Methamphetamine as the most common concomitant substance used with pregabalin misuse

BACKGROUND AND AIM

Non-medical use of Pregabalin (PGB) is a growing concern in many countries because of the serious consequences associated with their abuse. Judicial cases within the probation system, multiple drug users, and patients in treatment programs administered PGB at higher doses than suggested, commonly without prescription. For this reason, it is important to analyze PGB by adding it to the routine analysis scale in determining whether PGB is used for medical purposes or abuse. In this study, PGB analyzed (single or multiple substance use, concomitant substances) in urine samples of forensic and clinical cases by liquid chromatography-tandem mass spectrometry (LC-MS/MS). In addition to the sociodemographic and clinical characteristics of pregabalin-positive cases, the results were evaluated separately from a clinical and forensic perspective.

METHODS

All urine samples which was admitted to Addiction Toxicology Laboratory from 'drug abuse probation system' (forensic cases, n = 640) and from various departments of our hospital (clinical cases, n = 371) between December 2022 and April 2023. Screening analysis were carried out by immunoassay in total 1011 cases. LC-MS/MS method simultaneously analyzed amphetamine, benzoilecgonine, cocaine, codeine, metamphetamine, morphine, 3,4-metilenedioksi-N-metilamfetamin (MDMA), 11-nor-9-karboksi-Δ9-tetrahidrokannabinol and pregabalin in urine samples. PGB was added to the our routine substance screening analysis scale in December 2022 to detect pregabalin use.

RESULTS

PGB was detected in 12.3% of probabition cases and 13.2% of clinical cases. The mean age of PGB positive cases was 26.55 ± 7,52 years old, predominantly males (%85,9). Single PGB was detected in 53.2% of forensic cases (n = 42), and 38.7% of clinical cases (n = 19). The most common substance detected concomitantly with PGB was amphetamine type stimulants (ATSs:amphetamine, methamphetamine, ecstasy/MDMA etc.) (22.8% of forensic cases and 46.9% of clinical cases), followed by concomitant cannabis use (24.1% of forensic cases and 26.5% of clinical cases). Concomitant opioid use was rare (1.3% of forensic cases and 4.1% of clinical cases). Detection of PGB was significantly different across months on which the samples were collected (x2 = 82.8, df=4, p < 0.001).

CONCLUSION

Inconsistently with previous studies suggesting opioids as the most prevalant substances concominant with PGB, our results showed that stimulants (especially ATSs) were the most prevelant substances concominant with PGB, followed by cannabis. High proportion of PGB detection in probabition cases, frequently as a single substance abuse takes attention. These results suggest that PGB, may be used to avoid legal consequences. It is important for laboratories to be aware that they need to make changes as addition of newly abused substances in their analysis panels, when necessary, as differences between regions and cultures affect substance use patterns.

A Review of Drug Abuse, Misuse, and Related Laboratory Challenges

Various definitions can be considered for drugs and substance abuse. According to the National Institute on Abuse, the use of an over-the-counter drug in a different way than that prescribed to experience or arouse emotion is a simple form of drug abuse. The World Health Organization (WHO) also defines drug abuse as the persistent or sporadic use of drugs that are incompatible or unrelated to acceptable medical practice. With the increasing non-therapeutic use of prescription drugs, serious related consequences have also increased. Therefore, there is a need to know more precisely about the types of substances and drug abuse, which is the most important part of diagnosis and recognizing the tests that cause false positive and negative results. The purpose of this review article is to collect and summarize the most important and more common types of drugs of abuse and review the drugs that cause false results in screening tests. In addition, the most common detection methods of the drug will be reviewed and the advantages and drawbacks of each method will be discussed. In this article, we aimed to point out all the facts about the emerging problems in drug abuse, the methods of screening, and the possible false results in addition to troubleshooting strategies.

Lessons learnt from alcoholism and substance use disorders (SUDs) during the COVID-19 pandemic in India

SUD is a widespread non-communicable disease (NCD) with biological, social, or psychological foundations which policymakers have given less attention during the COVID-19 pandemic. People with alcohol dependence went into withdrawal as a result of the lockdown and acute lack of alcohol availability, which led to black marketing and, in extreme cases, suicide. On the other hand, De-addiction services in India were not adequately equipped for the SUD pandemic, and as a result, most services could not cope with lockdown problems. To generate revenue and to get out of this Catch-22 situation, the Government opened liquor shops and sold alcohol while people purchased it as usual because of excess stress, lack of social contact, loneliness and boredom. We recommend that during COVID-19 pandemic, national, state, and local governments, as along with organisations such as Alcoholics Anonymous, develop and support networks to address the needs of patients with SUD.

Burn Injuries in People Who Used Drug, 2009-2017: A Case-Control Study in Shiraz, Southern Iran

BACKGROUND

Burn injury is a critical health issue, which is associated with several morbidities and mortalities. Substance abuse, which is an important public health problem in Iran, can affect burn injury outcomes and etiologies in victims. This study was aimed to evaluate different aspects of burn injuries in people who used drug (PWUD) in two referral centers in the south of Iran.

METHODS

This Case-Control Study was conducted on burn victims referred to Amir-al Momenin Hospital and Ghotb-al-din Hospital from 2009 to 2017. Patients with a history of drug consumption were selected from the database and compared to randomly selected burn victims with no history of drug use. Demographics, burn etiology, underlying disease, total body surface area, hospitalization duration, and also the outcomes were collected and recorded in both groups. Data analysis was done by SPSS software.

RESULTS

A total of 5,912 inpatients were included in this study, which 2,397 of them (40.54%) were female. The mean age of the patients was 26.12 ± 19.18. Drug history was positive in 659 patients (11.15%). Familial issues and mental disorders were significantly higher in the PWUD group compared to the control group (P<0.001). Explosion etiology was significantly higher in the PWUD group (P<0.001). Psychiatric disorders (P<0.001), total body surface area (P=0.023), and hospital stay (P<0.001) were significantly higher in PWUD; however, the mortality rate had no statistically significant differences between the groups (P=0.583).

CONCLUSION

Substance abuse is a risk factor in burn victims, which can affect burn etiology and burn-related morbidities.

The effect of opium on severity of COVID-19 infection:An original study from Iran

Background: The COVID-19 infection is a novel virus without any specific targeted therapies; thus, focusing on primary epidemiologic concerns, preventive strategies, risk factors, exacerbation factors, and mortality-related factors are of great importance to better control this disorder. There are some controversies about the factors associated with COVID-19 in different theories, and addiction is no exception.

Methods: We conducted a large cross-sectional study of 513 hospitalized Iranian patients with COVID-19 infection to evaluate the severity of disease courses in patients with or without history of opium addiction. We recorded these data retrospectively after patients’ discharge from the hospital. For the quantitative data, we used independent-samples t and Mann-Whitney tests. The qualitative data were calculated using Fisher exact and chi-square tests in IBM SPSS Statistics Version 22. Also, p<0.05 was considered statistically significant.

Results: There was no significant difference regarding mean days of hospitalization in opium positive and negative groups (7.95±8.39 vs 8.35±5.11, respectively) (p=0.771); however, the need for intensive care unit (ICU) admission was significantly higher in the opium positive group (36% vs 11%) (p=0.005). The mean days of ICU stay was significantly higher in the opium positive group (2.36±3.81 vs 0.86±2.90) (p=0.026). The percentage of febrile patients, anosmia/hyposmia, and dysgeusia at the initiation of hospitalization was significantly lower in the opium positive group (39% vs 66%; 8% vs 23%; 8% vs; 20%, respectively) (p=0.002, 0.018, and.031, respectively). In the laboratory tests, only the white blood cell (WBC) count and the segmented cells were higher in the opium positive group (10.1±6.60 vs 7.38±4.14 and 73±20.47 vs 56.5±32.60, respectively) (p=0.018 and.001, respectively) and lymphocytes were lower in the opium positive (15.60±8.25 vs18.70±10.12) (p=0.048). Opium addicts had a significantly lower rate of azithromycin and lopinavir/ritonavir prescription in their initiation therapy (19% vs 34%, and 47% vs 70%, respectively) (p=0.038 and 0.012, respectively).

Conclusion: Opium addict patients with COVID infection may be more febrile and experience more disease-specific symptoms and more severe disease course. These patients may show more evidence of laboratory inflammation and probable superinfections, so may manage with more caution and somehow different therapeutic regimen.

Preserving wellness in dermatology residents

Although a dermatology residency is associated with a favorable lifestyle, nearly one in three budding dermatologists meet the criteria for burnout. The competitive nature of dermatology residency selection may confer a predisposition to burnout. Contributing factors during residency include a high-volume clinical experience and frequent use of electronic health records. Women may face particular pressures in managing work-life balance when starting a family during dermatology residency. In addition to preventing burnout before residency, fears of professional repercussions should be alleviated to ensure resident well-being. We have focusedW focus on the causes of burnout among dermatology residents and suggest solutions to promote wellness.

Association Between Statewide Opioid Prescribing Interventions and Opioid Prescribing Patterns in North Carolina, 2006-2018

OBJECTIVE

To examine the impact of three sequential statewide policy and legislative interventions on opioid prescribing practices among privately insured individuals in North Carolina.

METHODS

An interrupted time series approach was used to examine level and trajectory changes of new and prevalent opioid prescription rates, days' supply, and daily morphine milligram equivalents before and after implementation of a 1) prescription drug monitoring program, 2) state medical board initiative, and 3) legislative action. Analyses were conducted using individual-level claims data from a large private health insurance provider serving North Carolina residents, ages 18-64 years, from January 2006 to August 2018.

RESULTS

Rates of new and prevalent prescription opioid patients were relatively unaffected by the prescription monitoring program but sharply declined in the months immediately following both medical board (-3.7 new and -19.3 prevalent patients per 10,000 person months) and legislative (-14.1 new and -26.7 prevalent patients) actions. Among all opioid prescriptions, days' supply steadily increased on average over the study period but declined after legislative action (-1.5 days' supply per year).

CONCLUSIONS

The voluntary prescription drug monitoring program launched in 2010 only marginally affected opioid prescribing patterns on its own, but its redeployment as an investigative and clinical tool in multifaceted public policy approaches by the state medical board and legislature later in the decade plausibly contributed to notable declines in prescription rates and days' supply. This study lends new emphasis to the importance of enforcement mechanisms for state and national policies seeking to reverse this critical public health crisis.

New trend of drugs abused by secondary school students in Nigeria

Background

It appears that there is a new trend in the types of drugs abused by secondary school students in Nigeria that makes it difficult to identify current drug abusers.

Objectives

This study was conducted to reveal the trends with regards to the types of drugs abused by these students in the country.

Methods

This is an online and desktop review of published articles about the types of drugs abused by secondary school students during the period that spanned from 2010–2020.

Results

In all, 17 research reports were identified as having data on the types of drugs abused by secondary students in the Nigeria. It was found that 18 different drugs were empirically identified as being abused by secondary school students in 9 different states of Nigeria. The observed trend is that alcohol, cannabis, tobacco and cigarettes are the most abused drugs, while drugs that were least abused were cocaine, caffeine, glue, heroine, energy drinks, miraa, rohypnol and tramadol.

Conclusion

It was concluded that studies of drug abuse by secondary school students in Nigeria are not yet robust enough to reveal the types of drugs that are currently being abused.

Interventions for Decreasing Drug Abuse and Social Problem in Iran's Comprehensive Mental and Social Health Services

Objective: Social problems and drug abuse, especially addiction, divorce, poverty, crime, violence, alcohol consumption, and substance abuse, have increased in Iran over the past two decades. The present study aims to determine an approach to decrease drug abuse and social ‎problems in the Islamic Republic of Iran.

Method: A national program on providing comprehensive social and mental health services, entitled “SERAJ”, was developed and piloted in three districts of Iran. To compile this study, three types of data collection have been used: (1) review of the literature, (2) an in-depth interview with experts and stakeholders, (3) focused group discussions.

Results: In our proposed model for decreasing drug abuse and social ‎problems, comprehensive mental and social health service are provided. Social care is integrated into the primary health care and six types of services, including social health education, screening for risk factors of social problems, and drug abuse, identifying underlying psychiatric, psychological, or social causes, short consultations, referral to social workers, and follow-up.

Conclusion: Theoretically, if mental disorders are reduced, social harm and addiction will also be reduced because it is one of the important risk factors for divorce, violence, crime, drug abuse, and alcohol consumption. SERAJ reduces mental disorders; therefore, it can reduce social problems and addiction.

Evaluation of Drug Abuse in Patients With Lifelong Premature Ejaculation: A Cross-Sectional Study

Introduction

Most studies investigate sexual dysfunction in drug abusers; however, there are no data available about the pattern of drug abuse in patients with lifelong premature ejaculation (PE).

Aim

To assess the pattern of drug abuse in patients with lifelong PE and to evaluate its potential effect on their hormonal profile.

Methods

A cross-sectional study included patients with lifelong PE (n = 76) with no prescribed medications for 1 month and age-matched control without PE (n = 48). Participants were evaluated by history, examination, Arabic index of PE, and hormonal profile. A urine sample was screened by dipstick kits for the following drug abuse tramadol, opiate, tetrahydrocannabinol (cannabis), amphetamine, barbiturate, cocaine, and benzodiazepines. Positive results were confirmed with a immunoassay drug analyzer.

Main outcome measures

The outcomes of this study are positive and negative drug abuse and hormonal profile changes.

Results

Control patients and patients with PE showed median (interquartile range) of age 43 (33–46.8) and 38.5 (31–45) years, respectively. Drug abuse testing results showed significantly high positive drug abuse in patients with PE, 26 of 76 (34.2%), in comparison with control, 9 of 48 (19.1%) (P = .05). The most commonly abused drug was tetrahydrocannabinol in control, 3 of 9 (33.3%), and tramadol, 12 of 26 (46.2%), in patients with PE. Control patients and patients with PE with positive drug abuse had significantly higher smoking percent (P < .0001) and higher positive drug abuse history (P < .0001). However, there was no relationship between drug abuse and PE severity, and there were no significant changes in their hormonal profile.

Conclusions

Drug abuse is high among patients with lifelong PE in Upper Egypt, with tramadol being the comment drug. Drug abuse is common among smokers. However, no hormonal disturbance could be shown in drug abuse patients. Drug abuse might be considered in the evaluation of patients with PE.

Mohammed SA, Abdelhamed A, El Sayed RM. Evaluation of Drug Abuse in Patients With Lifelong Premature Ejaculation: A Cross-Sectional Study. Sex Med 2020;8:608–614.

Impact of Iowa's Prescription Monitoring Program on Opioid Pain Reliever Prescribing Patterns: An Interrupted Time Series Study 2003-2014

OBJECTIVE

To evaluate the impact of Iowa's prescription monitoring program (PMP), implemented in 2009, on opioid pain reliever (OPR) prescribing patterns.

METHODS

We conducted interrupted time series analyses using 2003-2014 health insurance claims from a private health insurer in Iowa. OPR prescriptions for all beneficiaries were included. Another data set included only OPR prescription for new opioid users required to have six months of insurance coverage. We evaluate four OPR prescribing patterns: 1) average daily dosage in morphine milligrams equivalents (MME), 2) MME per prescription, 3) average days' supply per prescription, and 4) prescription rate per 1,000 insured person-years. We examined confounding and effect measure modification of the relationship between PMP and prescribing patterns by age and sex.

RESULTS

During the 12 years of follow-up, 1,512,388 insured Iowans contributed 6,169,634.92 person-years of follow-up. Of these, 505,274 patients filled 2,401,818 OPR prescriptions and 360,688 new OPR users filled as many first OPR prescriptions. The increasing trend of OPR prescription rates from 2003 to 2009 declined post-PMP. Similarly, there was a large decline in MME per day and MME per prescription. The OPR days' supply kept increasing post-PMP implementation, albeit at a slightly slower rate than pre-PMP implementation. There was no confounding by age and sex; however, we observed heterogeneity by age and sex; patients aged ≥50 years and females received higher doses and more prescriptions pre-PMP and experienced the greatest declines post-PMP.

CONCLUSIONS

Our study suggests that Iowa PMP implementation may have resulted in declines in OPR prescribing, and this impact varies by patient age and sex.

Screening for Psychotherapeutic Medication Misuse in Primary Care Patients: Comparing Two Instruments

INTRODUCTION

Prescription psychotherapeutic medication misuse is a growing problem in the United States, but no method exists to routinely screen for this in primary care. Our study sought to (1) describe the prevalence of prescription psychotherapeutic medication misuse in primary care and the characteristics of patients who misuse and (2) compare 2 screening instruments modified to identify prescription medication misuse in primary care.

METHODS

Primary care patients from underserved, urban clinics within a health system completed anonymous computer-directed health screens that included standard questions about prescription medication misuse. They were also administered the 4-item Cut down, Annoyed, Guilty, and Eye-opener questionnaire modified to focus on prescription medications (RxCAGE) and a 6-item Prescription Opioid Misuse Index (POMI-e) expanded to include other prescription medications.

RESULTS

Of 2,339 respondents, 15.3% were positive for at least 2 items on the RxCAGE and 18.6% were positive for at least 2 items on the POMI-e. Using our computer-directed health screen as a comparison, we found that POMI-e had a higher area under the curve (0.63). A positive POMI-e was associated with being male, white and unemployed, having depression and anxiety, and currently using illicit substances, smoking, and misusing alcohol.

CONCLUSIONS

Rates of prescription medication misuse were substantial with both RxCAGE and POMI-e showing promise as screening instruments. Future studies are needed to test prescription medication misuse screening tools in broader populations and pilot interventions for those screening positive.

Impact of Marijuana Legalization in Colorado on Adolescent Emergency and Urgent Care Visits

PURPOSE

Approximately 6%-8% of U.S. adolescents are daily/past-month users of marijuana. However, survey data may not reliably reflect the impact of legalization on adolescents. The objective was to evaluate the impact of marijuana legalization on adolescent emergency department and urgent cares visits to a children's hospital in Colorado, a state that has allowed both medical and recreational marijuana.

METHODS

Retrospective review of marijuana-related visits by International Classification of Diseases codes and urine drug screens, from 2005 through 2015, for patients ≥ 13 and < 21 years old.

RESULTS

From 2005 to 2015, 4,202 marijuana-related visits were identified. Behavioral health evaluation was obtained for 2,813 (67%); a psychiatric diagnosis was made for the majority (71%) of these visits. Coingestants were common; the most common was ethanol (12%). Marijuana-related visits increased from 1.8 per 1,000 visits in 2009 to 4.9 in 2015. (p = < .0001) CONCLUSIONS: Despite national survey data suggesting no appreciable difference in adolescent marijuana use, our data demonstrate a significant increase in adolescent marijuana-associated emergency department and urgent cares visits in Colorado.

The Effect of Dexmedetomidine Prescription on Shivering during Operation in the Spinal Anesthesia Procedures of Selective Orthopedic Surgery of the Lower Limb in Addicted Patients

Background

Shivering during a surgery is common. Recently, Alpha-D-agonist dexmedetomidine has been used to control and prevent shivering during and after surgery. However, the anti-shivering effects of this drug in people are unknown with substance abuse. The purpose of this study was to investigate the anti-shivering effect of this drug in addicted individuals.

Methods

After obtaining the required criteria, the criteria were randomized in 2 groups, dexmedetomidine and normal saline (each group n = 30), and were matched in age and sex. The dexmedetomidine 0.5 mg/kg/h was given to one group and normal saline infusion was given to the other group as a placebo immediately after induction of anesthesia and before surgery for lower limb lesions. During the operation, patients were monitored for shivering as well as vital signs and arterial oxygen saturation. In addition, after surgery, patients were evaluated for clinical side effects.

Results

The results showed that systolic blood pressure was significantly lower in the dexmedetomidine group at 30 minutes to 150 minutes after injection during the operation (P < 0.01). There was no significant difference between the 2 groups at the other times. In intra-group comparisons in both groups, diastolic pressure drop was significantly decreased to 90 minutes after surgery. In general, at other times in each group, diastolic pressure changes were not significant compared to preoperative. In between group comparisons, the mean heart rate was significantly lower in the dexmedetomidine group at 30 minutes and 60 minutes compared to the control group. In addition, at other times, its lower values were not significantly different with the control group. The 2 groups did not show significant differences in the number of breaths per minute or as the intra-group (P > 0.05), although, the average respiratory rate per minute in the dexmedetomidine group was lower. Decreased temperature of the tympanic curvature was significantly lower in the DEX group at 10 and 60 minutes after surgery than the control group (P < 0.001). Arterial oxygen saturation was more than 97% in both groups before and after operation, and no difference was observed between the 2 groups.

Conclusions

Prescribing dexmedetomidine during spinal anesthesia in patients with substance abuse can significantly decrease the incidence of shivering during surgery while not having adverse effects on hemodynamics of patients and can be used as a safe and effective drug for this purpose.

Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States

OBJECTIVE

The authors sought to determine whether cannabis use is associated with a change in the risk of incident nonmedical prescription opioid use and opioid use disorder at 3-year follow-up.

METHOD

The authors used logistic regression models to assess prospective associations between cannabis use at wave 1 (2001-2002) and nonmedical prescription opioid use and prescription opioid use disorder at wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Corresponding analyses were performed among adults with moderate or more severe pain and with nonmedical opioid use at wave 1. Cannabis and prescription opioid use were measured with a structured interview (the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version). Other covariates included age, sex, race/ethnicity, anxiety or mood disorders, family history of drug, alcohol, and behavioral problems, and, in opioid use disorder analyses, nonmedical opioid use.

RESULTS

In logistic regression models, cannabis use at wave 1 was associated with increased incident nonmedical prescription opioid use (odds ratio=5.78, 95% CI=4.23-7.90) and opioid use disorder (odds ratio=7.76, 95% CI=4.95-12.16) at wave 2. These associations remained significant after adjustment for background characteristics (nonmedical opioid use: adjusted odds ratio=2.62, 95% CI=1.86-3.69; opioid use disorder: adjusted odds ratio=2.18, 95% CI=1.14-4.14). Among adults with pain at wave 1, cannabis use was also associated with increased incident nonmedical opioid use (adjusted odds ratio=2.99, 95% CI=1.63-5.47) at wave 2; it was also associated with increased incident prescription opioid use disorder, although the association fell short of significance (adjusted odds ratio=2.14, 95% CI=0.95-4.83). Among adults with nonmedical opioid use at wave 1, cannabis use was also associated with an increase in nonmedical opioid use (adjusted odds ratio=3.13, 95% CI=1.19-8.23).

CONCLUSIONS

Cannabis use appears to increase rather than decrease the risk of developing nonmedical prescription opioid use and opioid use disorder.

Prevalence of Risky Behaviors and Related Factors among Students of Dezful

Objective: There is a likelihood of risky behaviors such as drug abuse, risky sexual behavior, and adaptability issues in young ages. The present study aimed at investigating the prevalence of risky behaviors among students of Dezful University of Medical Sciences in 2014. Method: This was a descriptive-analytical cross sectional study, with a random sampling approach. Scale of measuring risky behaviors was used to measure the risky behaviors (high speed driving, maim, drug use, and sexual behaviors) and related factors. The mean, standard deviation, Chi-square tests, t tests, and ANOVA were used for data analysis. Results: The study was conducted on 150 (50%) female and 150 (50%) male students. Most of the participants aged 20 to 24 years. A statistically significant difference was obtained between the average scores of risky behaviors among female and male students (p˂0.05). The results of the present study revealed that the prevalence of risky behaviors, high speed driving, and drug consumption was different among the students of various study fields (p˂0.05). Conclusion: The prevalence of risky behaviors among students of Dezful University was relatively low, and the prevalence of these behaviors in female students was far less than in male students. Risky behaviors were associated with background variables, except for mother's occupation.

Antireward, compulsivity, and addiction: seminal contributions of Dr. Athina Markou to motivational dysregulation in addiction

RATIONALE AND OBJECTIVES

Addiction is defined as a chronically relapsing disorder characterized by compulsive drug seeking that is hypothesized to derive from multiple sources of motivational dysregulation.

METHODS AND RESULTS

Dr. Athina Markou made seminal contributions to our understanding of the neurobiology of addiction with her studies on the dysregulation of reward function using animal models with construct validity. Repeated overstimulation of the reward systems with drugs of abuse decreases reward function, characterized by brain stimulation reward and presumbably reflecting dysphoria-like states. The construct of negative reinforcement, defined as drug taking that alleviates a negative emotional state that is created by drug abstinence, is particularly relevant as a driving force in both the withdrawal/negative affect and preoccupation/anticipation stages of the addiction cycle.

CONCLUSIONS

The negative emotional state that drives such negative reinforcement is hypothesized to derive from the dysregulation of key neurochemical circuits that drive incentive-salience/reward systems (dopamine, opioid peptides) in the ventral striatum and from the recruitment of brain stress systems (corticotropin-releasing factor, dynorphin) within the extended amygdala. As drug taking becomes compulsive-like, the factors that motivate behavior are hypothesized to shift to drug-seeking behavior that is driven not only by positive reinforcement but also by negative reinforcement. This shift in motivation is hypothesized to reflect the allostatic misregulation of hedonic tone such that drug taking makes the hedonic negative emotional state worse during the process of seeking temporary relief with compulsive drug taking.

Prevalence of driving under the influence of psychoactive substances and road traffic crashes among Brazilian crack-using drivers

BACKGROUND

Substance use disorders are associated with the increased risk of driving under the influence (DUI), but little is known about crack-cocaine and its relationship with road traffic crashes (RTC).

METHOD

A multicenter sample of 765 crack-cocaine users was recruited in six Brazilian capitals in order to estimate the prevalence of DUI and RTC involvement. Legal, psychiatric, and drug-use aspects related with traffic safety were evaluated using the Addiction Severity Index - 6th version (ASI-6) and the Mini International Neuropsychiatric Interview.

RESULTS

Seventy-six (28.3%) current drivers reported accident involvement following crack-cocaine use. Among drivers (n=269), 45.7% and 30.5% reported DUIs in the past 6 months and 30 days, respectively. Drivers reporting DUI's in the past month (n=82) had higher scores in the "psychiatric", "legal", and "family problems" subscales from the ASI-6, and lower scores in the "family social support" subscale in comparison to those without a history of DUIs (n=187). An overall high prevalence of psychiatric comorbidity and substance consumption was observed. Participants with 5+ years of crack-cocaine use were more likely to have been in a RTC (RR=1.52, 95%IC: 1.02-2.75), independently of marijuana use, binge drinking and psychiatric comorbidities.

CONCLUSION

The high prevalence of RTC and DUI involvement among crack-using drivers supports the idea that they are at a high risk group regarding traffic safety. Years of crack consumption seem to be associated with RTC involvement. Also, the presence of psychiatric comorbidities, poly-drug use, and cognitive impairment usually associated with crack addiction could yield additional risk of accidents.

Sex Partner Type, Drug Use and Condom Use Self-Efficacy Among African Americans from Disadvantaged Neighborhoods: Are Associations with Consistent Condom Use Moderated by Gender?

Gender inequalities in sexual behavior are explored from the perspective of the theory of gender and power. This study focused on the effect of sex partner type (steady versus casual), drug use, and condom use self-efficacy regarding consistent condom use (CCU) among a community-based sample of adults. The sample included 1,357 African American men and women (M age 37.0, SD 13.1 years; 44% women, 66% men) from 61 disadvantaged census block groups in Atlanta, GA as part of a study of individual and neighborhood characteristics and HIV risk-taking. Having a steady partner decreased the odds of CCU, while higher condom use self-efficacy increased the odds of CCU. Among non-drug users, having a drug-using partner was associated with decreased odds of condom use for women only. Women with drug-using partners, especially a steady partner, were least likely to report CCU. Therefore, interventions intended to empower CCU among women need to expand beyond acknowledging the reduced control that women who use drugs demonstrate to also consider those who have drug-using sexual partners.

The Frequency of High-Risk Behaviors Among Iranian College Students Using Indirect Methods: Network Scale-Up and Crosswise Model

BACKGROUND

Since the direct questions usually underestimate the frequency of sensitive behaviors, indirect methods can be used to estimate the frequency of some risky behaviors such as illicit drug use, sexual behaviors especially where these behaviors are highly stigmatized.

OBJECTIVES

In the current study, we indirectly estimated the prevalence of some risky behaviors among college students using two indirect methods: network scale-up (NSU) and crosswise model (CM).

PATIENTS AND METHODS

Having recruited 563 students from one of Iran's major medical universities, the prevalence of opium and drug use, alcohol consumption, relationships with the opposite sex (RWOS),and extra/pre-marital sex (EPMS) were estimated using two indirect methods.

RESULTS

The estimated prevalence using the CM and NSU were alcohol consumption (16.8% vs. 8.1%), opium use (2.2% both), methamphetamine use (7.2% vs. 1.2%), taking tramadol without medical indications (14.8% vs. 4.8%), RWOS (42.3% vs. 31.9%), and EPMS (12.4% vs. 7.1%).

CONCLUSIONS

Lower estimations in the NSU method might be due to the transmission barrier, which means that students were not fully aware of the high-risk behaviors of their close friends. Nonetheless, it seems that these risky behaviors were more or less common among Iranian college students.

Preclinical Abuse Potential Assessment of Flibanserin: Effects on Intracranial Self-Stimulation in Female and Male Rats

INTRODUCTION

Flibanserin is a serotonin receptor subtype 1A agonist and 2A antagonist that has been approved by the Food and Drug Administration for treating female sexual interest and arousal disorder. Little is known about the abuse potential of flibanserin.

AIM

To examine abuse-related effects of flibanserin in rats using an intracranial self-stimulation (ICSS) procedure previously used to evaluate the abuse potential of other drugs.

METHODS

Adult female and male Sprague-Dawley rats with electrodes implanted in the medial forebrain bundle were trained to press a lever for electrical brain stimulation under a "frequency-rate" ICSS procedure. In this procedure, increasing frequencies of brain stimulation maintain increasing rates of responding. Drugs of abuse typically increase (or "facilitate") ICSS rates and produce leftward and upward shifts in ICSS frequency-rate curves, whereas drugs that lack abuse potential typically do not alter or only decrease ICSS rates. Initial studies determined the potency and time course of effects on ICSS produced by acute flibanserin administration (1.0, 3.2 and 10.0 mg/kg). Subsequent studies determined the effects of flibanserin (3.2-18 mg/kg) before and after a regimen of repeated flibanserin administration (5.6 mg/kg/d for 5 days). Effects of the abused stimulant amphetamine (1.0 mg/kg) were examined as a positive control.

MAIN OUTCOME MEASURES

Flibanserin effects on ICSS frequency-rate curves in female and male rats were examined and compared with the effects of amphetamine.

RESULTS

Baseline ICSS frequency-rate curves were similar in female and male rats. Acute and repeated administrations of flibanserin produced only decreases in ICSS rates, and rate-decreasing effects of the highest flibanserin dose (10 mg/kg) were greater in female than in male rats. In contrast to flibanserin, amphetamine produced an abuse-related increase in ICSS rates that did not differ between female and male rats.

CONCLUSION

These results suggest that flibanserin has low abuse potential. In addition, this study suggests that female rats might be more sensitive than male rats to the rate-decreasing effects of high flibanserin doses.

Impulsivity in abstinent alcohol and polydrug dependence: a multidimensional approach

RATIONALE

Dependence on drugs and alcohol is associated with impaired impulse control, but deficits are rarely compared across individuals dependent on different substances using several measures within a single study.

OBJECTIVES

We investigated impulsivity in abstinent substance-dependent individuals (AbD) using three complementary techniques: self-report, neuropsychological and neuroimaging. We hypothesised that AbDs would show increased impulsivity across modalities, and that this would depend on length of abstinence.

METHODS

Data were collected from the ICCAM study: 57 control and 86 AbDs, comprising a group with a history of dependence on alcohol only (n = 27) and a group with history of dependence on multiple substances ("polydrug", n = 59). All participants completed self-report measures of impulsivity: Barratt Impulsiveness Scale, UPPS Impulsive Behaviour Scale, Behaviour Inhibition/Activation System and Obsessive-Compulsive Inventory. They also performed three behavioural tasks: Stop Signal, Intra-Extra Dimensional Set-Shift and Kirby Delay Discounting; and completed a Go/NoGo task during fMRI.

RESULTS

AbDs scored significantly higher than controls on self-report measures, but alcohol and polydrug dependent groups did not differ significantly from each other. Polydrug participants had significantly higher discounting scores than both controls and alcohol participants. There were no group differences on the other behavioural measures or on the fMRI measure.

CONCLUSIONS

The results suggest that the current set of self-report measures of impulsivity is more sensitive in abstinent individuals than the behavioural or fMRI measures of neuronal activity. This highlights the importance of developing behavioural measures to assess different, more relevant, aspects of impulsivity alongside corresponding cognitive challenges for fMRI.

Neonatal drug withdrawal syndrome: cross-country comparison using hospital administrative data in England, the USA, Western Australia and Ontario, Canada

OBJECTIVES

We determined trends over time in the prevalence of neonatal drug withdrawal syndrome (NWS) in England compared with that reported in the USA, Western (W) Australia and Ontario, Canada. We also examined variation in prevalence of NWS according to maternal age, birth weight and across the English NHS by hospital trusts.

DESIGN AND SETTING

Retrospective study using national hospital administrative data (Hospital Episode Statistics) for the NHS in England between 1997 and 2011. NWS was identified using international classification of disease codes in hospital admission records. We searched the research literature and contacted researchers to identify studies reporting trends in the prevalence of NWS.

MAIN OUTCOME MEASURES

Prevalence of NWS by calendar year per 1000 live births for each country/state. For births in England, prevalence by maternal age group and birth weight group. Prevalence by NHS trust and region at birth, and funnel plot to show outlying English NHS hospital trusts (>3 SD of mean prevalence).

MAIN RESULTS

Mean prevalence rates of recorded NWS increased in all four countries. Rates stabilised in England and W. Australia from the early 2000s and rose steeply in the USA and Ontario during the late 2000s. The most recent prevalence rates were 2.7/1000 live births in England (2011; 1544 cases); 2.7/1000 in W. Australia (2009); 3.6/1000 in the USA (2009) and 5.1/1000 in Ontario (2011). The highest prevalence in England was among babies born to mothers aged 25-34 years at delivery and among babies born with low birth weight (1500-2500 g). In England in 2011, 8.6% of hospital trusts had a recorded prevalence outside 3 SD of the overall average (7% above, 1% below). The North East region of England had the highest recorded prevalence of NWS.

CONCLUSIONS

Although recorded NWS is stable in England and W. Australia, rising rates in the USA and Ontario may reflect better recognition and/or increased use of prescribed opiate analgesics and highlight the need for surveillance. The extent to which different prevalence rates by hospital trust reflect variation in occurrence, recognition or recording requires further investigation.

A Structural Equation Modeling of the Relationships between Depression, Drug Abuse and Social Support with Suicidal Ideation among Soldiers in Iran in 2015

BACKGROUND

Military service is a crucial period in the lives of young people and during this period soldier facing with multiple psychosocial problems.

OBJECTIVES

The present study aimed to explore structural analysis of the relationships between depression, drug abuse, social support and the risk of suicidal ideation among Military Medical University soldiers in Iran.

METHODS

In the present correlational research, a sample of 176 soldiers, from three units, was selected using randomly stratified sampling. Data were collected through the Social Support Questionnaire (SSQ), the Beck Depression Inventory-II (BDI-II), the Beck Scale for Suicide Ideation (BSS) and the Possibility of Drug Abuse Scale (LDAS). Structural equation modeling was used to test the fit of the model, identify direct and indirect effects of the psychosocial correlates. Data were analyzed using the SPSS and AMOS software (Verson22).

RESULTS

out of the whole subjects, 28.4% had suicidal ideation and 65.3% had degrees of depression (mild to severe). A significant reverse relationship was observed between social support and suicidal ideation (p<0.05). The strongest relationship was detected between drug abuse and suicidal ideation. The final structural model indicated that 74% of the variance in suicidal ideation was explained by the three examined variables of depression, social support and drug abuse.

CONCLUSIONS

The overall results showed that the risk of suicidal ideation, depression and drug abuse are relatively significant in Military Medical University soldiers requiring taking serious actions by the authorities and other relevant organizations in order to improve the psychosocial health status of these soldiers.

Iran's Activities on Prevention, Treatment and Harm Reduction of Drug Abuse

CONTEXT

In the present review study, authors investigated Iran's activities regarding prevention, abuse and harm reduction of drugs nationwide. The issue appears to be important in order to show the trend of activities in the country.

EVIDENCE ACQUISITION

In this report, authors gathered data from different Farsi/English peer review journals issued both in printed and online versions. These journals have been indexed in PubMed, ISI, ISC, SID, Magiran, UN, etc. These are among the most referred and cited databases.

RESULTS

Summarizing the data led to three distinguished sections: 1) drug supply reduction activities; 2) drug demand reduction activities; 3) harm reduction activities.

CONCLUSIONS

As the results showed, the trend of activities was encouraging and some additional activities could be included to future programs relying on early-onset preventions.

Survival Analysis of Drug Abuse Relapse in Addiction Treatment Centers

Background:

Drug abuse is a chronic and enduring phenomenon, which is among the important challenging public health problems. One of the main aspects in drug abuse is the relapse.

Objectives:

The aims of this study were to estimate the time to relapse (survival rate) and to evaluate some of its associated variables by survival analysis.

Patients and Methods:

This research was conducted in four addiction treatment centers on 140 self-referred addicts in Ilam city, Iran, in 2012. Cluster sampling method was used for selecting the samples and data were collected by interview and referring to the subjects’ records. The gathered data were analyzed through the life table, Kaplan-Meier analysis, log rank test, and Cox regression.

Results:

The relapse rate was 30.42%, mean and median of the time to relapse (survival time) were 27.40 ± 1.63 months (CI 95%: 24.19 - 30.60) and 25 ± 2.25 months (CI 95%: 22.5 - 27.5), respectively. In the first six months, the cumulative survival rate was 83%, while in the 24th month it was 46% and the following time was consistent. Job status (OR = 2.64), marital status (OR = 1.55), family size (OR = 1.20) and age (OR = 0.23) were statistically significant in Cox regression model.

Conclusions:

In the initial treatment, it seems necessary to supervise and monitor the treatment process through staff in addiction treatment centers together with the company of the addicts’ families to reduce relapse rate.

Clinical Needs of Patients with Problem Drug Use

INTRODUCTION

Illicit drug use is a serious public health problem associated with significant co-occurring medical disorders, mental disorders, and social problems. Yet most individuals with drug use disorders have never been treated, though they often seek medical treatment in primary care. The purpose of this study was to examine the baseline characteristics of people presenting in primary care with a range of problem drug use severity to identify their clinical needs.

METHODS

We examined sociodemographic characteristics, medical and psychiatric comorbidities, drug use severity, social and legal problems, and service utilization for 868 patients with drug problems. These patients were recruited from primary care clinics in a medical safety net setting. Based on Drug Abuse Screening Test results, individuals were categorized as having low, intermediate, or substantial/severe drug use severity.

RESULTS

Patients with substantial/severe drug use severity had serious drug use (opiates, stimulants, sedatives, intravenous drugs); high levels of homelessness (50%), psychiatric comorbidity (69%), and arrests for serious crimes (24%); and frequent use of expensive emergency department and inpatient hospitals. Patients with low drug use severity were primarily users of marijuana, with little reported use of other drugs, less psychiatric comorbidity, and more stable lifestyles. Patients with intermediate drug use severity fell in between the substantial/severe and low drug use severity subgroups on most variables.

CONCLUSIONS

Patients with the highest drug use severity are likely to require specialized psychiatric and substance abuse care, in addition to ongoing medical care that is equipped to address the consequences of severe/substantial drug use, including intravenous drug use. Because of their milder symptoms, patients with low drug use severity may benefit from a collaborative care model that integrates psychiatric and substance abuse care in the primary care setting. Patients with intermediate drug use severity may benefit from selective application of interventions suggested for patients with the highest and lowest drug use severity. Primary care safety net clinics are in a key position to serve patients with problem drug use by developing a range of responses that are locally effective and that may also inform national efforts to establish patient-centered medical homes and to implement the Affordable Care Act.

Using Shared Medical Appointments to Increase Access to Buprenorphine Treatment

INTRODUCTION

This study examines patient experiences with shared medical appointments for buprenorphine treatment at a safety net primary care clinic.

METHODS

This is a cross-sectional observational study of 28 participants in a primary care buprenorphine shared medical appointments program.

RESULTS

Participants reported appreciating the group visit format, gaining increased coping skills, and having more stable housing and less legal difficulty after starting the program.

CONCLUSION

The implementation of shared medical appointments for buprenorphine treatment benefits clinicians and patients. The nurse care manager and buprenorphine prescriber can efficiently attend to the clinical needs of multiple patients.

Crosswise Model to Assess Sensitive Issues: A Study on Prevalence of Drug Abuse Among University Students of Iran

Background:

Precise assessment of the prevalence of illicit drug use, face various methodological challenges.

Objectives:

The current study aimed to investigate the prevalence of illicit drug use among students studying at Universities in Shahroud (Northeast of Iran) through crosswise method.

Patients and Methods:

Participants of this cross-sectional study were 1646 students at Universities in Shahroud. The data collection instrument was a questionnaire designed based on crosswise model (CM).

Results:

The results of the study showed that 19% of students used at least one kind of illicit drug and 14.9% used opium residue once in their life. Moreover, 3.5% of students used drug and 3% used opium residue during the last month; 40.3% of the students admitted that they fully understood the instruction of the questionnaire; 9.6% said that did not comprehend the instruction at all, and 38.1% believed they partly understood the instruction. The result showed that 33.7% of the students fully trusted, 39.8% partly trusted, and 18.4% poorly trusted this method. There was a significant relationship between comprehension level and trust in CM (P < 0.001).

Conclusions:

This method can be appropriate to estimate sensitive issues; however, lack of understanding the method or doubting the confidentiality of the responses can lead to bias in the results. That is to say, if the instructions are introduced better, the level of trusting the method will increase and accordingly more reliable responses can be obtained. More studies under controlled conditions are required to interpret the findings of the current study better.

Drug Use and High-Risk Sexual Behaviors of Women at a Drop-In Center in Mazandaran Province, Iran, 2014

BACKGROUND

Female drug users are more likely to transmit human immunodeficiency virus (HIV) to their sexual partners. Little is known about HIV, sexually transmitted diseases (STDs), cervicitis, and drug abuse among female sex workers in Iran.

OBJECTIVES

Therefore, this study was conducted at a drop-in center (DIC) in Iran to investigate the prevalence of HIV associated risk factors, the prevalence of drug use, high-risk sexual behaviors, and the relationship between the associated factors in women.

PATIENTS AND METHODS

This quantitative cross-sectional study was conducted on 190 female sex workers (SW) in a DIC in Sari, Mazandaran, Northern Iran, in January and February 2014. The study sample was selected through census sampling. In the end, 190 female SWs referring to the DIC participated in our study. There was no limitation in sampling. The self-administered questionnaire was completed via an interview.

RESULTS

The results showed that 39% of the female SWs were less than 30 years old and 64% had elementary school education. In addition, 59% of the participants took some type of illegal drugs and 1.1% of them were reportedly injecting drug users. Moreover, 43% of them had substance dependent husbands, and 39% were reportedly regular condom users. They had 1 - 10 sexual partners on average per week. The overall prevalence of HIV infection was 4%. A significant relationship was found between the type of drugs used and factors such as having a substance dependent husband, use of condom during the last sexual contact, regular condom use, and the number of sexual acts per week. A significant correlation exists between using psychiatric drugs and factors like regular condom use, education, cervicitis, and the number of sexual conducts per week.

CONCLUSIONS

Female sex workers often engage in sex for financial reasons and are at high risk of drug abuse, HIV, and cervicitis. In addition, the rate of cervicitis among females with high-risk sexual behavior is considerable in Mazandaran, Iran. Therefore, the state authorities should provide sex workers with health care services and help them acquire a good job to support their life.

A Role for p38 Mitogen-activated Protein Kinase-mediated Threonine 30-dependent Norepinephrine Transporter Regulation in Cocaine Sensitization and Conditioned Place Preference

The noradrenergic and p38 mitogen-activated protein kinase (p38 MAPK) systems are implicated in cocaine-elicited behaviors. Previously, we demonstrated a role for p38 MAPK-mediated norepinephrine transporter (NET) Thr(30) phosphorylation in cocaine-induced NET up-regulation (Mannangatti, P., Arapulisamy, O., Shippenberg, T. S., Ramamoorthy, S., and Jayanthi, L. D. (2011) J. Biol. Chem. 286, 20239-20250). The present study explored the functional interaction between p38 MAPK-mediated NET regulation and cocaine-induced behaviors. In vitro cocaine treatment of mouse prefrontal cortex synaptosomes resulted in enhanced NET function, surface expression, and phosphorylation. Pretreatment with PD169316, a p38 MAPK inhibitor, completely blocked cocaine-mediated NET up-regulation and phosphorylation. In mice, in vivo administration of p38 MAPK inhibitor SB203580 completely blocked cocaine-induced NET up-regulation and p38 MAPK activation in the prefrontal cortex and nucleus accumbens. When tested for cocaine-induced locomotor sensitization and conditioned place preference (CPP), mice receiving SB203580 on cocaine challenge day or on postconditioning test day exhibited significantly reduced cocaine sensitization and CPP. A transactivator of transcription (TAT) peptide strategy was utilized to test the involvement of the NET-Thr(30) motif. In vitro treatment of synaptosomes with TAT-NET-Thr(30) (wild-type peptide) completely blocked cocaine-mediated NET up-regulation and phosphorylation. In vivo administration of TAT-NET-Thr(30) peptide but not TAT-NET-T30A (mutant peptide) completely blocked cocaine-mediated NET up-regulation and phosphorylation. In the cocaine CPP paradigm, mice receiving TAT-NET-Thr(30) but not TAT-NET-T30A on postconditioning test day exhibited significantly reduced cocaine CPP. Following extinction, TAT-NET-Thr(30) when given prior to cocaine challenge significantly reduced reinstatement of cocaine CPP. These results demonstrate that the direct inhibition of p38 MAPK or the manipulation of NET-Thr(30) motif/phosphorylation via a TAT peptide strategy prevents cocaine-induced NET up-regulation, locomotor sensitization, and CPP, suggesting a role for Thr(30)-linked NET regulation in cocaine-elicited behaviors.

Paracetamol-associated acute liver failure in Australian and New Zealand children: high rate of medication errors

BACKGROUND

In children, paracetamol overdose due to deliberate self-poisoning, accidental exposure or medication errors can lead to paediatric acute liver failure and death. In Australia and New Zealand, the nature of ingestion and outcomes of paracetamol-associated paediatric acute liver failure have not been described.

OBJECTIVE

To describe the nature and outcomes of paracetamol-associated paediatric acute liver failure.

DESIGN

Retrospective analysis of paracetamol-associated paediatric acute liver failure cases presenting 2002-2012.

SETTING

New Zealand and Queensland Paediatric Liver Transplant Services.

RESULTS

14 of 54 cases of paediatric acute liver failure were attributed to paracetamol, the majority were secondary to medication errors. 12 of the 14 children were under the age of 5 years. Seven children received doses in excess of 120 mg/kg/day. Many of the other children received either a double dose, too frequent administration, coadministration of other medicines containing paracetamol or regular paracetamol for up to 24 days. Three children underwent transplant. One of these and one other child died.

CONCLUSIONS

In Australia and New Zealand, paracetamol overdose secondary to medication errors is the leading cause of paediatric acute liver failure. A review of regional safety practices surrounding paracetamol use in children is indicated.

Socio-demographic characteristics associated with cigarettes smoking, drug abuse and alcohol drinking among male medical university students in Iran

BACKGROUND

Substance abuse is one of the most complicated social problems. Understanding socio-demographic characteristics of those who abuse substances could help deal with this problem more efficiently. The main objective of this study was to determine socio-demographic characteristics associated with alcohol drinking, cigarettes smoking and drug abuse among a sample of male medical university students in Iran.

METHODS

This cross-sectional study was conducted in 2014 among 425 male medical college students randomly selected with the proportional to size among different faculties in Isfahan and Kermanshah medical universities in Iran. A self-report written questionnaire was applied to collect data. Data were analyzed by the SPSS-20.

RESULTS

Mean age of the respondents was 19.9 yr (ranging from 18 to 22 yr). About 19.4%, 3.9%, and 10.1% of the respondents had history of cigarette smoking, drug use, and alcohol drinking during the past three months, respectively. Logistic regression showed that mother's educational level, living place, economic status, and parents' divorce were the most influential predictive factors on substance abuse.

CONCLUSIONS

Considering the high prevalence of substance abuse (especially smoking and alcohol drinking), it seems essential to design educational interventions to prevent substance abuse, paying attention to predictive factors mentioned above, among college students.

Liver injury is common among chronic abusers of ketamine

Abuse of ketamine leads to liver injury. We investigated the histopathologic and radiologic features of ketamine abusers with significant liver injury in a cross-sectional survey of 297 consecutive chronic abusers of ketamine with urinary tract dysfunction. Liver biopsy and magnetic resonance cholangiopancreatography were performed in patients with liver injury (concentrations of bilirubin, alkaline phosphatase, and/or alanine aminotransferase >2-fold the upper limit of normal). The prevalence of liver injury was 9.8% (all cases cholestatic). Bile duct injury was observed in all 7 patients assessed by liver biopsy. Two patients had bridging fibrosis despite their young age. Three of 6 patients who underwent magnetic resonance cholangiopancreatography examination were found to have prominent or dilated common bile ducts without obstructions or extrinsic compressions. Ketamine abuse therefore appears to lead to common bile duct dilatation, microscopic bile duct injury, and even significant liver fibrosis.

Deception for drugs: self-reported "doctor shopping" among young adults

BACKGROUND

Pharmaceutical abuse is a burgeoning problem, and various forms of drug diversion are becoming more common. At present, little is known about those who attempt to deceive physicians to receive medications, and even less is known about those who successfully avoid detection and abuse-related repercussions. The goal of this study is to assess the prevalence of attempted physician deception in a general population, explore common motives, and evaluate risk factors associated with the behavior.

METHODS

A stratified random sampling technique was used to obtain a locally representative sample of 2349 young adults. The sample was 48.4% male, 68.9% white, 24.4% black, and 2.8% Hispanic. Selected individuals were surveyed using a self-report instrument (80.4% response rate).

RESULTS

Of the respondents, 93 (4.0%) self-reported having attempted to deceive a physician to obtain a pharmaceutical. Most of these indicated that they were at least partially motivated by their own abuse. Approximately half reported that selling a portion of the prescription was a motivating factor. Alcohol use, marijuana use, and pharmaceutical misuse each were risk factors associated with attempted deception. Although no traits were definitively linked to the behavior, attempted deception was more commonly reported by men, Hispanics, self-identified lesbian/gay/bisexual/transgender individuals, and those at the lowest and highest extremes of the income spectrum. Logistic regression models of rare events indicated that past substance use along with sexual orientation and family income were related to attempted deception when controlling for other factors.

CONCLUSION

Results suggest that attempted physician deception may be more common than previously believed. Practicing physicians should attempt to use risk factor information presented within this study, albeit very cautiously. This study identifies general characteristics of young people who might divert medications but notes that only a small minority of any patient group will do so. Awareness should not equal bias in the treatment of these patients; instead, it should reinforce the need for careful clinical interviewing and the utilization of prescription drug monitoring programs and local law enforcement databases.

Risk of adverse health outcomes with increasing duration and regularity of opioid therapy

PURPOSE

The purpose of this study was to examine trends in frequency and daily dosage of opioid use and related adverse health outcomes in a commercially insured population.

METHODS

We examined medical claims from the Truven Health MarketScan commercial claims database for 789,457 continuously enrolled patients ages 18 to 64 years to whom opioids were dispensed during the first half of 2008. We tracked them every 6 months until either opioid use was discontinued or the end of 2010. We compared outcomes among all opioid users with those for patients who used opioids with only limited interruptions during the index period, referred to as "daily users." We contrasted the experience of daily users, other users, and nonusers for various outcomes.

RESULTS

Of all claimants, 10.7% had at least one opioid prescription during the first 6 months of 2008. Of these, 39.9% continued through a second 6-month period, and 18.0% continued through the end of 2010. Only 9.0% of all users qualified as daily users, but 87.1% of them continued some use of opioids through the end of 2010. Only 43.8% of all users who continued use through 2010 initially qualified as daily users. Among all users who continued use through 2010, days of use and daily dosage increased with duration of use. Among daily users, only dosage increased, rising from 101 to 114 morphine milligram equivalents/day over the 3 years. The prevalence of benzodiazepine use was greater for daily than all users, exceeding 40% among daily users who continued opioid use for 3 years. Drug abuse and overdose rates increased with longer use. Daily users accounted for 25.0%, other users for 43.6%, and nonusers for 31.4% of opioid analgesic overdoses.

CONCLUSIONS

Adverse health outcomes can increase with accumulating opioid use and increasing dosage. Existing guidelines developed by specialty societies for managing patients using opioids daily or nearly daily do not address the larger number of patients who use opioids intermittently over periods of years. Practitioners should consider applying such guidelines to patients who use opioids less frequently.

Sensitivity and specificity of CT scanning for determining the number of internally concealed packages in 'body-packers'

INTRODUCTION

If package counts on abdominal CTs of body-packers were known to be accurate, follow-up CTs could be avoided. The objective was to determine the accuracy of CT for the number of concealed packages in body-packers, and the reliability of package counts reported by body-packers who admit to concealing drugs.

METHODS

Suspected body-packers were identified from the emergency departments (ED) database. The medical record and radiology reports were reviewed for package counts determined by CT, patient-reported and physically retrieved. The last method was used as the reference standard. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated for CT package count accuracy. Reliability of patient-reported package counts was assessed using Pearson's correlation coefficient.

RESULTS

There were 50 confirmed body-packers on whom 104 CT scans were performed. Data for the index and reference tests were available for 84 scans. The sensitivity, specificity, PPV and NPV for CT package count were 63% (95% CI 46% to 77%), 82% (95% CI 67% to 92%), 76% (95% CI 58% to 89%) and 71% (95% CI 56% to 83%) respectively. For CTs with a package count<15, the sensitivity, specificity, PPV and NPV for CT package count were 96% (95% CI 80% to 99%), 95% (95% CI 82% to 99%), 93% (95% CI 76% to 99%) and 97% (95% CI 86% to 100%), respectively. Correlation between patient-reported package counts and the number of packages retrieved was high (r=0.90, p<0.001, R2=81%).

CONCLUSIONS

The accuracy of CT for determining the number of concealed packages is poor, although when applied to patients with few concealed packages accuracy is high and is useful as a rule-out test. Among patients who have admitted to drug concealment, the number of packages reported to be concealed is reliable.

Drug Abuse among University Students of Rafsanjan, Iran

OBJECTIVE

The present study aimed to determine the frequency of drug abused in a sample of university students in Rafsanjan, Iran.

METHODS

In this cross-sectional study, 1,260 students volunteered (311 males and 949 females) with mean age of 21.35 years. Data were collected by a self-administrated questionnaire regarding drugs abuse and demographic information.

RESULTS

Benzodiazepines were the most common abused drugs which were reported in 94 students (7.4%). Other agents studied were cigarette and tobacco (159, cases 12.6%), alcoholic drinks (60 cases, 4.7%), and opiates (42 cases, 3.3%). Forty-three students (3.4%) had used methylphenidate in the last 6 months. Of this, 39 (90.6%) experienced insomnia. All students who abused methylphenidate indicated that the reason for this behavior was to raise alertness and conscious levels.

CONCLUSION

The pattern of drug abuse among the students here seems similar to other reports from Iranian universities.

In utero drug and alcohol exposure in infants born to mothers prescribed maintenance methadone

AIMS

To describe the prevalence of in utero alcohol and illicit drug exposure in infants born to mothers prescribed methadone in pregnancy, and to compare the accuracy of maternal interview with infant toxicology.

METHODS

Urine and meconium samples were collected from 56 infants born to mothers prescribed methadone during pregnancy and a confidential interview conducted soon after delivery. Samples were screened for drugs of misuse and meconium samples analysed for the presence of fatty acid ethyl esters (FAEEs) to detect prenatal alcohol exposure.

RESULTS

91% of infants had been exposed to illicit drugs in utero, including opiates (73%), benzodiazepines (70%) and cannabinoids (59%). 47% of infants had elevated FAEEs. Meconium was more sensitive at detecting in utero drug exposure than urine toxicology (p<0.01 for opiates, benzodiazepines, cannabinoids) or maternal interview (p=0.03 for opiates, p<0.01 for cannabinoids).

CONCLUSIONS

The majority of infants born to mothers prescribed methadone during pregnancy are exposed to polysubstance misuse, and almost one-half additionally exposed to excess alcohol.

Addition of objective data to identify risk for medication misuse and abuse: the inconsistency score

OBJECTIVE

To identify and quantify the rate of aberrant drug-taking behaviors using objective data.

DESIGN

Institutional Review Board-approved anonymous, voluntary, quality improvement project.

SETTING

University-based, multidisciplinary pain management center.

SUBJECTS

Consecutive initial visit patients.

METHODS

Patients were interviewed, asked to provide a urine sample, and filled out a brief questionnaire about recent prescription, over-the-counter, and illicit drug use. Discrepancies between patient report (PQ), the Virginia State prescription monitoring program (PMP), referring physician records (MRs), and the point-of-care urine drug screen (POC UDS) results were scored from 0 (none) to a maximum of 2 points (2+ discrepancies) for each potential comparator between data sets. Maximum potential inconsistency score (IS) was 16 points.

RESULTS

Two hundred nine patients were interviewed to yield 118 specimens. Mean age of participants was 48.2 years (22-83 year); 65.3% were female. IS scores ranged from 1 to 11, and 52.5% of the patients had an IS ≥ 3. Higher IS scores correlated with higher numbers of pharmacies, prescribing physicians, prescriptions on the PMP, and presence of illicit substances in the urine. Addition of either POC UDS or PMP to PQ and MR increased identification of inconsistencies by >400%, and PMP plus UDS by >900%.

CONCLUSIONS

Patient report and the medical record are inadequate to screen for aberrant drug-related behaviors. Addition of PMP and POC UDS contribute significantly to identification of inconsistencies through higher IS scores and differentiate patients at higher risk of medication misuse, abuse, or diversion. Comparison of multiple sources of objective information provides better insight into inconsistencies of report and behavior, and may assist in more appropriate and safer prescribing decisions.

The association between family flexibility, food preoccupation and body image among crystal abuser women

Background

Methamphetamine (MA) is a highly addictive stimulant which has destructive effects. There is also evidence that methamphetamine use in some females, partly is due to their desire to lose weight. The purpose of this study was to determine the association between family flexibility, food preoccupation and body image among crystal abuser women.

Objectives

This study tried to evaluate whether food preoccupation, body image and family flexibility affect on crystal abuse in women.

Patients and Methods

Eighty crystal abuser women were chosen with convenience sampling and they responded to instrument of body image (Fisher), family flexibility (Olson) and food preoccupation (Tapper) questionnaires.

Results

There is a significant association between family flexibility and food preoccupation (P < 0.01) and also other variables; there is no significant association between family flexibility and body image, body image and food preoccupation (P > 0.05). Also, family flexibility is prediction of food preoccupation (P < 0.01).

Conclusions

These results emphasize that the components of eating behaviors (e.g. food preoccupation) and family flexibility can be considered in therapeutic interventions (prevention and treatment) for women to crystal withdrawal.