[Usage of psychoactive substances among adolescents in Tuzla Canton]

AIM

Prospective vertical cross-section study has been conducted with an aim to determine the prevalence for the consumption of the psycho-active substances and correlation between consumption and quality of life of sixteen year old adolescents in Tuzla Canton.

METHODS

Cluster sample is used with a class as the main sample unit. Information were collected through anonymous questionnaires consisted of social-demographic questions, then questions related to the use and consumption of psycho-active substances, as well as of questions related to the quality of life of adolescents (content with family, friends, financial status, health status and personal self-content).

RESULTS

356 students are included in this survey. Almost half of examinees smoked cigarettes at least once in a life, and about 80% use alcoholic beverages. Marihuana is used by 7% of students. Boys lead in consumption of alcohol and marihuana in relation to girls (alcohol; P=0.001; marihuana; P=0.001). 10.9% of students used tranquilizers without the prescription of the relevant doctor and 2.2% students used tranquillizers with proper doctor's prescription. Common thing, related to the consumption and use of all three substances, was the fact that friends use it as well (tobacco p=0.31; alcohol p=0.36; marihuana p=0.44; P=0.001). There is also significant correlation between alcohol consumption of the parents and their children (father use alcohol p=0.22; mother use alcohol p=0.21; P=0.001). Discontent with family financial situation expressed 23% students. Low self-respect of the examinees is statistically significantly connected with the use of all three substances (marihuana p=0.17; p=0.001; alcohol p=0.13; P=0.05; tobacco p=0.11; P=0.05).

CONCLUSION

Important and significant factors for the prevention of this public and health problem are: good communication with parents, selection of friends, prevention of the psycho-active substances use by the parents, improvement of social and financial condition in the family.

Non-medical use, abuse and dependence on sedatives and tranquilizers among U.S. adults: psychiatric and socio-demographic correlates

BACKGROUND

Non-medical use of sedatives and tranquilizers carries risks including development of abuse/dependence. Such use may correlate with psychiatric symptoms.

METHODS

Cross-sectional survey, the 2002-2004 National Survey on Drug Use and Health. Respondents 18 years and older (n=92,020). Bivariate and multivariable associations were investigated.

RESULTS

The prevalence of past-year non-medical use of sedatives or tranquilizers was 2.3%. Of those with non-medical use, 9.8% met criteria for abuse/dependence. On multivariable analysis, panic symptoms and elevated serious mental illness scores were associated with past-year non-medical use. Also, the following past-year socio-demographic and substance use covariates were associated with past-year non-medical sedative or tranquilizer use: female sex, white/hispanic/other ethnicity, criminal arrest, uninsurance, unemployment, alcohol abuse or dependence, cigarette use, illicit drug use, younger age of initiating illicit substance use, and any history of IV drug use. Among those with sedative or tranquilizer use, those with abuse/dependence were more likely to have agoraphobic symptoms. In addition, they were more likely to be older, unmarried, have a low education level and have been arrested.

CONCLUSIONS

Non-medical use of sedatives and tranquilizers is common. Furthermore, nearly 10% of those with non-medical use meet criteria for abuse/dependence. Anxiety symptoms associated with non-medical use (panic symptoms) and abuse/dependence (agoraphobia) should alert clinicians to screen for these problems and consider alternate treatment or referral.

Illicit tranquilliser use and dependence among female opiate users

This study determined the predictors of 12-month dependence on illicit tranquillisers among female opiate users attending three services in Glasgow, Scotland, UK. Twelve-month drug dependence was measured using the Diagnostic Interview Schedule. The Revised Clinical Interview Schedule (CIS-R) measured current neurotic symptoms. 60% (159/266) had used illicit tranquillisers in the past 30 days, and 50% (132/266) met criteria for 12-month dependence on illicit tranquillisers. Polydrug use, injecting drug use, childhood and adulthood abuse, adverse life experiences and current and previous mental health problems were associated with 12-month dependence on illicit tranquillisers. Using multiple logistic regression, polydrug use in last 30 days (OR 3.2, 95% CI 1.5 - 7.0), history of deliberate self-harm (OR 2.5, 95% CI 1.4 - 4.4), history of injecting drug use (OR 2.5, 1.2 - 5.2) and likely to need treatment for current neurotic symptoms (CIS-R > or = 18) (OR 2.4, 95% CI 1.3 - 4.4) predicted 12-month dependence on illicit tranquillisers. Drug users in general and female drug users in particular who are using illicit tranquillisers are also particularly likely to have psychiatric symptoms requiring treatment. Mental health problems should be assessed and monitored among this client group and counselling and psychosocial support should be provided when indicated.

Determinants of health-related quality of life of opiate users at entry to low-threshold methadone programs

OBJECTIVE

The aim of this study was to conduct an exploratory analysis of factors associated with poor health-related quality of life (HRQOL) among opiate users at entry to low-threshold methadone treatment.

METHODS

The SF-36 questionnaire was administered to 145 opiate users at enrollment into low-threshold methadone maintenance programs. ANOVA and correlational analyses were performed to investigate the determinants of poor physical and mental composite summary scales (PCS and MCS) of the SF-36 among opiate users. Stepwise regression methods were also employed to fit PCS and MCS multivariate models.

RESULTS

Age, employment status, chronic medical conditions, hospitalization, emotional abuse, sexual abuse and age at first injection episode were significantly associated with PCS. Mental health problems, sexual abuse, physical abuse, the use of sedatives, the use of cocaine, the number of days of cocaine use, sedative use and multiple substance use in the past month were significantly associated with MCS. The variances in the MCS and PCS were not readily explained by any one factor.

CONCLUSION

The multiplicity of factors influencing HRQOL of opiate users suggests the need for a range of services within the context of a methadone program, addressing primary medical care needs as well as treatment for both mental health problems and abuse issues.

Emotional impact of exposure to terrorism among young-old and old-old Israeli citizens

OBJECTIVE

Since September 2000, continuous terrorist attacks have exposed Israeli society to trauma, and the impact of these events on the mental health of the elderly Israeli population remains unclear. The authors sought to assess the prevalence of posttraumatic stress-related symptoms of distress, depression, optimism, self-efficacy, and sense of safety of the young-old and old-old Jewish population after 19 months of intense terrorism in Israel, in order to identify correlates of the psychological sequelae and compare symptoms and coping methods of these populations with those of younger adults.

METHODS

Authors did a telephone survey using stratified sampling with a national sample of young-old (65-74 years old), old-old (>74 years old) and a comparison group of younger adults (18-64 years old).

RESULTS

No difference was found in the level of exposure, traumatic stress symptoms, including probable PTSD, except for a nonsignificant tendency toward more depersonalization and emotional numbness in the elderly group, a tendency toward more sleeplessness, more re-experiencing of unwanted thoughts, hyperarousal, fewer avoidance symptoms, and less disengagement-coping in the old-old group. Younger adults were found to be significantly more optimistic. Young-old and old-old people used cigarettes/alcohol and tranquilizers more often to cope with the situation, and old-old people who used disengagement-coping felt less helped by it.

CONCLUSIONS

Young-old and old-old people do not differ significantly from the younger adult population with regard to their response to 19 months of intense and recurrent terrorism.

Variability in Tablet Fragment Weights When Splitting Unscored Cyclobenzaprine 10mg Tablets

OBJECTIVE

To determine the weight variation and calculated dosing variability of tablet fragments upon splitting unscored cyclobenzaprine hydrochloride 10 mg tablets using two common tablet splitting devices.

DESIGN

Comparative pharmaceutics study.

SETTING

Pharmacy school laboratory.

PARTICIPANTS

Not applicable.

INTERVENTIONS

Unscored cyclobenzaprine hydrochloride 10 mg tablets from one generic manufacturer were split with a tablet splitter or a kitchen knife by a licensed pharmacist and two doctor of pharmacy students (n = 15 tablets for each method per participant).

MAIN OUTCOME MEASURES

Fragment weights (FWs) were compared with the theoretical weights (TWs), which were calculated as one half of the mean weight of the tablets used in each part of the experiment; means, relative standard deviations (RSDs), and percentages of TW were also calculated.

RESULTS

The mean weight before splitting the 45 tablets with the tablet splitter was 136.6 +/- 2.1 mg (TW = 68.3 mg). The mean FW after splitting was 67.9 +/- 7.9 mg. The RSD of 11.6% corresponded to a range of 69.4% to 130.2% of the TW and an estimated drug content of the split fragments between 3.47 mg and 6.51 mg. The mean weight before splitting the 45 tablets cut with a kitchen knife was 136.6 +/- 2.0 mg (TW = 68.3 mg). The mean FW was 68.0 +/- 15.7 mg with a RSD of 23.2%, corresponding to a range of 49.9% to 149.5% of the TW and an estimated drug content of the split fragments between 2.49 mg and 7.48

CONCLUSION

Tablet fragments obtained after splitting this generic cyclobenzaprine 10 mg product varied considerably in weight and estimated drug content. Accordingly, splitting cyclobenzaprine 10 mg tablets to achieve 5 mg doses could result in unpredictable dosing and therapeutic response.

Drugs, recreational drug use and attitudes towards doping of high school athletes

The purpose of this investigation was to determine the substances used, and the attitudes towards doping of high school athletes. A four-page, self-completed questionnaire was designed to determine the drugs used (licit, illicit and doping substances) along with beliefs about doping and the psychosociological factors associated with their consumption. The questionnaire was distributed to all the high school students enrolled in a school sports association in the Lorraine region in Eastern France. The completed forms were received from 1459 athletes: 4 % stated that they had used doping agents at least once in their life (their main source of supply being peers and health professionals). Thirty-four percent of the sample smoked some tobacco, 66 % used alcohol, 19 % cannabis, 4 % ecstasy, 10 % tranquillizers, 9 % hypnotics, 4 % creatine and 41 % used vitamins against fatigue. Beliefs about doping did not differ among doping agent users and non-users, except for the associated health risks which were minimized by users. Users of doping agents stated that the quality of the relations that they maintain with their parents is sharply degraded, and they reported that they are susceptible to influence and difficult to live with. More often than non-doping agent users, these adolescents are neither happy, nor healthy, while paradoxically, they seem less anxious and they are more self-confident. Our findings suggest that doping prevention among young athletes cannot be limited uniquely to the list of banned drugs.

The use of tranquillizers among women undergoing substance-abuse treatment

Overuse of tranquillizers (e.g., Valium, Ativan, Xanax) is frequently overlooked in substance-abuse treatment. This paper presents findings on the prevalence and frequency of tranquillizer use and concurrent substance use in women undergoing substance-abuse treatment. Ninety-eight women in 9 short-term, residential, women-only treatment centres in the province of Ontario, Canada, completed questionnaires assessing their pre-treatment substance use. Forty-three percent reported that they used tranquillizers in the 6 months preceding their treatment, and 70% of these reported using tranquillizers at least 2 to 4 times per week. Duration of use ranged from 1 month to 20 years, with an average of 4 years. The majority of participants (86%) reported using at least 1 other substance in addition to tranquillizers. The findings suggest that a significant proportion of women in substance-abuse treatment may be dependent on tranquillizers in addition to other substances. Implications for the intervention of tranquillizer overuse in substance-abuse treatment settings are discussed.

The unrecognised cost of cancer patients' unrelieved symptoms:a nationwide follow-up of their surviving partners

We investigated if a cancer patient's unrelieved symptoms during the last 3 months of life increase the risk of long-term psychological morbidity of the surviving partner. All women (n=506) living in Sweden under 80 years of age, who lost their husband/partner owing to cancer of the prostate in 1996 or of the urinary bladder in 1995 or 1996 were asked to answer an anonymous postal questionnaire, 2-4 years after their loss. The widows' psychological morbidity was associated with the patient's unrelieved mental symptoms. When the patient was perceived to have been very anxious during last three months of life (compared to no observed symptoms) the relative risks for the widows' psychological morbidity were: 2.5 (1.4-4.3) for depression and 3.4 (1.4-8.2) for anxiety. When comparing reports of the patient's pain (much vs no), the relative risks were 0.8 (0.5-1.2) for widowhood depression, and 0.8 (0.4-1.7) for widowhood anxiety. The patients were found to have had adequate access to physical pain control but poor access to psychological symptom control. Efficiency in diagnosing and treating psychological complications of terminally ill cancer patients may not only improve their quality of life but possibly also prevent long-term psychological morbidity of their surviving partners.

Abuse of telazol: an animal tranquilizer

BACKGROUND

Telazol (tiletamine hydrochloride 50 mg/mL, zolazepam hydrochloride 50 mg/mL) is utilized in veterinary medicine as a small-animal anesthetic. Telazol is comparable to ketamine in efficacy, and in conjunction with ketamine, has been responsible for one reported human fatality. We report a case of a woman who abused telazol.

CASE REPORT

A 30-year-old female employee at a local zoo was found unresponsive by fellow workers in a clean animal treatment room. Initial reports were that she had injected veterinary-grade diazepam and telazol. On-scene paramedics reported her as obtunded and arousable to deep painful stimuli, with gag reflex intact. Systolic blood pressure was 90 mm Hg by palpation. A fresh needle puncture mark was present on her right arm; nearby were a syringe, tourniquet, and bottles of each drug. Emergency Department assessment included airway, breathing, circulation, and intravenous access. She was lavaged and given activated charcoal with a cathartic. Shortly after arrival, she became alert and oriented. Family members insisted this was not an overdose. The patient had been previously evaluated for reported episodes of syncope, "only in the evening, while at work," and was prescribed diazepam for anxiety. Product information on telazol was limited to the Veterinary Drug Physician's Desk Reference. A urine drugs-of-abuse screen was positive for benzodiazepines and cannabinoids. The patient subsequently revealed a history of recreational use of telazol. She was discharged to an in-patient detoxification facility, 12 hours postadmission.

CONCLUSION

Telazol used in veterinary medicine as an anesthetic agent, is structurally related to ketamine. Telazol causes almost immediate anesthetic effects, and sudden alertness is not uncommon as the effects of the drug subside. Urine drugs-of-abuse screens are unlikely to identify telazol. We report a veterinary worker who abused telazol.

Tranquilizing and antiserotonin activity of nicotinamide

Nicotinamide in large amounts antagonized the action of serotonin on smooth muscles in vitro and in vivo. It also tranquilized animals. The antagonism differed in some respects from that of an antimetabolite of serotonin.

The relationship between alcohol problems and use of tranquilizing drugs: longitudinal patterns among American women

A previous community study of older adults (Graham et al., 1996) indicated a relationship between alcohol problems and use of tranquilizing drugs despite no relationship between alcohol consumption and tranquilizer use. The present paper explores this issue further using longitudinal data from a representative sample of American women. The results replicated previous findings of a significant relationship between alcohol problems and tranquilizer use that was unrelated to alcohol consumption. Analyses of longitudinal patterns indicated that alcohol problems in 1981 predicted subsequent use of tranquilizing drugs and that this relationship may be moderated by anxiety, with the relationship being strongest for respondents who reported few or no problems with anxiety. The results indicated no support for the relationship being due to: a pharmacological interaction of alcohol with tranquilizing drugs; use of tranquilizing drugs precipitating alcohol problems; or depression, anxiety, poor health or childhood sexual abuse being common causes of both alcohol problems and tranquilizer use. The link between alcohol problems and use of tranquilizing drugs needs to be investigated further to increase understanding of addictive behaviors.

Use in 1992 of tranquilizers and smokeless tobacco among Miami's public school students

This analysis examined tranquilizer use by 466 adolescents in Dade County, Florida public schools in 1992. Significant factors which increased the probability of use include that the adolescents were female, older students, peers' use of tranquilizers, ready access, and they lived alone. Smokeless tobacco use among 468 students was positively and significantly linked to peer influence, students being male, younger, living alone, and the availability of smokeless tobacco.

Pharmacological properties of thalidomide (alpha-phthalimido glutarimide), a new sedative hypnotic drug

Thalidomide (alpha-phthalimidoglutarimide, "Distaval," "Contergan") is a new sedative hypnotic drug which produces no toxic effects when administered orally to animals in massive doses. This lack of toxicity may be due to limited absorption. The drug has a quietening effect on the central nervous system, reducing the voluntary activity of laboratory animals and promoting sleep. Unlike the barbiturate drugs it does not cause an initial excitation in mice, incoordination or narcosis. It potentiates the actions of other central nervous system depressants, in particular the barbiturates. Its sedative effects are counteracted by central nervous system stimulants. It has no deleterious side effects and does not affect the heart, respiration or autonomic nervous system.

A method for assessing the effects of drugs on the central actions of 5-hydroxytryptamine

Injection of 5-hydroxytryptophan into mice produces a characteristic head-twitch. For a given period of observation this response may be assessed quantitatively either by observing the proportion of mice showing at least one head-twitch (a quantal response) or by counting the number of head-twitches for each mouse (a graded response). A method, based on the quantal response, of investigating the effect of centrally acting compounds on the head-twitch response is described. Evidence is presented that the head-twitches are due to a central action of 5-hydroxytryptamine formed by decarboxylation of 5-hydroxytryptophan. Head-twitches are potentiated by monoamine oxidase inhibitors and by phenytoin. Antagonists tested include an inhibitor of decarboxylase, antagonists of 5-hydroxytryptamine, some antihistamines, major tranquillizers and analgesic and sympathomimetic drugs. Drugs which neither potentiate nor inhibit the response include barbiturates and minor tranquillizers. The method may be valuable in the preliminary examination of compounds likely to have a central action.

Serial tranquilization of a reticulated giraffe (Giraffa camelopardalis reticulata) using xylazine

A 5-yr-old captive-born reticulated giraffe (Giraffa camelopardalis reticulata) was tranquilized with i.m. xylazine 34 times in a 39-day period to allow nursing by her calf. Xylazine administered at approximately 0.16 mg/kg i.m. provided adequate sedation of the dam without detrimental side effects to the dam or the calf. While the dam was sedated, the calf was able to ingest adequate amounts of milk to produce acceptable weight gains until he was consistently eating solid foods.

Psychosocial correlates of substance use: comparing high school students with incarcerated offenders in Hong Kong

Drug use prevalence data were obtained from 969 adolescents, high school students and imprisoned offenders who reported use of cough medicine, organic solvents, cannabis, heroin, tranquilizers, and narcotics over the past six months. Incarcerated youths, in particular girls, had higher prevalence rates than students. Drug use frequencies were associated with psychosocial variables such as disinhibition, peer drug use, susceptibility to peer pressure, attitudes, encouragement by peers, and perceived availability of drugs. The psychosocial process of the initiation and maintenance of substance use was specified as a path model that considered 1) personality and social environment as distal precursors and 2) a drug-use predisposition and perceived availability as proximal precursors of three kinds of outcome variables: drug use, the intention to try illicit drugs if they were legal, and adverse outcomes of drug use. It was found that the same structural equation model fit the data of both samples of offenders and students, however, with very different weights assigned to the paths.

TRANQUILLIZING AND HYPOTENSIVE ACTIVITIES OF TWELVE PHENOTHIAZINES

Twelve phenothiazine derivatives have been compared in relation to their central sedative, tranquillizing and hypotensive activities. The ED50's of the compounds to suppress the conditioned response, unconditioned response and forced locomotor activity were determined. Suppressions of the conditioned and unconditioned responses were taken as criteria for tranquillizing and central sedative activities respectively. The "tranquillizing ratio" (ED50 for unconditioned response/ED50 for conditioned response) was used as the criterion of tranquillizing activity in relation to sedative activity and for purposes of comparison this ratio was assigned a value of unity for chlorpromazine. Perphenazine was the most potent drug in suppressing the conditioned and unconditioned responses whereas fluopromazine had the maximal "tranquillizing index" activity. Six compounds had great, three moderate and three mild hypotensive activity when doses of 1 mg/kg were injected intravenously into dogs. The relationship of the chemical structure to the central sedative activity is discussed.

THE EFFECT OF SOME PHENOTHIAZINE TRANQUILLIZERS ON THE OESTROUS CYCLE OF ALBINO MICE

The effects of reserpine and of nine phenothiazine compounds on the oestrous cycle of albino mice were tested. With the exception of promethazine (which is not a tranquillizer) all the phenothiazine compounds and reserpine prolonged the oestrous cycle. The mechanism by which these tranquillizers interfere with the oestrous cycle is discussed.