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Lagzi N, Bateni A, Goli R, Talebiazar N. The effect of multivitamins on anxiety and depression in patients undergoing methadone maintenance treatment: A double-blind randomized controlled trial. Int J Psychiatry Med 2023; 58:576-590. [PMID: 37256965 DOI: 10.1177/00912174231179320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The prevalence of addiction is increasing in the world. Methadone Maintenance Treatment (MMT) can be associated with severe stress and mild to moderate depressive symptoms. Vitamins and minerals are commonly found in multivitamins seem to improve mood. Therefore, the aim of this study was to evaluate the effect of multivitamins on anxiety and depression in patients undergoing MMT in a double-blind randomized controlled trial. METHODS The study was designed as a double-blind, randomized controlled trial and involved 70 male MMT patients over the age of 18. Participants were randomized to one of two groups, either those receiving multivitamins or those receiving a placebo for 12 weeks. The multivitamin capsule included vitamin E, B1, B2, B3, B5, B6, B12, C, biotin, folic acid, and zinc. Anxiety and depression were measured using standard questionnaires, before and after the intervention. RESULTS The between-group comparison (i.e., intervention vs. placebo) indicated there was no significant difference in anxiety scores; however, there was a significant between-group difference in depression scores, favoring the intervention group. CONCLUSIONS Multivitamin supplementation improved depression but did not have a significant impact on anxiety in patients undergoing MMT.
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Affiliation(s)
- Negar Lagzi
- Department of Community Medicine, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Amin Bateni
- Department of Community Medicine, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Rasoul Goli
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
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Winiker AK, Heidari O, Pollock S, Sodder S, Tobin K. Barriers to Assessing and Treating Trauma in Primary Care and Opportunities for Improvement: Perspectives from Prescribers of Medications for Opioid Use Disorder. Subst Use Misuse 2023; 58:1651-1659. [PMID: 37495397 PMCID: PMC10758239 DOI: 10.1080/10826084.2023.2238301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Background: Medication for Opioid Use Disorder (MOUD) is a best practice for treating individuals with opioid use disorder (OUD), and primary care-based MOUD management can reduce treatment barriers among OUD patients. Individuals with OUD experience disproportionately high rates of trauma and violence, highlighting the importance of addressing trauma, mental health, and substance use concurrently. However, clear guidelines for trauma-informed treatment in a primary care setting remain poorly established. Methods: A qualitative approach was engaged to explore primary care providers' perceptions of barriers and facilitators to assessing and treating trauma among MOUD patients. Twenty in-depth interviews were conducted in 2021 with Baltimore-based MOUD prescribers, including primary care physicians and nurse practitioners. Interview questions assessed experiences with identifying and treating trauma among MOUD patients, including challenges and opportunities. Results: Providers reported extensive histories of trauma experienced by MOUD patients. Barriers to addressing trauma include a lack of standardized protocols/procedures for identifying trauma, insufficient training/time to assess and treat trauma, and the limited availability of external mental health providers and specialty services. Opportunities included building strong, mutually respectful patient-provider relationships, providing individualized, person-centered care, and establishing connections to coordinated multidisciplinary treatment networks. Conclusions: MOUD treatment within primary care is an important way to increase OUD treatment access, but clearer standards are needed for the treatment of trauma within this patient population. These findings demonstrate opportunities to improve standards and systems such that primary care providers are better equipped to assess and treat the complex histories of trauma experienced by individuals with OUD.
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Affiliation(s)
- Abigail K. Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Omeid Heidari
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Sarah Pollock
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Shereen Sodder
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Karin Tobin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
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Padoei F, Mamsharifi P, Hazegh P, Boroumand H, Ostadmohammady F, Abbaszadeh-Mashkani S, Banafshe HR, Matini AH, Ghaderi A, Dehkohneh SG. The therapeutic effect of N-acetylcysteine as an add-on to methadone maintenance therapy medication in outpatients with substance use disorders: A randomized, double-blind, placebo-controlled clinical trial. Brain Behav 2023; 13:e2823. [PMID: 36448959 PMCID: PMC9847617 DOI: 10.1002/brb3.2823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/20/2022] [Accepted: 11/01/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Patients with substance use disorders (SUD) under methadone maintenance therapy (MMT) are susceptible to a number of complications (psychological and metabolic disorders). Evidence studies have shown the roles of the glutamatergic system in addiction. N-Acetylcysteine (NAC) enhances extracellular glutamate, and is effective in the treatment of neuropsychiatric disorders. We assessed oral NAC as an add-on to MMT medication for the treatment of SUD. METHODS In the current randomized, double-blind, placebo-controlled clinical trial, outpatients with SUD under MMT who were 18-60 years old received 2400 mg/day NAC (n = 30) or placebo (n = 30) for 12 weeks. Psychological status and metabolic biomarkers were assessed at baseline and the end of the trial. RESULTS Compared with the placebo group, NAC treatment resulted in a significant improvement in depression score (β -2.36; 95% CI, -3.97, -0.76; p = .005), and anxiety score (β -1.82; 95% CI, -3.19, -0.44; p = .01). Furthermore, NAC treatment resulted in a significant elevation in total antioxidant capacity levels (β 72.28 mmol/L; 95% CI, 11.36, 133.19; p = .02), total glutathione (GSH) levels (β 81.84 μmol/L; 95% CI, 15.40, 148.28; p = .01), and a significant reduction in high-sensitivity C-reactive protein levels (β -0.89 mg/L; 95% CI, -1.50, -0.28; p = .005), and homeostasis model of assessment-insulin resistance (β -0.33; 95% CI, -0.65, -0.009; p = .04), compared with the placebo group. CONCLUSION In the current study, improvement in depression and anxiety symptoms as well as some metabolic profiles with NAC treatment for 12 weeks in outpatients with SUD under MMT was detected.
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Affiliation(s)
- Fateme Padoei
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Peyman Mamsharifi
- Department of Psychology, Allameh Tabataba'i University, Tehran, Iran
| | - Pooya Hazegh
- Department of Psychiatry, Kashan University of Medical Sciences, Kashan, Iran
| | - Homa Boroumand
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | | | | | - Hamid Reza Banafshe
- Physiology Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Amir Hassan Matini
- Department of Clinical Pathology, Kashan University of Medical Sciences, Kashan, Iran
| | - Amir Ghaderi
- Department of Addiction studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran.,Clinical Research Development Unit-Matini/Kargarnejad Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Somayeh Ghadami Dehkohneh
- Department of Pharmacy, Acharya BM ready college of Pharmacy, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India
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The Effects of Comorbid Disordered Eating Behaviours on Outcomes at Follow-up from Residential Substance Use Disorder Treatment: a Latent Class Approach. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00975-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Jomehpour H, Pouriran MA, Heydari Yazdi AS, Baghban Haghighi M, Dastgheib MS, Omidvar-Tehrani S, Talaei A. Comparison of Psychopathologic Characteristics between Individuals Undergoing Methadone Maintenance Treatment, Opioid Dependents, and Control Group. ADDICTION & HEALTH 2022; 14:256-262. [PMID: 37559787 PMCID: PMC10408755 DOI: 10.34172/ahj.2022.1334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/12/2022] [Indexed: 08/11/2023]
Abstract
BACKGROUND Methadone maintenance treatment (MMT) can theoretically reduce the psychosocial harms of opioid dependency. The increasing number of MMT clinics in Iran during the last two decades was not accompanied by a reduction in addiction rates. Therefore, this study was conducted to compare the psychopathological characteristics of individuals on MMT, opioid dependents, and a control group in the Iranian population. METHODS This cross-sectional study was conducted in Mashhad to evaluate the psychopathological profile of 99 participants (33 opioid-dependent individuals [ODI], 33 MMT clients, and 33 controls) using the Symptom Checklist-90-Revised (SCL-90-R) questionnaire and demographic form. Parametric and non-parametric tests were used to compare the mean score of symptoms between the three groups. The Spearman correlation test was used to test the correlation of psychological features with age and dependency duration. FINDINGS There was no significant difference between MMT clients and ODI regarding the Global Severity Index (GSI) and nine items of the SCL-90-R questionnaire. However, a significant difference was found between the controls and two other groups (P<0.001). Paranoid ideation in the ODI was more frequent compared to MMT clients significantly (P=0.015). Psychological characteristics had a direct correlation with dependency duration and an inverse correlation with age (P<0.05). CONCLUSION Psychopathologic features observed in the dependent patients and MMT clients were significantly higher than in the control group. It seems that the psychopathology profile in MMT clients was not better than dependent individuals in Iran.
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Affiliation(s)
- Hamid Jomehpour
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mohammad Amin Pouriran
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aazam Sadat Heydari Yazdi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehri Baghban Haghighi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masume Sadat Dastgheib
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sahar Omidvar-Tehrani
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Talaei
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Antoniou T, McCormack D, Tadrous M, Juurlink DN, Gomes T. The Risk of Ventricular Dysrhythmia or Sudden Death in Patients Receiving Serotonin Reuptake Inhibitors With Methadone: A Population-Based Study. Front Pharmacol 2022; 13:861953. [PMID: 35517813 PMCID: PMC9065276 DOI: 10.3389/fphar.2022.861953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Methadone is associated with ventricular dysrhythmias and sudden death. Serotonin reuptake inhibitors (SRIs) may increase the risk of these events either by inhibiting metabolism of methadone’s proarrhythmic (S)-enantiomer, additive QT interval prolongation, or both. We sought to determine whether certain SRIs were associated with a higher risk of methadone-related ventricular dysrhythmias or sudden death. Methods: We conducted a nested case-control study of Ontario residents receiving methadone between April 1, 1996 and December 31, 2017. Cases, defined as patients who died of sudden cardiac death or were hospitalized with a ventricular dysrhythmia while on methadone, were matched with up to four controls who also received methadone on age, sex, and a disease risk score. We determined the odds ratio (OR) and p-value functions for the association between methadone-related cardiotoxicity and treatment with SRIs known to inhibit metabolism of (S)-methadone (paroxetine, fluvoxamine, sertraline) or prolong the QT interval (citalopram and escitalopram). Patients who were not treated with an SRI served as the reference group. Results: During the study period, we identified 626 cases and 2,299 matched controls. Following multivariable adjustment, we found that recent use of sertraline, fluvoxamine or paroxetine (adjusted OR 1.30; 95% confidence intervals [CI] 0.90–1.86) and citalopram and escitalopram (adjusted OR 1.26; 95% CI 0.97–1.63) were associated with small increases in the risk methadone-related cardiac toxicity, an assertion supported by the corresponding p-value functions. Interpretation: Certain SRIs may be associated with a small increase in cardiac toxicity in methadone-treated patients.
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Affiliation(s)
- Tony Antoniou
- Department of Family and Community Medicine, Unity Health Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | | | - Mina Tadrous
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada
| | - David N Juurlink
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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7
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Vold JH, Løberg EM, Aas CF, Steier JA, Johansson KA, Fadnes LT. Prevalence and correlates of suicide attempts in high-risk populations: a cross-sectional study among patients receiving opioid agonist therapy in Norway. BMC Psychiatry 2022; 22:181. [PMID: 35291968 PMCID: PMC8922793 DOI: 10.1186/s12888-022-03829-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Death by suicide in patients enrolled in opioid agonist therapy (OAT) is a major clinical concern. However, little knowledge exists regarding suicide attempts in this patient group. This study presents the lifetime prevalence of suicide attempts and the associations between suicide attempts and clinical and sociodemographic variables such as education, sex, early onset of substance use (< 13 years of age), substance use patterns, and injecting substance use among patients receiving OAT. METHODS We used data from a cohort of OAT patients in Norway obtained from a health assessment of self-reported suicide attempts and sociodemographic and clinical factors. A total of 595 patients receiving OAT were assessed from 2016 to 2020. A binary logistic regression analysis was performed and reported with an unadjusted odds ratio and 95% confidence intervals (OR). The purpose of this assessment was to analyze associations between suicide attempts and substance use patterns as well as the injection of substances during the 30 days leading up to the health assessment. A negative binomial regression analysis with an incidence rate ratio and 95% confidence intervals (IRR) was performed to investigate sex, education, early onset of substance use, and the number of suicide attempts. RESULTS Forty-one percent of the OAT patients had attempted to die by suicide at least once during their lifetime. An early onset of substance use was strongly associated with the suicide attempts (IRR: 1.7, 1.3-2.2). No significant association was found between suicide attempts and sex (IRR: 1.2, 0.9-1.6) or education (IRR: 0.6, 0.2-2.1). Likewise, no association was identified between suicide attempts and injecting substance use (OR: 0.9, 0.6-1.3), nor using alcohol (OR: 0.9, 0.7-1.3), amphetamines (OR: 1.0, 0.7-1.3), benzodiazepines (OR: 1.0, 0.7-1.4), cannabis (OR: 1.2, 0.9-1.7), cocaine (OR: 1.3, 0.6-3.0), or opioids (OR: 1.4, 0.9-2.0). CONCLUSION The lifetime prevalence of suicide attempts was alarmingly high in the OAT population. An early onset of substance use seemed to be an important risk factor for suicide attempts. There was a non-significant association to more current use of opioids among OAT patients with previous suicide attempts.
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Affiliation(s)
- Jørn Henrik Vold
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. .,Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.
| | - Else-Marie Løberg
- grid.412008.f0000 0000 9753 1393Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Department of Psychiatry, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Christer F. Aas
- grid.412008.f0000 0000 9753 1393Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jan Alexander Steier
- grid.412008.f0000 0000 9753 1393Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Kjell Arne Johansson
- grid.412008.f0000 0000 9753 1393Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- grid.412008.f0000 0000 9753 1393Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Molavi N, Rasouli-Azad M, Mirzaei H, Matini AH, Banafshe HR, Valiollahzadeh M, Hassanzadeh M, Saghazade AR, Abbaszadeh-Mashkani S, Mamsharifi P, Ghaderi A. The Effects of Probiotic Supplementation on Opioid-Related Disorder in Patients under Methadone Maintenance Treatment Programs. Int J Clin Pract 2022; 2022:1206914. [PMID: 35685534 PMCID: PMC9159114 DOI: 10.1155/2022/1206914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/11/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Patients under methadone maintenance treatment programs (MMTPs) are susceptible to numerous complications (e.g., mental and metabolic disorders). This study evaluated the effects of probiotics on clinical symptoms, biomarkers of oxidative stress, inflammation, insulin resistance, and serum lipid content in patients receiving MMTPs. MATERIALS AND METHODS A randomized, double-blind, placebo-controlled trial was conducted among 70 patients receiving MMTPs to receive either 1.8 × 109 CFU/day probiotics (n = 35) or placebo (n = 35) for 12 weeks. Clinical symptoms and metabolic profiles were measured before and after the intervention in patients receiving MMTPs. RESULTS Compared with the placebo group, probiotic supplementation resulted in a significant improvement in the severity of depression (P < 0.05). In addition, probiotic administration significantly decreased fasting plasma glucose (FPG), total cholesterol, and low-density lipoprotein cholesterol (LDL cholesterol) (P < 0.05). Furthermore, probiotics resulted in a significant reduction in high-sensitivity C-reactive protein (hs-CRP) and a significant elevation in total antioxidant capacity (TAC) and total glutathione (GSH) levels (P < 0.05). CONCLUSION Treatment with probiotics for 12 weeks to patients receiving MMTPs had beneficial effects on symptoms of depression, as well as several metabolic profiles. Clinical Trial Registration: this study was registered in the Iranian website (https://www.irct.ir) for clinical trials registration (https://fa.irct.ir/trial/46363/IRCT20170420033551N9). The registration date is March 22, 2020.
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Affiliation(s)
- Nader Molavi
- Department of Addiction Studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran
| | - Morad Rasouli-Azad
- International Center for Comparative Criminology, University of Montreal, Montreal, Canada
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Amir Hassan Matini
- Department of Clinical Pathology, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamid Reza Banafshe
- Department of Addiction Studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran
- Physiology Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Majid Hassanzadeh
- Department of Addiction Studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran
| | - Ahmad Reza Saghazade
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samira Abbaszadeh-Mashkani
- Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | - Peyman Mamsharifi
- Department of Psychology, Allameh Tabataba'i University, Tehran, Iran
| | - Amir Ghaderi
- Department of Addiction Studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran
- Clinical Research Development Unit-Matini/Kargarnejad Hospital, Kashan University of Medical Sciences, Kashan, Iran
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Jomehpour H, Aghayan S, Khosravi A, Afzaljavan F. The Effect of Krocina™ on Decreasing Substance User Withdrawal Syndrome, Craving, Depression and Stress: A Double-Blind Randomized Parallel Clinical Trial. Subst Use Misuse 2022; 57:613-620. [PMID: 35068330 DOI: 10.1080/10826084.2022.2026968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Due to the association between substance use abstinence with some psychological syndromes, the use of herbal medicines such as Crocus sativus L. have been considered as a proper approach to controlling withdrawal syndrome. The present study aimed to identify the effect of Krocina™ in reducing withdrawal symptoms, craving, depression, stress, anxiety and durability of treatment in the detoxification period and abstinence phase. METHODS In a double-blind randomized parallel clinical trial, 72 opioid users passing the detoxification period who were referred to the Soroush Center during 2020, randomly categorized into the two groups. Motivational interviewing sessions and 15 mg of Krocina™ twice a day were provided for six weeks for the cases. The placebo group received pills with the same coating and motivational interviewing. Withdrawal symptoms, craving, depression, stress and anxiety were assessed at the start of the study and then weekly using the Clinical Opiate Withdrawal Scale, Obsessive-Compulsive Drug Use Scale, and the Depression Anxiety Stress Scales-21, respectively. SPSS-v16 was used for statistical analyses. RESULTS Drug withdrawal symptoms and craving did not indicate a significant difference by Krocina™ intervention during the time (p > 0.05). Furthermore, depression, stress and anxiety were statistically similar between Krocina™ and placebo groups (p > 0.05). Moreover, we found similar findings between the two groups when analyzing only patients with negative urinary test (F = 0.03;p = 0.86). CONCLUSION Our finding rejected the effectiveness of 30 mg/day of Krocina™ for six weeks as an effective substance for decreasing withdrawal symptoms, craving, depression, anxiety and stress at the detoxification period and abstinence phase.
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Affiliation(s)
- Hamid Jomehpour
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Shahrokh Aghayan
- Sexual Health and Fertility Research center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Ahmad Khosravi
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran; Ophthalmic Epidemiology Research Centre, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Fahimeh Afzaljavan
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Medical Genetics and Molecular Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Wahab S, Chun Keat T, Azmi AD, Mahadevan R, Muhamed Ramli ER, Kian Boon L. Risk of Depression Among MMT Patients: Does Coping Strategies and Perceived Social Support Play a Role? Subst Abuse 2021; 15:11782218211049407. [PMID: 34658621 PMCID: PMC8516374 DOI: 10.1177/11782218211049407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/31/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Patients receiving methadone maintenance therapy (MMT) experience higher level of stress and are at greater risk of developing mental health problems such as depression which could potentially affect both quality of life and treatment outcomes. This cross-sectional study is aimed at understanding the relationship between psychosocial factors such as social support, coping, and depression among patients receiving MMT in a Malaysian Hospital. METHODS One hundred and ninety-six patients attending MMT program were recruited. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for depression, Multidimensional Scale of Perceived Social Support (MSPSS) was used to assess participants' perceived social support, and the Brief COPE questionnaire was used to assess coping strategies. The diagnosis of depression was made using Mini-International Neuropsychiatric Interview (MINI). RESULTS About 13.8% of our sample were diagnosed with depression. From our analysis, it was found that having higher levels of perceived social support (OR = 0.462, 95% CI 0.238-0.899, P < .05), the use of active and emotion focused coping mechanism (OR = 0.231, 95% CI 0.095-0.565, P < .005), and support seeking and self-distraction coping mechanism (OR = 0.196, 95% CI 0.074-0.521, P < .001) was associated with lower likelihood of depression. On the contrary, the use of dysfunctional coping strategies such as denial, behavioral disengagement, and self-blame was associated with increased likelihood of depression (OR = 9.384, 95% CI 3.081-28.581, P < .001). CONCLUSION Active and emotion focused along with support and self-distraction coping strategies, and higher levels of perceived social support may serve as a buffer against depression in patients receiving MMT.
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Affiliation(s)
- Suzaily Wahab
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Tee Chun Keat
- Department of Psychiatry, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
| | - Amirul Danial Azmi
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Raynuha Mahadevan
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | | | - Law Kian Boon
- Institute for Clinical Research, Ministry of Health, Shah Alam, Selangor, Malaysia
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Simpson KA, Gevorgian H, Kral AH, Wenger L, Bourgois P, Bluthenthal RN. Prevalence and predictors of recent temporary psychiatric hold among a cohort of people who inject drugs in Los Angeles and San Francisco, California. Drug Alcohol Depend 2021; 227:108916. [PMID: 34358770 PMCID: PMC8464528 DOI: 10.1016/j.drugalcdep.2021.108916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/11/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
California's Welfare and Institutions code 5150 allows for a temporary psychiatric hold (TPH) of individuals who present a danger to themselves or others and/or may be gravely disabled due to mental illness. Little is known about the frequency and predictors of involuntary holds among people who inject drugs (PWID). METHODS We sought to identify the prevalence and predictors of recent TPHs (within the past 12 months) among a community-recruited sample of PWID in Los Angeles and San Francisco, California during 2017-2018 (N = 531). Multivariable logistic regression modeling was used to evaluate demographic (e.g., age), economic (e.g., homelessness), drug use (e.g., types of drugs used), incarceration (e.g., recent arrest history) and mental health (e.g., lifetime mental health diagnosis) variables associated with recent TPH. RESULTS Age (40-49 years old vs age 50 or older: AOR = 5.85; 95 % CI = 2.18, 15.67), current homelessness (AOR = 3.75; 95 % CI = 1.28, 11.0), lifetime mental health history (AOR = 6.23; 95 % CI = 2.08, 18.66), and frequency of methamphetamine use (AOR = 1.01; 95 % CI = 1.00, 1.01) were statistically associated with increased odds of having experienced a TPH, while frequency of past month heroin/opioid use was associated with decreased odds of reporting a TPH (AOR = 0.99; 95 % CI = 0.99, 1.00) in multivariable analysis. CONCLUSIONS Diverse factors were associated with TPH among PWID. Our analysis underscores the need for research on PWID with co-occurring substance-use and mental illness disorders and homelessness. There is urgent need for expanding access to lower barrier publicly funded mental health treatment from a harm-reduction approach.
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Affiliation(s)
- Kelsey A Simpson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, 2001 N Soto Street, Los Angeles, CA, 90089, USA.
| | - Hrant Gevorgian
- Rutgers Health Community Medical Center, 99 Route 37 West, Toms River, NJ, 08755, USA
| | - Alex H Kral
- Community Health Research Division, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA
| | - Lynn Wenger
- Community Health Research Division, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA
| | - Philippe Bourgois
- Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Ricky N Bluthenthal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, 2001 N Soto Street, Los Angeles, CA, 90089, USA
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Metzger L, Teitelbaum M, Weber G, Kumaraswami S. Complex Pathology and Management in the Obstetric Patient: A Narrative Review for the Anesthesiologist. Cureus 2021; 13:e17196. [PMID: 34540424 PMCID: PMC8439398 DOI: 10.7759/cureus.17196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/20/2022] Open
Abstract
Pregnant patients may present with multiple complex comorbidities that can affect peripartum management and anesthetic care. The preanesthesia clinic is the ideal setting for early evaluation of high-risk pregnant patients. Comorbidities may include cardiovascular pathology such as valvular abnormalities, septal defects, aortopathies, arrythmias and cardiomyopathies. Additional comorbidities include pulmonary conditions such as obstructive sleep apnea as well as preexisting neuromuscular and skeletal disorders that may impact anesthetic management. Hematologic conditions involving both bleeding diathesis and thrombophilias may present unique challenges for the anesthesiologist. Patients may also present with endocrinopathies including diabetes and obesity. While not as common, high-risk patients may also have preexisting gastrointestinal conditions such as liver dysfunction, renal failure, and even post-transplant status. Ongoing and prior substance abuse, obstetric conditions such as placenta accreta spectrum disorders, and fetal conditions needing ex utero Intrapartum treatment also require advanced planning. Preanesthesia evaluations also help address important ethical and cultural considerations. Counseling patients regarding anesthetic considerations as well as addressing concerns will play a role in reducing racial and ethnic disparities. Anticipatory guidance by means of pre-anesthetic planning can facilitate multidisciplinary communication and planning. This can allow for an impactful and meaningful role in the care provided, allowing for safe maternal care and optimal outcomes.
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Affiliation(s)
- Lia Metzger
- Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | | | - Garret Weber
- Anesthesiology, New York Medical College, Valhalla, USA
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Exploring the Effects of Vitamin D Supplementation on Cognitive Functions and Mental Health Status in Subjects Under Methadone Maintenance Treatment. J Addict Med 2021; 14:18-25. [PMID: 31145174 DOI: 10.1097/adm.0000000000000550] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Vitamin D deficiency may be linked to several mental complications including cognitive deficits, depression, and anxiety in patients under methadone maintenance treatment (MMT). This study was designed to explore the effect of vitamin D supplementation on cognitive functions and mental health parameters in subjects under MMT. METHODS This randomized, double-blinded, placebo-controlled clinical trial was carried out among 64 patients under MMT. Participants were randomly allocated to receive either 50,000 IU vitamin D supplements (n = 32) or placebo (n = 32) every 2 weeks for 24 weeks. Cognitive functions and mental health parameters were taken at baseline and posttreatment to evaluate relevant variables. RESULTS After the 24-week intervention, compared with the placebo, serum 25(OH) vitamin D levels significantly increased in participants who received vitamin D supplements (β 14.50; 95% confidence interval [CI], 13.17-15.83; P < 0.001). In addition, compared with the placebo, subjects who received vitamin D had a significant reduction in Iowa Gambling Task (β -6.25; 95% CI, -8.60 to -3.90; P < 0.001), and significant increases in Verbal Fluency Test (β 2.82; 95% CI, 0.78-4.86; P = 0.007), Immediate Logic Memory (β 1. 32; 95% CI, 0.27-2.37; P = 0.01), Reverse Digit Span (β 2.06; 95% CI, 1.18-2.94; P < 0.001) and visual working memory (β 0.75; 95% CI, 0.33-1.16; P = 0.001). Also, vitamin D supplementation significantly improved BDI (β -2.76; 95% CI, -3.97 to -1.55; P < 0.001) compared with the placebo. When we applied Bonferroni correction, LM-Immediate (P = 0.07) became nonsignificant, and other mental health parameters did not alter. CONCLUSIONS Overall, taking 50,000 IU vitamin D supplements every 2 weeks for 24 weeks by patients under MMT had beneficial effects on cognitive functions and some mental health parameters. Further studies are needed to confirm our findings.
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Rogers AH, Zvolensky MJ, Ditre JW, Buckner JD, Asmundson GJG. Association of opioid misuse with anxiety and depression: A systematic review of the literature. Clin Psychol Rev 2021; 84:101978. [PMID: 33515811 DOI: 10.1016/j.cpr.2021.101978] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/19/2020] [Accepted: 11/29/2020] [Indexed: 12/14/2022]
Abstract
The opioid epidemic is a public health problem associated with a host of negative outcomes. Although clinicians recognize covariation between opioid misuse with anxiety and depressive symptoms and disorders, research on this topic has only recently accumulated. Progress in this domain is impeded by the lack of systematic and integrative research to better understand and treat these co-occurring problems. This paper represents the first attempt to systematically review the empirical literature examining relations between opioid use and misuse, and anxiety and depression. In the first section, we define key terms and describe the article selection strategy. In the second section, we review the prevalence of anxiety and depressive symptoms among individuals who use and misuse prescription and illicit opioids. In the third section, we review the magnitude of associations between anxiety and depressive symptoms and disorders with opioid misuse, as well as highlight studies examining the longitudinal and temporal sequence of the relations between these variables. In the fourth section, we focus on experimental therapeutics, reviewing what is known about individual difference and transdiagnostic vulnerability factors for anxiety and depression that might contribute to opioid misuse and its symptoms. Finally, we discuss current knowledge gaps and present a heuristic model to guide future research.
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Affiliation(s)
- Andrew H Rogers
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, United States; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; HEALTH Institute, University of Houston, Houston, TX, United States.
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - Julia D Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
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Cao P, Zhang Z, Zhong J, Xu S, Huang Q, Fan N. Effects of treatment status and life quality on anxiety in MMT patients. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:9. [PMID: 33441176 PMCID: PMC7805232 DOI: 10.1186/s13011-021-00343-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/02/2021] [Indexed: 11/17/2022]
Abstract
Background Anxiety, an important factor that affects the therapeutic effect and preservation rate of methadone maintenance treatment, has a high prevalence among MMT patients. This study aims to investigate the effects of treatment status and life quality on anxiety in MMT patients. Methods One hundred and Seventy-seven methadone maintenance treatment users in Guangzhou, China were evaluated. The socio-demographic, duration and MMT-related characteristics were documented. Anxiety level and quality of life were evaluated by Beck Anxiety inventory (BAI) and the Quality of Life-Drug Addiction (QOL-DA) respectively. The correlation between different factors and BAI score was also analyzed. Results The BAI total score and the QOL-DA score were 7.1±8.2, 163.5±21.4 respectively. 30.5% of the subjects showed mild to severe anxiety. Treatment interruption and QOL-DA score had strong correlations with the score of BAI, with correlation coefficients of 0.17 and − 0.08 respectively. Conclusions Anxiety symptoms were commonly presented in MMT patients. Treatment interruption and quality of life are two major factors affecting anxiety of MMT patients.
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Affiliation(s)
- Penghui Cao
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong Province, China
| | - Zhaohua Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong Province, China
| | - Jun Zhong
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong Province, China
| | - Shichao Xu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong Province, China
| | - Qiaofang Huang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong Province, China
| | - Ni Fan
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong Province, China.
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Vold JH, Aas C, Skurtveit S, Odsbu I, Chalabianloo F, Reutfors J, Halmøy A, Johansson KA, Fadnes LT. Potentially addictive drugs dispensing to patients receiving opioid agonist therapy: a register-based prospective cohort study in Norway and Sweden from 2015 to 2017. BMJ Open 2020; 10:e036860. [PMID: 32771988 PMCID: PMC7418685 DOI: 10.1136/bmjopen-2020-036860] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES To compare the use of benzodiazepines, z-hypnotics, gabapentinoids, opioids and centrally acting stimulants (CAS) among patients who had received opioid agonist therapy (OAT) in Norway and Sweden during the period 2015 - 2017. DESIGN A register-based prospective cohort study using information about dispensed drugs from the Norwegian Prescription Database and Swedish Prescribed Drug Register. SETTING Patients who were dispensed OAT opioids from pharmacies. PARTICIPANTS A total of 7176 Norwegian and 3591 Swedish patients on OAT were included. OUTCOME MEASURES The number and frequency of potentially addictive drugs dispensed were calculated for the two countries. The mean daily doses of dispensed benzodiazepines and z-hypnotics were summarised by calculating benzodiazepines in diazepam equivalents and z-hypnotics in zopiclone equivalents. RESULTS In 2017, 46% of patients in Norway, and 15% in Sweden, were dispensed a benzodiazepine. Moreover, 14% in Norway and 26% in Sweden received z-hypnotics. Gabapentinoids were dispensed to 10% of patients in Norway and 19% of patients in Sweden. In Norway, 6% and 12% of the patients received strong and weak non-OAT opioids, respectively, whereas in Sweden 10% were dispensed strong non-OAT opioids and 5% weak non-OAT opioids . CAS were dispensed to 4% in Norway and 18% in Sweden. The mean daily doses of benzodiazepines were 16 and 17 mg diazepam equivalents in Norway and Sweden, respectively. For z-hypnotics, the mean daily dose was 8 mg zopiclone equivalents in both countries. 'Benzodiazepines and z-hypnotics' was the most dispensed drug combination in 2017. Similar results were found in 2015 and 2016. CONCLUSIONS Nearly half of those patients who were dispensed an OAT opioid in Norway and Sweden were dispensed potentially addictive drugs. The differences identified between Norway and Sweden might be related to differences in eligibility guidelines and restrictions with respect to OAT.
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Affiliation(s)
- Jørn Henrik Vold
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Christer Aas
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Svetlana Skurtveit
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Ingvild Odsbu
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fatemeh Chalabianloo
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Johan Reutfors
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anne Halmøy
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Kjell Arne Johansson
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Li Q, Chen S, Liu K, Long D, Liu D, Jing Z, Huang X. Differences in Gut Microbial Diversity are Driven by Drug Use and Drug Cessation by Either Compulsory Detention or Methadone Maintenance Treatment. Microorganisms 2020; 8:microorganisms8030411. [PMID: 32183228 PMCID: PMC7143234 DOI: 10.3390/microorganisms8030411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/01/2020] [Accepted: 03/11/2020] [Indexed: 12/11/2022] Open
Abstract
In this work, we investigate differences in gut microbial diversity driven by drug use or by the widely used methods for drug cessation: methadone maintenance treatment (MMT) and compulsory detention (CD). Methods: 99 participants (28 CD participants, 16 MMT patients, 27 drug users, and 28 healthy controls) were selected using strict inclusion criteria. Nutritional intake and gut microbial diversity were analyzed with bioinformatics tools and SPSS 20.0. Results: Alpha diversity was not significantly different among groups, whereas beta diversity of gut microbiota and nutrient intake were significantly higher among MMT patients. Taxa were unevenly distributed between groups, with drug users having the highest proportion of Ruminococcus and MMT patients having the highest abundance of Bifidobacterium and Lactobacillus. Conclusion: Drug use, cessation method, and diet contribute to shaping human gut communities. High beta diversity among MMT patients is likely driven by methadone use and high nutrient intake, leading to increased orexin A and enrichment for beneficial bacteria, while diversity in CD participants is largely influenced by diet.
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Affiliation(s)
- Qiaoyan Li
- School of Public Health, Lanzhou University, No. 222 TianshuiNanlu, Lanzhou 730000, China; (Q.L.); (S.C.); (K.L.); (D.L.); (D.L.)
| | - Siqi Chen
- School of Public Health, Lanzhou University, No. 222 TianshuiNanlu, Lanzhou 730000, China; (Q.L.); (S.C.); (K.L.); (D.L.); (D.L.)
| | - Ke Liu
- School of Public Health, Lanzhou University, No. 222 TianshuiNanlu, Lanzhou 730000, China; (Q.L.); (S.C.); (K.L.); (D.L.); (D.L.)
| | - Danfeng Long
- School of Public Health, Lanzhou University, No. 222 TianshuiNanlu, Lanzhou 730000, China; (Q.L.); (S.C.); (K.L.); (D.L.); (D.L.)
| | - Diru Liu
- School of Public Health, Lanzhou University, No. 222 TianshuiNanlu, Lanzhou 730000, China; (Q.L.); (S.C.); (K.L.); (D.L.); (D.L.)
| | - Zhengchao Jing
- Mengzi Center for Disease Prevention and Control, Mengzi 661199, China
- Correspondence: (Z.J.); (X.H.)
| | - Xiaodan Huang
- School of Public Health, Lanzhou University, No. 222 TianshuiNanlu, Lanzhou 730000, China; (Q.L.); (S.C.); (K.L.); (D.L.); (D.L.)
- Correspondence: (Z.J.); (X.H.)
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Engagement in treatment for depression among people who inject drugs in Baltimore, Maryland. J Subst Abuse Treat 2019; 106:107-112. [PMID: 31540605 DOI: 10.1016/j.jsat.2019.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/31/2019] [Accepted: 09/04/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Mental health care may mitigate negative consequences related to substance use and bolster engagement in care for drug dependence. Despite the increased risk of depression among people who inject drugs (PWID), the longitudinal relationship of depression symptoms with depression and drug treatment utilization in this population remains uncharacterized. METHODS Data on depressive symptoms and depression treatment from current and former PWID in the ALIVE (AIDS Linked to the IntraVenous Experience) community-based cohort who had ≥3 study visits from July 2005 to June 2016 were included. We used logistic regression analysis with generalized estimating equations to examine factors associated with depression treatment in the 12 months following reported major depressive symptoms (CES-D ≥ 23) in the absence of treatment. We further examined the association between depression, depression treatment, and subsequent engagement in drug treatment among those with active substance use or alcohol dependence. RESULTS Of the 1544 participants, 34% were female, the median age was 51 years, and 91% were African-American. PWID reported major depressive symptoms at 22% of study visits. In adjusted analysis, acute emergency care, suicidal ideation, and recent alcohol or drug treatment were positively associated with initiating depression treatment. Depression was positively associated with subsequent treatment for substance dependence among those actively using (aOR = 1.30, 95% CI: 1.10-1.53). CONCLUSIONS PWID experience a high burden of depressive symptoms with significant unmet need of treatment for depression. Our findings suggest that mental health providers should bolster connections to chronic disease and alcohol and drug treatment providers.
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Association between mental health service utilisation and sharing of injection material among people who inject drugs in Montreal, Canada. Addict Behav 2019; 96:175-182. [PMID: 31108263 DOI: 10.1016/j.addbeh.2019.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 05/04/2019] [Accepted: 05/10/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND High-risk injection behaviors are associated with high prevalence of mental health problems among people who inject drugs (PWID). However, whether the use of mental health services is associated with lower risk of sharing injection material remains undetermined. This study aims to examine the association between mental health service utilisation and receptive sharing risk, and determine the potential modifying effect of psychological distress on this association. METHODS Participants answered an interviewer-administered questionnaire at 3-month intervals gathering information on sociodemographic characteristics, substance use and related behaviors, services utilisation and significant mental health markers. Relationship between the use of mental health services and receptive sharing was modeled using the generalized estimating equation (GEE), controlling for age at baseline, gender, and other potential confounders. Psychological distress was estimated using the Kessler Psychological Distress Scale (K10). Effect modification was investigated by adding an interaction term in the univariate GEE analysis. RESULTS 358 participants contributed to 2537 visits (median age 40.3, 82% male). Mental health service utilisation was reported in 631 visits (25%), receptive sharing in 321 visits (13%) and severe psychological distress in 359 visits (14%). In multivariate GEE analyses, a significant association was identified between receptive sharing and the use of mental health services (aOR = 0.69; 95% CI = 0.50-0.94). We found no evidence of effect modification by psychological distress. CONCLUSION Among PWID, mental health service utilisation was associated with lower likelihood of receptive sharing, regardless of level of psychological distress. These findings should be taken into account when designing harm reduction strategies for this population.
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Soens MA, He J, Bateman BT. Anesthesia considerations and post-operative pain management in pregnant women with chronic opioid use. Semin Perinatol 2019; 43:149-161. [PMID: 30791974 DOI: 10.1053/j.semperi.2019.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The prevalence of opioid use disorder in pregnancy has escalated markedly in recent years. Chronic opioid use during pregnancy poses several challenges for providing adequate analgesia and anesthesia in the peripartum period. These challenges include the potential for withdrawal, opioid tolerance and opioid-induced hyperalgesia. Here we discuss alterations in analgesic pharmacokinetics and pharmacodynamics that are associated with chronic opioid use. In addition, when treating pain in patients with opioid use disorder it is important to distinguish between different subgroups. In this review, we will discuss practical management strategies for parturients with (1) untreated opioid use disorder, (2) parturients on medication-assisted treatment (methadone, buprenorphine) and (3) patients recovering from opioid use disorder that are currently abstinent. Finally, we offer an overview of non-opioid strategies that may be utilized as part of a multimodal approach to providing optimal analgesia in this patient population.
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Affiliation(s)
- Mieke A Soens
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Jingui He
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Brian T Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Novak P, Feder KA, Ali MM, Chen J. Behavioral health treatment utilization among individuals with co-occurring opioid use disorder and mental illness: Evidence from a national survey. J Subst Abuse Treat 2019; 98:47-52. [PMID: 30665603 PMCID: PMC6350939 DOI: 10.1016/j.jsat.2018.12.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Past research shows that among individuals with substance use disorders, the presence of a co-occurring mental illness can influence the initiation, course, and success of behavioral health treatment, but little research has examined people with opioid use disorder (OUD) specifically. METHODS Using the 2008-2014 National Survey on Drug Use and Health, this study examines the utilization of substance use disorder and mental health treatment among individuals with OUD and different degrees of mental illness severity. The study also examined types of treatment, perceived unmet need for treatment, and barriers to care. RESULTS 47% of individuals with OUD and co-occurring mild/moderate mental illness did not receive any behavioral health treatment, and 21% of those with co-occurring serious mental illnesses did not receive any behavioral health treatment. Among those with OUD and co-occurring mild/moderate mental illness, 16% reported receiving both substance use disorder and mental health treatment; among those with co-occurring serious mental illness the rate was 32%. The most common form of treatment was prescription medication for mental health, and this was true regardless of whether or not the individual had any mental illness. More than 50% of the study population reported financial difficulties as a barrier to treatment. CONCLUSION A high proportion of individuals with OUD and co-occurring mental illness are not receiving needed care. However, nearly one in five of those with OUD but no diagnosed mental illness is receiving prescription medication for mental illness. These findings suggest that there is a need to better facilitate access to and coordinate behavioral health care across settings for individuals with OUD.
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Affiliation(s)
- Priscilla Novak
- University of Maryland, College Park, School of Public Health, Department of Health Services Administration, 4200 Valley Drive #2242, College Park, MD 20847, United States of America.
| | - Kenneth A Feder
- Johns Hopkins University, Bloomberg School of Public Health, United States of America
| | - Mir M Ali
- Office of the Assistant Secretary for Planning & Evaluation, US Department of Health & Human Services, United States of America
| | - Jie Chen
- University of Maryland, College Park, School of Public Health, United States of America
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Khalatbari-Mohseni A, Banafshe HR, Mirhosseini N, Asemi Z, Ghaderi A, Omidi A. The effects of crocin on psychological parameters in patients under methadone maintenance treatment: a randomized clinical trial. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:9. [PMID: 30795785 PMCID: PMC6387551 DOI: 10.1186/s13011-019-0198-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/11/2019] [Indexed: 12/31/2022]
Abstract
Background Methadone maintenance treatment (MMT) might be associated with the symptoms of depression and anxiety, sleep disturbances and sexual dysfunctions. This study was designed to determine the effects of crocin on psychological parameters in patients under MMT. Methods Patients under MMT were randomly allocated into two groups to receive either 30 mg/day crocin (2 plus crocin tablet, 15 mg BID) (n = 25) or placebo (2 tablets per day, 15 mg BID) (n = 25), one hour after taking food, for 8 weeks. Psychological parameters were evaluated at baseline and end of the trial to determine related associations between crocin and patients’ mental health status. Results After 8-week intervention, crocin significantly decreased Beck Depression Inventory (b − 6.66; 95% CI, − 9.88, − 3.45; P < 0.0001), Beck Anxiety Inventory (b − 4.35; 95% CI, − 5.94, − 2.75; P < 0.0001), general health questionnaire (b − 4.45; 95% CI, − 7.68, − 1.22; P = 0.008) and Pittsburgh Sleep Quality Index (b − 2.73; 95% CI, − 3.74, − 1.73; P < 0.0001) in patients under MMT, compared with the placebo. Crocin also significantly improved International Index of Erectile Functions (b 4.98; 95% CI, 2.08, 7.88; P = 0.001) rather than placebo. Conclusion Our findings indicated that taking crocin for 8 weeks by patients under MMT had beneficial effects on their mental health status. Crocin can be recommended as an adjunct to methadone in opioid withdrawal protocols because of the ability to improve the quality of life and decrease opioids side effects in these patients. This trial was registered in the Iranian website for clinical trials registry as http://www.irct.ir: IRCT2017110537243N1. Clinical trial registration number www.irct.ir: http://www.irct.ir: IRCT2017110537243N1.
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Affiliation(s)
| | - Hamid Reza Banafshe
- Department of Addiction studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran.,Department of Pharmacology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.,Physiology Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R., Iran
| | - Amir Ghaderi
- Department of Addiction studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran
| | - Abdollah Omidi
- Department of clinical psychology, School of Medicine, Kashan University of Medical Science, Kashan, Iran.
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Streck JM, Ochalek TA, Badger GJ, Sigmon SC. Interim buprenorphine treatment during delays to comprehensive treatment: Changes in psychiatric symptoms. Exp Clin Psychopharmacol 2018; 26:403-409. [PMID: 29939049 PMCID: PMC6072576 DOI: 10.1037/pha0000199] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Prevalence of depression, anxiety, and mood disorders among individuals with opioid use disorder far exceeds that of the general population. While psychiatric symptoms often improve upon entry into opioid treatment, this has typically been seen with treatments involving psychosocial counseling. In this secondary analysis, we examined changes in psychiatric symptoms during a randomized clinical trial evaluating an interim buprenorphine treatment without counseling among individuals awaiting entry into comprehensive treatment. Waitlisted adults with opioid use disorder (N = 50) were randomized to one of two 12-week conditions: interim buprenorphine treatment (IBT; n = 25) consisting of buprenorphine maintenance using a computerized medication dispenser, with bimonthly clinic visits and technology-assisted monitoring, or waitlist control (WLC; n = 25), wherein participants remained on the waitlist of their local clinic. All participants completed assessments of psychiatric symptoms at intake and Study Weeks 4, 8, and 12. We examined changes on the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Brief Symptom Inventory (BSI), and Psychiatric subscale of the Addiction Severity Index (ASI). Significant group-by-time interactions were observed for all measures of psychiatric severity examined: BAI (p < .05), BDI-II (p < .01), 5 BSI subscales (ps < .05), and the ASI Psychiatric subscale (p < .05). On all measures, IBT participants reported significantly reduced psychiatric severity at the 4-, 8-, and 12-week assessments relative to baseline. In contrast, there were no significant changes in psychiatric symptoms among WLC participants. IBT without counseling may improve psychiatric distress among waitlisted individuals with opioid use disorder. (PsycINFO Database Record
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Affiliation(s)
- Joanna M. Streck
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
- Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Taylor A. Ochalek
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
- Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Gary J. Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Stacey C. Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
- Department of Psychological Science, University of Vermont, Burlington, VT, USA
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
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Akutschmerztherapie bei Patienten mit Substanzabhängigkeitssyndrom. Schmerz 2018; 32:131-138. [DOI: 10.1007/s00482-018-0269-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/19/2017] [Indexed: 10/18/2022]
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Abstract
We conducted a cross-sectional study in Tuyen Quang Province, a mountainous province in northern Vietnam, to examine rates of psychological distress among 241 patients receiving methadone maintenance treatment (MMT). Using the Kessler psychological distress Scale, we found that approximately one-fourth (26.8%) of respondents suffered from mental health pathologies. Physical health problems, current drug use, and alcohol abuse were found to be associated with mental health problems among the participants. Our findings highlight the high prevalence of psychological distress among MMT patients in northern Vietnam, and the need to integrate mental and physical health care services, as well as behavioral health counseling, into currently existing MMT clinics in this region.
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Quinlan J, Cox F. Acute pain management in patients with drug dependence syndrome. Pain Rep 2017; 2:e611. [PMID: 29392226 PMCID: PMC5741366 DOI: 10.1097/pr9.0000000000000611] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/19/2017] [Indexed: 11/26/2022] Open
Abstract
Managing patients with dependence requires knowledge of pharmacology; an understanding of the diagnosis of dependence and recognition of withdrawal; skills in communication and collaborative working; and a nonjudgmental, empathic attitude.
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Affiliation(s)
| | - Felicia Cox
- Pain Management Service, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
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27
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Desrosiers A, Blokhina E, Krupitsky E, Zvartau E, Schottenfeld R, Chawarski M. Psychiatric symptoms, quality of life, and HIV status among people using opioids in Saint Petersburg, Russia. Drug Alcohol Depend 2017; 172:60-65. [PMID: 28130990 PMCID: PMC5408353 DOI: 10.1016/j.drugalcdep.2016.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 12/07/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The Russian Federation is experiencing a very high rate of HIV infection among people who inject drugs (PWID). However, few studies have explored characteristics of people with co-occurring opioid use disorders and HIV, including psychiatric symptom presentations and how these symptoms might relate to quality of life. The current study therefore explored a.) differences in baseline psychiatric symptoms among HIV+ and HIV- individuals with opioid use disorder seeking naltrexone treatment at two treatment centers in Saint Petersburg, Russia and b.) associations between psychiatric symptom constellations and quality of life. METHODS Participants were 328 adults enrolling in a randomized clinical trial evaluating outpatient treatments combining naltrexone with different drug counseling models. Psychiatric symptoms and quality of life were assessed using the Brief Symptom Inventory and The World Health Organization Quality of Life-BREF, respectively. RESULTS Approximately 60% of participants were HIV+. Those who were HIV+ scored significantly higher on BSI anxiety, depression, psychoticism, somatization, paranoid ideation, phobic anxiety, obsessive-compulsive, and GSI indexes (all p<0.05) than those HIV-. A K-means cluster analysis identified three distinct psychiatric symptom profiles; the proportion of HIV+ was significantly greater and quality of life indicators were significantly lower in the cluster with the highest psychiatric symptom levels. CONCLUSION Higher levels of psychiatric symptoms and lower quality of life indicators among HIV+ (compared to HIV-) individuals injecting drugs support the potential importance of combining interventions that target improving psychiatric symptoms with drug treatment, particularly for HIV+ patients.
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Affiliation(s)
| | | | - Evgeny Krupitsky
- First Pavlov State Medical University,St.-Petersburg Bekhterev Research Psychoneurological Institute
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Lai TJ, Su MH, Lee TSH, Yang HJ. Mental Health Problems in Recently Incarcerated Male Adult Drug Users in Taiwan: Patterns, Rates, and Implications for Treatment. Int J Ment Health Addict 2017. [DOI: 10.1007/s11469-016-9663-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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29
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Erectile Dysfunction Among Patients on Methadone Maintenance Therapy and Its Association With Quality of Life. J Addict Med 2017; 11:40-46. [DOI: 10.1097/adm.0000000000000267] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Scott N, Carrotte ER, Higgs P, Cogger S, Stoové MA, Aitken CK, Dietze PM. Longitudinal changes in psychological distress in a cohort of people who inject drugs in Melbourne, Australia. Drug Alcohol Depend 2016; 168:140-146. [PMID: 27664551 DOI: 10.1016/j.drugalcdep.2016.08.638] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/28/2016] [Accepted: 08/29/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous research into psychological distress among people who inject drugs (PWID) is predominantly cross-sectional; we determined longitudinal predictors of change in psychological distress among a cohort of PWID. METHOD We examined Kessler Psychological Distress Scale (K10) scores from 564 PWID (66% male) enrolled in the Melbourne Injecting Drug User Cohort Study. Gender-stratified linear models with fixed effects for each participant were used to examine correlates of change in individual K10 scores. Further linear regressions of adjusted K10 scores were used to measure correlations between demographic variables. RESULTS Participants reported higher K10 scores (higher psychological distress) than the general Australian population (mean K10 scores 23.4 (95%CI 22.6-24.2) and 14.5 (95%CI 14.3-14.7) respectively). The cohort's mean K10 score did not significantly differ over time, but individual variations were common. Women reported higher K10 scores than men (mean baseline K10 scores 25.2 (95%CI 23.9-26.6) and 22.4 (95%CI 21.5-23.3) respectively), however no significant differences remained after controlling for temporal factors. Key predictors of increases in K10 scores were being the victim of an assault in the past six months (P<0.001 for women and men) and intentionally overdosing in the past 12 months (P=.010 for women and P<0.001 for men). CONCLUSIONS PWID experience higher levels of psychological distress than the general population. Temporal rather than individual factors may account for the higher levels of psychological distress reported among women. Interventions to reduce rates of assault and/or intentional overdose should be explored to reduce high levels of psychological distress among PWID.
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Affiliation(s)
- Nick Scott
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Elise R Carrotte
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Peter Higgs
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; National Drug Research Institute, Faculty of Health Sciences, Curtin University, Melbourne Office, 6/19-35 Gertrude St, Fitzroy, Victoria 3065, Australia; Department of Public Health, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Shelley Cogger
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Mark A Stoové
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Campbell K Aitken
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Paul M Dietze
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
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Kingston REF, Marel C, Mills KL. A systematic review of the prevalence of comorbid mental health disorders in people presenting for substance use treatment in Australia. Drug Alcohol Rev 2016; 36:527-539. [PMID: 27786426 DOI: 10.1111/dar.12448] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/25/2016] [Accepted: 05/24/2016] [Indexed: 11/29/2022]
Abstract
ISSUES The aim of this paper was to conduct a systematic review of the prevalence of comorbid mental health conditions in people accessing treatment for substance use in Australia. APPROACH A systematic review identified studies meeting the following eligibility criteria: reporting original data published in English; sample presenting for substance use treatment in Australia; assessing the prevalence of mental health and substance use conditions and reporting the percentage of participants with co-occurring mental health and substance use conditions. A narrative analysis was conducted because of the heterogeneity of methods used to assess key outcome variables and small number of studies assessing particular mental health outcomes. The abstracts of 1173 records were screened, and 59 full articles were assessed for eligibility. Eighteen studies were included in the review. KEY FINDINGS Prevalence estimates of current mental disorders in substance use treatment clients varied (47 to 100%). Mood and anxiety disorders were particularly prevalent, with the prevalence of current depression ranging from 27 to 85% and current generalised anxiety disorder ranging from 1 to 75%. IMPLICATIONS The high prevalence of mood and anxiety disorders in substance use treatment settings indicates a need for clinicians to screen and assess for these disorders as part of routine clinical care, and be familiar with evidence-based management and treatment strategies. CONCLUSION Although further studies are required to determine the prevalence of the full range of mental health disorders in this population, these findings emphasise the high prevalence of comorbid mental disorders are among individuals accessing substance use treatment in Australia. [Kingston REF, Marel C, Mills KL. A systematic review of the prevalence of comorbid mental health disorders in people presenting for substance use treatment in Australia. Drug Alcohol Rev 2017;36:527-539].
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Affiliation(s)
- Rosemary E F Kingston
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Christina Marel
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Katherine L Mills
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Stein BD, Mendelsohn J, Gordon AJ, Dick AW, Burns RM, Sorbero M, Shih RA, Liccardo Pacula R. Opioid analgesic and benzodiazepine prescribing among Medicaid-enrollees with opioid use disorders: The influence of provider communities. J Addict Dis 2016; 36:14-22. [PMID: 27449904 DOI: 10.1080/10550887.2016.1211784] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Opioid analgesic and benzodiazepine use in individuals with opioid use disorders can increase the risk for medical consequences and relapse. Little is known about rates of use of these medications or prescribing patterns among communities of prescribers. The goal of this study was to examine rates of prescribing to Medicaid-enrollees in the calendar year after an opioid use disorder diagnosis, and to examine individual, county, and provider community factors associated with such prescribing. 2008 Medicaid claims data were used from 12 states to identify enrollees diagnosed with opioid use disorders, and 2009 claims data were used to identify rates of prescribing of each drug. Social network analysis was used to identify provider communities, and multivariate regression analyses was used to to identify patient, county, and provider community level factors associated with prescribing these drugs. The authors also examined variation in rates of prescribing across provider communities. Among Medicaid-enrollees identified with an opioid use disorder, 45% filled a prescription for an opioid analgesic, 37% filled a prescription for a benzodiazepine, and 21% filled a prescription for both in the year following their diagnosis. Females, older individuals, individuals with pain syndromes, and individuals residing in counties with higher rates of poverty were more likely to fill prescriptions. Prescribing rates varied substantially across provider communities, with rates in the highest quartile of prescribing communities over 2.5 times the rates in the lowest prescribing communities. Prescribing opioid analgesics and benzodiazepines to individuals diagnosed with opioid use disorders may increase risk of relapse and overdose. Interventions should be considered that target provider communities with the highest rates of prescribing and individuals at the highest risk.
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Affiliation(s)
- Bradley D Stein
- a RAND Corporation , Pittsburgh , Pennsylvania , USA.,b University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA
| | | | - Adam J Gordon
- b University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.,d Center for Health Equity Research and Promotion , VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA
| | | | | | - Mark Sorbero
- a RAND Corporation , Pittsburgh , Pennsylvania , USA
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Lalanne L, Lutz PE, Trojak B, Lang JP, Kieffer BL, Bacon E. Medications between psychiatric and addictive disorders. Prog Neuropsychopharmacol Biol Psychiatry 2016; 65:215-23. [PMID: 26514592 DOI: 10.1016/j.pnpbp.2015.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/02/2015] [Accepted: 10/25/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Many epidemiological studies have revealed a frequent co-occurrence of psychiatric and substance use disorders. The term used in the literature to refer to this co-occurrence is dual diagnosis. The high prevalence of dual diagnosis has led physicians to observe the effects of medication prescribed to treat psychiatric disorders on the co-occurring substance use disorder and vice versa. The concept of medications between psychiatric and addictive disorders stems from these clinical observations, alongside which, however, it has developed from the observation that both psychiatric and substance use disorders share common neurobiological pathways and trigger common cognitive disorders. This has led researchers to develop medications on the basis of neurobiological and cognitive rationales. MATERIAL AND METHOD In our article, we review peculiar medications based on neurobiological and cognitive rationales and that have an impact in both psychiatric and addictive disorders. RESULTS We highlight how interesting these new prescriptions are for clinical observation and for the treatment of patients suffering from dual diagnosis. CONCLUSION We then go on to discuss the interest in them from the perspective of clinical practice and clinical research, in that the development of medications to treat dual diagnosis helps to further our knowledge of both psychiatric and substance use disorders.
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Affiliation(s)
- Laurence Lalanne
- Translational Medicine and Neurogenetics, Institut de Génétique et de Biologie Molé-culaire et Cellulaire, INSERM U-964, CNRS UMR-7104, Université de Strasbourg, France; CHRU de Strasbourg-INSERM1114, Department of Psychiatry, University of Strasbourg, France.
| | - Pierre-Eric Lutz
- McGill Group for Suicide Studies, Douglas Mental Health research Centre, McGill University, Montréal, Canada; Douglas Mental Health Research Centre, McGill University, Montréal, Canada.
| | - Benoit Trojak
- Department of Psychiatry and Addictology, University Hospital of Dijon, France, EA 4452, LPPM, University of Burgundy, France.
| | - Jean-Philippe Lang
- CHRU de Strasbourg-INSERM1114, Department of Psychiatry, University of Strasbourg, France.
| | - Brigitte L Kieffer
- Translational Medicine and Neurogenetics, Institut de Génétique et de Biologie Molé-culaire et Cellulaire, INSERM U-964, CNRS UMR-7104, Université de Strasbourg, France; Douglas Mental Health Research Centre, McGill University, Montréal, Canada.
| | - Elisabeth Bacon
- Inserm U-1114, Department of Psychiatry, University of Strasbourg, France.
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Bizzarri JV, Casetti V, Sanna L, Maremmani AGI, Rovai L, Bacciardi S, Piacentino D, Conca A, Maremmani I. The newer Opioid Agonist Treatment with lower substitutive opiate doses is associated with better toxicology outcome than the older Harm Reduction Treatment. Ann Gen Psychiatry 2016; 15:34. [PMID: 27933094 PMCID: PMC5124303 DOI: 10.1186/s12991-016-0109-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 08/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Charge-free heroin use disorder treatment in Italy follows two main approaches, i.e., harm reduction treatment (HRT) strategy in community low-threshold facilities for drug addiction and opioid agonist treatment (OAT) in high-threshold facilities for opioid addiction, focusing on pharmacological maintenance according to the Dole and Nyswander strategy. We aimed to compare the impact of HRT and OAT on patient outcome, as assessed through negativity for drugs on about 1-year urinalyses. METHODS We examined retrospectively the urinalyses of HRT and OAT patients for which at least four randomly sampled urinalyses per month were available for about 1 year, during which patients were undergoing methadone or buprenorphine maintenance; urinalyses focused on heroin, cocaine, cannabinoids, and their metabolites. RESULTS Included were 189 HRT and 58 OAT patients. The latter were observed for a significantly longer period. There was a higher proportion of heroin- and cocaine-clean urinalyses in OAT patients, with cocaine-clean urinalyses discriminating best between the two groups. OAT patients were older, with longer dependence duration, more severe addiction history, and received lower methadone doses. Buprenorphine maintenance was more often associated with heroin-clean urinalyses. The higher the methadone doses, the lower were the percentage of heroin-clean urinalyses in HRT patients (negative correlation). CONCLUSIONS The OAT approach was related to higher recovery and polyabuse abstinence rates compared to the HRT approach, despite greater severity of substance use, psychiatric and physical comorbidities. Our results are consistent with the possibility to use lower maintenance opiate doses (after induction and stabilization in methadone treatment according to Dole and Nyswander methodology) in treating heroin addiction. This seemed to be impossible adopting the currently accepted HRT model.
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Affiliation(s)
| | | | - Livia Sanna
- Department of Psychiatry of Bolzano, Bolzano, Italy
| | - Angelo Giovanni Icro Maremmani
- Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Via Roma, 67 56100 Pisa, Italy ; AU-CNS-Association for the Application of Neuroscientific Knowledge to Social Aims, Pietrasanta, Italy
| | - Luca Rovai
- Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Via Roma, 67 56100 Pisa, Italy
| | - Silvia Bacciardi
- Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Via Roma, 67 56100 Pisa, Italy
| | | | | | - Icro Maremmani
- Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Via Roma, 67 56100 Pisa, Italy ; AU-CNS-Association for the Application of Neuroscientific Knowledge to Social Aims, Pietrasanta, Italy ; G De Lisio Institute of Behavioural Sciences, Pisa, Italy
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Teoh Bing Fei J, Yee A, Habil MHB. Psychiatric comorbidity among patients on methadone maintenance therapy and its influence on quality of life. Am J Addict 2015; 25:49-55. [DOI: 10.1111/ajad.12317] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/30/2015] [Accepted: 11/27/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Joni Teoh Bing Fei
- Department of Psychological Medicine; University Malaya Medical Centre; Kuala Lumpur Malaysia
| | - Anne Yee
- Department of Psychological Medicine; University Malaya Medical Centre; Kuala Lumpur Malaysia
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Expression patterns of antioxidant genes in human SH-SY5Y cells after treatment with methadone. Psychiatry Res 2015; 230:116-9. [PMID: 26321125 DOI: 10.1016/j.psychres.2015.08.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/01/2015] [Accepted: 08/16/2015] [Indexed: 01/16/2023]
Abstract
The expression levels of nine antioxidant genes in SH-SY5Y cells exposed to methadone (final concentrations 1-20µM) were investigated. Based on this study the genes could be categorized on three different groups. The number of down-regulated genes were increased as a function of exposure time (P=0.004). The methadone associated mRNA alterations were modulated by N-acetyl-cysteine. These findings suggested that different pathways for regulation of antioxidant genes could be active after exposing of SH-SY5Y cells to methadone; and also suggested that methadone might act by inducing the reactive oxygen species.
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Clinical Efficacy of Traditional Chinese Medicine, Suan Zao Ren Tang, for Sleep Disturbance during Methadone Maintenance: A Randomized, Double-Blind, Placebo-Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:710895. [PMID: 26346534 PMCID: PMC4539464 DOI: 10.1155/2015/710895] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 07/07/2015] [Accepted: 07/22/2015] [Indexed: 11/22/2022]
Abstract
Methadone maintenance therapy is an effective treatment for opiate dependence, but more than three-quarters of persons receiving the treatment report sleep quality disturbances. In this double-blind, randomized, controlled trial, we recruited 90 individuals receiving methadone for at least one month who reported sleep disturbances and had Pittsburgh Sleep Quality Index (PSQI) scores > 5. The purpose of this study was to determine whether Suan Zao Ren Tang, one of the most commonly prescribed traditional Chinese medications for treatment of insomnia, improves subjective sleep among methadone-maintained persons with disturbed sleep quality. Ninety patients were randomly assigned to intervention group (n = 45) and placebo group (n = 45), and all participants were analyzed. Compared with placebo treatment, Suan Zao Ren Tang treatment for four weeks produced a statistically significant improvement in the mean total PSQI scores (P = 0.007) and average sleep efficiency (P = 0.017). All adverse events (e.g., lethargy, diarrhea, and dizziness) were mild in severity. Suan Zao Ren Tang is effective for improving sleep quality and sleep efficiency among methadone-maintained patients with sleep complaints.
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Li J, Gu J, Lau JTF, Chen H, Mo PKH, Tang M. Prevalence of depressive symptoms and associated factors among people who inject drugs in China. Drug Alcohol Depend 2015; 151:228-35. [PMID: 25920800 DOI: 10.1016/j.drugalcdep.2015.03.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND People who inject drugs (PWID) have a high prevalence of mental health problems (e.g., depression) which compromise the effects of HIV prevention. We investigated the prevalence of depression and associated factors among PWID in Dazhou, China. METHODS Anonymous face-to-face interviews were administered to eligible participants by well-trained doctors. The Center of Epidemiological Studies Depression Scale (CES-D) was used to measure depression, using hierarchical linear regression models. RESULTS Among the 257 participants, 7.0%, 11.3%, and 75.1% were probable cases of mild (16 ≤ CES-D < 21), moderate (21 ≤ CES-D < 25), and severe (CES-D ≥ 25) depression, respectively. Hopefulness (standardized β = -0.34, p < 0.001) and emotional family support (β = -0.21, p < 0.001) were negatively associated, whereas severity of drug dependence (β = 0.12, p = 0.034) and unmet service needs (β = 0.20, p < 0.001) were positively associated, respectively, with CES-D scores. The adjusted analysis showed that resilience was negatively associated with CES-D, but it was not selected by the stepwise model containing hopefulness and emotional family support. Protective factors (i.e., hopefulness and emotional family support) and risk factors (i.e., severity of drug dependence and unmet service needs) remained significant in the same regression model. CONCLUSION Protective and risk factors were independently associated with depressive symptoms. Integrated interventions covering basic and psychosocial needs for PWID are warranted. Such interventions should strengthen emotional family support and cultivate positive factors such as hopefulness.
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Affiliation(s)
- Jinghua Li
- Division of Behavioral Health and Health Promotion, Faculty of Medicine, The School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jing Gu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Joseph T F Lau
- Division of Behavioral Health and Health Promotion, Faculty of Medicine, The School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China; Centre for Medical Anthropology and Behavioral Health, Sun Yat-sen University, Guangzhou, China.
| | - Hongyao Chen
- Dazhou Center for Disease Control and Prevention, Sichuan, China
| | - Phoenix K H Mo
- Division of Behavioral Health and Health Promotion, Faculty of Medicine, The School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Mei Tang
- Dazhou Center for Disease Control and Prevention, Sichuan, China
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Yang M, Liao Y, Wang Q, Chawarski MC, Hao W. Profiles of psychiatric disorders among heroin dependent individuals in Changsha, China. Drug Alcohol Depend 2015; 149:272-9. [PMID: 25680517 PMCID: PMC4609506 DOI: 10.1016/j.drugalcdep.2015.01.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/19/2015] [Accepted: 01/22/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND The strong comorbidity of psychiatric and substance use disorders is well documented outside of China, however it has not been studied extensively among drug using individuals in China. This study evaluated patterns of co-occurring psychiatric and substance use disorders among heroin dependent individuals in Changsha, China. METHODS Participants were 1002 individuals consecutively admitted between March 10 and October 30, 2008 into two compulsory and one voluntary drug rehabilitation centers in Changsha. The Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Patient Edition (SCID-I/P) and the Structured Clinical Interview for DSM-IV-TR Axis II personality Disorders (SCID-II) were used. RESULTS Mental health disorders were highly prevalent among study participants: 29.6% had at least one lifetime DSM-IV Axis I and 19.5% had at least one current (past month) Axis I mental health disorder. Antisocial (40.7%) and Borderline (22.6%) Personality Disorders were most prevalent DSM-IV Axis II lifetime diagnoses and a mood disorder (19.1%) was the most prevalent Axis I lifetime disorder; 57.8% had other substance use disorder in addition to opioid dependence. Study results indicate that females in compulsory settings have lower socio-economic status than males in compulsory settings, and that males in compulsory settings have higher rates of co-morbidities, including personality, mood disorders, substance use co-morbidities, and lower socio-economic status than males in the voluntary setting. CONCLUSIONS The study findings suggest an urgent need to expand and improve diagnostic and treatment capabilities in compulsory rehabilitation settings in China and a need for additional services and interventions specific for female rehabilitants.
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Affiliation(s)
- Mei Yang
- Mental Health Institute, Technology Institute of Psychiatry and Key Laboratory of Psychiatry of Hunan Province, Second Xiangya Hospital, Central South University, Changsha, China,Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, China
| | - Yanhui Liao
- Mental Health Institute, Technology Institute of Psychiatry and Key Laboratory of Psychiatry of Hunan Province, Second Xiangya Hospital, Central South University, Changsha, China
| | - Qiang Wang
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, China
| | - Marek C. Chawarski
- Department of Psychiatry, Yale School of Medicine, New Haven, USA,Corresponding author at: Yale School of Medicine, Department of Psychiatry, CMHC/SAC, Room S206, 34 Park St., New Haven, CT 06519, USA. (M.C. Chawarski)
| | - Wei Hao
- Mental Health Institute, Technology Institute of Psychiatry and Key Laboratory of Psychiatry of Hunan Province, Second Xiangya Hospital, Central South University, Changsha, China.
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Lin SH, Chen KC, Lee SY, Chiu NT, Lee IH, Chen PS, Yeh TL, Lu RB, Chen CC, Liao MH, Yang YK. The association between heroin expenditure and dopamine transporter availability--a single-photon emission computed tomography study. Psychiatry Res 2015; 231:292-7. [PMID: 25659472 DOI: 10.1016/j.pscychresns.2015.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 05/16/2014] [Accepted: 01/11/2015] [Indexed: 11/25/2022]
Abstract
One of the consequences of heroin dependency is a huge expenditure on drugs. This underlying economic expense may be a grave burden for heroin users and may lead to criminal behavior, which is a huge cost to society. The neuropsychological mechanism related to heroin purchase remains unclear. Based on recent findings and the established dopamine hypothesis of addiction, we speculated that expenditure on heroin and central dopamine activity may be associated. A total of 21 heroin users were enrolled in this study. The annual expenditure on heroin was assessed, and the availability of the dopamine transporter (DAT) was assessed by single-photon emission computed tomography (SPECT) using [(99m)TC]TRODAT-1. Parametric and nonparametric correlation analyses indicated that annual expenditure on heroin was significantly and negatively correlated with the availability of striatal DAT. After adjustment for potential confounders, the predictive power of DAT availability was significant. Striatal dopamine function may be associated with opioid purchasing behavior among heroin users, and the cycle of spiraling dysfunction in the dopamine reward system could play a role in this association.
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Affiliation(s)
- Shih-Hsien Lin
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Kao Chin Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Nan Tsing Chiu
- Department of Nuclear Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I Hui Lee
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Po See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
| | - Tzung Lieh Yeh
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Ru-Band Lu
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Chieh Chen
- Institute of Nuclear Energy Research, Atomic Energy Council, Executive Yuan, Taoyuan, Taiwan
| | - Mei-Hsiu Liao
- Institute of Nuclear Energy Research, Atomic Energy Council, Executive Yuan, Taoyuan, Taiwan
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan.
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Okpataku CI, Kwanashie HO, Ejiofor JI, Olisah VO. Prevalence and socio-demographic risk factors associated with psychoactive substance use in psychiatric out-patients of a tertiary hospital in Nigeria. Niger Med J 2014; 55:460-4. [PMID: 25538362 PMCID: PMC4262840 DOI: 10.4103/0300-1652.144695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The co-morbidity of psychoactive substance use and other mental disorders is a major challenge to the management of both conditions in several parts of the world. There is relative dearth of information on co-morbidity and its predictors in Nigeria. This study determined the prevalence and socio-demographic risk factors associated with psychoactive substance use in the psychiatric out-patients of a tertiary hospital in Nigeria. STUDY DESIGN A cross-sectional study. MATERIALS AND METHODS From routine clinic visits over a 4-month period, each consecutive 4(th) adult patients (>18 years) who had previously attended the clinic at least for 1 year, completed a socio-demographic and semi-structured drug use questionnaires and interview with the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) to generate substance use diagnosis. Data was analysed using the statistical package for social sciences (SPSS), version 16. Level of significance was set at P < 0.05. RESULTS The lifetime prevalence for the use of substance was 29.3%, while that for multiple substances was 17.7%. The most commonly used substances were alcohol, cannabis and tobacco and they were also the ones mostly used in combination with one or the other. A total of 10.1% of the patients had a psychoactive substance use disorder. Being male, married with at least primary education and unemployed were significant risk factors for substance use. CONCLUSION Psychoactive substance is common among the psychiatric outpatients of the hospital with males, those with formal education, the married and unemployed being at high risk of substance use.
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Peles E, Schreiber S, Domany Y, Adelson M. Impact of lifetime psychiatric diagnosis on long-term retention and survival of former opiate addicts in methadone maintenance treatment. World J Biol Psychiatry 2014; 15:629-35. [PMID: 25140586 DOI: 10.3109/15622975.2014.942359] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To characterize lifetime psychiatric diagnosis groups among methadone maintenance treatment (MMT) patients and associations of diagnosis to long-term (up to 20 years) retention and survival either during treatment or post discontinuation. METHODS A total of 758 patients with available psychiatric diagnosis (98% of those ever admitted between June 1993 and June 2012) were followed-up until June 2013. Lifetime psychiatric diagnosis was assessed according to DSM-IV-TR (Axis I, II, I & II, or none). Observed urine samples at 1 and 13 months were positive for drugs if at least one was positive. Survival data were based on the Israel National Population Registry. Survival and retention in MMT were compared (Kaplan Meier) between groups. RESULTS The Axis II (personality disorders) group had the worst mean long-term retention (5.8 years, 95% Confidence Interval (CI) 5.0-6.5) compared with the Axis I, Axis I & II or no psychiatric diagnosis groups (9.6 years, 95% CI 8.8-10.4) (P < 0.0005). Mean survival since admission (16.4 years, 95% CI 15.9-16.9) was similar for all groups. Axis II patients included more males, more drug injectors, were younger at initial opiate use and more likely left treatment before 1 year. CONCLUSIONS Personality and coping mechanisms (Axis II) could be significant obstacles to the success of MMT, warranting special interventions to overcome them.
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Affiliation(s)
- Einat Peles
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research , Tel Aviv , Israel
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J.R. Stewart B, Sindicich N, Turnbull D, M. Andrews J, A. Mikocka-Walus A. Changes in Australian injecting drug users’ mental health problems and service uptake from 2006-2012. ADVANCES IN DUAL DIAGNOSIS 2014. [DOI: 10.1108/add-07-2014-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to assess changes in rates of mental health problems and service utilisation for Australian regular injecting drug users (IDUs) from 2006 to 2012.
Design/methodology/approach
– Data were taken from Illicit Drug Reporting System national surveys with 914 regular IDUs in 2006 and 883 in 2012. Changes in rates of self-reported mental health problems and service use were assessed.
Findings
– Rates of self-reported mental health problems increased from 38.3 per cent in 2006 to 43.7 per cent in 2012 – mainly due to increases in anxiety rates. Conversely, there was a decrease in mental health service use from 70.2 to 58.4 per cent by 2012. However, there was a proportional increase in the use of psychologists. These trends remained after controlling for socio-demographic and medical differences between the 2006/2012 samples. K10 scores for 2012 participants validated the use of the self-report measures.
Practical implications
– Reductions in stigma, improvements in mental health literacy, and modest increases in anxiety may explain increases in self-report of mental health problems. Stagnant service utilisation rates in an expanding population willing to self-report may explain decreasing service use. The introduction of key mental health reforms also may have contributed, particularly with the increase in psychologist access. This paper highlights the need for improved population monitoring of mental health in disadvantaged groups such as IDUs.
Originality/value
– This paper is the first to assess changes in mental health outcomes over time in Australian IDUs. This examination covered a critical era in the mental health landscape, with significant increases in public awareness campaigns and major mental health reforms.
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Pain and emotional distress among substance-use patients beginning treatment relative to a representative comparison group. J Addict Med 2014; 8:407-14. [PMID: 25275876 DOI: 10.1097/adm.0000000000000072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES A secondary analysis assessed health-related quality-of-life (HRQOL) characteristics (ie, anxiety, depression, fatigue, and types of pain) among patients entering substance-use treatment and identified characteristics specific to treatment modalities relative to a representative comparison group. METHODS As part of a larger alcohol bank assessment, substance-use patients (n = 406) beginning methadone treatment (n = 170) or other outpatient treatment (n = 236) and a comparison group representative of the general population (n = 1000) completed a survey measuring anxiety, depression, fatigue, pain interference, and pain in the last 7 days. Previous studies lacked comparable and concurrent assessments across these 3 groups. RESULTS Patients entering substance-use treatment had relatively high levels of emotional distress and poorer HRQOL relative to the general population. Among treatment modalities, patients beginning methadone treatment reported the highest levels of pain interference and pain behavior and the poorest physical functioning. Before the potentially modifying effects of methadone maintenance, patients beginning agonist therapy reported the greatest levels of compromised quality of life. CONCLUSIONS These data present the magnitude of differences in HRQOL characteristics between treatment and comparison groups using the same assessment rubric and may help inform the design and timing of treatment modalities, thereby enhancing treatment efficacy for patients.
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Mackesy-Amiti ME, Donenberg GR, Ouellet LJ. Psychiatric correlates of injection risk behavior among young people who inject drugs. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 28:1089-95. [PMID: 25134053 DOI: 10.1037/a0036390] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
People who inject drugs (PWID) and have mental health conditions, such as major depression, an anxiety disorder, or antisocial or borderline personality disorder, may have elevated risk for HIV and HCV infection. This study examined the associations between psychiatric disorders and risky injection behavior in an out-of-treatment sample of young PWID. We recruited participants through outreach and respondent-driven sampling (RDS). Participants completed a computer-assisted self-interview and a psychiatric interview. Interviews took place at a community-based field site of the Community Outreach Intervention Projects. Participants were 570 young adults (18 to 25 years) who injected drugs in the previous 30 days. Psychiatric diagnoses were based on interviews using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). Injection behavior was classified into 3 categories: receptive syringe sharing, other equipment sharing only, and no sharing. Associations between injection risk behavior and psychiatric diagnoses were tested using RDS-weighted multinomial regressions. Substance-induced lifetime and past-year major depression, and borderline personality disorder, were significantly associated with a greater likelihood of receptive syringe sharing (p < .001). Substance-induced major depression in the past year was also associated with nonsyringe equipment sharing (p < .01). Primary major depression, antisocial personality disorder, and anxiety disorders other than posttraumatic stress disorder were slightly more prevalent among injectors who shared syringes; however, the associations were not statistically significant. Substance-induced major depression and borderline personality disorder are common among young PWID and are associated with risky injection behavior.
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Fan CY, Tan HKL, Chien IC, Chou SY. Prevalence of psychiatric disorders among heroin users who received methadone maintenance therapy in Taiwan. Am J Addict 2014; 23:249-56. [DOI: 10.1111/j.1521-0391.2014.12090.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/06/2013] [Accepted: 06/01/2013] [Indexed: 12/01/2022] Open
Affiliation(s)
- Chiung-Yueh Fan
- Department of Health; Taoyuan Mental Hospital; Taoyuan Taiwan
| | | | - I-Chia Chien
- Department of Health; Taoyuan Mental Hospital; Taoyuan Taiwan
- Department of Public Health and Institute of Public Health; National Yang-Ming University; Taipei Taiwan
| | - Sun-Yuan Chou
- Department of Health; Taoyuan Mental Hospital; Taoyuan Taiwan
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Fingleton N, Matheson C, Jaffray M. Changes in mental health during opiate replacement therapy: A systematic review. DRUGS: EDUCATION, PREVENTION AND POLICY 2014. [DOI: 10.3109/09687637.2014.899986] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lin SH, Chen KC, Lee SY, Hsiao CY, Lee IH, Yeh TL, Chen PS, Lu RB, Yang YK. The economic cost of heroin dependency and quality of life among heroin users in Taiwan. Psychiatry Res 2013; 209:512-7. [PMID: 23477899 DOI: 10.1016/j.psychres.2013.01.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 08/22/2012] [Accepted: 01/13/2013] [Indexed: 11/25/2022]
Abstract
Heroin dependence may cause an economic burden and has an impact on quality of life (QOL). However, assessments of economic cost are scarce and the relationship between economic cost and QOL is unclear in the Asian population. In the present study, an established questionnaire was modified to assess the economic cost and its association with QOL. A total of 121 volunteer subjects in a methadone maintenance therapy programme and 157 normal controls were enrolled. The total economic cost of heroin dependency is US$ 18,310 per person-year. The direct cost is US$ 11,791 per person-year (64% of the total cost), mostly consisting of the cost of heroin and other illegal drugs. The indirect cost is US$ 6519 (36% of the total cost) per person-year, most of which arises from productivity loss caused by unemployment and incarceration. The QOL of heroin-dependent patients is poorer than that of healthy controls in all domains. The overall QOL is negatively related to direct cost and total cost. The economic cost of heroin dependency is huge, equal to 1.07 times the average gross domestic product per capita. Reduction of the economic cost to society and the economic burden for heroin users is important.
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Affiliation(s)
- Shih-Hsien Lin
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
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Pabayo R, Alcantara C, Kawachi I, Wood E, Kerr T. The role of depression and social support in non-fatal drug overdose among a cohort of injection drug users in a Canadian setting. Drug Alcohol Depend 2013; 132:603-9. [PMID: 23647731 PMCID: PMC3770831 DOI: 10.1016/j.drugalcdep.2013.04.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 04/04/2013] [Accepted: 04/06/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Non-fatal overdose remains a significant source of morbidity among people who inject drugs (IDU). Although depression and social support are important in shaping the health of IDU, little is known about the relationship between these factors and overdose. Therefore, we sought to determine whether depressive symptoms and social support predicted non-fatal overdose among IDU in a Canadian setting. METHODS Data were derived from three prospective cohorts of people who use drugs: the Vancouver Injection Drug Users Study (VIDUS), the ACCESS Cohort, and the At-Risk Youth Study (ARYS). Multilevel modeling was used to determine if depression and social support were significant predictors of non-fatal overdose across time. Analyses were stratified by sex. RESULTS There were 1931 participants included in this analysis, including 653 (33.8%) females and 69 (3.6%) youth 20 years old or younger. Depressed men (adjusted odds ratio [AOR]=1.53, 95% confidence intervals [CI]=1.25, 1.87) and women (adjusted odds ratio [AOR]=2.23, 95% confidence intervals [CI]=1.65, 3.00) were more likely to experience a non-fatal overdose. Further, among women, those who reported having 3 or more persons they could rely upon for social support were less likely to experience a non-fatal overdose (AOR=0.54, 95% CI 0.31, 0.93). CONCLUSION Although depression was a significant predictor of non-fatal drug overdose, social support was a significant predictor among women only. Possible strategies to prevent non-fatal overdose may include identifying IDU experiencing severe depressive symptoms and providing targeted mental health treatments and mobilizing interpersonal social support among IDU, especially among women.
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Affiliation(s)
- Roman Pabayo
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Carmela Alcantara
- Department of Medicine, Columbia University Medical Center, 622 West 168 Street, PH-9, Room 9-319, New York, NY, USA, 10032
| | - Ichiro Kawachi
- Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, USA, 02115
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6,School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, CANADA, V6T 1Z3,Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6,School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, CANADA, V6T 1Z3,Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
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