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Jaume-Feliciosi N, Benca-Bachman CE, Holliday E, Palmer RH. Individual Differences in Substance Use Motives, Trauma, and Stress Among College-Based Polysubstance Users. Subst Use Misuse 2024; 59:1228-1239. [PMID: 38544304 PMCID: PMC11157642 DOI: 10.1080/10826084.2024.2330911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background: Co-use of alcohol and other drugs within a certain time frame (i.e., polysubstance use) has become increasingly prevalent, particularly among college-aged individuals, but understanding motives for co-use remains limited. Polysubstance use has been associated with a higher likelihood of negative health consequences as compared to single substance use. Objectives: The current study examined associations between motivations for using alcohol, tobacco, and cannabis among college students who use multiple substances versus students using only one substance or no substances. Additionally, we examined the effect of trauma and daily stress on polysubstance use in self-report data from individuals (N=134) participating in the MAPme Study. Results: First, the observed prevalence of polysubstance use was greater than expected by chance, with most individuals co-using alcohol and cannabis. "Alcohol and Other Drug Users" were more frequently motivated to drink for social (β=0.27, CI=[0.07, 0.44]), enhancement (β=0.26, CI=[0.01, 0.42]) and coping (β=0.21, CI=[0.06, 0.47]) reasons compared to individuals who consumed alcohol alone. Conclusions: Individual differences in motivations for use were partly explained by frequency of alcohol use and alcohol problem severity, but not by history of trauma or stress. Finally, while patterns of correlations among motivations for use across substances suggested a general tendency to be motivated to use substances for similar reasons, this was not supported by confirmatory factor models. Overall, shared motives may inform potential behavioral patterns for co-use of substances during college and might advise future treatment efforts.
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Affiliation(s)
- N Jaume-Feliciosi
- Behavioral Genetics of Addiction Laboratory, Department of Psychology at Emory University, Atlanta, GA, USA
| | - C E Benca-Bachman
- Behavioral Genetics of Addiction Laboratory, Department of Psychology at Emory University, Atlanta, GA, USA
| | - E Holliday
- Neuropsychology of Emerging Adulthood, Addiction, Recovery and Related Disorders Lab, Department of Psychology at Kennesaw State University & Center for Young Adult Addiction and Recovery, Kennesaw, GA, USA
| | - R H Palmer
- Behavioral Genetics of Addiction Laboratory, Department of Psychology at Emory University, Atlanta, GA, USA
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Lardier DT, Davis AN, Verdezoto CS, Cruz L, Magliulo S, Herrera A, Garcia-Reid P, Reid RJ. Latent Class Groups of Concurrent Substance Use Among Adolescents in an Urban Community: Correlates With Mental Health, Access to Drugs and Alcohol, and Risk Perception. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:124-135. [PMID: 38258859 DOI: 10.1177/29767342231207192] [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: 01/24/2024]
Abstract
BACKGROUND Concurrent substance use among adolescents has been associated with an increase in physical and mental health problems. These outcomes tend to be exacerbated among adolescents of color in underserved urban settings. The purpose of this study was to understand alcohol and concurrent drug use patterns among adolescents in an underserved urban community to provide targeted prevention and treatment recommendations. METHOD This study examined data among adolescents in an underserved urban community (N = 1789; 56.90% female; 70.86% Hispanic/Latino/a; meanage = 15.96 ± 1.56). Using latent class analysis (LCA) and multinomial logistic regression modeling, analyses identified independent correlates of latent class membership. RESULTS Five latent classes (LC) were identified including LC group 1: Predominant alcohol use and limited to no concurrent-drug use (n = 213; 11.9%); LC group 2: Concurrent drug and alcohol use including methamphetamine, marijuana and synthetic marijuana use, and alcohol use (n = 74; 4.2%); LC group 3: Concurrent drug and alcohol use, with no marijuana use (n = 204; 11.39%); LC group 4: High Concurrent drug use and alcohol use (n = 204; 11.40%); and LC group 5: Concurrent drug use without alcohol use (n = 1101; 61.52%). Significant between group differences were noted between latent class groups and sociodemographic characteristics. Multinomial logistic regression models identified the associations between sociodemographic characteristics and corollary clinical features of substance use on latent class groupings of alcohol and concurrent drug use. CONCLUSION Understanding concurrent substance use LC groups among adolescents is essential to providing targeted interventions and treatment programs, as well as early intervention programs that may help reduce substance use during adolescence.
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Affiliation(s)
- David T Lardier
- Department of Psychiatry and Behavioral Sciences, Division of Community Behavioral Health, The University of New Mexico School of Medicine, The University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Alexandra N Davis
- College of Education and Human Sciences, Department of Individual, Family and Community Education, The University of New Mexico, Albuquerque, NM, USA
| | - Carolina S Verdezoto
- Department of Psychiatry and Behavioral Sciences, Division of Community Behavioral Health, The University of New Mexico School of Medicine, The University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- College of Education and Human Sciences, Department of Individual, Family and Community Education, The University of New Mexico, Albuquerque, NM, USA
| | - Lynda Cruz
- College of Education and Human Sciences, Department of Individual, Family and Community Education, The University of New Mexico, Albuquerque, NM, USA
| | - Sabrina Magliulo
- College for Community Health, Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
| | - Andriana Herrera
- College for Community Health, Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
| | - Pauline Garcia-Reid
- College for Community Health, Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
| | - Robert J Reid
- College for Community Health, Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
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Mahu IT, Conrod PJ, Barrett SP, Sako A, Swansburg J, Stewart SH. The four-factor personality model and its qualitative correlates among opioid agonist therapy clients. Front Psychiatry 2023; 14:1129274. [PMID: 37363172 PMCID: PMC10289030 DOI: 10.3389/fpsyt.2023.1129274] [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] [Received: 12/21/2022] [Accepted: 05/15/2023] [Indexed: 06/28/2023] Open
Abstract
Background The Four Factor Personality Vulnerability model identifies four specific personality traits (e.g., sensation seeking [SS], impulsivity [IMP], anxiety sensitivity [AS], and hopelessness [HOP]) as implicated in substance use behaviors, motives for substance use, and co-occurring psychiatric conditions. Although the relationship between these traits and polysubstance use in opioid agonist therapy (OAT) clients has been investigated quantitatively, no study has examined the qualitative expression of each trait using clients' voice. Method Nineteen Methadone Maintenance Therapy (MMT) clients (68.4% male, 84.2% white, mean age[SD] = 42.71 [10.18]) scoring high on one of the four personality traits measured by the Substance Use Risk Profile Scale [SURPS] completed a semi-structured qualitative interview designed to explore their lived experience of their respective trait. Thematic analysis was used to derive themes, which were further quantified using content analysis. Results Themes emerging from interviews reflected (1) internalizing and externalizing symptoms, (2) adversity experiences, and (3) polysubstance use. Internalizing symptoms subthemes included symptoms of anxiety, fear, stress, depression, and avoidance coping. Externalizing subthemes included anger, disinhibited cognitions, and anti-social and risk-taking behaviors. Adverse experiences subthemes included poor health, poverty, homelessness, unemployment, trauma, and conflict. Finally, polysubstance use subthemes include substance types, methods of use, and motives. Differences emerged between personality profiles in the relative endorsement of various subthemes, including those pertaining to polysubstance use, that were largely as theoretically expected. Conclusion Personality is associated with unique cognitive, affective, and behavioral lived experiences, suggesting that personality may be a novel intervention target in adjunctive psychosocial treatment for those undergoing OAT.
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Affiliation(s)
- Ioan T. Mahu
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Patricia J. Conrod
- Ste-Justine Hospital, Centre de Recherche, Montreal, QC, Canada
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC, Canada
| | - Sean P. Barrett
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Aïssata Sako
- Quebec-Atlantic Node, Canadian Research Initiative in Substance Misuse, Centre de Recherche du CHUM, Montreal, QC, Canada
| | - Jennifer Swansburg
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Sherry H. Stewart
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
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Towers EB, Williams IL, Qillawala EI, Rissman EF, Lynch WJ. Sex/Gender Differences in the Time-Course for the Development of Substance Use Disorder: A Focus on the Telescoping Effect. Pharmacol Rev 2023; 75:217-249. [PMID: 36781217 PMCID: PMC9969523 DOI: 10.1124/pharmrev.121.000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/05/2022] [Accepted: 10/25/2022] [Indexed: 12/14/2022] Open
Abstract
Sex/gender effects have been demonstrated for multiple aspects of addiction, with one of the most commonly cited examples being the "telescoping effect" where women meet criteria and/or seek treatment of substance use disorder (SUD) after fewer years of drug use as compared with men. This phenomenon has been reported for multiple drug classes including opioids, psychostimulants, alcohol, and cannabis, as well as nonpharmacological addictions, such as gambling. However, there are some inconsistent reports that show either no difference between men and women or opposite effects and a faster course to addiction in men than women. Thus, the goals of this review are to evaluate evidence for and against the telescoping effect in women and to determine the conditions/populations for which the telescoping effect is most relevant. We also discuss evidence from preclinical studies, which strongly support the validity of the telescoping effect and show that female animals develop addiction-like features (e.g., compulsive drug use, an enhanced motivation for the drug, and enhanced drug-craving/vulnerability to relapse) more readily than male animals. We also discuss biologic factors that may contribute to the telescoping effect, such as ovarian hormones, and its neurobiological basis focusing on the mesolimbic dopamine reward pathway and the corticomesolimbic glutamatergic pathway considering the critical roles these pathways play in the rewarding/reinforcing effects of addictive drugs and SUD. We conclude with future research directions, including intervention strategies to prevent the development of SUD in women. SIGNIFICANCE STATEMENT: One of the most widely cited gender/sex differences in substance use disorder (SUD) is the "telescoping effect," which reflects an accelerated course in women versus men for the development and/or seeking treatment for SUD. This review evaluates evidence for and against a telescoping effect drawing upon data from both clinical and preclinical studies. We also discuss the contribution of biological factors and underlying neurobiological mechanisms and highlight potential targets to prevent the development of SUD in women.
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Affiliation(s)
- Eleanor Blair Towers
- Psychiatry and Neurobehavioral Sciences (E.B.T., I.L.W., E.I.Q., W.J.L.) and Medical Scientist Training Program (E.B.T.), University of Virginia, Charlottesville, Virginia, and Center for Human Health and the Environment and Program in Genetics, North Carolina State University, Raleigh, North Carolina (E.F.R.)
| | - Ivy L Williams
- Psychiatry and Neurobehavioral Sciences (E.B.T., I.L.W., E.I.Q., W.J.L.) and Medical Scientist Training Program (E.B.T.), University of Virginia, Charlottesville, Virginia, and Center for Human Health and the Environment and Program in Genetics, North Carolina State University, Raleigh, North Carolina (E.F.R.)
| | - Emaan I Qillawala
- Psychiatry and Neurobehavioral Sciences (E.B.T., I.L.W., E.I.Q., W.J.L.) and Medical Scientist Training Program (E.B.T.), University of Virginia, Charlottesville, Virginia, and Center for Human Health and the Environment and Program in Genetics, North Carolina State University, Raleigh, North Carolina (E.F.R.)
| | - Emilie F Rissman
- Psychiatry and Neurobehavioral Sciences (E.B.T., I.L.W., E.I.Q., W.J.L.) and Medical Scientist Training Program (E.B.T.), University of Virginia, Charlottesville, Virginia, and Center for Human Health and the Environment and Program in Genetics, North Carolina State University, Raleigh, North Carolina (E.F.R.)
| | - Wendy J Lynch
- Psychiatry and Neurobehavioral Sciences (E.B.T., I.L.W., E.I.Q., W.J.L.) and Medical Scientist Training Program (E.B.T.), University of Virginia, Charlottesville, Virginia, and Center for Human Health and the Environment and Program in Genetics, North Carolina State University, Raleigh, North Carolina (E.F.R.)
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Meyer D, Athota P, Gowen A, Nguyen NM, Schaal VL, Yelamanchili SV, Pendyala G. Effect of Combined Methamphetamine and Oxycodone Use on the Synaptic Proteome in an In Vitro Model of Polysubstance Use. Genes (Basel) 2022; 13:genes13101816. [PMID: 36292701 PMCID: PMC9601452 DOI: 10.3390/genes13101816] [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] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 01/03/2023] Open
Abstract
Polysubstance use (PSU) generally involves the simultaneous use of an opioid along with a stimulant. In recent years, this problem has escalated into a nationwide epidemic. Understanding the mechanisms and effects underlying the interaction between these drugs is essential for the development of treatments for those suffering from addiction. Currently, the effect of PSU on synapses-critical points of contact between neurons-remains poorly understood. Using an in vitro model of primary neurons, we examined the combined effects of the psychostimulant methamphetamine (METH) and the prescription opioid oxycodone (oxy) on the synaptic proteome using quantitative mass-spectrometry-based proteomics. A further ClueGO analysis and Ingenuity Pathway Analysis (IPA) indicated the dysregulation of several molecular functions, biological processes, and pathways associated with neural plasticity and structural development. We identified one key synaptic protein, Striatin-1, which plays a vital role in many of these processes and functions, to be downregulated following METH+oxy treatment. This downregulation of Striatin-1 was further validated by Western blot. Overall, the present study indicates several damaging effects of the combined use of METH and oxy on neural function and warrants further detailed investigation into mechanisms contributing to synaptic dysfunction.
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Affiliation(s)
- Daniel Meyer
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Pranavi Athota
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Austin Gowen
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Nghi M. Nguyen
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Department of Genetics, Cell Biology, and Anatomy; University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Victoria L. Schaal
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Sowmya V. Yelamanchili
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Department of Genetics, Cell Biology, and Anatomy; University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Gurudutt Pendyala
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Department of Genetics, Cell Biology, and Anatomy; University of Nebraska Medical Center, Omaha, NE 68198, USA
- National Strategic Research Institute, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Child Health Research Institute, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Correspondence: ; Tel.: +1-402-559-8690
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Lalwani K, Whitehorne-Smith P, Walcott G, McLeary JG, Mitchell G, Abel W. Prevalence and sociodemographic factors associated with polysubstance use: analysis of a population-based survey in Jamaica. BMC Psychiatry 2022; 22:513. [PMID: 35902836 PMCID: PMC9334544 DOI: 10.1186/s12888-022-04160-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/20/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND In Latin America and the Caribbean, there is a dearth of research exploring polysubstance use. This study aims to determine the prevalence, varying combinations and associated sociodemographic characteristics of polysubstance use in Jamaica. METHODS This study involved a secondary data analysis of the Jamaica National Drug Prevalence Survey 2016 dataset where 4,623 participants between the age of 12 and 65 years from each household were randomly selected as respondents. Statistical analysis was performed to determine the prevalence and the sociodemographic correlates of polysubstance use among Jamaicans. RESULTS 19.6% of respondents used two or more drugs in their lifetime. Of this amount 68.7% reported past year use and 61.9% reported past month use. Bivariate analyses reported polysubstance use was statistically significantly higher amongst males (U = 54,579, p = 0.000), those living in rural areas (U = 91,892, p = 0.003), non-Christian (U = 89,514, p = 0.014), and married persons (U = 74,672, p = 0.000). Past month polysubstance use was statistically significantly higher among employed persons than unemployed persons were (U = 81,342, p = 0.001). Surprisingly, there was a lack of significant differences between education level, household income and past month concurrent polysubstance use (p = 0.609; p = 0.115 respectively). Logistic regression model indicated males were 3.076 times more likely than females to report past month polysubstance use than females. Also, when compared to those 55-65 years old, participants 35-54 years were 2.922 times more likely and those 18-34 years were 4.914 times more likely to report past month polysubstance use. Additionally, those living in rural areas were 1.508 times more likely than participants living in urban areas to report past month polysubstance use. As it relates to occupational status, when compared to armed forces, skilled workers were 4.328 times more likely and unskilled workers were 7.146 times more likely to report past month polysubstance use. CONCLUSIONS One in five Jamaicans identified as polysubstance users, predominated by marijuana as the most common factor amongst the polysubstance combinations examined, signalling the need for early marijuana interventions.
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Affiliation(s)
- Kunal Lalwani
- Dept of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica.
| | | | - Geoffrey Walcott
- grid.12916.3d0000 0001 2322 4996Dept of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica
| | - Joni-Gaye McLeary
- grid.12916.3d0000 0001 2322 4996Dept of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica
| | - Gabrielle Mitchell
- grid.12916.3d0000 0001 2322 4996Dept of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica
| | - Wendel Abel
- grid.12916.3d0000 0001 2322 4996Dept of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica
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Seaman RW, Lordson C, Collins GT. Modeling Stimulant and Opioid Co-use in Rats Provided Concurrent Access to Methamphetamine and Fentanyl. Front Psychiatry 2022; 13:814574. [PMID: 35237191 PMCID: PMC8884160 DOI: 10.3389/fpsyt.2022.814574] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/19/2022] [Indexed: 11/21/2022] Open
Abstract
Concurrent use of stimulants (e.g., methamphetamine) and opioids (e.g., fentanyl) has become increasingly common in recent years and continues to pose an enormous health burden, worldwide. Despite the prevalence, relatively little is known about interactions between the reinforcing effects of stimulants and opioids in this pattern of polysubstance use. The goals of the current study were to evaluate the relative reinforcing and relapse-related effects of methamphetamine and fentanyl using a concurrent access, drug-vs.-drug choice procedure. Male Sprague-Dawley rats were first allowed to acquire self-administration for either 0.1 mg/kg/infusion methamphetamine or 0.0032 mg/kg/infusion fentanyl, independently, after which concurrent access to both drugs was provided. When training doses of methamphetamine and fentanyl were concurrently available, a subset of rats self-administered both drugs, either within a session or alternating across sessions, whereas the remaining rats responded exclusively for one drug. When the cost of the preferred drug was increased (i.e., unit dose reduced), or the cost of the non-preferred drug was decreased (i.e., unit dose increased), choice was largely allocated toward the cheaper alternative. Following extinction of responding, methamphetamine- and fentanyl-paired cues reinstated responding on both levers. Responding reinstated by a priming injection of methamphetamine or fentanyl allocated more responding to the lever previously reinforced by the priming drug. The current studies suggest that choice of methamphetamine and fentanyl is largely allocated to the cheaper alternative, although more co-use was observed than would be expected for economic substitutes. Moreover, they lay the groundwork for more fully evaluating interactions between commonly co-abused drugs (e.g., stimulants and opioids) in order to better understand the determinants of polysubstance use and develop effective treatment strategies for individuals suffering from a polysubstance use disorder.
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Affiliation(s)
- Robert W Seaman
- Department of Pharmacology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States.,South Texas Veterans Health Care System, San Antonio, TX, United States
| | - Chris Lordson
- Department of Pharmacology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Gregory T Collins
- Department of Pharmacology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States.,South Texas Veterans Health Care System, San Antonio, TX, United States
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8
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Predictors of Inpatient Care in a 10-Year Retrospective Cohort Registered in an Outpatient Substance Use Disorder Treatment Program. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00702-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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9
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Peacock A, Tran LT, Larney S, Stockings E, Santo T, Jones H, Santomauro D, Degenhardt L. All-cause and cause-specific mortality among people with regular or problematic cocaine use: a systematic review and meta-analysis. Addiction 2021; 116:725-742. [PMID: 32857457 PMCID: PMC7914269 DOI: 10.1111/add.15239] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/02/2020] [Accepted: 08/24/2020] [Indexed: 12/29/2022]
Abstract
AIMS To estimate pooled all-cause and cause-specific mortality risk for people with regular or problematic cocaine use. METHODS Systematic review and meta-analysis of prospective or retrospective cohort studies or clinical trials (n ≥30) of people with regular or problematic cocaine use with data on all-cause or cause-specific mortality. Of 2808 papers, 28 were eligible and reported on 21 cohorts, with a total 170 019 individuals. Cohorts identified based on acute care for drug poisoning or other severe health presentation were excluded. Title/abstract screening was conducted by one reviewer; a second reviewer independently checked 10% of excluded studies. Two reviewers conducted full-text screening. Data were extracted by one reviewer and checked by a second. A customized review-specific study reporting quality/risk of bias tool was used. Data on crude mortality rates (CMR) and standardized mortality ratios were extracted for both all-cause and cause-specific mortality. Standardized mortality ratios were imputed where not provided by the author using extracted data and information from the Global Burden of Disease Study 2017. Data were pooled using a random-effects model. RESULTS The pooled all-cause crude mortality rate was 1.24 per 100 person-years [95% confidence interval (CI) = 0.86, 1.78; n = 16 cohorts], but with considerable heterogeneity (I2 = 98.8%). The pooled all-cause standardized mortality ratio (SMR) was 6.13 (95% CI = 4.15, 9.05; n = 16 cohorts). Suicide (SMR = 6.26, 95% CI = 2.84, 13.80), accidental injury (SMR = 6.36, 95% CI = 4.18, 9.68), homicide (SMR = 9.38, 95% CI 3.45-25.48) and AIDS-related mortality (SMR = 23.12, 95% CI = 11.30, 47.31) were all elevated compared with age and sex peers in the general population. CONCLUSIONS There are elevated rates of mortality among people with regular or problematic cocaine use for traumatic deaths and deaths attributable to infectious disease.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia,School of Psychology, University of Tasmania, Hobart, Australia
| | - Lucy Thi Tran
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - Thomas Santo
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - Hayley Jones
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Damian Santomauro
- Queensland Centre for Mental Health Research and School of Public Health, University of Queensland, Brisbane, Australia,Institute for Health metrics and Evaluation, University of Washington, Washington, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
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10
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Sanvisens A, Hernández-Rubio A, Zuluaga P, Fuster D, Papaseit E, Galan S, Farré M, Muga R. Long-Term Outcomes of Patients With Cocaine Use Disorder: A 18-years Addiction Cohort Study. Front Pharmacol 2021; 12:625610. [PMID: 33679404 PMCID: PMC7930813 DOI: 10.3389/fphar.2021.625610] [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: 11/03/2020] [Accepted: 01/14/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Cocaine Use Disorder (CUD) has been associated with multiple complications and premature death. The purpose of the present study was to analyze the relationship between baseline medical comorbidity and long-term medical outcomes (i.e., hospitalization, death) in a cohort of patients primarily admitted for detoxification. In addition, we aimed to analyze cause-specific mortality. Methods: longitudinal study in CUD patients admitted for detoxification between 2001 and 2018. Substance use characteristics, laboratory parameters and medical comorbidity by VACS Index were assessed at admission. Follow-up and health-related outcomes were ascertained through visits and e-health records. Kaplan-Meier and Cox regression models were used to analyze survival and predictors of hospitalization and death. Results: 175 patients (77.7% men) were included. Age at admission was 35 years [IQR: 30–41 years], 59.4% of the patients being intranasal users, 33.5% injectors, and 7.1% smokers. Almost 23% of patients had concomitant alcohol use disorder, 39% were cannabis users and 9% opiate users. The median VACS Index score on admission was 10 points [IQR: 0–22]. After 12 years [IQR: 8.6–15 years] of follow-up there were 1,292 (80.7%) ED admissions and 308 (19.3%) hospitalizations. The incidence rate of ED admission and hospitalization was 18.6 × 100 p-y (95% CI: 15.8–21.8 × 100 p-y). Mortality rate was 1.4 × 100 p-y (95% CI: 0.9–2.0 × 100 p-y) and, baseline comorbidity predicted hospitalization and mortality: those with VACS Index >40 were 3.5 times (HR:3.52, 95% CI: 1.19–10.4) more likely to dye with respect to patients with VACS < 20. Conclusion: addiction care warrants optimal stratification of medical comorbidity to improve health outcomes and survival of CUD patients seeking treatment of the disorder.
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Affiliation(s)
- Arantza Sanvisens
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain
| | - Anna Hernández-Rubio
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain
| | - Paola Zuluaga
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain
| | - Daniel Fuster
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain
| | - Esther Papaseit
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Sara Galan
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain
| | - Magí Farré
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Robert Muga
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain
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11
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Freese L, Fraga de Souza M, Schüler Nin M, Calleti G, Flores Peres V, Gomez R, Maria Tannhauser Barros H. Elevated GABA levels in the medial prefrontal cortex and lower estrogen levels abolish cocaine sensitization behavior in ovariectomized female rats. Brain Res 2020; 1749:147144. [PMID: 33038296 DOI: 10.1016/j.brainres.2020.147144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 11/18/2022]
Abstract
Animal models show that cocaine sensitization, a behavioral marker of addiction, is more significant in intact gonadal female than male rats and ovariectomy suppress this behavior in female rats. However, few studies explore changes in neurotransmission related to this phenomenon. Here we investigated the in vivo changes on GABA, glutamate, and taurine levels in the medial prefrontal cortex (mPFC) of gonadal intact or ovariectomized female rats after a cocaine challenge administration. Adult female rats were bilaterally ovariectomized (OVX), or sham-operated (SHAM) and randomly assigned to control (CTR), acute (ACT), or repeated (RPT) cocaine administration groups. In the challenge day, after eight days of daily cocaine (15 mg/kg) or saline administration and ten days of washout and stereotaxic surgery, RPT and ACT groups received cocaine, and the CTR group received saline. Horizontal locomotion was monitored concomitantly with microdialysate collection to determine extracellular GABA, glutamate, and taurine levels. Hormonal determination in blood samples confirmed the lower hormonal status of the OVX. Cocaine sensitization occurred in SHAM-RPT female rats after the challenge administration. Non-sensitized OVX-RPT rats showed a peak of GABA at 30 min after cocaine administration, with no change on glutamate and taurine levels. Therefore, elevated GABA levels in the mPFC and lower serum estrogen levels abolish cocaine sensitization behavior in ovariectomized female rats. We discuss some possible implications of these finding for future models of cocaine sensitization research lighting in the female hormonal influence.
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Affiliation(s)
- Luana Freese
- Graduate Program in Health Sciences: Pharmacology and Toxicology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 90050-170, Porto Alegre, RS, Brazil.
| | - Marilise Fraga de Souza
- Graduate Program in Health Sciences: Pharmacology and Toxicology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 90050-170, Porto Alegre, RS, Brazil.
| | - Maurício Schüler Nin
- Graduate Program in Health Sciences: Pharmacology and Toxicology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 90050-170, Porto Alegre, RS, Brazil; Pharmacy Program, Centro Universitário Metodista - IPA, Brazil; Graduate Program in Biological Sciences: Pharmacology and Therapeutics, Universidade Federal do Rio Grande do Sul (UFRGS), 90040-060, Porto Alegre, RS, Brazil.
| | - Greice Calleti
- Graduate Program in Health Sciences: Pharmacology and Toxicology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 90050-170, Porto Alegre, RS, Brazil; Graduate Program in Biological Sciences: Pharmacology and Therapeutics, Universidade Federal do Rio Grande do Sul (UFRGS), 90040-060, Porto Alegre, RS, Brazil.
| | - Valéria Flores Peres
- Graduate Program in Health Sciences: Pharmacology and Toxicology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 90050-170, Porto Alegre, RS, Brazil.
| | - Rosane Gomez
- Graduate Program in Biological Sciences: Pharmacology and Therapeutics, Universidade Federal do Rio Grande do Sul (UFRGS), 90040-060, Porto Alegre, RS, Brazil.
| | - Helena Maria Tannhauser Barros
- Graduate Program in Health Sciences: Pharmacology and Toxicology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 90050-170, Porto Alegre, RS, Brazil; Department of Pharmacosciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 90050-170, Porto Alegre, RS, Brazil.
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12
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Crummy EA, O'Neal TJ, Baskin BM, Ferguson SM. One Is Not Enough: Understanding and Modeling Polysubstance Use. Front Neurosci 2020; 14:569. [PMID: 32612502 PMCID: PMC7309369 DOI: 10.3389/fnins.2020.00569] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/08/2020] [Indexed: 12/19/2022] Open
Abstract
Substance use disorder (SUD) is a chronic, relapsing disease with a highly multifaceted pathology that includes (but is not limited to) sensitivity to drug-associated cues, negative affect, and motivation to maintain drug consumption. SUDs are highly prevalent, with 35 million people meeting criteria for SUD. While drug use and addiction are highly studied, most investigations of SUDs examine drug use in isolation, rather than in the more prevalent context of comorbid substance histories. Indeed, 11.3% of individuals diagnosed with a SUD have concurrent alcohol and illicit drug use disorders. Furthermore, having a SUD with one substance increases susceptibility to developing dependence on additional substances. For example, the increased risk of developing heroin dependence is twofold for alcohol misusers, threefold for cannabis users, 15-fold for cocaine users, and 40-fold for prescription misusers. Given the prevalence and risk associated with polysubstance use and current public health crises, examining these disorders through the lens of co-use is essential for translatability and improved treatment efficacy. The escalating economic and social costs and continued rise in drug use has spurred interest in developing preclinical models that effectively model this phenomenon. Here, we review the current state of the field in understanding the behavioral and neural circuitry in the context of co-use with common pairings of alcohol, nicotine, cannabis, and other addictive substances. Moreover, we outline key considerations when developing polysubstance models, including challenges to developing preclinical models to provide insights and improve treatment outcomes.
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Affiliation(s)
- Elizabeth A Crummy
- Graduate Program in Neuroscience, University of Washington, Seattle, WA, United States.,Center for Neurobiology of Addiction, Pain, and Emotion, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, United States
| | - Timothy J O'Neal
- Graduate Program in Neuroscience, University of Washington, Seattle, WA, United States.,Center for Neurobiology of Addiction, Pain, and Emotion, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, United States
| | - Britahny M Baskin
- Graduate Program in Neuroscience, University of Washington, Seattle, WA, United States.,Center for Neurobiology of Addiction, Pain, and Emotion, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, United States
| | - Susan M Ferguson
- Center for Neurobiology of Addiction, Pain, and Emotion, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, United States.,Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, United States
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13
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Examining the Association Between Psychiatric Disorders and Cocaine Binges: Results From the COSMO Study. J Addict Med 2019; 12:136-142. [PMID: 29283956 DOI: 10.1097/adm.0000000000000378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Although cocaine binges and mental health problems have both been identified as significant risk factors for different health hazards, little is known about the relationship between mental health and cocaine binging. Hence, the aim of this study is to examine the association between psychiatric disorders and cocaine binge. METHODS Participants were part of a prospective cohort study of individuals who either smoke or inject cocaine. The dependent variable, namely a cocaine binge within the past month, was defined as the repetitive use of large quantities of cocaine until the individual was unable to access more of the drug or was physically unable to keep using. Psychiatric disorders were assessed using the Composite International Diagnostic Interview and the Diagnostic Interview Schedule questionnaires. Logistic regression models were performed to examine the association between cocaine binging and psychiatric disorders, adjusting for potential confounders. RESULTS Of the 492 participants, 24.4% reported at least 1 cocaine binging episode during the prior month. Among the study population, 48.0% met the criteria for antisocial personality disorder (ASPD), 45.5% for anxiety disorders, and 28.2% for mood disorders. Participants with ASPD were more likely to binge (adjusted odds ratio 1.73, 95% confidence interval 1.10-2.73), whereas those with a mood disorder were not. The association between anxiety disorders and cocaine binging was significant only in univariate analyses. CONCLUSION ASPD increased the odds of reporting cocaine binge in our study population. These results highlight the need for a better understanding of the specific dimensions of ASPD that contribute to the increased risk of unsafe drug use behaviors.
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14
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Tsirigotis K. Gender Differentiation of Indirect Self-Destructiveness in Drug Addicted Individuals (Indirect Self-Destructiveness in Addicted Women and Men). Psychiatr Q 2019; 90:371-383. [PMID: 30835014 PMCID: PMC6522439 DOI: 10.1007/s11126-019-09629-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The use of psychoactive substances is considered to be a typical self-destructive behaviour with addiction itself regarded as one of the self-destructiveness forms. The aim of this work was to explore the gender differentiation of the indirect self-destructiveness syndrome (and its particular categories) in drug addicted individuals treated in drug addiction treatment centres. 172 drug addicted individuals (116 men and 56 women, M age = 23,5), ranged from 19 to 28 years, was recruited. In order to examine indirect self-destructiveness and its manifestations, the Polish version of the "Chronic Self-Destructiveness Scale" by Kelley (CS-DS) was administered. The statistical processing of scores used the Mann-Whitney U significance test. Women treated for drug addiction achieved significantly higher scores on indirect self-destructiveness: general score (p = 0.001), subscales of Transgression and Risk (p = 0.001), Personal and Social Neglects (p = 0.02), and Lack of Planfulness (p < 0.001). They scored lower on Poor Health Maintenance (p < 0.002) and Helplessness (p < 0.001). There is a need for specific, gender-adjusted manners of intervention and treatment in addicted women. Optimistically, after an addiction treatment, women cope and feel better psychologically and socially. They also care more about their health.
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Affiliation(s)
- Konstantinos Tsirigotis
- Department of Psychology, The Jan Kochanowski University in Kielce, Piotrków Trybunalski Branch, 114/118 Słowackiego St, 97-300, Piotrków Trybunalski, Poland.
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15
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Colell E, Domingo-Salvany A, Espelt A, Parés-Badell O, Brugal MT. Differences in mortality in a cohort of cocaine use disorder patients with concurrent alcohol or opiates disorder. Addiction 2018; 113:1045-1055. [PMID: 29357115 DOI: 10.1111/add.14165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/21/2017] [Accepted: 01/12/2018] [Indexed: 12/24/2022]
Abstract
AIMS To study mortality in a cohort of cocaine use disorder patients, and compare results in those with concurrent alcohol or opiates disorder. DESIGN, SETTING AND PARTICIPANTS A cohort of 10 539 cocaine use disorder individuals entering drug treatment in public out-patient centres in the city of Barcelona was followed from 1997 to 2011. Participants were divided at baseline into three groups: those with only cocaine use disorder (CUD), those with cocaine and alcohol use disorder but not opioid (CAUD) and those with cocaine and opioid use disorder (COUD). Mortality was assessed through the Spanish National Mortality Register. MEASUREMENTS Crude mortality rates (CMR), standardized mortality ratios (SMR) and rate ratios (RR) were calculated for each group. A multivariable Cox regression model was fitted to obtain adjusted mortality hazard ratios (aHR) of CAUD and COUD with respect to CUD. Specific mortality causes were also examined. FINDINGS The total of 716 deaths registered resulted in a CMR = 6.0/1000 person-years (PY); 95% confidence interval (CI) = 5.1-7.0 for CUD, CMR = 5.8/1000 PY (95% CI = 4.9-6.7) for CAUD and CMR = 20.7/1000 PY (95% CI = 18.8-22.8) for COUD, with no significant differences among sexes. Compared with the general population, mortality was four times higher (SMR = 4.1, 95% CI = 3.5-4.8) among CUD, more than three times among CAUD (SMR = 3.4, 95% CI = 2.9-3.9) and more than 10 times among COUD (SMR = 11.6, 95% CI = 10.5-12.8), being always higher in women. External injuries, led by overdose, accumulated the biggest percentage of deaths among the three groups, but infectious diseases showed the highest excess mortality. Some differences regarding causes of death were observed between the three groups. CONCLUSIONS Mortality risk and excess mortality are significantly greater among those with cocaine and opiates use disorder than among people with only cocaine use disorder or cocaine and alcohol use disorder.
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Affiliation(s)
- Esther Colell
- Drug Abuse Epidemiology Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Antònia Domingo-Salvany
- Drug Abuse Epidemiology Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Albert Espelt
- Public Health Agency of Barcelona, Spain.,Institute of Biomedical Research Sant Pau, Barcelona, Spain.,Department of Psychobiology and Methodology of Health Sciences, Autonomous University of Barcelona, Bellaterra, Spain.,CIBER en Epidemiología y Salud Pública (CIBERESP), Biomedical Research Centre Network for Epidemiology and Public Health (Spain), Madrid, Spain.,Facultat de Ciències de la Salut de Manresa, Universitat de Vic. Universitat Central de Catalunya (UVicUCC), Av Universitària, Manresa, Spain
| | - Oleguer Parés-Badell
- Public Health Agency of Barcelona, Spain.,Institute of Biomedical Research Sant Pau, Barcelona, Spain
| | - M Teresa Brugal
- Public Health Agency of Barcelona, Spain.,Institute of Biomedical Research Sant Pau, Barcelona, Spain
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16
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Peles E, Schreiber S, Sason A, Adelson M. Similarities and changes between 15- and 24-year survival and retention rates of patients in a large medical-affiliated methadone maintenance treatment (MMT) center. Drug Alcohol Depend 2018; 185:112-119. [PMID: 29432974 DOI: 10.1016/j.drugalcdep.2017.11.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/26/2017] [Accepted: 11/28/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Environmental and social trends and patients' characteristics may affect predictors for methadone maintenance treatment (MMT) outcome. METHODS We have expanded our previous study of predictors for MMT outcome (from 619 to 890 patients) and the study period (from 15 to 24 years). Survival and retention in MMT since admission to the MMT clinic (6/1993-6/2016) and until death or study closure (6/2017) were compiled and analyzed. RESULTS Of 890 patients ever admitted (10,146.9 person-years (py)), 237 passed away (116 while in MMT). The mortality rate did not differ between those who stayed or left (2.6 vs. 2.1 per 100 py, p = 0.1), but it was lower among those who stayed ≥1 year during any admission (2.1 vs. 3.3 per 100 py, respectively, p = 0.004). Age <40 years, no hepatitis C or B, no HIV, and no benzodiazepine abuse after one year predicted longer survival (multivariate analyses). No opiate or benzodiazepine abuse after one year, methadone dose ≥100 mg/d, no DSM-IV-TR Axis II diagnosis only, and no direct hospital referral predicted longer retention. Cocaine abuse predicted poor retention and survival among 271 patients admitted during the extended part of the study period. CONCLUSIONS Predictors for retention (associated with MMT outcome) and mortality (associated with pre-treatment comorbidity) after 24 years were similar to those after 15 years. Cocaine abuse as a predictor of both poor retention and poor survival in the later period may reflect the escalating trend for cocaine abuse and should be studied if related to other unmonitored substances.
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Affiliation(s)
- Einat Peles
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, 1 Henrietta Szold Street, Tel-Aviv 64924, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shaul Schreiber
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, 1 Henrietta Szold Street, Tel-Aviv 64924, Israel; Department of Psychiatry, Tel Aviv Sourasky Medical Center, Weizmann St. 6, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Sason
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, 1 Henrietta Szold Street, Tel-Aviv 64924, Israel
| | - Miriam Adelson
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, 1 Henrietta Szold Street, Tel-Aviv 64924, Israel
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17
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Molist G, Brugal MT, Barrio G, Mesías B, Bosque-Prous M, Parés-Badell O, de la Fuente L. Effect of ageing and time since first heroin and cocaine use on mortality from external and natural causes in a Spanish cohort of drug users. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 53:8-16. [PMID: 29268239 DOI: 10.1016/j.drugpo.2017.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 11/10/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND We aimed to assess the effect of ageing and time since first heroin/cocaine use on cause-specific mortality risk and age disparities in excess mortality among heroin (HUs) and cocaine users (CUs) in Spain. METHODS A cohort of 15,305 HUs and 11,905 CUs aged 15-49 starting drug treatment during 1997-2007 in Madrid and Barcelona was followed until December 2008. Effects of ageing and time since first heroin/cocaine use were estimated using a competing risk Cox model and the relative and absolute excess mortality compared to the general population through directly age-sex standardized rate ratios (SRRs) and differences (SRDs), respectively. RESULTS Mortality risk from natural causes increased with time since first heroin use, whereas that from overdose declined after having peaked in the first quinquennium. Significant effects of time since first cocaine use were not identified, although fatal overdose risk seemed higher in CUs after five years. Mortality risk from natural causes (HUs and CUs), injuries (HUs), and overdoses (CUs) increased with age, the latter without reaching statistical significance. Crude mortality rates from overdoses and injuries remained very high at age 40-59 among both HUs (595 and 217 deaths/100,000 person-years, respectively) and CUs (191 and 88 deaths/100,000 person-years). SRDs from all and natural causes were much higher at age 40-59 than 15-29 in both HUs (2134 vs. 834 deaths/100,000 person-years) and CUs (927 vs. 221 deaths/100,000 person-years), while the opposite occurred with SRRs. CONCLUSION The high mortality risk among HUs and CUs at all ages from both external and natural causes, and increased SRDs with ageing, suggest that high-level healthcare and harm reduction services should be established early and maintained throughout the lifetime of these populations.
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Affiliation(s)
- Gemma Molist
- Área de Recerca i Innovació, Hospital General de Granollers, Barcelona, Spain, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain.
| | - M Teresa Brugal
- Public Health Agency of Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Gregorio Barrio
- National School of Public Health, Carlos III Health Institute, Madrid, Spain.
| | | | - Marina Bosque-Prous
- Public Health Agency of Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Oleguer Parés-Badell
- Public Health Agency of Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Luis de la Fuente
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain; National Epidemiology Center, Carlos III Health Institute, Madrid, Spain.
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18
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Auger N, Bilodeau-Bertrand M, Labesse ME, Kosatsky T. Association of elevated ambient temperature with death from cocaine overdose. Drug Alcohol Depend 2017. [PMID: 28645059 DOI: 10.1016/j.drugalcdep.2017.04.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ecologic data suggest that elevated outdoor temperature is correlated with mortality rates from cocaine overdose. Using non-aggregated death records, we studied the association of hot temperatures with risk of death from cocaine overdose. METHODS We carried out a case-crossover study of all deaths from cocaine or other drug overdose between the months of May and September, from 2000 through 2013 in Quebec, Canada. We used conditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between maximum outdoor temperature and death from cocaine or other drug overdose. The main outcome measure was death from cocaine overdose as a function of maximum temperature the day of death and the days immediately preceding death. RESULTS There were 316 deaths from cocaine overdose and 446 from other drug overdoses during the study. Elevated temperature the preceding week was associated with the likelihood of death from cocaine but not other drug overdose. Compared with 20°C, a maximum weekly temperature of 30°C was associated with an OR of 2.07 for death from cocaine overdose (95% CI 1.15-3.73), but an OR of 1.03 for other drug overdoses (95% CI 0.60-1.75). Associations for cocaine overdose were present with maximum daily temperature the day of and each of the three days preceding death. CONCLUSIONS Elevated ambient temperature is associated with the risk of death from cocaine overdose. Public health practitioners and drug users should be aware of the added risk of mortality when cocaine is used during hot days.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada.
| | - Marianne Bilodeau-Bertrand
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | | | - Tom Kosatsky
- National Collaborating Centre for Environmental Health, British Columbia Centre for Disease Control, Vancouver, Canada
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19
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Pavarin RM, Fioritti A. Mortality Trends among Cocaine Users Treated between 1989 and 2013 in Northern Italy: Results of a Longitudinal Study. J Psychoactive Drugs 2017; 50:72-80. [PMID: 28846059 DOI: 10.1080/02791072.2017.1365976] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A total of 852 participants attending 11 centers for addiction treatment in north Italy following problems due to cocaine abuse between 1989 and 2013 were recruited. Two typologies were created: cocaine users (never heroin) (CU) and heroin and cocaine users (HCU). During the 38-year follow-up period, 4.8% of the whole cohort died. Over the whole period, tumors were the main causes of death; starting in 2010, suicide deaths became the first cause of death. Among CUs, most deaths were due to road accidents and suicide; among HCUs, most of the deaths were from opiate overdose and from cardio-circulatory system diseases. The excess mortality observed for all causes in either sex was 6.24; higher in females (15.03) as compared in males (6.23), higher in HCUs (9.06) as compared in CUs (5.21). The directly age-sex standardized mortality rates were 5.31 per 100, higher for females, declining after 2009 for all patients and after 2004 for HCUs. Multivariate analysis confirms the decreasing trend in the risk of death and shows a higher mortality risk for participants in the under-25 age group. Among cocaine users, special attention should be paid to the prevention of suicide deaths.
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Affiliation(s)
- Raimondo Maria Pavarin
- a Doctor, Health Sociologist, and Chief of Epidemiological Monitoring Center on Addiction, Mental Health DSM-DP , Azienda USL, Bologna , Italy
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20
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Corkery JM, Claridge H, Goodair C, Schifano F. An exploratory study of information sources and key findings on UK cocaine-related deaths. J Psychopharmacol 2017. [PMID: 28648101 DOI: 10.1177/0269881117711923] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cocaine-related deaths have increased since the early 1990s in Europe, including the UK. Being multi-factorial, they are difficult to define, detect and record. The European Monitoring Centre for Drugs and Drug Addiction commissioned research to: describe trends reported to Special Mortality Registries and General Mortality Registers; provide demographic and drug-use characteristic information of cases; and establish how deaths are identified and classified. A questionnaire was developed and piloted amongst all European Monitoring Centre for Drugs and Drug Addiction Focal Point experts/Special Mortality Registries: 19 (63%) responded; nine countries provided aggregated data. UK General Mortality Registers use cause of death and toxicology to identify cocaine-related deaths. Categorisation is based on International Classification of Diseases codes. Special Mortality Registries use toxicology, autopsy, evidence and cause of death. The cocaine metabolites commonly screened for are: benzoylecgonine, ecgonine methyl ester, cocaethylene and ecgonine. The 2000s saw a generally accelerating upward trend in cases, followed by a decline in 2009. The UK recorded 2700-2900 deaths during 1998-2012. UK Special Mortality Registry data (2005-2009) indicate: 25-44 year-olds account for 74% of deaths; mean age=34 (range 15-81) years; 84% male. Cocaine overdoses account for two-thirds of cases; cocaine alone being mentioned/implicated in 23% in the UK. Opioids are involved in most (58%) cocaine overdose cases.
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Affiliation(s)
- John M Corkery
- 1 Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hatfield, UK
| | - Hugh Claridge
- 2 National Programme on Substance Abuse Deaths, St George's University of London, London, UK
| | - Christine Goodair
- 2 National Programme on Substance Abuse Deaths, St George's University of London, London, UK
| | - Fabrizio Schifano
- 1 Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hatfield, UK
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21
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Lake S, Kerr T, Buxton J, Guillemi S, Parashar S, Montaner J, Wood E, Milloy MJ. Prescription Opioid Injection Among HIV-Positive People Who Inject Drugs in a Canadian Setting. AIDS Behav 2016; 20:2941-2949. [PMID: 27146887 DOI: 10.1007/s10461-016-1369-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Prescription opioids (POs) are commonly prescribed to patients living with HIV/AIDS, while the illicit use of POs remains a major public health concern throughout Canada and the United States. We sought to identify the prevalence and correlates of PO injection among HIV-positive people who inject drugs (PWID) in Vancouver, Canada, where HIV/AIDS treatment and care is offered at no cost. We examined data from 634 individuals from an ongoing prospective cohort of HIV-positive PWID. Between December 2005 and November 2013, the median prevalence of recent PO injection was 24.2 % [interquartile range (IQR): 21.5-25.8 %]. In a multivariable generalized estimating equation model, Caucasian ethnicity, heroin injection, and drug dealing were positively associated with PO injection, while older age and methadone maintenance treatment were negatively associated with PO injection (all p < 0.05). Engagement on antiretroviral therapy was inversely associated with PO injection in a bivariable analysis, but did not remain significant after adjusting for heroin injection. These findings describe a particularly vulnerable sub-group of PWID who may benefit from targeted efforts to both minimize drug-related risk behaviors and support HIV/AIDS treatment.
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Affiliation(s)
- Stephanie Lake
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jane Buxton
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, Canada
| | - Silvia Guillemi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Surita Parashar
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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22
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Brugal MT, Molist G, Sarasa-Renedo A, de la Fuente L, Espelt A, Mesías B, Puerta C, Guitart AM, Barrio G. Assessing gender disparities in excess mortality of heroin or cocaine users compared to the general population. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 38:36-42. [DOI: 10.1016/j.drugpo.2016.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 08/12/2016] [Accepted: 10/19/2016] [Indexed: 01/18/2023]
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23
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Agabio R, Campesi I, Pisanu C, Gessa GL, Franconi F. Sex differences in substance use disorders: focus on side effects. Addict Biol 2016; 21:1030-42. [PMID: 27001402 DOI: 10.1111/adb.12395] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 02/24/2016] [Indexed: 12/19/2022]
Abstract
Although sex differences in several aspects of substance use disorders (SUDs) have been identified, less is known about the importance of possible sex differences in side effects induced by substances of abuse or by medications used to treat SUDs. In the SUD field, the perception of certain subjective effects are actively sought, while all other manifestations might operationally be considered side effects. This article was aimed at reviewing sex differences in side effects induced by alcohol, nicotine, heroin, marijuana and cocaine and by medications approved for alcohol, nicotine and heroin use disorders. A large body of evidence suggests that women are at higher risk of alcohol-induced injury, liver disease, cardiomyopathy, myopathy, brain damages and mortality. The risk of tobacco-induced coronary heart disease, lung disease and health problems is higher for women than for men. Women also experience greater exposure to side effects induced by heroin, marijuana and cocaine. In addition, women appear to be more vulnerable to the side effects induced by medications used to treat SUDs. Patients with SUDs should be advised that the risk of developing health problems may be higher for women than for men after consumption of the same amount of substances of abuse. Doses of medications for SUD women should be adjusted at least according to body weight. The sex differences observed also indicate an urgent need to recruit adequate numbers of female subjects in pre-clinical and clinical studies to improve our knowledge about SUDs in women.
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Affiliation(s)
- Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology; University of Cagliari; Cagliari Italy
| | - Ilaria Campesi
- National Laboratory of Gender Medicine of the National Institute of Biostructures and Biosystems; Osilo, Sassari Italy
- Department of Biomedical Sciences; University of Sassari; Sassari Italy
| | - Claudia Pisanu
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology; University of Cagliari; Cagliari Italy
| | - Gian Luigi Gessa
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology; University of Cagliari; Cagliari Italy
- Neuroscience Institute, Section of Cagliari; National Research Council of Italy; Cagliari Italy
| | - Flavia Franconi
- National Laboratory of Gender Medicine of the National Institute of Biostructures and Biosystems; Osilo, Sassari Italy
- Department of Biomedical Sciences; University of Sassari; Sassari Italy
- Assessorato alle Politiche per la Persona; Regione Basilicata Italy
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24
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Grasing K, Mathur D, DeSouza C, Newton TF, Moody DE, Sturgill M. Cocaine cardiovascular effects and pharmacokinetics after treatment with the acetylcholinesterase inhibitor donepezil. Am J Addict 2016; 25:392-9. [PMID: 27392137 DOI: 10.1111/ajad.12402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/11/2016] [Accepted: 06/25/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In rodents, cholinesterase inhibitors can cause sustained decreases in the reinforcing effects of cocaine. Nonetheless, cocaine is metabolized by butyrylcholinesterase (BuChE), raising concerns that cholinesterase inhibition could increase its peripheral concentrations, perhaps augmenting toxicity. Although donepezil is approved for use in patients and selective for inhibiting acetylcholinesterase over BuChE, no studies have reported cocaine bioavailability in human subjects receiving donepezil. METHODS Twelve cocaine-dependent veterans received three days of treatment with either oral placebo or 5 mg daily of donepezil, followed by cross-over to the opposite treatment. During both oral treatments, double-blind intravenous cocaine was administered at .0, .18, and .36 mg/kg in a laboratory setting, followed by determinations of heart rate, blood pressure, and plasma concentrations of cocaine and major metabolites. RESULTS Intravenous cocaine produced dose-related increases in systolic blood pressure that were most pronounced over the initial 30 minutes after treatment. Oral donepezil attenuated drug-induced elevations of systolic blood pressure following low-dose cocaine (.18 mg/kg). No significant difference in blood pressure following treatment with placebo or donepezil after high-dose cocaine (.36 mg/kg). Peak values of blood pressure and heart rate were unaffected by donepezil. Plasma concentrations of cocaine and metabolites did not differ in donepezil- and placebo-treated participants. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE We conclude that donepezil can attenuate drug-induced increases in systolic blood pressure following low-dose cocaine, but does not otherwise modify the cardiovascular effects of intravenous cocaine. Clinically significant changes in cocaine bioavailability and cardiovascular effects do not occur following this dose of donepezil. (Am J Addict 2016;25:392-399).
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Affiliation(s)
- Kenneth Grasing
- Substance Abuse Research Laboratory, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri.,Division of Clinical Pharmacology, Department of Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Deepan Mathur
- Substance Abuse Research Laboratory, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri
| | - Cherilyn DeSouza
- Substance Abuse Research Laboratory, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri.,Department of Psychiatry, University of Kansas School of Medicine, Kansas City, Kansas
| | - Thomas F Newton
- Department of Psychiatry and Behavioral Science and The Michael E. DeBakey Department of Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas
| | - David E Moody
- Department of Pharmacology and Toxicology, Center for Human Toxicology, University of Utah, Salt Lake City, Utah
| | - Marc Sturgill
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey
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25
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Stauffer CS, Musinipally V, Suen A, Lynch KL, Shapiro B, Woolley JD. A two-week pilot study of intranasal oxytocin for cocaine-dependent individuals receiving methadone maintenance treatment for opioid use disorder. ADDICTION RESEARCH & THEORY 2016; 24:490-498. [PMID: 28503120 PMCID: PMC5424696 DOI: 10.3109/16066359.2016.1173682] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
30-60% of patients receiving methadone for opioid use disorder (OUD) actively use cocaine. Cocaine use disorder (CUD) has no FDA-approved pharmacological treatment; existing psychosocial treatments are inadequate. Oxytocin, a social neuropeptide, has preclinical promise as an adjunctive treatment for both OUD and CUD. Twenty-two individuals receiving methadone for OUD with co-occurring CUD were randomized to receive oxytocin or placebo intranasally 40 IU twice daily for two weeks. A priori aims were feasibility and safety. Exploratory effectiveness aims included laboratory-based measures of drug craving, drug-related implicit cognition, and drug use. High retention rates (93.5%), the absence of study-related adverse events, and the fact that oxytocin was well tolerated in this population support the feasibility of larger trials. Two weeks of oxytocin (but not placebo) significantly reduced cocaine craving at day 15 compared to baseline (mean change±SD: OT=-0.23±0.19, p=0.004; PL=-0.16±0.29, p=0.114). For heroin craving, the placebo group reported a trend-level increase over time while the oxytocin group remained unchanged - with medium to large effect sizes between the groups (Cohen's d=0.71-0.90). Oxytocin led to a significant switch from implicit self-association with drugs to implicitly associating drugs with others (mean change±SD: 0.25±0.35, p=0.037) and a trend-level reduction in self-reported cocaine use over time (Z=-1.78, p=0.075). Furthermore, oxytocin significantly increased the accuracy of self-reported cocaine use when correlated with quantitative urine levels of cocaine metabolite. This proof-of-concept study provides promising early evidence that oxytocin may be an effective adjunct to the treatment of co-occurring CUD and OUD. Further investigation with larger trials is warranted.
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Affiliation(s)
- Christopher S. Stauffer
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143
- Department of Mental Health, San Francisco Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121
| | - Vivek Musinipally
- School of Medicine, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143
- Department of Mental Health, San Francisco Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121
| | - Angela Suen
- School of Medicine, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143
| | - Kara L. Lynch
- Department of Pathology and Laboratory Medicine, University of California San Francisco, 521 Parnassus Ave, San Francisco, CA 94143
| | - Brad Shapiro
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143
| | - Joshua D. Woolley
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143
- Department of Mental Health, San Francisco Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121
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26
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Gjersing L, Bretteville-Jensen AL. Are overdoses treated by ambulance services an opportunity for additional interventions? A prospective cohort study. Addiction 2015; 110:1767-74. [PMID: 26118947 DOI: 10.1111/add.13026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/21/2015] [Accepted: 05/21/2015] [Indexed: 11/28/2022]
Abstract
AIMS To assess whether people who inject drugs (PWID) and who are treated for overdose by ambulance services have a greater mortality risk compared with other PWID, and to compare mortality risk within potentially critical time-periods (1 week, 1 month, 3 months, 6 months, 1 year, 5 years) after an overdose attendance with the mortality risk within potentially non-critical time-periods (time before and/or after critical periods). DESIGN A prospective cohort study. SETTING Oslo, Norway. PARTICIPANTS A total of 172 PWID street-recruited in 1997 and followed-up until the end of 2004. MEASUREMENTS Interview data linked to data from ambulance records, Norwegian Correctional Services, Opioid Substitution Treatment records and National Cause of Death Registry. Separate Cox regression models (one for each critical time-period) were estimated. FINDINGS Ambulance services treated 54% of the participants for an overdose during follow-up. The mortality rate was 2.8 per 100 person-years for those with an overdose and 3.3 for those without; the adjusted hazard ratio (HR) was 1.3 (95% CI = 0.6, 2.6, P = 0.482). Mortality risk was greater in all but the shortest critical time-period following ambulance attendance than in the non-critical periods. The mortality risk remained significantly elevated during critical periods, even when adjusted for total time spent in prison and substitution treatment. The HR ranged from 9.4 (95% CI = 3.5, 25.4) in the month after an overdose to 13.9 (95% CI = 6.4, 30.2) in the 5-year period. CONCLUSIONS Mortality risk among people who inject drugs is significantly greater in time-periods after an overdose attendance than outside these time-periods.
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Affiliation(s)
- Linn Gjersing
- Norwegian Institute for Alcohol and Drug Research (SIRUS), PB 565 Sentrum, 0105, Oslo, Norway
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