1
|
Poireau M, Clergue-Duval V, Maillard A, Icick R, Azuar J, Smith P, Faurent M, Volle E, Delmaire C, Cabé J, Bloch V, Vorspan F. Predictors of abstinence maintenance after cocaine inpatient detoxification: A prospective study. Am J Addict 2024. [PMID: 38761123 DOI: 10.1111/ajad.13571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 03/05/2024] [Accepted: 04/24/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cocaine is a highly addictive substance, and with no approved medication for cocaine use disorder (CUD), leading to a heavy burden. Despite validated psychosocial treatments, relapse rates after detoxification are very high in CUD. Few consistent factors can predict abstinence after detoxification. Our study, therefore, aimed at identifying factors predicting abstinence among CUD patients after inpatient detoxification. METHODS Eighty-one CUD inpatients were included during detoxification and characterized for clinical and sociodemographic data at baseline and at a follow-up of 3 months after discharge, including a standard measure of their abstinence duration from cocaine. We performed Cox univariate analyzes to determine the factors associated with abstinence maintenance, followed by a multivariate Cox regression to identify independent predictors. RESULTS Abstinence maintenance was shorter in patients injecting cocaine (hazard ratio [HR] = 5.16, 95% confidence interval [CI]: 2.01-13.27, p < .001) and using cocaine heavily in the month before inclusion (HR = 1.03, 95% CI: 1.00-1.06, p = .046). Conversely, abstinence maintenance was longer in patients with longer inpatient detoxification stays (HR = 0.96, 95% CI: 0.94-0.99, p = .015) and prescribed with selective serotonin reuptake inhibitors (SSRIs) (HR = 0.30, 95% CI: 0.16-0.56, p < .001). DISCUSSION AND CONCLUSIONS Patients with severe CUD may require longer inpatient stays to achieve abstinence. Regarding SSRI prescription, more specific studies are needed to provide stronger recommendations about their use in clinical practice. SCIENTIFIC SIGNIFICANCE Our findings suggest several modifiable factors to improve inpatient treatment response in CUD. As there are no specific recommendations about the optimal duration of inpatient stay, our results could pave the way for evidence-based guidelines.
Collapse
Affiliation(s)
- Margaux Poireau
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP, Paris, France
- Université Paris Cité, UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, INSERM, Paris, France
- FHU NOR-SUD (Network of Research in Substance Use Disorders), APHP, Paris, France
| | - Virgile Clergue-Duval
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP, Paris, France
- Université Paris Cité, UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, INSERM, Paris, France
| | - Angéline Maillard
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP, Paris, France
- Université Paris Cité, UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, INSERM, Paris, France
| | - Romain Icick
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP, Paris, France
- Université Paris Cité, UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, INSERM, Paris, France
| | - Julien Azuar
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP, Paris, France
- Université Paris Cité, UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, INSERM, Paris, France
| | - Pauline Smith
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP, Paris, France
- Université Paris Cité, UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, INSERM, Paris, France
| | - Mathieu Faurent
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP, Paris, France
- Université Paris Cité, UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, INSERM, Paris, France
| | | | - Christine Delmaire
- Université Paris Cité, UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, INSERM, Paris, France
- Service de Neuroradiologie, Fondation Ophtalmologique Rothschild, Paris, France
| | - Julien Cabé
- Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Vanessa Bloch
- Université Paris Cité, UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, INSERM, Paris, France
- FHU NOR-SUD (Network of Research in Substance Use Disorders), APHP, Paris, France
- Service de Pharmacie à Usage Interne, Hôpital Fernand Widal, APHP, Paris, France
| | - Florence Vorspan
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP, Paris, France
- Université Paris Cité, UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, INSERM, Paris, France
- FHU NOR-SUD (Network of Research in Substance Use Disorders), APHP, Paris, France
| |
Collapse
|
2
|
Minozzi S, Saulle R, Amato L, Traccis F, Agabio R. Psychosocial interventions for stimulant use disorder. Cochrane Database Syst Rev 2024; 2:CD011866. [PMID: 38357958 PMCID: PMC10867898 DOI: 10.1002/14651858.cd011866.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Stimulant use disorder is a continuously growing medical and social burden without approved medications available for its treatment. Psychosocial interventions could be a valid approach to help people reduce or cease stimulant consumption. This is an update of a Cochrane review first published in 2016. OBJECTIVES To assess the efficacy and safety of psychosocial interventions for stimulant use disorder in adults. SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, three other databases, and two trials registers in September 2023. All searches included non-English language literature. We handsearched the references of topic-related systematic reviews and the included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing any psychosocial intervention with no intervention, treatment as usual (TAU), or a different intervention in adults with stimulant use disorder. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included a total of 64 RCTs (8241 participants). Seventy-three percent of studies included participants with cocaine or crack cocaine use disorder; 3.1% included participants with amphetamine use disorder; 10.9% included participants with methamphetamine use disorder; and 12.5% included participants with any stimulant use disorder. In 18 studies, all participants were in methadone maintenance treatment. In our primary comparison of any psychosocial treatment to no intervention, we included studies which compared a psychosocial intervention plus TAU to TAU alone. In this comparison, 12 studies evaluated cognitive behavioural therapy (CBT), 27 contingency management, three motivational interviewing, one study looked at psychodynamic therapy, and one study evaluated CBT plus contingency management. We also compared any psychosocial intervention to TAU. In this comparison, seven studies evaluated CBT, two contingency management, two motivational interviewing, and one evaluated a combination of CBT plus motivational interviewing. Seven studies compared contingency management reinforcement related to abstinence versus contingency management not related to abstinence. Finally, seven studies compared two different psychosocial approaches. We judged 65.6% of the studies to be at low risk of bias for random sequence generation and 19% at low risk for allocation concealment. Blinding of personnel and participants was not possible for the type of intervention, so we judged all the studies to be at high risk of performance bias for subjective outcomes but at low risk for objective outcomes. We judged 22% of the studies to be at low risk of detection bias for subjective outcomes. We judged most of the studies (69%) to be at low risk of attrition bias. When compared to no intervention, we found that psychosocial treatments: reduce the dropout rate (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.74 to 0.91; 30 studies, 4078 participants; high-certainty evidence); make little to no difference to point abstinence at the end of treatment (RR 1.15, 95% CI 0.94 to 1.41; 12 studies, 1293 participants; high-certainty evidence); make little to no difference to point abstinence at the longest follow-up (RR 1.22, 95% CI 0.91 to 1.62; 9 studies, 1187 participants; high-certainty evidence); probably increase continuous abstinence at the end of treatment (RR 1.89, 95% CI 1.20 to 2.97; 12 studies, 1770 participants; moderate-certainty evidence); may make little to no difference in continuous abstinence at the longest follow-up (RR 1.14, 95% CI 0.89 to 1.46; 4 studies, 295 participants; low-certainty evidence); reduce the frequency of drug intake at the end of treatment (standardised mean difference (SMD) -0.35, 95% CI -0.50 to -0.19; 10 studies, 1215 participants; high-certainty evidence); and increase the longest period of abstinence (SMD 0.54, 95% CI 0.41 to 0.68; 17 studies, 2118 participants; high-certainty evidence). When compared to TAU, we found that psychosocial treatments reduce the dropout rate (RR 0.79, 95% CI 0.65 to 0.97; 9 studies, 735 participants; high-certainty evidence) and may make little to no difference in point abstinence at the end of treatment (RR 1.67, 95% CI 0.64 to 4.31; 1 study, 128 participants; low-certainty evidence). We are uncertain whether they make any difference in point abstinence at the longest follow-up (RR 1.31, 95% CI 0.86 to 1.99; 2 studies, 124 participants; very low-certainty evidence). Compared to TAU, psychosocial treatments may make little to no difference in continuous abstinence at the end of treatment (RR 1.18, 95% CI 0.92 to 1.53; 1 study, 128 participants; low-certainty evidence); probably make little to no difference in the frequency of drug intake at the end of treatment (SMD -1.17, 95% CI -2.81 to 0.47, 4 studies, 479 participants, moderate-certainty evidence); and may make little to no difference in the longest period of abstinence (SMD -0.16, 95% CI -0.54 to 0.21; 1 study, 110 participants; low-certainty evidence). None of the studies for this comparison assessed continuous abstinence at the longest follow-up. Only five studies reported harms related to psychosocial interventions; four of them stated that no adverse events occurred. AUTHORS' CONCLUSIONS This review's findings indicate that psychosocial treatments can help people with stimulant use disorder by reducing dropout rates. This conclusion is based on high-certainty evidence from comparisons of psychosocial interventions with both no treatment and TAU. This is an important finding because many people with stimulant use disorders leave treatment prematurely. Stimulant use disorders are chronic, lifelong, relapsing mental disorders, which require substantial therapeutic efforts to achieve abstinence. For those who are not yet able to achieve complete abstinence, retention in treatment may help to reduce the risks associated with stimulant use. In addition, psychosocial interventions reduce stimulant use compared to no treatment, but they may make little to no difference to stimulant use when compared to TAU. The most studied and promising psychosocial approach is contingency management. Relatively few studies explored the other approaches, so we cannot rule out the possibility that the results were imprecise due to small sample sizes.
Collapse
Affiliation(s)
- Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Rosella Saulle
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Laura Amato
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Francesco Traccis
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| |
Collapse
|
3
|
Charkhat Gorgich EA, Rigi MG, Fanaei H, Parsaei H, Ghanbarzehi A. Brain-derived neurotrophic factor serum levels as a candidate biomarker for withdrawal in crack heroin dependence. Subst Abuse Treat Prev Policy 2024; 19:9. [PMID: 38245698 PMCID: PMC10800061 DOI: 10.1186/s13011-024-00591-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Crack heroin is a novel opiate derivative with highly addictive properties and unfamiliar health consequences. It causes a variety of brain dysfunctions that are mediated by neurochemical alterations and abnormal neuroplasticity. Brain-derived neurotrophic factor (BDNF) is a widely recognized biological marker implicated in the neuropathology of substance use during substance use disorder and withdrawal. Its involvement can significantly contribute to the severity of withdrawal symptoms. Hence, this study aimed to evaluate BDNF levels in crack heroin users before and after withdrawal. METHODS In this cross-sectional study, 148 male participants were recruited and divided into two groups: persons with crack heroin use disorder (n = 74) and the controls (n = 74). The BDNF serum levels were measured in both crack heroin users and control groups upon hospitalization and again after twenty-one days of withdrawal using the enzyme-linked immunosorbent assay. RESULTS The results demonstrated that BDNF levels in persons with crack heroin use disorder upon admission were significantly lower than the levels observed upon discharge and in the control group (p < 0.05). Additionally, a significant difference in BDNF levels was found between persons with crack heroin use disorder at admission and discharge (p = 0.038). Furthermore, BDNF levels showed an inverse correlation with the daily dose of substance use (r= -0.420, p = 0.03) and the duration of crack heroin use (r= -0.235, p = 0.001). CONCLUSIONS A progressive increment in BDNF levels during early detoxification is associated with the daily amount of substance use and the duration of substance use. Our findings suggest that changes in BDNF serum levels during crack heroin use disorder and withdrawal could serve as potential biomarkers for assessing the intensity of withdrawal symptoms and substance use-related behaviors.
Collapse
Affiliation(s)
| | | | - Hamed Fanaei
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Physiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Houman Parsaei
- Nervous System Stem Cells Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Anatomy, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Abdolhakim Ghanbarzehi
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran.
- Department of Neuroscience, School of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Department of Physiology, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran.
| |
Collapse
|
4
|
Gountas I, Sypsa V, Papatheodoridis G, Paraskevis D, Kalamitsis G, Anagnostou O, Antaraki A, Fotiou A, Hatzakis A. A hepatitis C outbreak preceded the HIV outbreak among persons who inject drugs in Athens, Greece: Insights from a mathematical modelling study. J Viral Hepat 2019; 26:1311-1317. [PMID: 31322302 DOI: 10.1111/jvh.13178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/20/2019] [Indexed: 01/08/2023]
Abstract
People who inject drugs (PWID) comprise one of the major transmission risk groups for human immunodeficiency virus (HIV) and hepatitis C virus (HCV). In 2011, Athens experienced a large HIV outbreak among PWID. Significant public health interventions were implemented in response to the HIV outbreak. The aims of this study were to estimate the indirect effects of the HIV interventions on HCV infection and to evaluate the concept of the association between HCV and HIV infections in the case of Athens. A dynamic, stochastic, individual-based model was developed to simulate HCV transmission among PWID. We calibrated the model to reproduce the observed HCV prevalence among PWID in Greece. Two years prior to the HIV outbreak, an undetected HCV outbreak has occurred. In 2009, the incidence of HCV infection increased from 640 (495, 842) cases in 2008 to 1260 (1060, 1500). The mean time from initiation of injecting drug use to HCV acquisition decreased from 29 months in 2008 to 13 months in 2009. After HIV interventions, HCV incidence declined by 64.8% in 2012, compared to 2009. The averted HCV incidence cases attributed to the HIV-implemented interventions were 2200 (1950, 2480), during 2012-2015. The cumulative number incident HCV cases in Athens during 2002-2015 was about 9900 (7800, 12 100). Our results highlight that before the 2011 HIV outbreak in Athens, an HCV outbreak occurred in 2009. Prevention measures for HIV that took place in the Athens metropolitan area in 2012 reduced significantly the incidence of HCV.
Collapse
Affiliation(s)
- Ilias Gountas
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Papatheodoridis
- Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens 'Laiko', Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Argiro Antaraki
- Greek Reitox focal point at the Athens University Mental Health, Neurosciences, & Precision Medicine Research Institute (MHRI), Athens, Greece
| | - Anastasios Fotiou
- Greek Reitox focal point at the Athens University Mental Health, Neurosciences, & Precision Medicine Research Institute (MHRI), Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases, Athens, Greece
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
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.
| | | |
Collapse
|
7
|
Sangroula D, Motiwala F, Wagle B, Shah VC, Hagi K, Lippmann S. Modafinil Treatment of Cocaine Dependence: A Systematic Review and Meta-Analysis. Subst Use Misuse 2017; 52:1292-1306. [PMID: 28350194 DOI: 10.1080/10826084.2016.1276597] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Currently, there is none FDA-approved medication to treat cocaine dependency. Studies conducted with various medications, including antipsychotics, antidepressants, anticonvulsants, and others, revealed inconsistent results. OBJECTIVES To meta-analytically investigate the efficacy and safety of modafinil in the treatment of cocaine-dependent patients. METHODS Randomized controlled trials with ≥20 subjects comparing the numerical therapeutic outcomes of modafinil with placebo were identified in databases, such as PUBMED, psycINFO, EMBASE, and Clinicaltrials.gov. Relevant data on efficacy and safety were extracted. Relative risk (RR) and standardized mean difference were applied for reporting dichotomous and continuous outcomes respectively. Random effects, subgroup, and meta-regression analyses were conducted to further explore the results and evaluate for any moderators. RESULTS In total, 11 studies (participants = 896, duration = 6.7 ± 1.9 weeks) comparing modafinil with placebo were systematically analyzed, which indicated that modafinil was not superior to placebo in improving the treatment retention rate (studies = 11, participants = 891, RR = 1.030, 95% CI = 0.918-1.156, p = .613). Similarly, data from 7/11 studies did not evidence superiority of modafinil in achieving cocaine abstinence (participants = 696, RR = 1.259, 95% CI = 0.813-1.949, p = .302). However, subgroup analysis of six studies conducted in the United States demonstrated superiority of modafinil in cocaine abstinence rate (studies = 6, participants = 669, 95% CI = 1.027-2.020, p = 0.035). In addition, no evidence suggested modafinil-related discontinuation or specific adverse events than placebo. CONCLUSIONS Overall, there is no evidence to conclude superiority of modafinil in increasing cocaine abstinence and treatment retention rate. However, promising result in subgroup analysis of cocaine abstinence, secondary outcomes, and good safety profile urged the need of larger studies to derive more conclusive results.
Collapse
Affiliation(s)
- Dinesh Sangroula
- a Department of Psychiatry , Jamaica Hospital Medical Center , New York , New York , USA
| | - Fatima Motiwala
- b Department of Psychiatric Research , Columbia University Medical Center , New York , New York , USA
| | - Bivek Wagle
- c Department of Biology , California State University , Hayward , California , USA
| | - Vivek C Shah
- d Department of Psychiatry , Nassau University Medical Center , East Meadow , New York , USA
| | | | - Steven Lippmann
- f Department of Psychiatry , University of Louisville School of Medicine , Louisville , Kentucky , USA
| |
Collapse
|
8
|
Vergara-Moragues E, Verdejo-García A, Lozano OM, Santiago-Ramajo S, González-Saiz F, Betanzos Espinosa P, Pérez García M. Association between executive function and outcome measure of treatment in therapeutic community among cocaine dependent individuals. J Subst Abuse Treat 2017; 78:48-55. [DOI: 10.1016/j.jsat.2017.04.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/28/2017] [Accepted: 04/21/2017] [Indexed: 11/26/2022]
|
9
|
Soyka M, Mutschler J. Treatment-refractory substance use disorder: Focus on alcohol, opioids, and cocaine. Prog Neuropsychopharmacol Biol Psychiatry 2016; 70:148-61. [PMID: 26577297 DOI: 10.1016/j.pnpbp.2015.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/23/2015] [Accepted: 11/11/2015] [Indexed: 12/20/2022]
Abstract
Substance use disorders are common, but only a small minority of patients receive adequate treatment. Although psychosocial therapies are effective, relapse is common. This review focusses on novel pharmacological and other treatments for patients with alcohol, opioid, or cocaine use disorders who do not respond to conventional treatments. Disulfiram, acamprosate, and the opioid antagonist naltrexone have been approved for the treatment of alcoholism. A novel, "as needed" approach is the use of the mu-opioid antagonist and partial kappa agonist nalmefene to reduce alcohol consumption. Other novel pharmacological approaches include the GABA-B receptor agonist baclofen, anticonvulsants such as topiramate and gabapentin, the partial nicotine receptor agonist varenicline, and other drugs. For opioid dependence, opioid agonist therapy with methadone or buprenorphine is the first-line treatment option. Other options include oral or depot naltrexone, morphine sulfate, depot or implant formulations, and heroin (diacetylmorphine) in treatment-refractory patients. To date, no pharmacological treatment has been approved for cocaine addiction; however, 3 potential pharmacological treatments are being studied, disulfiram, methylphenidate, and modafinil. Pharmacogenetic approaches may help to optimize treatment response in otherwise treatment-refractory patients and to identify which patients are more likely to respond to treatment, and neuromodulation techniques such as repeated transcranial magnetic stimulation and deep brain stimulation also may play a role in the treatment of substance use disorders. Although no magic bullet is in sight for treatment-refractory patients, some novel medications and brain stimulation techniques have the potential to enrich treatment options at least for some patients.
Collapse
Affiliation(s)
- Michael Soyka
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstrasse 7, 80336 Munich, Germany; Privatklinik Meiringen, Postfach 612, CH-3860 Meiringen, Switzerland.
| | - Jochen Mutschler
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Selnaustrasse 9, 8001 Zurich, Switzerland
| |
Collapse
|
10
|
Minozzi S, Saulle R, De Crescenzo F, Amato L. Psychosocial interventions for psychostimulant misuse. Cochrane Database Syst Rev 2016; 9:CD011866. [PMID: 27684277 PMCID: PMC6457581 DOI: 10.1002/14651858.cd011866.pub2] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Psychostimulant misuse is a continuously growing medical and social burden. There is no evidence proving the efficacy of pharmacotherapy. Psychosocial interventions could be a valid approach to help patients in reducing or ceasing drug consumption. OBJECTIVES To assess the effects of psychosocial interventions for psychostimulant misuse in adults. SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group Specialised Register (via CRSLive); Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; CINAHL; Web of Science and PsycINFO, from inception to November 2015. We also searched for ongoing and unpublished studies via ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (apps.who.int/trialsearch/).All searches included non-English language literature. We handsearched references of topic-related systematic reviews and the included studies. SELECTION CRITERIA We included randomised controlled trials comparing any psychosocial intervention with no intervention, treatment as usual (TAU) or a different intervention in adults with psychostimulant misuse or dependence. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included a total of 52 trials (6923 participants).The psychosocial interventions considered in the studies were: cognitive behavioural therapy (19 studies), contingency management (25 studies), motivational interviewing (5 studies), interpersonal therapy (3 studies), psychodynamic therapy (1 study), 12-step facilitation (4 studies).We judged most of the studies to be at unclear risk of selection bias; blinding of personnel and participants was not possible for the type of intervention, so all the studies were at high risk of performance bias with regard to subjective outcomes; the majority of studies did not specify whether the outcome assessors were blind. We did not consider it likely that the objective outcomes were influenced by lack of blinding.The comparisons made were: any psychosocial intervention versus no intervention (32 studies), any psychosocial intervention versus TAU (6 studies), and one psychosocial intervention versus an alternative psychosocial intervention (13 studies). Five of included studies did not provide any useful data for inclusion in statistical synthesis.We found that, when compared to no intervention, any psychosocial treatment: reduced the dropout rate (risk ratio (RR): 0.83, 95% confidence interval (CI) 0.76 to -0.91, 24 studies, 3393 participants, moderate quality evidence); increased continuous abstinence at the end of treatment (RR: 2.14, 95% CI 1.27 to -3.59, 8 studies, 1241 participants, low quality evidence); did not significantly increase continuous abstinence at the longest follow-up (RR: 2.12, 95% CI 0.77 to -5.86, 4 studies, 324 participants, low quality evidence); significantly increased the longest period of abstinence: (standardised mean difference (SMD): 0.48, 95% CI 0.34 to 0.63, 10 studies, 1354 participants, high quality evidence). However, it should be noted that the in the vast majority of the studies in this comparison the specific psychosocial treatment assessed in the experimental arm was given in add on to treatment as usual or to another specific psychosocial or pharmacological treatment which was received by both groups. So, many of the control groups in this comparison were not really untreated. Receiving some amount of treatment is not the same as not receiving any intervention, so we could argue that the overall effect of the experimental psychosocial treatment could be smaller if given in add on to TAU or to another intervention than if given to participants not receiving any intervention; this could translate to a smaller magnitude of the effect of the psychosocial intervention when it is given in add on.When compared to TAU, any psychosocial treatment reduced dropout rate (RR: 0.72, 95% CI 0.59 to 0.89, 6 studies, 516 participants, moderate quality evidence), did not increase continuous abstinence at the end of treatment (RR: 1.27, 95% CI 0.94 to 1.72, 2 studies, 224 participants, low quality evidence), did not increase longest period of abstinence (MD -3.15 days, 95% CI -10.35 to 4.05, 1 study, 110 participants, low quality evidence). No studies in this comparison assessed the outcome of continuous abstinence at longest follow-up.There were few studies comparing two or more psychosocial interventions, with small sample sizes and considerable heterogeneity in terms of the types of interventions assessed. None reported significant results.None of the studies reported harms related to psychosocial interventions. AUTHORS' CONCLUSIONS The addition of any psychosocial treatment to treatment as usual (usually characterised by group counselling or case management) probably reduces the dropout rate and increases the longest period of abstinence. It may increase the number of people achieving continuous abstinence at the end of treatment, although this might not be maintained at longest follow-up. The most studied and the most promising psychosocial approach to be added to treatment as usual is probably contingency management. However, the other approaches were only analysed in a few small studies, so we cannot rule out the possibility that the results were not significant because of imprecision. When compared to TAU, any psychosocial treatment may improve adherence, but it may not improve abstinence at the end of treatment or the longest period of abstinence.The majority of the studies took place in the United States, and this could limit the generalisability of the findings, because the effects of psychosocial treatments could be strongly influenced by the social context and ethnicity. The results of our review do not answer the most relevant clinical question, demonstrating which is the most effective type of psychosocial approach.Further studies should directly compare contingency management with the other psychosocial approaches.
Collapse
Affiliation(s)
- Silvia Minozzi
- Lazio Regional Health ServiceDepartment of EpidemiologyVia Cristoforo Colombo, 112RomeItaly00154
| | - Rosella Saulle
- Lazio Regional Health ServiceDepartment of EpidemiologyVia Cristoforo Colombo, 112RomeItaly00154
| | - Franco De Crescenzo
- Catholic University of the Sacred HeartInstitute of Psychiatry and PsychologyL.go A. Gemelli 8RomeItaly00168
| | - Laura Amato
- Lazio Regional Health ServiceDepartment of EpidemiologyVia Cristoforo Colombo, 112RomeItaly00154
| | | |
Collapse
|
11
|
Minozzi S, De Crescenzo F, Saulle R, Amato L. Psychosocial interventions for psychostimulant misuse. Cochrane Database Syst Rev 2015. [DOI: 10.1002/14651858.cd011866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
12
|
Dürsteler KM, Berger EM, Strasser J, Caflisch C, Mutschler J, Herdener M, Vogel M. Clinical potential of methylphenidate in the treatment of cocaine addiction: a review of the current evidence. Subst Abuse Rehabil 2015; 6:61-74. [PMID: 26124696 PMCID: PMC4476488 DOI: 10.2147/sar.s50807] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Cocaine use continues to be a public health problem, yet there is no proven effective pharmacotherapy for cocaine dependence. A promising approach to treating cocaine dependence may be agonist-replacement therapy, which is already used effectively in the treatment of opioid and tobacco dependence. The replacement approach for cocaine dependence posits that administration of a long-acting stimulant medication should normalize the neurochemical and behavioral perturbations resulting from chronic cocaine use. One potential medication to be substituted for cocaine is methylphenidate (MPH), as this stimulant possesses pharmacobehavioral properties similar to those of cocaine. Aim To provide a qualitative review addressing the rationale for the use of MPH as a cocaine substitute and its clinical potential in the treatment of cocaine dependence. Methods We searched MEDLINE for clinical studies using MPH in patients with cocaine abuse/dependence and screened the bibliographies of the articles found for pertinent literature. Results MPH, like cocaine, increases synaptic dopamine by inhibiting dopamine reuptake. The discriminative properties, reinforcing potential, and subjective effects of MPH and cocaine are almost identical and, importantly, MPH has been found to substitute for cocaine in animals and human volunteers under laboratory conditions. When taken orally in therapeutic doses, its abuse liability, however, appears low, which is especially true for extended-release MPH preparations. Though there are promising data in the literature, mainly from case reports and open-label studies, the results of randomized controlled trials have been disappointing so far and do not corroborate the use of MPH as a substitute for cocaine dependence in patients without attention deficit hyperactivity disorder. Conclusion Clinical studies evaluating MPH substitution for cocaine dependence have provided inconsistent findings. However, the negative findings may be explained by specific study characteristics, among them dosing, duration of treatment, or sample size. This needs to be considered when discussing the potential of MPH as replacement therapy for cocaine dependence. Finally, based on the results, we suggest possible directions for future research.
Collapse
Affiliation(s)
- Kenneth M Dürsteler
- Center for Addictive Disorders, Psychiatric University Clinics Basel, Basel, Switzerland ; Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Eva-Maria Berger
- Center for Addictive Disorders, Psychiatric University Clinics Basel, Basel, Switzerland
| | - Johannes Strasser
- Center for Addictive Disorders, Psychiatric University Clinics Basel, Basel, Switzerland
| | - Carlo Caflisch
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Jochen Mutschler
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Marcus Herdener
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Marc Vogel
- Center for Addictive Disorders, Psychiatric University Clinics Basel, Basel, Switzerland
| |
Collapse
|
13
|
Voon P, Callon C, Nguyen P, Dobrer S, Montaner JSG, Wood E, Kerr T. Denial of prescription analgesia among people who inject drugs in a Canadian setting. Drug Alcohol Rev 2014; 34:221-8. [PMID: 25521168 DOI: 10.1111/dar.12226] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 10/05/2014] [Indexed: 01/18/2023]
Abstract
INTRODUCTION AND AIMS Despite the high prevalence of pain among people who inject drugs (PWIDs), clinicians may be reluctant to prescribe opioid-based analgesia to those with a history of drug use or addiction. We sought to examine the prevalence and correlates of PWIDs reporting being denied of prescription analgesia (PA). We also explored reported reasons for and actions taken after being denied PA. DESIGN AND METHODS Using data from two prospective cohort studies of PWIDs, multivariate logistic regression was used to identify the prevalence and correlates of reporting being denied PA. Descriptive statistics were used to characterise reasons for denials and subsequent actions. RESULTS Approximately two-thirds (66.5%) of our sample of 462 active PWIDs reported having ever been denied PA. We found that reporting being denied PA was significantly and positively associated with having ever been enrolled in methadone maintenance treatment (adjusted odds ratio 1.76, 95% confidence interval 1.11-2.80) and daily cocaine injection (adjusted odds ratio 2.38, 95% confidence interval 1.00-5.66). The most commonly reported reason for being denied PA was being accused of drug seeking (44.0%). Commonly reported actions taken after being denied PA included buying the requested medication off the street (40.1%) or obtaining heroin to treat pain (32.9%). DISCUSSION AND CONCLUSIONS These findings highlight the challenges of addressing perceived pain and the need for strategies to prevent high-risk methods of self-managing pain, such as obtaining diverted medications or illicit substances for pain. Such strategies may include integrated pain management guidelines within methadone maintenance treatment and other substance use treatment programs.
Collapse
Affiliation(s)
- Pauline Voon
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | | | | | | | | | | | | |
Collapse
|
14
|
Deficits in behavioural inhibition in substance abuse and addiction: a meta-analysis. Drug Alcohol Depend 2014; 145:1-33. [PMID: 25195081 DOI: 10.1016/j.drugalcdep.2014.08.009] [Citation(s) in RCA: 356] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 08/14/2014] [Accepted: 08/14/2014] [Indexed: 01/08/2023]
Abstract
AIMS Deficits in behavioural inhibitory control are attracting increasing attention as a factor behind the development and maintenance of substance dependence. However, evidence for such a deficit is varied in the literature. Here, we synthesised published results to determine whether inhibitory ability is reliably impaired in substance users compared to controls. METHODS The meta-analysis used fixed-effects models to integrate results from 97 studies that compared groups with heavy substance use or addiction-like behaviours with healthy control participants on two experimental paradigms commonly used to assess response inhibition: the Go/NoGo task, and the Stop-Signal Task (SST). The primary measures of interest were commission errors to NoGo stimuli and stop-signal reaction time in the SST. Additionally, we examined omission errors to Go stimuli, and reaction time in both tasks. Because inhibition is more difficult when inhibition is required infrequently, we considered papers with rare and equiprobable NoGo stimuli separately. RESULTS Inhibitory deficits were apparent for heavy use/dependence on cocaine, MDMA, methamphetamine, tobacco, and alcohol (and, to a lesser extent, non-dependent heavy drinkers), and in pathological gamblers. On the other hand, no evidence for an inhibitory deficit was observed for opioids or cannabis, and contradictory evidence was observed for internet addiction. CONCLUSIONS The results are generally consistent with the view that substance use disorders and addiction-like behavioural disorders are associated with impairments in inhibitory control. Implications for treatment of substance use are discussed, along with suggestions for future research arising from the limitations of the extant literature.
Collapse
|
15
|
Kozor R, Grieve SM, Buchholz S, Kaye S, Darke S, Bhindi R, Figtree GA. Regular cocaine use is associated with increased systolic blood pressure, aortic stiffness and left ventricular mass in young otherwise healthy individuals. PLoS One 2014; 9:e89710. [PMID: 24717541 PMCID: PMC3981670 DOI: 10.1371/journal.pone.0089710] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 01/22/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The cardiovascular impact of cocaine use in otherwise healthy individuals who consider themselves 'social' users is not well established. METHODS/RESULTS Twenty regular cocaine users and 20 control subjects were recruited by word-of-mouth. Cardiovascular magnetic resonance was performed to assess cardiac and vascular structure and function. Cocaine users had higher systolic blood pressure compared to non-users (134±11 vs 126±11 mmHg, p = 0.036), a finding independent of age, body surface area, smoking and alcohol consumption. Cocaine use was associated with increased arterial stiffness - reflected by reduced aortic compliance (1.3±0.2 vs 1.7±0.5 cm2×10-2.mmHg-1, p = 0.004), decreased distensibility (3.8±0.9 vs 5.1±1.4 mmHg-1.10-3, p = 0.001), increased stiffness index (2.6±0.6 vs 2.1±0.6, p = 0.005), and higher pulse wave velocity (5.1±0.6 vs 4.4±0.6 m.s-1, p = 0.001). This change in aortic stiffness was independent of vessel wall thickness. Left ventricular mass was 18% higher in cocaine users (124±25 vs 105±16 g, p = 0.01), a finding that was independent of body surface area, and left atrial diameter was larger in the user group than controls (3.8±0.6 vs 3.5±0.3 cm, p = 0.04). The increased left ventricular mass, systolic blood pressure and vascular stiffness measures were all associated with duration and/or frequency of cocaine use. No late gadolinium enhancement or segmental wall motion abnormalities were seen in any of the subjects. CONCLUSIONS Compared with the non-user control cohort, cocaine users had increased aortic stiffness and systolic blood pressure, associated with greater left ventricular mass. These measures are all well known risk factors for premature cardiovascular events, highlighting the dangers of cocaine use, even in a 'social' setting, and have important public health implications.
Collapse
Affiliation(s)
- Rebecca Kozor
- North Shore Heart Research Group, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Stuart M. Grieve
- North Shore Heart Research Group, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
- Sydney Translational Imaging Laboratory, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Stefan Buchholz
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Ravinay Bhindi
- North Shore Heart Research Group, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Gemma A. Figtree
- North Shore Heart Research Group, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| |
Collapse
|
16
|
Degenhardt L, Baxter AJ, Lee YY, Hall W, Sara GE, Johns N, Flaxman A, Whiteford HA, Vos T. The global epidemiology and burden of psychostimulant dependence: findings from the Global Burden of Disease Study 2010. Drug Alcohol Depend 2014; 137:36-47. [PMID: 24559607 DOI: 10.1016/j.drugalcdep.2013.12.025] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 12/14/2013] [Accepted: 12/31/2013] [Indexed: 12/01/2022]
Abstract
AIMS To estimate the global prevalence of cocaine and amphetamine dependence and the burden of disease attributable to these disorders. METHODS An epidemiological model was developed using DisMod-MR, a Bayesian meta-regression tool, using epidemiological data (prevalence, incidence, remission and mortality) sourced from a multi-stage systematic review of data. Age, sex and region-specific prevalence was estimated for and multiplied by comorbidity-adjusted disability weightings to estimate years of life lost to disability (YLDs) from these disorders. Years of life lost (YLL) were estimated from cross-national vital registry data. Disability-adjusted life years (DALYs) were estimated by summing YLDs and YLLs in 21 regions, by sex and age, in 1990 and 2010. RESULTS In 2010, there were an estimated 24.1 million psychostimulant dependent people: 6.9 million cocaine and 17.2 million amphetamines, equating to a point prevalence of 0.10% (0.09-0.11%) for cocaine, and 0.25% (0.22-0.28%) for amphetamines. There were 37.6 amphetamine dependence DALYs (21.3-59.3) per 100,000 population in 2010 and 15.9 per 100,000 (9.3-25.0) cocaine dependence DALYs. There were clear differences between amphetamines and cocaine in the geographic distribution of crude DALYs. Over half of amphetamine dependence DALYs were in Asian regions (52%), whereas almost half of cocaine dependence DALYs were in the Americas (44%, with 23% in North America High Income). CONCLUSION Dependence upon psychostimulants is a substantial contributor to global disease burden; the contribution of cocaine and amphetamines to this burden varies dramatically by geographic region. There is a need to scale up evidence-based interventions to reduce this burden.
Collapse
Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, 2052, Australia; Melbourne School of Population and Global Health, University of Melbourne, 3053, Australia.
| | - Amanda J Baxter
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane 4074, Australia; School of Population Health, University of Queensland, Herston 4006, Australia
| | - Yong Yi Lee
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane 4074, Australia; School of Population Health, University of Queensland, Herston 4006, Australia
| | - Wayne Hall
- University of Queensland Centre for Clinical Research, University of Queensland, Brisbane 4006, Australia; National Addiction Centre, Kings College, London, England, United Kingdom
| | - Grant E Sara
- School of Population Health, University of Queensland, Herston 4006, Australia; InforMH, Mental Health and Drug and Alcohol Office, NSW Health, Sydney 2113, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney 2065, Australia
| | - Nicole Johns
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Abraham Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Harvey A Whiteford
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane 4074, Australia; School of Population Health, University of Queensland, Herston 4006, Australia
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| |
Collapse
|
17
|
de la Fuente L, Molist G, Espelt A, Barrio G, Guitart A, Bravo MJ, Brugal MT. Mortality risk factors and excess mortality in a cohort of cocaine users admitted to drug treatment in Spain. J Subst Abuse Treat 2014; 46:219-26. [DOI: 10.1016/j.jsat.2013.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 07/01/2013] [Accepted: 07/01/2013] [Indexed: 01/18/2023]
|
18
|
Abstract
Cocaine, the third mostly commonly used illicit drug in the United States, has a wide range of neuropsychiatric effects, including transient psychotic symptoms. When psychotic symptoms occur within a month of cocaine intoxication or withdrawal, the diagnosis is cocaine-induced psychotic disorder (CIPD). Current evidence suggests those with CIPD are likely to be male, have longer severity and duration of cocaine use, use intravenous cocaine, and have a lower body mass index. Differentiating CIPD from a primary psychotic disorder requires a detailed history of psychotic symptoms in relation to substance use and often a longitudinal assessment. Treatment includes providing a safe environment, managing agitation and psychosis, and addressing the underlying substance use disorder. This review begins with a clinical case and summarizes the literature on CIPD, including clinical presentation, differential diagnosis, mechanism and predictors of illness, and treatment.
Collapse
Affiliation(s)
- Yilang Tang
- a Department of Psychiatry and Behavioral Sciences , Emory University School of Medicine , Atlanta , Georgia , USA
| | | | | |
Collapse
|
19
|
Gambelunghe C, Bacci M, Aroni K, De Falco F, Ayroldi EM. Cocaine Addiction Treatment and Home Remedies: Use of the Scopolamine Transdermal Patch. Subst Use Misuse 2014; 49:1-6. [PMID: 23924240 DOI: 10.3109/10826084.2013.824477] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recently, there has been an enormous increase in the number of people seeking treatment for cocaine addiction. Fifteen male cocaine users aged 20-30 years who requested hair analysis from our forensic toxicology laboratory (Perugia, Italy) from March to June 2012, reported using scopolamine without medical supervision to reduce the anxiety associated with cocaine withdrawal. Self-reports were verified with the results obtained from the hair analysis. We discuss whether the use of scopolamine in cocaine abusers could be supported by a neurobiological and pharmacological point of view.
Collapse
Affiliation(s)
- Cristiana Gambelunghe
- a 1Department of Clinical and Experimental Medicine, Division of Legal and Sports Medicine, University of Perugia , Perugia, Italy
| | - Mauro Bacci
- a 1Department of Clinical and Experimental Medicine, Division of Legal and Sports Medicine, University of Perugia , Perugia, Italy
| | - Kyriaki Aroni
- a 1Department of Clinical and Experimental Medicine, Division of Legal and Sports Medicine, University of Perugia , Perugia, Italy
| | - Filomena De Falco
- a 1Department of Clinical and Experimental Medicine, Division of Legal and Sports Medicine, University of Perugia , Perugia, Italy
| | - Emira Maria Ayroldi
- b 2Department of Clinical and Experimental Medicine, Division of Pharmacology, University of Perugia , Perugia, Italy
| |
Collapse
|
20
|
Sordo L, Indave BI, Degenhardt L, Barrio G, Kaye S, Ruíz-Pérez I, Bravo MJ. A systematic review of evidence on the association between cocaine use and seizures. Drug Alcohol Depend 2013; 133:795-804. [PMID: 24051062 DOI: 10.1016/j.drugalcdep.2013.08.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 07/25/2013] [Accepted: 08/22/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Institutional monographs/medical textbooks mention seizures as a neurological complication of cocaine, but no systematic reviews (SRs) have been published on this issue. We aimed to conduct a SR of the literature on the relationship between cocaine use and seizures and to summarize the biological plausibility of that relationship. METHODS The pathophysiological mechanisms that may underlie an association between cocaine and seizures were summarized; a SR was then performed using three databases (EMBASE, Medline, PsycINFO) and the Cochrane-library to search for published papers (1980-2012) aimed at quantifying the associations between cocaine use and seizures. The inclusion criteria for selection were: articles based on clinical trials, cohort, case-control (CC) or cross-sectional (CS) studies, participants ≥ 14 years old and not pregnant, and use of cocaine in the last 72 h. Information was extracted, evaluated and cross-checked independently by two researchers. RESULTS Of the 1243 potentially relevant articles initially identified; one CC and 22 CS studies were finally selected. The CC study did not find cocaine use to be a risk-factor for seizures. In addition to the limitations of the CS design, these studies had important methodological weaknesses and biases. CONCLUSIONS Despite its biological plausibility, no rigorous scientific evidence supports a causal relationship between cocaine use and seizures. The misinterpretation of the role of cocaine may have important implications in medical services. Well-conducted studies are urgently needed.
Collapse
Affiliation(s)
- L Sordo
- National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain; Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University, Madrid, Spain; Network Biomedical Research Centers, Epidemiology and Public Health (CIBERESP in Spanish), Spain.
| | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
OBJECTIVES : Medical conditions in methamphetamine (MA) users have not been well characterized. Using both self-report and physical examination data, the aims of this study were to (1) describe the frequency of medical conditions in a sample of MA users 3 years posttreatment; (2) evaluate the association between medical conditions and MA use frequency; and (3) examine the relationship of route of administration with medical outcomes. METHODS : MA-dependent adults (N = 301) who participated in the Methamphetamine Treatment Project were interviewed and examined 3 years after treatment. Medical, demographic, and substance use characteristics were assessed using the Addiction Severity Index and Life Experiences Timeline. Current and lifetime medical conditions, electrocardiogram characteristics, and physical examination abnormalities were assessed. RESULTS : Among the most frequently reported lifetime conditions were wounds and burns (40.5%, N = 122) and severe dental problems (33%, N = 99), and a significant proportion of the sample evidenced prolonged corrected QT interval (19.6%, N = 43). Although health conditions were not associated with MA use frequency during follow-up, intravenous MA use was significantly associated with missing teeth (odds ratio = 2.4; 95% confidence interval, 1.2-4.7) and hepatitis C antibodies (odds ratio = 13.1; confidence interval, 5.6-30.1). CONCLUSION : In this sample of MA users, dental problems and corrected QT prolongation were observed at elevated rates. Although posttreatment MA use frequency was not associated with a majority of medical outcomes, intravenous MA use exacerbated risk for dental pathology and hepatitis C. Longer term follow-up research is needed to elucidate health trajectories of MA users.
Collapse
|
22
|
Crits-Christoph P, Gallop R, Gibbons MBC, Sadicario JS, Woody G. Measuring Outcome in the Treatment of Cocaine Dependence. JOURNAL OF ALCOHOLISM AND DRUG DEPENDENCE 2013; 1:108. [PMID: 26366427 PMCID: PMC4564116 DOI: 10.4172/2329-6488.1000108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Little in known about the extent to which outcome measures used in studies of the treatment of cocaine dependence are associated with longer-term use and with broader measures of clinical improvement. The current study examined reductions in use, and abstinence-oriented measures, in relation to functioning and longer-term clinical benefits in the treatment of cocaine dependence. METHODS Overall drug use, cocaine use, and functioning in a number of addiction-related domains for 487 patients diagnosed with DSM-IV cocaine dependence and treated with one of four psychosocial interventions in the NIDA Cocaine Collaborative Treatment Study were assessed monthly during 6 months of treatment and at 9, 12, 15, and 18 month follow-up. RESULTS Measures of during-treatment reduction in use were moderately correlated with drug and cocaine use measures 12 months, but showed non-significant or small correlations with measures of functioning at 12 months. Highest correlations were evident for abstinence measures (maximum consecutive days abstinence and completely abstinent) during treatment in relation to sustained (3 month) abstinence at 12 months. Latent class analysis of patterns of change over time revealed that most patients initially (months 1 to 4 of treatment) either became abstinent immediately or continued to use every month. Over the couse of follow-up, patients either maintained abstinence or used regularly - intermittent use was less common. CONCLUSIONS There were generally small associations between various measures of cocaine use and longer-term clinical benefits, other than abstinence was associated with continued abstinence. No one method of measuring outcome of treatment of cocaine dependence appears superior to others.
Collapse
Affiliation(s)
- Paul Crits-Christoph
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA
| | - Robert Gallop
- Applied Statistics Program, Department of Mathematics, West Chester University, 25 University Avenue, West Chester, PA 19383, USA
| | | | - Jaclyn S. Sadicario
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA
| | - George Woody
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA
| |
Collapse
|
23
|
Barrio G, Molist G, de la Fuente L, Fernández F, Guitart A, Bravo MJ, Brugal MT. Mortality in a cohort of young primary cocaine users: controlling the effect of the riskiest drug-use behaviors. Addict Behav 2013; 38:1601-4. [PMID: 23254204 DOI: 10.1016/j.addbeh.2012.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 10/10/2012] [Accepted: 10/16/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Published studies indicate that primary cocaine users (PCUs) have a mortality rate 4-8 times higher than their age-sex peers in the general population. Most PCUs are primary intranasal cocaine users, never-injectors and never-opioid users (PICUNINOs) and are usually underrepresented in cohort mortality studies. The aim is to estimate excess mortality in all PCUs and in the subgroups of never-opioid users and PICUNINOs in Spain. METHODS 714 PCUs aged 18-30 were street-recruited in 2004-2006 in Spain and followed until 2010 to ascertain vital status. Drug use was self-reported at baseline and 1-2years later. Mortality was compared with that of the general population using standardized mortality ratios (SMRs). RESULTS SMRs were 4.7 (95% CI: 2.4-9.0), 2.5 (95%CI: 0.8-7.8) and 3.1 (95% CI: 1.0-9.6), respectively, among all participants, never-opioid users and PICUNINOS when using only baseline data on drug use, and 1.2 (95% CI: 0.2-8.5) and 1.4 (95% CI: 0.2-9.9) among the latter two subgroups, when using baseline plus follow-up data. CONCLUSION Short-term mortality in young Spanish PCUs is 5 times higher than in the general population. This excess mortality may largely be explained by a history of opioid use or the risk of starting such use.
Collapse
Affiliation(s)
- Gregorio Barrio
- National School of Public Health, Carlos III Health Institute, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Spain.
| | | | | | | | | | | | | |
Collapse
|
24
|
"A costly turn on": patterns of use and perceived consequences of mephedrone based head shop products amongst Irish injectors. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:188-97. [PMID: 22342322 DOI: 10.1016/j.drugpo.2012.01.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 01/16/2012] [Accepted: 01/19/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Mephedrone injecting has recently been reported in Romania, Slovenia, Guernsey and Ireland. The research reported here aimed to describe the experiences of a group of Irish injecting drug users, who were injecting mephedrone based headshop products prior to the introduction of legislative controls in Ireland, with particular focus on pre- and post-legislative use, effects of injecting mephedrone, settings and contexts for injecting, polydrug use and serial drug injecting, risk perceptions and harm reduction practises. METHODS Following a predevelopment phase with a Privileged Access Interviewer, in-depth interviews using a phenomenological approach were conducted with eleven attendees of a low threshold harm reduction service. RESULTS The findings describe the abuse potential of these mephedrone based headshop products when used by intravenous injection. Although participants were aware of risks and safe injecting practises, compulsive re injecting with excessive binge use over long periods of time was common. Nasal to injection route transitions, intense paranoia, violent behaviour and aggression, emergence of Parkinson type symptomatologies (in the form of spasms and 'wobbling'), and permanent numbness in lower extremities were reported. Multi and serial drug injecting with heroin was used in efforts to manage the intense rush and avoid unpleasant comedown. Participants reported limb abscesses, vein clotting, damage and recession resulting from product toxicity, crystallisation of the products when diluted and flushing practises. Seven participants were homeless, with groin and street injecting common. Following legislative changes use of mephedrone products declined due to closure of headshops, increased street prices, concerns around contamination and the emergence of new street stimulant drugs. CONCLUSION Continued monitoring of drug displacement patterns in post legislative time frames is advised, alongside longitudinal ethnographic research to track the diffusion of mephedrone and other cathinone derivatives within injecting networks. Further investigation of the adverse health consequences of these drugs on injection is warranted.
Collapse
|
25
|
SANTOS SARA, BRUGAL MTERESA, BARRIO GREGORIO, CASTELLANO YOLANDA, DOMINGO-SALVANY ANTONIA, ESPELT ALBERT, BRAVO MJOSE, DE LA FUENTE LUIS. Assessing the effect of patterns of cocaine and alcohol use on the risk of adverse acute cocaine intoxication. Drug Alcohol Rev 2012; 31:439-46. [DOI: 10.1111/j.1465-3362.2011.00411.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
26
|
Abstract
Cocaine is a stimulant that leads to the rapid accumulation of catecholamines and serotonin in the brain due to prevention of their re-uptake into the neuron that released the neurotransmitter. Cocaine dependence is a public health concern and cause of significant morbidity and mortality worldwide. At present, there are no approved medications for the treatment of this devastating illness, and behavioral interventions have proven to be of limited use. However, there have been a number of recent trials testing promising agents including dopamine agonists, GABAergic medications and the cocaine vaccine. Here we discuss the most recent human clinical trials of potential medications for treatment of cocaine dependence, as well as pre-clinical studies for another promising agent, levo tetrahydropalmatine. Examination of these recent findings shows promise for GABAergic medications and the cocaine vaccine, as well as unique medications such as disulfiram, whose mechanism remains to be determined. Future work may also confirm specific subgroups of patients for treatment response based on clinical characteristics, biomarkers and pharmacogenetics. This review highlights the need for further, bigger studies in order to determine optimal clinical usage.
Collapse
Affiliation(s)
- Daryl Shorter
- Menninger Department of Psychiatry and Behavioral Science, Baylor College of Medicine, 1977 Butler Blvd., Suite E4.400, Houston, TX 77030, USA
- MEDVAMC - 2002 Holcombe Blvd., Bldg 110, Room 229, Houston, TX 77030, USA
| | - Thomas R Kosten
- Menninger Department of Psychiatry and Behavioral Science, Baylor College of Medicine, 1977 Butler Blvd., Suite E4.400, Houston, TX 77030, USA
- MEDVAMC - 2002 Holcombe Blvd., Bldg 110, Room 229, Houston, TX 77030, USA
| |
Collapse
|
27
|
Mortality among cocaine users: a systematic review of cohort studies. Drug Alcohol Depend 2011; 113:88-95. [PMID: 20828942 DOI: 10.1016/j.drugalcdep.2010.07.026] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 07/13/2010] [Accepted: 07/25/2010] [Indexed: 11/24/2022]
Abstract
AIMS To conduct a systematic review of mortality among cohort studies of cocaine users. METHODS Three electronic databases were searched (EMBASE, Medline and PsychINFO); other online databases were searched using online libraries and repositories of reports and literature in the drug and alcohol field, with requested contributions from trained librarians and experts. Searches and extraction were undertaken using protocols and cross-checking of decisions by two authors. Additional data were requested from study investigators where studies did not report relevant data. RESULTS 1911 articles and 2 reports were identified from searches, with data from another four studies located from review articles. Seven cohorts of "problem" or dependent cocaine users reported data that permitted mortality rates to be estimated. Crude mortality rates ranged from 0.53 (95% CI: 0.10-1.58) to 6.16 (95% CI: 5.21-7.11) per 100 PY. Standardised mortality ratios (SMRs) reported in four studies suggested that mortality was four to eight times higher among cocaine users than age and sex peers in the general population. CONCLUSIONS There are limited data on the extent of elevated mortality among problematic or dependent cocaine users and it is unclear how generalisable the results of these studies may be to other populations of problematic cocaine users. Greater attention to both the method of recruitment, and the characteristics of cocaine users, would enhance our understanding of the mortality risks of problematic cocaine use.
Collapse
|
28
|
Topp L, Hudson SL, Maher L. Mental health symptoms among street-based psychostimulant injectors in Sydney's Kings Cross. Subst Use Misuse 2010; 45:1180-200. [PMID: 20441457 DOI: 10.3109/10826080903443586] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Urban frontline services have recorded increases in psychostimulant-related presentations. A convenience sample of 183 street-based psychostimulant injectors recruited in April 2006 was administered the Kessler Psychological Distress Scale (K10) to assess psychological distress. Homelessness, unemployment, and recent public injection, along with gender (female) and financial and relationship problems, best predicted clinically significant K10 scores. Drug use measures were not significantly associated with distress once indicators of social marginalization were included. The risk environment of the street-based drug market accounts for much of the distress experienced in this milieu, highlighting the need for broad structural interventions, together with drug-specific responses.
Collapse
Affiliation(s)
- Libby Topp
- Centre for Health Research in Criminal Justice, Justice Health, Pagewood, Australia
| | | | | |
Collapse
|
29
|
Ford R, Bammer G, Becker N. Improving nurses' therapeutic attitude to patients who use illicit drugs: Workplace drug and alcohol education is not enough. Int J Nurs Pract 2009; 15:112-8. [DOI: 10.1111/j.1440-172x.2009.01732.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
30
|
Pronounced paranoia as a result of cocaine-disulfiram interaction: case report and mode of action. J Clin Psychopharmacol 2009; 29:99-101. [PMID: 19142124 DOI: 10.1097/jcp.0b013e3181934451] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
31
|
Lloyd-Smith E, Wood E, Li K, SG Montaner J, Kerr T. Incidence and determinants of initiation into cocaine injection and correlates of frequent cocaine injectors. Drug Alcohol Depend 2009; 99:176-82. [PMID: 18805655 PMCID: PMC2649881 DOI: 10.1016/j.drugalcdep.2008.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 07/08/2008] [Accepted: 07/24/2008] [Indexed: 01/09/2023]
Abstract
PURPOSE To investigate the incidence and correlates of cocaine injection initiation and the impacts of daily cocaine injection among a cohort of injection drug users. METHODS Among 1603 participants, from May 1996 to December 2005, risk factors for initiation of cocaine injection among baseline heroin users were determined by Cox proportional hazards regression and correlates of daily cocaine injection by generalized estimating equations. FINDINGS Of the 238 individuals who had never injected cocaine, 200 (84%) had at least one follow-up visit and 121 (61%) consequently initiated into cocaine injection, yielding an incidence density of initiation into cocaine injection of 21.9% (95% confidence interval (CI): 17.9-25.8) per 100 person-years. In a multivariate model, Downtown Eastside (DTES) residence (adjusted hazard ratio (AHR)=2.46, 95% CI: 1.68-3.60), incarceration (AHR=1.50, 95% CI: 1.01-2.24), requiring help injecting (AHR=1.57, 95% CI: 0.99-2.49), and binge drug use (AHR=1.82, 95% CI: 1.22-2.73) remained associated with initiation into cocaine injection. DTES residence (adjusted odds ratio (AOR)=1.99, 95% CI: 1.62-2.46), unstable housing (AOR=1.28, 95% CI: 1.04-1.53), incarceration (AOR=1.29, 95% CI: 1.04-1.60), sex trade involvement (AOR=1.46, 95% CI: 1.15-1.85), requiring help injecting (AOR=2.11, 95% CI: 1.73-2.58)), borrowing syringes (AOR=1.81, 95% CI: 1.35-2.43) and binge drug use (AOR=2.16, 95% CI: 1.81-2.58) were independently associated with daily cocaine injection. CONCLUSIONS The baseline prevalence and subsequent incidence of initiation into cocaine injection was high. Daily cocaine injection was independently associated with a number of health and social harms, including elevated HIV risk behavior.
Collapse
Affiliation(s)
- Elisa Lloyd-Smith
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, St. Paul's Hospital 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Department of Health Care and Epidemiology, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, St. Paul's Hospital 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Department of Medicine, University of British Columbia, Gordon and Leslie Diamond Health Care Centre 10th Floor – Room 10203 – 2775 Laurel Street, Vancouver, BC, V5Z 1M9
| | - Kathy Li
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, St. Paul's Hospital 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6
| | - Julio SG Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, St. Paul's Hospital 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Department of Medicine, University of British Columbia, Gordon and Leslie Diamond Health Care Centre 10th Floor – Room 10203 – 2775 Laurel Street, Vancouver, BC, V5Z 1M9
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, St. Paul's Hospital 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Department of Medicine, University of British Columbia, Gordon and Leslie Diamond Health Care Centre 10th Floor – Room 10203 – 2775 Laurel Street, Vancouver, BC, V5Z 1M9
| |
Collapse
|
32
|
Initiators: an examination of young injecting drug users who initiate others to injecting. AIDS Behav 2008; 12:885-90. [PMID: 18097744 DOI: 10.1007/s10461-007-9347-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Accepted: 12/03/2007] [Indexed: 10/22/2022]
Abstract
Research about initiation to injecting drugs emphasises the role that relationships with others plays in the experience, suggesting investigations of initiation should include an examination of both initiates and initiators. This paper uses cross-sectional data collected from 324 young, early-career injecting drug users (IDU) to describe the socio-demographic characteristics, drug and injecting practices, and harm reduction knowledge and practices of people who report initiating others to injecting. Fifty-five participants (17%) reported giving someone else their first injection. They reported initiating a total of 128 other people within the first 5 years of their own injecting. Compared to non-initiators, initiators were more likely to pass on harm reduction information [odds ratios (OR): 2.36, 95% confidence intervals (CI): 1.26-4.40]. However, the quality of this information was unknown and initiators did not have more accurate knowledge of blood borne viruses (BBV) than non-initiators, and commonly obtained needles and syringes from sources where the sterility of the equipment could not be guaranteed.
Collapse
|
33
|
Ford R, Bammer G, Becker N. The determinants of nurses’ therapeutic attitude to patients who use illicit drugs and implications for workforce development. J Clin Nurs 2008; 17:2452-62. [DOI: 10.1111/j.1365-2702.2007.02266.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
34
|
Darke S, Kaye S, McKetin R, Duflou J. Major physical and psychological harms of methamphetamine use. Drug Alcohol Rev 2008; 27:253-62. [PMID: 18368606 DOI: 10.1080/09595230801923702] [Citation(s) in RCA: 425] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
ISSUES The major physical and psychological health effects of methamphetamine use, and the factors associated with such harms. APPROACH Comprehensive review. KEY FINDINGS Physical harms reviewed included toxicity and mortality, cardiovascular/cerebrovascular pathology, dependence and blood-borne virus transmission. Psychological harms include methamphetamine psychosis, depression, suicide, anxiety and violent behaviours. IMPLICATIONS While high-profile health consequences, such as psychosis, are given prominence in the public debate, the negative sequelae extend far beyond this. This is a drug class that causes serious heart disease, has serious dependence liability and high rates of suicidal behaviours. CONCLUSION The current public image of methamphetamine does not portray adequately the extensive, and in many cases insidious, harms caused.
Collapse
Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | |
Collapse
|
35
|
SHEARER JAMES, JOHNSTON JENNIFER, FRY CRAIGL, KAYE SHARLENE, DILLON PAUL, DIETZE PAUL, COLLINS LINETTE. An Australian Profile on Cocaine Supply. ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1468-2311.2008.00505.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
36
|
Bryant J, Treloar C. The gendered context of initiation to injecting drug use: evidence for women as active initiates. Drug Alcohol Rev 2007; 26:287-93. [PMID: 17454018 DOI: 10.1080/09595230701247731] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This paper explores differences between women's and men's first experience of injecting in relation to socio-demographic context, drug use, and the role of others. We collected cross-sectional retrospective data from 334 recently initiated (<or=5 years) injecting drug users in New South Wales and Queensland, Australia using a structured questionnaire in face-to-face interviews. Logistic regression was used to estimate crude and adjusted odds ratios (OR). Findings from the adjusted analysis show that women had a shorter duration of illicit drug use prior to initiation (adjusted OR 0.84, 95%CI: 0.74 - 0.94), and were more likely to have their romantic-sexual partner facilitate the initiation by paying for the drugs (adjusted OR 4.64, 95%CI: 1.21 - 17.73). Women also reported a greater likelihood of being initiated in groups of other women (adjusted OR 2.87, 95%CI: 1.24 - 6.67), suggesting that some women play an active role in their initiation experience rather than relying on, or being lead by, a romantic-sexual partner. These findings demonstrate the crucial role that romantic-sexual partners play in women's initiation experience, but also provide evidence for the way that women can be active participants in their own initiation and in initiating other women.
Collapse
Affiliation(s)
- Joanne Bryant
- National Centre in HIV Social Research, University of New South Wales, Sydney, New South Wales, Australia.
| | | |
Collapse
|
37
|
Abstract
Despite huge advances in the neuroscience of substance abuse and dependence in the past 20 years, no approved pharmacological treatment exists for cocaine abuse. The available drugs for the treatment of cocaine abuse are poorly effective, hence the need for new compounds to be screened and tested for efficacy: targeting symptoms might improve the effectiveness of the treatment of cocaine abuse and dependence. On the basis of the known neurochemistry of cocaine, some target compounds have been studied: among others, BP-897, a D3 partial agonist; vanoxerine, a highly selective inhibitor of dopamine uptake; aripiprazole, a partial mixed-action agonist approved for the treatment of schizophrenia. Recently modafinil, approved for the treatment of narcolepsy, proved effective in favouring cocaine abstinence in cocaine-abusing people. Some placebo-controlled studies also reported the effectiveness of topiramate, a licensed antiepileptic drug, and of tiagabine, a gamma-aminobutyric acid (GABA) re-uptake inhibitor also approved as an anticonvulsant; both compounds increased cocaine abstinence with no serious adverse events. Promising results came from two more compounds acting on the GABA circuits, baclofen and valproic acid. Finally disulfiram, prescribed with active psychosocial therapy, was found to favour higher retention rates and longer abstinence periods from both alcohol and cocaine in polydrug-abusing patients. An alternative approach rests on the use of vaccines, to date in the experimental stage still. Psychosocial treatments are a useful companion in the pharmacotherapy of cocaine abuse, with group therapy and contingency management therapies improving motivation and social functioning, particularly in patients abusing alcohol as well.
Collapse
Affiliation(s)
- Antonio Preti
- Department of Psychology, University of Cagliari, Italy and Genneruxi Medical Center, Italy.
| |
Collapse
|
38
|
Bryant J, Treloar C. Risk practices and other characteristics of injecting drug users who obtain injecting equipment from pharmacies and personal networks. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2006. [DOI: 10.1016/j.drugpo.2006.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
39
|
Abstract
PURPOSE OF REVIEW This work reviews the evidence that substances of abuse can cause psychosis in nonpsychotic persons. The review is based on the concept that psychosis exists in continuum. Studies examining substance use in, or its effect on, already psychotic individuals were not reviewed. RECENT FINDINGS A substantial proportion of substance users experience psychosis. Use of cocaine, amphetamines, cannabis and alcohol seems to be associated with greater risk for psychosis. Severity and duration of use, age at the time of first use and vulnerability to develop psychosis by virtue of familial, possibly genetic and personality factors seem to be the determinants for the development of psychosis. Epidemiological and preliminary biological studies suggest that cannabis is a component cause in the development of schizophrenia. Evidence for the causative role of other substances is less systematic. SUMMARY There exists strong evidence that abuse of substances is associated with greater risk for psychosis and preliminary evidence for their causative role in the development of psychosis. More systematic examination of this issue is likely to throw light on the neurobiology of psychosis and possibly help the vulnerable population in primary prevention.
Collapse
Affiliation(s)
- Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
| | | |
Collapse
|
40
|
Sofuoglu M, Kosten TR. Emerging pharmacological strategies in the fight against cocaine addiction. Expert Opin Emerg Drugs 2006; 11:91-8. [PMID: 16503828 DOI: 10.1517/14728214.11.1.91] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cocaine addiction continues to be an important public health problem worldwide. At present, there are no proven pharmacotherapies for cocaine addiction. The studies reviewed here revealed a number of emerging targets for cocaine pharmacotherapy. First, disulfiram, a medication with dopaminergic effects, reduced cocaine use in a number of clinical trials. Second, GABA medications, tiagabine and topiramate, were found promising in clinical trials. Third, a beta-adrenergic blocker, propranolol, may be effective especially among cocaine-addicted individuals with high withdrawal severity. Fourth, treatment with a stimulant medication, modafinil, has reduced cocaine use. Last, a cocaine vaccine that slows entry of cocaine into the brain holds promise. These promising findings need to be further tested in controlled clinical trials.
Collapse
Affiliation(s)
- Mehmet Sofuoglu
- Department of Psychiatry, VA Connecticut Healthcare System, Yale University, School of Medicine, West Haven, CT 06516, USA.
| | | |
Collapse
|
41
|
Abstract
AIM To investigate the frequency of non-fatal cocaine overdose, and responses to overdoses, among injecting and non-injecting cocaine users. DESIGN Cross-sectional study. SETTING Sydney, Australia. PARTICIPANTS Two hundred current cocaine users. MEASUREMENTS Structured interview. FINDINGS Thirteen per cent of the sample had overdosed on cocaine, 7% in the preceding 12 months. Cocaine injectors were more likely to have overdosed, both ever (17 v 6%) and in the preceding 12 months (9 v 3%). The most common symptoms of overdose were palpitations (68%), intense sweating (44%) and seizures (40%). The use of other drugs in combination with cocaine prior to the most recent overdose was prevalent (64%), most commonly opioids (40%), alcohol (24%) and cannabis (24%). Those who had overdosed were more likely to be female, had longer cocaine use careers, had used more cocaine in the preceding month and preceding 6 months, had higher levels of cocaine dependence and more extensive polydrug use. Twenty-four per cent had witnessed a cocaine overdose, 13% in the preceding 12 months. Injectors were more likely to have witnessed overdoses, both ever (35% v 8%) and in the preceding 12 months (20% v 3%). CONCLUSIONS Experience of, and exposure to, overdose were not rare events. Cocaine users need to be aware of the possibility and nature of overdose, and that cocaine overdose can occur irrespective of method of use. There is a need to emphasise the potential danger of combining cocaine with other drugs.
Collapse
Affiliation(s)
- Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Australia.
| | | |
Collapse
|