The global distribution and epidemiology of alcohol and drug use among street-involved children and youth: a meta-analysis

Background: Street-involved children and youth (SICY) who work and live on/of the streets are more likely to inject drugs and engage in psychoactive substance use.Objectives: The present study aimed to identify the prevalence, distribution, sociodemographic determinants, and risk-taking associated with alcohol and drug use among SICY.Methods: Studies published in English related to alcohol and drug use among SICY were searched for from December 1 1985 to July 1 2022, on PubMed, Scopus, Cochrane, and Web of Science.Results: After full-text paper evaluation, 73 studies were included in the meta-analysis. Results indicated that lifetime prevalence rates were 44% (alcohol), 44% (crack), 33% (inhalants), 44% (solvents), 16% (tranquilizer/sedatives), 22% (opioids), and 62% (polysubstance use). The current prevalence rates were 40% (alcohol), 21% (crack), 20% (inhalants), 11% (tranquilizer/sedatives), and 1% (opioids). Also, life-time and current prevalence of alcohol and crack use, current prevalence of tranquilizer/sedative use, and life-time prevalence of polysubstance use were higher among older age groups. Life-time prevalence of tranquilizer/sedative use was lower among older age groups.Conclusions: The high prevalence of using alcohol, crack, and inhalants is a major issue because they are used extensively among different age groups, including minors. Such findings are beneficial for policymakers, health authorities, and professionals in developing programs aimed at minimizing inhalant use and other types of substance use harms among this group. It is important to accurately monitor this risk-exposed population to understand the mechanisms that might help protect them from high-risk substance use.

Defining Prescription Drug Misuse: A Naturalistic Evaluation of National Survey on Drug Use and Health Data From 2012-2014 to 2015-2017

OBJECTIVES

Prescription drug misuse (PDM) is a significant public health problem. As research has evolved, the definitions of misuse have varied over time, yet the implications of this variability have not been systematically studied. The objective of this study was to leverage a change in the measurement of PDM in a large population survey to identify its impact on the prevalence and correlates of this behavior.

METHODS

Data from the National Survey on Drug Use and Health were compared before and after a change in the definition of PDM from one that restricted the source and motive for use to one that captured any misuse other than directed by a prescriber. Three-year cohorts were constructed, representing a restricted definition of PDM (2012-2014) and a broad definition of PDM (2015-2017).

RESULTS

Segmented logistic regression models indicated a significant increase in PDM prevalence for all 3 drug types examined (opioids, tranquilizers, and sedatives). Although the magnitude of differences varied somewhat based on drug type, the broader definition was generally associated with older age, higher prevalence of health insurance, and higher odds of misusing one's own prescription. Some worsening of mental health indicators was observed, but results indicated few other clinical or substance use differences.

CONCLUSIONS

Definitions of prescription drug misuse have a substantial impact on the prevalence of misuse and some impact on the characteristics of the population. Further research is needed to understand the optimal strategy for measuring this behavior, based on the scientific or public health question or interest.

Prescription drug and alcohol simultaneous co-ingestion in U.S. young adults: Prevalence and correlates

Simultaneous co-ingestion of prescription medication (e.g., opioid, tranquilizer/sedative, stimulant) and alcohol is associated with overdose and elevated substance use, but no studies have examined prescription drug misuse (PDM) and alcohol co-ingestion in U.S. young adults (18-25 years), despite the high rates of PDM in this age group. We used the 2015-19 National Survey on Drug Use and Health (young adult N = 69,916) to examine prevalence of past-month PDM-alcohol co-ingestion, PDM characteristics, and sociodemographic, physical health, mental health, and substance use correlates. Logistic regression examined correlates, comparing those without past-year PDM, those with past-year but not past-month PDM, those with past-month PDM without alcohol co-ingestion, and those with past-month PDM and alcohol co-ingestion. An estimated 585,000 young adults engaged in any past-month PDM-alcohol co-ingestion, or between 32.7% (opioids) and 44.6% (tranquilizer/sedatives) of those who were engaged in past-month PDM. Co-ingestion varied by educational status and was more common in males and white or multiracial young adults. All PDM-involved groups had elevated odds of suicidal ideation and other psychopathology, but substance use and substance use disorder (SUD) odds were significantly higher in young adults with co-ingestion, versus all other groups. To illustrate, 41.1% with opioid-alcohol co-ingestion had multiple past-year SUDs, versus 2.0% in those without past-year PDM. Young adults with co-ingestion are particularly likely to have problematic alcohol use and higher rates of SUD. Counseling about the risks of PDM-alcohol co-ingestion and screening for co-ingestion among those at risk are warranted to limit poor outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Co-ingestion of prescription drugs and alcohol in US adults aged 50 years or older

OBJECTIVE

To examine prevalence of past-month prescription drug misuse (PDM) and alcohol co-ingestion and its correlates in adults age 50 or older.

METHODS

Data were from the 2015-2018 US National Survey on Drug Use and Health (n = 35,190). PDM-alcohol co-ingestion was defined as prescription opioid, tranquilizer/sedative, or stimulant misuse while "drinking alcohol or within a couple of hours of drinking." Co-ingestion prevalence was estimated, and logistic and negative binomial regressions examined the sociodemographic, physical health, mental health, substance use, and substance use disorder (SUD) correlates of co-ingestion.

RESULTS

Over 344,000 adults aged 50 years or older (0.3%) engaged in past-month PDM-alcohol co-ingestion, or 27.4% of those with past-month PDM. Past-month co-ingestion was linked to greater past-month alcohol use frequency and elevated adjusted odds ratios (aORs) for all examined substance use outcomes (e.g., non-PDM SUD aOR = 21.8; 49.7% prevalence rate). The aOR for suicidal ideation was 506% higher in those with co-ingestion than those without past-year PDM.

CONCLUSIONS

US adults aged 50 years or older with past-month PDM-alcohol co-ingestion are at high risk for SUD and concerning mental health symptoms. Screening for mental health and substance use treatment is warranted among aging adults with signs of PDM, especially involving co-ingestion.

Prescription tranquilizer/sedative misuse prevalence and correlates across age cohorts in the US

BACKGROUND

Prescription tranquilizer/sedative (e.g., alprazolam, zolpidem) misuse (i.e., use in ways not intended by the prescriber or without a prescription) is understudied, with little research identifying misuse correlates. Identification of key correlates could identify subgroups more likely to engage in misuse, allowing for targeted treatment. This work examines tranquilizer/sedative use and misuse prevalence rates and misuse correlates across U.S. age cohorts, using nationally representative data.

METHODS

Data were from the 2015-16 National Survey on Drug Use and Health (n = 114,043). Analyses used design-based logistic regression for past-year tranquilizer/sedative misuse correlates across participants or those engaged in past-year use; past-month misuse correlates were also examined in those with past-year misuse.

RESULTS

Young adults (18-25 years) had the highest prevalence of past-year and past-month tranquilizer/sedative misuse, with 42.8% of those with past-year use also engaged in misuse. Mental health correlates were associated with past-year misuse, while substance use, particularly opioid misuse, was associated with both past-year and past-month misuse. Substance use correlate strength was most likely to vary by age group, with older adults (65 years and older) having fewer significant correlates overall.

CONCLUSIONS

This work highlighted young adults and those with other substance use as most likely to engage in tranquilizer/sedative misuse. In particular, those endorsing suicidality and reporting opioid misuse are a subgroup of concern, given their especially elevated rates of misuse and the increased risk for overdose imparted by tranquilizer/sedative medication. Workplace-based interventions for young adults and school-based universal prevention may be warranted to limit tranquilizer/sedative misuse in these groups.

Personality and prescription drug use/misuse among first year undergraduates

Emerging adults (18-25 year olds) endorse the highest rates of prescription drug misuse. Attending college or university may confer additional risk. Previous research suggests that personality is an important predictor of many addictive behaviours. Four traits have been consistently implicated: anxiety sensitivity, hopelessness, sensation seeking, and impulsivity. Published studies on personality as a predictor of prescription drug abuse are limited, however, by a primary focus on overall prescription drug use, inconsistent operationalisation of misuse, and failure to control for alcohol use. Sample sizes have been small and non-specific. We sought to better understand how personality predicted the overall use, the medically-sanctioned use, and the misuse of prescription sedatives/tranquilizers, opioids, and stimulants. A large (N = 1755) sample of first year Canadian undergraduate students (mean age = 18.6 years; 68.9% female) was used. We predicted that: anxiety sensitivity would be related to sedatives/tranquilizers, hopelessness to opioids, sensation seeking to stimulants, and impulsivity to all three. Save for the impulsivity to opioid use path, predictions were fully supported in our "any use" model. For medically-sanctioned use: anxiety sensitivity predicted sedative/tranquilizers, hopelessness predicted opioids, and impulsivity predicted stimulants. For misuse: anxiety sensitivity (marginally) predicted sedatives/tranquilizers, sensation seeking predicted stimulants, and impulsivity predicted all three. Our models support using personality-matched interventions. Specifically, results suggest targeting anxiety sensitivity for sedative/tranquilizer misuse, sensation seeking for stimulant misuse, and impulsivity for unconstrained prescription drug misuse. Interventions with early coping skills that pertain to all four traits might be useful for preventing prescription drug uptake and later misuse.

The use of Tranquillizers in Psychiatry

I should like to discuss some of the clinical aspects of the tranquillizing drugs, but without going into great detail as to the many theoretical considerations in biochemistry, physiology, pharmacology, etc. which have been ventilated so often in connection with this form of treatment.

Examining the link between nonmedical use of sedatives, tranquilizers, and pain relievers with dispositions toward impulsivity among college students

BACKGROUND

The association between impulsive dispositions and the use of the central nervous system (CNS) depressant alcohol has been examined extensively; however, the links between other depressant use (sedatives, tranquilizers, and pain relievers) and impulsivity have been less studied, and findings have been equivocal. This may be due, in part, to varying operationalizations of "impulsivity," as well as issues related to the lumping versus splitting of various depressant substances when assessing use. The effect of gender on the impulsivity-depressant use relation has also yielded mixed results and remains understudied. The current study sought to determine whether lumping versus splitting of depressant substances and distinct impulsivity-related dispositions, as well as participant gender, impact the depressant-impulsivity relation.

METHOD

Participants were 778 undergraduate students (72% female, 80% White, 23% Hispanic), who completed a battery of self-report assessments online, including the UPPS-P.

RESULTS

Hierarchical linear models indicated that specific impulsive dispositions differentiated between users and non-users of specific depressant substances, and these relations varied by gender. For example, sensation seeking significantly differentiated between users and non-users of pain relievers for females only, whereas sensation seeking differentiated between users and non-users of tranquilizers among males but not females.

CONCLUSIONS

In addition to informing substance use research practices by providing evidence that lumping of depressant substances leads to loss of vital information, as well as demonstrating nuanced gender differences, findings can also inform screening and personality-targeted treatment practices.

Psychodynamic Observations on the Side Effects Induced by Neuroleptics

It has been pointed out above that every side effect produced by neuroleptics is invested with a psychodynamic significance in relation to the evolution of the psychosis. This side effect can, independently from its neurobiochemical cause, momentaneously act in a favourable or unfavourable way on the course of the disease. Moreover, the patient's attitude during the follow-up will be conditioned by what he experienced when he took the drug, for schizophrenics can generally establish no cause and effect relation between the absorption of a drug and their improvement.

It is therefore important to assess, for every patient, the way in which he experiences side effects at different stages of the treatment, in order to correct them or not, according to whether they are psychologically noxious or beneficial.

This empirical line is defensible on the grounds that a review of the various viewpoints now prevailing on the role of neurologic symptoms provoked by neuroleptics, shows that there is no agreement on their therapeutic value and that everyone tries, in fact, to correct them without compromising the efficacy of these drugs.

Étude Comparative de la Butapérazine et de la Prochlorpérazine Chez le Schizophrène Chronique

A comparative double-blind trial of butaperazine and prochlorperazine was carried out in 40 chronic schizophrenic patients. Subjects were matched in 20 pairs according to sex, age, duration of hospitalization, staff, ward and score on the B.P.R.S. Drugs were randomly allocated within each pair of patients and their effects evaluated according to the B.P.R.S. Posology was progressively increased up to 200 mg. daily but remained always equal for all patients. Results were analysed by non-parametric statistics for the B.P.R.S. and by an χ2 test for the global evaluation.

Butaperazine and prochlorperazine showed a significant therapeutic efficacy throughout the twelve-week period. At the fourth and tenth week, prochlorperazine was significantly superior to butaperazine. However, at the twelfth week there was no significant difference in the efficacy of both drugs, as measured by the B.P.R.S. and the global evaluation. Beyond 100 mg. daily of both drugs a plateau was reached which higher doses did not influence.

Side effects made their appearance sooner with butaperazine but at the end of the trial the frequency of side effects was comparable with both drugs.

A highly significant positive correlation between raters adds weight to our results*.

Withdrawal of Long-Term Phenothiazines from Chronically Hospitalized Psychiatric Patients

A study was conducted of the effect of substituting placebo medication for active phenothiazine medication under double-blind conditions, in a population of chronically hospitalized psychotic patients who had all been undergoing long-term phenothiazine treatment. Behavioural change was assessed monthly by psychiatric nurses using a ward behaviour inventory, which had been specially constructed to be sensitive to kinds of behaviour likely to affect the clinical prescription of phenothiazines.

At the fifth month of the study, differences were noted between the placebo-substituted group and a control group continuing to receive their originally-prescribed phenothiazine compounds. Significant worsening in the Placebo group did not appear until the fifth monthly rating, and at that time significant improvement in the control (medication unchanged) group also first became evident. These results support the hypothesis that the continued long-term use of phenothiazine compounds in chronically-hospitalized psychotics is effective in the sustained reduction of psychopathological behaviour.

An investigation of trifluoperazine and chlorprothixene within the same double-blind design indicated that both were significantly more effective than placebo in maintaining the behavioural level typical of the prior long-term medication with phenothiazines.

Using the FPN test as one measure of the time course of urinary excretion of some of the phenothiazine metabolites, no relationship was demonstrated in the placebo-substituted group between FPN changes and behavioural worsening. The FPN test, rated blind, was able to discriminate the placebo-substituted group from the group continuing to receive their usual phenothiazines; as a single measure of the time course of urinary excretion of phenothiazine metabolites, however, FPN changes were not related to behavioural worsening within the placebo-substituted group.

[Consumption of alcohol and other drugs by the active population in Spain]

OBJECTIVE

To describe consumption patterns of alcohol and other drugs in the active population in Spain by gender.

METHODS

Based on 15,082 active persons selected from the Domiciliary Survey of Alcohol and Drugs (Encuesta Domiciliaria de Alcohol y Drogas [EDADES]) 2007, we estimated prevalences for high-risk alcohol consumption (>50 g/day in males, >30 g/day in females), daily intake of tranquilizers, cannabis consumption in the last 30 days, and consumption of any other illegal drug in the last 12 months, by employment status, economic sector and occupational categories. Odds ratios (OR) and their confidence intervals (95% CI) were estimated by logistic regression models.

RESULTS

The following prevalences were found: high-risk alcohol consumption, 3.4%; daily use of tranquilizers, 2.3%; cannabis consumption in the last 30 days, 7.9%; and consumption of any illegal drug in the last 12 months, 11.9%. Except for tranquilizer use, prevalences were higher in men than in women. Consumption of tranquilizers (OR = 1.68; 95%CI: 1.04-2.73), cannabis and other illegal drugs were all higher in unemployed men than in employed men, while only tranquilizer consumption was higher in unemployed women (OR = 1.70; 95% CI: 1.23-2.34). High-risk alcohol consumption was greater among men engaged in the catering, primary production and construction sectors in comparison to manufacturing industries: OR = 1.63 (95% CI: 1.11-2.38), OR = 1.52 (95% CI: 1.04-2.20), and OR = 1.50 (95% CI: 1.10-2.04), respectively. For women, those in catering showed higher consumptions of cannabis (OR = 2.34; 95% CI: 1.28-4.27) and of other illegal drugs (OR = 2.85; 95% CI: 1.71-4.76); the latter were also higher in commerce, transport and administration sectors than in manufacturing industries.

CONCLUSIONS

These findings could serve as a useful reference for companies wanting to carry out preventive programs, and also for future studies assessing the impact of preventive measures.

Prevalences of illicit drug use in people aged 50 years and over from two surveys

BACKGROUND

little is known about illicit drug use in older people. Prevalences may rise as populations for whom illicit drug use has been more common and acceptable become older.

OBJECTIVES

to quantify illicit drug use in people aged 50 years and over in England and inner London and to compare this between 50 and 64 and 65+ age groups.

METHODS

primary analyses used data from the 2007 Adult Psychiatric Morbidity Survey (APMS) and the 2008-10 South East London Community Health (SELCoH) Survey. Secondary analyses included additional data on 50-64 year olds from the 1993, 2000 and 2007 APMS, and on 65-74 year olds from the 2000 and 2007 APMS.

RESULTS

cannabis was the drug most commonly used in all samples. Prevalences of use within the last 12 months in 50-64 and 65+ age groups were 1.8 and 0.4%, respectively, in England and 9.0 and 1.1%, respectively, in inner London. Prevalences of use at any time previously were 11.4, 1.7, 42.8 and 9.4%, respectively. Lifetime cannabis, amphetamine, cocaine and LSD use in 50-64 year olds had increased approximately tenfold in England from 1993. Lifetime and 12-month trends in tranquilisers were relatively stable.

CONCLUSIONS

use of some illicit drugs, particularly cannabis, has increased rapidly in mid- and late-life.

Note on derivatives of 2,5-diphenylfuran

Aminoalkyl derivatives of 2,5-diphenylfuran have been prepared and shown to be general central nervous system depressants.

Prescription drugs purchased through the internet: who are the end users?

Although prescription drugs are readily available on the Internet, little is known about the prevalence of Internet use for the purchase of medications without a legitimate prescription, and the characteristics of those that obtain non-prescribed drugs through online sources. The scientific literature on this topic is limited to anecdotal reports or studies plagued by small sample sizes. Within this context, the focus of this paper is an examination of five national data sets from the U.S. with the purpose of estimating: (1) how common obtaining prescription medications from the Internet actually is, (2) who are the typical populations of "end users" of these non-prescribed medications, and (3) which drugs are being purchased without a prescription. Three of the data sets are drawn from the RADARS (Researched Abuse Diversion and Addiction-Related Surveillance) System, a comprehensive series of studies designed to collect timely and geographically specific data on the abuse and diversion of a number of prescription stimulants and opioid analgesics. The remaining data sets include the National Survey on Drug Use and Health (NSDUH) and the Monitoring the Future (MTF) survey. Our analysis yielded uniformly low rates of prescription drug acquisition from online sources across all five data systems we examined. The consistency of this finding across very diverse populations suggests that the Internet is a relatively minor source for illicit purchases of prescription medications by the individual end-users of these drugs.

Is the use of hypnotics, sedatives and minor tranquilizers really a major health problem?

An analysis has been made of individual purchases of hypnotics, sedatives and minor tranquilizers made during 1973 by patients who had bought such drugs either only once (group S, n= 417) or regularly (group R, n=76) during a 16-month period five years earlier from pharmacies in the town of Ostersund, county of Jmtland, Sweden. By 1973, 17% of the patients in each group had either died or moved out of the country and were therefore excluded from the comparison. In group S, 81 patients (23%) bought the above drugs once or more in 1973, while the corresponding figure for group R was 55 (87%). Compared with 1968-69, there was a decrease in the number of prescriptions and also in the number of tablets obtained per individual. Furthermore, the number of tablets per prescription was lower in 1973. Among the drugs prescribed, benzodiazepines dominated during both periods, followed by barbiturates. In 1973 there was a substantial increase in the use of nitrazepam, mostly at the expense of diazepam and combined products. One patient in group S and one in group R showed a tendency to decrease the interval between purchases. The latter was already known to be a drug abuser five years earlier. Without knowing the reason why the drugs were prescribed and to what extent they were actually taken, it is impossible to say whether the other patient should be classified as drug abuser or not. Although the number of patients in this study is limited, it might be concluded that the risk of an occasional user of hypnotics, sedatives and minor tranquilizers living in this area becoming an abuser of such drugs within a five-year period is less than 1/345.

The nonmedical use of prescription drugs by adolescents

The abuse of prescription drugs such as opioids, stimulants, tranquilizers, and sleeping pills is the fastest-growing class of drugs being abused by adolescents. Among this class of drugs, prescription opioids are being abused the most, although the abuse of prescription stimulants has been studied the most. There is a paucity of information on the nonmedical use of tranquilizers and sleeping pills. In this article we will discuss the specific prescription drugs that are most commonly abused by adolescents and how physicians need to be cautious when prescribing these drugs. The issue of screening for the abuse of these drugs will be addressed, as will the importance of parents' monitoring the use of these drugs by their own children.

Trends in prescription drug abuse and dependence, co-occurrence with other substance use disorders, and treatment utilization: results from two national surveys

OBJECTIVES

This study examined trends in prescription drug abuse and dependence (sedatives, tranquilizers, opioids, and stimulants), co-occurrence with other substance use disorders and substance abuse treatment utilization among those with diagnoses of prescription drug abuse and dependence in two large, nationally representative, independent samples of adults in the United States in 1991-1992 and 2001-2002.

METHODS

Two nationally representative cross-sectional samples of civilian non-institutionalized adults 18 years or older in the United States, of which 52% were women. Data were collected from structured diagnostic interviews using the NIAAA Alcohol Use Disorder and Associated Disabilities Interview Schedule: Diagnostic and Statistical Manual version IV (DSM-IV). National prevalence estimates were derived from the 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (n = 42,862) and the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093).

RESULTS

The past-year prevalence of prescription sedative abuse, sedative dependence, opioid abuse, and opioid dependence increased from 1991-1992 to 2001-2002. The majority of individuals with past-year sedative (56.8%), tranquilizer (89.0%), stimulant (67.9%) and opioid (74.2%) use disorders also met DSM-IV criteria for an additional past-year substance use disorder. The co-occurrence of several forms of prescription drug use disorders and other substance use disorders increased from 1991-1992 to 2001-2002. A minority of individuals with past-year prescription drug abuse and approximately one-half of those with past-year prescription drug dependence utilized substance abuse treatment.

CONCLUSIONS

The findings reinforce the importance of continued national monitoring based on the increases in prescription drug abuse and dependence, high co-occurrence with other substance use disorders, and underutilization of substance abuse treatment services.