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An J, Wang X, Song H, Zhao T, Ren H, Kang W, Dong Z, Niu L, Shi H. Simultaneous determination of four sedative-hypnotics in human urine based on dendritic structured magnetic nanomaterials. ARAB J CHEM 2022. [DOI: 10.1016/j.arabjc.2022.104363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Morford KL, Tetrault JM, Zhou B, Li F, Gleeson B, Edelman EJ, Stein MD, Barry DT, Madden L. The impact of benzodiazepine exposure on treatment retention in an open-access methadone program: A retrospective cohort study. Drug Alcohol Depend 2022; 241:109707. [PMID: 36423462 PMCID: PMC9777057 DOI: 10.1016/j.drugalcdep.2022.109707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Open-access opioid treatment programs (OTP) offer same-day access to methadone without an appointment and aim to minimize treatment barriers that often reduce admission and/or retention. We explored whether patients with benzodiazepine exposure at treatment entry would have similar 12-month retention compared to those without benzodiazepine exposure. METHODS We conducted a retrospective cohort study of 2968 patients consecutively initiated on methadone between January 2015 and February 2017 at an open-access OTP. The sample was stratified into benzodiazepine-exposed and nonexposed groups based on intake urine toxicology. Group comparison of 12-month retention was conducted. Kaplan Meier analysis compared time to methadone treatment discontinuation between groups with a log-rank test. Multivariable Cox regression was performed to compare retention by baseline benzodiazepine exposure with adjustment for confounders. RESULTS Overall, 31% of patients with benzodiazepine exposure (n = 171) and 31% without exposure (n = 2423) were retained at 12 months (p = 0.95). Median treatment duration was 182 days (95% CI, 152-239) and 175 days (95% CI, 156-196) for patients with and without benzodiazepine exposure, respectively. Kaplan-Meier analysis showed no significant difference in treatment duration between groups (log-rank test p = 0.73). Cox regression found no difference in treatment retention between groups (adjusted Hazard Ratio= 1.03, 95% CI, 0.91-1.16). CONCLUSIONS In this cohort of patients receiving methadone at an open-access OTP, benzodiazepine exposure at intake was not observed to impact 12-month treatment retention or duration. These findings support U.S. Food and Drug Administration (FDA) recommendations to not withhold medications for opioid use disorder from patients taking benzodiazepines.
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Affiliation(s)
- Kenneth L. Morford
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, United States
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, United States
- APT Foundation, 1 Long Wharf Drive, New Haven, CT 06511, United States
| | - Jeanette M. Tetrault
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, United States
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, United States
- APT Foundation, 1 Long Wharf Drive, New Haven, CT 06511, United States
| | - Bin Zhou
- Yale Center for Analytic Sciences, Yale School of Public Health, P.O. Box 208034, New Haven, CT 06520, United States
| | - Fangyong Li
- Yale Center for Analytic Sciences, Yale School of Public Health, P.O. Box 208034, New Haven, CT 06520, United States
| | - Brynna Gleeson
- Vassar College, 124 Raymond Avenue, Poughkeepsie, NY 12604, United States
| | - E. Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, United States
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, United States
| | - Michael D. Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany St, Boston, MA 02118. United States
| | - Declan T. Barry
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, United States
- APT Foundation, 1 Long Wharf Drive, New Haven, CT 06511, United States
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, United States
| | - Lynn Madden
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, United States
- APT Foundation, 1 Long Wharf Drive, New Haven, CT 06511, United States
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Berro LF, Zamarripa CA, Rowlett JK. Self-Administration of Fentanyl-Alprazolam Combinations by Rhesus Monkeys Responding under a Progressive-Ratio Schedule. J Pharmacol Exp Ther 2022; 383:199-207. [PMID: 36153004 PMCID: PMC9667979 DOI: 10.1124/jpet.122.001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/16/2022] [Indexed: 01/07/2023] Open
Abstract
This study evaluated the reinforcing effects of fentanyl, alone or in combination with the benzodiazepine alprazolam, in rhesus monkeys (3 females, 3 males). Subjects were trained to self-administer the opioid remifentanil (0.3 µg/kg/injection) under a progressive-ratio schedule of reinforcement. The reinforcing effects of fentanyl (0.1-10 µg/kg/injection) or alprazolam (1.0-100 µg/kg/injection) alone, or in combinations of fixed proportions (1:1, 1:3, and 3:1 fentanyl:alprazolam, with 1:1 based on the potencies of drugs alone) were evaluated in single-day test sessions (with double determinations). Dose-equivalence analysis was used to determine the extent to which fentanyl and alprazolam combinations differed from additivity. Fentanyl functioned as a positive reinforcer in all monkeys, while alprazolam was a reinforcer in 3 of 6 monkeys only. Therefore, drug combination data were grouped as "alprazolam-taking" and "non-alprazolam-taking" monkeys. For alprazolam-taking monkeys, we observed additive effects for the 3:1 and 1:3 combinations, and a significant supra-additive interaction for the 1:1 combination of fentanyl and alprazolam. For 2 of the 3 non-alprazolam-taking monkeys, the combination of fentanyl and alprazolam resulted in enhanced reinforcing effects relative to either drug alone. However, the one monkey showed primarily inhibitory, or suppressive effects, with the 3:1 dose combination resulting in a relatively modest rightward shift in the fentanyl dose-response function. In summary, our findings show that combining fentanyl and alprazolam generally result in proportion-dependent additive or supra-additive enhancements. These data raise the possibility that the prevalence of opioid-benzodiazepine polydrug abuse may reflect a unique enhancement of these drugs' reinforcing effects, although individual differences may exist. SIGNIFICANCE STATEMENT: Addressing the critical question of the degree to which benzodiazepines can modulate the abuse-related effects of opioids may provide improved pathways to treatment of this common form of polydrug addiction. In the present study, we show that combinations of the opioid fentanyl and the benzodiazepine alprazolam can be more reinforcing than either drug alone in a rhesus monkey model, suggesting that enhancement of reinforcement processes may underlie this prevalent form of polydrug use disorder.
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Affiliation(s)
- Lais F Berro
- Department of Psychiatry & Human Behavior, Center for Innovation & Discovery in Addictions, University of Mississippi Medical Center, 2500 N State Street, Jackson, Mississippi
| | - C Austin Zamarripa
- Department of Psychiatry & Human Behavior, Center for Innovation & Discovery in Addictions, University of Mississippi Medical Center, 2500 N State Street, Jackson, Mississippi
| | - James K Rowlett
- Department of Psychiatry & Human Behavior, Center for Innovation & Discovery in Addictions, University of Mississippi Medical Center, 2500 N State Street, Jackson, Mississippi
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Landis RK, Opper I, Saloner B, Gordon AJ, Leslie DL, Sorbero M, Stein BD. Buprenorphine treatment episode duration, dosage, and concurrent prescribing of benzodiazepines and opioid analgesics: The effects of Medicaid prior authorization policies. Drug Alcohol Depend 2022; 241:109669. [PMID: 36332589 PMCID: PMC10695272 DOI: 10.1016/j.drugalcdep.2022.109669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/29/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Buprenorphine is an effective medication for the treatment of opioid use disorder (OUD), but the association between prior authorization policies and quality of care for individuals receiving buprenorphine treatment is not well-understood. METHODS Using 2006-2013 Medicaid Analytic eXtract (MAX) data from 34 states and the District of Columbia, we identified 294,031 episodes of buprenorphine treatment for OUD among individuals aged 14-64 years. We estimated generalized difference-in-differences models to examine the association between buprenorphine prior authorization policies and changes in buprenorphine treatment quality along four dimensions: (1) duration of at least 180 days, (2) dosage of at least 8 milligrams, and concurrent prescribing of (3) opioid analgesics and (4) benzodiazepines. RESULTS Buprenorphine prior authorization policies were associated with an 11-percentage point reduction (p < 0.01) in the likelihood of episodes with a duration of at least 180 days in the first four years after policy implementation. The policy was not associated with changes in effective dosage or concurrent prescribing of opioid analgesics or benzodiazepines. CONCLUSIONS Buprenorphine prior authorization policies were associated with a sizeable and significant reduction in episodes of at least 180 days duration, underscoring the importance of identifying and removing barriers to effective and appropriate OUD care.
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Affiliation(s)
- Rachel K Landis
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, USA.
| | - Isaac Opper
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA.
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, USA; Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
| | - Douglas L Leslie
- Department of Public Health Sciences and Center for Applied Studies in Health Economics, Penn State College of Medicine, Hershey, PA 17033, USA.
| | - Mark Sorbero
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA.
| | - Bradley D Stein
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA.
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Modeling the cost and impact of injectable opioid agonist therapy on overdose and overdose deaths. J Subst Abuse Treat 2022; 143:108871. [PMID: 36182753 DOI: 10.1016/j.jsat.2022.108871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 07/21/2022] [Accepted: 09/01/2022] [Indexed: 01/04/2023]
Abstract
AIMS Unsupervised injectable opioid agonist therapy (iOAT) may decrease the unmet treatment needs for people who inject opioids. We aimed to model whether unsupervised iOAT may be effective in reducing fatal and non-fatal overdose, and estimate the cost per life saved. METHODS The study used a decision tree model based on Australian and international parameters for overdose risk in people who inject opioids who are: not on OAT; new/stable to methadone/buprenorphine treatment; on iOAT; or on unsupervised iOAT. We modeled scenarios of (1) current OAT only (status quo), or current OAT plus either (2) 5% supervised iOAT, (3) 5% supervised or 5.69% unsupervised iOAT (based on willingness to enroll), OR (4) 1.2% supervised and 10% unsupervised iOAT (the same cost as scenario 2). The study measured overdoses (fatal and nonfatal) and treatment costs per 10,000 people who inject opioids per annum, and cost-per deaths averted on implementation of iOAT. RESULTS With current OAT, the study found an estimated 1655.5 (1552.7-1705.3) overdoses, 19.3 (17.9-20.3) overdose deaths and AUD 23,335,081 in treatment costs per 10,000 people per annum. Implementation of 5% enrollment in supervised iOAT costs an additional AUD 14,807,855 and showed a reduction of 122.9 (95% UI 114.2-130.5) overdoses and 2.0 (1.8-2.0) overdose deaths per 10,000 people per annum ($7,774,172 [7,283,182-8,146,989] per death averted). For the same treatment costs, additional coverage of 10% unsupervised iOAT and 1.2% supervised iOAT could be achieved, which the study estimated to prevent 269.0 (95% UI 250.0-278.7) overdoses and 4.0 (3.7-4.2) overdose deaths per 10,000 people per annum ($3,723,340 (3,385,878-3,894,379) per death averted), alongside further benefits of treatment unaccounted for in this study. CONCLUSION An implementation scenario with greater unsupervised iOAT compared to supervised iOAT allows for an increased reduction in overdose and overdose deaths per annum at the same cost, with the additional benefit of increased treatment coverage among people who inject opioids.
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Abstract
Sleep health is an important factor across several physical and mental health disorders, and a growing scientific consensus has identified sleep as a critical component of opioid use disorder (OUD), both in the active disease state and during OUD recovery. The goal of this narrative review is to collate the literature on sleep, opioid use, and OUD as a means of identifying therapeutic targets to improve OUD treatment outcomes. Sleep disturbance is common and often severe in persons with OUD, especially during opioid withdrawal, but also in persons on opioid maintenance therapies. There is ample evidence that sleep disturbances including reduced total sleep time, disrupted sleep continuity, and poor sleep quality often accompany negative OUD treatment outcomes. Sleep disturbances are bidirectionally associated with several other factors related to negative treatment outcomes, including chronic stress, stress reactivity, low positive affect, high negative affect, chronic pain, and drug craving. This constellation of outcome variables represents a more comprehensive appraisal of the quality of life and quality of recovery than is typically assessed in OUD clinical trials. To date, there are very few clinical trials or experimental studies aimed at improving sleep health in OUD patients, either as a means of improving stress, affect, and craving outcomes, or as a potential mechanistic target to reduce opioid withdrawal and drug use behaviors. As such, the direct impact of sleep improvement in OUD patients is largely unknown, yet mechanistic and clinical research suggests that therapeutic interventions that target sleep are a promising avenue to improve OUD treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Luong R, Parkin JA, Cunningham N. Acute concomitant injury and intoxication in complainants of recent sexual assault: A review. J Forensic Leg Med 2022; 92:102448. [DOI: 10.1016/j.jflm.2022.102448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
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Troubles de l’usage de l’alprazolam : une analyse de la base de données mondiale de pharmacovigilance VigiBase™. Therapie 2022. [DOI: 10.1016/j.therap.2022.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Blondino CT, Prom-Wormley EC. A network approach to substance use, internalizing, and externalizing comorbidity in U.S. adults. Addict Behav 2022; 134:107421. [PMID: 35878503 DOI: 10.1016/j.addbeh.2022.107421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/11/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Use of conventional cigarettes (CIG), alcohol, marijuana, and sedatives [i.e., benzodiazepines and barbiturates]) commonly co-occur with internalizing and externalizing disorders. It is unclear how these relationships extend to electronic cigarettes (ECIGs) and prescription drugs not prescribed (i.e., sedatives, tranquilizers, and painkillers [PDNP]), and whether they differ by gender. METHODS Adult data (N = 30,211) from Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health Study were used to estimate a network of current or past-month use for six substances, experiencing four internalizing symptoms in the past month, and experiencing seven externalizing symptoms in the past month. Visual comparisons, global strength invariance, network structure invariance, and edge strength invariance were tested to detail substance use and internalizing/externalizing symptom networks. RESULTS Overall, networks were consistent between men and women. The strongest substance use/mental health symptom connections estimated as edge-weights (EW) were between marijuana with lying (EW = 0.60, 95% CI = 0.49; 0.70), marijuana with engaging in fights (EW = 0.54, 95% CI = 0.27; 0.81), PDNP with having trouble sleeping (EW = 0.53, 95% CI = 0.40; 0.66), and alcohol and impulsivity (EW = 0.48, 95% CI = 0.42; 0.53). DISCUSSION There were many weak connections throughout the substance use and internalizing/externalizing network. A few important connections were identified and encourage future study. In particular, PDNP was most strongly associated with internalizing symptoms. Marijuana, alcohol and PDNP use were most strongly associated with externalizing symptoms.
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Affiliation(s)
- Courtney T Blondino
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, 830 East Main Street, PO Box 980212, Richmond, VA 23298-0212, USA.
| | - Elizabeth C Prom-Wormley
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, 830 East Main Street, PO Box 980212, Richmond, VA 23298-0212, USA.
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Bushnell GA, Gerhard T, Keyes K, Hasin D, Cerdá M, Olfson M. Association of Benzodiazepine Treatment for Sleep Disorders With Drug Overdose Risk Among Young People. JAMA Netw Open 2022; 5:e2243215. [PMID: 36413369 PMCID: PMC9682430 DOI: 10.1001/jamanetworkopen.2022.43215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Benzodiazepines are prescribed for the treatment of adolescent sleep disorders; however, benzodiazepine overdoses occur, often in combination with opioids. OBJECTIVE To evaluate whether benzodiazepine treatment for sleep disorders, compared with alternative pharmacologic treatments (trazodone, hydroxyzine, zolpidem, zaleplon, and eszopiclone), is associated with increased risk of drug overdose for young people. DESIGN, SETTING, AND PARTICIPANTS This cohort study included privately insured people 10 to 29 years of age identified from a US commercial claims database (MarketScan), from January 1, 2009, to December 31, 2018. Young people with a sleep disorder diagnosis initiating benzodiazepine (n = 23 084) or comparator pharmacologic treatments (n = 66 706) were included in the study. Statistical analysis was performed from November 1, 2021, to May 16, 2022. EXPOSURES New use of benzodiazepine treatment or comparator pharmacologic treatments (defined as ≥1 year without a prescription for benzodiazepine or comparator medications). MAIN OUTCOMES AND MEASURES Incident diagnosed drug overdoses were identified from inpatient and emergency department records within 6 months of treatment initiation. The propensity score-adjusted cumulative incidence of overdose and hazard ratios (HRs) were estimated with intention-to-treat (analyzed based on initial treatment) and as-treated analyses (added censoring at treatment discontinuation). Results were stratified by prior prescription opioid fill. RESULTS The cohort included 23 084 young people initiating benzodiazepine treatment (14 444 female participants [62.6%]; mean [SD] age, 23 [4.1] years) and 66 706 initiating a comparator treatment (38 446 female participants [57.6%]; mean [SD] age, 22 [4.4] years). Six months after treatment initiation, 9.7% (95% CI, 9.3%-10.1%) of benzodiazepine users and 12.3% (95% CI, 12.1%-12.6%) of the comparator group were still receiving treatment. The crude incidence of drug overdose at 6 months was 0.9% for benzodiazepine initiators and 0.8% for comparator treatment initiators. In adjusted analyses, an increased risk of drug overdose was associated with benzodiazepines vs comparator treatments (intention-to-treat analysis: HR, 1.25 [95% CI, 1.03-1.51]; as-treated analysis: HR, 1.44 [95% CI, 1.14-1.80]). This association was stronger among young people with a recent prescription opioid fill vs those without a recent prescription opioid fill (as-treated analysis: adjusted HR, 2.01 [95% CI, 1.24-3.25] vs adjusted HR, 1.31 [95% CI, 1.00-1.70]). CONCLUSIONS AND RELEVANCE The findings of this study suggest that benzodiazepines, compared with alternative pharmacologic treatments for common sleep disorders, were associated with an increased risk of drug overdose among young people during the following 6-month period, especially among those with a recent opioid prescription. Drug overdose is an important safety consideration when treating young people with benzodiazepines.
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Affiliation(s)
- Greta A. Bushnell
- Center for Pharmacoepidemiology and Treatment Sciences, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey
- Department of Biostatistics and Epidemiology, Rutgers University School of Public Health, Piscataway, New Jersey
| | - Tobias Gerhard
- Center for Pharmacoepidemiology and Treatment Sciences, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey
| | - Katherine Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Deborah Hasin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University School of Medicine, New York, New York
| | - Mark Olfson
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
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Zamboni L, Toldo S, Fusina F, Mattiello M, Mannari V, Campagnari S, Schiavone V, Congiu A, Verlato G, Chiamulera C, Lugoboni F. Study protocol-Evoked craving in high-dose benzodiazepine users. Front Psychiatry 2022; 13:956892. [PMID: 36311534 PMCID: PMC9608779 DOI: 10.3389/fpsyt.2022.956892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Benzodiazepine (BDZ) abuse, especially concerning high doses of BDZs, is an impairing substance use disorder (SUD) that is often difficult to treat. Craving and cue reactivity (CR) are two important phenomena that have a prominent role in maintaining addiction and triggering relapses in BDZ abuse; nevertheless, they have rarely been addressed in scientific literature. The present study aims to fill these gaps by implementing a highly innovative virtual reality (VR) design to assess the impact of substance-related environmental cues on BDZ craving, as well as their influence on patients' affective states. Therefore, on one hand, this research will contribute to the assessment of VR feasibility in the study of these phenomena, and, on the other, it will help disentangle the role that CR and craving have on mood and attention, which are equally important factors to consider when treating SUDs. We will recruit a healthy control group and a patient group comprising people seeking treatment for BDZ detoxification. The experimental design will consist of the presentation of three VR scenarios, one neutral, one BDZ-related but without BDZ cues, and another with BDZ cues. The craving will be measured through a virtual analog scale (VAS); the Profile of Mood States (POMS) and Alcohol Attention Scale (AAS) questionnaires in a modified version will also be administered. We will additionally control for VR-induced feelings of sickness by administering the Simulator Sickness Questionnaire (SSQ), and the Presence Questionnaire (PQ) will be used to investigate participants' sense of presence in virtual environments. We expect patients to exhibit higher levels of craving, and that the craving will be higher after exposure to a cue-related virtual environment as compared to a neutral scenario.
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Affiliation(s)
- Lorenzo Zamboni
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico “G.B. Rossi”, Verona, Italy
- Department of Neurosciences, University of Verona, Verona, Italy
| | - Silvia Toldo
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Francesca Fusina
- Padova Neuroscience Center, University of Padua, Padua, Italy
- Department of General Psychology, University of Padua, Padua, Italy
| | - Matteo Mattiello
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico “G.B. Rossi”, Verona, Italy
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Vanessa Mannari
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Simone Campagnari
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico “G.B. Rossi”, Verona, Italy
| | - Valentina Schiavone
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alessio Congiu
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico “G.B. Rossi”, Verona, Italy
| | - Giuseppe Verlato
- Diagnostics and Public Health-Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Cristiano Chiamulera
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Fabio Lugoboni
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico “G.B. Rossi”, Verona, Italy
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Hozack BA, Kistler JM, Vaccaro AR, Beredjiklian PK. Benzodiazepines and Related Drugs in Orthopaedics. J Bone Joint Surg Am 2022; 104:2204-2210. [PMID: 36223476 DOI: 10.2106/jbjs.22.00516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Benzodiazepines are among the most commonly prescribed drugs worldwide and are often used as anxiolytics, hypnotics, anticonvulsants, and muscle relaxants. ➤ The risk of dependence on and abuse of these medications has recently gained more attention in light of the current opioid epidemic. ➤ Benzodiazepines can increase the risk of prolonged opioid use and abuse. ➤ Given the prevalence of the use of benzodiazepines and related drugs, orthopaedic patients are often prescribed these medications. ➤ Orthopaedic surgeons need to be aware of the prevalence of benzodiazepine and related drug prescriptions in the general population, their current uses in orthopaedic surgery, and the risks and adverse effects of their use.
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Affiliation(s)
- Bryan A Hozack
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Computed Tomography Angiography (CTA) in Selected Scenarios with Risk of Possible False-Positive or False-Negative Conclusions in Diagnosing Brain Death. LIFE (BASEL, SWITZERLAND) 2022; 12:life12101551. [PMID: 36294986 PMCID: PMC9604663 DOI: 10.3390/life12101551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
It is widely accepted that brain death (BD) is a diagnosis based on clinical examination. However, false-positive and false-negative evaluation results may be serious limitations. Ancillary tests are used when there is uncertainty about the reliability of the neurologic examination. Computed tomography angiography (CTA) is an ancillary test that tends to have the lowest false-positive rates. However, there are various influencing factors that can have an unfavorable effect on the validity of the examination method. There are inconsistent protocols regarding the evaluation criteria such as scoring systems. Among the most widely used different scoring systems the 4-point CTA-scoring system has been accepted as the most reliable method. Appropriate timing and/or Doppler pre-testing could reduce the number of possible premature examinations and increase the sensitivity of CTA in diagnosing cerebral circulatory arrest (CCA). In some cases of inconclusive CTA, the whole brain computed tomography perfusion (CTP) could be a crucial adjunct. Due to the increasing significance of CTA/CTP in determining BD, the methodology (including benefits and limitations) should also be conveyed via innovative electronic training tools, such as the BRAINDEXweb teaching tool based on an expert system.
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Ingebrigtsen E, Persett PS, Brekke M, Heyerdahl F, Hovda KE, Vallersnes OM. Poisoning with central stimulant drugs: an observational study from Oslo, Norway. Int J Emerg Med 2022; 15:54. [PMID: 36175843 PMCID: PMC9520889 DOI: 10.1186/s12245-022-00457-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The use of central stimulant drugs causes significant morbidity. We describe poisonings with central stimulant drugs and compare the different central stimulants concerning combinations with other drugs, treatment, and clinical course. METHODS: Patients presenting from 1 October 2013 to 31 March 2016 with poisoning related to the recreational use of central stimulant drugs were retrospectively included at a primary care emergency outpatient clinic and at a hospital emergency department in Oslo, Norway. Diagnosis of toxic agents was mainly based on the clinical assessment of the doctor treating the patient. Amphetamine and methamphetamine were co-categorized as amphetamine. RESULTS Among the 1131 cases of acute poisoning with central stimulant drugs at the outpatient clinic, amphetamine was involved in 808 (71.4%), cocaine in 252 (22.3%) methylenedioxymethamphetamine (MDMA) in 104 (9.2%), and methylphenidate in 13 (1.1%). Among the 211 cases at the hospital, amphetamine was involved in 167 (79.1%), cocaine in 60 (28.4%), and MDMA in 38 (18.0%). Amphetamine was frequently combined with opioids (40.1% at the outpatient clinic and 41.9% at the hospital) and benzodiazepines (28.3% and 45.5%), while MDMA often was combined with ethanol (64.4% and 71.1%), as was cocaine (62.7% and 61.7%). Sedation was given in 5.2% and 38.4% of cases, naloxone in 9.4% and 37.0%, and flumazenil in 0.1% and 28.0%. In total, 16.5% of the cases at the outpatient clinic were transferred to a hospital for medical review and 8.5% to a psychiatric hospital. Among the hospital patients, 92.9% were admitted to intensive care. CONCLUSION Amphetamine was the most common central stimulant drug involved in acute poisoning in Oslo, often combined with opioids and benzodiazepines.
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Affiliation(s)
- Erlend Ingebrigtsen
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Surgery, Orkdal Hospital, St Olav's Hospital, Orkdal, Norway
| | | | - Mette Brekke
- General Practice Research Unit, University of Oslo, Oslo, Norway
| | - Fridtjof Heyerdahl
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway
- The Norwegian Air Ambulance Foundation, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Knut Erik Hovda
- Department of Acute Medicine, The Norwegian CBRNe Centre of Medicine, Oslo University Hospital, Oslo, Norway
| | - Odd Martin Vallersnes
- Department of General Practice, University of Oslo, Oslo, Norway.
- Department of Emergency General Practice, Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway.
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Bakewell BK, Townsend CB, Ly JA, Sherman M, Abdelfattah HM, Solarz M, Woozley K, Ilyas AM. The Effect of Preoperative Benzodiazepine Usage on Postoperative Opioid Consumption After Hand Surgery: A Multicenter Analysis. Cureus 2022; 14:e29609. [PMID: 36321037 PMCID: PMC9601921 DOI: 10.7759/cureus.29609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 12/01/2022] Open
Abstract
Background Prescription rates of opioids and benzodiazepines have steadily increased in the last decade with the percentage of prescription opioid overdose deaths involving benzodiazepines more than doubling during that time. Orthopaedic surgery is one of the highest-volume opioid prescribing medical specialties, but the effects of benzodiazepine use on orthopaedic surgery patient outcomes are not well understood. The purpose of the study was to utilize the state Prescription Drug Monitoring Program (PDMP) database to investigate if perioperative benzodiazepine use predisposes patients to prolonged opioid use following hand and upper extremity orthopaedic surgery. Methods This study was retrospective and conducted at three urban academic institutions. All patients who underwent carpal tunnel release, thumb basal joint arthroplasty, and distal radius fracture open reduction internal fixation performed by 14 board-certified, fellowship-trained orthopaedic hand and upper extremity surgeons between April 2018 and August 2019, were collected via a database query. All opioid and benzodiazepine prescriptions were collected from three months preoperatively to six months postoperatively. Results In this study, 634 patients met the inclusion criteria presented to one of the three institutions during the 18-month study period. Patients consisted of 276 carpal tunnel releases, 217 distal radius fracture open reduction internal fixations, and 141 thumb basal joint arthroplasties. Benzodiazepine users were 14.6% more likely to fill an additional opioid prescription (p<0.005) and were 10.8% more likely to experience prolonged three to six-month postoperative opioid use (p<0.005). Conclusion This study found that patients who use benzodiazepines are at a higher risk of filling additional opioid prescriptions and prolonged opioid use following hand and upper extremity surgery. Prescribers should take this into account when prescribing opioids after upper extremity orthopaedic surgery.
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El Zahran T, Kanaan E, Kobeissi L, Bouassi J, Sarieddine A, Carpenter J, Kazzi Z, Hitti E. Benzodiazepine use disorder: A cross-sectional study at a tertiary care center in Lebanon. Medicine (Baltimore) 2022; 101:e30762. [PMID: 36197240 PMCID: PMC9509078 DOI: 10.1097/md.0000000000030762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Benzodiazepines are medications used for the treatment of multiple conditions including anxiety disorders, insomnia, agitation, and seizures. They are the most prescribed psychiatric medications and the third most misused drugs among adults and adolescents in the US. This study aims to assess the patient utilization patterns and benzodiazepine use disorder among Lebanese patients. A cross-sectional study was performed on Lebanese patients presenting to the Emergency Department of the American University of Beirut Medical Center (AUBMC), between November 11th, 2019, and May 30th, 2020. Institutional review board approved the study, and an informed consent was obtained from patients. A total of 244 patients were included in the final analysis. A total of 154 (63.1%) patients were found to have benzodiazepine use disorder as per the DSM-V criteria with the majority (64%) being females and young adults aged 18 to 40 years. The most common medication was alprazolam, and anxiety was the most common reason for benzodiazepine use. The majority (88%) of patients obtained their medications using a physician's prescription. More than half of users were not satisfied with the physician's instructions and lacked knowledge about side effects and abuse potential. The high rate of benzodiazepine misuse among our young adults highlights an important public health concern that requires interventions and policy implementation.
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Affiliation(s)
- Tharwat El Zahran
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- *Correspondence: Tharwat El Zahran, Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon (e-mail: )
| | - Elie Kanaan
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lynn Kobeissi
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joseph Bouassi
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aseel Sarieddine
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joseph Carpenter
- Department of Emergency Medicine, Emory University, Atlanta, GA, USA
| | - Ziad Kazzi
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Emergency Medicine, Emory University, Atlanta, GA, USA
| | - Eveline Hitti
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Abstract
While substance experimentation typically begins in adolescence, substance use disorders (SUDs) usually develop in late teens or early adulthood, often in individuals who are vulnerable because of biological and socioeconomic risk factors. Severe SUDs-synonymous with addiction-involve changes in limbic and prefrontal brain areas after chronic drug exposure. These changes involve learned associations between drug reward and cues that trigger the anticipation of that reward (known as incentive salience), as well as heightened dysphoria during withdrawal and weakened prefrontal circuits needed for inhibiting habitual responses.
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Affiliation(s)
- Wilson M Compton
- National Institute on Drug Abuse, 301 North Stonestreet Avenue, MSC 6025, Bethesda, MD 20892-6025, USA.
| | - Eric M Wargo
- National Institute on Drug Abuse, 301 North Stonestreet Avenue, MSC 6025, Bethesda, MD 20892-6025, USA
| | - Nora D Volkow
- National Institute on Drug Abuse, 301 North Stonestreet Avenue, MSC 6025, Bethesda, MD 20892-6025, USA
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Arroyo-Novoa CM, Figueroa-Ramos MI, Puntillo KA. Pain, Anxiety, and the Continuous Use of Opioids and Benzodiazepines in Trauma Intensive Care Unit Survivors: An Exploratory Study. PUERTO RICO HEALTH SCIENCES JOURNAL 2022; 41:111-116. [PMID: 36018737 PMCID: PMC9469201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate at-home opioid and benzodiazepine use, the degrees of pain and anxiety, and the incidence of probable withdrawal in post-discharge Trauma Intensive Care Unit (TICU) survivors. METHODS This was an exploratory study of post-TICU survivors who had participated in a previous study of opioid and benzodiazepine withdrawal. We surveyed survivors by telephone asking for retrospective information (during their first 4-months postdischarge- Time 1) and current information (around 2-years post-discharge- Time 2). RESULTS A mostly male (82%), young (median 38 years [IQR, 28-52]) sample of 27 TICU survivors reported using opioids (56%) at Time 1 for a median of 30 (IQR,14-90) days. Twelve percent of 26 survivors were still using opioids at Time 2. Sixty percent of the survivors had pain during Time 1, a median pain score of 6 (IQR, 5-8) on a 0-10 numeric rating scale (NRS).; 57% had pain at Time 2, median NRS score=6 (IQR, 4-7). Sixty-five percent of survivors had anxiety during Time 1, NRS median=7 (IQR, 5-9); 50% had anxiety at Time 2, NRS median= 6 (IQR, 3-7). At Time 1, 26% used prescribed benzodiazepines, and 12% used benzodiazepines at Time 2. Five and one of the 27 patients reported symptoms of opioid or benzodiazepine withdrawal, respectively, upon discontinuation or weaning. CONCLUSION Many TICU survivors had discontinued opioid/benzodiazepine prescriptions by 4-months post discharge while half reporting pain/anxiety for up to 2-years. Investigating the effects of acute-to-chronic pain in ICU survivors and gaining a better understanding of the mechanisms of prolonged opioid use are warranted.
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Affiliation(s)
- Carmen Mabel Arroyo-Novoa
- Professor, School of Nursing, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Milagros I Figueroa-Ramos
- Professor, School of Nursing, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Kathleen A Puntillo
- Professor Emeritus, School of Nursing, University of California, San Francisco, California, USA
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Trends in opioid analgesic utilisation among people with a history of opioid dependence. Drug Alcohol Depend 2022; 238:109548. [PMID: 35841733 DOI: 10.1016/j.drugalcdep.2022.109548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND We aimed to characterise opioid analgesic utilisation over a 16-year period among a cohort of people with a history of opioid dependence, comparing rates of use in and out of opioid agonist treatment (OAT). METHODS Retrospective cohort study in New South Wales, Australia, including 28,891 people with documented opioid dependence initiating opioid analgesics between July 2003 and December 2018. Linked administrative records provided data on prescription dispensings, sociodemographics, clinical characteristics, and OAT. Generalised estimating equation models estimated the incidence and adjusted incidence rate ratios (IRR) comparing periods in and out of OAT for the number of opioid analgesic dispensings (overall, for strong opioids, and the most commonly dispensed opioid types) and the amount dispensed in oral morphine equivalent milligrams (OME). RESULTS At initiation, 43.7% of the cohort were enrolled in OAT. The most commonly initiated opioid was codeine (including combinations with paracetamol; 67.8%), and 49.6% of the cohort were dispensed a psychotropic medicine in the previous 90 days. Incidence of all opioid analgesic dispensings was higher during periods out of OAT compared to in OAT (5.8 v. 2.3 dispensings per person-year; IRR 0.39, 95% CI 0.38, 0.41), with findings similar when stratified by type. Being in OAT was associated with a lower OME amount dispensed compared to out of OAT (-57.7%, 95% CI-58.8, -56.7). CONCLUSIONS People with opioid dependence had high rates of recent psychotropic medicine utilisation and current OAT enrolment at the time of opioid analgesic initiation. OAT was associated with a significant reduction in opioid analgesic dispensing.
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Edinoff AN, Nix CA, Odisho AS, Babin CP, Derouen AG, Lutfallah SC, Cornett EM, Murnane KS, Kaye AM, Kaye AD. Novel Designer Benzodiazepines: Comprehensive Review of Evolving Clinical and Adverse Effects. Neurol Int 2022; 14:648-663. [PMID: 35997362 PMCID: PMC9397074 DOI: 10.3390/neurolint14030053] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/16/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
As tranquilizers, benzodiazepines have a wide range of clinical uses. Recently, there has been a significant rise in the number of novel psychoactive substances, including designer benzodiazepines. Flubromazolam(8-bromo-6-(2-fluorophenyl)-1-methyl-4H-[1,2,4]triazolo[4,3-a][1,4]benzodiazeZpine) is a triazolo-analogue of flubromazepam. The most common effects noted by recreational users include heavy hypnosis and sedation, long-lasting amnesia, and rapid development of tolerance. Other effects included anxiolysis, muscle-relaxing effects, euphoria, loss of control, and severe withdrawals. Clonazolam, or 6-(2-chlorophenyl)-1-methyl-8-nitro-4H-[1,2,4]triazolo[4,3-α]-[1,4]-benzodiazepine, is a triazolo-analog of clonazepam. It is reported to be over twice as potent as alprazolam. Deschloroetizolam (2-Ethyl-9-methyl-4-phenyl-6H-thieno[3,2-f][1,2,4]triazolo[4,3-a][1,4]diazepine) is part of the thienodiazepine drug class, which, like benzodiazepines, stimulates GABA-A receptors. Meclonazepam ((3S)-5-(2-chlorophenyl)-3-methyl-7-nitro-1,3-dihydro-1,4-benzodiazepin-2-one) is a designer benzodiazepine with additional anti-parasitic effects. Although it has proven to be an efficacious therapy for schistosomiasis, its sedative side effects have prevented it from being marketed as a therapeutic agent. The use of DBZs has been a subject of multiple recent clinical studies, likely related to increasing presence and availability on the internet drug market and lack of regulation. Many studies have aimed to identify the prevalence of DBZs and their effects on those using them. This review discussed these designer benzodiazepines and the dangers and adverse effects that the clinician should know.
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Affiliation(s)
- Amber N. Edinoff
- Department of Psychiatry, Massachusetts General Hospital, Harvard School of Medicine, Boston, MA 02114, USA
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
- Louisiana Addiction Research Center, Shreveport, LA 71103, USA
- Correspondence: ; Tel.: +1-(617)-726-2000
| | - Catherine A. Nix
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
- Louisiana Addiction Research Center, Shreveport, LA 71103, USA
| | - Amira S. Odisho
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
| | - Caroline P. Babin
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
| | - Alyssa G. Derouen
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
| | - Salim C. Lutfallah
- School of Medicine, Louisiana State University New Orleans, New Orleans, LA 70112, USA
| | - Elyse M. Cornett
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA 71103, USA
| | - Kevin S. Murnane
- Department of Psychiatry, Massachusetts General Hospital, Harvard School of Medicine, Boston, MA 02114, USA
- Louisiana Addiction Research Center, Shreveport, LA 71103, USA
- Department of Pharmacology, Toxicology & Neuroscience, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
| | - Adam M. Kaye
- Thomas J. Long School of Pharmacy and Health Sciences, Department of Pharmacy Practice, University of the Pacific, Stockton, CA 95211, USA
| | - Alan D. Kaye
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA 71103, USA
- Department of Pharmacology, Toxicology & Neuroscience, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
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Gittins R, Missen L, Maidment I. Misuse of Over the Counter and Prescription Only Medication by Adults Accessing Specialist Treatment Services in the UK: A Narrative Synthesis. Subst Abuse 2022; 16:11782218221111833. [PMID: 35845971 PMCID: PMC9280808 DOI: 10.1177/11782218221111833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022]
Abstract
Background Concerns about the misuse of over the counter (OTC) and prescription only medication (POM) are due to their impact upon physical/mental wellbeing, drug interactions and drug-related deaths. Improving an understanding of the pattern of use by people accessing specialist substance misuse services (SMSs) should enable improvements to treatment provision. Aim To review the literature on the misuse of OTC/POM among adults accessing SMS, including the pattern of use, types of medication and associated characteristics. Methods This review is reported in line with PRISMA. The protocol has been registered on PROSPERO (CRD42020135216) and separately published. A search of Cochrane, OVID Medline, Pubmed, Scopus and Web of Science databases and grey literature was undertaken. Only English language publications outlining OTC/POM misuse by adults in receipt of psychological/pharmacological interventions for substance misuse were included. Two reviewers conducted the title, abstract and full-text reviews using predetermined selection criteria and a piloted data extraction form to ensure a consistent approach. A third reviewer resolved disagreements and the Mixed Methods Appraisal Tool assessed for bias. Ethical approval was not required. Results Thirteen studies with notable heterogeneity were included in the narrative synthesis after non-UK-based and ineligible publications were excluded, from the 143 potentially relevant papers. To reduce bias all studies were included in the analysis and GRADE-CERQual was applied. 'High confidence' was identified for all review findings, despite moderate methodological limitations. Antihistamine, benzodiazepine and opioid misuse was mentioned most frequently. Usage patterns and supply sources varied. Adverse consequences and polypharmacy are concerning. Withdrawal symptoms perpetuated misuse, often alongside illicit substance use, comorbid psychiatric/pain disorders and street drug shortages. Conclusion OTC/POM misuse is common amongst adults accessing SMS. A renewed approach to withdrawal management is required. The limited number of studies may impact on generalisability but allowed for a more detailed review. Restricting to UK studies improved relevance due to drug market variations and availability of medicines in different countries. Further UK-based research on OTC/POM misuse in SMS is needed to build upon the current paucity in the published literature.
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Affiliation(s)
- Rosalind Gittins
- Clinical Department, Humankind, Durham, UK
- Aston Pharmacy School, Aston University, Birmingham, UK
| | | | - Ian Maidment
- Aston Pharmacy School, Aston University, Birmingham, UK
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Changes in the unregulated opioid drug supply during income assistance payment weeks in Vancouver, Canada: An exploratory analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103707. [DOI: 10.1016/j.drugpo.2022.103707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 11/22/2022]
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Huhn AS, Finan PH, Gamaldo CE, Hammond AS, Umbricht A, Bergeria CL, Strain EC, Dunn KE. Suvorexant ameliorated sleep disturbance, opioid withdrawal, and craving during a buprenorphine taper. Sci Transl Med 2022; 14:eabn8238. [PMID: 35731889 DOI: 10.1126/scitranslmed.abn8238] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Increased orexin/hypocretin signaling is implicated in opioid withdrawal, sleep disturbances, and drug-seeking behaviors. This study examined whether a dual-orexin receptor antagonist would improve sleep and withdrawal outcomes when compared with placebo during a buprenorphine/naloxone taper. Thirty-eight participants with opioid use disorder were recruited to a clinical research unit and maintained on 8/2 to 16/4 mg of buprenorphine/naloxone treatment for 3 days before being randomized to 20 mg of suvorexant (n = 14), 40 mg of suvorexant (n = 12), or placebo (n = 12); 26 individuals completed the study. After randomization, participants underwent a 4-day buprenorphine/naloxone taper and 4-day post-taper observation period. Total sleep time (TST) was collected nightly with a wireless electroencephalography device and wrist-worn actigraphy; opioid withdrawal symptoms were assessed via the Subjective Opiate Withdrawal Scale (SOWS); and abuse potential was assessed on a 0- to 100-point visual analog scale of "High" every morning. A priori outcomes included two-group (collapsing suvorexant doses versus placebo) and three-group comparisons of area-under-the-curve (AUC) scores for TST, SOWS, and High. In two-group comparisons, participants receiving suvorexant displayed increased TST during the buprenorphine/naloxone taper and decreased SOWS during the post-taper period. In three-group comparisons, participants receiving 20 mg of suvorexant versus placebo displayed increased AUC for TST during the buprenorphine/naloxone taper, but there was no difference in SOWS among groups. There was no evidence of abuse potential in two- or three-group analyses. The results suggest that suvorexant might be a promising treatment for sleep and opioid withdrawal in individuals undergoing a buprenorphine/naloxone taper.
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Affiliation(s)
- Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Charlene E Gamaldo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Alexis S Hammond
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Annie Umbricht
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Cecilia L Bergeria
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Eric C Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
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Jayamaha AR, Dharmarathna ND, Herath ND, Ranadeva ND, Fernando MM, Samarasinghe KL, Amarabandu PN, Senanayake B, Darshana T, Renuka N, Rajapakse IH, Gunasekara CP, Meegoda L, Fernando N. The Pattern of Substance Use and Characteristics of the Individuals Enrolled in Residential Treatment at Selected Rehabilitation Centers in Sri Lanka: A Descriptive Cross-Sectional Study. Subst Abuse 2022; 16:11782218221100823. [PMID: 35645565 PMCID: PMC9130826 DOI: 10.1177/11782218221100823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/26/2022] [Indexed: 01/23/2023]
Abstract
Introduction: Substance use becomes censorious when it leads to harmful effects on
individuals, their families, and the community. The nature of substance use
in Sri Lankan context is poorly understood and empirical evidences are
sparse. The study aimed to describe patterns of substance use and
characteristics of the individuals enrolled in residential treatment at
selected rehabilitation centers in Sri Lanka. Material and methods: A descriptive cross-sectional study was conducted among 205 individuals
enrolled in selected rehabilitation centers. Pretested
interviewer-administered questionnaire was used to collect data. Data were
analyzed using descriptive statistics. Results: Most of the individuals who enrolled in residential treatment at selected
rehabilitation centers were unmarried (n = 124, 60.5%), Sinhala (n = 186,
90.7%), Buddhist (n = 166, 81.0%), males (n = 202, 98.5%) and belonged to
the young adult age (18-35 years) category (n = 178, 86.8%). All the
participants were poly-drug users and cannabis was the most commonly used
(n = 183, 89.3%) illicit drug followed by heroin (n = 172, 83.9%),
methamphetamine (n = 150, 73.2%) and cocaine (n = 78, 38%). The most
(n = 152, 74.1%) problematic substance for life was heroin. Most of the
participants (n = 149, 72.7%) had used drugs several times per day. The mean
duration of substance use was 7 ± 5 years. Participants (n = 177, 86.3%)
reported that the substances were available in their residential areas and
their friends (n = 197, 96.1%) were also using the substances. Conclusions: Pattern of substance use and characteristics of the individuals were unique
in Sri Lanka and need to be considered when implementing and strengthening
the programs for drug prevention and rehabilitation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Nilani Renuka
- National Dangerous Drugs Control Board, Colombo, Sri Lanka
| | | | | | - Lalitha Meegoda
- University of Sri Jayewardenepura, Jayewardenepura, Sri Lanka
| | - Neluka Fernando
- University of Sri Jayewardenepura, Jayewardenepura, Sri Lanka
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Larnder A, Saatchi A, Borden SA, Moa B, Gill CG, Wallace B, Hore D. Variability in the unregulated opioid market in the context of extreme rates of overdose. Drug Alcohol Depend 2022; 235:109427. [PMID: 35405459 DOI: 10.1016/j.drugalcdep.2022.109427] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Drug checking uses analytical chemistry technologies to report on the composition of drugs from the unregulated market to reduce substance use-related risks, while additionally allowing for monitoring and reporting of the supply. In the context of an overdose crisis linked to fentanyl, we used drug checking data to examine variability within the illicit opioid supply. METHODS In this time-series analysis, data was collected from a drug checking service in Victoria, Canada from November 2020 to July 2021. Drugs reported as opioids by participants of the service (N = 454) were analyzed to determine sample composition and paper spray mass spectroscopy was used to quantify low-concentration actives. Interquartile and statistical process control (SPC) analysis, namely standard deviation control charts, were used to examine the degree of variability among samples. RESULTS Fentanyl was found in 96% of samples reported to be opioids, with a median concentration of 9%. Concentrations varied significantly, with a standard deviation of 7% for fentanyl and where nearly 20% of data points fell outside the control limits. Over half of the samples contained an additional and unexpected active, most commonly etizolam (43% of samples). Etizolam also showed a large level of variability, uncorrelated to that of fentanyl. CONCLUSIONS Based on our chemical quantification and SPC analysis, a high degree of variability was found in opioid samples from the unregulated market in both the drugs detected and the concentrations of those drugs. This demonstrated the opioid crisis to be less attributable to a bad batch of drugs but rather the general variability found in the unregulated market.
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Affiliation(s)
- Ashley Larnder
- Department of Chemistry, University of Victoria, Victoria, British Columbia, V8W 3V6, Canada
| | - Armin Saatchi
- Department of Chemistry, University of Victoria, Victoria, British Columbia, V8W 3V6, Canada; Applied Environmental Research Laboratories (AERL), Department of Chemistry, Vancouver Island University, Nanaimo, British Columbia V9R 5S5, Canada
| | - Scott A Borden
- Department of Chemistry, University of Victoria, Victoria, British Columbia, V8W 3V6, Canada; Applied Environmental Research Laboratories (AERL), Department of Chemistry, Vancouver Island University, Nanaimo, British Columbia V9R 5S5, Canada
| | - Belaid Moa
- University Systems, University of Victoria, Victoria, British Columbia V8W 2Y2, Canada; Department of Electrical and Computer Engineering, University of Victoria, Victoria, British Columbia V8W 2Y2, Canada
| | - Chris G Gill
- Department of Chemistry, University of Victoria, Victoria, British Columbia, V8W 3V6, Canada; Applied Environmental Research Laboratories (AERL), Department of Chemistry, Vancouver Island University, Nanaimo, British Columbia V9R 5S5, Canada; Department of Chemistry, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada; Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington 98195, United States.
| | - Bruce Wallace
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia V8W 2Y2, Canada; School of Social Work, University of Victoria, Victoria, British Columbia V8W 2Y2, Canada.
| | - Dennis Hore
- Department of Chemistry, University of Victoria, Victoria, British Columbia, V8W 3V6, Canada; Department of Computer Science, University of Victoria, Victoria, British Columbia V8W 3P6, Canada.
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76
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Andersson L. A transition of power in opioid substitution treatment: Clinic managers' views on the consequences of a patient choice reform. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:279-300. [PMID: 35720521 PMCID: PMC9152230 DOI: 10.1177/14550725221075003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/05/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives: Opioid substitution treatment (OST) is often described as a strict and highly regulated treatment method, in which patients have limited influence over their treatment. In 2014, a reform was introduced by the regional council of Skåne in southern Sweden, which allowed OST patients to choose their treatment provider, thus transferring power from care providers to patients. The aim of this study was to examine what this increase in patient influence has meant for the clinics that provide OST in Skåne, and how these clinics have dealt with the new competitive situation that has arisen following the introduction of the reform. Methods: The study is based on two waves of semi-structured interviews with clinic managers at all OST clinics in Skåne. Results: The clinic managers described the increase in patient influence as a positive change, which had led to the patients being treated with more respect. The competition among clinics was expressed, among other things, in the form of differing views on the prescription of benzodiazepines, which initially gave rise to dissatisfaction among clinics with a more restrictive approach to such prescriptions. The reform did not lead to any clear diversity between clinics, apart from different approaches to the prescription of benzodiazepines. The incentive for competition-based diversity is, however, limited by the strict national regulatory system and by the reimbursement system, which restricts the ways in which clinics can conduct treatment activities. Conclusion: OST-clinic managers were largely positive about the increased patient empowerment and the shift in power balance associated with the patient choice reform. The introduction of the reform did not lead to any clear diversity between treatment providers, apart from differing views on the prescription of benzodiazepines, which by some managers was regarded as unfair competition.
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77
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Wurf G, O’Neal P. Community‐based
counselling for benzodiazepine withdrawal: A mixed‐methods study of client outcomes. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gerald Wurf
- School of Educational Psychology and Counselling Monash University Melbourne Victoria Australia
| | - Paul O’Neal
- School of Educational Psychology and Counselling Monash University Melbourne Victoria Australia
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78
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Bahji A, Li Y, Vickers-Smith R, Crystal S, Kerns RD, Gordon KS, Macmadu A, Skanderson M, So-Armah K, Sung ML, Bhondoekhan F, Marshall BDL, Edelman EJ. Self-Reported Cannabis Use and HIV Viral Control among Patients with HIV Engaged in Care: Results from a National Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5649. [PMID: 35565045 PMCID: PMC9101884 DOI: 10.3390/ijerph19095649] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023]
Abstract
Background: The association between cannabis use and HIV-1 RNA (viral load) among people with HIV (PWH) engaged in care is unclear. Methods: We used data collected from 2002 to 2018 on PWH receiving antiretroviral therapy (ART) enrolled in the Veterans Aging Cohort Study. Generalized estimating equations were used to estimate associations between self-reported past-year cannabis use and detectable viral load (≥500 copies/mL), with and without adjustment for demographics, other substance use, and adherence. Results: Among 2515 participants, 97% were male, 66% were Black, the mean age was 50 years, and 33% had detectable HIV viral load at the first study visit. In unadjusted analyses, PWH with any past-year cannabis use had 21% higher odds of a detectable viral load than those with no past-year use (OR = 1.21; 95% CI, 1.07-1.37). However, there was no significant association between cannabis use and viral load after adjustment. Conclusions: Among PWH engaged in care and receiving ART, cannabis use is associated with decreased adherence in unadjusted analyses but does not appear to directly impact viral control. Future studies are needed to understand other potential risks and benefits of cannabis use among PWH.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1, Canada
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada
- Research in Addiction Medicine Scholars Program, Boston University Medical Center, Boston, MA 02118, USA
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Yu Li
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA; (Y.L.); (A.M.); (F.B.); (B.D.L.M.)
| | - Rachel Vickers-Smith
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY 40536, USA;
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Rutgers University, Rutgers, NJ 08901, USA;
| | - Robert D. Kerns
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA;
- VA Connecticut Healthcare System, West Haven, CT 06516, USA; (K.S.G.); (M.S.); (M.L.S.)
| | - Kirsha S. Gordon
- VA Connecticut Healthcare System, West Haven, CT 06516, USA; (K.S.G.); (M.S.); (M.L.S.)
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA; (Y.L.); (A.M.); (F.B.); (B.D.L.M.)
| | - Melissa Skanderson
- VA Connecticut Healthcare System, West Haven, CT 06516, USA; (K.S.G.); (M.S.); (M.L.S.)
| | - Kaku So-Armah
- Clinical Addiction Research & Education (CARE) Unit, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Minhee L. Sung
- VA Connecticut Healthcare System, West Haven, CT 06516, USA; (K.S.G.); (M.S.); (M.L.S.)
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Fiona Bhondoekhan
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA; (Y.L.); (A.M.); (F.B.); (B.D.L.M.)
| | - Brandon D. L. Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA; (Y.L.); (A.M.); (F.B.); (B.D.L.M.)
| | - E. Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT 06511, USA
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Palamar JJ, Ciccarone D, Rutherford C, Keyes KM, Carr TH, Cottler LB. Trends in seizures of powders and pills containing illicit fentanyl in the United States, 2018 through 2021. Drug Alcohol Depend 2022; 234:109398. [PMID: 35370014 PMCID: PMC9027012 DOI: 10.1016/j.drugalcdep.2022.109398] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prevalence of fentanyl-laced counterfeit prescription pills has been increasing in the US, possibly placing a wider population at risk for unintentional exposure. We aimed to determine whether there have been shifts in the number of fentanyl seizures and in the form of fentanyl seized in the US. METHODS We examined quarterly national seizure data from High Intensity Drug Trafficking Areas to determine the number of drug seizures in the US containing fentanyl from January 2018 through December 2021. Generalized additive models were used to estimate trends in the number and weight of pill and powder seizures containing fentanyl. RESULTS There was an increase both in the number of fentanyl-containing powder seizures (from 424 in 2018 Quarter 1 [Q1] to 1539 in 2021 Quarter 4 [Q4], β = 0.94, p < 0.001) and in the number of pill seizures (from 68 to 635, β = 0.96, p < 0.01). The proportion of pills to total seizures more than doubled from 13.8% in 2018 Q1 to 29.2% in 2021 Q4 (β = 0.92, p < 0.001). Weight of powder fentanyl seizures increased from 298.2 kg in 2018 Q1 to 2416.0 kg in 2021 Q4 (β = 1.12, p = 0.01); the number of pills seized increased from 42,202 in 2018 Q1 to 2,089,186 in 2021 Q4 (β = 0.90, p < 0.001). CONCLUSIONS Seizures of drugs containing fentanyl have been increasing in the US. Given that over a quarter of fentanyl seizures are now in pill form, people who obtain counterfeit pills such as those disguised as oxycodone or alprazolam are at risk for unintentional exposure to fentanyl.
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Affiliation(s)
- Joseph J. Palamar
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA,Correspondence to: New York University Grossman School of Medicine, Department of Population Health, 180 Madison Avenue, Room 1752, New York, NY 10016, USA. (J.J. Palamar)
| | - Daniel Ciccarone
- University of California, San Francisco, Department of Family and Community Medicine, San Francisco, CA, USA
| | - Caroline Rutherford
- Columbia University, Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - Katherine M. Keyes
- Columbia University, Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - Thomas H. Carr
- College of Public Affairs, Center for Drug Policy and Prevention, University of Baltimore, United States,Office of National Drug Control Policy, Washington, Baltimore High Intensity Drug Trafficking Areas Program, United States, Center for Drug Policy and Prevention, University of Baltimore, United States
| | - Linda B. Cottler
- NDEWS, University of Florida, United States,University of Florida, Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, United States
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80
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Cochran G, Charron E, Brown JL, Cernasev A, Hohmeier KC, Winhusen TJ. Risky alcohol use among patients dispensed opioid medications: A clinical community pharmacy study. Drug Alcohol Depend 2022; 234:109406. [PMID: 35316690 PMCID: PMC9018607 DOI: 10.1016/j.drugalcdep.2022.109406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/21/2022] [Accepted: 03/11/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Included among the significant risk factors for opioid overdose is concomitant use of other central nervous system depressants, particularly alcohol. Given the continued expansion of community pharmacy in the continuum of care, it is imperative to characterize alcohol use among pharmacy patients dispensed opioids in order to establish a foundation for identification and intervention in these settings. METHODS This secondary analysis utilized data from a one-time, cross-sectional health assessment conducted among patients dispensed opioid medications in 19 community pharmacies in Indiana and Ohio. Adult, English speaking, patients not receiving cancer care who were dispensed opioid medications were asked to self-report alcohol and substance use, behavioral and physical health, and demographic information. Descriptive and logistic regression analyses were employed to characterize alcohol use/risky alcohol use and patient characteristics associated therewith. RESULTS The analytical sample included 1494 individuals. Participants were on average 49 years of age (Standard Deviation=14.9)-with 6% being persons of color (n = 89). Weekly drinking was reported by 18.1% (n = 204) and daily drinking was reported by 6.8% (n = 77) of the study sample, with a total of 143 (9.6%) participants reporting moderate/high risk drinking. Males (Adjusted Odds Ratio [AOR]=1.94, 95% CI=1.3,2.9), those with higher pain interference (AOR=1.44, 95% CI=1.0,2.0), overdose history (AOR=1.93, 95% CI=1.1,3.5), sedative use (AOR=2.11, 95% CI=1.3,3.5), and tobacco use (AOR=2.41, 95% CI=1.6,3.7) had increased likelihood of moderate/high risk alcohol use (all p < 0.05). CONCLUSIONS Medication labeling and clinical guidelines clearly indicate that patients should abstain from concomitant use of opioids and alcohol. This study has identified rates and associated risk factors of risky alcohol use among a clinical sample of community pharmacy patients dispensed opioid medications. Continuing this line of research and potential clinical service development has the ability to improve patient safety through addressing a significant gap within the current opioid epidemic.
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Affiliation(s)
- Gerald Cochran
- University of Utah, Department of Internal Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, USA.
| | - Elizabeth Charron
- University of Utah, Department of Internal Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, USA.
| | - Jennifer L Brown
- University of Cincinnati, Department of Psychiatry and Behavioral Neuroscience, 260 Stetson Street, Cincinnati, OH 45267-0559, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA.
| | - Alina Cernasev
- University of Tennessee, Nashville, College of Pharmacy, 301 S Perimeter Park Dr, Nashville, TN 37211, USA.
| | - Kenneth C Hohmeier
- University of Tennessee, Nashville, College of Pharmacy, 301 S Perimeter Park Dr, Nashville, TN 37211, USA.
| | - T John Winhusen
- University of Cincinnati, Department of Psychiatry and Behavioral Neuroscience, 260 Stetson Street, Cincinnati, OH 45267-0559, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA.
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81
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Karamouzian M, Pilarinos A, Hayashi K, Buxton JA, Kerr T. Latent patterns of polysubstance use among people who use opioids: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103584. [DOI: 10.1016/j.drugpo.2022.103584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/20/2021] [Accepted: 01/11/2022] [Indexed: 02/07/2023]
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82
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Ballester P, Muriel J, Peiró AM. CYP2D6 phenotypes and opioid metabolism: the path to personalized analgesia. Expert Opin Drug Metab Toxicol 2022; 18:261-275. [PMID: 35649041 DOI: 10.1080/17425255.2022.2085552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Opioids play a fundamental role in chronic pain, especially considering when 1 of 5 Europeans adults, even more in older females, suffer from it. However, half of them do not reach an adequate pain relief. Could pharmacogenomics help to choose the most appropriate analgesic drug? AREAS COVERED The objective of the present narrative review was to assess the influence of cytochrome P450 2D6 (CYP2D6) phenotypes on pain relief, analgesic tolerability, and potential opioid misuse. Until December 2021, a literature search was conducted through the MEDLINE, PubMed database, including papers from the last 10 years. CYP2D6 plays a major role in metabolism that directly impacts on opioid (tramadol, codeine, or oxycodone) concentration with differences between sexes, with a female trend toward poorer pain control. In fact, CYP2D6 gene variants are the most actionable to be translated into clinical practice according to regulatory drug agencies and international guidelines. EXPERT OPINION CYP2D6 genotype can influence opioids' pharmacokinetics, effectiveness, side effects, and average opioid dose. This knowledge needs to be incorporated in pain management. Environmental factors, psychological together with genetic factors, under a sex perspective, must be considered when you are selecting the most personalized pain therapy for your patients.
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Affiliation(s)
- Pura Ballester
- Neuropharmacology on Pain (NED) group, Alicante Institute for Health and Biomedical Research (ISABIAL Foundation), Alicante, Spain
| | - Javier Muriel
- Neuropharmacology on Pain (NED) group, Alicante Institute for Health and Biomedical Research (ISABIAL Foundation), Alicante, Spain
| | - Ana M Peiró
- Neuropharmacology on Pain (NED) group, Alicante Institute for Health and Biomedical Research (ISABIAL Foundation), Alicante, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain
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83
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Rock KL, Reynolds LM, Rees P, Copeland CS. Highlighting the hidden dangers of a 'weak' opioid: Deaths following use of dihydrocodeine in England (2001-2020). Drug Alcohol Depend 2022; 233:109376. [PMID: 35248998 DOI: 10.1016/j.drugalcdep.2022.109376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/12/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dihydrocodeine (DHC) is considered a 'weak' opioid, but there is evidence of its increasing misuse in overdose deaths. This research aims to analyse trends in DHC-related deaths in England relevant to source and dose of DHC, and decedent demographics. METHODS Cases from England reported to the National Programme on Substance Abuse Deaths (NPSAD) where DHC was identified at post-mortem and/or implicated in death between 2001 and 2020 were extracted for analysis. RESULTS 2071 DHC-related deaths were identified. The greatest number of deaths involved illicitly obtained DHC and a significant increase in these deaths was recorded over time (r = 0.5, p = 0.03). However, there was a concurrent decline in the implication rate of DHC in causing death (r = -0.6, p < 0.01). Fatalities were primarily due to accidental overdose (64.8%) and misuse was highly prevalent in combination with additional central nervous system depressants (95.3%), namely illicit heroin/morphine and diazepam. In contrast, when DHC was obtained over-the-counter (OTC) suicide mortality accounted for almost half of the deaths (42.5%). Differences in polysubstance use were also identified, with less heroin/morphine and benzodiazepine co-detection, but increased OTC codeine co-detection. CONCLUSIONS DHC misuse in England is increasing. The pharmacological consideration of DHC as a 'weak' opioid may be misinterpreted by users, leading to accidental overdosing. There is an urgent need to understand increasing polypharmacy in overdose deaths. Additionally, suicides involving DHC is a potential cause for concern and a review of OTC opioid-paracetamol preparations is necessary to determine whether the benefits of these medications continue to outweigh the risks of intentional overdose.
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Affiliation(s)
- Kirsten L Rock
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Medicine, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, UK.
| | - Laura M Reynolds
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Medicine, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, UK
| | - Paul Rees
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Medicine, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, UK
| | - Caroline S Copeland
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Medicine, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, UK; National Programme on Substance Abuse Deaths, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
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84
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Argo A, Zerbo S, Buscemi R, Trignano C, Bertol E, Albano GD, Vaiano F. A Forensic Diagnostic Algorithm for Drug-Related Deaths: A Case Series. TOXICS 2022; 10:152. [PMID: 35448413 PMCID: PMC9024928 DOI: 10.3390/toxics10040152] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/11/2022] [Accepted: 03/19/2022] [Indexed: 02/06/2023]
Abstract
The best evidence provided in the literature worldwide suggests the importance of harmonizing the investigation in drug-related fatalities. In this study, the application of a multidisciplinary approach in eight cases of drug-related deaths is presented. Although death scene findings could be highly suggestive of drug intoxication, external examination and toxicological screening test alone are insufficient. There are several variables, and it is not always easy to give the proper interpretation of the drug detection. A complete autopsy is necessary to correctly complete organ and tissues sampling for further histological and toxicological studies and obtain body fluids. The use of peripheral blood is recommended to avoid artifacts. The collection of many specimens is warranted to get more responses. The sampling aims to provide a picture of the distribution of the substance in the body. The sample and the selection of the drugs and the matrices to investigate are case-dependent. The presented diagnostic algorithm provides the coroner with all the elements to investigate drug-related deaths and cooperate with toxicologists. Toxicological forensic diagnosis is still extremely heterogeneous in regional and national contexts. Funding for method development, research, networking, facilities, and technologies improvement is mandatory to standardize the toxicological investigation.
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Affiliation(s)
- Antonina Argo
- PROMISE Department, University of Palermo, 90100 Palermo, Italy; (A.A.); (S.Z.); (R.B.)
| | - Stefania Zerbo
- Department of Biomedical Sciences, University of Sassari, 7100 Sassari, Italy;
| | - Roberto Buscemi
- Department of Biomedical Sciences, University of Sassari, 7100 Sassari, Italy;
| | - Claudia Trignano
- Department of Health Sciences, University of Florence, 50121 Florence, Italy; (E.B.); (F.V.)
| | - Elisabetta Bertol
- Department of Biomedical Sciences, University of Sassari, 7100 Sassari, Italy;
| | | | - Fabio Vaiano
- Department of Biomedical Sciences, University of Sassari, 7100 Sassari, Italy;
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Vodovar D, Chevillard L, Caillé F, Risède P, Pottier G, Auvity S, Mégarbane B, Tournier N. Mechanisms of respiratory depression induced by the combination of buprenorphine and diazepam in rats. Br J Anaesth 2022; 128:584-595. [PMID: 34872716 DOI: 10.1016/j.bja.2021.10.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/05/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The safety profile of buprenorphine has encouraged its widespread use. However, fatalities have been attributed to benzodiazepine/buprenorphine combinations, by poorly understood mechanisms of toxicity. Mechanistic hypotheses include (i) benzodiazepine-mediated increase in brain buprenorphine (pharmacokinetic hypothesis); (ii) benzodiazepine-mediated potentiation of buprenorphine interaction with opioid receptors (receptor hypothesis); and (iii) combined effects of buprenorphine and benzodiazepine on respiratory parameters (pharmacodynamic hypothesis). METHODS We studied the neuro-respiratory effects of buprenorphine (30 mg kg-1, i.p.), diazepam (20 mg kg-1, s.c.), and diazepam/buprenorphine combination in rats using arterial blood gas analysis, plethysmography, and diaphragm electromyography. Pretreatments with various opioid and gamma-aminobutyric acid receptor antagonists were tested. Diazepam impact on brain 11C-buprenorphine kinetics and binding to opioid receptors was studied using positron emission tomography imaging. RESULTS In contrast to diazepam and buprenorphine alone, diazepam/buprenorphine induced early-onset sedation (P<0.05) and respiratory depression (P<0.001). Diazepam did not alter 11C-buprenorphine brain kinetics or binding to opioid receptors. Diazepam/buprenorphine-induced effects on inspiratory time were additive, driven by buprenorphine (P<0.0001) and were blocked by naloxonazine (P<0.01). Diazepam/buprenorphine-induced effects on expiratory time were non-additive (P<0.001), different from buprenorphine-induced effects (P<0.05) and were blocked by flumazenil (P<0.01). Diazepam/buprenorphine-induced effects on tidal volume were non-additive (P<0.01), different from diazepam- (P<0.05) and buprenorphine-induced effects (P<0.0001) and were blocked by naloxonazine (P<0.05) and flumazenil (P<0.05). Compared with buprenorphine, diazepam/buprenorphine decreased diaphragm contraction amplitude (P<0.01). CONCLUSIONS Pharmacodynamic parameters and antagonist pretreatments indicate that diazepam/buprenorphine-induced respiratory depression results from a pharmacodynamic interaction between both drugs on ventilatory parameters.
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Affiliation(s)
- Dominique Vodovar
- Inserm UMRS-1144, Paris, France; Université de Paris, Paris, France; Université Paris-Saclay - CEA - CNRS - Inserm - BioMaps, Orsay, France; Paris Poison Center, Assistance Publique - Hôpitaux de Paris, Paris, France; Department of Medical and Toxicological Critical Care, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Lucie Chevillard
- Inserm UMRS-1144, Paris, France; Université de Paris, Paris, France
| | - Fabien Caillé
- Université Paris-Saclay - CEA - CNRS - Inserm - BioMaps, Orsay, France
| | | | - Géraldine Pottier
- Université Paris-Saclay - CEA - CNRS - Inserm - BioMaps, Orsay, France
| | - Sylvain Auvity
- Université Paris-Saclay - CEA - CNRS - Inserm - BioMaps, Orsay, France
| | - Bruno Mégarbane
- Inserm UMRS-1144, Paris, France; Université de Paris, Paris, France; Department of Medical and Toxicological Critical Care, Assistance Publique - Hôpitaux de Paris, Paris, France.
| | - Nicolas Tournier
- Université Paris-Saclay - CEA - CNRS - Inserm - BioMaps, Orsay, France
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86
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Azab SMS, Tawfik H, Hayes BD. Intoxication related to substances use in patients presenting to Ain Shams University Poisoning Treatment Center, Cairo, Egypt (2015-2019). Drug Alcohol Rev 2022; 41:1109-1118. [PMID: 35178787 DOI: 10.1111/dar.13443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Illicit drug use may result in several emergencies. Hospital emergency data can help to detect new patterns of substance use and high-risk trends of drug use. This epidemiological study aimed to investigate the pattern and outcome of cases with substance use intoxication who presented to Ain Shams University Poisoning Treatment Centre, Cairo, Egypt. METHODS This retrospective study included all cases of acute intoxication due to use/misuse of substances who presented to the centre during the period (2015-2019). RESULTS The study included 11 281 cases; young adults (aged 20-40 years) represented the greatest proportion of cases (6519, 57.8%). Males were the predominant gender in all age groups (representing 79.2% of the cases). Tramadol was the most common substance of exposure in all age groups except for children and adolescents where cannabis was the most common one. There were 162 fatalities (1.4% of all cases) and opioids had the greatest case fatality rate. DISCUSSION AND CONCLUSIONS Tramadol was the most used drug that resulted in acute intoxication, followed by cannabis. A total of 43.6% of the cases of acute intoxications were due to recreational use/misuse of prescription drugs.
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Affiliation(s)
- Sonya M S Azab
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hany Tawfik
- Poisoning Treatment Center, Ain Shams University Hospitals, Cairo, Egypt
| | - Bryan D Hayes
- Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Division of Medical Toxicology, Harvard Medical School, Boston, Massachusetts, USA
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87
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Rapid and accurate etizolam detection using surface-enhanced Raman spectroscopy for community drug checking. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103611. [PMID: 35151084 DOI: 10.1016/j.drugpo.2022.103611] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/22/2021] [Accepted: 01/31/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND In British Columbia, Canada, illicit opioids have been increasingly combined with etizolam, a benzodiazepine analog, that continues to challenge popular portable drug checking technologies as it is often present in low concentrations as a result of its high potency. An unknown combination of opioids and benzodiazepines may have dangerous consequences due to unpredictable dosing, increased respiratory depression, and complicated overdose response measures. METHODS Surface-enhanced Raman spectroscopy (SERS) using a portable Raman spectrometer is used to establish a univariate model for the detection of etizolam in opioid drug mixtures (n=100) obtained from the Vancouver Island Drug Checking Project, where the presence of etizolam has been determined using paper-spray mass spectrometry. Benzodiazepine immunoassay test strips are also performed on all samples for comparison. RESULTS SERS is shown to detect etizolam with high sensitivity (96%) and specificity (86%). In contrast, benzodiazepine test strips demonstrate a low sensitivity (8%) for the detection of etizolam of the same samples (n=100), with only small improvements when studied over a larger subset of samples (n=506, sensitivity = 29%). CONCLUSION We have demonstrated the potential of SERS for trace detection of etizolam within complex sample matrices. Since SERS is one of the few portable technologies capable of trace detection, further studies on its ability for quantification and discrimination of trace adulterants in street samples is of significant interest for point-of-care applications.
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88
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Almeida-González M, Boada LD, Henríquez-Hernández LA, Luzardo OP, Zaragoza E, Burillo-Putze G, Quintana-Montesdeoca MP, Zumbado M. Medical Psychotropics in Forensic Autopsies in European Countries: Results from a Three-Year Retrospective Study in Spain. TOXICS 2022; 10:toxics10020064. [PMID: 35202250 PMCID: PMC8876624 DOI: 10.3390/toxics10020064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 12/21/2022]
Abstract
Medical psychotropics are widely used and prescribed in developed countries. These medications may have an impairing effect on mood or perception and may induce harmful behaviors. Nevertheless, in Europe, studies on their importance from a medico-legal perspective are scarce. To fill this gap, we evaluate the determinants of these drugs in a retrospective study based on data obtained from forensic autopsies. Toxicological analyses were performed on 394 blood samples from compulsory autopsies at the Institute of Legal Medicine of Las Palmas. Of the samples, 41% (159) were positive for at least one psychotropic, with benzodiazepines being the most frequently detected (24.1%), followed by opiates and antidepressants. Benzodiazepines, opiates, and antidepressants were detected more frequently in men who suffered a violent death. More than 30% of the positive samples showed two or more drugs, suggesting a prevalence of polypharmacy among forensic autopsy subjects, with the most frequently combination found being benzodiazepines plus opiates (28.3% of positive samples). A combination of opiates plus antidepressants was also found in subjects involved in violent deaths. Our results suggest that more than 40% of the adult European population involved in medico-legal issues may be under the influence of legal psychotropics. The link between violent deaths and the use of medical psychotropics is particularly worrisome and indicates that these drugs should be carefully monitored in developed countries, in all forensic autopsies, in a similar way to illegal psychotropics.
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Affiliation(s)
- Maira Almeida-González
- Institute of Legal Medicine of Las Palmas, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain; (M.A.-G.); (L.D.B.); (E.Z.)
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain; (O.P.L.); (M.P.Q.-M.); (M.Z.)
| | - Luis D. Boada
- Institute of Legal Medicine of Las Palmas, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain; (M.A.-G.); (L.D.B.); (E.Z.)
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain; (O.P.L.); (M.P.Q.-M.); (M.Z.)
| | - Luis Alberto Henríquez-Hernández
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain; (O.P.L.); (M.P.Q.-M.); (M.Z.)
- Correspondence: ; Tel.: +34-928-451-461
| | - Octavio P. Luzardo
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain; (O.P.L.); (M.P.Q.-M.); (M.Z.)
| | - Enrique Zaragoza
- Institute of Legal Medicine of Las Palmas, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain; (M.A.-G.); (L.D.B.); (E.Z.)
| | - Guillermo Burillo-Putze
- Emergency Department, Hospital Universitario de Canarias, Carretera Ofra S/N, 38320 San Cristóbal de La Laguna, Spain;
| | - María P. Quintana-Montesdeoca
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain; (O.P.L.); (M.P.Q.-M.); (M.Z.)
| | - Manuel Zumbado
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain; (O.P.L.); (M.P.Q.-M.); (M.Z.)
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Emerging trends in point-of-care sensors for illicit drugs analysis. Talanta 2022; 238:123048. [PMID: 34801905 DOI: 10.1016/j.talanta.2021.123048] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 12/18/2022]
Abstract
Consumption of illicit narcotic drugs and fatal or criminal activities under their influence has become an utmost concern worldwide. These drugs influence an individual's feelings, perceptions, and emotions by altering the state of consciousness and thus can result in serious safety breaches at critical workplaces. Point-of-care drug-testing devices have become the need-of-the-hour for many sections such as the law enforcement agencies, the workplaces, etc. for safety and security. This review focuses on the recent progress on various electrochemical and optical nanosensors developed for the analysis of the most common illicit drugs (or their metabolites) such as tetrahydrocannabinol (THC), cocaine (COC), opioids (OPs), amphetamines & methamphetamine, and benzodiazepine (BZDs). The paper also highlights the sensitivity and selectivity of various sensing modalities along with evolving parameters such as real-time monitoring and measurement via a smart user interface. An overall outlook of recent technological advances in point of care (POC) devices and guided insights and directions for future research is presented.
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90
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Herlinger K, Lingford-Hughes A. Opioid use disorder and the brain: a clinical perspective. Addiction 2022; 117:495-505. [PMID: 34228373 DOI: 10.1111/add.15636] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/16/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023]
Abstract
Opioid use disorder (OUD) has gained increasing publicity and interest during recent years, with many countries describing problems of epidemic proportions with regard to opioid use and deaths related to opioids. While opioids are not themselves acutely neurotoxic, the chronic relapsing and remitting nature of this disorder means that individuals are often exposed to exogenous opioids for lengthy periods of time (either illicit or prescribed as treatment). We are increasingly characterizing the effect of such long-term opioid exposure on the brain. This narrative review aims to summarize the literature regarding OUD and the brain from a clinical perspective. Alterations of brain structure and function are discussed, as well as neurological and psychiatric disorders in OUD. Finally, we review current and new directions for assessment and treatment.
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Affiliation(s)
- Katherine Herlinger
- MRC Addiction Research Clinical Training Programme, Imperial College London, London, UK
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91
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Jakobsson G, Gustavsson S, Jönsson AK, Ahlner J, Gréen H, Kronstrand R. Oxycodone-Related Deaths: The Significance of Pharmacokinetic and Pharmacodynamic Drug Interactions. Eur J Drug Metab Pharmacokinet 2022; 47:259-270. [PMID: 35025054 PMCID: PMC8917044 DOI: 10.1007/s13318-021-00750-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Oxycodone is frequently prescribed as well as detected in postmortem cases. Concurrent use of pharmacodynamically or pharmacokinetically interacting drugs can cause adverse effects or even fatal intoxication. The aims of this study were to investigate differences in prescriptions for and toxicological findings of pharmacodynamically and pharmacokinetically interacting drugs in fatal oxycodone-related intoxications and other causes of death. We also aimed to investigate the differences in prevalence of oxycodone prescriptions, and the detected postmortem oxycodone concentrations between fatal oxycodone-related intoxications and other causes of death. METHODS Forensic autopsy cases (2012-2018) where oxycodone was identified in femoral blood (n = 1236) were included. Medical history and prescription data were retrieved from national databases and linked to the forensic toxicology findings. RESULTS Oxycodone-related deaths were found to have higher blood concentrations of oxycodone (median 0.30 µg/g vs. 0.05 µg/g) and were less likely to have a prescription for oxycodone (OR 0.62) compared to nonintoxication deaths. Pharmacodynamically interacting drugs were prescribed in 79% and found in blood in 81% of the cases. Pharmacokinetically interacting drugs were rarely prescribed (1%). Oxycodone-related deaths were more likely to have prescriptions for a pharmacodynamically interacting drug (OR 1.7) and more often have co-findings of one or multiple pharmacodynamically interacting drugs (OR 5.6). CONCLUSION The results suggest that combined use of oxycodone and pharmacodynamically interacting drugs is associated with oxycodone-related death and that non-medical use of oxycodone is a potential risk factor for oxycodone-related intoxication.
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Affiliation(s)
- Gerd Jakobsson
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, 587 58, Linköping, Sweden. .,Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, 581 83, Linköping, Sweden.
| | - Sara Gustavsson
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, 587 58, Linköping, Sweden
| | - Anna K Jönsson
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, 587 58, Linköping, Sweden.,Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Johan Ahlner
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Henrik Gréen
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, 587 58, Linköping, Sweden.,Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Robert Kronstrand
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, 587 58, Linköping, Sweden.,Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, 581 83, Linköping, Sweden
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92
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Bråbäck M, Brantefors A, Franck J, Brådvik L, Isendahl P, Nilsson S, Troberg K, Håkansson A. Substance Use, Hospitalizations, and Co-Occurring Disorders among Patients Transferred from a Needle Exchange Program to Opioid Maintenance Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020697. [PMID: 35055519 PMCID: PMC8775654 DOI: 10.3390/ijerph19020697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Abstract
Opioid use disorders (OUD) is a relapsing condition with high mortality. Opioid maintenance treatment (OMT) reduces heroin use, and overall morbidity and mortality. The prevalence of psychiatric and substance use disorders, potential baseline predictors for psychiatric hospitalization, and psychiatric diagnoses at follow-up were investigated and may give hints about possible preventative strategies. The medical records for 71 patients were reviewed 36 months following referral to OMT from a needle exchange program (NEP). Their psychiatric diagnoses and hospitalizations were identified. Their baseline characteristics were assessed for potential differences between hospitalized versus non-hospitalized patients and between patients with and without psychiatric diagnoses in a longitudinal observational study without controls. A regression analysis was performed to identify predictors for hospitalization when controlling for OMT status. Sixty-five percent of the patients were hospitalized at least once with a psychiatric diagnosis. Substance-related reasons were prevalent, and detoxification occurred among 59% of patients, with sedative- hypnotics (benzodiazepines, zopiclone, zolpidem, and pregabalin) being the substance used by 52% of patients. Baseline use of these drugs and/or buprenorphine predicted for hospitalization when controlling for OMT status. During the follow-up period, 72% of patients met the criteria for a psychiatric diagnosis other than OUD. The prevalence of non-substance use disorders overlapping with SUD was 41%, and that overlapping with anxiety disorder was 27% of all participants. Increased attention to psychiatric co-occurring disorders in the treatment of OUD is required and the importance of addressing sedative-hypnotics use when initiating OMT is highlighted.
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Affiliation(s)
- Martin Bråbäck
- Department of Clinical Sciences Lund, Faculty of Medicine, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden; (M.B.); (A.B.); (L.B.); (K.T.); (A.H.)
- Addiction Center Malmö, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden;
| | - Anna Brantefors
- Department of Clinical Sciences Lund, Faculty of Medicine, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden; (M.B.); (A.B.); (L.B.); (K.T.); (A.H.)
- Addiction Center Malmö, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden;
| | - Johan Franck
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, SE171 77 Solna, Sweden;
| | - Louise Brådvik
- Department of Clinical Sciences Lund, Faculty of Medicine, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden; (M.B.); (A.B.); (L.B.); (K.T.); (A.H.)
- Correspondence: ; Tel.: +46-46-7332410
| | - Pernilla Isendahl
- Department of Infectious Diseases, University Hospital Skåne, SE205 02 Malmö, Sweden;
| | - Suzan Nilsson
- Addiction Center Malmö, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden;
| | - Katja Troberg
- Department of Clinical Sciences Lund, Faculty of Medicine, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden; (M.B.); (A.B.); (L.B.); (K.T.); (A.H.)
- Addiction Center Malmö, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden;
| | - Anders Håkansson
- Department of Clinical Sciences Lund, Faculty of Medicine, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden; (M.B.); (A.B.); (L.B.); (K.T.); (A.H.)
- Addiction Center Malmö, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden;
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93
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Engin E. GABA A receptor subtypes and benzodiazepine use, misuse, and abuse. Front Psychiatry 2022; 13:1060949. [PMID: 36713896 PMCID: PMC9879605 DOI: 10.3389/fpsyt.2022.1060949] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/29/2022] [Indexed: 01/14/2023] Open
Abstract
Benzodiazepines have been in use for over half a century. While they remain highly prescribed, their unfavorable side-effect profile and abuse liability motivated a search for alternatives. Most of these efforts focused on the development of benzodiazepine-like drugs that are selective for specific GABAA receptor subtypes. While there is ample evidence that subtype-selective GABAA receptor ligands have great potential for providing symptom relief without typical benzodiazepine side-effects, it is less clear whether subtype-selective targeting strategies can also reduce misuse and abuse potential. This review focuses on the three benzodiazepine properties that are relevant to the DSM-5-TR criteria for Sedative, Hypnotic, or Anxiolytic Use Disorder, namely, reinforcing properties of benzodiazepines, maladaptive behaviors related to benzodiazepine use, and benzodiazepine tolerance and dependence. We review existing evidence regarding the involvement of different GABAA receptor subtypes in each of these areas. The reviewed studies suggest that α1-containing GABAA receptors play an integral role in benzodiazepine-induced plasticity in reward-related brain areas and might be involved in the development of tolerance and dependence to benzodiazepines. However, a systematic comparison of the contributions of all benzodiazepine-sensitive GABAA receptors to these processes, a mechanistic understanding of how the positive modulation of each receptor subtype might contribute to the brain mechanisms underlying each of these processes, and a definitive answer to the question of whether specific chronic modulation of any given subtype would result in some or all of the benzodiazepine effects are currently lacking from the literature. Moreover, how non-selective benzodiazepines might lead to the maladaptive behaviors listed in DSM and how different GABAA receptor subtypes might be involved in the development of these behaviors remains unexplored. Considering the increasing burden of benzodiazepine abuse, the common practice of benzodiazepine misuse that leads to severe dependence, and the current efforts to generate side-effect free benzodiazepine alternatives, there is an urgent need for systematic, mechanistic research that provides a better understanding of the brain mechanisms of benzodiazepine misuse and abuse, including the involvement of specific GABAA receptor subtypes in these processes, to establish an informed foundation for preclinical and clinical efforts.
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Affiliation(s)
- Elif Engin
- Stress Neurobiology Laboratory, Division of Basic Neuroscience, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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94
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Zamboni L, Portoghese I, Congiu A, Zandonai T, Casari R, Fusina F, Bertoldi A, Lugoboni F. Polysubstance Use Patterns Among High Dose Benzodiazepine Users: A Latent Class Analysis and Differences Between Male and Female Use. Front Psychiatry 2022; 13:811130. [PMID: 35145442 PMCID: PMC8821140 DOI: 10.3389/fpsyt.2022.811130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/03/2022] [Indexed: 11/23/2022] Open
Abstract
Benzodiazepines (BZDs) represent one of the most widely used groups of pharmaceuticals, but if used for long periods of time they are associated with dependence and an increased risk of harmful effects. High-dose (HD) BZD dependence is a specific substance use disorder associated with a poor quality of life. It is especially important to pinpoint differences in HD BZD addict subgroups in order to tailor treatment to the individual's specific needs, also considering possible comorbidities with other substance use disorders. We conducted a study to evaluate HD BZD dependence (converted doses to diazepam equivalents, mg) in an Italian sample of 1,354 participants. We also investigated if and to which extent participants co-used other substances (alcohol, tobacco, cannabis/cannabinoids, cocaine, and heroin). We then performed latent class analysis (LCA) to identify the use patterns of these substances, finding three classes: participants in Class 1 (4.3% of the sample) had the highest probability of also using cocaine and alcohol (Polysubstance BZD users); Class 2 comprised subjects with the highest probability of being former heroin, cocaine, THC, and alcohol users (Former polysubstance BZD users); Class 3 represented mono-dependence BZD users (78.5% of the sample) and was the most prevalent among women, while young men were most prevalent in Class 1. The present study underlines different characteristics in HD BZD users both concerning other addictions and sex, and also highlights the need for a stricter control of BZD use, ranging from prescriptions to sales.
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Affiliation(s)
- Lorenzo Zamboni
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy.,Department of Neurosciences, University of Verona, Verona, Italy
| | - Igor Portoghese
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Alessio Congiu
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy
| | - Thomas Zandonai
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University, Elche, Spain.,Neuropharmacology on Pain and Functional Diversity (NED), Institute of Health and Biomedical Research of Alicante (ISABIAL), Alicante, Spain
| | - Rebecca Casari
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy
| | - Francesca Fusina
- Padova Neuroscience Center, University of Padova, Padova, Italy.,Department of General Psychology, University of Padova, Padova, Italy
| | - Anna Bertoldi
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy
| | - Fabio Lugoboni
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy
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95
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Weiss NH, Kiefer R, Goncharenko S, Raudales AM, Forkus SR, Schick MR, Contractor AA. Emotion regulation and substance use: A meta-analysis. Drug Alcohol Depend 2022; 230:109131. [PMID: 34864568 PMCID: PMC8714680 DOI: 10.1016/j.drugalcdep.2021.109131] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/26/2021] [Accepted: 09/30/2021] [Indexed: 01/03/2023]
Abstract
There has been exponential growth in research on emotion regulation and substance use in the past decade. The current meta-analysis evaluated variability in the magnitude of the relation between aspects of emotion regulation and substance use. A search of PsycINFO, Embase, PubMed, CINAHL Plus, and PILOTS in December 2020 resulted in 6642 initial studies, of which 95 met inclusion criteria (association between emotion regulation and substance use was reported, participants were > 18 years old, article was in English). A total of 445 effects were obtained (N = 156,025 participants; weighted Mage = 29.31; 59.5% female; 66.1% White; 76.6% non-clinical). Emotion regulation and substance use were significantly related (r = 0.19; p < 0.001; 95%CI [0.17, 0.20]). Emotion regulation abilities were generally more strongly related to substance use than emotion regulation strategies; this pattern was stronger for behavioral vs. cognitive abilities and extended to both negative and positive emotions. Relations were stronger for older and clinical samples; mixed effects were found for sex and no conclusive effects were found for race. Despite limitations of the existing literature (e.g., cross-sectional, self-reports), results indicated that the magnitude of the relation between emotion regulation and substance use varied considerably as a function of emotion regulation and substance use constructs and sample characteristics.
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96
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Gittins R, Vaziri R, Maidment I. Surveying Over the Counter and Prescription Only Medication Misuse in Treatment Services During COVID-19. SUBSTANCE ABUSE: RESEARCH AND TREATMENT 2022; 16:11782218221135875. [DOI: 10.1177/11782218221135875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022]
Abstract
Background: A greater understanding of Over the Counter (OTC) and Prescription Only Medication (POM) misuse amongst adults accessing substance misuse services (SMS) during COVID-19 is required to identify how SMS can better meet the needs of the people who require treatment. Aim: To use a questionnaire to explore OTC/POM misuse during COVID-19 in adults accessing community SMS in England. Methods: In 2020 to 2021 anonymous self-administered online/paper questionnaires which collated quantitative and qualitative data were completed. They were piloted for suitability and ethical approval was obtained. Thematic analysis was conducted for qualitative data and chi-square tests used to assess the relationship between quantitative variables. Results: Participants were Caucasian (94.6% British), majority male (58.9%), aged 18 to 61 years. Most were prescribed medication for problematic substance use, with a 92.5% self-reported adherence rate. The misuse of benzodiazepines (22.2%) codeine products (30.8%) and pregabalin (14.5%) predominated and 37.5% misused 2 or more medicines. Administration was usually oral and concomitant use of other substances was common: alcohol 44.6% (52% daily), tobacco/vaping 73.2% and illicit substances 58.9%. There were statistically significant associations identified, including between changes during COVID-19 to OTC/POM misuse and illicit use. Only 56 questionnaires were included in the analysis: we believe this low number was because of infection control measures, limited footfall in services, pressures on staff limiting their capacity to distribute the paper questionnaires and reliance upon telephone consultations limiting online distribution. Increasing OTC/POM misuse and obtaining illicit supplies were reported when access to usual supplies were restricted; however, changes to doses/dispensing arrangement liberalisation in response to COVID-19 were positively viewed. Conclusion: OTC/POM misuse, including polypharmacy and concomitant use of other substances occurred during COVID-19: SMS need to be vigilant for these issues and mitigate the associated risks for example with harm reduction interventions. Further qualitative research is required to explore the issues identified.
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Affiliation(s)
- Rosalind Gittins
- Clinical Department, Humankind, Durham, UK
- Aston Pharmacy School, Aston University, Birmingham, UK
| | | | - Ian Maidment
- Aston Pharmacy School, Aston University, Birmingham, UK
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Effort-Reward Imbalance at Work and Drug Misuse: Evidence from a National Survey in the U.S. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413334. [PMID: 34948938 PMCID: PMC8702104 DOI: 10.3390/ijerph182413334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 12/25/2022]
Abstract
With the rise of drug misuse among workers in recent years, preliminary research on potential risk factors in the workplace of single-type of drug misuse has been reported. This is the first study to examine cross-sectional associations of work stress, in terms of effort-reward imbalance, with multiple drug misuse (including any drug misuse, opioid misuse, sedatives misuse, cannabis misuse, and other drug misuse) during the past 12 months in a national sample of U.S. workers. Data of 2211 workers were derived from the nationally representative and population-based Midlife in the United States (MIDUS) study. Internal consistency reliability and factorial validity of a 17-item effort-reward imbalance measure were robust and satisfactory. After adjustment for relevant covariates, logistic regression analyses showed that workers experiencing effort-reward imbalance at work had significantly higher odds of any drug misuse (OR and 95% CI = 1.18 (1.03, 1.37)), especially opioid misuse (OR and 95% CI = 1.35 (1.07, 1.69)) and other drug misuse (OR and 95% CI = 1.36 (1.01, 1.83)). The findings suggest that a stressful work environment may act as a determinant of drug misuse, and further prospective evidence is needed.
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98
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Nataraj N, Zhang K, Strahan AE, Guy GP. Congruence of opioid prescriptions and dispensing using electronic records and claims data. Health Serv Res 2021; 56:1245-1251. [PMID: 34008209 PMCID: PMC8586485 DOI: 10.1111/1475-6773.13673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 04/05/2021] [Accepted: 04/14/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To quantify discrepancies between opioid prescribing and dispensing via the percentage of patients with Electronic Medical Record (EMR) prescriptions who subsequently filled the prescription within 90 days, defined as congruence, and compared opioid congruence with related medications. DATA SOURCES Deidentified data from the IBM MarketScan Explorys Claims-EMR Dataset. STUDY DESIGN In this retrospective, observational study, we examined congruence for commonly prescribed controlled substances-opioids, stimulants, and benzodiazepines. Congruence was stratified by age group and sex. DATA COLLECTION/EXTRACTION METHODS Continuously enrolled adults aged 18-64 years with an EMR encounter (excluding inpatient settings) and ≥ 1 prescription for selected classes between 1/1/2016 and 10/2/2017. PRINCIPAL FINDINGS During the study period, 1,353,478 adults had ≥1 EMR encounter. Patients with stimulants prescriptions had the highest congruence (83%) corresponding to 7151 claims for 8,635 EMR prescriptions, followed by opioids (66%; 62,766/95,690) and benzodiazepines (64%; 30,181/47,408). Chi-square testing showed congruence differed by age group within opioids (P < .0001) and benzodiazepines (P < .0001) and was higher among females within benzodiazepines (P < .0001). CONCLUSIONS These findings demonstrate that relying on claims data alone for opioid prescribing measures might underestimate actual prescribing magnitude by as much as one-third in these data. Combined EMR and claims data can help future research better understand characteristics associated with congruence or incongruence between prescribing and dispensing.
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Affiliation(s)
- Nisha Nataraj
- Division of Overdose Prevention, National Center for Injury Prevention and ControlCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Kun Zhang
- Division of Overdose Prevention, National Center for Injury Prevention and ControlCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Andrea E. Strahan
- Division of Overdose Prevention, National Center for Injury Prevention and ControlCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Gery P. Guy
- Division of Overdose Prevention, National Center for Injury Prevention and ControlCenters for Disease Control and PreventionAtlantaGeorgiaUSA
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99
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Schepis TS, McCabe SE. The latent class structure of substance use in US adults 50 years and older. Int J Geriatr Psychiatry 2021; 36:1867-1877. [PMID: 34318511 PMCID: PMC8996684 DOI: 10.1002/gps.5605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/21/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Substance use rates have increased in adults 50 years and older, and substance use in this population is associated with significant consequences. Given that little is known about their underlying substance use patterns, the objective was to identify latent classes of adults 50 years and older by past-year substance use, past-month substance use, and past-year substance use disorder (SUD) diagnosis. METHODS The National Survey on Drug Use and Health is an annual nationwide cross-sectional U.S. survey. Participants were 35,229 civilian, non-institutionalized U.S. residents, 50 years and older. Past-year and past-month alcohol, tobacco, marijuana, heroin, cocaine, methamphetamine use, and opioid, stimulant, and tranquilizer/sedative prescription drug misuse (PDM) were captured, as was past-year DSM-IV SUD from these substances. Correlates included mental health, physical health, and healthcare utilization variables. RESULTS Latent class analysis indicated four past-year or past-month substance use subgroups (Alcohol-Only, Alcohol-Tobacco-Marijuana, Cocaine-Polydrug, PDM-Polydrug), with SUD prevalence rising from 3.2% to 17.3%, 68.8%, and 78.5% by past-year subgroup; similarly, rates of past-year suicidal ideation increased from 2.1%, to 4.8%, 12.0%, and 20.4% by past-year subgroup. For SUD, there were three subgroups (Low Nicotine Dependence [ND], High Alcohol Use Disorder, Multiple SUDs). Over 90% of adults were in a low-risk subgroup (i.e., Alcohol-Only and Low ND), but members of Cocaine-Polydrug, PDM-Polydrug, or Multiple SUDs latent classes had high rates of mental and physical health concerns. CONCLUSIONS Most adults 50 and older have lower risk profiles, but those engaged in PDM or cocaine use are heavily substance-involved and need screening and likely multi-disciplinary intervention.
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Affiliation(s)
- Ty S. Schepis
- Department of Psychology, Texas State University, San Marcos, Texas, USA,Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan, USA,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA,Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
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100
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Arab AZ, Conti AA, Davey F, Khan F, Baldacchino AM. Relationship Between Cardiovascular Disease Pathology and Fatal Opioid and Other Sedative Overdose: A Post-Mortem Investigation and Pilot Study. Front Pharmacol 2021; 12:725034. [PMID: 34803676 PMCID: PMC8602184 DOI: 10.3389/fphar.2021.725034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: In 2019, Scotland reported the highest number of drug deaths amongst EU countries. Of the 1,264 drug deaths reported in 2019, 94% were related to polysedative use. Studies have proposed a relationship between opioid use and cardiovascular disease. Furthermore, the concomitant use of sedatives and opioids has been associated with lethal cardiopulmonary events. However, evidence is still limited for the relationship between polysedative use and cardiovascular diseases. Thus, the present study aimed to investigate the association between polysedative use and the underlying cardiovascular pathologies in drug deaths. Methods: This study consisted of a post-mortem investigation of 436 drug deaths. Data extracted from post-mortem reports included socio-demographic characteristics (e.g., gender, age), cardiovascular pathologies (e.g., atherosclerosis, atheroma, and inflammation), in addition to the presence of opioids (e.g. methadone, heroin) and other substances (e.g., alcohol, benzodiazepine) in the blood of the deceased. Stepwise multiple regression models were employed to identify which substances predicted cardiovascular pathologies. Results: The presence of opioids, benzodiazepines, and alcohol in the blood of the deceased predicted overall cardiovascular disease (CVD) severity [R2 = 0.33, F (5, 430) = 39.64, p < 0.0001; adjusted R2 = 0.32, f2 = 0.49]. Positive Beta coefficients may indicate an exacerbation of CVD (B = 0.48 95% CI = 0.25, 0.70) due to the presence of opioids in the blood of the deceased. Negative associations may instead indicate a relative protective effect of alcohol (B = −0.2, 95% CI = −0.41, −0.00) and benzodiazepines (B = −0.29, 95% CI = −0.48, −0.09) on CVD. Conclusion: These findings may inform national clinical guidelines on the need to monitor individuals who abuse opioids for presence of cardiovascular disease risk factors pathologies and provide timely interventions to reduce mortality in the population.
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Affiliation(s)
- Abdulmalik Zuhair Arab
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Aldo Alberto Conti
- Division of Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Fleur Davey
- NHS Fife, Queen Margaret Hospital, Dunfermline, United Kingdom
| | - Faisel Khan
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Alexander Mario Baldacchino
- Division of Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
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