isfahan addiction treatment centers in 2019-2020. The study population was the total number of people with drug abuse in Isfahan addiction treatment centers that 300 people with substance abuse and 300 people as control group were included. Social support and social health questionnaires were distributed among the participants. The Keez Social Health Questionnaire, designed in the United States in 2004, is about daily life and the social environment and measures social health. Another questionnaire was the social support of Sherbon and Stewart (MOS). This scale was a self-report tool that measured the amount of social support received by the subject. Results The results showed a positive, direct, and significant relationship between the dimensions of social support and social health in the group of patients with drug abuse (P < 0.05). Comparison of social support and its dimensions in the two control and affected groups showed that the scores in the healthy group were significantly higher than the affected group (P < 0.05). Conclusion According to the results of this study, the level of social support and social health in people with substance abuse is less than other people in society, and to improve the social health of people with substance abuse, more social support should be provided.
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Affiliation(s)
- Afsaneh Nourafkan
- Department of Community and Family Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Amini
- Department of Community and Family Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Address for correspondence: Dr. Zahra Amini, Department of Community and Family Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan City, Isfahan, Iran. E-mail:
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Sherry TB, Nguyen T, Dick AW, Bradford AC, Simon K, Stein BD. A National Retrospective Study of Antidepressants' Effects on Overdose and Self-Harm Among Adults Treated With Opioid Analgesics. Psychiatr Serv 2023; 74:24-30. [PMID: 35770423 PMCID: PMC10654712 DOI: 10.1176/appi.ps.20220070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Because individuals with a history of depression who are receiving opioids are at higher risk for adverse events, the authors examined whether antidepressant treatment reduces risk for overdose and self-harm among individuals with a history of depression who receive opioids. METHODS Commercial insurance claims of individuals with a history of depression receiving opioids from 2007 to 2017 were used to quantify the association between antidepressant fills and adverse events among individuals after initiation of opioid treatment; the authors accounted for selection into treatment and used discrete-time, proportional hazards survival models. RESULTS Among 283,374 adults with a history of depression treatment, 8,203 experienced 47,486 adverse events from 2007 to 2017 in the 12 months after initiation of opioid treatment. Approximately half (N=144,052, 50.8%) filled an antidepressant prescription at least once in the 12 months after the opioid episode began. Individuals receiving antidepressants for at least 6 weeks had a reduced risk for any adverse event (adjusted odds ratio [AOR]=0.79, 95% confidence interval [CI]=0.65-0.97) as well as a reduced risk for opioid overdoses (AOR=0.78, 95% CI=0.64-0.96), overdoses from nonopioid controlled substances (AOR=0.76, 95% CI=0.62-0.94), overdoses from other substances (AOR=0.79, 95% CI=0.65-0.97), and other self-harm events (AOR=0.82, 95% CI=0.67-1.00). CONCLUSIONS Individuals with a history of depression who received opioid analgesics had a significantly lower risk for overdose and self-harm after they had been taking antidepressants for at least 6 weeks. Universal screening for mood disorders among individuals receiving opioids, and promptly providing evidence-based depression treatment when appropriate, may reduce adverse events.
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Affiliation(s)
- Tisamarie B Sherry
- RAND Corporation, Arlington, Virginia (Sherry), Boston (Dick), and Pittsburgh (Stein); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Nguyen); O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington (Bradford, Simon)
| | - Thuy Nguyen
- RAND Corporation, Arlington, Virginia (Sherry), Boston (Dick), and Pittsburgh (Stein); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Nguyen); O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington (Bradford, Simon)
| | - Andrew W Dick
- RAND Corporation, Arlington, Virginia (Sherry), Boston (Dick), and Pittsburgh (Stein); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Nguyen); O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington (Bradford, Simon)
| | - Ashley C Bradford
- RAND Corporation, Arlington, Virginia (Sherry), Boston (Dick), and Pittsburgh (Stein); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Nguyen); O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington (Bradford, Simon)
| | - Kosali Simon
- RAND Corporation, Arlington, Virginia (Sherry), Boston (Dick), and Pittsburgh (Stein); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Nguyen); O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington (Bradford, Simon)
| | - Bradley D Stein
- RAND Corporation, Arlington, Virginia (Sherry), Boston (Dick), and Pittsburgh (Stein); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Nguyen); O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington (Bradford, Simon)
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Rahbar Taramsari M, Mobayen M, Feizkhah A, Letafatkar N, Esmailzadeh M, Hoseinzadeh S, Yeganehdoost F, Mehdipour F, Bagheri Toolaroud P. The Effect of Drug Abuse on Clinical Outcomes of Adult Burn Patients Admitted to a Burn Center in the North of Iran. Bull Emerg Trauma 2023; 11:90-95. [PMID: 37193010 PMCID: PMC10182718 DOI: 10.30476/beat.2023.98282.1424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 05/18/2023] Open
Abstract
Objective Burn trauma is a life-threatening incident that may be accompanied by several risk factors that increase morbidity and mortality. Drug abuse is one of the lifestyle dangers on the rise globally and can have an impact on the outcomes of burn injuries. This study aimed to evaluate the effect of drug abuse on the clinical outcomes of adult burn patients who were admitted to a burn center in the North of Iran. Methods This retrospective cross-sectional study included adult burn patients who were referred to Velayat Hospital, between March 1, 2021, and March 20, 2022. The hospital information system (HIS) was used to select patients with a history of drug use and then were compared with burn victims who had never used drugs before. In both groups, demographic information, the cause of the burn, the comorbid diseases, total body surface area, length of stay, and outcomes were collected and recorded for both groups. Results This study included 114 inpatients, 90 of whom (78.95%) were men. The mean age of the patients was 43±15 years. The mean length of hospitalization in the drug-user group was significantly higher than in the non-drug abuse group (p=0.004). The drug abuse group had significantly higher rates of comorbid diseases (p=0.021), inhalation injury (p<0.001), mortality (p=0.002), and pneumonia (p<0.001). However, there were no statistically significant differences in the Infection and Sir's rates (p=0.583) between the groups. Conclusion Drug abuse is a risk factor in adult burn patients, which can affect the length of stay and burn-related morbidities.
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Affiliation(s)
- Morteza Rahbar Taramsari
- Department of Forensic Medicine and Toxicology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammadreza Mobayen
- Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Feizkhah
- Department of Medical Physics, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Negin Letafatkar
- Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mojdeh Esmailzadeh
- Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Sara Hoseinzadeh
- Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Farank Yeganehdoost
- Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Fatemeh Mehdipour
- Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Parissa Bagheri Toolaroud
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran.
- Corresponding author: Parissa Bagheri Toolaroud Address: Health Information Management Research Center, Kashan University of Medical Sciences, Postal code: 87159-73449, Kashan, Iran. Tel: +98-9112812842; Fax: +98-31-55548883; +98-31-55589373 e-mail:
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Keim CK, Schwartz RA, Kapila R. Levamisole-induced and COVID-19-induced retiform purpura: two overlapping, emerging clinical syndromes. Arch Dermatol Res 2023; 315:265-273. [PMID: 34807290 PMCID: PMC8607060 DOI: 10.1007/s00403-021-02303-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/11/2021] [Indexed: 10/28/2022]
Abstract
Levamisole exposure in cocaine users is a well-recognized cause of retiform purpura, a distinctive net-like maculopapular patch. Prolonged exposure to levamisole can lead to a serious systemic syndrome known as levamisole-induced vasculitis, most commonly involving the kidneys and lungs. More recently, retiform purpura has been observed in patients with the novel coronavirus disease of 2019 (COVID-19). Due to their overlapping dermatologic and systemic manifestations, levamisole-induced and COVID-19-induced retiform purpura may mimic one another in clinical presentation. The possibility that patients may present with one or both syndromes creates a diagnostic challenge. This review of levamisole-induced and COVID-19-induced retiform purpura highlights their corresponding and distinctive features. Additionally, we propose a unique staging system for levamisole-induced retiform purpura that may be valid for future classification of COVID-19-induced retiform purpura.
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Affiliation(s)
- Catherine K. Keim
- grid.430387.b0000 0004 1936 8796Rutgers New Jersey Medical School, MSB H-576, 185 South Orange Ave, Newark, NJ 07103 USA
| | - Robert A. Schwartz
- grid.430387.b0000 0004 1936 8796Dermatology and Pathology, Rutgers New Jersey Medical School, MSB H-576, 185 South Orange Ave, Newark, NJ 07103 USA
| | - Rajendra Kapila
- grid.430387.b0000 0004 1936 8796Infectious Diseases, Rutgers New Jersey Medical School, MSB H-576, 185 South Orange Ave, Newark, NJ 07103 USA
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Valdes EG, Reist C, Aamar R, Hallisey B, Stanton ES, Williams L, Andel R, Gorman J. Use of Predictive Analytics to Identify Unhealthy Opioid Use and Guide Intervention. Psychiatr Serv 2022:appips202200034. [PMID: 36545772 DOI: 10.1176/appi.ps.202200034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The authors aimed to use the newly developed Opioid Risk Stratification Tool to identify individuals who may be at risk for unhealthy opioid use and to examine the impact of applying a mailing and engagement intervention to this population and their prescribers, with the goal of reducing high-risk prescribing behaviors, opioid medication use, and mortality rates. METHODS A nonrandomized controlled study was conducted with members from two Medicaid managed care organizations. In both the intervention (N=131) and control (N=187) groups, an algorithm identified members at moderate to high risk for hazardous opioid use. Members at increased risk in the intervention group and their prescribers received a letter from the managed care organization, and members still at risk 3 months after the mailing were contacted by a care coordinator. Individuals in the control group were not contacted. Medicaid claims data were used to compare opioid use and prescribing practices between groups before and after the intervention. RESULTS Individuals in the intervention group were less likely to have any opioid prescription postintervention compared with those in the control group (OR=0.55, p<0.001), and the intervention group had a greater reduction in the number of individuals with concurrent opioid and benzodiazepine prescriptions (OR=0.49, p=0.042). Practices such as multiple opioid prescriptions and multiple prescribers of opioids were not affected by the intervention. CONCLUSIONS An intervention targeting individuals at risk for hazardous opioid use was associated with a reduction in some high-risk prescribing practices. Future research should determine the ideal mix of interventions to reduce as many risk factors as possible.
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Affiliation(s)
- Elise G Valdes
- Relias, Morrisville, North Carolina (Valdes, Reist, Aamar, Gorman); MindX Sciences, Indianapolis (Reist); Eastpointe Human Services, Beulaville, North Carolina (Hallisey); Partners Health Management, Gastonia, North Carolina (Stanton, Williams); Edson College of Nursing and Health Innovation, Arizona State University, Phoenix (Andel)
| | - Christopher Reist
- Relias, Morrisville, North Carolina (Valdes, Reist, Aamar, Gorman); MindX Sciences, Indianapolis (Reist); Eastpointe Human Services, Beulaville, North Carolina (Hallisey); Partners Health Management, Gastonia, North Carolina (Stanton, Williams); Edson College of Nursing and Health Innovation, Arizona State University, Phoenix (Andel)
| | - Rola Aamar
- Relias, Morrisville, North Carolina (Valdes, Reist, Aamar, Gorman); MindX Sciences, Indianapolis (Reist); Eastpointe Human Services, Beulaville, North Carolina (Hallisey); Partners Health Management, Gastonia, North Carolina (Stanton, Williams); Edson College of Nursing and Health Innovation, Arizona State University, Phoenix (Andel)
| | - Barbara Hallisey
- Relias, Morrisville, North Carolina (Valdes, Reist, Aamar, Gorman); MindX Sciences, Indianapolis (Reist); Eastpointe Human Services, Beulaville, North Carolina (Hallisey); Partners Health Management, Gastonia, North Carolina (Stanton, Williams); Edson College of Nursing and Health Innovation, Arizona State University, Phoenix (Andel)
| | - Elizabeth Shirley Stanton
- Relias, Morrisville, North Carolina (Valdes, Reist, Aamar, Gorman); MindX Sciences, Indianapolis (Reist); Eastpointe Human Services, Beulaville, North Carolina (Hallisey); Partners Health Management, Gastonia, North Carolina (Stanton, Williams); Edson College of Nursing and Health Innovation, Arizona State University, Phoenix (Andel)
| | - Leah Williams
- Relias, Morrisville, North Carolina (Valdes, Reist, Aamar, Gorman); MindX Sciences, Indianapolis (Reist); Eastpointe Human Services, Beulaville, North Carolina (Hallisey); Partners Health Management, Gastonia, North Carolina (Stanton, Williams); Edson College of Nursing and Health Innovation, Arizona State University, Phoenix (Andel)
| | - Ross Andel
- Relias, Morrisville, North Carolina (Valdes, Reist, Aamar, Gorman); MindX Sciences, Indianapolis (Reist); Eastpointe Human Services, Beulaville, North Carolina (Hallisey); Partners Health Management, Gastonia, North Carolina (Stanton, Williams); Edson College of Nursing and Health Innovation, Arizona State University, Phoenix (Andel)
| | - Jack Gorman
- Relias, Morrisville, North Carolina (Valdes, Reist, Aamar, Gorman); MindX Sciences, Indianapolis (Reist); Eastpointe Human Services, Beulaville, North Carolina (Hallisey); Partners Health Management, Gastonia, North Carolina (Stanton, Williams); Edson College of Nursing and Health Innovation, Arizona State University, Phoenix (Andel)
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Olfson M, Mauro C, Wall MM, Barry CL, Choi CJ, Mojtabai R. Medicaid Expansion and Racial-Ethnic Health Care Coverage Disparities Among Low-Income Adults With Substance Use Disorders. Psychiatr Serv 2022:appips20220155. [PMID: 36321322 DOI: 10.1176/appi.ps.20220155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVE In light of historical racial-ethnic disparities in health care coverage, the authors assessed changes in coverage in nationally representative samples of Black, White, and Hispanic low-income adults with substance use disorders after the 2014 Affordable Care Act Medicaid expansion. METHODS Data from 12 years of the annual National Survey on Drug Use and Health (2008-2019) identified low-income adults ages 18-64 years with alcohol, cannabis, cocaine, or heroin use disorder (N=749,033). Trends in coverage focused on non-Hispanic Black, non-Hispanic White, and Hispanic individuals. Age- and sex-adjusted difference-in-differences analysis assessed effects of expansion state residence on insurance coverage for the three groups. RESULTS Before Medicaid expansion (2008-2013), 38.5% of Black, 37.6% of White, and 51.2% of Hispanic low-income adults with substance use disorders were uninsured. After expansion (2014-2019), these proportions significantly declined for Black (24.2%), White (22.0%), and Hispanic (34.5%) groups. Decreases in rates of individuals without insurance and increases in Medicaid coverage tended to be more pronounced for those in expansion states than for those in nonexpansion states. In nonexpansion states, the proportions of those without insurance significantly decreased among Black and White individuals but not among Hispanic individuals. Proportions receiving past-year substance use treatment did not significantly change and remained low postexpansion: Black, 10.7%; White, 14.6%; and Hispanic, 9.0%. CONCLUSIONS After Medicaid expansion, coverage increased for low-income Black, White, and Hispanic adults with substance use disorders. For all three groups, Medicaid coverage disproportionately increased among those living in expansion states. However, coverage remained far from universal, especially for Hispanic adults with substance use disorders.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson, Wall), and Mailman School of Public Health (Olfson, Mauro, Wall), Columbia University, New York City; Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York (Barry); Division of Mental Health Data Science, New York State Psychiatric Institute, New York City (Choi); Department of Mental Health, Bloomberg School of Public Health, and Department of Psychiatry, Johns Hopkins University, Baltimore (Mojtabai)
| | - Christine Mauro
- Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson, Wall), and Mailman School of Public Health (Olfson, Mauro, Wall), Columbia University, New York City; Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York (Barry); Division of Mental Health Data Science, New York State Psychiatric Institute, New York City (Choi); Department of Mental Health, Bloomberg School of Public Health, and Department of Psychiatry, Johns Hopkins University, Baltimore (Mojtabai)
| | - Melanie M Wall
- Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson, Wall), and Mailman School of Public Health (Olfson, Mauro, Wall), Columbia University, New York City; Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York (Barry); Division of Mental Health Data Science, New York State Psychiatric Institute, New York City (Choi); Department of Mental Health, Bloomberg School of Public Health, and Department of Psychiatry, Johns Hopkins University, Baltimore (Mojtabai)
| | - Colleen L Barry
- Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson, Wall), and Mailman School of Public Health (Olfson, Mauro, Wall), Columbia University, New York City; Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York (Barry); Division of Mental Health Data Science, New York State Psychiatric Institute, New York City (Choi); Department of Mental Health, Bloomberg School of Public Health, and Department of Psychiatry, Johns Hopkins University, Baltimore (Mojtabai)
| | - C Jean Choi
- Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson, Wall), and Mailman School of Public Health (Olfson, Mauro, Wall), Columbia University, New York City; Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York (Barry); Division of Mental Health Data Science, New York State Psychiatric Institute, New York City (Choi); Department of Mental Health, Bloomberg School of Public Health, and Department of Psychiatry, Johns Hopkins University, Baltimore (Mojtabai)
| | - Ramin Mojtabai
- Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson, Wall), and Mailman School of Public Health (Olfson, Mauro, Wall), Columbia University, New York City; Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York (Barry); Division of Mental Health Data Science, New York State Psychiatric Institute, New York City (Choi); Department of Mental Health, Bloomberg School of Public Health, and Department of Psychiatry, Johns Hopkins University, Baltimore (Mojtabai)
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Takemura Y, Tanifuji T, Okazaki S, Shinko Y, Otsuka I, Horai T, Shirai T, Aso K, Yamamoto N, Hishimoto A. Epigenetic clock analysis in methamphetamine dependence. Psychiatry Res 2022; 317:114901. [PMID: 36244160 DOI: 10.1016/j.psychres.2022.114901] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/24/2022] [Accepted: 10/08/2022] [Indexed: 01/05/2023]
Abstract
Methamphetamine (MA) is used worldwide and causes serious public health and social problems. MA affects the central nervous, cardiac, and immune systems, which causes neuropsychiatric and cardiovascular diseases and infection. Epigenetic changes, including DNA methylation (DNAm), are associated with various clinical phenotypes of MA abuse. DNAm is related to biological aging and health risks; hence, we aimed to assess the changes in biological aging in MA dependence using the DNAm age and DNA methylation-based telomere length (DNAmTL). We used five measures of DNAm age (HorvathAge, HannumAge, SkinBloodAge, PhenoAge, and GrimAge), DNAmTL, and DNAm-based age-predictive factors (plasma proteins and blood cell composition). We compared patients with MA dependence and healthy controls (n = 24 each) using the DNAm profiles obtained from whole-blood samples. Patients with MA dependence showed significant acceleration in PhenoAge and GrimAge, as well as a trend for significant acceleration in DNAmTL. Following adjustment for confounding factors, MA dependence was significantly associated with accelerations in PhenoAge, GrimAge, and DNAmTL, as well as alterations in DNAm-based age-predictive factors (beta-2-microglobulin, granulocytes, and naive cluster of differentiation 4+ T cells). Our results suggested an acceleration of biological aging and specific changes in the DNAm of age- predictive factors in MA dependence.
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Affiliation(s)
- Yukihiro Takemura
- Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan; Department of Psychiatry, Fukko-kai Tarumi Hospital, Kobe, Japan
| | - Takaki Tanifuji
- Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Satoshi Okazaki
- Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
| | - Yutaka Shinko
- Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Ikuo Otsuka
- Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Tadasu Horai
- Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Toshiyuki Shirai
- Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Katsuro Aso
- Department of Psychiatry, Fukko-kai Tarumi Hospital, Kobe, Japan
| | - Noriya Yamamoto
- Department of Psychiatry, Fukko-kai Tarumi Hospital, Kobe, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan; Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Heinlein E, Taylor J, Goldberg R, Potts W, RachBeisel J, Medoff D, Li L, Himelhoch S. Impact of a Targeted Intervention on Hepatitis C Care Among African Americans With Serious Mental Illness. Psychiatr Serv 2022; 73:1278-1281. [PMID: 35473365 DOI: 10.1176/appi.ps.202100410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to update findings on the continuum of care for hepatitis C virus (HCV) infection with follow-up data for individuals with serious mental illness and to identify predictors of decisions to decline vaccination. METHODS The screening, testing, immunization, risk reduction, and referral (STIRR) intervention has been shown to increase testing and immunization rates. Prevalence of HCV diagnoses, HCV continuum of care, and hepatitis A (HAV) and B (HBV) vaccination were evaluated with laboratory results and chart review. RESULTS The prevalence of HCV was 15% (N=40 of 270 African Americans receiving the STIRR intervention). Of the 40 individuals identified as having HCV, 75% (N=30) accepted referral to treatment, of whom 47% (N=14) achieved sustained virologic response. Nearly 68% (N=155) of those eligible received at least partial HAV/HBV vaccination. CONCLUSIONS The STIRR intervention facilitated access to treatment for HCV and high acceptance of hepatitis vaccination. Avoidance proved to be a significant factor in decisions to decline vaccination.
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Affiliation(s)
- Emily Heinlein
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Heinlein, Taylor, Goldberg, Potts, RachBeisel, Medoff, Li); U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5), Mental Illness Research, Education, and Clinical Center, Baltimore (Goldberg); Department of Psychiatry, College of Medicine, University of Kentucky, Lexington (Himelhoch)
| | - Jessica Taylor
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Heinlein, Taylor, Goldberg, Potts, RachBeisel, Medoff, Li); U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5), Mental Illness Research, Education, and Clinical Center, Baltimore (Goldberg); Department of Psychiatry, College of Medicine, University of Kentucky, Lexington (Himelhoch)
| | - Richard Goldberg
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Heinlein, Taylor, Goldberg, Potts, RachBeisel, Medoff, Li); U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5), Mental Illness Research, Education, and Clinical Center, Baltimore (Goldberg); Department of Psychiatry, College of Medicine, University of Kentucky, Lexington (Himelhoch)
| | - Wendy Potts
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Heinlein, Taylor, Goldberg, Potts, RachBeisel, Medoff, Li); U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5), Mental Illness Research, Education, and Clinical Center, Baltimore (Goldberg); Department of Psychiatry, College of Medicine, University of Kentucky, Lexington (Himelhoch)
| | - Jill RachBeisel
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Heinlein, Taylor, Goldberg, Potts, RachBeisel, Medoff, Li); U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5), Mental Illness Research, Education, and Clinical Center, Baltimore (Goldberg); Department of Psychiatry, College of Medicine, University of Kentucky, Lexington (Himelhoch)
| | - Deborah Medoff
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Heinlein, Taylor, Goldberg, Potts, RachBeisel, Medoff, Li); U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5), Mental Illness Research, Education, and Clinical Center, Baltimore (Goldberg); Department of Psychiatry, College of Medicine, University of Kentucky, Lexington (Himelhoch)
| | - Lan Li
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Heinlein, Taylor, Goldberg, Potts, RachBeisel, Medoff, Li); U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5), Mental Illness Research, Education, and Clinical Center, Baltimore (Goldberg); Department of Psychiatry, College of Medicine, University of Kentucky, Lexington (Himelhoch)
| | - Seth Himelhoch
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Heinlein, Taylor, Goldberg, Potts, RachBeisel, Medoff, Li); U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5), Mental Illness Research, Education, and Clinical Center, Baltimore (Goldberg); Department of Psychiatry, College of Medicine, University of Kentucky, Lexington (Himelhoch)
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Khamcharoen W, Kaewjua K, Yomthiangthae P, Anekrattanasap A, Chailapakul O, Siangproh W. Recent developments in microfluidic paper-based analytical devices for pharmaceutical analysis. Curr Top Med Chem 2022; 22:CTMC-EPUB-127245. [PMID: 36305123 DOI: 10.2174/1568026623666221027144310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/29/2022] [Accepted: 10/12/2022] [Indexed: 11/22/2022]
Abstract
In the last decade, due to the global increase in diseases, drugs for biomedical applications have increased dramatically. Therefore, there is an urgent need for analytical tools to monitor, treat, investigate, and control drug compounds in diverse matrices. The new and challenging task has been looking for simple, low-cost, rapid, and portable analytical platforms. The development of microfluidic paper-based analytical devices (µPADs) has garnered immense attention in many analytical applications due to the benefit of cellulose structure. It can be functionalized and serves as an ideal channel and scaffold for the transportation and immobilization of various substances. Microfluidic technology has been considered an effective tool in pharmaceutical analysis that facilitates the quantitative measurement of several parameters on cells or other biological systems. The µPADs represent unique advantages over conventional microfluidics, such as the self-pumping capability. They have low material costs, are easy to fabricate, and do not require external power sources. This review gives an overview of the current designs in this decade for µPADs and their respective application in pharmaceutical analysis. These include device designs, choice of paper material, and fabrication techniques with their advantages and drawbacks. In addition, the strategies for improving analytical performance in terms of simplicity, high sensitivity, and selectivity are highlighted, followed by the application of µPADs design for the detection of drug compounds for various purposes. Moreover, we present recent advances involving µPAD technologies in the field of pharmaceutical applications. Finally, we discussed the challenges and potential of µPADs for the transition from laboratory to commercialization.
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Affiliation(s)
- Wisarut Khamcharoen
- Department of Chemistry, Faculty of Science, Srinakharinwirot University, Sukhumvit 23, Wattana, Bangkok 10110, Thailand
| | - Kantima Kaewjua
- Department of Chemistry, Faculty of Science, Srinakharinwirot University, Sukhumvit 23, Wattana, Bangkok 10110, Thailand
| | - Phanumas Yomthiangthae
- Department of Chemistry, Faculty of Science, Srinakharinwirot University, Sukhumvit 23, Wattana, Bangkok 10110, Thailand
| | - Ananyaporn Anekrattanasap
- Department of Chemistry, Faculty of Science, Srinakharinwirot University, Sukhumvit 23, Wattana, Bangkok 10110, Thailand
| | - Orawon Chailapakul
- Electrochemistry and Optical Spectroscopy Center of Excellence, Department of Chemistry, Faculty of Science, Chulalongkorn University, Pathumwan, Bangkok 10330, Thailand
| | - Weena Siangproh
- Department of Chemistry, Faculty of Science, Srinakharinwirot University, Sukhumvit 23, Wattana, Bangkok 10110, Thailand
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Rotimi K, Edeh FK, Aiden J, Itiola AJ, Obamiro K. Factors that influence pharmacists' efforts in addressing substance use in Nigeria: An exploratory study. Explor Res Clin Soc Pharm 2022; 8:100189. [PMID: 36311825 PMCID: PMC9615029 DOI: 10.1016/j.rcsop.2022.100189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/08/2022] [Accepted: 10/08/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Substance use is a major global public health problem. Over the years, the burden of substance use has increased worldwide, with Nigeria having a prevalence that is substantially above the global average. Tackling this challenge requires a collaborative effort between different health professionals. Despite the critical roles pharmacists could play in substance use prevention and management, exploration of pharmacists' role in mitigating substance use in society has received limited attention in most sub-Saharan countries. In this study, we explored the experiences of pharmacists in substance use prevention and management. Methods We conducted semi-structured interviews to explore pharmacists' perceptions of their roles in the prevention and management of substance use in Nigeria. Following data transcription, we conducted a thematic content analysis. Results The four major themes that emerged included 1) the extent of pharmacists' involvement in the decision-making process for addressing substance use, 2) factors that influence pharmacists efforts in addressing substance use in Nigeria, 3) how to improve rational prescribing practices and, 4) capacity building to enhance pharmacists participation in addressing substance use. Conclusion Pharmacists have the opportunity to play critical roles in the prevention and management of substance use, but several individual and systemic challenges limit their full potential. Addressing these challenges is crucial in increasing pharmacists' participation in preventing and managing substance use.
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Affiliation(s)
- Kunle Rotimi
- Malaria Consortium, Nigeria,Corresponding author.
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Ahmad J, Joel UC, Talabi FO, Bibian ON, Aiyesimoju AB, Adefemi VO, Gever VC. Impact of social media-based intervention in reducing youths' propensity to engage in drug abuse in Nigeria. Eval Program Plann 2022; 94:102122. [PMID: 35780530 DOI: 10.1016/j.evalprogplan.2022.102122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/16/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Abstract
Drug abuse is one of the serious social problems facing the globe today. There have been cases of young people under the influence of drugs; engaging in different crimes such as kidnapping, rape, and armed robbery. The goal of this study was to test the effectiveness of social media-based intervention in reducing drug abuse propensity among youths in Nigeria. The design of the study was a two-way ANOVA with repeated measures. The Substance Abuse Proclivity (SAP) scale was used to collect data for the study. The study showed that social media-based intervention effectively reduced drug abuse propensity for participants in the treatment group compared with those in the control group. A follow-up intervention after two years shows a steady decline in drug abuse propensity among youth in the treatment group, unlike those in the control group. Comparatively, the training skills type of intervention was more effective than motivational interviewing.
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Affiliation(s)
- Jamilah Ahmad
- School of Communication, Universiti Sains Malaysia, 11800 USM Pulau Pinang, Malaysia
| | - Ugwuoke C Joel
- Department of Mass Communication, Redeemer's University, Ede, Osun State, Nigeria
| | - Felix Olajide Talabi
- Department of Mass Communication, Redeemer's University, Ede, Osun State, Nigeria
| | | | | | - Victor Oluwole Adefemi
- Department of Linguistics and Communication Studies, Osun State University, Ikire Campus, Osun State, Nigeria
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Chen J, Wang DM, Fan F, Fu F, Wei D, Tang S, Tian Y, Du Y, Zhu R, Li Y, Wang L, Zhang XY. Prevalence, demographics, and cognitive dysfunction among methamphetamine-dependent individuals with childhood maltreatment. J Psychiatr Res 2022; 153:182-188. [PMID: 35820226 DOI: 10.1016/j.jpsychires.2022.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/14/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Abstract
Previous studies have shown that dependent individuals (DIs) have higher rates of childhood maltreatment and poorer cognitive performance compared with healthy controls. However, little attention has been paid to the cognitive dysfunction of DIs with childhood maltreatment. The purpose of this study was to explore the cognitive deficits of maltreated methamphetamine-dependent individuals (METH-DIs) using a cross-sectional and case-control design. In addition, we aimed to examine the prevalence of childhood maltreatment and the demographic and clinical characteristics of Chinese male METH-DIs. 330 METH-DIs and 143 healthy controls were recruited and completed a detailed questionnaire on demographic and drug-related variables. Childhood abuse data were collected from the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Cognitive function was assessed by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The Beck Depression Inventory, Beck Anxiety Inventory, and Visual Analogue Scale (VAS) were used to assess the clinical state of the METH-DIs. 166 of 326 (50.9%) METH-DIs had experienced at least one type of childhood maltreatment. Maltreated METH-DIs were more likely to have a lower level of education (t324 = 5.81, p < 0.001), a higher level of depression(t324 = -2.68, p < 0.01), and a younger onset age of drug use (t324 = 3.58, p < 0.01) than METH-DIs who had no experience of childhood maltreatment. Maltreated METH-DIs also performed worse on the RBANS attention score than METH-DIs who did not experience maltreatment (F1,324 = 15.41, p < 0.001, partial η2 = 0.05). Our findings revealed that some demographic and clinical variables were associated with maltreatment among METH-DIs. Moreover, attention dysfunction was found in maltreated METH-DIs, which conforms to the theory of latent vulnerability.
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Affiliation(s)
- Jiajing Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dong Mei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| | - Fusheng Fan
- Xin Hua Drug Rehabilitation Center, Sichuan, China
| | - Fabing Fu
- Xin Hua Drug Rehabilitation Center, Sichuan, China
| | - Dejun Wei
- Xin Hua Drug Rehabilitation Center, Sichuan, China
| | | | - Yang Tian
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuxuan Du
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Rongrong Zhu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuqing Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Levin A, Nagib PB, Deiparine S, Gao T, Mitchell J, Davis AK. Inconsistencies between national drug policy and professional beliefs about psychoactive drugs among psychiatrists in the United States. Int J Drug Policy 2022; 108:103816. [PMID: 35964449 DOI: 10.1016/j.drugpo.2022.103816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence points to an incongruence between international drug policy and expert opinion about safety, abuse potential, and therapeutic potential of specific drugs. However, no prior studies have directly explored psychiatrists' attitudes about the current drug schedule. Therefore, we examined whether American psychiatrists' perceptions of four psychoactive drugs differed from those indicated by their schedules. METHODS A quasi-experimental online survey of a convenience sample of psychiatrists in the United States (N=181; Mean age=48.7; Female=35%). Participants were randomized to receive 1-of-4 vignettes, each depicting a depressed patient reporting relief from symptoms after non-prescribed psychoactive drug use (i.e., psilocybin [Schedule I], methamphetamine [SchedII], ketamine [SchedIII], or alprazolam [SchedIV]). Participants responded to questions related to this clinical scenario and then rated the safety, therapeutic, and abuse potentials of these four drugs and alcohol. RESULTS There were significant differences by vignette condition in mean likelihood ratings of: warning against engaging in drug use again (p<.01), being concerned about developing a new psychiatric problem (p<.001), being concerned about increased suicide risk (p<.01) and being supportive of further use of this drug as part of the treatment plan (p<.001). Overall, non-prescribed use of methamphetamine and alprazolam was rated more concerning and less acceptable than non-prescribed use of psilocybin and ketamine. Compared to psilocybin and ketamine, participants rated methamphetamine and alprazolam as less safe (p<.001), having less therapeutic potential (p<.001), and having more abuse potential (p<.001). Mean ratings of safety and abuse/therapeutic potential of alprazolam and methamphetamine were equivalent to that of alcohol, and all three were rated more harmful than psilocybin and ketamine. CONCLUSION American psychiatrists' perceptions about safety and abuse/therapeutic potentials associated with certain psychoactive drugs were inconsistent with those indicated by their placement in drug schedules. These findings add to a growing consensus amongst experts that the current drug policy is not scientifically coherent.
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Affiliation(s)
- Adam Levin
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States; Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH 43210, United States
| | - Paul B Nagib
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States; Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH 43210, United States
| | - Selina Deiparine
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Thomas Gao
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Justin Mitchell
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Alan K Davis
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH 43210, United States; Center for Psychedelic and Consciousness Research, Johns Hopkins University, Baltimore, MD 21224, United States; College of Medicine, The Ohio State University, Columbus, OH 43210, United States.
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Parisi A, Wilson AB, Villodas M, Phillips J, Dohler E. A Systematic Review of Interventions Targeting Criminogenic Risk Factors Among Persons With Serious Mental Illness. Psychiatr Serv 2022; 73:897-909. [PMID: 34911352 DOI: 10.1176/appi.ps.202000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Individuals with serious mental illness are overrepresented in the criminal justice system. Research has found that interventions targeting risk factors for recidivism (i.e., criminogenic risks) reduce justice involvement in the general correctional population. However, more needs to be learned regarding use of these interventions among individuals with serious mental illness. To this end, this systematic review synthesized research on interventions that target criminogenic risk factors and are delivered to justice-involved individuals with serious mental illness. METHODS A systematic search of six computerized bibliographic databases from inception to 2021 yielded 8,360 potentially relevant studies. Title and abstract screening, full-text reviews, and data extraction were performed independently, and discrepancies were resolved through discussion. To identify additional articles meeting inclusion criteria, experts in the field were contacted, and reference-harvesting techniques were used. Study quality was assessed with the Mixed Methods Appraisal Tool. RESULTS Twenty-one studies were identified that evaluated nine interventions delivered to justice-involved individuals with serious mental illness. All identified programs targeted criminogenic risk factors, were group based, and used cognitive-behavioral strategies. Study quality was moderate to high. Interventions were associated with improvements in recidivism, violence, and criminogenic risk factors. CONCLUSIONS This review is the first to evaluate interventions targeting criminogenic risks among justice-involved individuals with serious mental illness. Findings suggest that outcomes associated with these interventions are promising. Given the overrepresentation of persons with serious mental illness in the criminal justice system, these findings provide an important step toward identifying services that curb justice involvement in this population.
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Affiliation(s)
- Anna Parisi
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City (Parisi); School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill (Wilson, Villodas, Phillips, Dohler)
| | - Amy Blank Wilson
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City (Parisi); School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill (Wilson, Villodas, Phillips, Dohler)
| | - Melissa Villodas
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City (Parisi); School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill (Wilson, Villodas, Phillips, Dohler)
| | - Jon Phillips
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City (Parisi); School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill (Wilson, Villodas, Phillips, Dohler)
| | - Ehren Dohler
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City (Parisi); School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill (Wilson, Villodas, Phillips, Dohler)
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Chan ASW, Tang PMK, Yan E. Chemsex and its risk factors associated with human immunodeficiency virus among men who have sex with men in Hong Kong. World J Virol 2022; 11:208-211. [PMID: 36159612 PMCID: PMC9372789 DOI: 10.5501/wjv.v11.i4.208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 06/08/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
We were intrigued by Hanum et al, who published a study on the prevalence of human immunodeficiency virus (HIV) in homosexual, bisexual, and other men who have sex with men at sexual health clinics in England and the relationship between baseline variables and future HIV occurrence. Chemically-enhanced sexual experience (chemsex) is becoming a global phenomenon. There are increasing medical and academic concerns about chemsex, where substances are used to boost sexual satisfaction, which is prevalent in groups, especially among homosexuals. Lesbians, gays, bisexuals, transgenders, and queers have become increasingly visible, valued, and committed community. However, chemsex requires urgent attention.
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Affiliation(s)
- Alex Siu Wing Chan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Patrick Ming Kuen Tang
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Elsie Yan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China
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Bowen P, Zhang RP. Psychometric properties of the Drug Use Disorders Identification Test (DUDIT) and prevalence of drug use among SA site-based construction workers. PSYCHOL HEALTH MED 2022:1-12. [PMID: 35861743 DOI: 10.1080/13548506.2022.2103160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/11/2022] [Indexed: 10/17/2022]
Abstract
Construction workers in South Africa are an at-risk group for HIV/AIDS. Substance misuse, other than alcohol, is associated with poor decision-making, risky lifestyle behaviour, and non-use of condoms. Substance misuse is also associated with harmful and hazardous alcohol consumption and depression. The Drug Use Disorders Identification Test (DUDIT) is a widely used screening tool to detect drug abuse. The present study examines both the psychometric properties of the DUDIT and the prevalence of drug abuse among construction workers. A field study involving 496 male workers at 18 construction sites of seven construction companies in the Western Cape province of South Africa, was undertaken. Descriptive statistics, reliability, and exploratory and confirmatory factor analyses were used to determine the prevalence of substance use, and the dimensionality, reliability and construct validity of the DUDIT. Approximately 10% of participants reported some form of substance use. Four hundred and sixty-seven employees (94.2%) were determined not to have drug-related problems (DUDIT score < 6). Of the at-risk employees (score >5), 5.0% (n = 25) were classified as 'possibly having a drug-related problem' (score 6-24) and 0.8% (n = 4) as 'possibly highly dependent on drugs' (score 25 or more). Of the 47 employees who reported drug use, 29 (61.7%) were classified as having a medium to high risk in relation to drug use. The internal consistency of the DUDIT was very good. The DUDIT reported a one-factor factorial structure, and the model fit indices indicated good model fit to the data. All factor loadings were significant, but there was some evidence of collinearity. Concurrent validity was demonstrated. DUDIT items 1 and 10 require further investigation due to their poor performance compared to the other items. The contribution of these two items needs to be investigated using item response theory (IRT).
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Affiliation(s)
- Paul Bowen
- Department of Construction Economics and Management, University of Cape Town, Cape Town, South Africa
| | - Rita Peihua Zhang
- School of Property, Construction & Project Management, RMIT University, Melbourne, Australia
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Marcovitz DE, Pettapiece-Phillips M, Kast KA, White K, Himelhoch H, Audet C. Implementation of a Hub-and-Spoke Partnership for Opioid Use Disorder Treatment in a Medicaid Nonexpansion State. Psychiatr Serv 2022; 73:819-822. [PMID: 34875847 DOI: 10.1176/appi.ps.202100343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hub-and-spoke (H&S) partnerships for managing opioid use disorder vary by U.S. state. This column provides the first description of the development of an H&S partnership in Tennessee, a Medicaid nonexpansion state. Medicaid expansion allows states to fund evidence-based substance use disorder treatment and community-based psychosocial interventions. In an H&S model in a Medicaid nonexpansion context, federal grant support must fund not only treatment itself but also the creation and maintenance of parallel billing and documentation processes for various partners, reducing the funds available for patient care.
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Affiliation(s)
- David E Marcovitz
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee (Marcovitz, Pettapiece-Phillips, Kast, White, Audet); Department of Surgery and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Himelhoch). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Mariah Pettapiece-Phillips
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee (Marcovitz, Pettapiece-Phillips, Kast, White, Audet); Department of Surgery and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Himelhoch). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Kristopher A Kast
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee (Marcovitz, Pettapiece-Phillips, Kast, White, Audet); Department of Surgery and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Himelhoch). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Katie White
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee (Marcovitz, Pettapiece-Phillips, Kast, White, Audet); Department of Surgery and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Himelhoch). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Heather Himelhoch
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee (Marcovitz, Pettapiece-Phillips, Kast, White, Audet); Department of Surgery and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Himelhoch). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Carolyn Audet
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee (Marcovitz, Pettapiece-Phillips, Kast, White, Audet); Department of Surgery and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Himelhoch). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
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Scoppetta O, Avendaño Prieto BL, Cassiani Miranda C. Individual factors associated with the consumption of illicit substances: a review of reviews. Rev Colomb Psiquiatr (Engl Ed) 2022; 51:206-217. [PMID: 36085126 DOI: 10.1016/j.rcpeng.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/30/2020] [Indexed: 06/15/2023]
Abstract
INTRODUCTION According to national studies, the use of illicit drugs is growing in Colombia. With this, the prevalence of substance use disorders and the set of health effects related to this practice also increases. Knowledge of the factors associated with the use of illicit drugs is necessary to guide the comprehensive care of the phenomenon. METHODS This is a systematic review of reviews on factors associated with the consumption of illicit drugs with seven databases and evaluation of the quality of the manuscripts according to AMSTAR. RESULTS Information was extracted from 38 reviews on individual factors associated with the use of illicit drugs. Demographic factors are associated with consumption through other factors. There is evidence of the association between mental and behavioural disorders and personality disorders. CONCLUSIONS The likelihood of consumption of illicit substances and disorders due to their use is affected by a set of personal factors including sociodemographic characteristics, mental health conditions, sexual behaviour, legal drug use, age of onset and risk perception.
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Affiliation(s)
- Orlando Scoppetta
- Psicólogo, Magister en Estudios de Población, Universidad Católica de Colombia, Avenida Caracas No. 46-22, Bogotá, Colombia.
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Abstract
OBJECTIVE Pharmacotherapy for opioid use disorder is effective but underused from a clinical perspective, and average treatment duration is shorter than current recommendations. In this analysis, the authors examined factors associated with initiation of, engagement in, and duration of treatment among patients with opioid use disorder. METHODS Using the OptumLabs Data Warehouse (a large, national, deidentified database of commercial or Medicare Advantage plan enrollees), the authors identified a sample of 204,225 patients with opioid use disorder between July 1, 2010, and April 1, 2019. Factors associated with initial treatment type were identified with multinomial logistic regression. The odds of treatment engagement, defined as two claims for treatment and a treatment episode of ≥30 days, were estimated with logistic regression. The hazard ratios for treatment discontinuation were estimated with a Cox proportional hazards model. RESULTS Treatment initiation with pharmacotherapy (alone or in combination with psychosocial therapy) was associated with higher odds of treatment engagement and a lower hazard of treatment discontinuation. Patients with certain behavioral health conditions (e.g., anxiety or mood disorders) had higher odds of initiating treatment with pharmacotherapy and engaging in treatment and a lower hazard of discontinuing treatment. Patients with certain painful general health conditions (e.g., fibromyalgia or musculoskeletal disorders) had lower odds of initiating and engaging in treatment. CONCLUSIONS Treatment initiation with pharmacotherapy was associated with treatment engagement and duration. Previous contact with behavioral health treatment may support initiating, engaging in, and remaining in treatment. Patients with painful conditions may benefit from provider support in initiating treatment for opioid use disorder.
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Affiliation(s)
- Ryan Mutter
- Health Analysis Division, Congressional Budget Office, Washington, D.C. (Mutter); OptumLabs, Minnetonka, Minnesota (Spencer, McPheeters)
| | - Donna Spencer
- Health Analysis Division, Congressional Budget Office, Washington, D.C. (Mutter); OptumLabs, Minnetonka, Minnesota (Spencer, McPheeters)
| | - Jeffrey McPheeters
- Health Analysis Division, Congressional Budget Office, Washington, D.C. (Mutter); OptumLabs, Minnetonka, Minnesota (Spencer, McPheeters)
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Romanova OL, Chauhan M, Blagonravov ML, Kislov MA, Ershov AV, Krupin KN. Baclofen (fun drug) and ethanol combined poisoning in humans: A histopathology and morphometry model. J Forensic Leg Med 2022; 90:102373. [PMID: 35671675 DOI: 10.1016/j.jflm.2022.102373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/01/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND - This study intends to address the scarcity of data regarding the pathogenesis of Baclofen poisoning in humans, which has seen a recent increase, worldwide, especially amongst the young people. Another reason for the conduction of this study was lack of the substantial data about the histo-pathological findings of lungs, in synergistic toxicity of Baclofen with Ethanol, in-spite of it being very common in humans, and both being respiratory depressant with similar mechanism of action. PURPOSE - The authors aimed to understand the pathogenesis of fatal poisonings in humans due to Baclofen in combination with Ethanol via an animal research model. The enhancement of the overall scientific literature by extending research along the lines of the handful studies available in this regard was another adjunct goal of the study. MATERIAL AND METHODS Fifteen Wistar rats were divided into control and test group of five and ten subjects respectively. The test group was further divided into two sub-groups of five each, with Baclofen administered to one, and it in conjunction with Ethanol to the other, in lowest dosages adjusted for the humans. Rats in both the groups were euthanized by dislocation of the cervical vertebrae for the histopathology examination. RESULTS Capillary and venous plethora, hemorrhages in the inter-alveolar septi, hemorrhages into the alveoli and sludging was seen in the 1st sub-group. The plethora of venules, capillaries and arterioles, with sludging by the WBC (white blood corpuscle) infiltrates was seen in the 2nd sub-group. Desquamation of the ciliated epithelium and edematous thickening of the intra-alveolar septi, along with features suggestive of the peri-vascular edema was seen in the 2nd sub-group. The morphometric analysis of the micro vessels showed a significantly higher value of the arteriolar diameter in the 2nd sub-group, in comparison to 1st, but the venular diameter in the two sub-groups did not differ to any extent.
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Affiliation(s)
- O L Romanova
- Department of General Physiology, Medical Institute of Russian University of People Friendship, Research Institute of Human Morphology, Moscow, Russia.
| | - M Chauhan
- Department of Forensic Medicine and Toxicology, Government Medical College and Hospital, Chandigarh, 160030, India.
| | - M L Blagonravov
- Department of General Pathology and Pathological Physiology, Medical Institute of Russian University of People Friendship, Moscow, Russia.
| | - M A Kislov
- Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| | - A V Ershov
- Institute of General Resuscitation Named After V. A. Negovsky Federal State Budgetary Scientific Institution, Federal Scientific and Clinical Center of Reаnimatology and Rehabilitation, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| | - K N Krupin
- Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
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Maguire DR, Minervini V. Interactions between opioids and stimulants: Behavioral pharmacology of abuse-related effects. Adv Pharmacol 2022; 93:1-33. [PMID: 35341563 DOI: 10.1016/bs.apha.2021.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Opioid abuse continues to be a significant public health challenge, with rates of opioid-related overdose deaths increasing continuously over the last two decades. There also has been a sharp increase in overdose deaths involving stimulant drugs, primarily cocaine and methamphetamine. Recent estimates indicate a high prevalence of co-use of opioids and stimulants, which is a particularly complex problem. Behavioral pharmacology research over the last few decades has characterized interactions between opioids and stimulants as well as evaluated potential treatments. This chapter describes interactions between opioids and stimulants, with a focus on pre-clinical studies of abuse-related behavioral effects using self-administration, reinstatement, drug discrimination, place conditioning, and intracranial self-stimulation paradigms in laboratory animals. In general, the literature provides substantial evidence of mutual enhancement between opioids and stimulants for abuse-related effects, although such results are not ubiquitous. Enhanced abuse-related effects could manifest in many ways including engaging in drug seeking and taking behaviors with greater persistence, effort, and motivation and/or increased likelihood of relapse. Moreover, studies on opioid/stimulant combinations set the stage for evaluating potential treatments for polysubstance use. Behavioral pharmacology research has proven invaluable for elucidating these relationships using rigorous experimental designs and quantitative analyses of pharmacological and behavioral data.
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Abstract
OBJECTIVE The study examined temporal and geographic trends in telehealth availability at U.S. behavioral health treatment facilities and risk factors for not offering telehealth. METHODS Longitudinal data on 15,691 outpatient behavioral health treatment facilities were extracted daily from the Substance Abuse and Mental Health Services Administration's Behavioral Health Treatment Services Locator between January 20, 2020, and January 20, 2021. Facilities operated by the Department of Veterans Affairs were excluded. Bivariate analyses were used to assess trends in telehealth availability in 2020 and 2021. Multivariable regression analysis was used to examine facility- and county-level characteristics associated with telehealth availability in 2021. RESULTS Telehealth availability increased by 77% from 2020 to 2021 for mental health treatment facilities and by 143% for substance use disorder treatment facilities. By January 2021, 68% of outpatient mental health facilities and 57% of substance use disorder treatment facilities in the sample were offering telehealth. Mental health and substance use disorder treatment facilities that did not accept Medicaid as a form of payment were less likely to offer telehealth in 2021, compared with facilities that accepted Medicaid. Mental health and substance use disorder treatment facilities that accepted private insurance were more likely to offer telehealth in 2021, compared with facilities that did not accept private insurance. CONCLUSIONS Although 2020 saw a dramatic increase in telehealth availability at behavioral health treatment facilities, 32% of mental health treatment facilities and 43% of substance use disorder treatment facilities did not offer telehealth in January 2021, nearly 1 year into the pandemic.
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Affiliation(s)
- Jonathan Cantor
- RAND Corporation, Santa Monica, California (Cantor, Hanson), Boston (McBain), Arlington, Virginia (Kofner), and Pittsburgh (Stein); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Yu)
| | - Ryan K McBain
- RAND Corporation, Santa Monica, California (Cantor, Hanson), Boston (McBain), Arlington, Virginia (Kofner), and Pittsburgh (Stein); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Yu)
| | - Aaron Kofner
- RAND Corporation, Santa Monica, California (Cantor, Hanson), Boston (McBain), Arlington, Virginia (Kofner), and Pittsburgh (Stein); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Yu)
| | - Russell Hanson
- RAND Corporation, Santa Monica, California (Cantor, Hanson), Boston (McBain), Arlington, Virginia (Kofner), and Pittsburgh (Stein); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Yu)
| | - Bradley D Stein
- RAND Corporation, Santa Monica, California (Cantor, Hanson), Boston (McBain), Arlington, Virginia (Kofner), and Pittsburgh (Stein); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Yu)
| | - Hao Yu
- RAND Corporation, Santa Monica, California (Cantor, Hanson), Boston (McBain), Arlington, Virginia (Kofner), and Pittsburgh (Stein); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Yu)
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Xia W, Li HCW, Liang T, Luo Y, Ho LLK, Cheung AT, Song P. Structured online training for university students to deliver peer-led addiction counselling for young drug abusers in China: Effect on improving knowledge, attitude, confidence, and skills. Patient Educ Couns 2022; 105:1009-1017. [PMID: 34334262 DOI: 10.1016/j.pec.2021.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To measure the effect of a structured online training programme on improving the knowledge, attitude, confidence, and skills of university students to deliver peer-led addiction counselling to young drug abusers. METHODS A structured training programme was designed for university students with a background in health-related disciplines. Pre- and post-training evaluations were conducted for 245 university students with health-related backgrounds who completed the training programme. The participants' knowledge of and attitudes towards drug abuse and their confidence in delivering addiction counselling were evaluated and compared before and after the training. Counselling skills were assessed using a simulated standardised case. RESULTS A paired test indicated that after attending the training programme, the participants' knowledge of and attitudes towards drug abuse and their confidence in delivering addiction counselling were significantly improved. Most of the trained participants demonstrated satisfactory counselling skills. CONCLUSION Participation in a one-day structured addiction training programme significantly improved students' knowledge of and attitudes towards drug abuse and their confidence and skills to deliver addiction counselling. PRACTICE IMPLICATION Future research should elucidate the implementation of the counselling skills in terms of the counselling outcomes and successful referral. The clients' health outcomes should be assessed to reflect the peer counsellors' skills.
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Affiliation(s)
- Wei Xia
- School of Nursing, Sun Yat-Sen University, Guangzhou, China; School of Nursing, The University of Hong Kong, Hong Kong SAR.
| | | | - Tingna Liang
- School of Nursing, The University of Hong Kong, Hong Kong SAR.
| | - Yuanhui Luo
- School of Nursing, The University of Hong Kong, Hong Kong SAR.
| | | | | | - Peige Song
- Zhejiang University School of Medicine, Hangzhou, China; Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
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Ober AJ, Hunter SB, McCullough CM, Leamon I, McCreary M, Beas I, Montero A, Tarn DM, Bromley E, Hurley B, Sheehe J, Martinez J, Watkins KE. Opioid Use Disorder Among Clients of Community Mental Health Clinics: Prevalence, Characteristics, and Treatment Willingness. Psychiatr Serv 2022; 73:271-279. [PMID: 34281359 PMCID: PMC8770719 DOI: 10.1176/appi.ps.202000818] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the prevalence of co-occurring opioid use disorder and willingness to engage in treatment among clients of eight Los Angeles County Department of Mental Health outpatient clinics. METHODS Adults presenting for an appointment over a 2-week period were invited to complete a voluntary, anonymous health survey. Clients who indicated opioid use in the past year were offered a longer survey assessing probable opioid use disorder. Willingness to take medication and receive treatment also was assessed. RESULTS In total, 3,090 clients completed screening. Among these, 8% had a probable prescription (Rx) opioid use disorder and 2% a probable heroin use disorder. Of the clients with probable Rx opioid use or heroin use disorder, 49% and 25% were female, respectively. Among those with probable Rx opioid use disorder, 43% were Black, 33% were Hispanic, and 12% were White, and among those with probable heroin use disorder, 24% were Black, 22% were Hispanic, and 39% were White. Seventy-eight percent of those with Rx opioid use disorder had never received any treatment, and 82% had never taken a medication for this disorder; 39% of those with heroin use disorder had never received any treatment, and 39% had never received a medication. The strongest predictor of willingness to take a medication was believing that it would help stop opioid use (buprenorphine, β=13.54, p=0.003, and naltrexone long-acting injection, β=15.83, p<0.001). CONCLUSIONS These findings highlight the need to identify people with opioid use disorder and to educate clients in mental health settings about medications for these disorders.
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Affiliation(s)
| | | | | | - Isabel Leamon
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407
| | | | - Ivan Beas
- David Geffen School of Medicine at UCLA
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Abstract
Individually, the COVID-19 pandemic and opioid epidemic have each been responsible for hundreds of thousands of deaths. Systemic racism, including public perceptions about people who use opioids, inadequate substance abuse prevention and treatment efforts, heightened risks for COVID-19 exposure, and inadequate access to testing and health care, has contributed to the ongoing disparities underlying these health crises. Thus, the authors propose an integrative framework for conceptualizing the COVID-19, opioid use, and racism (COR) syndemic, with traumatic stress as a critical underpinning of this model. Action is needed to address trauma and the COR syndemic. Implications for research, practice, and policy are discussed.
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Affiliation(s)
- Denise Nguyen Hien
- Rutgers Center of Alcohol & Substance Use Studies (Hien, Bauer) and Graduate School of Applied and Professional Psychology (Hien, Franklin, Lalwani, Pean), Rutgers University, Piscataway, New Jersey. Ruth S. Shim, M.D., M.P.H., and Michael T. Compton, M.D., M.P.H., are editors of this column
| | - Alexandria G Bauer
- Rutgers Center of Alcohol & Substance Use Studies (Hien, Bauer) and Graduate School of Applied and Professional Psychology (Hien, Franklin, Lalwani, Pean), Rutgers University, Piscataway, New Jersey. Ruth S. Shim, M.D., M.P.H., and Michael T. Compton, M.D., M.P.H., are editors of this column
| | - Liza Franklin
- Rutgers Center of Alcohol & Substance Use Studies (Hien, Bauer) and Graduate School of Applied and Professional Psychology (Hien, Franklin, Lalwani, Pean), Rutgers University, Piscataway, New Jersey. Ruth S. Shim, M.D., M.P.H., and Michael T. Compton, M.D., M.P.H., are editors of this column
| | - Tanya Lalwani
- Rutgers Center of Alcohol & Substance Use Studies (Hien, Bauer) and Graduate School of Applied and Professional Psychology (Hien, Franklin, Lalwani, Pean), Rutgers University, Piscataway, New Jersey. Ruth S. Shim, M.D., M.P.H., and Michael T. Compton, M.D., M.P.H., are editors of this column
| | - Kierra Pean
- Rutgers Center of Alcohol & Substance Use Studies (Hien, Bauer) and Graduate School of Applied and Professional Psychology (Hien, Franklin, Lalwani, Pean), Rutgers University, Piscataway, New Jersey. Ruth S. Shim, M.D., M.P.H., and Michael T. Compton, M.D., M.P.H., are editors of this column
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Öztürk YE, Yeter O, Ateş I. Changes in the frequency and pattern of drugs detected among suspected drug users during the COVID-19 pandemic in Turkey. Int J Legal Med 2022; 136:1273-1279. [PMID: 35147732 PMCID: PMC8831157 DOI: 10.1007/s00414-022-02794-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
From March 13 until May 31, 2020, a complete lockdown in Turkey was planned and implemented by the government of Turkey. The vulnerable population with substance use disorders was affected more than others due to the social isolation measures meant to control the pandemic. This study presents detailed and broad data on drug abuse in suspected cases during the first wave of the COVID-19 pandemic in Turkey and compares the frequencies and patterns of drug abuse before and during the pandemic. The samples were screened by liquid chromatography-high resolution mass spectrometry and liquid chromatography-tandem mass spectrometry. Blood and urine samples of suspected users (n = 9669) were analyzed for drugs of abuse during the first wave of the COVID-19 pandemic and compared with their results (n = 8727) obtained just before the COVID-19 pandemic. The use of party drugs, such as MDMA and cocaine, and the classic illicit drug cannabis was significantly decreased and followed the same trend after complete lockdown was over. In contrast, methamphetamine use increased significantly during the lockdown period and continued after the lockdown. Interestingly, the number of tests that were positive for pregabalin as a misused licit drug increased, and this increase continued after the lockdown. The results showed a significant increase in drug abuse cases and changes in drug abuse trends, with an alteration toward more easily obtainable and lower-priced drugs. Using more dangerous and easily available licit and illicit drugs may cause serious health problems.
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Affiliation(s)
- Yeter Erol Öztürk
- Council of Forensic Medicine, Chemistry Department, 34196, Bahcelievler, Istanbul, Turkey.
| | - Oya Yeter
- Council of Forensic Medicine, Chemistry Department, 34196, Bahcelievler, Istanbul, Turkey
| | - Ismail Ateş
- Council of Forensic Medicine, Chemistry Department, 34196, Bahcelievler, Istanbul, Turkey
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Essink S, Nugteren-van Lonkhuyzen JJ, van Riel AJHP, Dekker D, Hondebrink L. Significant toxicity following an increase in poisonings with designer benzodiazepines in the Netherlands between 2010 and 2020. Drug Alcohol Depend 2022; 231:109244. [PMID: 34998250 DOI: 10.1016/j.drugalcdep.2021.109244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/05/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Designer benzodiazepines (DBs) are an emerging class of new psychoactive substances. While structurally derived from pharmaceutical benzodiazepines, their toxicological profile is less clear. We investigated time trends in the rate of DB poisonings and their clinical toxicity. METHODS A retrospective observational study was performed on the incidence rate of DB poisonings, relative to all recreational drug poisonings reported to the Dutch Poisons Information Center (DPIC) from 2010 to 2020. Time-trend analysis was performed using Poisson regression. A prospective cohort study was performed on toxicity of DBs, including the Poisoning Severity Score, from January 2016-June 2019. Data was collected through telephone interviews. RESULTS Between 2010 and 2020, the DPIC was consulted on 142 DB exposures. The incidence rate of DB exposures increased from 0.1% to 4.3%, with a year effect estimate of 1.35 (95% CI [1.14;1.54]). Twenty different DBs were reported, mostly etizolam (33%), clonazolam (17%), and flunitrazolam (8%). During consultation (often shortly after exposure), poisoning was graded moderate-severe in 29% of cases (n = 146). In the prospective cohort sample with follow-up (n = 22), 86% of cases (n = 19) showed a moderate-severe poisoning. The severity of poisoning did not differ between mono- and mixed intoxications. Frequently reported symptoms in the prospective cohort sample included drowsiness (86%), confusion (59%), and agitation (55%). Coma was observed in seven cases (32%) and respiratory depression requiring mechanical ventilation in five cases (23%). CONCLUSION The rate of DB poisonings reported to the DPIC strongly increased from 2010 to 2020, indicating increased (ab)use of DBs. Most DB exposures resulted in moderate-severe toxicity with neurological effects.
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Affiliation(s)
- Sharon Essink
- Dutch Poisons Information Center (DPIC), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Johanna J Nugteren-van Lonkhuyzen
- Dutch Poisons Information Center (DPIC), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Antoinette J H P van Riel
- Dutch Poisons Information Center (DPIC), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Douwe Dekker
- Dutch Poisons Information Center (DPIC), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Department of Internal Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Laura Hondebrink
- Dutch Poisons Information Center (DPIC), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Fawale MB, Adebowale AA, Idowu AO, Balogun SA, Sanusi AA, Komolafe MA. Tramadol-Induced Acute Seizures: A Report of Three Cases. West Afr J Med 2022; 39:90-94. [PMID: 35167199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
There is a rise in substance abuse in Nigeria and prescription drugs, particularly opioid analgesics, which are increasingly becoming a target of abuse. Abuse of the opiod tramadol has the potential to precipitate seizures. We present 3 cases of tramadol-induced seizures presenting at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. The three patients were men, aged 22-40 years and abused other drugs including alcohol, cannabis and Rohypnol. This report illustrates the fact that tramadol abuse may be associated with acute seizures and it is reasonable to consider drug/opiod-induced seizure in every case of unexplained first episode of seizure in a young adult.
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Affiliation(s)
- M B Fawale
- Department of Internal Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - A A Adebowale
- Department of Internal Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - A O Idowu
- Department of Internal Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - S A Balogun
- Neurosurgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - A A Sanusi
- Department of Internal Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - M A Komolafe
- Department of Internal Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
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83
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Abstract
Trace amine-associated receptor 1 (TAAR1) is the best characterized receptor selectively activated by trace amines. It is broadly expressed in the monoaminergic system in the brain including ventral tegmental area (VTA), nucleus accumbens (NAc), dorsal raphe (DR) and substantial nigra (SN). Extensive studies have suggested that TAAR1 plays an important role in the modulation of monoaminergic system, especially dopamine (DA) transmission which may underlie the mechanisms by which TAAR1 interventions affect drug abuse-like behaviors. TAAR1 activation inhibits the rewarding and reinforcing effects of drugs from different classes including psychostimulants, opioid and alcohol as well as drug-induced increase in DA accumulation. The mechanisms of TAAR1's function in mediating drug abuse-like behaviors are not clear. However, it is hypothesized that TAAR1 interaction with DA transporter (DAT) and dopamine D2 receptor (D2) and the subsequent modulation of cellular cascades may contribute to the effects of TAAR1 in regulating drug abuse. Further studies are needed to investigate the role of TAAR1 in other drugs of abuse-related behaviors and its safety and efficacy for prolonged medications. Together, TAAR1 inhibits drug-induced DA transmission and drug abuse-related behaviors. Therefore, TAAR1 may be a promising therapeutic target for the treatment of drug addiction.
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Affiliation(s)
- Ruyan Wu
- Medical College of Yangzhou University, Yangzhou, China,Department of Pharmacology and Toxicology, University at Buffalo, Buffalo, NY, USA
| | - Jianfeng Liu
- Department of Psychological and Brain Sciences, College of Liberal Arts, Texas A&M University, College Station, TX, USA
| | - Jun-Xu Li
- Department of Pharmacology and Toxicology, University at Buffalo, Buffalo, NY, USA,Corresponding authors: Dr. Jun-Xu Li, , Department of Pharmacology and Toxicology, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14214. Tel: +1 716 829 2482; Fax: +1 716 829 2801
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Abstract
The kappa opioid receptor (KOR)-related ligands have been demonstrated in preclinical studies for several therapeutic potentials. This chapter highlights (1) how non-human primates (NHP) studies facilitate the research and development of ligands targeting the KOR, (2) effects of the endogenous opioid peptide, dynorphin A-(1-17), and its analogs in NHP, and (3) pleiotropic effects and therapeutic applications of KOR-related ligands. In particular, synthetic ligands targeting the KOR have been extensively studied in NHP in three therapeutic areas, i.e., the treatment for itch, pain, and substance use disorders. As the KORs are widely expressed in the peripheral and central nervous systems, pleiotropic effects of KOR-related ligands, such as discriminative stimulus effects, neuroendocrine effects (e.g., prolactin release and stimulation of hypothalamic-pituitary-adrenal axis), and diuresis, in NHP are discussed. Centrally acting KOR agonists are known to produce adverse effects including dysphoria, hallucination, and sedation. Nonetheless, with strategic advances in medicinal chemistry, three classes of KOR-related agonists, i.e., peripherally restricted KOR agonists, mixed KOR/mu opioid receptor partial agonists, and G protein-biased KOR agonists, warrant additional NHP studies to improve our understanding of their functional efficacy, selectivity, and tolerability. Pharmacological studies in NHP which carry high translational significance will facilitate future development of KOR-based medications.
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Affiliation(s)
- Mei-Chuan Ko
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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85
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Layman HM, Thorisdottir IE, Halldorsdottir T, Sigfusdottir ID, Allegrante JP, Kristjansson AL. Substance Use Among Youth During the COVID-19 Pandemic: a Systematic Review. Curr Psychiatry Rep 2022; 24:307-24. [PMID: 35476186 DOI: 10.1007/s11920-022-01338-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW To review the literature on the trends in substance use among youth during the coronavirus SARS-CoV-2 (COVID-19) pandemic. RECENT FINDINGS The pandemic has given rise to concerns about the mental health and social well-being of youth, including its potential to increase or exacerbate substance use behaviors. This systematic review identified and included 49 studies of use across alcohol, cannabis, tobacco, e-cigarettes/vaping, and other drugs, and unspecified substances. The majority of studies across all categories of youth substance use reported reductions in prevalence, except in the case of other drugs and unspecified drug and substance use, which included three studies that reported an increase in use and three studies that reported decrease in use. Overall, the results of this review suggest that the prevalence of youth substance use has largely declined during the pandemic. Youth substance use in the post-pandemic years will require monitoring and continued surveillance.
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86
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Magyar CTJ, Prevost GA, Nett PC. Vasoconstrictor nasal spray causing life-threatening complications after bariatric surgery: A case report. Int J Surg Case Rep 2021; 89:106574. [PMID: 34864257 PMCID: PMC8645905 DOI: 10.1016/j.ijscr.2021.106574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/31/2021] [Accepted: 10/31/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction and importance Bariatric surgery is an evolving surgical field with increasing cases per year, as obesity is prevalent, especially in developed countries. Complication diagnosis and management can be challenging. Marginal ulcers and anastomosis perforation are rare, but their incidence is likely underestimated. Case presentation To the best of our knowledge, we present the first case with a two and a half years history of recurrent ischemia, marginal ulcers, and recurrent perforation after laparoscopic omega loop gastric bypass, most likely due to an abuse of an over-the-counter (OTC) sympathomimetic nasal spray. The complications (Clavien-Dindo classification IIIb) caused the necessity of recurrent hospitalizations and diagnostic interventions and an open conversion into Roux-Y gastric bypass in a damage control manner. Clinical discussion and conclusion Conclusively, we advocate evaluating drug abuse, including OTC medications that patients might not report on a daily-based medical history, as an etiology for marginal ulcers and anastomosis perforation, especially in late and recurrent cases. Abuse of OTC sympathomimetic nasal spray can cause recurrent gastrojejunal anastomosis ischemia. Re-Do surgery cannot prevent recurrence of ischemia in these cases. In recurrence of ischemia, detailed medical history, including OTC drugs, is crucial.
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Affiliation(s)
- Christian T J Magyar
- Department for Visceral Surgery and Medicine, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Gian A Prevost
- Department for Visceral Surgery and Medicine, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Philipp C Nett
- Department for Visceral Surgery and Medicine, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland.
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87
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Dasgupta N, Brown JR, Nocera M, Lazard A, Slavova S, Freeman PR. Abuse-Deterrent Opioids: A Survey of Physician Beliefs, Behaviors, and Psychology. Pain Ther 2021; 11:133-151. [PMID: 34870790 PMCID: PMC8861217 DOI: 10.1007/s40122-021-00343-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Evaluate beliefs and behaviors pertaining to abuse-deterrent opioids (ADFs). Design Survey in 2019 by invitation to all licensed physicians. Setting Commonwealth of Kentucky. Participants 374 physicians. Methods Descriptive statistics, and hypothesis test that early adopter prescribers would have greater endorsement of opioid risk management. Results Of all prescribers, 55% believed all opioid analgesics should have ADF requirements (15% were unsure); 74% supported mandating insurance coverage. Only one-third considered whether an opioid was ADF when prescribing, motivated by patient family diversion (94%) and societal supply reduction (88%). About half believed ADFs were equally effective in preventing abuse by intact swallowing, injection, chewing, snorting, smoking routes. Only 4% of OxyContin prescribers chose it primarily because of ADF properties. Instead, the most common reason (33%) was being started by another prescriber. A quarter of physicians chose not to prescribe ADFs because of heroin switching potential. Early adopters strongly believed ADFs were effective in reducing abuse (PR 3.2; 95% CI 1.5, 6.6) compared to mainstream physicians. Early-adopter risk-management practices more often included tools increasing agency and measurement: urine drug screens (PR 2.0; 1.3, 3.1), risk screening (PR 1.3; 0.94, 1.9). While nearly all respondents (96%) felt that opioid abuse was a problem in the community, only 57% believed it was a problem among patients in their practice. Attribution theory revealed an externalization of opioid abuse problems that deflected blame from patients on to family members. Conclusions The primary motivator for prescribing ADFs was preventing diversion by family members, not patient-level abuse concerns. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-021-00343-z.
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Affiliation(s)
- Nabarun Dasgupta
- UNC CB 7505, 725 Martin Luther King Jr. Blvd., Chapel Hill, NC, 27599, USA.
| | - John R Brown
- UNC CB 7505, 725 Martin Luther King Jr. Blvd., Chapel Hill, NC, 27599, USA
| | - Maryalice Nocera
- UNC CB 7505, 725 Martin Luther King Jr. Blvd., Chapel Hill, NC, 27599, USA
| | - Allison Lazard
- UNC CB 7505, 725 Martin Luther King Jr. Blvd., Chapel Hill, NC, 27599, USA
| | - Svetla Slavova
- UNC CB 7505, 725 Martin Luther King Jr. Blvd., Chapel Hill, NC, 27599, USA
| | - Patricia R Freeman
- UNC CB 7505, 725 Martin Luther King Jr. Blvd., Chapel Hill, NC, 27599, USA
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88
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Glac W, Dunacka J, Grembecka B, Świątek G, Majkutewicz I, Wrona D. Prolonged Peripheral Immunosuppressive Responses as Consequences of Random Amphetamine Treatment, Amphetamine Withdrawal and Subsequent Amphetamine Challenges in Rats. J Neuroimmune Pharmacol 2021; 16:870-887. [PMID: 33586062 PMCID: PMC8714631 DOI: 10.1007/s11481-021-09988-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/03/2021] [Indexed: 01/02/2023]
Abstract
Drug-induced immunosuppression may underline increased hypothalamic-pituitary-adrenal axis response to stress observed following chronic psychostimulant treatment. However, the consequences of random amphetamine (AMPH) treatment, withdrawal and AMPH challenge after withdrawal on the peripheral immunity and systemic corticosterone response are unknown. In this study, the total blood and spleen leukocyte, lymphocyte, T, B, NK, TCD4+/TCD8+ cell numbers and ratio, pro-inflammatory interferon gamma (IFN-γ), and anti-inflammatory interleukin-4 (IL-4) production, and plasma corticosterone concentration in Wistar rats were investigated after: chronic, random AMPH/SAL treatment alone (20 injections in 60 days, 1 mg/kg b.w., i.p.), AMPH/SAL withdrawal (for 20 consecutive days after random AMPH/SAL exposure) or AMPH/SAL challenge after withdrawal (single injection after the AMPH/SAL withdrawal phase). The results showed blood and spleen leukopenia, lymphopenia, lower blood production of IFN-ɤ, and increased plasma corticosterone concentration after the AMPH treatment, which were more pronounced in the AMPH after withdrawal group. In contrast, an increased number of blood NK cells and production of IL-4 after chronic, random AMPH treatment alone, were found. Blood AMPH-induced leukopenia and lymphopenia were due to decreased total number of T, B lymphocytes and, at least in part, of granulocytes and monocytes. Moreover, decreases in the number of blood TCD4+ and TCD8+ lymphocytes both in the AMPH chronic alone and withdrawal phases, were found.The major findings of this study are that AMPH treatment after the long-term withdrawal from previous random AMPH exposure, accelerates the drug-induced immunosuppressive and systemic corticosterone responses, suggesting prolonged immunosuppressive effects and an increase in incidence of infectious diseases. Prolonged peripheral immunosuppressive responses as consequences of random amphetamine…The results indicate that the chronic and random AMPH exposure alone and the acute (single injection) challenge of the drug after the withdrawal phase induced long-term immunosuppressive effects, which were similar to those occurring during the stress response, and sensitized the peripheral immunosuppressive and corticosterone responses of the rat to the disinhibitory effects of this stressor.
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Affiliation(s)
- Wojciech Glac
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdansk, 59 Wita Stwosza Str, 80-308, Gdansk, Poland.
| | - Joanna Dunacka
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdansk, 59 Wita Stwosza Str, 80-308, Gdansk, Poland
| | - Beata Grembecka
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdansk, 59 Wita Stwosza Str, 80-308, Gdansk, Poland
| | - Grzegorz Świątek
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdansk, 59 Wita Stwosza Str, 80-308, Gdansk, Poland
| | - Irena Majkutewicz
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdansk, 59 Wita Stwosza Str, 80-308, Gdansk, Poland
| | - Danuta Wrona
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdansk, 59 Wita Stwosza Str, 80-308, Gdansk, Poland.
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89
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Bodík M, Mackuľak T, Feher M, Staňová AV, Grabicová K, Varjúová D, Bodík I. Searching for the correlations between the use of different groups of pharmaceuticals from wastewaters. Ecotoxicol Environ Saf 2021; 228:112973. [PMID: 34794023 DOI: 10.1016/j.ecoenv.2021.112973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/12/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
Wastewater contains a wealth of information about the inhabitants of cities. Wastewater-based epidemiology (WBE) has become an effective tool for monitoring public health by analyzing various biomarkers (e.g., chemicals and microorganisms) in wastewater. This way, the estimation of pharmaceuticals' consumption behavior and/or illicit drugs can be calculated. However, monitoring consumption alone is not the only option. If we consider wastewater as a statistical representation of the population's health, medical information can be derived. In this work, we used data from 15 different wastewater treatment plants in Slovak Republic to explore correlations between the use of typical pharmaceuticals and illicit drugs. The analysis was based on the wastewater monitoring data from four years (2016-2019), and 68 different compounds were taken into account. One of the strongest correlations found was between Antihyperlipidemics and Antihypertensives, with Pearson's correlation coefficient of 0.82. This type of analysis within the WBE represents a new potential as an additional source of information for the pharmaceutical, medical and government sectors in assessing health risk factors in the population. Such an evaluation method has even a great potential for artificial intelligence and machine learning for calculating health risk factors together with other sources of data.
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Affiliation(s)
- Michal Bodík
- Nanotechnology group, ETH Zürich, Säumerstrasse 4, CH-8803 Rüschlikon, Switzerland.
| | - Tomáš Mackuľak
- Department of Environmental Engineering, Faculty of Chemistry and Food Technology, Slovak University of Technology in Bratislava, Radlinského 9, 812 37 Bratislava, Slovak Republic
| | - Miroslav Feher
- Department of Environmental Engineering, Faculty of Chemistry and Food Technology, Slovak University of Technology in Bratislava, Radlinského 9, 812 37 Bratislava, Slovak Republic
| | - Andrea Vojs Staňová
- Faculty of Fisheries and Protection of Waters, South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, University of South Bohemia in České Budějovice, Zátiší 728/II, 389 25 Vodňany, Czech Republic; Department of Analytical Chemistry, Faculty of Natural Sciences, Comenius University, Ilkovičova 6, 842 15 Bratislava, Slovak Republic
| | - Kateřina Grabicová
- Faculty of Fisheries and Protection of Waters, South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, University of South Bohemia in České Budějovice, Zátiší 728/II, 389 25 Vodňany, Czech Republic
| | - Dóra Varjúová
- Department of Environmental Engineering, Faculty of Chemistry and Food Technology, Slovak University of Technology in Bratislava, Radlinského 9, 812 37 Bratislava, Slovak Republic
| | - Igor Bodík
- Department of Environmental Engineering, Faculty of Chemistry and Food Technology, Slovak University of Technology in Bratislava, Radlinského 9, 812 37 Bratislava, Slovak Republic
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90
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Dahlman D, Li X, Crump C, Sundquist J, Sundquist K. Drug use disorder and risk of incident and fatal prostate cancer among Swedish men: a nationwide epidemiological study. Cancer Causes Control 2021. [PMID: 34743253 DOI: 10.1007/s10552-021-01513-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022]
Abstract
Purpose Prostate cancer is the second most common cancer in men and a leading cause of cancer mortality worldwide. Men with drug use disorders (DUD) may potentially be at high risk for prostate cancer mortality because of delayed diagnosis and/or undertreatment. In this study, we aimed to investigate prostate cancer incidence, mortality, and stage at time of diagnosis among men with DUD compared to the general male population in Sweden. Methods We performed a follow-up study based on Swedish national register data for the period January 1997–December 2016. The study was based on 1,361,532 men aged 50–75 years at inclusion, of whom 9,259 were registered with DUD. Cox regression analysis was used to compute adjusted hazard ratios (HRs) for incident and fatal prostate cancer, and cancer stage at time of diagnosis, associated with DUD. Results DUD was associated with a slightly increased risk of incident prostate cancer (HR: 1.07, 95% confidence interval [CI] 1.00–1.14, p = 0.048) and substantially higher risk of fatal prostate cancer (HR: 1.59, 95% CI 1.40–1.82, p < 0.001), adjusted for age, socioeconomic factors, and comorbidities related to tobacco smoking and alcohol use disorder. No association was found between DUD and prostate cancer stage at diagnosis. Conclusions Men with DUD have an increased risk of fatal prostate cancer, possibly related to undertreatment in this patient population. Our findings should raise attention among medical staff and decision-makers towards a disadvantaged group of men in need of easily accessible prostate cancer evaluation and treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s10552-021-01513-2.
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91
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Grammatikopoulou MG, Gkiouras K, Pepa A, Persynaki A, Taousani E, Milapidou M, Smyrnakis E, Goulis DG. Health status of women affected by homelessness: A cluster of in concreto human rights violations and a time for action. Maturitas 2021; 154:31-45. [PMID: 34736578 DOI: 10.1016/j.maturitas.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
Health problems of women experiencing homelessness are driven either from the usual background characteristics of this population, or from the homeless lifestyle. Apart from poverty and unemployment, transition to homelessness is often associated with substance abuse, history of victimization, stress, poor mental health and human immunodeficiency virus (HIV). Water insecurity can undermine bodily hygiene and dental health, posing a greater risk of dehydration and opportunistic infections. Exposure to extreme environmental conditions like heat waves and natural disasters increases morbidity, accelerates aging, and reduces life expectancy. Nutrition-wise, a high prevalence of food insecurity, obesity, and micronutrient deficiencies are apparent due to low diet quality and food waste. Poor hygiene, violence, and overcrowding increase the susceptibility of these women to communicable diseases, including sexually transmitted ones and COVID-19. Furthermore, established cardiovascular disease and diabetes mellitus are often either undertreated or neglected, and their complications are more widespread than in the general population. In addition, lack of medical screening and contraception non-use induce a variety of reproductive health issues. All these health conditions are tightly related to violations of human rights in this population, including the rights to housing, water, food, reproduction, health, work, and no discrimination. Thus, the care provided to women experiencing homelessness should be optimized at a multidimensional level, spanning beyond the provision of a warm bed, to include access to clean water and sanitation, psychological support and stress-coping strategies, disease management and acute health care, food of adequate quality, opportunities for employment and support for any minor dependants.
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Affiliation(s)
- Maria G Grammatikopoulou
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aleks Pepa
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Greece
| | | | - Eleftheria Taousani
- Department of Midwifery, Faculty of Health Sciences, International Hellenic University, Alexander Campus, Thessaloniki, Greece
| | - Maria Milapidou
- Dr. Juris, Post Doc Researcher, Faculty of Law, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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92
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Veerappa A, Pendyala G, Guda C. A systems omics-based approach to decode substance use disorders and neuroadaptations. Neurosci Biobehav Rev 2021; 130:61-80. [PMID: 34411560 PMCID: PMC8511293 DOI: 10.1016/j.neubiorev.2021.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/23/2021] [Accepted: 08/14/2021] [Indexed: 11/15/2022]
Abstract
Substance use disorders (SUDs) are a group of neuropsychiatric conditions manifesting due to excessive dependence on potential drugs of abuse such as psychostimulants, opioids including prescription opioids, alcohol, inhalants, etc. Experimental studies have generated enormous data in the area of SUDs, but outcomes from such data have remained largely fragmented. In this review, we attempt to coalesce these data points providing an important first step towards our understanding of the etiology of SUDs. We propose and describe a 'core addictome' pathway that behaves central to all SUDs. Besides, we also have made some notable observations paving way for several hypotheses; MECP2 behaves as a master switch during substance use; five distinct gene clusters were identified based on respective substance addiction; a central cluster of genes serves as a hub of the addiction pathway connecting all other substance addiction clusters. In addition to describing these findings, we have emphasized the importance of some candidate genes that are of substantial interest for further investigation and serve as high-value targets for translational efforts.
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Affiliation(s)
- Avinash Veerappa
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Gurudutt Pendyala
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE, 68198, USA; Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, 68198, USA; Child Health Research Institute, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Chittibabu Guda
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE, 68198, USA; Center for Biomedical Informatics Research and Innovation, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
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93
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Estévez-Danta A, Montes R, Bijlsma L, Cela R, Celma A, González-Mariño I, Miró M, Gutmann V, de San Román-Landa UP, Prieto A, Ventura M, Rodil R, Quintana JB. Source identification of amphetamine-like stimulants in Spanish wastewater through enantiomeric profiling. Water Res 2021; 206:117719. [PMID: 34624656 DOI: 10.1016/j.watres.2021.117719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 05/25/2023]
Abstract
Amphetamine (AMP), methamphetamine (MAMP) and 3,4-methylenedioxymethamphetamine (MDMA) occur in wastewater not only as a result of illicit consumption, but also, in some cases, from prescription drug use or by direct drug disposal into the sewage system. Enantiomeric profiling of these chiral drugs could give more insight into the origin of their occurrence. In this manuscript, a new analytical methodology for the enantiomeric analysis of amphetamine-like substances in wastewater has been developed. The method consists of a solid-phase extraction (SPE) followed by liquid chromatography-triple quadrupole-tandem mass spectrometry (LC-MS/MS), which showed low quantification limits in the 2.4-5.5 ng L-1 range. The LC-MS/MS method was first applied to characterize a total of 38 solid street drug samples anonymously provided by consumers. The results of these analysis showed that AMP and MDMA trafficked into Spain are synthesized as racemate, while MAMP is exclusively produced as the S(+)-enantiomer. Then, the analytical method was employed to analyse urban wastewater samples collected from the wastewater treatment plants (WWTPs) of five different cities in 2018 and 2019. Consumption estimated through normalized population loads in wastewater showed an increased pattern of AMP use in the Basque Country. Furthermore, the enantiomeric profiling of wastewater samples was contrasted to lisdexamfetamine (LIS) and selegiline (SEL) prescription figures, two pharmaceuticals which metabolize to S(+)-AMP, and to R(-)-AMP and R(-)-MAMP, respectively. From this analysis, and considering uncertainties derived from metabolism and adherence to treatment, it was concluded that LIS is a relevant source of AMP in those cases with low wastewater loads, i.e. up to a maximum of 60% of AMP detected in wastewater in some samples could originate from LIS prescription, while SEL does not represent a significant source of AMP nor MAMP. Finally, removal efficiencies could be evaluated for the WWTP (serving ca. 860,000 inhabitants) with higher AMP influent concentrations. The removal of AMP was satisfactory with rates higher than 99%, whereas MDMA showed an average removal of approximately 60%, accompanied by an enrichment of R(-)-MDMA.
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Affiliation(s)
- Andrea Estévez-Danta
- Department of Analytical Chemistry, Nutrition and Food Sciences, Institute of Research on Chemical and Biological Analysis (IAQBUS), Universidade de Santiago de Compostela, Constantino Candeira S/N, Santiago de Compostela 15782, Spain
| | - Rosa Montes
- Department of Analytical Chemistry, Nutrition and Food Sciences, Institute of Research on Chemical and Biological Analysis (IAQBUS), Universidade de Santiago de Compostela, Constantino Candeira S/N, Santiago de Compostela 15782, Spain.
| | - Lubertus Bijlsma
- Environmental and Public Health Analytical Chemistry, Research Institute for Pesticides and Water, University Jaume I, Castellón, Spain
| | - Rafael Cela
- Department of Analytical Chemistry, Nutrition and Food Sciences, Institute of Research on Chemical and Biological Analysis (IAQBUS), Universidade de Santiago de Compostela, Constantino Candeira S/N, Santiago de Compostela 15782, Spain
| | - Alberto Celma
- Environmental and Public Health Analytical Chemistry, Research Institute for Pesticides and Water, University Jaume I, Castellón, Spain
| | - Iria González-Mariño
- Department of Analytical Chemistry, Nutrition and Food Sciences, Institute of Research on Chemical and Biological Analysis (IAQBUS), Universidade de Santiago de Compostela, Constantino Candeira S/N, Santiago de Compostela 15782, Spain; Department of Analytical Chemistry, Nutrition and Bromatology, Faculty of Chemical Sciences, University of Salamanca, Salamanca, Spain
| | - Manuel Miró
- FI-TRACE group, Department of Chemistry, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Vanessa Gutmann
- Department of Analytical Chemistry, Nutrition and Food Sciences, Institute of Research on Chemical and Biological Analysis (IAQBUS), Universidade de Santiago de Compostela, Constantino Candeira S/N, Santiago de Compostela 15782, Spain
| | | | - Ailette Prieto
- Department of Analytical Chemistry, Faculty of Science and Technology, University of the Basque Country, Bilbao, Spain; Research Centre for Experimental Marine Biology and Biotechnology, University of the Basque Country (PiE-UPV/EHU), Plentzia, Basque Country 48620, Spain
| | - Mireia Ventura
- Energy Control, Asociación Bienestar y Desarrollo, Barcelona, Spain
| | - Rosario Rodil
- Department of Analytical Chemistry, Nutrition and Food Sciences, Institute of Research on Chemical and Biological Analysis (IAQBUS), Universidade de Santiago de Compostela, Constantino Candeira S/N, Santiago de Compostela 15782, Spain
| | - José Benito Quintana
- Department of Analytical Chemistry, Nutrition and Food Sciences, Institute of Research on Chemical and Biological Analysis (IAQBUS), Universidade de Santiago de Compostela, Constantino Candeira S/N, Santiago de Compostela 15782, Spain.
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Fama R, Le Berre AP, Sassoon SA, Zahr NM, Pohl KM, Pfefferbaum A, Sullivan EV. Memory impairment in alcohol use disorder is associated with regional frontal brain volumes. Drug Alcohol Depend 2021; 228:109058. [PMID: 34610518 PMCID: PMC8595873 DOI: 10.1016/j.drugalcdep.2021.109058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/03/2021] [Accepted: 09/13/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Episodic memory deficits occur in alcohol use disorder (AUD), but their anatomical substrates remain in question. Although persistent memory impairment is classically associated with limbic circuitry disruption, learning and retrieval of new information also relies on frontal systems. Despite AUD vulnerability of frontal lobe integrity, relations between frontal regions and memory processes have been under-appreciated. METHODS Participants included 91 AUD (49 with a drug diagnosis history) and 36 controls. Verbal and visual episodic memory scores were age- and education-corrected. Structural magnetic resonance imaging (MRI) data yielded regional frontal lobe (precentral, superior, orbital, middle, inferior, supplemental motor, and medial) and total hippocampal volumes. RESULTS AUD were impaired on all memory scores and had smaller precentral frontal and hippocampal volumes than controls. Orbital, superior, and inferior frontal volumes and lifetime alcohol consumption were independent predictors of episodic memory in AUD. Selectivity was established with a double dissociation, where orbital frontal volume predicted verbal but not visual memory, whereas inferior frontal volumes predicted visual but not verbal memory. Further, superior frontal volumes predicted verbal memory in AUD alone, whereas orbital frontal volumes predicted verbal memory in AUD+drug abuse history. CONCLUSIONS Selective relations among frontal subregions and episodic memory processes highlight the relevance of extra-limbic regions in mnemonic processes in AUD. Memory deficits resulting from frontal dysfunction, unlike the episodic memory impairment associated with limbic dysfunction, may be more amenable to recovery with cessation or reduction of alcohol misuse and may partially explain the heterogeneity in episodic memory abilities in AUD.
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Affiliation(s)
- Rosemary Fama
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA 94305, USA; Center for Health Sciences, Bioscience Division, SRI International, 333 Ravenswood Ave, Menlo Park, CA 94025, USA.
| | - Anne-Pascale Le Berre
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA 94305, USA
| | - Stephanie A Sassoon
- Center for Health Sciences, Bioscience Division, SRI International, 333 Ravenswood Ave, Menlo Park, CA 94025, USA
| | - Natalie M Zahr
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA 94305, USA; Center for Health Sciences, Bioscience Division, SRI International, 333 Ravenswood Ave, Menlo Park, CA 94025, USA
| | - Kilian M Pohl
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA 94305, USA; Center for Health Sciences, Bioscience Division, SRI International, 333 Ravenswood Ave, Menlo Park, CA 94025, USA
| | - Adolf Pfefferbaum
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA 94305, USA; Center for Health Sciences, Bioscience Division, SRI International, 333 Ravenswood Ave, Menlo Park, CA 94025, USA
| | - Edith V Sullivan
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA 94305, USA
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95
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Bohnert S, Georgiades K, Monoranu CM, Bohnert M, Büttner A, Ondruschka B. Quantitative evidence of suppressed TMEM119 microglial immunohistochemistry in fatal morphine intoxications. Int J Legal Med 2021; 135:2315-2322. [PMID: 34553260 PMCID: PMC8523458 DOI: 10.1007/s00414-021-02699-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022]
Abstract
The aim of this pilot study was to investigate the diagnostic potential of TMEM119 as a useful microglia-specific marker in combination with immunostainings for phagocytic function and infiltrating capacity of monocytes in cases of lethal monosubstance intoxications by morphine (MOR), methamphetamine (METH), and of ethanol-associated death (ETH) respectively. Human brain tissue samples were obtained from forensic autopsies of cases with single substance abuse (MOR, n = 8; ETH, n = 10; METH, n = 9) and then compared to a cohort of cardiovascular fatalities as controls (n = 9). Brain tissue samples of cortex, white matter, and hippocampus were collected and stained immunohistochemically with antibodies against TMEM119, CD68KiM1P, and CCR2. We could document the lowest density of TMEM119-positive cells in MOR deaths with highly significant differences to the control densities in all three regions investigated. In ETH and METH deaths, the expression of TMEM119 was comparable to cell densities in controls. The results indicate that the immunoreaction in brain tissue is different in these groups depending on the drug type used for abuse.
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Affiliation(s)
- Simone Bohnert
- Institute of Forensic Medicine, University of Wuerzburg, Versbacher Str. 3, 97078, Wuerzburg, Germany.
| | - Kosmas Georgiades
- Institute of Forensic Medicine, University of Wuerzburg, Versbacher Str. 3, 97078, Wuerzburg, Germany
| | - Camelia-Maria Monoranu
- Department of Neuropathology, Institute of Pathology, University of Wuerzburg, Josef-Schneider Str. 2, 97080, Wuerzburg, Germany
| | - Michael Bohnert
- Institute of Forensic Medicine, University of Wuerzburg, Versbacher Str. 3, 97078, Wuerzburg, Germany
| | - Andreas Büttner
- Institute of Legal Medicine, Rostock University Medical Center, St.-Georg-Strasse 108, 18055, Rostock, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany
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96
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Dahlman D, Ohlsson H, Edwards AC, Sundquist J, Håkansson A, Sundquist K. Socioeconomic correlates of incident and fatal opioid overdose among Swedish people with opioid use disorder. Subst Abuse Treat Prev Policy 2021; 16:73. [PMID: 34565405 PMCID: PMC8474855 DOI: 10.1186/s13011-021-00409-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/10/2022]
Abstract
Background Opioid overdose (OD) and opioid OD death are major health threats to people with opioid use disorder (OUD). Socioeconomic factors are underexplored potential determinants of opioid OD. In this study, we assessed socioeconomic and other factors and their associations with incident and fatal opioid OD, in a cohort consisting of 22,079 individuals with OUD. Methods We performed a retrospective, longitudinal study based on Swedish national register data for the period January 2005–December 2017. We used Cox proportional hazard models to investigate the risk of incident and fatal opioid OD as a function of several individual, parental and neighborhood covariates. Results Univariate analysis showed that several covariates were associated with incident and fatal opioid OD. In the multivariate analysis, incident opioid OD was associated with educational attainment (Hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.94–0.97), having received social welfare (HR 1.31; 95% CI 1.22–1.39), and criminal conviction (HR 1.53; 95% CI 1.42–1.65). Fatal opioid OD was also associated with criminal conviction (HR 1.93; 95% CI 1.61–2.32). Conclusion Individuals with low education and receipt of social welfare had higher risks of incident opioid OD and individuals with criminal conviction were identified as a risk group for both incident and fatal opioid OD. Our findings should raise attention among health prevention policy makers in general, and among decision-makers within the criminal justice system and social services in particular. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-021-00409-3.
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Affiliation(s)
- Disa Dahlman
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Clinical Research Center/CRC, Lund University/Region Skåne, Box 503 22, Malmö, Sweden. .,Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden. .,Malmö Addiction Centre, Skåne University Hospital, Malmö, Sweden.
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Clinical Research Center/CRC, Lund University/Region Skåne, Box 503 22, Malmö, Sweden
| | - Alexis C Edwards
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Clinical Research Center/CRC, Lund University/Region Skåne, Box 503 22, Malmö, Sweden.,Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, USA.,Center for Community-Based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Matsue, Japan
| | - Anders Håkansson
- Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden.,Malmö Addiction Centre, Skåne University Hospital, Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Clinical Research Center/CRC, Lund University/Region Skåne, Box 503 22, Malmö, Sweden.,Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, USA.,Center for Community-Based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Matsue, Japan
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97
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Patterson A, Sonnweber M, Lau S, Günther MP, Seifritz E, Kirchebner J. Schizophrenia and substance use disorder: Characteristics of coexisting issues in a forensic setting. Drug Alcohol Depend 2021; 226:108850. [PMID: 34198133 DOI: 10.1016/j.drugalcdep.2021.108850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/29/2021] [Accepted: 05/08/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Recent research has identified higher prevalence of offending behavior in patients with comorbid schizophrenia spectrum disorder (SSD) and substance use disorder (SUD) compared to patients with SSD only and to the general population. However, findings on the subgroup of patients with SUD, SSD and offending behavior in forensic psychiatric care are scarce and inconsistent. The present study used machine learning to uncover more detailed characteristics of offender patients in forensic psychiatric care with comorbid SSD and SUD. METHODS Using machine learning algorithms, 370 offender patients (91.6 % male, mean age of M = 34.1, SD = 10.2) and 558 variables were explored in order to build three models to differentiate between no substance use disorder, cannabis use disorder and any other substance use disorder. To counteract the risk of overfitting, the dataset was split, employing variable filtering, machine learning model building and selection embedded in a nested resampling approach on one subset. The best model was then selected and validated on the second data subset. RESULTS Distinguishing between SUD vs. no drug use disorder yielded models with an AUC of 70 and 78. Variables assignable to demographics, social disintegration, antisocial behavior and illness were identified as most influential for the distinction. The model comparing cannabis use disorder with other substance use disorders provided no significant differences. CONCLUSIONS From a clinical perspective, offender patients suffering from schizophrenia spectrum and comorbid substance use disorder seem particularly challenging to treat, but initial differences in psychopathology will dissipate over inpatient treatment. Our data suggest that offender patients may benefit from appropriate treatment that focuses on illicit drug abuse to reduce criminal behavior and improve social integration.
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98
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Henke RM, Head MA, Camacho-Cook J, Lin JR, Carroll CD. Cost Offsets of Treatment for Serious Mental Illness and Substance Use Disorder. Psychiatr Serv 2021; 72:1006-1011. [PMID: 33971721 DOI: 10.1176/appi.ps.201900445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The authors examined whether timely treatment for serious mental illness and substance use disorder reduces overall health care costs in a 3-year period. METHODS Claims data from the IBM MarketScan Research Databases (2010-2017) were analyzed. The population studied included 2,997 Medicaid enrollees and 35,805 commercial insurance enrollees ages 18-64 years with an index event for a serious mental illness and 2,315 Medicaid enrollees and 28,419 commercial insurance enrollees with an index event for a substance use disorder. Health care costs in the 3 years after an index event were calculated for enrollees who received care that met a minimum threshold for treatment and for those who did not receive such care. The Toolkit for Weighting and Analysis of Nonequivalent Groups was used to control for statistically significant differences in pretreatment characteristics between the groups. RESULTS All health care spending for enrollees who were engaged in behavioral health treatment for substance use disorder or a serious mental illness increased from year 0 to year 1 but decreased faster than the spending of enrollees who were not engaged in treatment, with larger trends for those engaged in substance use disorder treatment. Expenses for inpatient and emergency department care decreased over the 3 follow-up years; however, spending on outpatient services was significantly higher in all 3 follow-up years for those engaged in treatment. CONCLUSIONS Health care delivery and payment models that improve access to behavioral health treatment may reduce emergency department, inpatient, and overall health care costs for particular subpopulations.
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Affiliation(s)
- Rachel Mosher Henke
- IBM Watson Health, Cambridge, Massachusetts (Henke, Head, Camacho-Cook); IBM Watson Health, Bethesda, Maryland (Lin); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
| | - Michael A Head
- IBM Watson Health, Cambridge, Massachusetts (Henke, Head, Camacho-Cook); IBM Watson Health, Bethesda, Maryland (Lin); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
| | - Jessica Camacho-Cook
- IBM Watson Health, Cambridge, Massachusetts (Henke, Head, Camacho-Cook); IBM Watson Health, Bethesda, Maryland (Lin); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
| | - Janice R Lin
- IBM Watson Health, Cambridge, Massachusetts (Henke, Head, Camacho-Cook); IBM Watson Health, Bethesda, Maryland (Lin); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
| | - Christopher D Carroll
- IBM Watson Health, Cambridge, Massachusetts (Henke, Head, Camacho-Cook); IBM Watson Health, Bethesda, Maryland (Lin); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
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99
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Ung C, Yonekawa Y, Waljee JF, Gunaseelan V, Lai YL, Woodward MA. Persistent Opioid Use after Ophthalmic Surgery in Opioid-Naive Patients and Associated Risk Factors. Ophthalmology 2021; 128:1266-1273. [PMID: 33895223 PMCID: PMC8384648 DOI: 10.1016/j.ophtha.2021.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To determine the rate and risk factors for new persistent opioid use after ophthalmic surgery in the United States. DESIGN Retrospective claims-based cohort analysis. PARTICIPANTS Opioid-naive patients 13 years of age and older who underwent incisional ophthalmic surgery between January 1, 2012, and June 30, 2017, and were included in Optum's de-identified Clinformatics Data Mart database. METHODS New persistent opioid use was defined as filling an opioid prescription in the 90-day and the 91- to 180-day periods after the surgical procedure. The outcome variable was an initial perioperative opioid prescription fill. Rates of new persistent opioid use were calculated, and multivariate logistic regression models were used to identify variables increasing the risk of new persistent use and refill of an opioid prescription after the initial perioperative prescription in first 30 days. MAIN OUTCOME MEASURES New persistent opioid use and refill. RESULTS A total of 327 379 opioid-naive patients (mean age, 67 years [standard deviation, 16 years]; 178 067 women [54.4%]) who underwent ophthalmic surgery were examined. Among these patients, 14 841 (4.5%) had an initial perioperative opioid fill. The rate of new persistent opioid use was 3.4% (498 of 14 841 patients) compared with 0.6% (1833 of 312 538 patients) in patients who did not have an initial perioperative opioid fill. After adjusting for patient characteristics, initial perioperative opioid fill was associated independently with increased odds of new persistent use (adjusted odds ratio [OR], 6.21; 95% confidence interval [CI], 5.57-6.91; P < 0.001). Among patients who had filled an initial perioperative prescription, a prescription size of 150 morphine milligram equivalents or more was associated with an increased odds of refill (adjusted OR, 1.87; 95% CI, 1.58-2.22; P < 0.001). CONCLUSIONS Exposure to opioids in the perioperative period is associated with new persistent use in patients who were previously opioid-naive. This suggests that exposure to opioids is an independent risk factor for persistent use in patients undergoing incisional ophthalmic surgery. Surgeons should be aware of those risks to identify at-risk patients given the current national opioid crisis and to minimize prescribing opioids when possible.
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Affiliation(s)
- Cindy Ung
- South Coast Retina Center, Long Beach, California
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jennifer F Waljee
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan
| | - Vidhya Gunaseelan
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan; Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Yen-Ling Lai
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan
| | - Maria A Woodward
- W. K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan.
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Sil S, Periyasamy P, Thangaraj A, Niu F, Chemparathy DT, Buch S. Advances in the Experimental Models of HIV-Associated Neurological Disorders. Curr HIV/AIDS Rep 2021; 18:459-474. [PMID: 34427869 DOI: 10.1007/s11904-021-00570-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Involvement of the central nervous system (CNS) in HIV-1 infection is commonly associated with neurological disorders and cognitive impairment, commonly referred to as HIV-associated neurocognitive disorders (HAND). Severe and progressive neurocognitive impairment is rarely observed in the post-cART era; however, asymptomatic and mild neurocognitive disorders still exist, despite viral suppression. Additionally, comorbid conditions can also contribute to the pathogenesis of HAND. RECENT FINDINGS In this review, we summarize the characterization of HAND, factors contributing, and the functional impairments in both preclinical and clinical models. Specifically, we also discuss recent advances in the animal models of HAND and in in vitro cultures and the potential role of drugs of abuse in this model system of HAND. Potential peripheral biomarkers associated with HAND are also discussed. Overall, this review identifies some of the recent advances in the field of HAND in cell culture studies, animal models, clinical findings, and the limitations of each model system, which can play a key role in developing novel therapeutics in the field.
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Affiliation(s)
- Susmita Sil
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198-5880, USA.
| | - Palsamy Periyasamy
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198-5880, USA.
| | - Annadurai Thangaraj
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198-5880, USA
| | - Fang Niu
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198-5880, USA
| | - Divya T Chemparathy
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198-5880, USA
| | - Shilpa Buch
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198-5880, USA
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