The use of psychoactive substances among medical students in southern Brazil

Drug use among medical students in São Paulo, Brazil: a cross-sectional study during the coronavirus disease 2019 pandemic

BACKGROUND

Medical students demonstrate higher rates of substance use than other university students and the general population. The challenges imposed by the coronavirus disease 2019 (COVID-19) pandemic raised significant concerns about mental health and substance use.

OBJECTIVES

Assess the current prevalence of substance use among medical students at the University of São Paulo and evaluate the impact of the COVID-19 pandemic on drug consumption.

DESIGN AND SETTING

A cross-sectional study was conducted on 275 medical students from the University of São Paulo Medical School (São Paulo, Brazil) in August 2020.

METHODS

Substance use (lifetime, previous 12 months, and frequency of use before and during the COVID-19 pandemic) and socioeconomic data were assessed using an online self-administered questionnaire. Symptoms of depression were assessed using the Patient Health Questionnaire-9.

RESULTS

Alcohol was the most consumed substance in their lifetime (95.6%), followed by illicit drugs (61.1%), marijuana (60%), and tobacco (57.5%). The most commonly consumed substances in the previous year were alcohol (82.9%), illicit drugs (44.7%), marijuana (42.5%), and tobacco (36%). Students in the first two academic years consumed fewer substances than those from higher years. There was a decreasing trend in the prevalence of most substances used after the COVID-19 pandemic among sporadic users. However, frequent users maintained their drug use patterns.

CONCLUSION

The prevalence of substance use was high in this population and increased from the basic to the clinical cycle. The COVID-19 pandemic may have affected the frequency of drug use and prevalence estimates.

Cannabis Use in Physicians: A Systematic Review and Meta-Analysis

Background: Cannabis use by physicians can be detrimental for them and their patients. We conducted a systematic review and meta-analysis on the prevalence of cannabis use by medical doctors (MDs)/students. Method: PubMed, Cochrane, Embase, PsycInfo and ScienceDirect were searched for studies reporting cannabis use in MDs/students. For each frequency of use (lifetime/past year/past month/daily), we stratified a random effect meta-analysis depending on specialties, education level, continents, and periods of time, which were further compared using meta-regressions. Results: We included 54 studies with a total of 42,936 MDs/students: 20,267 MDs, 20,063 medical students, and 1976 residents. Overall, 37% had used cannabis at least once over their lifetime, 14% over the past year, 8% over the past month and 1.1 per thousand (‱) had a daily use. Medical students had a greater cannabis use than MDs over their lifetime (38% vs. 35%, p < 0.001), the past year (24% vs. 5%, p < 0.001), and the past month (10% vs. 2%, p < 0.05), without significance for daily use (0.5% vs. 0.05%, NS). Insufficient data precluded comparisons among medical specialties. MDs/students from Asian countries seemed to have the lowest cannabis use: 16% over their lifetime, 10% in the past year, 1% in the past month, and 0.4% daily. Regarding periods of time, cannabis use seems to follow a U-shape, with a high use before 1990, followed by a decrease between 1990 and 2005, and a rebound after 2005. Younger and male MDs/students had the highest cannabis use. Conclusions: If more than a third of MDs tried cannabis at least once in their lifetime, this means its daily use is low but not uncommon (1.1‱). Medical students are the biggest cannabis users. Despite being common worldwide, cannabis use is predominant in the West, with a rebound since 2005 making salient those public health interventions during the early stage of medical studies.

Prevalence of Cannabis Use Among Medical Students: A Systematic Review and Meta-analysis

OBJECTIVE

Cannabis is reported to be the most common illicit substance used among medical students; however, the number of related studies is limited and their results are not systematically reviewed. The aim of our study was to analyze the prevalence of lifetime and current use of cannabis among medical students worldwide.

METHODS

A systematic review and meta-analysis was performed with adherence to the PRISMA guidelines. The electronic databases PubMed, Scopus, and Cochrane library were searched for studies on the prevalence of cannabis use among medical students. Prevalence of lifetime, past-year, and past-month cannabis use was extracted. Pooled prevalence and relative risk for sex were calculated using the random effects model and subgroup analyses were conducted.

RESULTS

A total of 38 observational (cross-sectional and cohort) studies were included (total number of participants 19 932), and most of them were conducted in Europe, Central and Southern America, and the United States. Overall pooled prevalence of lifetime cannabis use was 31.4% (95% confidence interval [CI]: 23.7%-39.6%), past-year use was 17.2% (95% CI: 10.8%-24.6%), and past-month use was 8.8% (95% CI: 5.6%-12.5%). Men displayed higher rates of cannabis use with a pooled relative risk of 1.55 (95% CI: 1.32-1.81). Heterogeneity was high (I 2 > 75%) and there were differences among continents in all outcomes (P < .001).

CONCLUSIONS

In conclusion, 1 in 3 medical students has used cannabis, whereas 8.8% were current users. Significant differences among continents were observed, but common finding was that male students tend to consume cannabis more often than female students.

The use of drugs and medical students: a literature review

SUMMARY INTRODUCTION The consumption and abuse of alcohol and other drugs are increasingly present in the lives of university students and may already be considered a public health problem because of the direct impacts on the physical and mental health of these individuals. The requirements of the medical program play a vital role in the increasing rate of drug users. OBJECTIVES To carry out a systematic review of the literature on the use of drugs, licit or not, in Brazilian medical students. METHODS A descriptive-exploratory study, in which the SciELO and MEDLINE databases were used. A total of 99 articles were found, of which 16 were selected for this review. RESULTS Alcohol and tobacco were the most frequently used licit drugs among medical students. The most consumed illicit drugs were marijuana, solvents, “lança-perfume” (ether spray), and anxiolytics. The male genre presented a tendency of consuming more significant amounts of all kinds of drugs, with the exception of tranquilizers. It was found an increasing prevalence of drug consumption in medical students, as the program progressed, which may result from the intrinsic stress from medical school activities. Students who do not use psychoactive drugs are more likely to live with their parents, to disapprove drugs consumption, to practice religious beliefs and to be employed. Conclusion The prevalence of licit and illicit drug use among medical students is high, even though they understand the injuries it may cause.

Estudio de factores asociados y prevalencia de consumo de sustancias psicoactivas ilegales en estudiantes de una universidad colombiana

Introducción. El consumo de sustancias psicoactivas e ilegales es un problema que muestra frecuencias crecientes de hasta 30% en estudiantes universitarios.Objetivo. Determinar la frecuencia y los factores asociados al consumo de sustancias psicoactivas e ilegales en los estudiantes de una universidad colombiana.Materiales y métodos. Se realizó un estudio de corte transversal. La población fue una muestra representativa de 343 estudiantes. Se utilizó una encuesta anónima sobre el consumo de sustancias psicoactivas en población universitaria y sus factores asociados.Resultados. El 31.5% de los encuestdaos manifestaron haber consumido alguna sustancia psicoactiva ilegal en algún momento de los últimos 12 meses. El promedio de edad del primer consumo fue 17±2.1 años, teniendo en cuenta que 61.1% correspondió a marihuana. Todos los factores asociados que se consideraron mostraron una relación significativa con el consumo en los últimos 30 días, un año y alguna vez en la vida. Asimismo, los problemas familiares fueron el factor asociado con mayor razón de prevalencia (RP=15.467, consumo último año), seguido de presión de amigos (RP=7.847).Conclusiones. El consumo de sustancias psicoactivas ilegales en la población estudiantil de la universidad analizada parece ser considerable, lo que sugiere una intervención con énfasis en los programas más involucrados.

The use of psychotropic substances among students: The prevalence, factor association, and abuse

This detailed review analyzed the previously published studies related to the prevalence of psychotropic substances use, associated factors, and the misuse of the psychotropics among students. A comprehensive literature search covering six databases was performed. References from published articles and reports were extracted. This helped in identifying the available information on the use of psychotropic drugs. A total of 16 articles were included in this review. There is an upsurge of using psychotropics with the preceding years. More students are exposed to the risk of using psychotropic substances due to the multiple factors like stress, increased academic workload, etc. The misuse is found to be common with prescribed psychotropic substances. Students need to be aware of the bad outcomes of using psychotropic substances. Participation of every stakeholder to curb this menace needs to be emphasized. More extensive studies are required to know about the increasing prevalence, factors, and misuse of psychotropics.

Sedative Drug Use among King Saud University Medical Students: A Cross-Sectional Sampling Study

Introduction. Medical students experience significant psychological stress and are therefore at higher risk of using sedatives. There are currently no studies describing the prevalence of sedative drug use among medical students in Saudi Arabia. The aim of this study was to evaluate the prevalence and factors associated with sedative drug use among medical students in Saudi Arabia. Materials and Methods. A cross-sectional convenience sampling study gathered data by anonymous questionnaire from students enrolled at the King Saud University College of Medicine in 2011. The questionnaires collected data regarding social and demographic variables, sleep patterns, and the use of stimulant and sedative drugs since enrollment. Sedatives were defined as any pharmaceutical preparations that induce sleep. Results and Discussion. Of the 729 students who returned questionnaires, 17.0% reported sedative drug use at some time since enrollment. Higher academic year, lower grade point average, regular exercise, fewer hours of sleep per day, poorer quality of sleep, and the presence of sleeping disorders were found to be significantly associated with sedative drug use. Conclusions. Further study is required to increase our understanding of sedative drug use patterns in this relatively high-risk group, as such understanding will help in the development of early intervention programs.

Anxiety symptoms in crack cocaine and inhalant users admitted to a psychiatric hospital in southern Brazil

OBJECTIVE

The occurrence of psychiatric comorbidity among individuals with crack or inhalant dependence is frequently observed. The objective of this study was to investigate anxiety symptoms among crack cocaine and inhalant users in southern Brazil.

METHODS

The study investigated two groups of volunteers of equal size (n=50): one group consisted of crack cocaine users, and the other group consisted of inhalant users. Research volunteers completed the Portuguese versions of the State-Trait Anxiety Inventory (STAI), Hamilton Anxiety Rating Scale (HAM-A), and Self-Report Questionnaire (SRQ).

RESULTS

Both crack and inhalant users experience significant symptoms of anxiety. Inhalant users presented significantly more anxiety symptoms than crack users according to the HAM-A questionnaire only. In contrast to the results of the HAM-A, the STAI failed to demonstrate a significant difference between the two groups of substance users. SRQ scores revealed that crack and inhalants users had significant degrees of morbidity.

CONCLUSION

A significant difference regarding anxiety symptomatology, especially state anxiety, was observed among inhalant and crack users. Anxiety and overall mental psychopathology were significantly correlated in this sample. The results indicate that screening initiatives to detect anxiety and additional psychiatric comorbidities among crack and inhalant users are feasible and relevant.

The use of appetite suppressants among health sciences undergraduate students in Southern Brazil

OBJECTIVE

To investigate the prevalence of appetite suppressant use among health sciences students in Southern Brazil.

METHODS

Undergraduate students (n=300) from seven health science undergraduate courses of the Universidade de Caxias do Sul completed a questionnaire about the use of substances to suppress appetite.

RESULTS

A significant percentage (15%; n=45) of research participants used appetite suppressants at least once in their lives. The most commonly used substances were sympathomimetic stimulant drugs (5%), including amfepramone (3.3%) and fenproporex (1.7%). The lifetime use of appetite suppressants was more prevalent among Nursing (26.7%) and Nutrition (24.4%%) students. There was no reported use of appetite suppressants among medical students. The use of appetite suppressants was significantly more prevalent among women. The majority of those who used these substances did so under medical recommendation. Most of users took appetite suppressants for more than 3 months.

CONCLUSION

Lifetime use of appetite suppressants was substantial, being sympathomimetic stimulant drugs the most commonly used agents. Students enrolled in Nursing and Nutrition courses presented a significantly higher prevalence of lifetime use of appetite suppressants.

Drug consumption among medical students in São Paulo, Brazil: influences of gender and academic year

OBJECTIVE

To analyze alcohol, tobacco and other drug use among medical students.

METHOD

Over a five-year period (1996-2001), we evaluated 457 students at the Universidade de São Paulo School of Medicine, located in São Paulo, Brazil. The students participated by filling out an anonymous questionnaire on drug use (lifetime, previous 12 months and previous 30 days). The influence that gender and academic year have on drug use was also analyzed.

RESULTS

During the study period, there was an increase in the use of illicit drugs, especially inhalants and amphetamines, among the medical students evaluated. Drug use (except that of marijuana and inhalants) was comparable between the genders, and academic year was an important influencing factor.

DISCUSSION

Increased inhalant use was observed among the medical students, especially among males and students in the early undergraduate years. This is suggestive of a specific behavioral pattern among medical students. Our findings corroborate those of previous studies.

CONCLUSION

Inhalant use is on the rise among medical students at the Universidade de São Paulo School of Medicine. Because of the negative health effects of illicit drug use, further studies are needed in order to deepen the understanding of this phenomenon and to facilitate the development of preventive measures.

Consumption of alcohol, cigarettes and illegal substances among physicians and medical students in Brandenburg and Saxony (Germany)

Background

Patients regard health care professionals as role models for leading a healthy lifestyle. Health care professionals' own behaviour and attitudes concerning healthy lifestyle have an influence in counselling patients. The aim of this study was to assess consumption of alcohol, cigarettes and illegal substances among physicians and medical students in two German states: Brandenburg and Saxony.

Methods

Socio-demographic data and individual risk behaviour was collected by an anonymous self-administered questionnaire. Physicians were approached via mail and students were recruited during tutorials or lectures.

Results

41.6% of physicians and 60.9% of medical students responded to the questionnaire; more than 50% of the respondents in both groups were females. The majority of respondents consumed alcohol at least once per week; median daily alcohol consumption ranged from 3.88 g/d (female medical students) to 12.6 g/d (male physicians). A significantly higher percentage of men (p < 0.05) reported hazardous or harmful drinking compared to women. A quarter of all participating physicians and one third of all students indicated unhealthy alcohol-drinking behaviour. The majority of physicians (85.7%) and medical students (78.5%) were non-smokers. Both groups contained significantly more female non-smokers (p < 0.05). Use of illegal substances was considerably lower in physicians (5.1%) than medical students (33.0%). Male students indicated a significantly (p < 0.001) higher level of illegal drug-use compared to female students.

Conclusion

More than one third of the medical students and health care professionals showed problematic alcohol-drinking behaviour. Although the proportion of non-smokers in the investigated sample was higher than in the general population, when compared to the general population, medical students between 18-24 reported higher consumption of illegal substances.

These results indicate that methods for educating and promoting healthy lifestyle, particularly with respect to excessive alcohol consumption, tobacco use and abuse of illegal drugs should be considered.

Amphetamine causes dopamine depletion and cell death in the mouse olfactory bulb

Amphetamine is a neurotoxic psychostimulant that causes dopamine depletion and neuronal death in the rodent striatum. In the present study, we sought to determine if toxic doses of the drug can also induce pathological changes in the mouse olfactory bulb. We found that injections of amphetamine (10 mg/kg x 4, given 2 h apart) caused significant decreases in dopamine levels in that structure. This dose of the drug also induced substantial increases in the number of terminal deoxynucleotidyl transferase-mediated deoxyribonucleotide triphosphate (dNTP) nick end labeling (TUNEL)-positive cells in the olfactory bulb indicative of elevated DNA fragmentation. These results show that the toxic effects of amphetamine involve the olfactory bulb in addition to the striatum. These observations need to be taken into consideration when discussing the clinical course of amphetamine addiction.