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Saint SR, Onyango E, Korona-Bailey J, Jayasundara J, Hall K, Mukhopadhyay S. Diphenhydramine-involved Fatal and Nonfatal Drug Overdoses in Tennessee, 2019-2022. Subst Use Misuse 2024; 59:638-642. [PMID: 38189325 DOI: 10.1080/10826084.2023.2280542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND Diphenhydramine (DPH), known as the brand name Benadryl, is an over-the-counter medication associated with accidental ingestion leading to nonfatal overdoses. Additionally, DPH has been used in tandem with illicit substances leading to fatal drug overdoses. OBJECTIVE In response to DPH being seized with illicit drugs as an adulterant, as well as its growing intentional misuse, we sought to explore its recent involvement in fatal and nonfatal drug overdoses in the state of Tennessee. METHODS We conducted a statewide cross-sectional study to determine the characteristics of DPH-involved fatal and nonfatal overdoses in Tennessee during 2019-2022 using data from the State Unintentional Drug Overdose Reporting System, the Electronic Surveillance System for the Early Notification of Community-based Epidemics, and the National Forensic Laboratory Information System Public Data Query System. Frequencies were generated to compare demographic characteristics, circumstances, and toxicology between fatal and nonfatal DPH-involved overdoses. RESULTS We identified 143 suspected nonfatal DPH and 409 fatal DPH-involved overdoses in Tennessee from 2019 to 2022. Nonfatal overdoses remained consistent while fatal overdoses peaked in 2021. Most nonfatal overdoses were under 18 (63.4%), while most fatal overdoses were between 18 and 64 years of age (95.7%). For fatal overdoses, fentanyl was the most prevalent substance on toxicology followed by prescription opioids. CONCLUSION Nonfatal overdoses remained consistent while fatal overdoses peaked in 2021 in Tennessee. Use of DPH among other illicit substances lends to evidence suggesting its use as an adulterant. Monitoring of DPH-involved fatal and nonfatal overdoses is critical to inform harm reduction initiatives.
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Affiliation(s)
- Sarah Riley Saint
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, Tennessee, USA
| | - Edward Onyango
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, Tennessee, USA
| | - Jessica Korona-Bailey
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, Tennessee, USA
| | - Joshua Jayasundara
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, Tennessee, USA
| | - Kristi Hall
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, Tennessee, USA
| | - Sutapa Mukhopadhyay
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, Tennessee, USA
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2
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Hughes AR, Grusing S, Lin A, Hendrickson RG, Sheridan DC, Marshall R, Horowitz BZ. Trends in intentional abuse and misuse ingestions in school-aged children and adolescents reported to US poison centers from 2000-2020. Clin Toxicol (Phila) 2023; 61:64-71. [PMID: 36469528 DOI: 10.1080/15563650.2022.2120818] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/17/2022] [Accepted: 08/30/2022] [Indexed: 12/12/2022]
Abstract
CONTEXT Childhood and adolescent misuse and abuse exposures remain a serious public health challenge in the United States. This study aimed to describe recent trends and patterns of intentional substance misuse and abuse exposures among school-aged children and adolescents in the United States. METHODS This study was a retrospective cohort study of intentional misuse and abuse exposures in children 6 through 18 years reported to the National Poison Data System (NPDS) from January 1, 2000, through December 31, 2020. Demographic trends, reported clinical effects, treatments, management sites, and health outcomes were assessed overall and within four age categories: 6-9, 10-12, 13-15, and 16-18. RESULTS Between 2000 and 2020, there were 338,727 cases regarding intentional misuse and abuse exposures for children ages 6 through 18 years old. Overall, misuse/abuse ingestions fluctuated over time, with a peak in 2011. The majority of intentional misuse/abuse ingestions occurred in males (58.3%), and more than 80% of all reported exposure cases occurred in youth aged 13 to 18. 32.6% of ingestions resulted in worse than minor clinical outcomes. Older age groups had a greater number of severe medical outcomes compared to younger age groups. Major or life-threatening exposures (including those resulting in death) were more common in males. Overall, deaths were rare (n = 450), 0.1%). Male sex, older age, abuse ingestions, exposure site of a public area or other residence, and multiple ingested substances were other factors associated with increased mortality. Marijuana exposure rates had the highest average monthly increase overall, with the most dramatic rise occurring from 2017 to 2020. Edible marijuana preparations accounted for the highest increase in call rates compared with all other forms of marijuana. DISCUSSION AND CONCLUSION With over 330,000 poison center cases reported during the 20-year study period, intentional substance misuse and abuse exposures substantially impact the pediatric population. The substances most commonly misused/abused are more widely available substances such as over-the-counter medications, household products and pharmaceuticals commonly prescribed to youth. Differences in age and sex were evident, with males and adolescents more likely to abuse and misuse substances. Our study describes an upward trend in marijuana misuse/abuse exposures among youth, especially those involving edible products. These findings highlight an ongoing concern about the impact of rapidly evolving cannabis legalization on this vulnerable population.
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Affiliation(s)
- Adrienne R Hughes
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
- Oregon-Alaska Poison Center, Portland, OR, USA
| | - Sara Grusing
- Oregon Health and Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Amber Lin
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Robert G Hendrickson
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
- Oregon-Alaska Poison Center, Portland, OR, USA
| | - David C Sheridan
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Rebecca Marshall
- Child Psychiatry, Oregon Health and Science University, Portland, OR, USA
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3
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Ji JJ, Zhao J, Xiang P, Yan H, Shen M. Chiral analysis of dextromethorphan and levomethorphan in human hair by liquid chromatography-tandem mass spectrometry. Forensic Toxicol 2022; 40:312-321. [PMID: 36454412 DOI: 10.1007/s11419-022-00620-2] [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: 12/14/2021] [Accepted: 03/07/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE Methorphan exists in two enantiomeric forms including dextromethorphan and levomethorphan. Dextromethorphan is an over-the-counter antitussive drug, whereas levomethorphan is strictly controlled as a narcotic drug. Chiral analysis of methorphan could, therefore, assist clinicians and forensic experts in differentiating between illicit and therapeutic use and in tracing the source of the drug. METHODS A method for enantiomeric separation and quantification of levomethorphan and dextromethorphan in human hair was developed and validated using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Hair was extracted in hydrochloric acid/methanol (1:20, v/v). The supernatant were separated using a Supelco Astec Chirobiotic™ V2 column (250 × 2.1 mm, i.d., 5 μm particle size) and analyzed on a triple quadrupole linear ion trap mass spectrometer in multiple reaction monitoring mode. RESULTS The limits of detection for dextromethorphan and levomethorphan were 2 and 1 pg/mg, respectively; the lower limit of quantification was 2 pg/mg for both drugs. Good linearity (r > 0.995) was observed for both analytes over the linear range. Precision values were below 10% for both analytes; accuracy values ranged from 87.5 to 101%. The extraction recoveries were 78.3-98.4%, and matrix effects were 70.5-88.6%. This method was applied to human hair samples from 120 people suspected of methorphan use to further distinguish the drug chirality. Dextromethorphan was detected in all 120 samples at a concentration range of 2.7-19,100 pg/mg, whereas levomethorphan was not detected in any sample. CONCLUSIONS A sensitive quantitative method was established for the enantiomeric separation of dextromethorphan and levomethorphan in hair. This is the first study to achieve chiral analysis of methorphan in human hair.
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Affiliation(s)
- Jiao-Jiao Ji
- Department of Forensic Medicine, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, 200063, China
| | - Junbo Zhao
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, 200063, China
| | - Ping Xiang
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, 200063, China
| | - Hui Yan
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, 200063, China
| | - Min Shen
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, 200063, China.
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4
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Sheridan DC, Marshall R, Lin A, Hughes A, Horowitz BZ. Trends Over 2 Decades in Adolescent Suicidal and Recreational Ingestions of Over-the-Counter Coricidin Preparations. Pediatr Emerg Care 2022; 38:e1304-e1308. [PMID: 35510725 DOI: 10.1097/pec.0000000000002732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess national trends in recreational and suicidal ingestions of over-the-counter cough preparations that contain Coricidin. METHODS Using the American Association of Poison Control Center's National Poison Data System, we obtained data from 2004 to 2017 on patients aged 13 to 19 years with an ingestion of "Coricidin." We examined trends over time overall and ingestion intent (recreational vs suicidal) using linear regression. We compared patient characteristics, substances ingested, clinical effects and therapies, and outcomes by suicidal versus misuse or recreational intention. RESULTS An initial search with the inclusion criteria found 19,213 calls that matched study inclusion criteria. On average, there was a yearly linear increase of 180.0 (95% confidence interval [CI], 136.6-223.3; P < 0.01) ingestions per year. Within suicide ingestions, there was an average yearly increase of 97.9 (95% CI, 66.9-128.9; P < 0.01) ingestions, and within misuse/recreational ingestions, there was an average yearly increase of 82.1 (95% CI, 60.3-103.9; P < 0.01) ingestions. The most common clinical effect was tachycardia, which occurred in 42.4% of ingestions. Altered mental status, mydriasis, and ataxia were all more common in misuse/recreational ingestions. Suicidal ingestions resulted in more hospital admissions and need for medical treatment. Recreational-use coded calls peaked in 2013, whereas calls coded for suicide attempts have continued to rise dramatically, with a 50% increase in the 14-year study period. CONCLUSION Combination Coricidin products are a major source of morbidity in adolescents. Targeted preventive measures in primary care offices or larger-scale policy/legislative efforts may be helpful to address this.
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Affiliation(s)
| | | | - Amber Lin
- From the Departments of Emergency Medicine
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Affiliation(s)
- David C Sheridan
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
| | - Adrienne Hughes
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.,Oregon Poison Center, Portland, OR
| | - B Zane Horowitz
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.,Oregon Poison Center, Portland, OR
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6
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Nemanich A, Liebelt E, Sabbatini AK. Increased rates of diphenhydramine overdose, abuse, and misuse in the United States, 2005-2016. Clin Toxicol (Phila) 2021; 59:1002-1008. [PMID: 33688782 DOI: 10.1080/15563650.2021.1892716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe trends in abuse, misuse, and suicide attempts involving diphenhydramine (DPH). METHODS We analyzed intentional DPH exposures of individuals ≥10 years old reported to U.S. Poison Control Centers using data from the National Poison Data System, 2005-2016. RESULTS There were 158,774 intentional DPH exposures in our dataset. The rate of intentional exposures increased 63% over the 12-year study period for all ages combined. Suicide attempts involving DPH showed a bimodal distribution-increasing 263% among children 10-14 years of age, and 126 and 143% among those 55-64 and ≥65 years of age, respectively. Older adults in both the 55-64 and ≥65-year-old age groups had about a 230% increase in rates of misuse. Major adverse clinical effects increased by 91%. There were 745 total reported deaths with a 3.6% increase across all age groups. CONCLUSIONS Intentional DPH exposures among individuals ≥10 years old have been increasing since 2005. Increasing rates of suicide attempts among children ages 10-14 and increasing misuse among individuals ≥65, coupled with a trend toward greater severity of overdoses, highlight the significant public health impact of this commonly available over-the-counter drug.
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Affiliation(s)
- Antonia Nemanich
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
| | | | - Amber K Sabbatini
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
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7
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Dabbagh R, Aldofyan M, Alzaid W, Alsulimani A, Alshamrani S, Alqahtani S, Abuhaimed A. Prescription and over-the-counter drug misuse among female students at a Saudi university. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1856210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Rufaidah Dabbagh
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Wejdan Alzaid
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Samar Alqahtani
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
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8
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Gillespie NA, Bates TC, Hickie IB, Medland SE, Verhulst B, Kirkpatrick RM, Kendler KS, Martin NG, Benotsch EG. Genetic and environmental risk factors in the non-medical use of over-the-counter or prescribed analgesics, and their relationship to major classes of licit and illicit substance use and misuse in a population-based sample of young adult twins. Addiction 2019; 114:2229-2240. [PMID: 31313399 PMCID: PMC6868294 DOI: 10.1111/add.14750] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/03/2018] [Accepted: 07/09/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS The non-medical use of over-the-counter or prescribed analgesics (NMUA) is a significant public health problem. Little is known about the genetic and environmental etiology of NMUA and how these risks relate to other classes of substance use and misuse. Our aims were to estimate the heritability NMUA and sources of genetic and environmental covariance with cannabis and nicotine use, cannabis and alcohol use disorders and nicotine dependence in Australian twins. DESIGN Biometrical genetic analyses or twin methods using structural equation univariate and multivariate modeling. SETTING Australia. PARTICIPANTS A total of 2007 young adult twins [66% female; μage = 25.9, standard deviation (SD) = 3.6, range = 18-38] from the Brisbane Longitudinal Twin Study retrospectively assessed between 2009 and 2016. MEASUREMENTS Self-reported NMUA (non-opioid or opioid-based), life-time nicotine, cannabis and opioid use, DSM-V cannabis and alcohol use disorders and the Fagerström Test for Nicotine Dependence. FINDINGS Life-time NMUA was reported by 19.4% of the sample. Univariate heritability explained 46% [95% confidence interval (CI) = 0.29-0.57] of the risks in NMUA. Multivariate analyses revealed that NMUA is moderately associated genetically with cannabis (rg = 0.41) and nicotine (rg = 0.45) use and nicotine dependence (rg = 0.34). In contrast, the genetic correlations with cannabis (rg = 0.15) and alcohol (rg = 0.07) use disorders are weak. CONCLUSIONS In young male and female adults in Australia, the non-medical use of over-the-counter or prescribed analgesics appears to have moderate heritability. NMUA is moderately associated with cannabis and nicotine use and nicotine dependence. Its genetic etiology is largely distinct from that of cannabis and alcohol use disorders.
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Affiliation(s)
- Nathan A Gillespie
- Virginia Institute for Psychiatric and Behavior Genetics, Virginia Commonwealth University, VA, USA
- QIMR Berghofer Medical Research Institute, QLD, Australia
| | | | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, NSW, Australia
| | | | - Brad Verhulst
- Psychology Department, Michigan State University, MI, USA
| | - Robert M Kirkpatrick
- Virginia Institute for Psychiatric and Behavior Genetics, Virginia Commonwealth University, VA, USA
| | - Kenneth S Kendler
- Virginia Institute for Psychiatric and Behavior Genetics, Virginia Commonwealth University, VA, USA
| | | | - Eric G Benotsch
- Psychology Department, Virginia Commonwealth University, VA, USA
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9
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Abraham O, Chmielinski J. Adolescents' Misuse of Over-The-Counter Medications: The Need for Pharmacist-led Intervention. Innov Pharm 2018; 9:1-7. [PMID: 34007709 PMCID: PMC6302752 DOI: 10.24926/iip.v9i3.979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Adolescents' misuse of over-the-counter (OTC) medications is a growing patient safety concern, resulting in an alarming number of poisonings and emergency department visits. OTC medications are easily accessible and adolescents often have the misconception that these medications are safe, even at higher than recommended doses. Dextromethorphan and acetaminophen are the most common and frequently misused OTC medications among adolescents, with significantly dangerous health risks if used improperly. Pharmacists are critical to the provision of education on safe OTC medication use for adolescents and their family caregivers by leading and implementing relevant community-based interventions. Ideal channels in which to do this in the community are pharmacies and schools. It is challenging to gain the attention of adolescents and to engage them; methods that include innovative measures and initiatives may be the solution. Research is needed to determine how pharmacists can improve adolescents' knowledge and safe use of OTC medications. Pharmacists must be supported through training and acquisition of expertise specific to adolescent engagement and education. The development of pharmacist-led educational interventions that are tailored for adolescents that address their limited OTC medication knowledge and raise awareness of safety risks associated with misuse is crucial to preventing and reducing this patient safety problem in the community.
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Abstract
Adolescent substance abuse remains common, with almost a third of adolescents admitting to ethanol use, and a quarter admitting to illicit drug use. It is essential for pediatricians to regularly screen adolescent patients for substance use, because early initiation of drug use has been associated with physical, behavioral, and social health risks. Adolescents abuse what is common and readily available; this includes ethanol, over-the-counter products, marijuana, and inhalants. The most common and effective clinical treatments for significant toxicity from substances of abuse is symptomatic and supportive care including hemodynamic support, respiratory support, and sedation to control psychomotor agitation.
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Affiliation(s)
- George Sam Wang
- Section of Emergency Medicine and Medical Toxicology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO.,Rocky Mountain Poison and Drug Center, Denver Health Hospital, Denver, CO
| | - Christopher Hoyte
- Rocky Mountain Poison and Drug Center, Denver Health Hospital, Denver, CO.,Department of Emergency Medicine and Medical Toxicology, University of Colorado Anschutz Medical Campus, University Hospital, Aurora, CO
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11
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Le VT, Norris Turner A, McDaniel A, Hale KM, Athas C, Kwiek NC. Nonmedical use of over-the-counter medications is significantly associated with nonmedical use of prescription drugs among university students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:1-8. [PMID: 28812451 DOI: 10.1080/07448481.2017.1356312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine the association between nonmedical use of over-the-counter medications (NMUOTC) and nonmedical use of prescription drugs (NMUPD). PARTICIPANTS University students surveyed on NMUOTC and NMUPD between August and December 2011 (N = 939). METHODS Cross-sectional data analysis of online survey. RESULTS The majority of respondents were women, undergraduate, Caucasian, and not affiliated with Greek life. NMUPD and NMUOTC were reported by 21.4% and 11.2% of students, respectively. NMUOTC was significantly associated with NMUPD in unadjusted analyses and after adjustment for gender, age, race/ethnicity, and Greek membership (odds ratio: 3.37, 95% confidence interval: 2.17, 5.23). Secondary analyses showed a relationship between over-the-counter (OTC) cough medication misuse and NMUPD, OTC stimulant misuse and prescription stimulant misuse, and OTC sleep aid misuse with prescription depressant misuse. CONCLUSIONS Results suggest the importance of both measuring the prevalence of OTC misuse and incorporating its misuse into assessments of polydrug use in the university population.
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Affiliation(s)
- Vi T Le
- a College of Public Health , The Ohio State University , Columbus , Ohio , USA
| | - Abigail Norris Turner
- b Division of Infectious Diseases, College of Medicine , The Ohio State University , Columbus , Ohio , USA
| | - Anne McDaniel
- c The Center for the Study of Student Life, Office of Student Life , The Ohio State University , Columbus , Ohio , USA
| | - Kenneth M Hale
- d Higher Education Center for Alcohol and Drug Misuse Prevention and Recovery , The Ohio State University , Columbus , Ohio , USA
| | - Christina Athas
- c The Center for the Study of Student Life, Office of Student Life , The Ohio State University , Columbus , Ohio , USA
| | - Nicole C Kwiek
- e Division of Pharmacology, College of Pharmacy , The Ohio State University , Columbus , Ohio , USA
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12
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Zaprutko T, Koligat D, Michalak M, Wieczorek M, Józiak M, Ratajczak M, Szydłowska K, Miazek J, Kus K, Nowakowska E. Misuse of OTC drugs in Poland. Health Policy 2016; 120:875-81. [PMID: 27344198 DOI: 10.1016/j.healthpol.2016.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/27/2016] [Accepted: 06/13/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The misuse of over-the-counter (OTC) drugs became a global public health concern. Although abuse with dextrometorphan (DXM), pseudoefedrine (PSD), codeine (COD) or benzydamine (BND) may lead even to psychosis, drugs containing these substances are relatively cheap and freely available. In Poland the Act on Counteracting Drug Addiction was amended in 2015, however it seems that there are still some points which could be improved. METHODS Study was conducted between October 2014 and June 2015 using a specially designed questionnaire delivered to pharmacists from the Greater Poland region. Questionnaire consisting of 11 closed questions was distributed by direct contact and via the Internet. From over 2500 distributed questionnaires, we received 761 sheets and 680 were included. RESULTS The misuse of OTC drugs is increasing in Poland from pharmacists point of view. The most popular substance was PSD followed by COD and DXM. The main reason of misuse of these drugs could be related to the use of Internet and free access to these medications. In respondents (58.2%) opinion OTC drugs containing analyzed substances should be moved into the prescription status. CONCLUSIONS The misuse of OTC drugs should be considered as a very dangerous phenomenon. Although the Act on Counteracting Drug Addiction was amended in Poland in 2015, there are some facets requiring improvement. Social education may play a key role in the limitation of misuse of OTC drugs.
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Affiliation(s)
- Tomasz Zaprutko
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 79 Dąbrowskiego Street, 60529 Poznań, Poland.
| | - Dorota Koligat
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 79 Dąbrowskiego Street, 60529 Poznań, Poland
| | - Michał Michalak
- Department of Computer Sciences and Statistics, Poznan University of Medical Sciences, 79 Dąbrowskiego Street, 60529 Poznań, Poland
| | - Marta Wieczorek
- Student Scientific Society, Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 79 Dąbrowskiego Street, 60529 Poznań, Poland
| | - Malwina Józiak
- Student Scientific Society, Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 79 Dąbrowskiego Street, 60529 Poznań, Poland
| | - Monika Ratajczak
- Student Scientific Society, Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 79 Dąbrowskiego Street, 60529 Poznań, Poland
| | - Kinga Szydłowska
- Student Scientific Society, Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 79 Dąbrowskiego Street, 60529 Poznań, Poland
| | - Joanna Miazek
- Student Scientific Society, Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 79 Dąbrowskiego Street, 60529 Poznań, Poland
| | - Krzysztof Kus
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 79 Dąbrowskiego Street, 60529 Poznań, Poland
| | - Elżbieta Nowakowska
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 79 Dąbrowskiego Street, 60529 Poznań, Poland
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Abstract
Codeine is widely prescribed in clinical practice with over the counter (OTC) preparations of codeine freely available for consumption typically as a component of remedies for the common cold/cough. We describe the first reported case of acute confusional state in a previously healthy 14-year-old girl ultimately attributed to inappropriate codeine use. The usage of codeine in the paediatric setting has been highlighted in recent years with many reported deaths--mostly due to respiratory depression. The risks associated with codeine usage may be particularly unnecessary with OTC cough suppressants as evidence of efficacy is absent. Finally, codeine dependence is a common problem among adults and has been reported locally and internationally among adolescents. The combination of lack of efficacy, risk of acute intoxication and dependence, suggests that the use of OTC codeine preparations may be unwarranted.
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Affiliation(s)
- David O Reilly
- School of Medicine, National University of Ireland, Galway, HSE West, Galway, Connacht, Ireland Donegal Clinical Research Academy, Letterkenny General Hospital, HSE West, Letterkenny, Ulster, Ireland
| | - Mathew Thomas
- Department of Paediatrics, Letterkenny General Hospital, HSE West, Letterkenny, Ulster, Ireland
| | - Edina Moylett
- Academic Department of Paediatrics, National University of Ireland, Galway, HSE West, Galway, Connacht, Ireland
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14
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‘Codeine is my companion’: misuse and dependence on codeine containing medicines in Ireland. Ir J Psychol Med 2015; 35:275-288. [DOI: 10.1017/ipm.2015.60] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ObjectivesGlobal concern around over the counter availability of codeine containing products and risk of misuse, dependence and related harms are evident. A phenomenological study of lived experiences of codeine misuse and dependence was undertaken in Ireland, following the Pharmaceutical Society of Ireland’s 2010 guidelines for restricted supply of non-prescription codeine containing products.MethodsIn-depth interviews were conducted with a purposive sample of adult codeine misusers and dependents (n=21), both actively using, in treatment and in recovery. The narratives were analysed using the Empirical Phenomenological Psychological five-step method (Karlsson, 1995). A total of 10 themes with 82 categories were identified. Two concepts at a higher level of abstraction above the theme-level emerged during the final stage of analysis. The concepts identified were ‘emotional pain and user self-legitimization of use’ and ‘entrapment into habit-forming and invisible dependent use’. These concepts were reported in different ways by a majority of participants.ResultsFindings are presented under the following themes: (1) profile and product preferences; (2) awareness of habit forming use and harm; (3) negotiating pharmacy sales; (4) alternative sourcing routes; (5) the codeine feeling; (6) the daily routine; (7) acute and chronic side effects; (8) social isolation; (9) withdrawal and dependence and (10) help-seeking and treatment experiences.ConclusionsThere is a public health and regulatory imperative to develop proactive responses tackling public availability of codeine containing medicines, risk minimisation in consumer self-treatment for pain, enhanced patient awareness of potential for habit forming use and its consequences and continued health professional pharmacovigilence.
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Rao MG, Varambally S, Venkatasubramanian G, Gangadhar BN. Hazards of antihistamine dependence in psychiatric patients: A case report. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2015; 27:153-7. [DOI: 10.3233/jrs-150656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Intentional misuse of over-the-counter medications, mental health, and polysubstance use in young adults. J Community Health 2015; 39:688-95. [PMID: 24338111 DOI: 10.1007/s10900-013-9811-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In recent years, the non-medical use of prescription drugs (without a doctor's prescription) has increased dramatically. Less attention has been paid to the intentional misuse of over-the-counter (OTC) medications. Misuse of OTC medications has negative health consequences similar to those of illicit drugs, including psychosis, tachycardia, seizures and agitation. When mixed with alcohol or other drugs, these medications can also be dangerous: OTC-related emergency room visits increased 70% from 2004 to 2008. This study examined the intentional misuse of OTC medications, the non-medical use of prescription drugs, the use of alcohol and illicit drugs, and psychological factors in two samples of young adults (ages 18-25) from different areas of the United States (Total N = 1,197). Overall, 18.6% of the Colorado sample and 13.0% of the Virginia sample reported lifetime misuse of an OTC medication. Participants who reported misusing OTC medications were also significantly more likely to report using marijuana, ecstasy, cocaine, and non-medical use of prescription analgesics, stimulants, anxiolytics, and sedatives. Participants who reported misusing OTC medications were more than twice as likely to report hazardous alcohol use, relative to individuals who denied misusing OTC medications. Individuals who had misused OTC medications scored significantly higher in sensation seeking and hopelessness and reported more symptoms of depression, anxiety, and somatic distress, relative to those who denied OTC misuse. Results suggest that a considerable minority of young adults are jeopardizing their health with the misuse of OTC medications as part of a pattern of polysubstance use.
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Nod and wave: An Internet study of the codeine intoxication phenomenon. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:67-77. [DOI: 10.1016/j.drugpo.2014.06.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 06/18/2014] [Accepted: 06/23/2014] [Indexed: 11/21/2022]
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18
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Usage of Over-the-Counter and Herbal Products in Common Cold in Poland: Findings from Consumer Survey. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 878:21-7. [PMID: 26285612 PMCID: PMC7120590 DOI: 10.1007/5584_2015_155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Upper respiratory tract infections are usually self-treated with synthetic and herbal over-the-counter products. The aim of the study was to assess the reasons for the purchase of those medications in Poland. We examined 413 adults, aged 18 and over (70.5 % of them were women) using a questionnaire. The findings demonstrate that oral synthetic products were used by 76 % of respondents, while herbal products by 30 %. Synthetic products were used mainly by educated people under 65 years of age, students, and the employed. Herbal products were used mainly by older people. In conclusion, synthetic products against common cold are perceived as more effective. Such medications are used by people who probably would like to recover and return to professional activity as quickly as possible. As they generally use more medications, they are at increased risk of adverse effects resulting from drug interactions, and they should be a target group for health education programs.
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Claire Van Hout M. “Doctor shopping and pharmacy hopping”: practice innovations relating to codeine. DRUGS AND ALCOHOL TODAY 2014. [DOI: 10.1108/dat-03-2014-0014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The misuse of pharmaceutical opioid analgesics is identified as a global public health concern. Codeine represents an interesting quandary in terms of its regulated status, with individuals varying in their metabolism of codeine, estimation of safe dosages, risk of adverse health consequences and abuse potential. Efforts to quantify and address hidden non-compliant medical codeine use, overuse and intentional misuse is compromised by availability to the public in prescribed and over the counter forms. The paper aims to discuss these issues.
Design/methodology/approach
– A review of literature on codeine use, misuse and dependence, and associated innovative medical and pharmacy interventions is presented, and was conducted as part of a larger scoping review on codeine.
Findings
– The review highlights the complexities associated with monitoring public health awareness of codeine's abuse potential, and customer/patients trends in non-compliant codeine use for therapeutic and recreational purposes. Aberrant codeine behaviours centre on visiting multiple doctors for prescriptions, repeated lost or stolen prescriptions, forging prescriptions and use of multiple pharmacies. Innovations to monitor misuse of codeine include national prescription databases and recent developments in real-time monitoring of dispensing activity.
Practical implications
– Further development of real-time monitoring processes with process evaluation is advised.
Originality/value
– This viewpoint is intended to demonstrate how efforts to quantify and address codeine use are compromised by its availability. It intends to encourage further policy and practitioner dialogue on how to monitor, support and intervene with consumers misusing codeine.
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Shehnaz SI, Agarwal AK, Khan N. A systematic review of self-medication practices among adolescents. J Adolesc Health 2014; 55:467-83. [PMID: 25245937 DOI: 10.1016/j.jadohealth.2014.07.001] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 10/24/2022]
Abstract
The purpose was to systematically review the global trends and factors influencing self-medication (SM) among adolescents. Databases (Medline/Pubmed, Ingenta, Cochrane Library, EMBASE, CINAHL, Proquest, Scopus, and Google Scholar) were searched for peer-reviewed research published between January 2000 and December 2013 on SM among adolescents aged 13-18 years. Articles were scrutinized for country of origin, sample size, recall period, prevalence rates and associations, influencing factors, medicines used, self-medicated health complaints, sources of drug information, recommendation and procurement, knowledge about medicines, and adverse drug reactions. One hundred and sixty-three publications met the inclusion criteria. SM prevalence ranged from 2% to 92% in different countries. The most frequently self-medicated over-the-counter and prescription-only medicines were analgesics and antibiotics, respectively. Headache, allergies, and fever were the most common self-medicated health complaints reported. Misuse of both over-the-counter and prescription-only medicines reflected a risky trend. Female gender, older age, maternal education, and familial practices were associated with SM among adolescents. The primary sources of drug information, recommendation, and procurement included pharmacists, parents, and friends. High-risk practices such as diversion of prescription medicines and utilization of previous prescriptions were also reported. Most studies revealed gaps in drug knowledge, although adolescents self-rated it as satisfactory. However, few adverse drug reactions were reported, probably because of lack of awareness about the potential harmful effects of medicines. Recommendations for "responsible SM" have been made to minimize the adverse effects of SM. Understanding the links between various factors promoting SM can be helpful in deriving strategies aimed at reducing drug-related health risks among adolescents. Moreover, these will aid in creating awareness among adolescents about the potential risks of using drugs without proper information and consultation. Studies need to be designed to assess the changing trend and identify new correlates of self-medication practices among adolescents, which pose fresh challenges to monitor the menace.
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Affiliation(s)
- Syed Ilyas Shehnaz
- Department of Pharmacology, Gulf Medical University, Ajman, United Arab Emirates.
| | - Anoop Kumar Agarwal
- Department of Pharmacology, Gulf Medical University, Ajman, United Arab Emirates
| | - Nelofer Khan
- Department of Biochemistry, Gulf Medical University, Ajman, United Arab Emirates
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21
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Vidourek RA, King KA, Burbage ML. Correlates to over-the-counter drug use among college students. JOURNAL OF SUBSTANCE USE 2014. [DOI: 10.3109/14659891.2014.911978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Lim KG, Rank MA, Hahn PY, Keogh KA, Morgenthaler TI, Olson EJ. Long-term safety of nebulized lidocaine for adults with difficult-to-control chronic cough: a case series. Chest 2013; 143:1060-1065. [PMID: 23238692 DOI: 10.1378/chest.12-1533] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The long-term safety of patient-administered nebulized lidocaine for control of chronic cough has not been established. METHODS We performed a retrospective study of adults who received a prescription and nurse education for nebulized lidocaine for chronic cough between 2002 and 2007. A survey questionnaire inquiring about adverse reactions and the effectiveness of nebulized lidocaine was developed and administered to these individuals after the nebulized lidocaine trial. We conducted two mailings and a postmailing phone follow-up to nonresponders. When adverse events were reported in the questionnaire response, a structured phone interview was conducted to obtain additional details. RESULTS Of 165 eligible patients, 99 (60%) responded to the survey. Responders were a median age of 62 years (range, 29-87 years); 77 (79%) were women, and 80 (82%) were white. The median duration of cough was 5 years before treatment with nebulized lidocaine. Of the patients who used nebulized lidocaine (93% of survey responders), 43% reported an adverse event. However, none of these events required an emergency visit, hospitalization, or antibiotic therapy for aspiration pneumonia. The mean (SD) of the pretreatment cough severity score was 8.4 (1.6) and posttreatment was 5.9 (3.4) (P < .001). Of the patients reporting improvement in cough symptoms (49%), 80% reported improvement within the first 2 weeks. CONCLUSIONS Adults tolerated self-administration of nebulized lidocaine for difficult-to-control chronic cough. No serious adverse effects occurred while providing symptomatic control in 49% of patients.
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Affiliation(s)
- Kaiser G Lim
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
| | - Matthew A Rank
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN
| | - Peter Y Hahn
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Karina A Keogh
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | - Eric J Olson
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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Abstract
BACKGROUND The sale of over-the-counter (OTC) medicines from pharmacies can help individuals self-manage symptoms. However, some OTC medicines may be abused, with addiction and harms being increasingly recognised. This review describes the current knowledge and understanding of OTC medicine abuse. APPROACH Comprehensive search of international empirical and review literature between 1990 and 2011. FINDINGS OTC MEDICINE ABUSE WAS IDENTIFIED IN MANY COUNTRIES AND ALTHOUGH IMPLICATED PRODUCTS VARIED, FIVE KEY GROUPS EMERGED: codeine-based (especially compound analgesic) medicines, cough products (particularly dextromethorphan), sedative antihistamines, decongestants and laxatives. No clear patterns relating to those affected or their experiences were identified and they may represent a hard-to-reach group, which coupled with heterogeneous data, makes estimating the scale of abuse problematic. Associated harms included direct physiological or psychological harm (e.g. opiate addiction), harm from another ingredient (e.g. ibuprofen-related gastric bleeding) and associated social and economic problems. Strategies and interventions included limiting supplies, raising public and professional awareness and using existing services and Internet support groups, although associated evaluations were lacking. Terminological variations were identified. CONCLUSIONS OTC medicine abuse is a recognised problem internationally but is currently incompletely understood. Research is needed to quantify scale of abuse, evaluate interventions and capture individual experiences, to inform policy, regulation and interventions.
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Affiliation(s)
- Richard J Cooper
- School of Health and Related Research (ScHARR), University of Sheffield , Sheffield , UK
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Abel C, Johnson K, Waller D, Abdalla M, Goldsmith CAW. Nonprescription medication use and literacy among New Hampshire eighth graders. J Am Pharm Assoc (2003) 2012; 52:777-82. [DOI: 10.1331/japha.2012.11158] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gracious B, Abe N, Sundberg J. The importance of taking a history of over-the-counter medication use: a brief review and case illustration of "PRN" antihistamine dependence in a hospitalized adolescent. J Child Adolesc Psychopharmacol 2010; 20:521-4. [PMID: 21186972 PMCID: PMC3025184 DOI: 10.1089/cap.2010.0031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Over-the-counter (OTC) and prescription medication abuse has been rapidly increasing, yet publications on OTC abuse in adolescents are limited. We present a brief literature review and a novel report of antihistamine dependence emerging after admission in an adolescent, subsequently treated with naltrexone. This case highlights the need to take a thorough history of OTC, herbal, and prescription drug use from parents and patients separately and repeatedly, at initial presentation, and again if withdrawal symptoms emerge. General strategies for combating OTC and prescription abuse are given.
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Affiliation(s)
- Barbara Gracious
- Department of Psychiatry, Nationwide Children's Hospital/The Ohio State University, Columbus, Ohio 43205, USA.
| | - Naomi Abe
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jane Sundberg
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
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Abstract
This article provides an overview of drug and alcohol use and risk factors among American adolescents. Current trends indicate that tobacco, alcohol, and marijuana are the most frequently used substances among this age group. Further, the greatest risk factors for using these substances are being male, being White, being an older adolescent, engaging in sexual risk behaviors, having a family history of substance abuse, associating with peers who abuse substances, and lacking a sense of school commitment and connectedness. These findings underscore the need to involve communities, families, schools, and peer groups to effectively prevent and treat this problem.
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