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Jang KW, Kim J, Jung HW, Lee SK, Park BJ, Kang HC, Kim CH, Lee HK, Roh D. Public Perception Towards Drug Abuse in South Korea: The Effects of Overconfidence and Affirmation. Psychiatry Investig 2024; 21:746-754. [PMID: 39089700 PMCID: PMC11298263 DOI: 10.30773/pi.2023.0328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/24/2024] [Accepted: 05/16/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVE The abuse of prescription drugs and over-the-counter medicines has been a major issue addressed as a serious public health problem worldwide. This study explored factors contributing to substance abuse in Korea by examining the status of substance abuse among Korean adults and evaluating their knowledge, attitudes, and intentions toward substance abuse. METHODS Data were collected online from a sample of participants 19 years old or older from May 20 to June 1, 2020 (n=1,020). The survey consisted of questions on demographics, perceptions of drug risk, motives for drug use, and attitudes toward drug addiction treatment. Principal component and multiple logistic regression analyses were used to explore the factors contributing to the perception of drug abuse. RESULTS In the multivariate regression analysis, overconfidence in handling drug usage, acceptance of addictive substances, and affirmation of public support for drug abuse were associated with opioid abuse (Nagelkerke R2=0.486), and additionally affirmation of legal cannabis usage and motivation to use diet pills were associated with diet pill abuse (Nagelkerke R2=0.569). CONCLUSION The findings of this study suggest that the actual situation of substance abuse among Korean adults increases awareness of and attitudes toward drug use related to substance abuse.
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Affiliation(s)
- Ki Won Jang
- Mind-Neuromodulation Laboratory, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Jiheon Kim
- Mind-Neuromodulation Laboratory, Hallym University College of Medicine, Chuncheon, Republic of Korea
- Department of Psychiatry, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Han Wool Jung
- Mind-Neuromodulation Laboratory, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Sang-Kyu Lee
- Mind-Neuromodulation Laboratory, Hallym University College of Medicine, Chuncheon, Republic of Korea
- Department of Psychiatry, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Byung Joo Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hoon-Chul Kang
- Division of Pediatric Neurology, Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chan-Hyung Kim
- Department of Psychiatry and Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae Kook Lee
- Department of Psychiatry, The Catholic University of Korea Uijeongbu St. Mary’s Hospital, Uijeongbu, Republic of Korea
| | - Daeyoung Roh
- Mind-Neuromodulation Laboratory, Hallym University College of Medicine, Chuncheon, Republic of Korea
- Department of Psychiatry, Hallym University College of Medicine, Chuncheon, Republic of Korea
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Dertadian GC. Is non-medical use normal? Normalisation, medicalisation and pharmaceutical consumption. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104123. [PMID: 37454607 DOI: 10.1016/j.drugpo.2023.104123] [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: 05/02/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
The theory of the normalisation of youth drug use in advanced capitalist societies has had an enduring legacy in contemporary drug scholarship. While the literature on the normalisation of 'illicit' drugs is well developed, less has been written about application of the theory to emerging discourse of pharmaceutical 'abuse', and how this might necessitate different thinking around what can be considered normal consumption. Pharmaceuticals are not directly associated with criminality, and their use does not traditionally attract stigma. In fact, social science scholarship has illustrated how many substances deemed illicit are normalised in the context of an ever-growing set of medical treatments. This paper explores the assumptions about legality, sociality and pleasure which sit behind the drug normalisation thesis, by reflecting on the relevance of drug normalisation in relation to pharmaceuticals, as well as examining scholarship on the medicalisation of society and qualitative research on non-medical use to illustrate the parallel processes of normalisation that apply to pharmaceuticals. The paper argues that questions of normalisation in relation to pharmaceutical use require a deeper engagement with the normative expectations we attach to pleasure, consumption and medicine, and the way this is structured by proximity to medical authority, whiteness and middle-classness.
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Striebel J, Ruppen W, Schneider T. Simultaneous application of lidocaine and ketamine during ambulatory infusion therapy: a retrospective analysis. Pain Manag 2023; 13:539-553. [PMID: 37850330 DOI: 10.2217/pmt-2023-0037] [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] [Indexed: 10/19/2023] Open
Abstract
Background: Infusions with lidocaine or ketamine have been separately established in the treatment of chronic pain. This study aims to retrospectively evaluate the effect of combined infusions of lidocaine and ketamine. Materials & methods: Patient records were screened for receipt of combined ambulatory infusions of lidocaine and ketamine from 2012 through 2021. A scoring system was designed to assess pain response retrospectively. Results: A total of 319 patients were included. Median pain reduction in days was 10.00 (interquartile range: 13.25). Side effects were limited to the acute phase of infusions. A total of 41.4% of patients who received concomitant pain medication reported a dose reduction. Conclusion: Our data support combined infusions as a safe therapy option, with good short-, medium- and long-term reductions in pain and great heterogeneity in treatment response. Clinical trial registration: ClinicalTrials.gov (NCT05103319).
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Affiliation(s)
- Julia Striebel
- Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine & Pain Therapy, University Hospital Basel, Basel, 4031, Switzerland
| | - Wilhelm Ruppen
- Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine & Pain Therapy, University Hospital Basel, Basel, 4031, Switzerland
| | - Tobias Schneider
- Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine & Pain Therapy, University Hospital Basel, Basel, 4031, Switzerland
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Shojaati N, Osgood ND. Opioid-related harms and care impacts of conventional and AI-based prescription management strategies: insights from leveraging agent-based modeling and machine learning. Front Digit Health 2023; 5:1174845. [PMID: 37408540 PMCID: PMC10318360 DOI: 10.3389/fdgth.2023.1174845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/05/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Like its counterpart to the south, Canada ranks among the top five countries with the highest rates of opioid prescriptions. With many suffering from opioid use disorder first having encountered opioids via prescription routes, practitioners and health systems have an enduring need to identify and effectively respond to the problematic use of opioid prescription. There are strong challenges to successfully addressing this need: importantly, the patterns of prescription fulfillment that signal opioid abuse can be subtle and difficult to recognize, and overzealous enforcement can deprive those with legitimate pain management needs the appropriate care. Moreover, injudicious responses risk shifting those suffering from early-stage abuse of prescribed opioids to illicitly sourced street alternatives, whose varying dosage, availability, and the risk of adulteration can pose grave health risks. Methods This study employs a dynamic modeling and simulation to evaluate the effectiveness of prescription regimes employing machine learning monitoring programs to identify the patients who are at risk of opioid abuse while being treated with prescribed opioids. To this end, an agent-based model was developed and implemented to examine the effect of reduced prescribing and prescription drug monitoring programs on overdose and escalation to street opioids among patients, and on the legitimacy of fulfillments of opioid prescriptions over a 5-year time horizon. A study released by the Canadian Institute for Health Information was used to estimate the parameter values and assist in the validation of the existing agent-based model. Results and discussion The model estimates that lowering the prescription doses exerted the most favorable impact on the outcomes of interest over 5 years with a minimum burden on patients with a legitimate need for pharmaceutical opioids. The accurate conclusion about the impact of public health interventions requires a comprehensive set of outcomes to test their multi-dimensional effects, as utilized in this research. Finally, combining machine learning and agent-based modeling can provide significant advantages, particularly when using the latter to gain insights into the long-term effects and dynamic circumstances of the former.
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Nawaz A, Nielsen S, Mehmood T, Abdullah A, Ahmed A, Ullah W, Khan A. Prescription drug dependence with and without concurrent illicit drug use: a multicenter cross-sectional survey among an addiction treatment seeking population. Front Psychiatry 2023; 14:1133606. [PMID: 37324815 PMCID: PMC10267420 DOI: 10.3389/fpsyt.2023.1133606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Background Dependence on prescription drugs and illicit drugs imposes a global health and social burden. Despite accumulating evidence of prescription drugs and illicit drugs dependence, none of the systematized studies has explored the magnitude of this problem in Pakistan. The aim is to investigate the extent and associated factors of prescription drug dependence (PDD), as opposed to concomitant prescription drug dependence and illicit drug use (PIDU), within a sample of individuals seeking addiction treatment. Methods The cross sectional study was conducted on the sample recruited from three drug treatment centers in Pakistan. Face-to-face interviews were conducted with participants who met ICD-10 criteria for prescription drug dependence. Several aspects like substance use histories, negative health outcomes, patient attitude, pharmacy and physician practices also collected to predict the determinants of (PDD). Binomial logistic regression models examined the factors associated with PDD and PIDU. Results Of the 537 treatment seeking individuals interviewed at baseline, close to one third (178, 33.3%) met criteria for dependence on prescription drugs. The majority of the participants were male (93.3%), average age of 31 years, having urban residence (67.4%). Among participants who met criteria for dependence on prescription drugs (71.9%), reported benzodiazepines as the most frequently used drug, followed by narcotic analgesics (56.8%), cannabis/marijuana (45.5%), and heroin (41.5%). The patients reported alprazolam, buprenorphine, nalbuphine, and pentazocin use as alternatives to illicit drugs. PDD was significantly negatively associated with injectable route (OR = 0.281, 95% CI, 0.079-0.993) and psychotic symptoms (OR = 0.315, 95% CI, 0.100, 0.986). This implies that PDD is less likely to be associated with an injectable route and psychotic symptoms in contrast to PIDU. Pain, depression and sleep disorder were primary reasons for PDD. PDD was associated with the attitude that prescription drugs are safer than illicit drugs (OR = 4.057, 95%CI, 1.254-13.122) and PDD was associated with being on professional terms (i.e., having an established relationship) with pharmaceutical drugs retailers for acquisition of prescription drugs. Discussion and conclusion The study found benzodiazepine and opioid dependence in sub sample of addiction treatment seekers. The results have implications for drug policy and intervention strategies for preventing and treating drug use disorders.
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Affiliation(s)
- Asma Nawaz
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Tahir Mehmood
- School of Natural Sciences, National University of Science and Technology, Islamabad, Pakistan
| | | | - Ali Ahmed
- School of Pharmacy, Monash University, Bandar Sunway, Selangor, Malaysia
| | - Waseem Ullah
- Department of Pharmacy Practice, Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Ahmad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
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Vosburg SK, Faraone SV, Riley E, Whitaker T, Kardish J, Baker D, Kollins SH, Rush CR. Intranasal Use of Prescription Stimulants Among Adults Aged 18 to 30: Results From A Crowdsourcing Platform. J Atten Disord 2023; 27:14-25. [PMID: 35904240 DOI: 10.1177/10870547221112948] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Few studies of prescription stimulant non-oral, non-medical use (NMU) (defined by use not as prescribed) have been conducted in adults beyond the college population. The purpose of this study was to characterize prescription stimulant non-oral use, specifically intranasal (IN) use (snorting) in young adults. METHOD Amazon's MTurk platform was used to recruit participants for an online survey. Data were collected from March to April 2020. RESULTS Thirty-two percent (n = 157) of survey respondents (N = 975), aged 18 to 30, reported IN prescription stimulant use (average of 32.1 episodes of lifetime IN use). Adderall was the most-reported prescription stimulant used intranasally (89.2%). Most IN users (82%; n = 68) reported spending no more than 5 minutes tampering with prescription stimulants. Intranasal users said they would take the medication orally if unable to tamper or manipulate medication for IN use. CONCLUSION These data help quantify a complex public health issue of ongoing IN use of prescription stimulants and suggest a potential role for manipulation-deterrent medications.
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Affiliation(s)
| | | | - Elizabeth Riley
- University of Kentucky, College of Public Health, Lexington, USA
| | | | | | - David Baker
- Vallon Pharmaceuticals, Philadelphia, PA, USA
| | - Scott H Kollins
- Duke ADHD Program, Durham, NC, USA.,Holmusk, New York, NY, USA
| | - Craig R Rush
- University of Kentucky, College of Medicine, Lexington, USA
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Dash GF, Martin NG, Agrawal A, Lynskey MT, Slutske WS. Are prescription misuse and illicit drug use etiologically distinct? A genetically-informed analysis of opioids and stimulants. Psychol Med 2022; 52:3176-3183. [PMID: 33455586 PMCID: PMC8286273 DOI: 10.1017/s0033291720005267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Drug classes are grouped based on their chemical and pharmacological properties, but prescription and illicit drugs differ in other important ways. Potential differences in genetic and environmental influences on the (mis)use of prescription and illicit drugs that are subsumed under the same class should be examined. Opioid and stimulant classes contain prescription and illicit forms differentially associated with salient risk factors (common route of administration, legality), making them useful comparators for addressing this etiological issue. METHODS A total of 2410 individual Australian twins [Mage = 31.77 (s.d. = 2.48); 67% women] were interviewed about prescription misuse and illicit use of opioids and stimulants. Univariate and bivariate biometric models partitioned variances and covariances into additive genetic, shared environmental, and unique environmental influences across drug types. RESULTS Variation in the propensity to misuse prescription opioids was attributable to genes (41%) and unique environment (59%). Illicit opioid use was attributable to shared (71%) and unique (29%) environment. Prescription stimulant misuse was attributable to genes (79%) and unique environment (21%). Illicit stimulant use was attributable to genes (48%), shared environment (29%), and unique environment (23%). There was evidence for genetic influence common to both stimulant types, but limited evidence for genetic influence common to both opioid types. Bivariate correlations suggested that prescription opioid use may be more genetically similar to prescription stimulant use than to illicit opioid use. CONCLUSIONS Prescription opioid misuse may share little genetic influence with illicit opioid use. Future research may consider avoiding unitary drug classifications, particularly when examining genetic influences.
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Affiliation(s)
- Genevieve F. Dash
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Nicholas G. Martin
- Queensland Institute of Medical Research- Berghofer, Brisbane, QLD, Australia
| | - Arpana Agrawal
- School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael T. Lynskey
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Wendy S. Slutske
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
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Dillinger JG, Pezel T, Fauvel C, Delmas C, Schurtz G, Trimaille A, Gerbaud E, Roule V, Dib JC, Boccara A, Millischer D, Thuaire C, Fabre J, Levasseur T, Boukertouta T, Darmon A, Azencot R, Merat B, Haugel-Moreau M, Grentzinger A, Charbonnel C, Zakine C, Bedossa M, Lattuca B, Roubille F, Aboyans V, Puymirat E, Cohen A, Vicaut E, Henry P. Prevalence of psychoactive drug use in patients hospitalized for acute cardiac events: Rationale and design of the ADDICT-ICCU trial, from the Emergency and Acute Cardiovascular Care Working Group and the National College of Cardiologists in Training of the French Society of Cardiology. Arch Cardiovasc Dis 2022; 115:514-520. [PMID: 36154799 DOI: 10.1016/j.acvd.2022.05.012] [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: 03/09/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psychoactive drugs, including illicit drugs, are associated with an increased rate of cardiovascular events. The prevalence and outcome of patients using these drugs at the time of admission to an intensive cardiac care unit is unknown. AIM To assess the prevalence of psychoactive drugs detected in consecutive patients hospitalized in an intensive cardiac care unit for an acute cardiovascular event. METHODS This is a nationwide prospective multicentre study, involving 39 centres throughout France, including all consecutive patients hospitalized in an intensive cardiac care unit within 2weeks. Psychoactive drug use will be assessed systematically by urine drug assay within 2hours of intensive cardiac care unit admission, to detect illicit (cannabinoids, cocaine, amphetamines, ecstasy, heroin and other opioids) and non-illicit (barbiturates, benzodiazepines, tricyclic antidepressants, methadone and buprenorphine) psychoactive drugs. Smoking will be investigated systematically by exhaled carbon monoxide measurement, and alcohol consumption using a standardized questionnaire. In-hospital major adverse events, including death, resuscitated cardiac arrest and cardiogenic shock, will be recorded. After discharge, all-cause death and major adverse cardiovascular events will be recorded systematically and adjudicated at 12months of follow-up. RESULTS The primary outcome will be the prevalence of psychoactive drugs detected by systematic screening among all patients hospitalized in an intensive cardiac care unit. The in-hospital major adverse events will be analysed according to the presence or absence of detected psychoactive drugs. Subgroup analysis stratified by initial clinical presentation and type of psychoactive drug will be performed. CONCLUSIONS This is the first prospective multicentre study to assess the prevalence of psychoactive drugs detected by systematic screening in consecutive patients hospitalized for acute cardiovascular events.
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Affiliation(s)
- Jean-Guillaume Dillinger
- Department of Cardiology, Hôpital Lariboisière, AP-HP, Université de Paris Cité, Inserm U-942, 75010 Paris, France
| | - Théo Pezel
- Department of Cardiology, Hôpital Lariboisière, AP-HP, Université de Paris Cité, Inserm U-942, 75010 Paris, France
| | - Charles Fauvel
- Department of Cardiology, Rouen University Hospital, 76000 Rouen, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31000 Toulouse, France
| | - Guillaume Schurtz
- Department of Cardiology, University Hospital of Lille, 59000 Lille, France
| | - Antonin Trimaille
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 33604 Pessac Cedex, France; Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, 33000 Bordeaux, France
| | - Vincent Roule
- Department of Cardiology, Caen University Hospital, 14000 Caen, France
| | - Jean-Claude Dib
- Département de Cardiologie, Clinique Ambroise Paré, 92200 Neuilly-sur-Seine, France
| | - Albert Boccara
- Department of Cardiology, Andre Gregoire Hospital, 93100 Montreuil, France
| | - Damien Millischer
- Service de Cardiologie, Hôpital Montfermeil, 93370 Montfermeil, France
| | - Christophe Thuaire
- Service de Cardiologie, Centre Hospitalier de Chartres, 28630 Le Coudray, France
| | - Julien Fabre
- Department of Cardiology, University Hospital of Martinique, 97261 Fort-de-France, France
| | - Thomas Levasseur
- Service de Cardiologie, Centre Hospitalier de Fréjus/Saint-Raphaël, 83600 Fréjus, France
| | | | - Arthur Darmon
- Department of Cardiology, Hôpital Bichat, AP-HP, Université de Paris Cité, 75018 Paris, France
| | - Ruben Azencot
- Service de Cardiologie, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Benoit Merat
- Service de Cardiologie et Médecine Aéronautique, Hôpital d'Instruction des Armées Percy, 92140 Clamart, France
| | - Marie Haugel-Moreau
- Service de Cardiologie, Hôpital Ambroise Paré, AP-HP, 92012 Boulogne-Billancourt, France
| | - Alain Grentzinger
- Service de Cardiologie, Centre Hospitalier de Saintonge, 17100 Saintes, France
| | | | - Cyril Zakine
- Clinique Saint Gatien Alliance (NCT+), 37540 Saint-Cyr-sur-Loire, France
| | - Marc Bedossa
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 35000 Rennes, France
| | - Benoît Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, 30029 Nîmes, France
| | - François Roubille
- Department of Cardiology, CHU de Montpellier, 34000 Montpellier, France
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital; and Inserm U1094 & IRD U270, Limoges University, 87000 Limoges, France
| | - Etienne Puymirat
- Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), AP-HP, 75015 Paris, France
| | - Ariel Cohen
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, 75012 Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique, Hôpital Fernand Widal, AP-HP, 75010 Paris, France
| | - Patrick Henry
- Department of Cardiology, Hôpital Lariboisière, AP-HP, Université de Paris Cité, Inserm U-942, 75010 Paris, France.
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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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Kontu M, Kantojärvi L, Hakko H, Riala K, Riipinen P. Misuse of prescribed psychotropic medication and drug crime offending: A follow-up case-control study of former adolescent psychiatric inpatients. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2022; 32:124-137. [PMID: 35735190 PMCID: PMC9327718 DOI: 10.1002/cbm.2254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Various psychotropic prescription drugs are known to have potential for misuse. Among teenagers, non-medical use of prescription drugs may predate illicit drug use or occur concomitantly. AIMS Our aim was to examine prescriptions of psychotropic medications among drug crime offenders and non-criminal controls in a psychiatric inpatient cohort of 13-17-year-olds. Our research question was: were prescribed psychotropic and potentially addictive drugs associated with later drug crime offending. METHODS Our sample was of all 60 adolescents who had been convicted of a drug crime by young adulthood with a twice-sized control group, matched for gender, age and family-type, from a cohort of 508 adolescents consecutively admitted to a psychiatric inpatient care in Finland between April 2001 and March 2006. Adolescence-related information on substance use and psychiatric disorders was obtained by semi-structured interviews. Follow-up information on crimes and medication purchases was obtained from Finnish nationwide registers. The association of studied factors to drug crime offending was examined using stepwise binary logistic regression analysis. RESULTS 75% of drug crime offenders and 47% of non-criminal controls had used addictive psychotropic medications during the follow-up period (p < 0.001). 74% of all drug crime offenders' purchases of prescribed addictive drugs occurred within the year preceding drug crimes. Of addictive drugs, the use of clonazepam and gabapentinoids was most likely to associate with drug crime offending (AOR 7.77, p < 0.001). Conduct and substance use disorders diagnosed in adolescence (AOR 3.49, p = 0.010; AOR 2.34, p = 0.050) were predictors for drug crime offending. CONCLUSIONS Our findings suggest that, when treating young adults with conduct disorder and a history of substance use, physicians should prescribe addictive medications with caution, favouring instead non-addictive medications complemented by psychosocial interventions.
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Affiliation(s)
- Mikaela Kontu
- Department of PsychiatryResearch Unit of Clinical NeuroscienceUniversity of OuluOuluFinland
| | | | - Helinä Hakko
- Department of PsychiatryOulu University HospitalOuluFinland
| | - Kaisa Riala
- Department of PsychiatryOulu University HospitalOuluFinland
| | - Pirkko Riipinen
- Department of PsychiatryResearch Unit of Clinical NeuroscienceUniversity of OuluOuluFinland
- Department of PsychiatryOulu University HospitalOuluFinland
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11
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Abayateye F, Fornssler B, Feng C, D’Arcy C, Alphonsus K. Prescription drug misuse among adults in Canada: a scoping review. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2053890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Francis Abayateye
- Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Barb Fornssler
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Cindy Feng
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Carl D’Arcy
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Khrisha Alphonsus
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
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12
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Compensatory Role of Insulin in the Extinction but Not Reinstatement of Morphine-Induced Conditioned Place Preference in the Streptozotocin-Induced Diabetic Rats. Neurochem Res 2022; 47:1565-1573. [DOI: 10.1007/s11064-022-03550-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/19/2022] [Accepted: 02/05/2022] [Indexed: 02/02/2023]
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13
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Abdelhamid BM, Mostafa Gomaa H, Abdelgaleel AG, Hussein W, Mohamed Ali H. Prevalence of drug abusers in patients undergoing elective surgeries at the Cairo University Teaching Hospital; Prospective cohort study. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2036526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Bassant Mohamed Abdelhamid
- Department of Anesthesiology, Surgical ICU and Pain Management, Kasr-Alainy Faculty of Medicine, Cairo University, Giza, Egypt
- Department of Anesthesiology, Surgical ICU and Pain Management, Armed Forces College of Medicine, Cairo, Egypt
| | - Hala Mostafa Gomaa
- Department of Anesthesiology, Surgical ICU and Pain Management, Kasr-Alainy Faculty of Medicine, Cairo University, Giza, Egypt
| | - Amira Gamal Abdelgaleel
- Department of Anesthesiology, Surgical ICU and Pain Management, Kasr-Alainy Faculty of Medicine, Cairo University, Giza, Egypt
| | - Wael Hussein
- Department of Anesthesiology, Surgical ICU and Pain Management, Armed Forces College of Medicine, Cairo, Egypt
| | - Hassan Mohamed Ali
- Department of Anesthesiology, Surgical ICU and Pain Management, Kasr-Alainy Faculty of Medicine, Cairo University, Giza, Egypt
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14
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Kalkman GA, van den Brink W, Pierce M, Atsma F, Vissers KCP, Schers HJ, van Dongen RTM, Kramers C, Schellekens AFA. Monitoring Opioids in Europe: The Need for Shared Definitions and Measuring Drivers of Opioid Use and Related Harms. Eur Addict Res 2022; 28:231-240. [PMID: 35196659 DOI: 10.1159/000521996] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 01/14/2022] [Indexed: 11/19/2022]
Abstract
The past 20 years, the USA is facing a serious opioid crisis initiated by an increase in prescription opioid use. Europe has also seen an increase in prescription opioid use, but the extent of related harm is still largely unknown. Given the impact of the US opioid epidemic, it is important to closely monitor signs of emerging opioid-related problems to guarantee early warnings and timely actions. Shared and meaningful definitions for opioid use and related harms, and relevant information about specific drivers for opioid use and related problems are needed for an adequate policy response. In this commentary, we discuss these definitions, the need to know more about the specific drivers for increased opioid use, its related harm, and proposals for strategies to move forward. Policy recommendations include making a distinction between licit and illicit opioids when monitoring and reporting on opioid-related harm, and using oral morphine equivalents to quantify prescription opioid use in a clinically relevant and comparable manner. A major topic of further research is exploring unique and universal drivers of prescription opioid (mis)use across Europe, in particular the role of opioid diversion.
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Affiliation(s)
- Gerard A Kalkman
- Department of Clinical Pharmacy, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.,Department of Pharmacology-Toxicology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Wim van den Brink
- Amsterdam UMC, Location AMC, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
| | - Mimi Pierce
- Amsterdam UMC, Location AMC, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
| | - Femke Atsma
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, The Netherlands
| | - Kris C P Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henk J Schers
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert T M van Dongen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Pain Management and Palliative Care, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Cornelis Kramers
- Department of Clinical Pharmacy, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.,Department of Pharmacology-Toxicology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Arnt F A Schellekens
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands.,Radboud University Medical Centre, Donders Institute for Clinical Neuroscience, Nijmegen, The Netherlands.,Nijmegen Institute for Science Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
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15
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Drazdowski TK, Schulte M, Wolitzky-Taylor KB, Schaper H, Chapman JE. Motivations for Prescription Drug Misuse Related to Mental Health Problems in Adults. Subst Use Misuse 2021; 57:316-327. [PMID: 34903123 PMCID: PMC8842830 DOI: 10.1080/10826084.2021.2012687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Prescription drug misuse (PDM) is a significant public health problem associated with mental health symptoms. OBJECTIVES This project investigates the connections between PDM motivations and mental health to inform intervention efforts. METHODS Using nationally representative adult data from the 2016-2018 National Survey on Drug Use and Health (N = 128,205; 53% female) this project investigated which motivations for misuse are related to past-year mental health problems including any mental illness, serious mental illness, major depressive episode, and suicidal thoughts. Complex samples logistic regression models of the main motivation of PDM for each mental health problem were conducted separately for each prescription drug class (i.e., opioids, tranquilizers, sedatives, and stimulants) while controlling for demographic characteristics. RESULTS Adults that reported PDM were more likely than those with no PDM to endorse past year mental health problems. Compared to those that reported PDM of other medications, those misusing prescription opioids and tranquilizers to help with emotions and misusing sedatives to "relax or relieve tension" were more likely to have all categories of mental health problems. Those that misused prescription stimulants to "help study" had lower odds of all mental health problems. CONCLUSIONS While there were differences based on prescription drug class, a range of motivations increased adults' likelihood to have mental health problems and common themes were found across drug classes. While causality is still undetermined, prevention and intervention efforts that are multifaceted and individualized, while broadly providing adults with other ways to cope with negative emotions are likely to help reduce PDM.
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Affiliation(s)
- Tess K. Drazdowski
- UCLA Integrated Substance Abuse Programs, Los Angeles, California, USA
- Oregon Social Learning Center, Eugene, Oregon, USA
| | - Marya Schulte
- UCLA Integrated Substance Abuse Programs, Los Angeles, California, USA
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16
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Ahrari M, Ali S, Hartling L, Dong K, Drendel AL, Klassen TP, Schreiner K, Dyson MP. Nonmedical Opioid Use After Short-term Therapeutic Exposure in Children: A Systematic Review. Pediatrics 2021; 148:183452. [PMID: 34816280 DOI: 10.1542/peds.2021-051927] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Opioid-related harms continue to rise for children and youth. Analgesic prescribing decisions are challenging because the risk for future nonmedical opioid use or disorder is unclear. OBJECTIVE To synthesize research examining the association between short-term therapeutic opioid exposure and future nonmedical opioid use or opioid use disorder and associated risk factors. DATA SOURCES We searched 11 electronic databases. STUDY SELECTION Two reviewers screened studies. Studies were included if: they were published in English or French, participants had short-term (≤14 days) or an unknown duration of therapeutic exposure to opioids before 18 years, and reported opioid use disorder or misuse. DATA EXTRACTION Data were extracted, and methodologic quality was assessed by 2 reviewers. Data were summarized narratively. RESULTS We included 21 observational studies (49 944 602 participants). One study demonstrated that short-term therapeutic exposure may be associated with opioid abuse; 4 showed an association between medical and nonmedical opioid use without specifying duration of exposure. Other studies reported on prevalence or incidence of nonmedical use after medical exposure to opioids. Risk factors were contradictory and remain unclear. LIMITATIONS Most studies did not specify duration of exposure and were of low methodologic quality, and participants might not have been opioid naïve. CONCLUSIONS Some studies suggest an association between lifetime therapeutic opioid use and nonmedical opioid use. Given the lack of clear evidence regarding short-term therapeutic exposure, health care providers should carefully evaluate pain management options and educate patients and caregivers about safe, judicious, and appropriate use of opioids and potential signs of misuse.
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Affiliation(s)
| | - Samina Ali
- Departments of Pediatrics.,Emergency Medicine.,Women and Children's Health Research Institute
| | | | | | - Amy L Drendel
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Terry P Klassen
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Kurt Schreiner
- Pediatric Parents' Advisory Group, University of Alberta, Edmonton, Alberta, Canada
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17
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DiNardi M. Aging out of the federal dependent coverage mandate and purchases of prescription drugs with high rates of misuse. ECONOMICS AND HUMAN BIOLOGY 2021; 43:101066. [PMID: 34655854 DOI: 10.1016/j.ehb.2021.101066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/19/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
Prescription central nervous system depressants, opioid pain relievers, and stimulants provide therapeutic value, but misuse for their recreational value is a growing problem in the United States. Because health insurance lowers the cost of purchasing prescription drugs, losing coverage may cause individuals to forgo treatment and decrease prescription drug consumption which could reduce health and increase the likelihood of overdose and death if individuals substitute to using illicit drugs. I estimate the reduced form effect of aging out of the federal dependent coverage mandate at age 26 on legal purchases of prescription central nervous system depressants, opioids, and stimulants. Individuals are 0.5-0.9% points less likely to purchase a prescription central nervous system depressant and 0.8-1.5% points less likely to purchase a prescription opioid after turning 26. These effects are strongest for women, while estimated effects for men are generally negative but imprecise.
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Affiliation(s)
- Michael DiNardi
- Department of Economics, University of Rhode Island, 10 Chafee Road, Kingston, RI 02881, USA.
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18
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Ehntholt A, Pabayo R, Berkman L, Kawachi I. Race, Adolescent Socioeconomic Status, and Lifetime Non-Medical Use of Prescription Painkillers: Evidence from the National Longitudinal Study of Adolescent to Adult Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12289. [PMID: 34886020 PMCID: PMC8657390 DOI: 10.3390/ijerph182312289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 11/16/2022]
Abstract
The misuse of prescription painkillers is a major contributor to the ongoing drug overdose epidemic. This study investigated variability in non-medical use of prescription painkillers (NMUPP) by race and early-life socioeconomic status (SES) in a sample now at increased risk for opioid overdose. Data from two waves of the National Longitudinal Study of Adolescent to Adult Health (n = 11,602) were used to calculate prevalence of reported NMUPP by Wave 4 (2008; mean age 28), and to assess variation by race and by equivalized household family income at Wave 1 (1994/5). Predicted values for prevalence of NMUPP were modelled, adjusting for age, sex, parental education, and region. Race and SES in adolescence were associated with later reported NMUPP. A gradient was seen in prevalence by SES (adjusted: family income quartile 1 = 13.3%; quartile 2 = 13.8%; quartile 3 = 14.8%; quartile 4 = 16.0%; trend p-value = 0.007). Prevalence was higher among males. Racial/ethnic differences in prevalence were seen (non-Hispanic white (NHW) = 18.5%; non-Hispanic black (NHB) = 5.8%; Hispanic = 10.5%; Other = 10.0%). SES differences were less pronounced upon stratification, with trend tests significant only among females (p = 0.004), and marginally significant among Hispanic males (p = 0.06). Early-life SES was associated with reported lifetime NMUPP: the higher the family income in adolescence, the greater the likelihood of NMUPP by young adulthood. Variations in NMUPP by income paled in comparison with racial/ethnic differences. Results point to a possible long-enduring association between SES and NMUPP, and a need to examine underlying mechanisms.
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Affiliation(s)
- Amy Ehntholt
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (L.B.); (I.K.)
| | - Roman Pabayo
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - Lisa Berkman
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (L.B.); (I.K.)
- Harvard Center for Population and Development Studies, Cambridge, MA 02138, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (L.B.); (I.K.)
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19
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Alkhalaf AA, Bukhari RA, Alshehri EA, Alshehri SO, Badr AF. Abuse liability of gabapentin in the Saudi population after the pregabalin restriction: A cross-sectional study. J Taibah Univ Med Sci 2021; 16:700-705. [PMID: 34690650 PMCID: PMC8498723 DOI: 10.1016/j.jtumed.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Following the recently conducted local studies on the growing misuse of pregabalin, Pregabalin misuse has received national attention. These studies have led to the authorities restricting the availability of pregabalin to hospital pharmacies alone. While the recent epidemiological studies and case reports found gabapentin to be misused worldwide, it was previously presumed to be free of any abuse potential. This study assesses the likelihood of there being a diversion to Gabapentin abuse following the Pregabalin restriction in Jeddah, KSA. Methods A cross sectional observational study was conducted between November 2017 and December 2017 using a self-constructed online survey via Twitter and WhatsApp. The survey items included participants' demographics, additional history, Gabapentin for non-medical use (frequency, concurrent use with other drugs, and motivators), and how the participants knew about the Gabapentin misuse. The data was subjected to a descriptive analysis via the utilization of frequencies and percentages. The analysis was carried out by using SPSS V21. Results Data of the 370 respondents who took the surveys were collected. Most of the respondents were women (n = 289; 78.1%) and below the age of 30 years (n = 300; 81.1%). A total of 72 respondents (19.5%) had a history of psychoactive drug abuse. Ten of the respondents reported Gabapentin misuse (2.7%). Half of the participants reported prior Pregabalin misuse, and were un-employed. Most of the misusers (n = 8; 80%) came to know about the psychotropic effects of Gabapentin from friends. The most common motives for using it were to 'have fun' and 'peer pressure' (n = 6; 60%). Half of the misusers used Gabapentin on a weekly basis. Conclusion The findings of our study suggest a potential diversion from Pregabalin to Gabapentin misuse. Regulations and periodic reviews of the psychoactive prescription medications available in the community pharmacies are essential.
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Affiliation(s)
- Amina A Alkhalaf
- Department of Pharmacy Practice, College of Pharmacy, King Abdulaziz University, Jeddah, KSA
| | - Raneem A Bukhari
- Department of Pharmacy Practice, College of Pharmacy, King Abdulaziz University, Jeddah, KSA
| | - Elham A Alshehri
- Department of Pharmacy Practice, College of Pharmacy, King Abdulaziz University, Jeddah, KSA
| | - Samah O Alshehri
- Department of Pharmacy Practice, College of Pharmacy, King Abdulaziz University, Jeddah, KSA
| | - Aisha F Badr
- Department of Pharmacy Practice, College of Pharmacy, King Abdulaziz University, Jeddah, KSA
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20
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Carson DC, Lane EB. A Quasi-Experimental Evaluation of a School-Based Prescription Opioid Misuse Education Program. JOURNAL OF DRUG EDUCATION 2021; 50:84-97. [PMID: 35125038 DOI: 10.1177/00472379211072857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The use of prescription opioids is a matter of concern among academics and practitioners, but there remains a lack of programming to target this issue. One program, This Is (Not) About Drugs (TINAD), is intended to address part of this need by altering youth perceptions of the risks associated prescription opioid misuse as well as heroin. This study presents results from a quasi-experimental evaluation of TINAD. Propensity score matching techniques were used to account for selection effects across treatment and comparison groups. Program participants demonstrated increases in understanding of the similarities between prescription opioids and heroin and the risks associated with prescription opioid misuse. While these results are promising, TINAD requires a more rigorous evaluation of its effectiveness.
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Affiliation(s)
- Dena C Carson
- 10668Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Emelyne B Lane
- 10668Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
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21
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Phaugat P, Nishal S, Dhiman R. Abuse Deterrent Formulations in Constraining the Abuse Potential of Prescription Medicines: A Myth or Truth. Curr Drug Deliv 2021; 19:466-478. [PMID: 34353262 DOI: 10.2174/1567201818666210805145819] [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: 12/19/2020] [Revised: 06/07/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diverse pain killers used for the management of varied categories of pain are being misused in order to have extreme pleasant effect by a large number of populations. To overcome the misuse of prescription drugs, regulatory bodies have given stress on development of abuse resistance. METHODS We studied numerous literatures: (1) Research and review papers including the guidelines for pain management, abuse, and abuse deterrence; (2) Description and categorization of pain along with the management approaches; (3) advantages and disadvantages of the abuse deterrent formulations were described. RESULTS Abuse deterrent formulations are the contemporary remedial treatment for pain with reduced prospects of being abused. But these comprise the huge expense in contrast to the generic drugs as well as the non-deterrent branded equivalents. CONCLUSION Many challenges are faced throughout the development of abuse deterrent formulations. These formulations displayed substantial drop in abuse incidences but it may lead to other modes of abuse which may prove more harmful for the users.
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Affiliation(s)
- Parmita Phaugat
- Drug Safety Associate; Pharmacovigilance, Parexel International. India
| | - Suchitra Nishal
- College of Pharmacy, University of Health Sciences Rohtak. India
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22
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Piispa I, Karjalainen K, Karttunen N. Nonmedical use of prescription drugs: A comparison between intoxication-oriented and other nonmedical users. NORDIC STUDIES ON ALCOHOL AND DRUGS 2021; 39:64-75. [PMID: 35308467 PMCID: PMC8899273 DOI: 10.1177/14550725211018082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/28/2021] [Indexed: 11/30/2022] Open
Abstract
Aims: Nonmedical use of prescription drugs (NMUPD) is a major public health concern. The aim of the study was to compare intoxication-oriented users to those who utilised prescription drugs nonmedically for other purposes. The characteristics of the study groups, prescription drugs used, motivations for their use and sources of prescription drugs were also examined. Methods: Data were derived from the population-based Drug Survey 2014 which was conducted in Finland. The respondents were divided into intoxication-oriented users (n = 118) and other nonmedical users (n = 74) according to the motivation behind their NMUPD. The reference population (n = 3277) did not report any NMUPD. Pearson’s chi square test was used to compare the distributions. A multinomial logistic regression model was used to estimate the association of sociodemographic background and intoxicant use with NMUPD. Results: Low education level and illegal drug use were associated with intoxication-oriented and other nonmedical use of prescription drugs. Intoxication-oriented use was associated also with younger age and current smoking. Sedatives were the most commonly used prescription drugs among intoxication-oriented users, and opioids among other nonmedical users. Experimentation and facilitating social interactions as a motivation for use were emphasised among intoxication-oriented users. Friends and relatives were the most common sources of prescription drugs for nonmedical use, especially among intoxication-oriented users. Conclusion: The characteristics, motivations and sources of nonmedically used prescription drugs differed in intoxication-oriented and other nonmedical users. These findings may help to identify those at risk for NMUPD. More attention should be paid to the motivations of NMUPD when new prevention and intervention methods are developed.
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Affiliation(s)
| | | | - Niina Karttunen
- University of Eastern Finland, Kuopio, Finland; and AddictionLink, A-Clinic Foundation, Ratamestarinkatu, Helsinki, Finland
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23
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Archibong VB, Ekanem T, Igiri A, Ofutet EO, Ifie JE. The effect of codeine administration on oxidative stress biomarkers and the expression of the neuron-specific enolase in the brain of Wistar rats. Naunyn Schmiedebergs Arch Pharmacol 2021; 394:1665-1673. [PMID: 33938954 DOI: 10.1007/s00210-021-02094-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
The study aimed to assess the effects of codeine medication on some oxidative stress parameters and how it affects the expression of enolase in neuronal cells. The codeine medication used for the study was Archilin™ with codeine syrup and dihydrocodeine 30 mg. The study used 30 male Wistar rats which were grouped in five: A, B, C, D, and E (n = 6), while treatments were administered for 21 days. Based on the LD50s of 6.09 ml/kg body weight (b.wt.) Archilin™ with codeine syrup and 3.145 mg/kg b.wt. dihydrocodeine, group A served as control and were given normal saline; groups B and C were treated with 1 mg/kg and 2 mg/kg b.wt. dihydrocodeine, respectively; while groups D and E were treated with 2 ml/kg and 4 ml/kg b.wt. Archilin™ with codeine syrup, respectively. After treatments, animals were sacrificed via cervical dislocation and the brains were harvested and prepared for determination of oxidative stress biomarkers as well as immunohistochemical studies of neuron-specific enolase (NSE) to assess for neuronal cell integrity. Significantly decreased mean values (p < 0.05) of superoxide dismutase (SOD) and catalase (CAT) activities were observed while malondialdehyde (MDA) is significantly increased (p < 0.05) among treated groups. The expression of enolase was downregulated in treatment groups when compared to control. Animals in group A which are control showed strong staining intensity of the prefrontal cortex compared to groups C, D, and E which showed mild staining. The scoring of group A for cerebellum showed strong staining intensity, groups B and C showed mild staining, while groups D and E showed weak staining intensity. From the findings of this study, prolonged codeine syrup administration causes oxidative stress and this affects the expression of enolase in neuronal cells resulting in glucose hypometabolism which eventually results in functional brain failure.
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Affiliation(s)
- Victor Bassey Archibong
- Department of Human Anatomy, Faculty of Biomedical Sciences, Kampala International University, Western Campus, Ishaka, Uganda
| | - Theresa Ekanem
- Department of Anatomy, Faculty of Basic Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Anozeng Igiri
- Department of Anatomy, Faculty of Basic Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Emmanuel Oleba Ofutet
- Department of Physiology, College of Medical Sciences, University of Calabar, Cross River State, Calabar, Nigeria
| | - Josiah Eseoghene Ifie
- Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University, Western Campus, Ishaka, Uganda.
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Sampasa-Kanyinga H, Bakwa-Kanyinga F, Chaput JP, Hamilton HA, Elton-Marshall T, Colman I. Nonmedical use of prescription opioids, psychological distress, and suicidality among adolescents. Soc Psychiatry Psychiatr Epidemiol 2021; 56:783-791. [PMID: 32909052 DOI: 10.1007/s00127-020-01958-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/01/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The present study examined associations between nonmedical use of prescription opioids and serious psychological distress, suicidal ideation, and suicide attempts, and tested whether age and sex moderate these relationships. METHODS Data on 5582 adolescents were obtained from a representative province-wide survey of students in grades 7 through 12 (mean age: 15.3 years) across Ontario, Canada. Nonmedical use of prescribed opioids in the last 12 months was categorized in "no use", "infrequent use (1-2 times)", and "regular use (3 times or more)". Logistic regression analysis was adjusted for age, sex, ethnicity, subjective socioeconomic status, and other substance use (i.e., tobacco cigarette, alcohol, cannabis). RESULTS Overall, regular nonmedical use of prescription opioids was strongly associated with greater odds of serious psychological distress (OR: 3.47; 95% CI 1.42-8.45), suicidal ideation (OR: 2.73; 95% CI 1.84-4.05), and suicide attempts (OR: 3.21; 95% CI 1.40-7.37). However, infrequent nonmedical use of prescription opioids was associated with greater odds of serious psychological distress (OR: 1.79; 95% CI 1.08-2.98) and suicidal ideation (OR: 1.63; 95% CI 1.20-2.21), but not suicide attempts (OR: 1.84; 95% CI 0.76-4.45). Age-stratified analyses showed that both infrequent (OR: 1.61; 95% CI 1.01-2.58) and regular (OR: 3.40; 95% CI 2.11-5.46) nonmedical use of prescription opioids was strongly associated with greater odds of suicidal ideation among 15- to 20-year-olds, but not 11- to 14-year-olds. CONCLUSION These findings suggest that nonmedical use of prescription opioids is strongly associated with mental health problems among adolescents. Future research using a longitudinal design is needed to confirm age differences and temporality.
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Affiliation(s)
- Hugues Sampasa-Kanyinga
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
| | - Felly Bakwa-Kanyinga
- Department of Social and Preventive Medicine, Laval University, Quebec City, QC, Canada
| | - Jean-Philippe Chaput
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.,Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Hayley A Hamilton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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Kontu M, Hakko H, Riala K, Riipinen P. Adolescence Predictors for Drug Crime Offending: A Follow-up Study of Former Adolescent Psychiatric Inpatients. Community Ment Health J 2021; 57:736-745. [PMID: 32910370 PMCID: PMC7981305 DOI: 10.1007/s10597-020-00708-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/02/2020] [Indexed: 11/26/2022]
Abstract
Our aim was to examine adolescent predictors (family- and school-related factors, substance use, and psychiatric disorders) for drug crime offending. The initial study population consisted of 508 former adolescent psychiatric inpatients aged between 13 and 17 years. Of them, 60 (12%) had committed a drug crime by young adulthood and they were matched with 120 (24%) non-criminal controls by sex, age and family type. During adolescent hospitalization, study participants were interviewed using valid semi-structured research instruments. Criminal records were obtained from the Finnish Legal Register Centre up to young adulthood. A distant relationship with a father, lying, and thieving, moderate/high nicotine dependence and weekly use of stimulants were shown to be the most prominent predictors for drug crime offending. Our findings encourage the use of modern child- and family-centered approaches in preventing youth involvement in illegal drug use and drug crimes.
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Affiliation(s)
- Mikaela Kontu
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, P.O.Box 5000, 90014, Oulu, Finland.
| | - Helinä Hakko
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Kaisa Riala
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Pirkko Riipinen
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, P.O.Box 5000, 90014, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
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26
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Mavrikaki M, Lintz T, Constantino N, Page S, Chartoff E. Chronic opioid exposure differentially modulates oxycodone self-administration in male and female rats. Addict Biol 2021; 26:e12973. [PMID: 33078503 PMCID: PMC8129895 DOI: 10.1111/adb.12973] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/20/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022]
Abstract
Withdrawal from opioid painkillers can produce short‐lived physical symptoms and protracted psychological symptoms including anxiety and depressive‐like states that often lead to opioid misuse and opioid use disorder (OUD). Studies testing the hypothesis that opioid withdrawal potentiates the reinforcing effects of opioid self‐administration (SA) are largely inconclusive and have focused on males. Although some clinical evidence indicates that women are more likely than men to misuse opioids to self‐medicate, preclinical studies in both sexes are lacking. Based on clinical reports, we hypothesized that withdrawal from escalating‐dose morphine injections that approximates a prescription painkiller regimen would lead to increased oxycodone SA to a greater extent in female compared to male rats. After escalating‐dose morphine (5–30 mg/kg or vehicle, twice/day for 12 days), rats underwent a 2‐week abstinence period during which withdrawal signs were measured. The impact of this treatment was assessed on oxycodone SA acquisition, maintenance, dose response, and progressive ratio responding, with additional analyses to compare sexes. We found that both sexes expressed somatic withdrawal, whereas only males demonstrated hyperalgesia in the warm water tail flick assay. During SA acquisition, males with prior morphine exposure took significantly more oxycodone than females. Finally, females with prior morphine exposure demonstrated the lowest motivation to SA oxycodone in the progressive ratio test. Contrary to our initial hypothesis, our findings suggest that prior opioid exposure increases vulnerability to initiate misuse more in males and decreases the reinforcing efficacy of oxycodone in females.
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Affiliation(s)
- Maria Mavrikaki
- Department of Psychiatry, Harvard Medical School McLean Hospital Belmont Massachusetts USA
| | - Tania Lintz
- Department of Psychiatry, Harvard Medical School McLean Hospital Belmont Massachusetts USA
| | - Nick Constantino
- Department of Psychiatry, Harvard Medical School McLean Hospital Belmont Massachusetts USA
| | - Sarah Page
- Department of Psychiatry, Harvard Medical School McLean Hospital Belmont Massachusetts USA
| | - Elena Chartoff
- Department of Psychiatry, Harvard Medical School McLean Hospital Belmont Massachusetts USA
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27
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Arnold TD, Lin L(A, Cotton BP, Bryson WC, Polenick CA. Gender Differences in Patterns and Correlates of Continued Substance Use among Patients in Methadone Maintenance Treatment. Subst Use Misuse 2021; 56:529-538. [PMID: 33645425 PMCID: PMC8279751 DOI: 10.1080/10826084.2021.1887242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Continued substance use is common during opioid use disorder (OUD) treatment. There are still inconsistencies in how continued substance use and concurrent patterns of substance use among patients with OUD varies by gender. There is still more to learn regarding how factors associated with continued and concurrent use might differ for men and women in methadone maintenance treatment (MMT). Methods: This cross-sectional study examined predictors of concurrent substance use subgroups among patients receiving MMT. The sample included 341 (n = 161 women) MMT patients aged 18 and older from opioid treatment programs in Southern New England and the Pacific Northwest. Patients completed a survey assessing sociodemographic and clinical characteristics including past-month substance use. Latent class analyses were conducted by gender to identify groups based on substance use and determine predictors of those classes. Results: Three-class solutions were the optimal fit for both men and women. For both genders, the first subgroup was characterized as Unlikely Users (59.8% women, 52.8% men). Classes 2 and 3 among women were Cannabis/Opioid Users (23.7%) and Stimulant/Opioid Users (13.0%). Among men, Classes 2 and 3 consisted of Alcohol/Cannabis Users (21.9%) and Cannabis/Stimulant/Opioid Users (25.3%). Ever using Suboxone (buprenorphine/naloxone) and depression/anxiety symptoms were significantly linked to substance use group among women, whereas homelessness and employment status were significantly associated with substance use group among men. Conclusions: This study furthers understanding of gender differences in factors associated with continued substance use and distinctive patterns of concurrent substance use that may guide tailored treatments among patients MMT.
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Affiliation(s)
- Tomorrow D. Arnold
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
- Department of Psychology, University of Tennessee, Chattanooga, TN 37403
| | - Lewei (Allison) Lin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48109
| | - Brandi P. Cotton
- College of Nursing, University of Rhode Island, Kingston, RI 02881
| | - William C. Bryson
- Department of Psychiatry, Oregon Health and Sciences University, Portland, OR, USA
| | - Courtney A. Polenick
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48104
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Murray K, Lin Y, Makary MM, Whang PG, Geha P. Brain Structure and Function of Chronic Low Back Pain Patients on Long-Term Opioid Analgesic Treatment: A Preliminary Study. Mol Pain 2021; 17:1744806921990938. [PMID: 33567986 PMCID: PMC7883154 DOI: 10.1177/1744806921990938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Chronic low back pain (CLBP) is often treated with opioid analgesics (OA), a class of medications associated with a significant risk of misuse. However, little is known about how treatment with OA affect the brain in chronic pain patients. Gaining this knowledge is a necessary first step towards understanding OA associated analgesia and elucidating long-term risk of OA misuse. Here we study CLBP patients chronically medicated with opioids without any evidence of misuse and compare them to CLBP patients not on opioids and to healthy controls using structural and functional brain imaging. CLBP patients medicated with OA showed loss of volume in the nucleus accumbens and thalamus, and an overall significant decrease in signal to noise ratio in their sub-cortical areas. Power spectral density analysis (PSD) of frequency content in the accumbens’ resting state activity revealed that both medicated and unmedicated patients showed loss of PSD within the slow-5 frequency band (0.01–0.027 Hz) while only CLBP patients on OA showed additional density loss within the slow-4 frequency band (0.027–0.073 Hz). We conclude that chronic treatment with OA is associated with altered brain structure and function within sensory limbic areas.
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Affiliation(s)
- Kyle Murray
- Department of Physics and Astronomy, University of Rochester, Rochester, NY, USA
| | - Yezhe Lin
- Department of Psychiatry, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Meena M Makary
- The John B. Pierce Laboratory, New Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Systems and Biomedical Engineering Department, Faculty of Engineering, Cairo University, Giza, Egypt
| | - Peter G Whang
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Paul Geha
- Department of Psychiatry, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.,The John B. Pierce Laboratory, New Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
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Zhang S, Wu S, Wu Q, Durkin DW, Marsiglia FF. Adolescent drug use initiation and transition into other drugs: A retrospective longitudinal examination across race/ethnicity. Addict Behav 2021; 113:106679. [PMID: 33032193 DOI: 10.1016/j.addbeh.2020.106679] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Understanding adolescent drug use mechanisms is critical for drug use prevention. Although some theories such as the gateway theory suggest that drug users gradually transition into using more addictive drugs, there is no consensus about such a hypothesis. One important factor that hinders the advancement of knowledge in this area is the scarcity of longitudinal studies examining the type of drugs adolescents initially use and the different pathways adolescents take to transition into using other drugs as they grow older. METHODS Using the pooled sample of adolescent dug users (14-17 years old; n = 10,644) from the National Survey on Drug Use and Health (2015-2018), we constructed longitudinal data on adolescents' illicit drug use history other than the use of tobacco and alcohol based on the age of drug initiation. This allowed us to investigate what drugs were initially used by adolescents, how the use of these drugs may have progressed into a new drug, and whether there were racial/ethnic differences in the initiation and progression. The retrospective longitudinal data analyses applied life table method and Cox regression models. RESULTS Two thirds of the adolescent drug users initiated their drug use trajectories with marijuana, one quarter with inhalants, and the remaining with hallucinogens, prescription drugs, and hard drugs. Adolescent drug users who initiated with different drugs showed unique trajectories to the use of a new drug. By year 8, the probability of using a new drug was about 40% and 70% to 80% for adolescents who initiated with inhalants and other drugs, respectively. The probability of using a new drug for adolescents who initiated with marijuana and inhalants accumulated stably over time, and its difference with that of other drug users diminished over time. The multivariate Cox regression models suggest the observed discrepancies generally held after controlling for covariates. There were also racial/ethnic differences in adolescent drug use initiation and progression, with Black/African American adolescents being the least likely to switch to the use of a new drug. CONCLUSION Adolescents' initial use of marijuana and inhalants may lead to substantial risks of using other drugs over time. It is therefore important to screen adolescent drug use comprehensively and provide early interventions to prevent an escalation to more detrimental drugs. The findings provide new evidence to support aspects of both the gateway and generalized risk drug use theories.
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30
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Doyle MA, Mazei-Robison MS. Opioid-Induced Molecular and Cellular Plasticity of Ventral Tegmental Area Dopamine Neurons. Cold Spring Harb Perspect Med 2021; 11:cshperspect.a039362. [PMID: 31964652 PMCID: PMC7371531 DOI: 10.1101/cshperspect.a039362] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Opioid drugs are highly valued as potent analgesics; however, there are significant risks associated with long-term use because of their abuse liability. Opioids cause changes in ventral tegmental area (VTA) gene expression and cell activity that have been linked to addiction-related behaviors in rodent models. Here, we focus on VTA dopamine (DA) neurons and review the cellular, structural, and synaptic plasticity changes induced by acute and chronic opioid exposure. We also discuss many avenues for future research including determination of whether opioid neuroadaptations are specific for subpopulations of VTA DA neurons. A better understanding of the molecular adaptations within the cells and circuits that drive opioid abuse is crucial for the development of better treatments for substance use disorders and to create novel, safer pain-relieving therapeutics.
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31
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Butler SF, Faraone SV, Rostain AL, Newcorn JH, Antshel KM, Robbins RS, Green JL. Non-medical Use of Prescription Stimulants Among College Students: Non-oral Routes of Administration, Risk Factors, Motivations, and Pathways. Front Psychiatry 2021; 12:667118. [PMID: 34483980 PMCID: PMC8415354 DOI: 10.3389/fpsyt.2021.667118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Non-medical use (NMU) of prescription stimulant medications is a continuing public health concern. Stimulant medications prescribed for attention-deficit/hyperactivity disorder (ADHD) are widely available on college campuses, and, as a consequence, college students may have multiple opportunities to engage in prescription stimulant NMU. This online self-report survey examined prescription stimulant NMU among college students, including: (1) patterns of non-oral route of administration (ROA); (2) motivations for non-oral ROAs; and (3) retrospectively recalled pathways of initiation. Method: The survey sample was created from a pool of 3,379 respondents, who were matched to a sampling frame constructed from the 18-26-year-old, college student sample of the 2016 American Community Survey (ACS). About 14% (n = 486) from the overall pool were identified as college students with self-reported prescription stimulant NMU, all of whom completed the survey. The survey covered user characteristics, prescription and illicit substance use, age of first NMU, motivations for NMU, sources of procurement, and ROAs used. Results: Among 486 students reporting prescription stimulant NMU, 43% had a lifetime diagnosis of ADHD. More than 90% reported polysubstance use, with 55% using illicit substances other than marijuana. Slightly more than 2 in 5 (43.3%) reported using illicit substances prior to prescription stimulant NMU, 24.6% used both at the same age, and 32.0% engaged in NMU of prescription stimulants prior to using illicit substances. Prescription stimulant NMU preceded prescription opioid NMU 45% of the time. More than a quarter of those engaged in prescription stimulant NMU (27.9%) initiated prescription stimulants alone or at the same age as other drugs. Most prescription stimulant NMU was oral, however 23.0% reported any non-oral use: snorting (20.4%), smoking (6.0%)and/or injection (3.5%). Non-oral use was associated with being male, obtaining medication from a dealer, use to get high, and/or a substance use disorder diagnosis. Conclusions: Prescription stimulant NMU often occurs in the larger context of other substance use among college students. Injection, an under-researched route for prescription stimulants, was associated with male gender, history of substance use and higher likelihood of illicit substance use. Nearly a quarter of college student survey respondents reported use with non-oral routes, which is associated with other high-risk behaviors. Efforts to reduce non-oral prescription stimulant NMU in college students are warranted.
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Affiliation(s)
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, The State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | - Anthony L Rostain
- Department of Psychiatry, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Jeffrey H Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kevin M Antshel
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | | | - Jody L Green
- Inflexxion, an IBH Company, Irvine, CA, United States
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Huynh P, Victor G, Ray B. Using prescribing and toxicology data to determine non-medical prescription drug overdose. Addict Behav Rep 2020; 12:100289. [PMID: 32637565 PMCID: PMC7330872 DOI: 10.1016/j.abrep.2020.100289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Overdose deaths have increased dramatically in the United States and are often attributed to prescription opioids. This study presents a framework for "overdose typologies", including non-medical prescription drug use, to more accurately describe drug use patterns. METHODS This study examined linked prescription drug monitoring program (PDMP) and toxicology data (2016-2018) from accidental overdose deaths from a large metropolitan coroner's office in the Midwest (Indianapolis, Indiana). RESULTS In total, 1,112 accidental overdose deaths occurred and over two-thirds (68.0%; n = 756) were coded as an illicit drug user with no prescription opioid present in the toxicology. The most infrequent categories were prescription opioid users 5.5% (n = 61). CONCLUSION Linked PDMP and toxicology reports are useful in identifying drug use patterns that contribute to mortality.
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Affiliation(s)
- Philip Huynh
- Center for Behavioral Health and Justice at Wayne State University, Detroit, MI, United States
| | - Grant Victor
- Center for Behavioral Health and Justice at Wayne State University, Detroit, MI, United States
| | - Brad Ray
- Center for Behavioral Health and Justice at Wayne State University, Detroit, MI, United States
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Chapman M, Thomas M, Thompson K. What People Really Think About Safety around Horses: The Relationship between Risk Perception, Values and Safety Behaviours. Animals (Basel) 2020; 10:E2222. [PMID: 33256171 PMCID: PMC7761269 DOI: 10.3390/ani10122222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
The equestrian industry reports high rates of serious injuries, illness and fatalities when compared to other high-risk sports and work environments. To address these ongoing safety concerns, a greater understanding of the relationship between human risk perception, values and safety behaviours is required. This paper presents results from an international survey that explored relationships between a respondents' willingness to take risk during daily activities along with, their perceptions of risk and behaviours during horse-related interactions. Respondents' comments around risk management principles and safety-first inspirations were also analysed. We examined what humans think about hazardous situations or activities and how they managed risk with suitable controls. Analysis identified three important findings. First, safe behaviours around horses were associated with safety training (formal and/or informal). Second, unsafe behaviours around horses were associated with higher levels of equestrian experience as well as income from horse-related work. Finally, findings revealed a general acceptance of danger and imminent injury during horse interactions. This may explain why some respondents de-emphasised or 'talked-down' the importance of safety-first principles. In this paper we predominantly reported quantitative findings of respondents self-reported safety behaviours, general and horse-related risk perceptions despite injury or illness. We discussed the benefits of improved safety-first principles like training, risk assessments, rider-horse match with enriched safety communications to enhance risk-mitigation during human-horse interactions.
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Affiliation(s)
- Meredith Chapman
- The Appleton Institute, Central Queensland University, 44 Greenhill Road, Wayville, SA 5034, Australia;
- Safety in Focus, PO Box 711, Narrabri, NSW 2390, Australia
| | - Matthew Thomas
- The Appleton Institute, Central Queensland University, 44 Greenhill Road, Wayville, SA 5034, Australia;
| | - Kirrilly Thompson
- UniSA Business, University of South Australia, 101 Currie Street, Adelaide, SA 5001, Australia;
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Meruva S, Rezaei L, Thool P, Donovan MD. Use of Drug Release Testing to Evaluate the Retention of Abuse-Deterrent Properties of Polyethylene Oxide Matrix Tablets. AAPS PharmSciTech 2020; 21:270. [PMID: 33025237 DOI: 10.1208/s12249-020-01804-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/28/2020] [Indexed: 11/30/2022] Open
Abstract
Abuse-deterrent formulations (ADFs) using physical/chemical barrier approaches limit abuse by providing resistance to dosage form manipulation to limit drug extraction or altered release. Standardizing in vitro testing methods to assess the resistance to manipulation presents a number of challenges, including the variation in particle sizes resulting from the use of various tools to alter the tablet matrix (e.g., grinding, chipping, crushing). A prototype, direct-compression ADF using a sintered polyethylene oxide (PEO) matrix containing dextromethorphan, an enantiomeric form of the opioid, levorphanol, was developed to evaluate testing methodologies for retention of abuse-deterrent properties following dosage form tampering. Sintered PEO tablets were manipulated by grinding, and drug content and release were evaluated for the recovered granules. Drug content analysis revealed that higher amounts of drug were contained in the smaller size granules (< 250 μm, 190% of the theoretical amount) compared with the larger particles (> 250 μm, 55-75% of theoretical amount). Release testing was performed on various size granule fractions (> 850 μm, 500-850 μm, 250-500 μm, and < 250 μm) using USP type I (basket), type II (paddle), and type IV (flow-through) apparatus. The USP type I and type II apparatus gave highly variable release results with poor discrimination among the release rates from different size granules. The observed sticking of the hydrated granules to the baskets and paddles, agglomeration of hydrated granules within the baskets/vessels, and ongoing PEO hydration with subsequent gel formation further altered the particle size and impacted the rate of drug release. The use of a flow-through apparatus (USP type IV) resulted in improved discrimination of drug release from different size granules with less variability due to better dispersion of granules (minimal sticking and aggregation). Drug release profiles from the USP type IV apparatus showed that the larger size granules (> 500 μm) offered continued resistance to drug release following tablet manipulation, but the smaller size granules (< 500 μm) provided rapid drug release that was unhindered by the hydrated granule matrix. Since < 500-μm size particles are preferred for nasal abuse, improved direct-compression ADF formulations should minimize the formation of these smaller-sized particles following tampering to maintain the product's abuse-deterrent features.
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Papp LM, Barringer A, Blumenstock SM, Gu P, Blaydes M, Lam J, Kouros CD. Development and Acceptability of a Method to Investigate Prescription Drug Misuse in Daily Life: Ecological Momentary Assessment Study. JMIR Mhealth Uhealth 2020; 8:e21676. [PMID: 32877351 PMCID: PMC7563627 DOI: 10.2196/21676] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/11/2020] [Accepted: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background Prescription drug misuse and abuse is an established public health challenge, and young adults are particularly affected. There is a striking lack of real-time, naturalistic data collection assessing intentions to misuse and other precipitating factors at the time of actual misuse, leaving the conditions under which individuals are most likely to misuse prescription medications unknown. Ecological momentary assessment (EMA) apps and protocols designed to capture this information would accelerate and expand the knowledge base and could directly contribute to prevention and treatment efforts. Objective The objectives of this study are to describe the development and administration of a mobile app and the EMA protocol designed to collect real-time factors associated with college students’ prescription drug misuse intentions and behaviors in daily life; present completion rates, compliance, acceptability, and reactivity associated with the EMA protocol for participants who endorsed recent prescription drug misuse at screening (ie, risk group; n=300) and those who did not (ie, nonrisk group; n=55); and establish initial construct validity by linking the reports of misuse behaviors in daily life collected via the EMA app to prescription drug misuse reported on a standard survey. Methods An EMA data collection app and protocol were designed specifically to capture hypothesized contextual factors along with prescription drug misuse intentions and behaviors in daily life. Using this protocol, young adult college students (N=352) completed signal- and event-contingent reports over a 28-day period. When the intention to misuse a prescription drug was endorsed, a brief follow-up prompt was sent 15 min later to collect participants’ indications of whether or not misuse had occurred. Results Risk-group participants were significantly more likely than nonrisk counterparts to endorse any prescription drug misuse intentions in daily life (P<.001), to complete one or more follow-up reports (P<.001), and to endorse any prescription drug misuse behavior in daily life on the follow-ups (P<.001). Overall, participants demonstrated consistent engagement with the EMA procedures and returned an average of 74.5 (SD 23.82; range 10-122) reports. Participants in the risk and nonrisk groups did not differ in the number of reports they completed (P=.12), the number of their reporting days (P=.32), or their average completion rates (P=.14). The results indicated some evidence of reactivity to the momentary reporting procedure. Participants reported uniformly positive experiences and remained highly engaged throughout the reporting protocol and broader study. Conclusions The novel EMA app and protocol provide an effective way to assess real-time factors associated with prescription drug misuse intentions and behaviors in daily life. The resulting investigations offer the potential to provide highly translatable information for research and prevention efforts.
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Affiliation(s)
- Lauren M Papp
- Department of Human Development and Family Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Alexandra Barringer
- Department of Human Development and Family Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Shari M Blumenstock
- Department of Human Development and Family Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Pamela Gu
- Department of Human Development and Family Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Madison Blaydes
- Department of Human Development and Family Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Jaime Lam
- Department of Human Development and Family Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Chrystyna D Kouros
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
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Larochelle MR, Wakeman SE, Ameli O, Chaisson CE, McPheeters JT, Crown WH, Azocar F, Sanghavi DM. Relative Cost Differences of Initial Treatment Strategies for Newly Diagnosed Opioid Use Disorder: A Cohort Study. Med Care 2020; 58:919-926. [PMID: 32842044 PMCID: PMC7641182 DOI: 10.1097/mlr.0000000000001394] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Relative costs of care among treatment options for opioid use disorder (OUD) are unknown. METHODS We identified a cohort of 40,885 individuals with a new diagnosis of OUD in a large national de-identified claims database covering commercially insured and Medicare Advantage enrollees. We assigned individuals to 1 of 6 mutually exclusive initial treatment pathways: (1) Inpatient Detox/Rehabilitation Treatment Center; (2) Behavioral Health Intensive, intensive outpatient or Partial Hospitalization Services; (3) Methadone or Buprenorphine; (4) Naltrexone; (5) Behavioral Health Outpatient Services, or; (6) No Treatment. We assessed total costs of care in the initial 90 day treatment period for each strategy using a differences in differences approach controlling for baseline costs. RESULTS Within 90 days of diagnosis, 94.8% of individuals received treatment, with the initial treatments being: 15.8% for Inpatient Detox/Rehabilitation Treatment Center, 4.8% for Behavioral Health Intensive, Intensive Outpatient or Partial Hospitalization Services, 12.5% for buprenorphine/methadone, 2.4% for naltrexone, and 59.3% for Behavioral Health Outpatient Services. Average unadjusted costs increased from $3250 per member per month (SD $7846) at baseline to $5047 per member per month (SD $11,856) in the 90 day follow-up period. Compared with no treatment, initial 90 day costs were lower for buprenorphine/methadone [Adjusted Difference in Differences Cost Ratio (ADIDCR) 0.65; 95% confidence interval (CI), 0.52-0.80], naltrexone (ADIDCR 0.53; 95% CI, 0.42-0.67), and behavioral health outpatient (ADIDCR 0.54; 95% CI, 0.44-0.66). Costs were higher for inpatient detox (ADIDCR 2.30; 95% CI, 1.88-2.83). CONCLUSION Improving health system capacity and insurance coverage and incentives for outpatient management of OUD may reduce health care costs.
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Affiliation(s)
- Marc R. Larochelle
- Clinical Addiction Research and Education Unit at Boston University School of Medicine and Boston Medical Center
| | - Sarah E. Wakeman
- Massachusetts General Hospital, Division of General Internal Medicine and Harvard Medical School, Boston
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De Rycke E, Stove C, Dubruel P, De Saeger S, Beloglazova N. Recent developments in electrochemical detection of illicit drugs in diverse matrices. Biosens Bioelectron 2020; 169:112579. [PMID: 32947080 DOI: 10.1016/j.bios.2020.112579] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/20/2020] [Accepted: 08/31/2020] [Indexed: 01/24/2023]
Abstract
Drug abuse is a global problem, requiring an interdisciplinary approach. Discovery, production, trafficking, and consumption of illicit drugs have been constantly growing, leading to heavy consequences for environment, human health, and society in general. Therefore, an urgent need for rapid, sensitive, portable and easy-to-operate detection methods for numerous drugs of interest in diverse matrices, from police samples, biological fluids and hair to sewage water has risen. Electrochemical sensors are promising alternatives to chromatography and spectrometry. Last decades, electrochemical sensing of illegal drugs has experienced a very significant growth, driven by improved transducers and signal amplifiers helping to improve the sensitivity and selectivity. The present review summarizes recent advances (last 10 years) in electrochemical detection of the most prevailing illicit drugs (such as cocaine, heroin, and (meth)amphetamine), their precursors and derivatives in different matrices. Various electrochemical sensors making use of different transducers with their (dis)advantages were discussed, and their sensitivity and applicability were critically compared. In those cases where natural or synthetic recognition elements were included in the sensing system to increase specificity, selected recognition elements, their immobilization, working conditions, and analytical performance were discussed. Finally, an outlook is presented with suggestions and recommendations for future developments.
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Affiliation(s)
- Esther De Rycke
- Centre of Excellence in Mycotoxicology and Public Health, Department of Bioanalysis, Ghent University, Ottergemsesteenweg 460, B-9000 Ghent, Belgium; Polymer Chemistry & Biomaterials Research Group, Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, Building S4-Bis, B-9000 Ghent, Belgium.
| | - Christophe Stove
- Laboratory of Toxicology, Ghent University, Ottergemsesteenweg 460, B-9000 Ghent, Belgium
| | - Peter Dubruel
- Polymer Chemistry & Biomaterials Research Group, Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, Building S4-Bis, B-9000 Ghent, Belgium
| | - Sarah De Saeger
- Centre of Excellence in Mycotoxicology and Public Health, Department of Bioanalysis, Ghent University, Ottergemsesteenweg 460, B-9000 Ghent, Belgium
| | - Natalia Beloglazova
- Centre of Excellence in Mycotoxicology and Public Health, Department of Bioanalysis, Ghent University, Ottergemsesteenweg 460, B-9000 Ghent, Belgium; Nanotechnology Education and Research Center, South Ural State University, 454080 Chelyabinsk, Russia
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Cornwell WD, Sriram U, Seliga A, Zuluaga-Ramirez V, Gajghate S, Rom S, Winfield M, Heldt NA, Ambrose D, Rogers TJ, Persidsky Y. Tobacco smoke and morphine alter peripheral and CNS inflammation following HIV infection in a humanized mouse model. Sci Rep 2020; 10:13977. [PMID: 32814790 PMCID: PMC7438518 DOI: 10.1038/s41598-020-70374-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/23/2020] [Indexed: 12/16/2022] Open
Abstract
Tobacco smoking is common in HIV-infected patients, and is prevalent among intravenous opiate abusers. Conversely, intravenous opiate abusers are more likely HIV-infected, and opiate abuse is associated with more severe neuroinflammation. Given the coincident use of tobacco smoking among HIV-infected intravenous drug users (IVDUs), we set out to study the effects of smoke exposure, chronic morphine administration, and HIV infection using the NSG humanized mouse model. Our results show that smoke, morphine, and the combination promotes the decline in CD4+ T cells in HIV-infected mice. Further, chronic morphine administration increases the numbers of circulating CD8+ T cells which express the inhibitory receptor PD-1, as well as the cytolytic proteins perforin and granzyme B in the infected mice. We also found that the combination of smoke and morphine inhibited the expression of IL-1α, IL-4 and IL-17A. Finally, the combination of smoke and morphine exposure induces microglial activation following infection, as well as in the absence of HIV infection. To our knowledge, this is the first report to assess the combined effects of smoke and chronic morphine exposure on the inflammation associated with HIV infection, and demonstrate that these two insults exert significant neuroinflammatory activity.
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Affiliation(s)
- William D Cornwell
- Center for Inflammation, Translational and Clinical Lung Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA.
| | - Uma Sriram
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA
| | - Alecia Seliga
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA
| | - Viviana Zuluaga-Ramirez
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA
| | - Sachin Gajghate
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA
| | - Slava Rom
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA
| | - Malika Winfield
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA
| | - Nathan A Heldt
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA
| | - David Ambrose
- Center for Inflammation, Translational and Clinical Lung Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA
| | - Thomas J Rogers
- Center for Inflammation, Translational and Clinical Lung Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA
| | - Yuri Persidsky
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA
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Trends in Opioid Use in a Cohort of Patients with Rheumatoid Arthritis. Pain Res Manag 2020; 2020:3891436. [PMID: 32724487 PMCID: PMC7382740 DOI: 10.1155/2020/3891436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/26/2020] [Indexed: 11/23/2022]
Abstract
The objective was to determine the trend in the use of opioid analgesics in a cohort of patients diagnosed with and treated for rheumatoid arthritis (RA) in 24 cities in Colombia. This retrospective cohort study included adult patients diagnosed with RA, which was managed in a specialized institution in Colombia between January 2011 and December 2012. The first rheumatology visit was recorded as an index date, and monthly monitoring of the analgesic medication received was performed until December 2017. Sociodemographic variables, the use of opioids, and concomitant prescriptions were evaluated. A total of 1,329 patients diagnosed with and treated for RA were included; they had a mean age of 61.2 ± 11.8 years and were predominantly females (n = 936; 82.9%). A total of 1,129 (84.9%) subjects used opioids for at least one month, and a growing trend, from 13.5% to 21.4%, was observed in patients who received opioids every month throughout a 7-year follow-up of the cohort. In total, 46.7% of the cases used opioids for more than 12 months. The most commonly used opioids were codeine (76.3%) and tramadol (71.1%). All patients received conventional disease-modifying antirheumatic drugs (DMARDs), 85.6% received systemic corticosteroids, 73.9% received nonsteroidal anti-inflammatory drugs, and 15.9% received biological DMARDs. A high proportion of opioid use was shown for pain management in patients with RA, in many cases for more than 12 months, in whom the efficacy and especially safety, related to the risk of dependence, should be monitored.
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Lamy FR, Daniulaityte R, Barratt MJ, Lokala U, Sheth A, Carlson RG. Listed for sale: Analyzing data on fentanyl, fentanyl analogs and other novel synthetic opioids on one cryptomarket. Drug Alcohol Depend 2020; 213:108115. [PMID: 32585419 PMCID: PMC7736148 DOI: 10.1016/j.drugalcdep.2020.108115] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/14/2020] [Accepted: 06/08/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The United States is facing a "triple wave" epidemic fueled by novel synthetic opioids. Cryptomarkets, anonymous marketplaces located on the deep web, play an increasingly important role in the distribution of illicit substances. This article presents the data collected and processed by the eDarkTrends platform concerning the availability trends of novel synthetic opioids listed on one cryptomarket. METHODS Listings from the DreamMarket cryptomarket "Opioids" and "Research Chemicals" sections were collected between March 2018 and January 2019. Collected data were processed using eDarkTrends Named Entity Recognition algorithm to identify opioid drugs, and to analyze their availability trends in terms of frequency of listings, available average weights, average prices, and geographic indicators of shipment origin and destination information. RESULTS 95,011 opioid-related listings were collected through 26 crawling sessions. 33 novel synthetic opioids were identified in 3.3 % of the collected listings. 44.7 % of these listings advertised fentanyl (pharmaceutical and non-pharmaceutical) or fentanyl analogs for an average of 2.8 kgs per crawl. "Synthetic heroin" accounted for 33.2 % of novel synthetic opioid listings for an average 1.1 kgs per crawl with 97.7 % of listings advertised as shipped from Canada. Other novel synthetic opioids (e.g., U-47,700, AP-237) represented 22 % of these listings for an average of 6.1 kgs per crawl with 97.2 % of listings advertised as shipped from China. CONCLUSIONS Our data indicate consistent availability of a wide variety of novel synthetic opioids both in retail and wholesale-level amounts. Identification of new substances highlights the value of cryptomarket data for early warning systems of emerging substance use trends.
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Affiliation(s)
- Francois R. Lamy
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand,Corresponding author
| | - Raminta Daniulaityte
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Monica J. Barratt
- Social and Global Studies Centre, RMIT University, Melbourne, VIC, Australia,National Drug and Alcohol Research Centre, UNSW Sydney, NSW, Australia
| | - Usha Lokala
- Kno.e.sis Center, Department of Computer Science, Wright State University, Dayton, OH, United States
| | - Amit Sheth
- Artificial Intelligence Center, University of South Carolina, Columbia, SC, United States
| | - Robert G. Carlson
- Center for Interventions, Treatment, and Addictions Research, Department of Population and Public Health Sciences, Wright State University, Dayton, OH, United States
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Collins EA. Understanding the Risk Factors and Lived Experiences of Prescription Drug Abuse Among Canadian Children and Adolescents: A Retrospective Phenomenological Study. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2020. [DOI: 10.1080/1067828x.2020.1736223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Eric A. Collins
- Health & Rehabilitation Sciences, Western University, London, Ontario, Canada
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42
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Ge X, Henningfield JE, Siddhanti S, Jobes J, Lu L, Xie S, Ziola M, Kelsh D, Vince B, Di Fonzo CJ, Tagliaferri M, Zalevsky J, Doberstein SK, Hoch U, Eldon MA. Human Abuse Potential of Oral NKTR-181 in Recreational Opioid Users: A Randomized, Double-Blind, Crossover Study. PAIN MEDICINE 2020; 21:e114-e126. [PMID: 31553457 DOI: 10.1093/pm/pnz232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the human abuse potential, pharmacokinetics, pharmacodynamics, and safety of oral NKTR-181 (oxycodegol), a novel full mu-opioid receptor agonist, relative to oral oxycodone. DESIGN This double-blind, randomized, single-dose, crossover human abuse potential study was conducted in healthy, adult, non-physically dependent recreational opioid users. SETTING Inpatient clinical research site. SUBJECTS Seventy-one subjects randomized (95.7% male, 65.2% African American, mean age = 31.7 years). METHODS The primary objective was to compare two therapeutic doses of NKTR-181 (400 and 600 mg) with 40 and 60 mg of oxycodone and a supratherapeutic dose (1200 mg) of NKTR-181 with 60 mg of oxycodone using visual analog scale (VAS) ratings for Drug Liking "at this moment" (Drug Liking). Secondary objectives included VAS ratings for other subjective measures, and central nervous system (CNS) mu-opioid effects were assessed using pupillometry. Each subject received single oral doses of five treatments and matching placebo. RESULTS Compared with 40 and 60 mg of oxycodone, the maximum mean Drug Liking score at 400 and 600 mg NKTR-181 was significantly lower, and the rate of onset and extent of Drug Liking for all NKTR-181 doses in the first two hours postdose were also significantly lower. Delayed attenuated Drug Liking and pupillary miosis response following administration of NKTR-181 vs oxycodone were consistent with slower NKTR-181 CNS entry kinetics and mu-opioid receptor binding. No adverse events were rated as severe, and somnolence and dizziness occurred more frequently when subjects received oxycodone. CONCLUSIONS NKTR-181 at oral doses of 400 and 600 mg showed significantly fewer and less severe subjective effects accepted as representative of opioid abuse potential, such as lower peak Drug Liking in recreational opioid users, than 40 and 60 mg of oxycodone.
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Affiliation(s)
- Xue Ge
- Nektar Therapeutics, San Francisco, California
| | - Jack E Henningfield
- The Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland.,Pinney Associates, Bethesda, Maryland
| | | | - Janet Jobes
- Nektar Therapeutics, San Francisco, California
| | - Lin Lu
- Nektar Therapeutics, San Francisco, California
| | - Sunny Xie
- Nektar Therapeutics, San Francisco, California
| | | | - Debra Kelsh
- Altasciences Clinical Research, Overland Park, Kansas, USA
| | - Bradley Vince
- Altasciences Clinical Research, Overland Park, Kansas, USA
| | | | | | | | | | - Ute Hoch
- Nektar Therapeutics, San Francisco, California
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Li DJ, Chen SL, Chang YP, Yen CF. Factors Affecting Painkillers, Sedatives/Hypnotics, Nicotine, and Unhealthy Alcohol Use Among Gay and Bisexual Men in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E851. [PMID: 32013262 PMCID: PMC7038077 DOI: 10.3390/ijerph17030851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 01/29/2023]
Abstract
Substance use has become a major health problem globally for sexual minorities. However, few studies have explored multi-dimensional factors associated with smoking, drinking, and prescription drug use. We aimed to investigate the factors affecting painkiller, sedative/hypnotic, nicotine and unhealthy alcohol use among gay and bisexual men in Taiwan. We recruited 500 gay or bisexual men and assessed their experiences of using painkillers, sedatives/hypnotics, nicotine, alcohol and multi-dimensional factors with self-reported questionnaires. Multivariate logistic regression with a forward stepwise model was used to verify the factors associated with substance use. Overall, 9.4%, 5.4%, and 13.8% of the participants reported using painkillers, sedatives/hypnotics, and nicotine, respectively, and 5.6% reported unhealthy alcohol use. Victims of traditional homophobic bullying in childhood and adolescence were more likely to report nicotine use, sedative/hypnotic use, and unhealthy alcohol use in early adulthood than non-victims. Missing classes or truancy at senior high school was associated with painkiller and sedative/hypnotic use in early adulthood. Traditional homophobic bullying and missing classes or truancy in childhood and adolescence predicted substance use in early adulthood among the gay and bisexual men in this study. Timely preventions and interventions for substance use are crucial for gay and bisexual men, especially for those who experience homophobic bullying and missing classes or truancy.
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Affiliation(s)
- Dian-Jeng Li
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung 80276, Taiwan
| | - Shiou-Lan Chen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, New York, NY14214–3079, USA;
| | - Cheng-Fang Yen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
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Kiang MV, Humphreys K, Cullen MR, Basu S. Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study. BMJ 2020; 368:l6968. [PMID: 31996352 PMCID: PMC7190021 DOI: 10.1136/bmj.l6968] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the distribution and patterns of opioid prescribing in the United States. DESIGN Retrospective, observational study. SETTING National private insurer covering all 50 US states and Washington DC. PARTICIPANTS An annual average of 669 495 providers prescribing 8.9 million opioid prescriptions to 3.9 million patients from 2003 through 2017. MAIN OUTCOME MEASURES Standardized doses of opioids in morphine milligram equivalents (MMEs) and number of opioid prescriptions. RESULTS In 2017, the top 1% of providers accounted for 49% of all opioid doses and 27% of all opioid prescriptions. In absolute terms, the top 1% of providers prescribed an average of 748 000 MMEs-nearly 1000 times more than the middle 1%. At least half of all providers in the top 1% in one year were also in the top 1% in adjacent years. More than two fifths of all prescriptions written by the top 1% of providers were for more than 50 MMEs a day and over four fifths were for longer than seven days. In contrast, prescriptions written by the bottom 99% of providers were below these thresholds, with 86% of prescriptions for less than 50 MMEs a day and 71% for fewer than seven days. Providers prescribing high amounts of opioids and patients receiving high amounts of opioids persisted over time, with over half of both appearing in adjacent years. CONCLUSIONS Most prescriptions written by the majority of providers are under the recommended thresholds, suggesting that most US providers are careful in their prescribing. Interventions focusing on this group of providers are unlikely to effect beneficial change and could induce unnecessary burden. A large proportion of providers have established relationships with their patients over multiple years. Interventions to reduce inappropriate opioid prescribing should be focused on improving patient care, management of patients with complex pain, and reducing comorbidities rather than seeking to enforce a threshold for prescribing.
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Affiliation(s)
- Mathew V Kiang
- Center for Population Health Sciences, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA 94304, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
- Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Mark R Cullen
- Center for Population Health Sciences, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA 94304, USA
| | - Sanjay Basu
- Center for Primary Care, Harvard Medical School, Boston, MA, USA
- Research and Analytics, Collective Health, San Francisco, CA, USA
- School of Public Health, Imperial College, London, UK
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Abstract
Opioid use disorder (OUD) is a chronic relapsing disorder that, whilst initially driven by activation of brain reward neurocircuits, increasingly engages anti-reward neurocircuits that drive adverse emotional states and relapse. However, successful recovery is possible with appropriate treatment, although with a persisting propensity to relapse. The individual and public health burdens of OUD are immense; 26.8 million people were estimated to be living with OUD globally in 2016, with >100,000 opioid overdose deaths annually, including >47,000 in the USA in 2017. Well-conducted trials have demonstrated that long-term opioid agonist therapy with methadone and buprenorphine have great efficacy for OUD treatment and can save lives. New forms of the opioid receptor antagonist naltrexone are also being studied. Some frequently used approaches have less scientifically robust evidence but are nevertheless considered important, including community preventive strategies, harm reduction interventions to reduce adverse sequelae from ongoing use and mutual aid groups. Other commonly used approaches, such as detoxification alone, lack scientific evidence. Delivery of effective prevention and treatment responses is often complicated by coexisting comorbidities and inadequate support, as well as by conflicting public and political opinions. Science has a crucial role to play in informing public attitudes and developing fuller evidence to understand OUD and its associated harms, as well as in obtaining the evidence today that will improve the prevention and treatment interventions of tomorrow.
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Peacock A, Gisev N, Memedovic S, Larance B, Brown J, Cairns R, Buckley N, Farrell M, Degenhardt L. Opioid use and harms associated with a sustained-release tapentadol formulation: A post-marketing surveillance study. Drug Alcohol Depend 2020; 206:107697. [PMID: 31869601 DOI: 10.1016/j.drugalcdep.2019.107697] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 02/06/2023]
Abstract
AIMS A sustained-release formulation (SRF) of tapentadol has been marketed in Australia since February 2013. This study examined tapentadol SRF extra-medical use, attractiveness for extra-medical use, and associated harms in Australia. METHODS This post-marketing study comprises analyses of Australian community sales data (2011-2017) for eleven pharmaceutical opioids (prescription and over-the-counter codeine disaggregated); calls to three poisons information centres (covering five of the eight jurisdictions in Australia) related to pharmaceutical opioids and coded by the centres as 'misuse' or 'abuse' (2011-2017); and interviews with people who inject drugs (n = 888) recruited as part of the Illicit Drug Reporting System (IDRS) from all Australian capital cities (2017). RESULTS Population-level availability of tapentadol SRF increased from market launch, comprising the sixth largest market share of all opioid unit sales, and third greatest share in oral morphine equivalent milligrams sold, in December 2017. Lifetime tapentadol SRF use among the IDRS sample (n = 888) was low (1.5%; 95%CI 0.9-2.5), with few reporting past-6 month non-prescribed use or injection. Non-fatal overdose following tapentadol use was self-reported by less than 1% (95%CI 0.1-0.8). Between 2013-2017, 1.1% (n = 25) of pharmaceutical opioid 'misuse/abuse' calls were related to tapentadol, and predominantly the SRF. CONCLUSIONS Increasing utilisation of tapentadol sustained-release formulation was observed, along with indications of extra-medical use and harms associated with use, although on a smaller scale relative to other opioids. These findings need to be interpreted in the context of the low level of exposure to tapentadol sustained-release formulation among the sentinel population of people who inject drugs.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia; School of Medicine, University of Tasmania, TAS, Australia.
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Sonja Memedovic
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia; School of Psychology, University of Wollongong, NSW, Australia
| | - Jared Brown
- NSW Poisons Information Centre, The Children's Hospital at Westmead, NSW, Australia
| | - Rose Cairns
- NSW Poisons Information Centre, The Children's Hospital at Westmead, NSW, Australia; School of Medical Sciences, University of Sydney, NSW, Australia
| | - Nicholas Buckley
- NSW Poisons Information Centre, The Children's Hospital at Westmead, NSW, Australia; School of Medical Sciences, University of Sydney, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
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Mathis SM, Hagemeier N, Foster KN, Baker K, Pack RP. "It's Took Over This Region": Patient Perspectives of Prescription Drug Abuse in Appalachia. Subst Use Misuse 2020; 55:37-47. [PMID: 31526177 PMCID: PMC6917981 DOI: 10.1080/10826084.2019.1654514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Prescription drug abuse is a public health problem in the United States and the region of Appalachia, specifically. Primary care and addiction medicine-as possible points of access for prescription drugs with abuse potential and points of intervention for prescription drug abuse-are among the medical fields at its forefront. Little is known, however, about perceptions of prescription drug abuse across the two patient populations. Objectives: The objective of this qualitative analysis was to explore perceptions of the scale and context of prescription drug abuse among primary care and addiction medicine patients in Appalachia. Methods: As part of a mixed methods study, semi-structured interviews were conducted with 20 patients from primary care and addiction medicine in Central and South Central Appalachia from 2014 to 2015. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to identify themes. Results: Three themes were identified: (1) pervasiveness of prescription drug abuse, describing perceptions of its high prevalence and negative consequences; (2) routes and routine practices for prescription drug acquisition and distribution, describing perceptions of routes of access to prescription drugs and behaviors exhibited to acquire and distribute prescription drugs; and (3) rationales for prescription drug acquisition and distribution, describing perceptions of the two underlying reasons for these processes-tolerance/addiction and revenue source. Conclusions/Importance: Perceptions of prescription drug abuse among primary care and addiction medicine patients in Appalachia are multifaceted, especially regarding prescription drug acquisition and distribution. Clinical practice implications for mitigating prescription drug abuse are discussed.
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Affiliation(s)
- Stephanie M Mathis
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA.,Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, Tennessee, USA
| | - Nicholas Hagemeier
- Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, Tennessee, USA.,Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee, USA
| | - Kelly N Foster
- Department of Sociology and Anthropology, College of Arts and Sciences, East Tennessee State University, Johnson City, Tennessee, USA.,Applied Social Research Laboratory, East Tennessee State University, Johnson City, Tennessee, USA
| | - Katie Baker
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Robert P Pack
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA.,Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, Tennessee, USA
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Correlates of nonmedical use of prescription opioids among a cohort of adolescents in Ontario, Canada. J Psychiatr Res 2020; 120:175-184. [PMID: 31706075 DOI: 10.1016/j.jpsychires.2019.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 10/22/2019] [Accepted: 10/31/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Mortality and morbidity rates related to prescription opioid analgesics have been rising in North America and may be a gateway to the nonmedical use of prescription opioids (NUPO). The purpose of this study was to explore correlates of NUPO in the adolescent population given the scarce literature in this area. METHODS Cross-sectional data from 10,163 middle- and high-school students (15.1 ± 1.8 years old; 57.0% female; 55.6% White ethnic background) in Ontario were derived from the 2017 Ontario Student Drug Use and Health Survey. Potential correlates of NUPO in the past year included sociodemographic, behavioral, parental, and school characteristics. RESULTS Overall prevalence of NUPO was 10.7%. In the final multivariable model, NUPO was significantly associated with 8 of the 21 correlates examined. Students who used prescription opioids nonmedically were of black, South Asian, and "other" ethnic backgrounds (OR 2.83, OR 1.77, and OR 1.67, respectively); reported a lower subjective socioeconomic status (OR 0.92), lower parental support (OR 0.90), and lower academic performance (OR 0.86); met physical activity recommendations (OR 1.48); consumed energy drinks (OR 1.42); smoked tobacco cigarettes (OR 2.33); and used cannabis (OR 1.84). CONCLUSIONS Findings from this study show a wide variety of correlates of NUPO among Canadian adolescents, and highlight the need for further research and the value in targeted prevention and multi-level intervention programs for NUPO in this population.
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Eiroa-Orosa FJ, Gebac S, Braquehais MD, Llavayol E, Garcia-Gutierrez A, Feixas G. Substance Abuse Among Health Professionals: A Personal Construct Analysis. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2019. [DOI: 10.1080/10720537.2019.1706676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Francisco José Eiroa-Orosa
- Section of Personality, Evaluation and Psychological Treatment, Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, School of Psychology, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Silvia Gebac
- Section of Personality, Evaluation and Psychological Treatment, Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, School of Psychology, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - María Dolores Braquehais
- Integral Caring Programme for Sick Health Professionals, Galatea Clinic, Galatea Foundation,Barcelona, Catalonia, Spain
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Spain
| | - Enric Llavayol
- Integral Caring Programme for Sick Health Professionals, Galatea Clinic, Galatea Foundation,Barcelona, Catalonia, Spain
| | - Alejandro Garcia-Gutierrez
- Section of Personality, Evaluation and Psychological Treatment, Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, School of Psychology, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Guillem Feixas
- Section of Personality, Evaluation and Psychological Treatment, Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, School of Psychology, Universitat de Barcelona, Barcelona, Catalonia, Spain
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Meruva S, Donovan MD. Polyethylene Oxide (PEO) Molecular Weight Effects on Abuse-Deterrent Properties of Matrix Tablets. AAPS PharmSciTech 2019; 21:28. [PMID: 31858320 DOI: 10.1208/s12249-019-1565-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/13/2019] [Indexed: 12/30/2022] Open
Abstract
While polyethylene oxide (PEO)-based matrix tablets are frequently used as abuse-deterrent dosage forms, there is limited information available regarding how the selection of formulation components and manufacturing processes affect the resulting abuse-deterrent properties. The objective of the current study was to evaluate the effects of formulation and process variables on the abuse-deterrent features of PEO-containing tablets. Directly compressed tablets were prepared using three different PEO molecular weights (100,000; 900,000; and 5,000,000). As anticipated, sintering/thermal treatment above the melting point of PEO was crucial to impart crush-resistant features (tablet hardness > 500 N). In addition to the sintering temperature, the weight fraction of PEO in the tablets affected their mechanical strength, and at least 50% w/w PEO was required to impart the desired crush-resistant features. In addition, the formulation and process variables also impacted syringeability and injectability of the PEO gels formed when the tablets were hydrated to simulate attempted drug extraction. High molecular weight PEO (900,000 and 5,000,000) produced gels more resistant to syringeability and injectability compared to low molecular weight PEO (100,000). Sintering above the polymer melting point decreased PEO crystallinity after cooling, and longer sintering times resulted in PEO degradation producing lower viscosity gels with reduced resistance to syringeability and injectability. Although sintering above the melting point of PEO imparts optimal mechanical strength to the tablets, prolonged sintering durations negatively impact polymer stability and alter the resulting abuse-deterrent features of the PEO-based tablet formulations.
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