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Tardelli VS, Fidalgo TM, Martins SS. Z-Drug Use and Benzodiazepine Use and Misuse Among LGB Populations: The Role of Psychological Distress. J Addict Med 2024; 18:437-442. [PMID: 38557937 DOI: 10.1097/adm.0000000000001309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Z-drugs (hypnotics such as zolpidem, zopiclone, and zaleplon) and benzodiazepines (BZDs) are sedative medications with misuse liability. The goals of this study are to report the (1) prevalence of past-year any Z-drug use, any BZD use, and any BZD misuse by sexual identity category and psychological distress; (2) associations among these 3 categories between sexual identity and past-year psychological distress; (3) associations among these 3 categories with sexual identity by past-year psychological distress status. METHODS Data were collected from the National Survey on Drug Use and Health (years 2015-2019 [n = 210,392]), a yearly representative national household survey of the American population. We report prevalences of any Z-drug use, any BZD use, and any BZD misuse by sexual identity and past-year psychological distress status. We ran logistic regressions with complex survey design with the 3 dichotomous variables described above as the dependent variables, stratified and not-stratified by psychological distress. RESULTS Prevalence of any Z-drug an BZD use and any BZD misuse were higher among LGB (lesbian/gay/bisexual) populations, especially gay men and bisexual women. Psychological distress was positively associated with any Z-drug and BZD use and any BZD misuse. Women were at higher risk of Z-drug (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.18-1.37) and BZD use (OR, 1.64; 95% CI, 1.55-1.73), but lower risk of BZD misuse (OR, 0.82; 95% CI, 0.76-0.88). When stratifying by psychological distress, differences between LGB and heterosexuals were more pronounced among those without past-year psychological distress, especially gay men and bisexual women. CONCLUSIONS The presence of psychological distress attenuates the disparities between LGB and heterosexual individuals in Z-drug use and BZD use and misuse.
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Affiliation(s)
- Vitor S Tardelli
- From the Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (VST, TMF); and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (SSM)
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La Maida N, Di Giorgi A, Pichini S, Pellegrini M, Di Trana A, Elmo MG, Polselli GM, Casella P, Di Stefano A, Ducci G. Comprehensive Monitoring of Psychoactive Substances in Psychiatric Patients Using Liquid Chromatography-High-Resolution Mass Spectrometry: A Key Tool for Treatment Planning and Understanding Consumption Patterns in Rome, Italy. Ther Drug Monit 2024; 46:203-209. [PMID: 38018870 DOI: 10.1097/ftd.0000000000001163] [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: 06/21/2023] [Accepted: 10/05/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The comprehensive monitoring of licit and illicit drug consumption plays a crucial role in understanding the complexities of patient conditions and designing effective treatment strategies. In this study, the prevalence of psychoactive prescription drugs, classical illicit drugs, and new psychoactive substances (NPS) were objectively assessed in individuals diagnosed with drug-related psychiatric disorders or episodes. METHODS Blood, urine, and hair samples were collected from psychiatric patients admitted to the Mental Health Department and Drug Addiction Service of the North Rome Local Health Authority with declared or suspected psychoactive drug use. Comprehensive drug screening was conducted for all samples using ultra-high-performance liquid chromatography-high-resolution mass spectrometry. RESULTS A total of 71 blood and urine and 50 hair samples were analyzed to confirm the suitability of the ultra-high-performance liquid chromatography-high-resolution mass spectrometry method for the study purposes. The main substances found in blood and urine were antipsychotics (71.8% and 66.2%) and benzodiazepines (62.0% and 59.2%), respectively, whereas cocaine (84.0%) and antipsychotics (74.0%) was more evident in hair. Z-drugs were detected in blood (7.0%), urine (5.6%), and hair (24%) samples; amphetamines were mainly detected in hair samples (14.0%). Synthetic cathinones were the most frequently detected NPS in hair specimens (8.0%), whereas synthetic cannabinoids were mainly found in blood samples (11.3%). These analyses showed that patients were polydrug users (77.5% detected in blood and urine, and 94.0% in hair). CONCLUSIONS Comprehensive screening enabled the assessment of past, recent, and actual consumption of psychoactive substances, including licit and illicit drugs and NPS, by psychiatric patients. A thorough understanding of substance consumption patterns can enhance therapeutic interventions and management of psychiatric disorders associated with psychoactive substance use.
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Affiliation(s)
- Nunzia La Maida
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandro Di Giorgi
- Department of Excellence of Biomedical Science and Public Health, University "Politecnica delle Marche" of Ancona, Ancona, Italy
| | - Simona Pichini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Manuela Pellegrini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Annagiulia Di Trana
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Giuseppa Elmo
- Department of Mental Health, Azienda Sanitaria Locale (ASL) Roma 1-Servizio Psichiatrico di Diagnosi e Cura (SPDC), San Filippo Neri Hospital, Rome, Italy
| | - Gian Marco Polselli
- Department of Mental Health, Azienda Sanitaria Locale (ASL) Roma 1-Servizio Psichiatrico di Diagnosi e Cura (SPDC), San Filippo Neri Hospital, Rome, Italy
- Department of Mental Health, Azienda Sanitaria Locale (ASL) Roma 1-Servizio Psichiatrico di Diagnosi e Cura (SPDC), S. Spirito Hospital, Rome, Italy
| | - Pietro Casella
- Department of Mental Health, Azienda Sanitaria Locale (ASL) Roma 1-Drug Dipendence and Addiction Unit, Rome, Italy; and
| | - Adele Di Stefano
- Department of Mental Health, Azienda Sanitaria Locale (ASL) Roma 1-Mental Health and Drug Dipendence Unit in prison, Rome, Italy
| | - Giuseppe Ducci
- Department of Mental Health, Azienda Sanitaria Locale (ASL) Roma 1-Servizio Psichiatrico di Diagnosi e Cura (SPDC), San Filippo Neri Hospital, Rome, Italy
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Cogan JC, Raghunathan RR, Beauchemin MP, Accordino MK, Huang Y, Elkin EB, Melamed A, Wright JD, Hershman DL. New and Persistent Sedative-Hypnotic Use After Adjuvant Chemotherapy for Breast Cancer. J Natl Cancer Inst 2022; 114:1698-1705. [PMID: 36130058 PMCID: PMC9745429 DOI: 10.1093/jnci/djac170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/19/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Sedative-hypnotic medications are used to treat chemotherapy-related nausea, anxiety, and insomnia. However, prolonged sedative-hypnotic use can lead to dependence, misuse, and increased health-care use. We aimed to estimate the rates at which patients who receive adjuvant chemotherapy for breast cancer become new persistent users of sedative-hypnotic medications, specifically benzodiazepines and nonbenzodiazepine sedative-hypnotics (Z-drugs). METHODS Using the MarketScan health-care claims database, we identified sedative-hypnotic-naïve patients who received adjuvant chemotherapy for breast cancer. Patients who filled 1 and more prescriptions during chemotherapy and 2 and more prescriptions up to 1 year after chemotherapy were classified as new persistent users. Univariate and multivariable logistic regression analyses were used to estimate odds of new persistent use and associated characteristics. RESULTS We identified 22 039 benzodiazepine-naïve patients and 23 816 Z-drug-naïve patients who received adjuvant chemotherapy from 2008 to 2017. Among benzodiazepine-naïve patients, 6159 (27.9%) filled 1 and more benzodiazepine prescriptions during chemotherapy, and 963 of those (15.6%) went on to become new persistent users. Among Z-drug-naïve patients, 1769 (7.4%) filled 1 and more prescriptions during chemotherapy, and 483 (27.3%) became new persistent users. In both groups, shorter durations of chemotherapy and receipt of opioid prescriptions were associated with new persistent use. Medicaid insurance was associated with new persistent benzodiazepine use (odds ratio = 1.88, 95% confidence interval = 1.43 to 2.47) compared with commercial or Medicare insurance. CONCLUSIONS Patients who receive sedative-hypnotic medications during adjuvant chemotherapy for breast cancer are at risk of becoming new persistent users of these medications after chemotherapy. Providers should ensure appropriate sedative-hypnotic use through tapering dosages and encouraging nonpharmacologic strategies when appropriate.
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Affiliation(s)
- Jacob C Cogan
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
- Columbia University College of Physicians and Surgeons, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Rohit R Raghunathan
- Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Melissa P Beauchemin
- Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
- Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Melissa K Accordino
- Columbia University College of Physicians and Surgeons, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Yongmei Huang
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Elena B Elkin
- Herbert Irving Comprehensive Cancer Center, New York, NY, USA
- Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
- Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
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Tardelli VS, Bianco MC, Prakash R, Segura LE, Castaldelli-Maia JM, Fidalgo TM, Martins SS. Overdose deaths involving non-BZD hypnotic/sedatives in the USA: Trends analyses. LANCET REGIONAL HEALTH. AMERICAS 2022; 10:100190. [PMID: 36777690 PMCID: PMC9904096 DOI: 10.1016/j.lana.2022.100190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background There is sparse knowledge on overdose deaths resulting from non-benzodiazepines and gabapentinoids usage. We examined overdose death rate across demographics categories and the overdose death trends over time. Methods Using data from the National Center for Health Statistics (USA), we identified 21,167 persons that died with an overdose ICD code as the underlying cause of death and had a T42.6/T42.7 ICD code, which include gabapentinoids and z-drugs, among their multiple causes of death. The overdose death rate was calculated per 100,000 persons for every year between 2000 and 2018. We used joinpoint regression analyses to assess trends over time. Results We identified a rise in the proportion of deaths with a T42.6/T42.7 ICD code between 2000 and 2006 (yearly change: +0.06) and between 2006 and 2015 (yearly change: +0.32). From 2000 to 2008, the proportion of deaths with any other T code rose significantly (yearly change: +3.56). Between 2008 and 2018, there was also a significant rise (yearly change: +1.31). From 2000 to 2015, the proportion of deaths with a T42.6/T42.7 ICD code with any other T code rose (yearly change: +2.58). From 2000 to 2015, the proportion of deaths with a T42.6/T42.7 ICD code with a concurrent benzodiazepine T code rose (yearly change: +1.98). From 2000 to 2005, the proportion of alcohol T codes rose non-significantly (yearly change: +0.35). Finally, the proportion of alcohol T codes fell significantly between 2008 and 2018 (yearly change: - 0.74). Interpretation Deaths due to non-benzodiazepine hypnotics and gabapentinoids increased significantly over the last two decades. Clinicians should not assume that replacing benzodiazepines and opioids with these medications necessarily lowers risk to the patient. Funding This study was funded by an internal grant from the Columbia University President's Global Innovation Fund (PI: Martins).
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Affiliation(s)
- Vitor S. Tardelli
- Departamento de Psiquiatria, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil,Translational Addiction Research Laboratory, Center for Addiction and Mental Health, Toronto, ON, Canada,Corresponding author at: Departamento de Psiquiatria, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | - Marina C.M. Bianco
- Departamento de Psiquiatria, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Rashmika Prakash
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Luis E. Segura
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - João M. Castaldelli-Maia
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA,Department of Psychiatry, Medical School, University of São Paulo, São Paulo, SP, Brazil,Department of Neuroscience, Medical School, FMABC University Center, Santo André, SP, Brazil
| | - Thiago M. Fidalgo
- Departamento de Psiquiatria, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Silvia S. Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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Cogan JC, Raghunathan RR, Beauchemin MP, Accordino MK, Elkin EB, Melamed A, Wright JD, Hershman DL. New and persistent controlled substance use among patients undergoing mastectomy and reconstructive surgery. Breast Cancer Res Treat 2021; 189:445-454. [PMID: 34089118 DOI: 10.1007/s10549-021-06275-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Prolonged use of controlled substances can place patients at increased risk of dependence and complications. Women who have mastectomy and reconstructive surgery (M + R) may be vulnerable to becoming new persistent users (NPUs) of opioid and sedative-hypnotic medications. METHODS Using the MarketScan health-care claims database, we identified opioid- and sedative-hypnotic-naïve women who had M + R from 2008 to 2017. Women who filled ≥ 1 peri-operative prescription and ≥ 2 post-operative prescriptions within one year after surgery were classified as NPUs. Univariate and multivariable logistic regression analyses were used to estimate rates of new persistent use and predictive factors. Risk summary scores were created based on the sum of associated factors. RESULTS We evaluated 23,025 opioid-naïve women and 25,046 sedative-hypnotic-naïve women. We found that 17,174 opioid-naïve women filled a peri-operative opioid prescription, and of those, 2962 (17.2%) became opioid NPUs post-operatively. Additionally, 9426 sedative-hypnotic-naïve women filled a peri-operative sedative-hypnotic prescription, and of those, 1612 (17.1%) became sedative-hypnotic NPUs. Development of new persistent sedative-hypnotic use was associated with age ≤ 49 [OR 1.77 (95% CI 1.40-2.24)] and age 50-64 [1.60 (1.27-2.03)] compared to age ≥ 65; Medicaid insurance [2.34 (1.40-3.90)]; southern residence [1.42 (1.22-1.64)]; breast cancer diagnosis [2.24 (1.28-3.91)]; and chemotherapy [2.17 (1.94-2.42)]. Risk of NPU increased with higher risk score. Women with ≥ 3 of these risk factors were three times more likely to become sedative-hypnotic NPUs than patients with 0 or 1 factors [2.94 (2.51-3.43)]. Comparable findings were seen regarding new persistent opioid use. CONCLUSION Women who have M + R are at risk of developing both new persistent opioid and new persistent sedative-hypnotic use. A patient's risk of becoming an NPU increases as their number of risk factors increases. Non-pharmacologic strategies are needed to manage pain and anxiety following cancer-related surgery.
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Affiliation(s)
- Jacob C Cogan
- Columbia University College of Physicians and Surgeons, New York, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, USA.,NewYork-Presbyterian Hospital, New York, USA
| | - Rohit R Raghunathan
- Joseph L. Mailman School of Public Health, Columbia University, New York, USA
| | - Melissa P Beauchemin
- Columbia University College of Physicians and Surgeons, New York, USA.,Joseph L. Mailman School of Public Health, Columbia University, New York, USA.,NewYork-Presbyterian Hospital, New York, USA
| | - Melissa K Accordino
- Columbia University College of Physicians and Surgeons, New York, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, USA.,NewYork-Presbyterian Hospital, New York, USA
| | - Elena B Elkin
- Joseph L. Mailman School of Public Health, Columbia University, New York, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, USA
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, New York, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, USA.,NewYork-Presbyterian Hospital, New York, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, USA.,NewYork-Presbyterian Hospital, New York, USA
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, New York, USA. .,Joseph L. Mailman School of Public Health, Columbia University, New York, USA. .,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, USA. .,NewYork-Presbyterian Hospital, New York, USA.
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