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Clement A, Dillinger JG, Ramonatxo A, Roule V, Picard F, Thevenet E, Swedzky F, Hauguel-Moreau M, Sulman D, Stevenard M, Amri N, Martinez D, Maitre-Ballesteros L, Landemaine T, Coppens A, Bouali N, Guiraud-Chaumeil P, Gall E, Lequipar A, Henry P, Pezel T. In-hospital prognosis of acute ST-elevation myocardial infarction in patients with recent recreational drug use. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:324-332. [PMID: 38381068 DOI: 10.1093/ehjacc/zuae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/22/2024] [Accepted: 02/03/2024] [Indexed: 02/22/2024]
Abstract
AIMS Although recreational drug use may induce ST-elevated myocardial infarction (STEMI), its prevalence in patients hospitalized in intensive cardiac care units (ICCUs), as well as its short-term cardiovascular consequences, remains unknown. We aimed to assess the in-hospital prognosis of STEMI in patients with recreational drug use from the ADDICT-ICCU study. METHODS AND RESULTS From 7-22 April 2021, recreational drug use was detected prospectively by a systematic urine multidrug test in all consecutive patients admitted for STEMI in 39 ICCUs across France. The primary endpoint was major adverse cardiac events (MACEs) defined by death, resuscitated cardiac arrest, or cardiogenic shock. Among the 325 patients (age 62 ± 13 years, 79% men), 41 (12.6%) had a positive multidrug test (cannabis: 11.1%, opioids: 4.6%, cocaine: 1.2%, 3,4-methylenedioxymethamphetamine: 0.6%). The prevalence increased to 34.0% in patients under 50 years of age. Recreational drug users were more frequently men (93% vs. 77%, p = 0.02), younger (50 ± 12 years vs. 63 ± 13 years, P < 0.001), and more active smokers (78% vs. 34%, P < 0.001). During hospitalization, 17 MACEs occurred (5.2%), including 6 deaths (1.8%), 10 cardiogenic shocks (3.1%), and 7 resuscitated cardiac arrests (2.2%). Major adverse cardiac events (17.1% vs. 3.5%, P < 0.001) and ventricular arrhythmia (9.8% vs. 1.4%, P = 0.01) were more frequent in recreational drug users. Use of recreational drugs was associated with more MACEs after adjustment for comorbidities (odds ratio = 13.1; 95% confidence interval: 3.4-54.6). CONCLUSION In patients with STEMI, recreational drug use is prevalent, especially in patients under 50 years of age, and is independently associated with an increase of MACEs with more ventricular arrhythmia. TRIAL REGISTRATION URL: https://clinicaltrials.gov/ct2/show/NCT05063097.
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Affiliation(s)
- Arthur Clement
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Jean-Guillaume Dillinger
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Arthur Ramonatxo
- Department of Cardiology, University Hospital of Poitiers, 86000 Poitiers, France
| | - Vincent Roule
- Department of Cardiology, Caen University Hospital, 14000 Caen, France
| | - Fabien Picard
- Service de Cardiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Eugenie Thevenet
- Department of Cardiology, University Hospital of Martinique, 97261 Fort-de-France, France
| | - Federico Swedzky
- Service de cardiologie, Hôpital Henri Duffaut, 84902 Avignon, France
| | - Marie Hauguel-Moreau
- Université de Versailles-Saint Quentin, INSERM U1018, CESP, ACTION Study Group, Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne, France
| | - David Sulman
- Université de Paris, Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France
| | - Mathilde Stevenard
- Service de cardiologie et médecine aéronautique, Hôpital d'Instruction des Armées Percy, 92140 Clamart, France
| | - Nabil Amri
- Service de Cardiologie Interventionnelle, CHU Timone, APHM, Aix Marseille Univ, Marseille, France
| | - David Martinez
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | | | - Thomas Landemaine
- Unité de Soins intensifs Cardiologiques, CHU Amiens, 80000 Amiens, France
| | - Alexandre Coppens
- Department of Cardiology, Andre Gregoire Hospital, 93100 Montreuil, France
| | - Nabil Bouali
- Department of Cardiology, University Hospital of Poitiers, 86000 Poitiers, France
- Service de Cardiologie, Centre hospitalier de Saintonge, 17100 Saintes, France
| | - Paul Guiraud-Chaumeil
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Emmanuel Gall
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Antoine Lequipar
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Patrick Henry
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Theo Pezel
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 2 Rue Ambroise Paré, 75010 Paris, France
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Boun SS, Omonaiye O, Yaya S. Prevalence and health consequences of nonmedical use of tramadol in Africa: A systematic scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002784. [PMID: 38236813 PMCID: PMC10796000 DOI: 10.1371/journal.pgph.0002784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/04/2023] [Indexed: 01/22/2024]
Abstract
Tramadol is a widely prescribed painkiller around the world. As a synthetic opioid, it offers a valuable substitute for morphine and its derivatives in African countries. However, the adverse health effects of tramadol use resulting from illicit trafficking, like those caused by fentanyl and methadone in North America, have not been well-documented in Africa. This scoping review aims to shed light on the nature and scope of the nonmedical use (NMU) of tramadol in Africa and its associated health consequences. To carry out our scoping review, we used Arksey and O'Malley's (2005) five-step approach for exploratory analysis and followed Joanna Briggs Institute guidelines for scoping reviews to ensure systematic and replicable studies. We then searched six databases: Medline, Global Health (EBSCO), Scopus, Web of Science, the African Journals online database, and for grey literature via Google Scholar without any time restriction. The articles were imported into Covidence and reviewed by two independent researchers. Eighty-three studies on NMU of tramadol's prevalence or health consequences were selected from 532 titles/abstracts screened, including 60 cross-sectional and six qualitative studies from 10 African countries. Findings from the included studies highlighted five distinct groups significantly affected by the NMU of tramadol. These groups include: 1) young adults/active populations with varying degrees of prevalence ranging from 1.9% to 77.04%, 2) professionals, where drivers exhibit a relatively high prevalence of tramadol NMU, ranging from 7.2% to 35.1%, and commercial motorcyclists, with a prevalence of 76%, 3) patients, who have a high rate of tramadol NMUs, with prevalence rates ranging from 77.1% to 92%, 4) academics, with a considerable rate of tramadol misuse among substance-using undergraduates (74.2%) and substance-using high school students (83.3%), and 5) other individuals impacted in various ways. The health consequences are classified into four distinct types: intoxication, dependence syndrome, withdrawal syndrome and other symptoms. Despite providing a comprehensive global overview of the phenomenon described in the African literature, this systematic scoping review's main limitations stem from the relatively limited exploration of various consequences of the NMU of tramadol, notably those of a social and economic nature. Our review shows that tramadol misuse affects diverse populations in Africa. The prevalence of misuse varies within sub-populations, indicating the complexity of the issue. Professional and academic groups have different rates of misuse across regions. This highlights the need for targeted interventions to address unique challenges contributing to tramadol misuse. Future studies should focus on the social and economic costs of abuse on households to better understand the impact on well-being. Systematic review registration: Open Science Framework: https://osf.io/ykt25/.
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Affiliation(s)
- Saidou Sabi Boun
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Olumuyiwa Omonaiye
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Australia
- Deakin University Centre for Quality and Patient Safety Research–Eastern Health Partnership, Box Hill, Victoria, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Belete H, Mekonen T, Espinosa DC, Ambaw F, Connor J, Chan G, Hides L, Hall W, Leung J. Cannabis use in sub-Saharan Africa: A systematic review and meta-analysis. Addiction 2023. [PMID: 36807954 DOI: 10.1111/add.16170] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/29/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND AND AIMS The most available data on the prevalence of cannabis use come from population surveys conducted in high-income countries in North America, Oceania and Europe. Less is known about the prevalence of cannabis use in Africa. This systematic review aimed to summarize general population-level cannabis use in sub-Saharan Africa since 2010. METHODS A comprehensive search was conducted in PubMed, EMBASE, PsycINFO and AJOL databases in addition to Global Health Data Exchange and grey literature without language restriction. Search terms related to 'substance', 'Substance-Related Disorders' and 'Prevalence' and 'Africa South of the Sahara' were used. Studies that reported cannabis use in the general population were selected, while studies from clinical populations and high-risk groups were excluded. Prevalence data on cannabis use in the general population of adolescents (10-17 years) and adults (≥ 18 years) in sub-Saharan Africa were extracted. RESULTS The study included 53 studies for the quantitative meta-analysis and included 13 239 participants. Among adolescents, the life-time, 12-month and 6-month prevalence of cannabis use were 7.9% [95% confidence interval (CI) = 5.4-10.9%], 5.2% (95% CI = 1.7-10.3%) and 4.5% (95% CI = 3.3-5.8%), respectively. The corresponding life-time, 12-month and 6-month prevalence of cannabis use among adults were 12.6% (95% CI = 6.1-21.2%), 2.2% (95% CI = 1.7-2.7%, with data only available from Tanzania and Uganda) and 4.7% (95% CI = 3.3-6.4%), respectively. The male-to-female life-time cannabis use relative risk was 1.90 (95% CI = 1.25-2.98) among adolescents and 1.67 (CI = 0.63-4.39) among adults. CONCLUSIONS Life-time cannabis use prevalence in sub-Saharan Africa appears to be approximately 12% for adults and just under 8% for adolescents.
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Affiliation(s)
- Habte Belete
- Department of Psychiatry, Bahir Dar University, Bahir Dar, Ethiopia.,School of Psychology, The University of Queensland, Brisbane, Australia
| | - Tesfa Mekonen
- Department of Psychiatry, Bahir Dar University, Bahir Dar, Ethiopia.,School of Psychology, The University of Queensland, Brisbane, Australia
| | | | - Fentie Ambaw
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Jason Connor
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia.,Discipline of Psychiatry, The University of Queensland, Brisbane, Australia
| | - Gary Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Leanne Hides
- School of Psychology, The University of Queensland, Brisbane, Australia.,National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Janni Leung
- School of Psychology, The University of Queensland, Brisbane, Australia.,National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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