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Manza P, Tomasi D, Shokri-Kojori E, Zhang R, Kroll D, Feldman D, McPherson K, Biesecker C, Dennis E, Johnson A, Yuan K, Wang WT, Yonga MV, Wang GJ, Volkow ND. Neural circuit selective for fast but not slow dopamine increases in drug reward. Nat Commun 2023; 14:6408. [PMID: 37938560 PMCID: PMC10632365 DOI: 10.1038/s41467-023-41972-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/20/2023] [Indexed: 11/09/2023] Open
Abstract
The faster a drug enters the brain, the greater its addictive potential, yet the brain circuits underlying the rate dependency to drug reward remain unresolved. With simultaneous PET-fMRI we linked dynamics of dopamine signaling, brain activity/connectivity, and self-reported 'high' in 20 adults receiving methylphenidate orally (results in slow delivery) and intravenously (results in fast delivery) (trial NCT03326245). We estimated speed of striatal dopamine increases to oral and IV methylphenidate and then tested where brain activity was associated with slow and fast dopamine dynamics (primary endpoint). We then tested whether these brain circuits were temporally associated with individual 'high' ratings to methylphenidate (secondary endpoint). A corticostriatal circuit comprising the dorsal anterior cingulate cortex and insula and their connections with dorsal caudate was activated by fast (but not slow) dopamine increases and paralleled 'high' ratings. These data provide evidence in humans for a link between dACC/insula activation and fast but not slow dopamine increases and document a critical role of the salience network in drug reward.
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Affiliation(s)
- Peter Manza
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
| | - Dardo Tomasi
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Ehsan Shokri-Kojori
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Rui Zhang
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Danielle Kroll
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Dana Feldman
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Katherine McPherson
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Catherine Biesecker
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Evan Dennis
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Allison Johnson
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Kai Yuan
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, PR China
| | - Wen-Tung Wang
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Michele-Vera Yonga
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Gene-Jack Wang
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Nora D Volkow
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
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Soeiro T, Pradel V, Lapeyre-Mestre M, Micallef J. Systematic assessment of non-medical use of prescription drugs using doctor-shopping indicators: A nation-wide, repeated cross-sectional study. Addiction 2023; 118:1984-1993. [PMID: 37203878 DOI: 10.1111/add.16261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/04/2023] [Indexed: 05/20/2023]
Abstract
AIMS The aim of this study was to present the first nation-wide, systematic, repeated assessment of doctor-shopping (i.e. visiting multiple physicians to be prescribed the same drug) during 10 years for more than 200 psychoactive prescription drugs in the 67 million inhabitants in France. DESIGN This was a nation-wide, repeated cross-sectional study. SETTING AND PARTICIPANTS Data are from the French National Health Data System in 2010, 2015 and 2019 for 214 psychoactive prescription drugs (i.e. anaesthetics, analgesics, antiepileptics, anti-Parkinson drugs, psycholeptics, psychoanaleptics, other nervous system drugs and antihistamines for systemic use). MEASUREMENTS The detection and quantification of doctor-shopping relied upon an algorithm that detects overlapping prescriptions from repeated visits to different physicians. We used two doctor-shopping indicators aggregated at population level for each drug dispensed to more than 5000 patients: (i) the quantity doctor-shopped, expressed in defined daily doses (DDD), which measures the total quantity doctor-shopped by the study population for a given drug; and (ii) the proportion doctor-shopped, expressed as a percentage, which standardizes the quantity doctor-shopped according to the use level of the drug. FINDINGS The analyses included approximately 200 million dispensings to approximately 30 million patients each year. Opioids (e.g. buprenorphine, methadone, morphine, oxycodone and fentanyl), benzodiazepines and non-benzodiazepine hypnotics (Z-drugs) (e.g. diazepam, oxazepam, zolpidem and clonazepam) had the highest proportions doctor-shopped during the study period. In most cases, the proportion and the quantity doctor-shopped increased for opioids and decreased for benzodiazepines and Z-drugs. Pregabalin had the sharpest increase in the proportion doctor-shopped (from 0.28 to 1.40%), in parallel with a sharp increase in the quantity doctor-shopped (+843%, from 0.7 to 6.6 DDD/100 000 inhabitants/day). Oxycodone had the sharpest increase in the quantity doctor-shopped (+1000%, from 0.1 to 1.1 DDD/100 000 inhabitants/day), in parallel with a sharp increase in the proportion doctor-shopped (from 0.71 to 1.41%). Detailed results for all drugs during the study period can be explored interactively at: https://soeiro.gitlab.io/megadose/. CONCLUSIONS In France, doctor-shopping occurs for many drugs from many pharmacological classes, and mainly involves opioid maintenance drugs, some opioids analgesics, some benzodiazepines and Z-drugs and pregabalin.
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Affiliation(s)
- Thomas Soeiro
- Aix-Marseille Université, Inserm, Marseille, France
- Unité de pharmacoépidémiologie, Service de pharmacologie clinique, Hôpitaux universitaires de Marseille, Marseille, France
- Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Service de pharmacologie clinique, Hôpitaux universitaires de Marseille, Marseille, France
| | - Vincent Pradel
- Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Service de pharmacologie clinique, Hôpitaux universitaires de Marseille, Marseille, France
| | - Maryse Lapeyre-Mestre
- Université de Toulouse, Inserm, Toulouse, France
- Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Service de pharmacologie clinique, Centre hospitalier universitaire de Toulouse, Toulouse, France
| | - Joëlle Micallef
- Aix-Marseille Université, Inserm, Marseille, France
- Unité de pharmacoépidémiologie, Service de pharmacologie clinique, Hôpitaux universitaires de Marseille, Marseille, France
- Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Service de pharmacologie clinique, Hôpitaux universitaires de Marseille, Marseille, France
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3
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Guerra C, Soeiro T, Lacroix C, Jouve E, Micallef J, Frauger E. [Increasing methylphenidate abuse: Tracking and profiles during 13-years]. Therapie 2022; 77:713-721. [PMID: 35599193 DOI: 10.1016/j.therap.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/24/2022] [Accepted: 03/14/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Methylphenidate is indicated for attention deficit hyperactivity disorder (ADHD). Several studies have evaluated its abuse in specific populations (students, drug users) and few in the general population. This work describes the extent of its abuse in a region of more than 5 million inhabitants. METHOD Based on regional health insurance data from 2005 to 2017, the clustering method identifies different methylphenidate use profiles according to several characteristics (number of different prescribers and pharmacies, number of dispensations, number of defined daily dose dispensed). The groups characterised by high values of these variables will be qualified as "deviant". RESULTS In 13 years, the number of patients with at least one dispensation in the first quarter has been multiplied by 5.8 times. The proportion of adults has increased (20% in 2017) and their number has been multiplied by 10. Five groups are identified, three of them are characterised by "deviant" behaviour. Group 5 (n=11, 0.04%) has higher values than 4 (n=112, 0.4%) and 3 (n=407, 1.6%). These patients are older and more frequently use benzodiazepines and opiate substitution drugs. Groups 1 (n=13,132, 51%) and 2 (n=11,941, 46.7%) are more likely to be taken up by young subjects. The number of subjects with "deviant" behaviour increased until 2011 and after a decrease, the highest number of subjects concerned has been observed since 2015. CONCLUSION In view of the increase of subjects with "deviant" behaviour, it is necessary to make the medical community and patients aware on the risk of abuse of methylphenidate. The recent extension of the indication for ADHD in adults and the broadening of the conditions of prescription require increased vigilance.
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Affiliation(s)
- Clémence Guerra
- CEIP-Addictovigilance Paca Corse, Service de Pharmacologie Clinique, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille ; Aix-Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR1106, Marseille, France
| | - Thomas Soeiro
- CEIP-Addictovigilance Paca Corse, Service de Pharmacologie Clinique, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille ; Aix-Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR1106, Marseille, France
| | - Clémence Lacroix
- CEIP-Addictovigilance Paca Corse, Service de Pharmacologie Clinique, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille ; Aix-Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR1106, Marseille, France
| | - Elisabeth Jouve
- CEIP-Addictovigilance Paca Corse, Service de Pharmacologie Clinique, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille ; Aix-Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR1106, Marseille, France
| | - Joelle Micallef
- CEIP-Addictovigilance Paca Corse, Service de Pharmacologie Clinique, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille ; Aix-Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR1106, Marseille, France
| | - Elisabeth Frauger
- CEIP-Addictovigilance Paca Corse, Service de Pharmacologie Clinique, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille ; Aix-Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR1106, Marseille, France.
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Carolan D. ADHD stimulant medication misuse and considerations for current prescribing practice: a literature review. Ir J Med Sci 2021; 191:313-320. [PMID: 33559870 DOI: 10.1007/s11845-020-02502-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Stimulant medications have been prescribed to effectively treat childhood Attention Deficit Hyperactivity Disorder (ADHD) since the 1960's, with improved outcomes observed in the three core symptom domains. Over the course of these decades researchers and clinicians have debated the issue of negative outcomes with regard to later development of substance use disorders (SUD) for these children. AIMS To chronicle the development of medical and scientific opinion on the subject of SUD outcomes in ADHD and to appraise most recently published research in this sphere. METHODS A systematic search of the literature was conducted over 4 databases. Removal of duplicates, application of exclusion criteria and inclusion of publications identified through manual and citation-based search yielded 9 papers. RESULTS Prescriptions for stimulant medications are increasing worldwide and in tandem the prevalence of stimulant misuse. Much research focuses on non-medical stimulant misuse as a study aid; however, they are also used as recreational drugs with action on dopaminergic neurotransmitter pathways implicated in addiction disorders. Considering the risks and benefits of stimulant prescribing on later SUD development research in recent decades has produced inconsistent results. Current research supports the hypothesis of improved SUD outcomes for young people treated early and intensely, with poorer outcomes for those with less robust treatment histories. CONCLUSIONS Consideration of the impact that variable treatment trajectories may have on the risk of later SUD development is recommended, with further research potentially leading to the development of different management pathways based on an individual's multivariate treatment profile.
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Affiliation(s)
- Deirdre Carolan
- Department of Psychiatry, Health Service Executive South, Cork, Ireland.
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Pharmacological Neuroenhancement: Current Aspects of Categorization, Epidemiology, Pharmacology, Drug Development, Ethics, and Future Perspectives. Neural Plast 2021; 2021:8823383. [PMID: 33519929 PMCID: PMC7817276 DOI: 10.1155/2021/8823383] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/15/2020] [Accepted: 12/30/2020] [Indexed: 11/17/2022] Open
Abstract
Recent pharmacoepidemiologic studies suggest that pharmacological neuroenhancement (pNE) and mood enhancement are globally expanding phenomena with distinctly different regional characteristics. Sociocultural and regulatory aspects, as well as health policies, play a central role in addition to medical care and prescription practices. The users mainly display self-involved motivations related to cognitive enhancement, emotional stability, and adaptivity. Natural stimulants, as well as drugs, represent substance abuse groups. The latter comprise purines, methylxanthines, phenylethylamines, modafinil, nootropics, antidepressants but also benzodiazepines, β-adrenoceptor antagonists, and cannabis. Predominant pharmacodynamic target structures of these substances are the noradrenergic/dopaminergic and cholinergic receptor/transporter systems. Further targets comprise adenosine, serotonin, and glutamate receptors. Meta-analyses of randomized-controlled studies in healthy individuals show no or very limited verifiability of positive effects of pNE on attention, vigilance, learning, and memory. Only some members of the substance abuse groups, i.e., phenylethylamines and modafinil, display positive effects on attention and vigilance that are comparable to caffeinated drinks. However, the development of new antidementia drugs will increase the availability and the potential abuse of pNE. Social education, restrictive regulatory measures, and consistent medical prescription practices are essential to restrict the phenomenon of neuroenhancement with its social, medical, and ethical implications. This review provides a comprehensive overview of the highly dynamic field of pharmacological neuroenhancement and elaborates the dramatic challenges for the medical, sociocultural, and ethical fundaments of society.
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Soeiro T, Frauger É, Pradel V, Micallef J. Doctor shopping for methylphenidate as a proxy for misuse and potential abuse in the 67 million inhabitants in France. Fundam Clin Pharmacol 2020; 35:751-761. [PMID: 33025606 DOI: 10.1111/fcp.12612] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/02/2020] [Accepted: 10/01/2020] [Indexed: 01/15/2023]
Abstract
Doctor shopping enables subjects to receive more than the prescribed dose out of any medical management, which suggests a search for high doses and makes doctor shopping a relevant proxy for misuse and potential abuse. Therefore, this study aimed to identify and characterize profiles of subjects with doctor-shopping behavior for methylphenidate in the entire French population. This study is a cross-sectional study of doctor-shopping behavior for methylphenidate in France, in 2016, using the Système national des données de santé, and accounting for overlapping prescriptions. Subjects who obtained >840 mg by doctor shopping were defined as subjects with heavy doctor-shopping behavior, and subjects who obtained >0 mg and ≤840 mg by doctor shopping were defined as subjects with light doctor-shopping behavior. A total of 63 739 subjects were included, and received 339.6 kg of methylphenidate. Among them, 216 (0.3%) subjects had heavy doctor-shopping behavior, and 313 (0.5%) subjects had light doctor-shopping behavior. Compared with subjects with light doctor-shopping behavior, subjects with heavy doctor-shopping behavior were older (64% of 30- to 49-year-old subjects vs. 77% of ≤17-year-old subjects; P < 0.001), received more concomitant dispensings of antipsychotics (37% vs. 26%; P = 0.008) and opioid maintenance treatments (50% vs. 6%; P < 0.001), and had more prescribers (4 [IQR = 2-5] vs. 2 [IQR = 2-3]; P < 0.001). In the French context where prescription and dispensing of methylphenidate are highly regulated and methylphenidate is much less used than in other countries, these results are a warning signal to avoid trivializing methylphenidate in adults.
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Affiliation(s)
- Thomas Soeiro
- Aix-Marseille Université, Inserm, UMR 1106, Assistance publique - Hôpitaux de Marseille, Service de Pharmacologie Clinique, Centre d'Évaluation et d'Information sur la Pharmacodépendance - Addictovigilance, 264 rue Saint Pierre, Marseille, 13005, France
| | - Élisabeth Frauger
- Aix-Marseille Université, Inserm, UMR 1106, Assistance publique - Hôpitaux de Marseille, Service de Pharmacologie Clinique, Centre d'Évaluation et d'Information sur la Pharmacodépendance - Addictovigilance, 264 rue Saint Pierre, Marseille, 13005, France
| | - Vincent Pradel
- Aix-Marseille Université, Inserm, UMR 1106, Assistance publique - Hôpitaux de Marseille, Service de Pharmacologie Clinique, Centre d'Évaluation et d'Information sur la Pharmacodépendance - Addictovigilance, 264 rue Saint Pierre, Marseille, 13005, France
| | - Joëlle Micallef
- Aix-Marseille Université, Inserm, UMR 1106, Assistance publique - Hôpitaux de Marseille, Service de Pharmacologie Clinique, Centre d'Évaluation et d'Information sur la Pharmacodépendance - Addictovigilance, 264 rue Saint Pierre, Marseille, 13005, France
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7
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Woźniak-Karczewska M, Baranowski D, Framski G, Marczak Ł, Čvančarová M, Corvini PFX, Chrzanowski Ł. Biodegradation of ritalinic acid by Nocardioides sp. - Novel imidazole-based alkaloid metabolite as a potential marker in sewage epidemiology. JOURNAL OF HAZARDOUS MATERIALS 2020; 385:121554. [PMID: 31753665 DOI: 10.1016/j.jhazmat.2019.121554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/12/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
The consumption of methylphenidate, a nootropic drug used to improve mental performance, is becoming increasingly serious. Methylphenidate is metabolized in human liver to ritalinic acid, which has been commonly detected in sewage and surface waters. Additionally, ritalinic acid serves as a biomarker in sewage epidemiology studies. Thus knowledge of the stability and microbial degradation pathways of ritalinic acid is essential for proper estimation of methylphenidate consumption. In the study reported here, we describe the fast formation of a previously unknown, dead-end metabolite of ritalinic acid by Nocardioides sp. strain MW5. HRMS and 2D NMR analyses allowed precisely identification of the compound as an imidazole-based alkaloid cation with chemical formula 11-[3-(formylamino)propyl]-1,2,3,4,6,7,8,9-octahydrodipyrido[1,2-a:1',2'-c]imidazole-5-ium. In experiments, Nocardioides sp. strain MW5 transformed 34% of ritalinic acid into this metabolite, while 52% was mineralized into CO2. Alkaloid was not biodegraded during the OECD 301 F test. This study provides new insight into the environmental fate of methylphenidate and its metabolites. The data collected are essential for assessing nootropic drug consumption by sewage epidemiology and should lead to a better understanding of microbial degradation of ritalinic acid.
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Affiliation(s)
- Marta Woźniak-Karczewska
- Institute of Chemical Technology and Engineering, Poznan University of Technology, Berdychowo 4, 60-965 Poznan, Poland; Institute for Ecopreneurship, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Gründenstrasse 40, 4132 Muttenz, Switzerland.
| | - Daniel Baranowski
- Institute of Bioorganic Chemistry, Polish Academy of Sciences, Noskowskiego 12/14, 61-704 Poznań, Poland
| | - Grzegorz Framski
- Institute of Bioorganic Chemistry, Polish Academy of Sciences, Noskowskiego 12/14, 61-704 Poznań, Poland
| | - Łukasz Marczak
- Institute of Bioorganic Chemistry, Polish Academy of Sciences, Noskowskiego 12/14, 61-704 Poznań, Poland
| | - Monika Čvančarová
- Institute for Ecopreneurship, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Gründenstrasse 40, 4132 Muttenz, Switzerland
| | - Philippe F-X Corvini
- Institute for Ecopreneurship, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Gründenstrasse 40, 4132 Muttenz, Switzerland; State Key Laboratory for Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210093, PR China
| | - Łukasz Chrzanowski
- Institute of Chemical Technology and Engineering, Poznan University of Technology, Berdychowo 4, 60-965 Poznan, Poland
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Wilms W, Woźniak-Karczewska M, Corvini PFX, Chrzanowski Ł. Nootropic drugs: Methylphenidate, modafinil and piracetam - Population use trends, occurrence in the environment, ecotoxicity and removal methods - A review. CHEMOSPHERE 2019; 233:771-785. [PMID: 31200137 DOI: 10.1016/j.chemosphere.2019.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/28/2019] [Accepted: 06/02/2019] [Indexed: 06/09/2023]
Abstract
Pharmaceuticals which originally were designed to treat people with neurological and psychiatric conditions, e.g. Alzheimer's disease or attention deficit hyperactivity disorder (ADHD), are nowadays often misused by students as a 'brain doping' substances. These substances are known as nootropic drugs, smart drugs or cognitive enhancers, as they increase memory, attention and concentration of healthy individuals. Since they are easily available illicitly, their consumption is observed to be growing. Currently, these pharmaceuticals started gaining researchers' attention, especially since they have been recently detected in wastewater, surface water and even drinking water. This review summarises the current state of knowledge on nootropic drugs in terms of their population use trends and ethics, occurrence in the environment and detection techniques, toxicity and removal methods, in example of methylphenidate, modafinil and piracetam - three most popular nootropics. It points out that the main sources of knowledge on cognitive enhancers illicit use are often inconsistent questionnaires, which are not supported by wastewater analysis to become more veracious. Simultaneously, the studies concerning toxicity and removal methods of nootropic drugs are still limited and in many cases environmentally irrelevant. Although the prescription rules has been subjected to more strict control in developed countries, regulatory frameworks with regard to their ecosystem occurrence are still lacking and should be introduced. Moreover, the use of environmentally relevant concentrations in toxicity studies should be a standard, leading to proper ecotoxicity risk assessment. Based on this review, it is recommended to routinely monitor nootropics and their metabolites in waste- and surface waters.
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Affiliation(s)
- Wiktoria Wilms
- Faculty of Chemical Technology, Poznan University of Technology, Berdychowo 4, 60-965, Poznań, Poland
| | - Marta Woźniak-Karczewska
- Faculty of Chemical Technology, Poznan University of Technology, Berdychowo 4, 60-965, Poznań, Poland
| | - Philippe F-X Corvini
- Institute for Ecopreneurship, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Gründenstrasse 40, 4132, Muttenz, Switzerland
| | - Łukasz Chrzanowski
- Faculty of Chemical Technology, Poznan University of Technology, Berdychowo 4, 60-965, Poznań, Poland.
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9
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Ilario C, Alt A, Bader M, Sentissi O. [Can ADHD have an adulthood onset?]. Encephale 2019; 45:357-362. [PMID: 31255245 DOI: 10.1016/j.encep.2019.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 04/22/2019] [Accepted: 05/06/2019] [Indexed: 11/30/2022]
Abstract
ADHD is the most common psychiatric disorder of childhood. It is considered to be a neurodevelopmental disorder that may persist from chilhood into adulthood. In childood it is associated with several outcomes such as inattention, hyperactivity and impulsivity. Symptoms may change as a person gets older with an increased risk of developing psychiatric comorbidities such as depression, anxiety and substance addiction. However, recent studies diverge from the traditional perspective. These authors hypothesized that ADHD may appear in adulthood, not as a continuation of child ADHD, but some limitations have to be considered. Firstly, ADHD often goes unrecognized throughout childhood. Secondly, families may help the children to develop compensation strategies and adaptative behaviors. The purpose of this report is to better investigate these different and innovative clinical results and understand if adult ADHD could really be considered as a distinct, different pathology, as a late-onset disorder. We conducted a brief review of literature and included the most recent scientific longitudinal follow-up cohort studies. We conclude that, while adult ADHD is still considered a continuation from childhood, many questions of late-onset ADHD remain and further research is necessary to better understand and explain the etiology, the development, the clinical impact, and the psychotherapeutic and pharmacologic treatment of this late-onset disorder.
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Affiliation(s)
- C Ilario
- Cappi Jonction, Department of Mental Health and Psychiatry, University Hospital of Geneva, 35, rue des Bains, 1205 Genève, Suisse
| | - A Alt
- Cappi Jonction, Department of Mental Health and Psychiatry, University Hospital of Geneva, 35, rue des Bains, 1205 Genève, Suisse
| | - M Bader
- Unité de recherche, service universitaire de psychiatrie de l'enfant et de l'adolescent, avenue d'Echallens 9, 1004 Lausanne, Suisse
| | - O Sentissi
- Cappi Jonction, Department of Mental Health and Psychiatry, University Hospital of Geneva, 35, rue des Bains, 1205 Genève, Suisse.
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O'Donnell A, Addison M, Spencer L, Zurhold H, Rosenkranz M, McGovern R, Gilvarry E, Martens M, Verthein U, Kaner E. Which individual, social and environmental influences shape key phases in the amphetamine type stimulant use trajectory? A systematic narrative review and thematic synthesis of the qualitative literature. Addiction 2019; 114:24-47. [PMID: 30176077 PMCID: PMC6519251 DOI: 10.1111/add.14434] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/04/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS There is limited evidence on what shapes amphetamine-type stimulant (ATS) use trajectories. This systematic narrative review and qualitative synthesis aimed to identify individual, social and environmental influences shaping key phases in the ATS use trajectory: initiation, continuation, increase/relapse and decrease/abstinence. METHODS MEDLINE, PsycINFO, EMBASE, and PROQUEST (social science premium collection) were searched from 2000 to 2018. Studies of any qualitative design were eligible for inclusion. Extracted data were analysed according to four key phases within drug pathways, and then cross-analysed for individual, social and environmental influences. RESULTS Forty-four papers based on 39 unique studies were included, reporting the views of 1879 ATS users. Participants were aged 14-58 years, from varied socio-economic and demographic groups, and located in North America, Europe, Australasia and South East Asia. Reasons for initiation included: to boost performance at work and in sexual relationships, promote a sense of social 'belonging' and help manage stress. Similar reasons motivated continued use, combined with the challenge of managing withdrawal effects in long-term users. Increased tolerance and/or experiencing a critical life event contributed to an increase in use. Reasons for decrease focused on: increased awareness of the negative health impacts of long-term use, disconnecting from social networks or relationships and financial instability. CONCLUSIONS Amphetamine-type stimulant users are a highly diverse population, and their drug use careers are shaped by a complex dynamic of individual, social and environmental factors. Tailored, joined-up interventions are needed to address users' overlapping economic, health and social care needs in order to support long-term abstinence.
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Affiliation(s)
- Amy O'Donnell
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Michelle Addison
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Liam Spencer
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Heike Zurhold
- Centre of Interdisciplinary Addiction Research of Hamburg University, Department of PsychiatryUniversity Medical Centre Hamburg‐EppendorfHamburgGermany
| | - Moritz Rosenkranz
- Centre of Interdisciplinary Addiction Research of Hamburg University, Department of PsychiatryUniversity Medical Centre Hamburg‐EppendorfHamburgGermany
| | - Ruth McGovern
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Eilish Gilvarry
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Marcus‐Sebastian Martens
- Centre of Interdisciplinary Addiction Research of Hamburg University, Department of PsychiatryUniversity Medical Centre Hamburg‐EppendorfHamburgGermany
| | - Uwe Verthein
- Centre of Interdisciplinary Addiction Research of Hamburg University, Department of PsychiatryUniversity Medical Centre Hamburg‐EppendorfHamburgGermany
| | - Eileen Kaner
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
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11
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Jang M, Kim J, Shin I, Kang S, Choi H, Yang W. Simultaneous determination of methylphenidate and ritalinic acid in hair using LC-MS/MS. Forensic Sci Int 2018; 294:183-188. [PMID: 30530155 DOI: 10.1016/j.forsciint.2018.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/23/2018] [Accepted: 11/25/2018] [Indexed: 11/15/2022]
Abstract
Methylphenidate (MPH) is one of the most commonly prescribed stimulants for attention deficit hyperactivity disorder and its abuse is on the rise with its growing availability. Some analytical methods have been reported for the detection of MPH in hair. However, the concentration range of MPH as well as its metabolite, ritalinic acid (RA) in the hair of MPH abuse cases has not been reported. In this study, a sensitive and reliable liquid chromatography-tandem mass spectrometry method was developed and validated for the simultaneous determination of MPH and RA in hair. Sample preparation was carried out by a simple methanol extraction using 10mg of hair. Limits of detection for MPH and RA in hair were 0.5pg/mg and 1pg/mg, respectively, and the limits of quantification (LOQs) were 1pg/mg for both the analytes. Validation results showed good linearity in the range of 1-100pg/mg with acceptable precision and accuracy. The developed method was applied to real hair samples obtained from ten drug users who obtained MPH illegally without a prescription. MPH concentrations in the hair samples ranged from 1.0pg/mg to 265.0pg/mg, and RA was present at concentrations <LOQ-76.3pg/mg. In this study, hair analysis and background findings revealed that most subjects have abused illicit substances (methamphetamine, Δ9-tetrahydrocannabinol, zolpidem etc.) other than MPH. The low picogram range of LODs for MPH and RA in hair was achieved with the present method and the results from real sample analysis would provide useful information related to MPH abuse under forensic settings.
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Affiliation(s)
- Moonhee Jang
- National Forensic Service, 139 Jiyang-ro, Yangcheon-Gu, Seoul 158-707, Republic of Korea.
| | - Jihyun Kim
- National Forensic Service, 139 Jiyang-ro, Yangcheon-Gu, Seoul 158-707, Republic of Korea
| | - Ilchung Shin
- National Forensic Service, 139 Jiyang-ro, Yangcheon-Gu, Seoul 158-707, Republic of Korea
| | - Seojin Kang
- National Forensic Service, 139 Jiyang-ro, Yangcheon-Gu, Seoul 158-707, Republic of Korea
| | - Hyeyoung Choi
- National Forensic Service, 139 Jiyang-ro, Yangcheon-Gu, Seoul 158-707, Republic of Korea
| | - Wonkyung Yang
- National Forensic Service, 139 Jiyang-ro, Yangcheon-Gu, Seoul 158-707, Republic of Korea
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12
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Pauly V, Frauger E, Lepelley M, Mallaret M, Boucherie Q, Micallef J. Reply to 'Overuse or underuse of methylphenidate in adults in France: commentary on Pauly et al. 2018' by Weibel et al. Br J Clin Pharmacol 2018; 85:275-276. [PMID: 30421494 DOI: 10.1111/bcp.13776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 09/30/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Vanessa Pauly
- Laboratoire de santé publique EA 3279, CEReSS-Centre d'Etudes et de Recherche sur les services de santé et la qualité de vie, Centre d'évaluation de la pharmacodépendance-addictovigilance (CEIP-A) de Marseille (PACA Corse) associé, Faculté de médecine, Aix-Marseille Université, Marseille, France
| | - Elisabeth Frauger
- Service de pharmacologie clinique et pharmacovigilance, CNRS, CEIP-addictovigilance PACA Corse, INSERM 1106, Institut des neurosciences des systemes, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Marion Lepelley
- Centre d'Addictovigilance (CEIP) de Grenoble, Pavillon E CHU, Grenoble, France
| | - Michel Mallaret
- Centre d'Addictovigilance (CEIP) de Grenoble, Pavillon E CHU, Grenoble, France
| | - Quentin Boucherie
- Service de pharmacologie clinique et pharmacovigilance, CNRS, CEIP-addictovigilance PACA Corse, INSERM 1106, Institut des neurosciences des systemes, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Joelle Micallef
- Service de pharmacologie clinique et pharmacovigilance, CNRS, CEIP-addictovigilance PACA Corse, INSERM 1106, Institut des neurosciences des systemes, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
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13
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Bjerkeli PJ, Vicente RP, Mulinari S, Johnell K, Merlo J. Overuse of methylphenidate: an analysis of Swedish pharmacy dispensing data. Clin Epidemiol 2018; 10:1657-1665. [PMID: 30519114 PMCID: PMC6233857 DOI: 10.2147/clep.s178638] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To identify overuse of methylphenidate and to investigate patterns of overuse in relation to sociodemographic and clinical characteristics. PATIENTS AND METHODS Swedish national, pharmacy dispensing data were analyzed for all 56,922 individuals aged 6-79 years, who filled a methylphenidate prescription between 2010 and 2011. Overuse was defined as having above 150% days covered by the dispensed amount during 365 days from the first prescription fill, assuming use at the maximum recommended daily dose. RESULTS In total, 4,304 individuals (7.6% of the methylphenidate users) were categorized as overusers. The risk of overuse increased with age (OR for 46-65 years vs 6-12 years 17.5, 95% CI 14.3-21.3), and was higher in men (OR 1.4, 95% CI 1.3-1.5) and individuals with low income (OR 1.1, 95% CI 1.0-1.2), as well as in individuals with an attention deficit hyperactivity disorder (ADHD) diagnosis (OR 1.4, 95% CI 1.3-1.6), health care visits (OR 1.3, 95% CI 1.2-1.4), previous ADHD medication use (OR 2.6, 95% CI 2.4-2.8), and previous diagnosis of mental and behavioral disorders due to psychoactive substance use (OR 2.1 95% CI 2.0-2.3). CONCLUSION Among individuals using methylphenidate in Sweden, 7.6% receive amounts that are larger than what they should have a medical need for, assuming that they were using the maximum recommended daily dose 365 days per year. Notably, the prevalence of overuse was associated with previous diagnosis of alcohol and drug misuse. The prevalence was also positively associated with higher age and previous use of ADHD medication. These findings may point toward a link between exposure time and overuse. However, future studies with long-term data are needed to investigate this.
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Affiliation(s)
- Pernilla J Bjerkeli
- Department for Biomedicine and Public Health Research, School of Health and Education, University of Skövde, Skövde, Sweden,
- Department of Clinical Sciences, Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden,
| | - Raquel Perez Vicente
- Department of Clinical Sciences, Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden,
| | - Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
| | - Kristina Johnell
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Juan Merlo
- Department of Clinical Sciences, Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden,
- Center for Primary Health Care Research, Region Skåne, Malmö, Sweden
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14
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Storebø OJ, Pedersen N, Ramstad E, Kielsholm ML, Nielsen SS, Krogh HB, Moreira‐Maia CR, Magnusson FL, Holmskov M, Gerner T, Skoog M, Rosendal S, Groth C, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Håkonsen SJ, Aagaard L, Simonsen E, Gluud C. Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents - assessment of adverse events in non-randomised studies. Cochrane Database Syst Rev 2018; 5:CD012069. [PMID: 29744873 PMCID: PMC6494554 DOI: 10.1002/14651858.cd012069.pub2] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood. The psychostimulant methylphenidate is the most frequently used medication to treat it. Several studies have investigated the benefits of methylphenidate, showing possible favourable effects on ADHD symptoms, but the true magnitude of the effect is unknown. Concerning adverse events associated with the treatment, our systematic review of randomised clinical trials (RCTs) demonstrated no increase in serious adverse events, but a high proportion of participants suffered a range of non-serious adverse events. OBJECTIVES To assess the adverse events associated with methylphenidate treatment for children and adolescents with ADHD in non-randomised studies. SEARCH METHODS In January 2016, we searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, 12 other databases and two trials registers. We also checked reference lists and contacted authors and pharmaceutical companies to identify additional studies. SELECTION CRITERIA We included non-randomised study designs. These comprised comparative and non-comparative cohort studies, patient-control studies, patient reports/series and cross-sectional studies of methylphenidate administered at any dosage or formulation. We also included methylphenidate groups from RCTs assessing methylphenidate versus other interventions for ADHD as well as data from follow-up periods in RCTs. Participants had to have an ADHD diagnosis (from the 3rd to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders or the 9th or 10th edition of theInternational Classification of Diseases, with or without comorbid diagnoses. We required that at least 75% of participants had a normal intellectual capacity (intelligence quotient of more than 70 points) and were aged below 20 years. We excluded studies that used another ADHD drug as a co-intervention. DATA COLLECTION AND ANALYSIS Fourteen review authors selected studies independently. Two review authors assessed risk of bias independently using the ROBINS-I tool for assessing risk of bias in non-randomised studies of interventions. All review authors extracted data. We defined serious adverse events according to the International Committee of Harmonization as any lethal, life-threatening or life-changing event. We considered all other adverse events to be non-serious adverse events and conducted meta-analyses of data from comparative studies. We calculated meta-analytic estimates of prevalence from non-comparative cohorts studies and synthesised data from patient reports/series qualitatively. We investigated heterogeneity by conducting subgroup analyses, and we also conducted sensitivity analyses. MAIN RESULTS We included a total of 260 studies: 7 comparative cohort studies, 6 of which compared 968 patients who were exposed to methylphenidate to 166 controls, and 1 which assessed 1224 patients that were exposed or not exposed to methylphenidate during different time periods; 4 patient-control studies (53,192 exposed to methylphenidate and 19,906 controls); 177 non-comparative cohort studies (2,207,751 participants); 2 cross-sectional studies (96 participants) and 70 patient reports/series (206 participants). Participants' ages ranged from 3 years to 20 years. Risk of bias in the included comparative studies ranged from moderate to critical, with most studies showing critical risk of bias. We evaluated all non-comparative studies at critical risk of bias. The GRADE quality rating of the evidence was very low.Primary outcomesIn the comparative studies, methylphenidate increased the risk ratio (RR) of serious adverse events (RR 1.36, 95% confidence interval (CI) 1.17 to 1.57; 2 studies, 72,005 participants); any psychotic disorder (RR 1.36, 95% CI 1.17 to 1.57; 1 study, 71,771 participants); and arrhythmia (RR 1.61, 95% CI 1.48 to 1.74; 1 study, 1224 participants) compared to no intervention.In the non-comparative cohort studies, the proportion of participants on methylphenidate experiencing any serious adverse event was 1.20% (95% CI 0.70% to 2.00%; 50 studies, 162,422 participants). Withdrawal from methylphenidate due to any serious adverse events occurred in 1.20% (95% CI 0.60% to 2.30%; 7 studies, 1173 participants) and adverse events of unknown severity led to withdrawal in 7.30% of participants (95% CI 5.30% to 10.0%; 22 studies, 3708 participants).Secondary outcomesIn the comparative studies, methylphenidate, compared to no intervention, increased the RR of insomnia and sleep problems (RR 2.58, 95% CI 1.24 to 5.34; 3 studies, 425 participants) and decreased appetite (RR 15.06, 95% CI 2.12 to 106.83; 1 study, 335 participants).With non-comparative cohort studies, the proportion of participants on methylphenidate with any non-serious adverse events was 51.2% (95% CI 41.2% to 61.1%; 49 studies, 13,978 participants). These included difficulty falling asleep, 17.9% (95% CI 14.7% to 21.6%; 82 studies, 11,507 participants); headache, 14.4% (95% CI 11.3% to 18.3%; 90 studies, 13,469 participants); abdominal pain, 10.7% (95% CI 8.60% to 13.3%; 79 studies, 11,750 participants); and decreased appetite, 31.1% (95% CI 26.5% to 36.2%; 84 studies, 11,594 participants). Withdrawal of methylphenidate due to non-serious adverse events occurred in 6.20% (95% CI 4.80% to 7.90%; 37 studies, 7142 participants), and 16.2% were withdrawn for unknown reasons (95% CI 13.0% to 19.9%; 57 studies, 8340 participants). AUTHORS' CONCLUSIONS Our findings suggest that methylphenidate may be associated with a number of serious adverse events as well as a large number of non-serious adverse events in children and adolescents, which often lead to withdrawal of methylphenidate. Our certainty in the evidence is very low, and accordingly, it is not possible to accurately estimate the actual risk of adverse events. It might be higher than reported here.Given the possible association between methylphenidate and the adverse events identified, it may be important to identify people who are most susceptible to adverse events. To do this we must undertake large-scale, high-quality RCTs, along with studies aimed at identifying responders and non-responders.
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Affiliation(s)
- Ole Jakob Storebø
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
- University of Southern DenmarkDepartment of Psychology, Faculty of Health ScienceCampusvej 55OdenseDenmark5230
| | - Nadia Pedersen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Erica Ramstad
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | | | | | - Helle B Krogh
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Carlos R Moreira‐Maia
- Federal University of Rio Grande do SulDepartment of PsychiatryRua Ramiro Barcelos, 2350‐2201APorto AlegreRSBrazil90035‐003
| | | | | | - Trine Gerner
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Maria Skoog
- Clinical Studies Sweden ‐ Forum SouthClinical Study SupportLundSweden
| | - Susanne Rosendal
- Psychiatric Centre North ZealandThe Capital Region of DenmarkDenmark
| | - Camilla Groth
- Herlev University HospitalPediatric DepartmentCapital RegionHerlevDenmark
| | | | | | - Dorothy Gauci
- Department of HealthDirectorate for Health Information and Research95 G'Mangia HillG'MangiaMaltaPTA 1313
| | - Morris Zwi
- Whittington HealthIslington Child and Adolescent Mental Health Service580 Holloway RoadLondonLondonUKN7 6LB
| | - Richard Kirubakaran
- Christian Medical CollegeCochrane South Asia, Prof. BV Moses Centre for Evidence‐Informed Healthcare and Health PolicyCarman Block II FloorCMC Campus, BagayamVelloreIndia632002
| | - Sasja J Håkonsen
- Aalborg UniversityDepartment of Health Science and TechnologyNiels Jernes Vej 14AalborgDenmark9220
| | | | - Erik Simonsen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
- Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchCopenhagenDenmark
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15
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Olafsson S, Tyrfingsson T, Runarsdottir V, Bergmann OM, Hansdottir I, Björnsson ES, Johannsson B, Sigurdardottir B, Fridriksdottir RH, Löve A, Hellard M, Löve TJ, Gudnason T, Heimisdottir M, Gottfredsson M. Treatment as Prevention for Hepatitis C (TraP Hep C) - a nationwide elimination programme in Iceland using direct-acting antiviral agents. J Intern Med 2018; 283:500-507. [PMID: 29512219 DOI: 10.1111/joim.12740] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A nationwide programme for the treatment of all patients infected with hepatitis C virus (HCV) was launched in Iceland in January 2016. By providing universal access to direct-acting antiviral agents to the entire patient population, the two key aims of the project were to (i) offer a cure to patients and thus reduce the long-term sequelae of chronic hepatitis C, and (ii) to reduce domestic incidence of HCV in the population by 80% prior to the WHO goal of HCV elimination by the year 2030. An important part of the programme is that vast majority of cases will be treated within 36 months from the launch of the project, during 2016-2018. Emphasis is placed on early case finding and treatment of patients at high risk for transmitting HCV, that is people who inject drugs (PWID), as well as patients with advanced liver disease. In addition to treatment scale-up, the project also entails intensification of harm reduction efforts, improved access to diagnostic tests, as well as educational campaigns to curtail spread, facilitate early detection and improve linkage to care. With these efforts, Iceland is anticipated to achieve the WHO hepatitis C elimination goals well before 2030. This article describes the background and organization of this project. Clinical trial number: NCT02647879.
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Affiliation(s)
- S Olafsson
- Division of Gastroenterology and Hepatology, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - T Tyrfingsson
- SAA - National Center of Addiction Medicine, Reykjavik, Iceland
| | - V Runarsdottir
- SAA - National Center of Addiction Medicine, Reykjavik, Iceland
| | - O M Bergmann
- Division of Gastroenterology and Hepatology, Landspitali University Hospital, Reykjavik, Iceland
| | - I Hansdottir
- SAA - National Center of Addiction Medicine, Reykjavik, Iceland.,Faculty of Psychology, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - E S Björnsson
- Division of Gastroenterology and Hepatology, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - B Johannsson
- Division of Infectious Diseases, Landspitali University Hospital, Reykjavik, Iceland
| | - B Sigurdardottir
- Division of Infectious Diseases, Landspitali University Hospital, Reykjavik, Iceland
| | - R H Fridriksdottir
- Division of Gastroenterology and Hepatology, Landspitali University Hospital, Reykjavik, Iceland
| | - A Löve
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Division of Virology, Landspitali University Hospital, Reykjavik, Iceland
| | - M Hellard
- Centre for Population Health, Burnet Institute, Melbourne, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, Australia.,Department of Infectious Diseases, Alfred Hospital, Melbourne, VIC, Australia
| | - T J Löve
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Science, Landspitali University Hospital, Reykjavik, Iceland
| | - T Gudnason
- Chief Epidemiologist, Directorate of Health, Landspitali University Hospital, Reykjavik, Iceland
| | - M Heimisdottir
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Division of Finance, Landspitali University Hospital, Reykjavik, Iceland
| | - M Gottfredsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Division of Infectious Diseases, Landspitali University Hospital, Reykjavik, Iceland.,Department of Science, Landspitali University Hospital, Reykjavik, Iceland
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16
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Pauly V, Frauger E, Lepelley M, Mallaret M, Boucherie Q, Micallef J. Patterns and profiles of methylphenidate use both in children and adults. Br J Clin Pharmacol 2018; 84:1215-1227. [PMID: 29512177 DOI: 10.1111/bcp.13544] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 01/23/2018] [Accepted: 01/28/2018] [Indexed: 12/16/2022] Open
Abstract
AIM The aim of the present study was to characterize patterns of use of methylphenidate (MPH), a prescription stimulant medication recommended in the treatment of attention deficit hyperactivity disorder (ADHD) and of narcolepsy, in France, both in children and adults, over a 3-year period. METHODS Using the French General Health Insurance database, limited to two areas covering approximately 4 million individuals, we made up a cohort of incident MPH users between July 2010 and June 2013. Splitting them into distinct age groups (18-24, 25-49 and ≥50 years of age for adults and <6, 6-11 and 12-17 years of age for children), we established the characteristics of these populations at MPH initiation and during follow-up according to the duration of treatment, quantities dispensed and coprescription with central nervous system (CNS) drugs. RESULTS We included a cohort of 3534 incident users, involving 30 238 dispensings of MPH, leading to an annual rate of 29 incident users per 100 000 in 2013. Children (66% of new users) were characterized by long-term use of MPH with few comedications. The group of 25-49-year-old patients were dispensed MPH more frequently than other groups, had the highest mean dose and were more often coprescribed other CNS drugs. The ≥50 year-old group was more often coprescribed antidepressants and antiparkinsonian drugs. CONCLUSIONS Our pharmacoepidemiological study involving incident MPH users with a large number of characteristics showed different patterns of MPH use among children and adults. The results from the 25-49-year-old group suggested that MPH might be being used for medical conditions other than ADHD or narcolepsy in adults, and that it might be subject to misuse and/or abuse.
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Affiliation(s)
- Vanessa Pauly
- Laboratoire de santé publique EA 3279, Centre d'évaluation de la pharmacodépendance-addictovigilance (CEIP-A) de Marseille (PACA Corse) associé, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Elisabeth Frauger
- Service de pharmacologie clinique et pharmacovigilance, CNRS, CEIP - addictovigilance PACA Corse, INSERM 1106, Institut des neurosciences des systemes, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille université, 13385, Marseille, France
| | - Magalie Lepelley
- Centre d'Addictovigilance (CEIP) de Grenoble, Pavillon E CHU, 38043, Grenoble, France
| | - Michel Mallaret
- Centre d'Addictovigilance (CEIP) de Grenoble, Pavillon E CHU, 38043, Grenoble, France
| | - Quentin Boucherie
- Service de pharmacologie clinique et pharmacovigilance, CNRS, CEIP - addictovigilance PACA Corse, INSERM 1106, Institut des neurosciences des systemes, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille université, 13385, Marseille, France
| | - Joëlle Micallef
- Service de pharmacologie clinique et pharmacovigilance, CNRS, CEIP - addictovigilance PACA Corse, INSERM 1106, Institut des neurosciences des systemes, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille université, 13385, Marseille, France
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17
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Runarsdottir V, Hansdottir I, Tyrfingsson T, Einarsson M, Dugosh K, Royer-Malvestuto C, Pettinati H, Khalsa J, Woody GE. Extended-Release Injectable Naltrexone (XR-NTX) With Intensive Psychosocial Therapy for Amphetamine-Dependent Persons Seeking Treatment: A Placebo-Controlled Trial. J Addict Med 2018; 11:197-204. [PMID: 28379861 PMCID: PMC5449233 DOI: 10.1097/adm.0000000000000297] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Explore the efficacy of extended-release injectable naltrexone (XR-NTX) for preventing relapse to amphetamine use. METHOD Clinical trial of 100 amphetamine-dependent, treatment-seeking patients who were randomized to 6 monthly 380 mg doses of XR-NTX or matching placebo before entering intensive outpatient after varying lengths of inpatient treatment in Reykjavik, Iceland. Weekly urine drug tests, retention, and standardized instruments assessed efficacy. RESULTS Of 169 approached, 100 were randomized. Although amphetamine dependence was the main reason for seeking treatment, three-quarters or more of participants had 1 or more other substance dependencies. Of 51 randomized to XR-NTX, 20 received 4 or more injections; of 49 assigned to placebo, 26 received 4 or more injections. Of the planned 2400 weekly urine drug tests, 1247 were collected (52%); 4% of these were positive for amphetamine, 8% for benzodiazepine, 7% for marijuana, 1% for cocaine, and 1% for opioid. XR-NTX had no effect on amphetamine-positive tests, retention, or other outcomes. Those providing half or more of their tests attended more weeks of treatment than those providing less than half of their tests (m = 10.76 vs 3.31; t (92) = 5.91, P < 0.0001), and 92 participants provided at least 1 test. CONCLUSIONS Adding XR-NTX to the usual combination of inpatient and intensive outpatient treatment did not reduce amphetamine use. The low prevalence of substance use among collected urine samples, and the association between collected samples and weeks in treatment, was consistent with other studies showing that staying in treatment is associated with better outcomes.
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Affiliation(s)
- Valgerdur Runarsdottir
- Society of Alcoholism and Other Addictions, Vogur Hospital, Reykjavík, Iceland (VR, IH, TT, ME); Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Treatment Research Institute, Philadelphia, PA (GEW); and the National Institute on Drug Abuse, Rockville, MD (JK)
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18
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Akaltun İ, Kara T. Recreational abuse of a prescribed medication by an adolescent with attention deficit hyperactivity disorder. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1372847] [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: 10/18/2022] Open
Affiliation(s)
- İsmail Akaltun
- Department of Child and Adolescent Psychiatry, Gaziantep Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Tayfun Kara
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Bjarnadottir GD, Johannsson M, Magnusson A, Rafnar BO, Sigurdsson E, Steingrimsson S, Asgrimsson V, Snorradottir I, Bragadottir H, Haraldsson HM. Methylphenidate disintegration from oral formulations for intravenous use by experienced substance users. Drug Alcohol Depend 2017. [PMID: 28651152 DOI: 10.1016/j.drugalcdep.2017.04.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Methylphenidate (MPH) is a prescription stimulant used to treat attention-deficit hyperactivity disorder. MPH is currently the preferred substance among most intravenous (i.v.) substance users in Iceland. Four types of MPH preparations were available in Iceland at the time of study: Immediate-release (IR), sustained-release (SR), osmotic controlled-release oral delivery (OROS) tablet and osmotic-controlled release (OCR). MPH OROS has previously been rated the least desirable by i.v. users and we hypothesized that this was associated with difficulty of disintegrating MPH from OROS formulation. The aim of the study was to measure the amount of MPH and the viscosity of the disintegrated solutions that were made from the four MPH formulations by four i.v.-users and non-users. METHODS A convenience sample of four i.v. substance users and 12 non-users. Non-users imitated the methods applied by experienced i.v. substance users for disintegrated MPH formulations. RESULTS Both groups managed to disintegrate over 50% of MPH from IR and SR formulations but only 20% from OROS (p<0.0001). The viscosity of the disintegrated MPH was significantly higher for MPH OROS and MPH OCR and the preparation was significantly more time-consuming than for the other MPH samples. No differences were observed between users and non-users. CONCLUSIONS To our knowledge, this is the first investigation of viscosity and the amount of disintegrated MPH from prescription drugs for i.v. use. The results indicate that the ease of disintegration, amount of MPH and viscosity may explain the difference in popularity for i.v. use between different MPH formulations.
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Affiliation(s)
- G D Bjarnadottir
- Mental Health Services, Landspitali - The National University Hospital, 101 Reykjavik, Iceland; Faculty of Medicine, Department of Psychiatry, University of Iceland, 101 Reykjavík, Iceland.
| | - M Johannsson
- Faculty of Medicine, Department of Pharmacology and Toxicology,University of Iceland, 107 Reykjavik, Iceland
| | - A Magnusson
- Department of Psychiatry, Akureyri Hospital, 600 Akureyri, Iceland
| | - B O Rafnar
- Mental Health Services, Landspitali - The National University Hospital, 101 Reykjavik, Iceland; Faculty of Medicine, Department of Psychiatry, University of Iceland, 101 Reykjavík, Iceland
| | - E Sigurdsson
- Mental Health Services, Landspitali - The National University Hospital, 101 Reykjavik, Iceland; Faculty of Medicine, Department of Psychiatry, University of Iceland, 101 Reykjavík, Iceland
| | - S Steingrimsson
- Centre for Ethics, Law and Mental Health (CELAM), Sahlgrenska Academy, The University of Gothenburg, 41677 Gothenburg, Sweden; Faculty of Medicine, Department of Psychiatry, University of Iceland, 101 Reykjavík, Iceland
| | - V Asgrimsson
- Faculty of Medicine, Department of Pharmacology and Toxicology,University of Iceland, 107 Reykjavik, Iceland
| | - I Snorradottir
- Faculty of Medicine, Department of Pharmacology and Toxicology,University of Iceland, 107 Reykjavik, Iceland
| | - H Bragadottir
- Mental Health Services, Landspitali - The National University Hospital, 101 Reykjavik, Iceland
| | - H M Haraldsson
- Mental Health Services, Landspitali - The National University Hospital, 101 Reykjavik, Iceland; Faculty of Medicine, Department of Psychiatry, University of Iceland, 101 Reykjavík, Iceland
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Sallam M, Esbjörnsson J, Baldvinsdóttir G, Indriðason H, Björnsdóttir TB, Widell A, Gottfreðsson M, Löve A, Medstrand P. Molecular epidemiology of HIV-1 in Iceland: Early introductions, transmission dynamics and recent outbreaks among injection drug users. INFECTION GENETICS AND EVOLUTION 2017; 49:157-163. [DOI: 10.1016/j.meegid.2017.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/19/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
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Dahlman D, Abrahamsson T, Kral AH, Hakansson A. Nonmedical Use of Antihistaminergic Anxiolytics and Other Prescription Drugs among Persons with Opioid Dependence. JOURNAL OF ADDICTION 2016; 2016:9298571. [PMID: 28097037 PMCID: PMC5206437 DOI: 10.1155/2016/9298571] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/27/2016] [Indexed: 11/25/2022]
Abstract
Background. Nonmedical prescription drug use (NMPDU) is an increasing problem, insufficiently studied among people in opioid maintenance treatment (OMT). This study investigates the prevalence of and factors associated with NMPDU for drug classes insufficiently described in opioid-dependent populations, including antihistaminergic anxiolytics and central stimulants. Methods. Study participants were recruited at two OMT clinics in Malmo, Sweden, between October 2014 and December 2015 (N = 73) and interviewed about their use, motivations for use, and acquisition and administration of prescription drugs. Results. The majority of the sample reported lifetime NMPDU: 60% for benzodiazepine-like hypnotics (z-drugs), 21% for pregabalin, 19% for stimulants, and 12%-15% for antihistaminergic anxiolytics. Lower age was associated with nonmedical benzodiazepine use (Adjusted Odds Ratio = 0.89; 95% Confidence Interval = 0.82-0.97). Illicit acquisition was reported by 61% of people using z-drugs, 46% of people using pregabalin, and 38% of people using prescription stimulants, but only by 6-10% of people using antihistaminergic anxiolytics. Conclusions. The substantial nonmedical use of pregabalin, z-drugs, and prescription stimulants found in this study suggests that clinicians should prescribe these drugs with great caution. Nonmedical use of antihistaminergic anxiolytics does not seem to be a clinical issue among people in OMT in a Swedish setting, but we propose future studies to monitor their use.
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Affiliation(s)
- Disa Dahlman
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
- Malmo Addiction Centre, Malmo, Sweden
| | - Tove Abrahamsson
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
- Malmo Addiction Centre, Malmo, Sweden
| | - Alex H. Kral
- Behavioral and Urban Health Program, RTI International, San Francisco, CA, USA
| | - Anders Hakansson
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
- Malmo Addiction Centre, Malmo, Sweden
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Vérité F, Micallef J. [Acute psychiatric symptoms during methylphenidate intravenous injections: A case report]. Therapie 2016; 72:367-372. [PMID: 27988038 DOI: 10.1016/j.therap.2016.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 10/04/2016] [Accepted: 10/13/2016] [Indexed: 11/24/2022]
Abstract
We report the case of a 32-year-old man who developed acute psychiatric disorders after repeated intravenous injections of methylphenidate. The behavioural disorders with extreme psychomotor restlessness and delirious syndrome have resolved within 24hours. The available data highlight the fact that the prescriptions of methylphenidate, an amphetamine-like substance, are constantly increasing in Europe and Northern America. The potential of abuse and addiction to this drug, which is growingly misused, is now clearly established. The medical professionals should be cautious and attentive to the risk of misuse of this drug.
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Affiliation(s)
- Fabrice Vérité
- EPSM de la Sarthe, unité d'accueil et d'orientation, 20, avenue du 19-Mars-1962, 72700 Allonnes, France.
| | - Joëlle Micallef
- Service de pharmacologie, CEIP-addictovigilance PACA Corse, INT, institut des neurosciences Timone, Aix-Marseille université, CNRS, CHU Timone, AP-HM, 13385 Marseille, France
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Soyka M, Mutschler J. Treatment-refractory substance use disorder: Focus on alcohol, opioids, and cocaine. Prog Neuropsychopharmacol Biol Psychiatry 2016; 70:148-61. [PMID: 26577297 DOI: 10.1016/j.pnpbp.2015.11.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/23/2015] [Accepted: 11/11/2015] [Indexed: 12/20/2022]
Abstract
Substance use disorders are common, but only a small minority of patients receive adequate treatment. Although psychosocial therapies are effective, relapse is common. This review focusses on novel pharmacological and other treatments for patients with alcohol, opioid, or cocaine use disorders who do not respond to conventional treatments. Disulfiram, acamprosate, and the opioid antagonist naltrexone have been approved for the treatment of alcoholism. A novel, "as needed" approach is the use of the mu-opioid antagonist and partial kappa agonist nalmefene to reduce alcohol consumption. Other novel pharmacological approaches include the GABA-B receptor agonist baclofen, anticonvulsants such as topiramate and gabapentin, the partial nicotine receptor agonist varenicline, and other drugs. For opioid dependence, opioid agonist therapy with methadone or buprenorphine is the first-line treatment option. Other options include oral or depot naltrexone, morphine sulfate, depot or implant formulations, and heroin (diacetylmorphine) in treatment-refractory patients. To date, no pharmacological treatment has been approved for cocaine addiction; however, 3 potential pharmacological treatments are being studied, disulfiram, methylphenidate, and modafinil. Pharmacogenetic approaches may help to optimize treatment response in otherwise treatment-refractory patients and to identify which patients are more likely to respond to treatment, and neuromodulation techniques such as repeated transcranial magnetic stimulation and deep brain stimulation also may play a role in the treatment of substance use disorders. Although no magic bullet is in sight for treatment-refractory patients, some novel medications and brain stimulation techniques have the potential to enrich treatment options at least for some patients.
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Affiliation(s)
- Michael Soyka
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstrasse 7, 80336 Munich, Germany; Privatklinik Meiringen, Postfach 612, CH-3860 Meiringen, Switzerland.
| | - Jochen Mutschler
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Selnaustrasse 9, 8001 Zurich, Switzerland
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Abstract
As the first drug to see widespread use for the treatment of attention deficit hyperactivity disorder (ADHD), methylphenidate was the forerunner and catalyst to the modern era of rapidly increasing diagnosis, treatment, and medication development for this condition. During its often controversial history, it has variously elucidated the importance of dopamine signaling in memory and attention, provoked concerns about pharmaceutical cognitive enhancement, driven innovation in controlled-release technologies and enantiospecific therapeutics, and stimulated debate about the impact of pharmaceutical sales techniques on the practice of medicine. In this Review, we will illustrate the history and importance of methylphenidate to ADHD treatment and neuroscience in general, as well as provide key information about its synthesis, structure-activity relationship, pharmacological activity, metabolism, manufacturing, FDA-approved indications, and adverse effects.
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Affiliation(s)
- Cody J. Wenthur
- Department of Chemistry, The Scripps Research Institute, La Jolla, California 92037, United States
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Steingrímsson S, Sigurdsson MI, Aspelund T, Sigfússon S, Magnússon A. Total population-based study of the impact of substance use disorders on the overall survival of psychiatric inpatients. Nord J Psychiatry 2016; 70:161-6. [PMID: 26317284 DOI: 10.3109/08039488.2015.1062143] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with severe mental illness have a shortened lifespan, and substance use disorder (SUD) is an especially important diagnosis in this respect. There have been no studies comparing directly SUD to other diagnoses in a nationwide cohort. AIMS To directly compare differences in mortality rates of psychiatric inpatients with a discharge diagnosis of SUD versus other psychiatric diagnoses. METHODS A register-based study was made of all patients admitted to psychiatric hospitals in Iceland between 1983 and 2007. Patients were grouped according to discharge diagnoses. Survival with respect to SUD was compared using Cox-proportional hazard ratio, excluding those with an organic mental disorder. Furthermore, the survival of patients with SUD and co-morbid diagnoses was evaluated. RESULTS A total of 14,281 patients (over the age of 18 years) were admitted to a psychiatric hospital in Iceland during the study period, with a total of 156,356 years of follow-up. For both men and women, a diagnosis of SUD conferred similar mortality as a diagnosis of schizophrenia without SUD, while individuals with a diagnosis of a mood disorder or "other disorders" had significantly lower mortality than SUD. For men with SUD, a co-occurring mental disorder was associated with an increased risk of dying, however, this was not found for women. CONCLUSIONS SUD was the psychiatric diagnosis that had the highest mortality rate among psychiatric inpatients, in both men and women. An additional psychiatric diagnosis on a pre-existing SUD diagnosis did increase the risk for men but not women.
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Affiliation(s)
- Steinn Steingrímsson
- a Steinn Steingrímsson, Mental health services, Landspitali the National University Hospital of Iceland, Reykjavik, Iceland and Centre of Ethics, Law and Mental Health (CELAM), Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Martin I Sigurdsson
- b Martin I. Sigurdsson, Faculty of Medicine, University of Iceland , Reykjavik , Iceland
| | - Thor Aspelund
- c Thor Aspelund, Faculty of Medicine, University of Iceland , Reykjavik , Iceland
| | | | - Andrés Magnússon
- e Andrés Magnússon, Mental health services, Landspitali the National University Hospital of Iceland , Reykjavik , Iceland
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