Prevalence of dependence on prescription drugs and associated mental disorders in a representative sample of general hospital patients

[The use of prescription drugs with dependence potential in Germany : A prospective analysis of prescriptions in the public healthcare system between 2006 and 2010]

BACKGROUND

In Germany, about 1.4 to 2.6 million people are dependent on prescription drugs, mainly benzodiazepine derivatives and opioid analgesics. Despite this large number of affected people, studies on prescription behaviour and drug intake are scarce. There are particularly few empirical findings available with regard to elderly people age 65 and over who are disproportionally affected by prescription drug abuse.

METHODS

The North German Pharmacy Computing Centre (Norddeutsches Apothekenrechenzentrum, NARZ) collects the prescription data of about 11 million citizens and covers over 80% of drug pharmacies in North Germany. Based on the data from NARZ, we evaluate person-related prescriptions of benzodiazepines, Z‑drugs and opioid analgesics. By means of incremental calculations, we determine the prevalence of prescription drug use, the long-term intake, the average daily dose of these medications and present this information as a five-year trend (2006-2010).

RESULTS

In 2006, 10.6% of the members of public healthcare system were prescribed at least one of the medications under study. This proportion hardly changed within the five-year span. The share of patients with benzodiazepine prescription steadily decreased from 2006 (5.5%) to 2010 (5.1%), especially among elderly people. While the prevalence of Z‑drug prescriptions remained the same at about 1%, there was a slight increase in prescriptions of opioid analgesics with 5.4% in 2006 to 5.7% in 2010. The proportion of patients with long-term prescriptions decreased with regard to benzodiazepines (from 17.0 to 12.8%) and Z‑drugs (from 24.3 to 21.2%), but increased for opioid analgesics (from 19.2 to 21.2%).

CONCLUSION

The analytical method used in this study is an innovative epidemiological approach to evaluate person-related register data over the course of several years. Establishing a monitoring system of prescription drugs with potential for dependence may allow for a quicker identification of trends and initiation of appropriate measures.

Substance Addiction in Old Age

Abstract. There is a lack of studies using a structured face-to-face interview focusing on the full spectrum of substance addictions according to ICD or DSM classification systems in older patients. We therefore examined a cohort of 400 randomly selected, at least 65-year-old inpatients of a general hospital concerning addictive disorders using a well-tested structured clinical interview (DSM-IV-TR-based SKID-I). Nearly one third of this cohort was substance dependent: The 12-month prevalence rate for nicotine was 10.3% and for alcohol dependence 3%, with 24.4% and 66.7%, respectively, being severely dependent. These rates were similar to those found in the general German population of persons under 65 year of age. A fifth of the cohort was (mostly mildly) dependent on prescription drugs, remarkably including nonopioid analgesics. One case with a previous dependence on gabapentin was identified. Identification and management of addiction disorders should be considered as part of the basic geriatric assessment.

Probability and predictors of remission from life-time prescription drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions

While prescription drug use disorders (PDUD) has become an important and growing public health problem, little is known about their course. This study aims to estimate cumulative probability of remission from sedatives, tranquilizers, opioids and stimulants, and to identify predictors of remission across substances. Analyses were done for the sub-sample of individuals with lifetime history of abuse or dependence on sedatives (n = 402), tranquilizers (n = 372), opioids (n = 521), and stimulants (n = 765) at Wave 1 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Cumulative probability estimates and hazard ratios for remission from PDUD were obtained for the general population. Lifetime cumulative probability estimates of remission were above 96% for all substances assessed. Half of the cases of PDUD remitted between 4 and 5 years after onset. Remission from PDUD was greater for younger individuals. Males exhibited lower hazards of remission for stimulants use disorder. A diagnosis of personality disorders decreased probability of remission for sedatives and stimulants. Only abuse or dependence on some prescription drugs decreased the probability of remission from other PDUD, whereas other drug disorders did not predict remission. A significant proportion of individuals with PDUD achieve remission at some point in their life-time. Predictors of remission were found to be mostly substance-specific rather than common across substances. The lower rates of remission among some subgroups of the population highlight the need to strengthen preventive and intervention efforts among vulnerable population subgroups.

Misuse of medicines in the European Union: a systematic review of the literature

BACKGROUND

Although awareness of the misuse of medicines is increasing, data on the extent of the problem in the European Union (EU) are lacking.

METHODS

In order to assess the magnitude and severity of the problem, a systematic review of the literature on the misuse of analgesics, opioid substitution medicines and sedatives/hypnotics (with the exception of benzodiazepines) was conducted using the PubMed and Web of Science databases. Relevant literature was identified between 2001 and 2011.

RESULTS

The main groups of misused medicines include opioid analgesics, methadone, buprenorphine and Z-drugs. Regional trends in medicine misuse indicate heterogeneity across the EU with respect to misused medicine types and research activities. Prevalence, high-risk populations and factors contributing to medicine misuse are discussed.

CONCLUSION

The implications of these findings for prevention, treatment, and policy in the EU are considered.

Twelve months of nightly zolpidem does not lead to dose escalation: a prospective placebo-controlled study

STUDY OBJECTIVES

To assess hypnotic self-administration and likelihood of dose escalation over 12 months of nightly use of zolpidem versus placebo in primary insomniacs.

DESIGN

Randomized, double-blind, placebo-controlled, clinical trial.

SETTING

Outpatient with tri-monthly one-week, sleep laboratory assessments.

PARTICIPANTS

Thirty-three primary insomniacs, without psychiatric disorders or drug and alcohol abuse, 32-64 yrs old, 14 men and 19 women.

INTERVENTIONS

Participants were randomized to take zolpidem 10 mg (n = 17) or placebo (n = 16) nightly for 12 months. In probes during month 1, 4, and 12, after sampling color-coded placebo or zolpidem capsules on 2 nights, color-coded zolpidem or placebo was chosen on 5 consecutive nights and 1, 2, or 3 of the chosen capsules (5 mg each) could be self-administered on a given choice night.

RESULTS

Zolpidem was chosen more nights than placebo (80% of nights) and number of nights zolpidem was chosen did not differ over the 12 months. More zolpidem than placebo capsules were self-administered, and the total number of placebo or zolpidem capsules self-administered did not differ as a function of duration of use. In contrast, the total number of placebo capsules self-administered by the placebo group increased across time. The nightly capsule self-administration on zolpidem nights did not differ from that on placebo nights and neither nightly self-administration rates increased over the 12 months. An average 9.3 mg nightly dose was self-administered.

CONCLUSIONS

Zolpidem was preferred to placebo, but its self-administration did not increase with 12 months of use. Chronic hypnotic use by primary insomniacs does not lead to dose escalation.

Brief intervention in general hospital for problematic prescription drug use: 12-month outcome

BACKGROUND

The problematic use of prescription drugs (PDs) and related disorders are considerably prevalent but evidence concerning brief intervention for problematic PD users is sparse. A previous analysis of the present study on the effectiveness of brief intervention for problematic PD use in a general hospital revealed a significant reduction in PD use after 3 months. The analyses presented herein provides data from the 12-month follow-up.

METHOD

In a randomized controlled trial, 126 proactively recruited general hospital patients were analyzed. The intervention group received two brief Motivational Interviewing (MI) sessions. Two follow-ups (after 3 and 12 months) were conducted. Intervention effects at 12-month follow-up on PD cessation and reduction were analyzed using regression methods and controlling for significant group differences. Subgroups of sedative/hypnotic- and opioid-users were examined.

RESULTS

No significant intervention effects were found in the overall sample. Respecting significant differences between the intervention and control groups, we detected no effects of the intervention for the subgroups of sedative/hypnotic- or opioid-users.

CONCLUSIONS

In contrast to the short-term effects after 3 months, no long-term effects of brief MI sessions on PD use were found. More intensive interventions, booster-sessions or regular aftercare might help in stabilizing intervention effects on PD use among hospital patients. However, studies using larger samples are needed to allow more powerful and specific analyses. Different samples should be examined. Problems concerning the recruitment of study participants in PD research were discussed and should be considered in further studies.

A randomized controlled trial of sertraline for the treatment of depression in persons with traumatic brain injury

OBJECTIVE

To examine the efficacy of sertraline in the treatment of depression after traumatic brain injury (TBI).

DESIGN

Double-blind, randomized controlled trial.

SETTING

Research center at a major urban medical center.

PARTICIPANTS

Subjects were a referred and volunteer sample of 52 participants with TBI, a diagnosis of major depression disorder (MDD), and a score on the Hamilton Rating Scale for Depression (HAM-D) of 18 or greater. The majority of the sample was male (58%), had less than 14 years of education (73%), had incomes below $20,000 (82%), and were from minority backgrounds (75%). Approximately one third of the sample had mild brain injuries, and two thirds had moderate to severe brain injuries. The mean age was 47+/-11, and the mean time since injury was 17+/-14 years. One participant withdrew from the study because of side effects.

INTERVENTION

Daily oral sertraline in doses starting at 25mg and increasing to therapeutic levels (up to 200mg) or placebo for 10 weeks.

MAIN OUTCOME MEASURES

The HAM-D, the Beck Anxiety Inventory, and the Life-3 quality of life (QOL).

RESULTS

No statistically significant differences were found at baseline between drug and placebo groups on baseline measures of depression (24.8+/-7.3 vs 27.7+/-7.0), anxiety (16.4+/-12.3 vs 24.0+/-14.9), or QOL (2.96+/-1.0 vs 2.9+/-0.9). The income level of those receiving placebo was significantly lower than those participants receiving medication. Analyses of covariance revealed significant changes from preintervention to posttreatment for all 3 outcome measures (P<.001) but no group effects. Random-effects modeling did not find any significant difference in patterns of scores of the outcome measures between the placebo and medication groups.

CONCLUSIONS

Both groups showed improvements in mood, anxiety, and QOL, with 59% of the experimental group and 32% of the placebo group responding to the treatment, defined as a reduction of a person's HAM-D score by 50%.

Randomized controlled trial of a brief intervention for problematic prescription drug use in non-treatment-seeking patients

AIMS

Dependence on or problematic use of prescription drugs (PD) is estimated to be between 1 and 2% in the general population. In contrast, the proportion of substance-specific treatment in PD use disorders at 0.5% is comparatively low. With an estimated prevalence of 4.7%, PD-specific disorders are widespread in general hospitals compared to the general population. Brief intervention delivered in general hospitals might be useful to promote discontinuation or reduction of problematic prescription drug use.

DESIGN

A randomized, controlled clinical trial.

SETTING

Internal, surgical and gynaecological wards of a general and a university hospital.

PARTICIPANTS

One hundred and twenty-six patients fulfilling criteria for either regular use of PD (more than 60 days within the last 3 months) or dependence on or abuse of PD, respectively, were allocated randomly to two conditions.

INTERVENTION

Subjects received two counselling sessions based on Motivational Interviewing plus an individualized written feedback (intervention group, IG) or a booklet on health behaviour (control group, CG).

MEASUREMENTS

The outcome was measured as reduction (>25%) and discontinuation of PD intake in terms of defined daily dosages (DDD).

FINDINGS

After 3 months, more participants in the IG reduced their DDD compared to the participants in the CG (51.8% versus 30%; chi(2) = 6.17; P = 0.017). In the IG 17.9%, in the CG 8.6% discontinued use of PD (chi(2) = 2.42; P = 0.17). Conclusions Brief intervention based on Motivational Interviewing is effective in reducing PD intake in non-treatment-seeking patients.