Efficacy of standard nicotine replacement therapy (NRT) versus video-assisted nurse-led NRT on tobacco cessation: A randomized controlled pilot trial

A systematic review of task-sharing interventions for substance use and substance use disorder in low- and middle-income countries

INTRODUCTION

Substance use (SU) and substance use disorders (SUDs) are associated with adverse health and socio-economic consequences. Due to the shortage of specialist healthcare providers, people with SUDs in low- and middle-income countries (LMICs) have limited access to adequate treatment. Task-sharing with non-specialist health workers (NSHWs) has the potential to improve treatment accessibility for these individuals. This review synthesizes the evidence on the effectiveness of task-sharing interventions for SU and SUDs outcomes in LMICs.

METHODS

PsycINFO, MEDLINE, EMBASE, Global Health and CENTRAL databases were searched to identify eligible studies. Quality assessment was conducted using the Cochrane risk of bias (RoB2) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. A narrative synthesis was undertaken to analyze the data.

RESULTS

Nineteen RCTs and two quasi-experimental studies met the eligibility criteria, and the majority had a low risk of bias rating. NSHW-delivered interventions significantly impact SU and SUDs outcomes, particularly in reducing alcohol and other substance use, cessation of smoking, and use of opioids. Multiple sessions delivered via face-to-face interactions was the most utilized method for intervention delivery. There were variations in terms of components of the intervention across studies; however, the most common intervention strategies used were a) personalized feedback, b) psychoeducation, c) motivational enhancement, d) problem-solving, and e) coping skills.

CONCLUSION

Our review highlights the growing interests in leveraging NSHWs to provide interventions to people with SU and SUDs in LMICs where access to treatment is limited. However, additional research is necessary to explore the effectiveness of these interventions and identify the specific active components linked to enhancing treatment outcomes on a broader scale.

Smoking: Pathogenetic Mechanisms, Possibilities of Medical Correction (Literature Review)

The smoking epidemic is one of the greatest threats to human health, as it is the leading cause of death worldwide, as well as many preventable diseases. Diseases associated with smoking include cardiovascular disease, atherosclerosis, type 2 diabetes, chronic pancreatitis, chronic obstructive pulmonary disease, cancer, osteoporosis and others. The aim is to analyze information on the pathogenetic mechanisms of tobacco exposure and methods of its drug correction. Among the 4,000 chemicals identified in tobacco smoke, nicotine is the main active ingredient in tobacco products. It is highly toxic and potentially lethal. Nicotine affects many systems, including the neurological, neuromuscular, cardiovascular, respiratory, immunological and gastrointestinal systems. Therefore, nicotine-containing drugs reduce the symptoms of nicotine withdrawal in regular smokers who abstain from smoking. The presence of different types of nicotinic acetylcholine receptors, their regulation and desensitization affect these complex physiological effects. Nicotine replacement drugs contain pure nicotine, in order to reduce the patient’s propensity to use tobacco, physiological and psychomotor withdrawal symptoms. They increase the level of nicotine in the blood, thus facilitating the transition from cigarette smoking to complete abstinence. Smokers can quit without using nicotine-containing drugs, but most those who try do not succeed on the first try. Nicotine replacement drugs only affect physical dependence. Nicotine is the main factor responsible for dependence on cigarette smoking, and its rate of absorption and entry into the brain are considered key factors responsible for the high potential for abuse of this drug. The advantage of nicotine-containing drugs is the patient’s independence from the method of administration, determination of abstinence, duration of treatment, level of supportive counseling, place of treatment (hospital, clinic or support group), as well as fixed, variable or reduced doses. There are a number of nicotine-containing drugs in various forms that effectively promote smoking cessation in adults.