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Amin-Esmaeili M, Farokhnia M, Susukida R, Leggio L, Johnson RM, Crum RM, Mojtabai R. Reduced drug use as an alternative valid outcome in individuals with stimulant use disorders: Findings from 13 multisite randomized clinical trials. Addiction 2024; 119:833-843. [PMID: 38197836 PMCID: PMC11009085 DOI: 10.1111/add.16409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 11/10/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND AND AIMS Total abstinence has historically been the goal of treatment for substance use disorders; however, there is a growing recognition of the health benefits associated with reduced use as a harm reduction measure in stimulant use disorders treatment. We aimed to assess the validity of reduced stimulant use as an outcome measure in randomized controlled trials (RCTs) of pharmacological interventions for stimulant use disorder. DESIGN We conducted a secondary analysis of a pooled dataset of 13 RCTs. SETTING AND PARTICIPANTS Participants were individuals seeking treatment for cocaine or methamphetamine use disorders (N = 2062) in a wide range of treatment facilities in the United States. MEASUREMENTS We validated reduced stimulant use against a set of clinical indicators drawn from harmonized measurements, including severity of problems caused by drug use, comorbid depression, global severity of substance use and improvement, severity of drug-seeking behavior, craving and high-risk behaviors, all assessed at the end of the trial, as well as follow-up urine toxicology. A series of mixed effect regression models was conducted to validate reduction in frequency of use against no reduction in use and abstinence. FINDINGS More participants reduced frequency of primary drug use than achieved abstinence (18.0% vs. 14.2%, respectively). Reduced use was significantly associated with decreases in craving for the primary drug [60.1%, 95% confidence interval (CI) = 54.3%-64.7%], drug seeking behaviors (41.0%, 95% CI = 36.6%-45.7%), depression severity (39.9%, 95% CI = 30.9%-48.3%), as well as multiple measures of global improvement in psychosocial functioning and severity of drug-related problems, albeit less strongly so than abstinence. Moreover, reduced use was associated with sustained clinical benefit at follow-up, as confirmed by negative urine tests (adjusted odds ratio compared with those with no reduction in use: 0.50, 95% CI = 0.35-0.71). CONCLUSION Reduced frequency of stimulant use appears to be associated with meaningful improvement in various clinical indicators of recovery. Assessment of reduced use, in addition to abstinence, could broaden the scope of outcomes measured in randomized controlled trials of stimulant use disorders and facilitate the development of more diverse treatment approaches.
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Affiliation(s)
- Masoumeh Amin-Esmaeili
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Farokhnia
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore, MD, USA
| | - Ryoko Susukida
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore, MD, USA
- Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
- Division of Addiction Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rosa M Crum
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hrabarchuk EI, Hannah T, Kalagara R, Li AY, Schupper AJ, McCarthy L, Ali M, Quinones A, Gometz A, Lovell M, Choudhri TF. Baseline ImPACT Composite Scores in Student-Athletes With Attention-Deficit/Hyperactivity Disorder. Arch Clin Neuropsychol 2024; 39:347-354. [PMID: 37824213 DOI: 10.1093/arclin/acad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Athletes who are diagnosed with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of concussion compared to other athletes. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a widely used concussion tool, but it relies on pre-injury baseline testing that can be affected by psychiatric conditions. This research aims to determine if there are differences in pre-injury testing composite scores in student-athletes with ADHD compared to those without ADHD diagnosis. METHODS We obtained 11,563 pre-season ImPACT assessments of 7,454 student-athletes (ages: 12-22) from 2009 to 2019. After exclusions, there were 6,920 control and 276 ADHD subjects. Multivariable linear regression analyses compared the independent effect of ADHD on the six ImPACT composite score metrics with Bonferroni correction for multiple comparisons with a = 0.008. RESULTS Univariate analyses indicated ADHD is associated with more symptoms as measured by the Post-Concussion Symptom Scale (PCSS) (β = 2.67, 95% CI: 1.47-3.87, p < .0001) and worse Impulse Control scores (β = 0.93, 95% CI: 0.33-1.53, p = .002). In multivariate analysis, this association was the same for symptom score (β = 2.48, 95% CI: 1.22-3.74, p < .0001), but Impulse Control was not significantly different after multiple comparison adjustment (β = 0.87, 95% CI: 0.22-1.15, p = .009). CONCLUSIONS The ADHD subjects reported worse symptoms at baseline and had worse Impulse Control in univariate analysis, but not multivariate analysis. These results can further guide clinicians in concussion diagnosis and test interpretations for student-athletes with ADHD, considering the symptom burden at baseline.
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Affiliation(s)
- Eugene I Hrabarchuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Theodore Hannah
- Department of Neurosurgery, Lewis Katz School of Medicine Temple University, Philadelphia, PA, USA
| | - Roshini Kalagara
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adam Y Li
- Department of Neurosurgery, University of Rochester School of Medicine, New York, NY, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lily McCarthy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Addison Quinones
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex Gometz
- Physical Medicine and Rehabilitation, Concussion Management of New York, NY, USA
| | - Mark Lovell
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tanvir F Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Erath TG, LaCroix R, O'Keefe E, Higgins ST, Rawson RA. Substance use patterns, sociodemographics, and health profiles of harm reduction service recipients in Burlington, Vermont. Harm Reduct J 2024; 21:76. [PMID: 38580997 PMCID: PMC10998322 DOI: 10.1186/s12954-024-00995-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/31/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Understanding current substance use practices is critical to reduce and prevent overdose deaths among individuals at increased risk including persons who use and inject drugs. Because individuals participating in harm reduction and syringe service programs are actively using drugs and vary in treatment participation, information on their current drug use and preferred drugs provides a unique window into the drug use ecology of communities that can inform future intervention services and treatment provision. METHODS Between March and June 2023, 150 participants in a harm reduction program in Burlington, Vermont completed a survey examining sociodemographics; treatment and medication for opioid use disorder (MOUD) status; substance use; injection information; overdose information; and mental health, medical, and health information. Descriptive analyses assessed overall findings. Comparisons between primary drug subgroups (stimulants, opioids, stimulants-opioids) of past-three-month drug use and treatment participation were analyzed using chi-square and Fisher's exact test. RESULTS Most participants reported being unhoused or unstable housing (80.7%) and unemployed (64.0%) or on disability (21.3%). The drug with the greatest proportion of participants reporting past three-month use was crack cocaine (83.3%). Fentanyl use was reported by 69.3% of participants and xylazine by 38.0% of participants. High rates of stimulant use were reported across all participants independent of whether stimulants were a participant's primary drug. Fentanyl, heroin, and xylazine use was less common in the stimulants subgroup compared to opioid-containing subgroups (p < .001). Current- and past-year MOUD treatment was reported by 58.0% and 77.3% of participants. Emergency rooms were the most common past-year medical treatment location (48.7%; M = 2.72 visits). CONCLUSIONS Findings indicate high rates of polysubstance use and the underrecognized effects of stimulant use among people who use drugs-including its notable and increasing role in drug-overdose deaths. Crack cocaine was the most used stimulant, a geographical difference from much of the US where methamphetamine is most common. With the increasing prevalence of fentanyl-adulterated stimulants and differences in opioid use observed between subgroups, these findings highlight the importance and necessity of harm reduction interventions (e.g., drug checking services, fentanyl test strips) and effective treatment for individuals using stimulants alongside MOUD treatment.
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Affiliation(s)
- Tyler G Erath
- Vermont Center on Behavior and Health, Burlington, VT, USA.
- Department of Psychiatry, University of Vermont, University Health Center, 1 S. Prospect St., Burlington, VT, 05401, USA.
| | | | - Erin O'Keefe
- Howard Center Safe Recovery, Burlington, VT, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, Burlington, VT, USA
- Department of Psychiatry, University of Vermont, University Health Center, 1 S. Prospect St., Burlington, VT, 05401, USA
- Center on Rural Addictions, University of Vermont, Burlington, VT, USA
| | - Richard A Rawson
- Vermont Center on Behavior and Health, Burlington, VT, USA
- Department of Psychiatry, University of Vermont, University Health Center, 1 S. Prospect St., Burlington, VT, 05401, USA
- Center on Rural Addictions, University of Vermont, Burlington, VT, USA
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Rosenthal EA, Hinshaw SP. Pubertal timing in adolescents with ADHD: extension and replication in an all-female sample. Eur Child Adolesc Psychiatry 2024; 33:1133-1141. [PMID: 37245161 PMCID: PMC11032289 DOI: 10.1007/s00787-023-02239-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/17/2023] [Indexed: 05/29/2023]
Abstract
Pubertal timing predicts a miscellany of negative mental and physical health outcomes. Prior work examining pubertal timing in youth with attention-deficit hyperactivity disorder (ADHD) has failed to investigate potential sex specificity of results. Therefore, we aim to extend past findings in a sample of female adolescents with ADHD. We compare pubertal timing (1) between females with and without carefully diagnosed ADHD and (2) between females with ADHD who do vs. do not have a history of stimulant medication use during childhood. We examine 127 adolescent females with childhood-diagnosed ADHD and 82 matched neurotypical peers (Mage: 14.2 years, range: 11.3-18.2) from the Berkeley Girls with ADHD Longitudinal Study (Wave 2). We measured pubertal timing using self-reported Tanner staging and age at menarche. Three strategies compared pubertal timing across groups: (1)χ 2 tests of Tanner Stages, (2) t tests of residuals of pubertal status regressed on age, and (3) t tests of age at menarche. Pubertal timing of girls with and without ADHD did not differ significantly across methods and measures. Yet females with ADHD who had received stimulant medication during childhood menstruated later than those without a stimulant history, potentially related to differences in BMI across groups. On the other hand, no significant differences between medicated vs. non-medicated participants emerged for the two Tanner staging indicators. Our findings extend prior work, suggesting that females with ADHD are developing physically at a similar time as their peers, which parallels findings from previous mixed-sex samples that did not examine effects separately by sex.
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Affiliation(s)
- Emily A Rosenthal
- Department of Psychology, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720-1650, USA.
| | - Stephen P Hinshaw
- Department of Psychology, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720-1650, USA
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 675 18th Street, San Francisco, CA, 94107, USA
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Rudolph JE, Cepeda JA, Astemborski J, Kirk GD, Mehta SH, German D, Genberg BL. Longitudinal patterns of use of stimulants and opioids in the AIDS linked to the IntraVenous experience cohort, 2005-2019. Int J Drug Policy 2024; 126:104364. [PMID: 38408416 DOI: 10.1016/j.drugpo.2024.104364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/30/2024] [Accepted: 02/16/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Overdoses involving opioids and stimulants are on the rise, yet few studies have examined longitudinal trends in use of both substances. We sought to describe use and co-use of opioids and stimulants, 2005-2019, in the AIDS Linked to the Intravenous Experience (ALIVE) cohort - a community-based cohort of people with a history of injection drug use living in or near Baltimore, MD. METHODS We included 2083 ALIVE participants, who had at least two visits during the study period. Our outcome was based on self-reported use of opioids and stimulants in the prior 6 months. We estimated prevalence of 4 categories of use (neither stimulants nor opioids, only stimulants, only opioids, stimulants and opioids), using a non-parametric multi-state model, accounting for the competing event of death and weighting for informative loss to follow-up. All analyses were stratified by enrollment cohort, with the main analysis including participants who enrolled prior to 2015 and a sub-analysis including participants who enrolled 2015-2018. RESULTS In the main analysis, prevalence of using stimulants and opioids decreased from 38 % in 2005 to 12 % 2013 but stabilized from 2014 onwards (13-19 %). The prevalence of using only stimulants (7-11 %) and only opioids (5-10 %) was stable across time. Participants who reported using both were more likely to report homelessness, depression, and other substance use (e.g., marijuana and heavy alcohol use) than participants in the other use categories. On average, 65 % of visits with use of both were followed by a subsequent visit with use of both; of participants transitioning out of using both, 13% transitioned to using neither. CONCLUSIONS While use of stimulants and opioids declined in the cohort through 2013, a meaningful proportion of participants persistently used both. More research is needed to understand and develop strategies to mitigate harms associated with persistent use of both stimulants and opioids.
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Affiliation(s)
- Jacqueline E Rudolph
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Javier A Cepeda
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jacquie Astemborski
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Gregory D Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle German
- Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Becky L Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Cohen-Laroque J, Grangier I, Perez N, Kirschner M, Kaiser S, Sabé M. Positive and negative symptoms in methamphetamine-induced psychosis compared to schizophrenia: A systematic review and meta-analysis. Schizophr Res 2024; 267:182-190. [PMID: 38554698 DOI: 10.1016/j.schres.2024.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 03/06/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The clinical profiles of methamphetamine-induced psychosis (MIP) and schizophrenia are largely overlapping making differentiation challenging. In this systematic review and meta-analysis, we aim to compare the positive and negative symptoms of MIP and schizophrenia to better understand the differences between them. STUDY DESIGN In accordance with our pre-registered protocol (CRD42021286619), we conducted a search of English-language studies up to December 16th, 2022, in PubMed, EMBASE, and PsycINFO, including stable outpatients with MIP and schizophrenia. We used the Newcastle-Ottawa Scale to measure the quality of cross-sectional, case-control, and cohort studies. STUDY RESULTS Of the 2052 articles retrieved, we included 12 studies (6 cross-sectional, 3 case-control, and 2 cohort studies) in our meta-analysis, involving 624 individuals with MIP and 524 individuals with schizophrenia. Our analysis found no significant difference in positive symptoms between the two groups (SMD, -0.01; 95%CI, -0.13 to +0.11; p = 1). However, individuals with MIP showed significantly less negative symptoms compared to those with schizophrenia (SMD, -0.35; 95CI%, -0.54 to -0.16; p = 0.01; I2 = 54 %). Our sensitivity analysis, which included only studies with a low risk of bias, did not change the results. However, our meta-analysis is limited by its cross-sectional approach, which limits the interpretation of causal associations. Furthermore, differences in population, inclusion criteria, methodology, and drug exposure impact our findings. CONCLUSIONS Negative symptoms are less prominent in individuals with MIP. While both groups do not differ regarding positive symptoms, raises the possibility of shared and partly different underlying neurobiological mechanisms related to MIP and schizophrenia.
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Affiliation(s)
| | - Inès Grangier
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Natacha Perez
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland
| | - Matthias Kirschner
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland
| | - Stefan Kaiser
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland
| | - Michel Sabé
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland.
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Song W, Simona A, Zhang P, Bates DW, Urman RD. Stimulant Drugs and Stimulant Use Disorder. Anesthesiol Clin 2024; 42:103-115. [PMID: 38278583 DOI: 10.1016/j.anclin.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
The authors aim to summarize several key points of stimulant drugs and stimulant use disorder, including their indications, short-term and long-term adverse effects, current treatment strategies, and association with opioid medications. The global prevalence of stimulant use has seen annual increase in the last decade. Multiple studies have shown that stimulant use and stimulant use disorder are associated with a range of individual and public health issues. Stimulant misuse has led to a significant increase of overdose deaths in the United States.
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Affiliation(s)
- Wenyu Song
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Boston, MA 02120, USA.
| | - Aurélien Simona
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Boston, MA 02120, USA; Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Ping Zhang
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH 43210, USA; Department of Computer Science and Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - David W Bates
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Boston, MA 02120, USA
| | - Richard D Urman
- Department of Anaesthesiology, College of Medicine The Ohio State University, Columbus, OH 43210, USA
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Stein J, Jorge BC, Nagaoka LT, Reis ACC, Manoel BDM, Godoi AR, Fioravante VC, Martinez FE, Pinheiro PFF, Pupo AS, Arena AC. Can exposure to lisdexamfetamine dimesylate from juvenile period to peripubertal compromise male reproductive parameters in adult rats? Toxicol Appl Pharmacol 2024; 484:116867. [PMID: 38378049 DOI: 10.1016/j.taap.2024.116867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/22/2024]
Abstract
Lisdexamfetamine (LDX) is a d-amphetamine prodrug used to treat attention deficit and hyperactivity disorder, a common neurodevelopmental disorder in children and adolescents. Due to its action mediated by elevated levels of catecholamines, mainly dopamine and noradrenaline, which influence hormonal regulation and directly affect the gonads, this drug may potentially disrupt reproductive performance. This study evaluated the effects of exposure to LDX from the juvenile to peripubertal period (critical stages of development) on systemic and reproductive toxicity parameters in male rats. Male Wistar rats (23 days old) were treated with 0; 5.2; 8.6 or 12.1 mg/kg/day of LDX from post-natal day (PND) 23 to 53, by gavage. LDX treatment led to reduced daily food and water consumption, as well as a decrease in social behaviors. The day of preputial separation remained unaltered, although the treated animals exhibited reduced weight. At PND 54, the treated animals presented signs of systemic toxicity, evidenced by a reduction in body weight gain, increase in the relative weight of the liver, spleen, and seminal gland, reduction in erythrocyte and leukocyte counts, reduced total protein levels, and disruptions in oxidative parameters. In adulthood, there was an increase in immobile sperm, reduced sperm count, morphometric changes in the testis, and altered oxidative parameters, without compromising male sexual behavior and fertility. These findings showed that LDX-treatment during the juvenile and peripubertal periods induced immediate systemic toxicity and adversely influenced reproductive function in adult life, indicating that caution is necessary when prescribing this drug during the peripubertal phase.
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Affiliation(s)
- Julia Stein
- Department of Structural and Functional Biology, Morphology sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Bárbara Campos Jorge
- Department of Structural and Functional Biology, Morphology sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Lívia Trippe Nagaoka
- Department of Structural and Functional Biology, Morphology sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Ana Carolina Casali Reis
- Department of Structural and Functional Biology, Morphology sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Beatriz de Matos Manoel
- Department of Structural and Functional Biology, Morphology sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Alana Rezende Godoi
- Department of Structural and Functional Biology, Anatomy sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Vanessa Caroline Fioravante
- Department of Structural and Functional Biology, Anatomy sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Francisco Eduardo Martinez
- Department of Structural and Functional Biology, Anatomy sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Patrícia Fernanda Felipe Pinheiro
- Department of Structural and Functional Biology, Anatomy sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - André Sampaio Pupo
- Department of Biophysics and Pharmacology, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Arielle Cristina Arena
- Department of Structural and Functional Biology, Morphology sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil; Center of Information and Toxicological Assistance (CIATOX), Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.
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Almeida CVP, Neng NR, Nogueira JMF, Ruivo J. Application of a bar adsorptive microextraction based methodology for doping control of alkylamine stimulants in urine matrices. J Chromatogr B Analyt Technol Biomed Life Sci 2024; 1234:124006. [PMID: 38246007 DOI: 10.1016/j.jchromb.2024.124006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/18/2023] [Accepted: 01/06/2024] [Indexed: 01/23/2024]
Abstract
To comply with 'World Anti-Doping Agency' (WADA) guidelines, doping control laboratories must continuously adjust their analytical procedures. Therefore, sample preparation continues to play a critical step in modern analytical strategies, namely by replacing the tedious, time and solvent consuming commonly employed (e.g. liquid-liquid extraction). The present contribution proposes, for the first time in doping control, bar adsorptive microextraction (BAμE) as an alternative analytical technique for the qualitative determination of six alkyl amine stimulants (AAs; 1,3-dimethylbutylamine, 1,4-dimethylpentylamine, heptaminol, isometheptene, octodrine and tuaminoheptane) in urine matrices followed by derivatization prior to gas chromatography coupled to mass spectrometry, operating in the selected ion monitoring mode acquisition (GC-MS(SIM)). After selecting the most selective coating phase, i.e., a mixed-mode reversed phase/strong anion exchange sorbent (P2), assays performed under optimized experimental conditions [microextraction - BAμE(P2), 1 h (1,000 rpm), pH 11, 10 % NaCl; back-extraction - methanol (150 μL), 30 min, under sonication], allowed remarkable recoveries ranging from 48.7 % (heptaminol, 200 ng/mL) to 83.1 % (1,4-dimethylpentylamine, 200 ng/mL). The validation assessment assays of the proposed methodology showed suitable limits of identification (5.0-35.0 ng/mL), appropriate linear dynamic ranges (5.0-200.0 ng/mL) and good determination coefficients (r2 > 0.9937), as well as excellent selectivity, robustness, accuracy and precision. To check whether the methodology is fit-for-purpose, four previously analysed proficiency urine samples were successfully tested, in which were unequivocally detected and identified some of the target AAs. The present methodology showed to be a remarkable alternative in comparison to other dedicated analytical approaches to screen AAs in urine matrices, since it is cost-effective, user- and eco-friendly, requiring low volume of urine sample (1 mL). The great potential of this analytical technology in doping control lies in a very effective microextraction combined with the minimization of potential interferents, presenting itself as an added value to be applied to other types of substances and complex matrices.
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Affiliation(s)
- C V P Almeida
- Laboratório de Análises de Dopagem, Instituto Nacional de Saúde Doutor Ricardo Jorge IP, Av. Prof. Egas Moniz (Estádio Universitário), 1600-190 Lisboa, Portugal.
| | - N R Neng
- Centro de Química Estrutural, Institute of Molecular Sciences, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal.
| | - J M F Nogueira
- Centro de Química Estrutural, Institute of Molecular Sciences, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal.
| | - J Ruivo
- Laboratório de Análises de Dopagem, Instituto Nacional de Saúde Doutor Ricardo Jorge IP, Av. Prof. Egas Moniz (Estádio Universitário), 1600-190 Lisboa, Portugal.
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Zhu L, Ni T, Guan F. Methamphetamine-Induced Psychosis and Schizophrenia: A Call for Special Attention. Am J Psychiatry 2024; 181:168. [PMID: 38298079 DOI: 10.1176/appi.ajp.20230467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Li Zhu
- Department of Forensic Psychiatry, Key Laboratory of National Health Commission for Forensic Sciences, School of Medicine & Forensics, Xi'an Jiaotong University, Xi'an, China
| | - Tong Ni
- Department of Forensic Psychiatry, Key Laboratory of National Health Commission for Forensic Sciences, School of Medicine & Forensics, Xi'an Jiaotong University, Xi'an, China
| | - Fanglin Guan
- Department of Forensic Psychiatry, Key Laboratory of National Health Commission for Forensic Sciences, School of Medicine & Forensics, Xi'an Jiaotong University, Xi'an, China
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Qadhi OA, Mohammed Alasmari M, Nasser Alsulaihim I, Syed W, Al-Rawi MBA. Evaluation of clinical knowledge of drugs causing addiction and associated social determinants among male pharmacy and nursing students in Riyadh, Saudi Arabia - A Cross-Sectional study. Prev Med Rep 2024; 38:102606. [PMID: 38375160 PMCID: PMC10874849 DOI: 10.1016/j.pmedr.2024.102606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 02/21/2024] Open
Abstract
Drug abuse is a rising psychological concept in many countries, and its use among individuals is increasing. Therefore, this study aimed to assess the Knowledge and demographic factors associated with drug abuse among male pharmacy and nursing students at King Saud University, Riyadh, Saudi Arabia. This study used a cross-sectional design targeting male entry-level pharmacy and nursing students in their first and second years of Bachelor of Nursing and Doctor of Pharmacy courses. Of them, 85.3 % of the pharmacy and 75.3 % of nursing students thought that cocaine causes drug addiction, followed by heroin (pharmacy 80.7 %; nursing students 71 %), and morphine (pharmacy 75.2 %; nursing students 59.1 %). In this study, 52 % (n = 105) claimed low awareness, whereas 48 % (n = 97) indicated good understanding regarding drug addictions. Furthermore, the mean knowledge score among pharmacy students was higher (7.073 ± 2.570) in comparison to nursing (5.806 ± 2.494) (t = 3.540; p = 0. 0001). In addition, the father's occupation was found to be significantly associated with the mean knowledge score of drug addiction (F = 2.667; p = 0.034). According to the findings, 52 % of male students had insufficient knowledge about drugs that cause addiction. Age, course of study, and father's occupation all had a substantial impact on knowledge scores. The knowledge score on the complications of addictive substances was not significantly associated with the characteristics of the students (p = 0.05). As a result, we advocate for the introduction of educational initiatives that educate students about the harmful consequences of drug addiction and how to avoid issues.
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Affiliation(s)
- Omaimah A. Qadhi
- Department of Medical-Surgical College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Moadeyah Mohammed Alasmari
- Department of Maternity and Child Health, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Nasser Alsulaihim
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Wajid Syed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mahmood Basil A. Al-Rawi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Seaman RW, Lamon K, Whitton N, Latimer B, Sulima A, Rice KC, Murnane KS, Collins GT. Impacts of Self-Administered 3,4-Methylenedioxypyrovalerone (MDPV) Alone, and in Combination with Caffeine, on Recognition Memory and Striatal Monoamine Neurochemistry in Male Sprague-Dawley Rats: Comparisons with Methamphetamine and Cocaine. bioRxiv 2024:2024.01.31.578247. [PMID: 38352595 PMCID: PMC10862826 DOI: 10.1101/2024.01.31.578247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Recent data suggest that 3,4-methylenedioxypyrovalerone (MDPV) has neurotoxic effects; however, the cognitive and neurochemical consequences of MDPV self-administration remain largely unexplored. Furthermore, despite the fact that drug preparations that contain MDPV often also contain caffeine, little is known regarding the toxic effects produced by the co-use of these two stimulants. The current study investigated the degree to which self-administered MDPV, or a mixture of MDPV+caffeine can produce deficits in recognition memory and alter neurochemistry relative to prototypical stimulants. Male Sprague-Dawley rats were provided 90-min or 12-h access to MDPV, MDPV+caffeine, methamphetamine, cocaine, or saline for 6 weeks. Novel object recognition (NOR) memory was evaluated prior to any drug self-administration history and 3 weeks after the final self-administration session. Rats that had 12-h access to methamphetamine and those that had 90-min or 12-h access to MDPV+caffeine exhibited significant deficits in NOR, whereas no significant deficits were observed in rats that self-administered cocaine or MDPV. Striatal mono-amine levels were not systematically affected. These data demonstrate synergism between MDPV and caffeine with regard to producing recognition memory deficits and lethality, highlighting the importance of recapitulating the manner in which drugs are used (e.g., in mixtures containing multiple stimulants, binge-like patterns of intake).
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Affiliation(s)
- Robert W Seaman
- Department of Pharmacology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Kariann Lamon
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, United States
- Louisiana Addiction Research Center, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, United States
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, United States
| | - Nicholas Whitton
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, United States
- Louisiana Addiction Research Center, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, United States
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, United States
| | - Brian Latimer
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, United States
- Louisiana Addiction Research Center, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, United States
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, United States
| | - Agnieszka Sulima
- Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, Intramural Research Program, National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, United States
| | - Kenner C Rice
- Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, Intramural Research Program, National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, United States
| | - Kevin S Murnane
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, United States
- Louisiana Addiction Research Center, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, United States
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, United States
| | - Gregory T Collins
- Department of Pharmacology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
- South Texas Veterans Health Care System, San Antonio, TX, United States
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Huskamp HA, Uscher-Pines L, Raja P, Normand SLT, Mehrotra A, Busch AB. Trends in Use of Telemedicine for Stimulant Initiation Among Children and Adults. Psychiatr Serv 2024:appips20230421. [PMID: 38239181 DOI: 10.1176/appi.ps.20230421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE The authors sought to examine trends in stimulant initiation and follow-up care for attention-deficit hyperactivity disorder (ADHD) via telemedicine. METHODS This retrospective longitudinal study used national, deidentified commercial health insurance outpatient claims among children (ages 2-17 years; N=535,629) and adults (ages 18-64 years; N=2,116,160) from January 2019 through April 2022. Regression analyses were used to examine risk for stimulant initiation, whether initiation occurred via telemedicine or in-person care, and receipt of a follow-up visit. RESULTS The mean monthly adjusted number of stimulant initiations per 100,000 enrollees was similar for children before and during the COVID-19 pandemic (prepandemic, 57 initiations; during pandemic, 56 initiations) but increased for adults (prepandemic, 27 initiations; during pandemic, 33 initiations). Initiations via telemedicine peaked at 53%-57% in April 2020 and dropped to about 14% among children and 28% among adults in April 2022. Telemedicine initiations were significantly more common among psychiatrists than among other prescribers (OR=3.70, 95% CI=3.38-4.06 [children]; OR=3.02, 95% CI=2.87-3.17 [adults]) and less common for rural residents (OR=0.57, 95% CI=0.40-0.82 [children]; OR=0.75, 95% CI=0.61-0.92 [adults]). Follow-up care was significantly more common among individuals whose care was initiated via telemedicine than among those receiving in-person care (OR=1.09, 95% CI=1.00-1.19 [children]; OR=1.61, 95% CI=1.53-1.69 [adults]). CONCLUSIONS Many stimulant treatments were initiated via telemedicine. Proposed rules to prohibit controlled substance prescribing without an in-person evaluation would require significant changes in current practice, potentially limiting access to stimulant medications for ADHD.
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Affiliation(s)
- Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston (Huskamp, Normand, Mehrotra, Busch); RAND, Arlington, Virginia (Uscher-Pines); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Raja); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| | - Lori Uscher-Pines
- Department of Health Care Policy, Harvard Medical School, Boston (Huskamp, Normand, Mehrotra, Busch); RAND, Arlington, Virginia (Uscher-Pines); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Raja); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| | - Pushpa Raja
- Department of Health Care Policy, Harvard Medical School, Boston (Huskamp, Normand, Mehrotra, Busch); RAND, Arlington, Virginia (Uscher-Pines); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Raja); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| | - Sharon-Lise T Normand
- Department of Health Care Policy, Harvard Medical School, Boston (Huskamp, Normand, Mehrotra, Busch); RAND, Arlington, Virginia (Uscher-Pines); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Raja); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston (Huskamp, Normand, Mehrotra, Busch); RAND, Arlington, Virginia (Uscher-Pines); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Raja); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| | - Alisa B Busch
- Department of Health Care Policy, Harvard Medical School, Boston (Huskamp, Normand, Mehrotra, Busch); RAND, Arlington, Virginia (Uscher-Pines); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Raja); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
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Rawy M, Abdalla G, Look K. Polysubstance mortality trends in White and Black Americans during the opioid epidemic, 1999-2018. BMC Public Health 2024; 24:112. [PMID: 38184563 PMCID: PMC10771660 DOI: 10.1186/s12889-023-17563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/21/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Psychoactive drug combinations are increasingly contributing to overdose deaths among White and Black Americans. To understand the evolving nature of overdose crisis, inform policies, and develop tailored and equitable interventions, this study provides a comprehensive assessment of polysubstance mortality trends by race and sex during the opioid epidemic. METHODS We used serial cross-sectional US mortality data for White and Black populations from 1999 through 2018 to calculate annual age-adjusted death rates (AADR) involving any opioid, opioid subtypes, benzodiazepines, cocaine, psychostimulants, or combinations of these drugs, stratified by race and sex. Trend changes in AADR were analyzed using joinpoint regression models and expressed as average annual percent change (AAPC) during each period of the three waves of the opioid epidemic: 1999-2010 (wave 1), 2010-2013 (wave 2), and 2013-2018 (wave 3). Prevalence measures assessed the percent co-involvement of an investigated drug in the overall death from another drug. RESULTS Polysubstance mortality has shifted from a modest rise in death rates due to benzodiazepine-opioid overdoses among White persons (wave 1) to a substantial increase in death rates due to illicit drug combinations impacting both White and Black populations (wave 3). Concurrent cocaine-opioid use had the highest polysubstance mortality rates in 2018 among Black (5.28 per 100,000) and White (3.53 per 100,000) persons. The steepest increase in death rates during wave 3 was observed across all psychoactive drugs when combined with synthetic opioids in both racial groups. Since 2013, Black persons have died faster from cocaine-opioid and psychostimulant-opioid overdoses. Between 2013 and 2018, opioids were highly prevalent in cocaine-related deaths, increasing by 33% in White persons compared to 135% in Blacks. By 2018, opioids contributed to approximately half of psychostimulant and 85% of benzodiazepine fatal overdoses in both groups. The magnitude and type of drug combinations with the highest death rates differed by race and sex, with Black men exhibiting the highest overdose burden beginning in 2013. CONCLUSIONS The current drug crisis should be considered in the context of polysubstance use. Effective measures and policies are needed to curb synthetic opioid-involved deaths and address disparate mortality rates in Black communities.
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Affiliation(s)
- Marwa Rawy
- University of Wisconsin-Madison, Madison, USA.
| | | | - Kevin Look
- University of Wisconsin-Madison, Madison, USA
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15
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Reddon H, Socias ME, DeBeck K, Hayashi K, Walsh Z, Milloy MJ. Cannabis use to manage stimulant cravings among people who use unregulated drugs. Addict Behav 2024; 148:107867. [PMID: 37748225 PMCID: PMC10896268 DOI: 10.1016/j.addbeh.2023.107867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND We sought to analyze the association between cannabis use to manage stimulant cravings and self-reported changes in stimulant use among structurally marginalized people who use unregulated drugs (PWUD). METHODS The data for this secondary analysis was collected from a cross-sectional questionnaire administered to people who concurrently use cannabis and unregulated stimulants in Vancouver, Canada. We used logistic regression models to analyze the association between cannabis use to manage stimulant cravings and self-reported changes in the frequency of stimulant use. RESULTS In total, 297 individuals were included in the present study. Cannabis use to manage stimulant cravings was reported by 134 (45.1 %) participants and 104 (77.6 %) of these participants reported decreasing their stimulant use during periods of cannabis use. In the multivariable logistic regression analysis, cannabis use to manage stimulant cravings (adjusted Odds Ratio [aOR] = 0.24, 95 % confidence interval [CI]: 0.10, 0.56) was significantly associated with self-reported reductions in stimulant use. In the sub-analyses, cannabis use to manage stimulant cravings was significantly associated with reduced stimulant use among people who used crystal methamphetamine daily (aOR = 0.08, 95 % CI: 0.02-0.37) and was not significantly associated with reduced stimulant use among people who used crack/cocaine daily (aOR = 0.33, 95 % CI: 0.04-2.86). CONCLUSIONS These findings indicate that cannabis use to manage stimulant cravings is a common harm reduction strategy and suggest that this may be an effective strategy to reduce stimulant use among some PWUD.
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Affiliation(s)
- Hudson Reddon
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada.
| | - Maria Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; School of Public Policy, Simon Fraser University, Burnaby, BC V6B 5K3, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Zach Walsh
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; University of British Columbia, Department of Psychology, Kelowna, BC V1V 1V7, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
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Cruz SL, Bencomo-Cruz M, Medina-Mora ME, Vázquez-Quiroz F, Fleiz-Bautista C. First drug-checking study at an electronic festival and fentanyl detection in the central region of Mexico. Harm Reduct J 2023; 20:174. [PMID: 38053148 DOI: 10.1186/s12954-023-00905-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Perception of drug adulteration has increased in Mexico, but there is little research on adulterants and toxicity. The aim of this study was to identify drug composition in an electronic music outdoor festival nearby Mexico City. METHODS The participants completed a questionnaire with demographic data, harm reduction strategies, drug-use patterns, history, and the drug they expected to find. We took a small sample of each substance and prepared it for drug checking. A two-section drug testing station was placed within the grounds of the festival. Interaction with participants occurred at the front part. Drug checking was conducted at the rear part. The service was free of charge, voluntary and confidential. Forty persons aged 22 to 48 years participated (mode = 28), of which 92.5% were male, most (82.5%) were single. Through the Substance Analysis Program of "ReverdeSer Collective," we conducted the testing with the attendants that provided 51 drug samples, following ethical and biosafety protocols. We used colorimetry, Fourier Transform Infrared Spectroscopy, and fentanyl immunoassay strips for sample analysis. RESULTS Substances of choice among attendants were psychostimulants (MDMA and other amphetamine-like drugs) and hallucinogens. Most samples contained what the users expected plus adulterants. Main adulterants were methylene-dioxy-ethyl-amphetamine, methylene-dioxy-propyl-amphetamine, hydroxyamphetamine, and the selective serotonin reuptake inhibitor venlafaxine. Fentanyl was present in 2 out of 4 cocaine samples and in 14 of the 22 confirmed MDMA samples. CONCLUSIONS Some of the adulterants found pose serious health risks, especially fentanyl, amphetamine-like substances, and venlafaxine. Therefore, it is urgent to monitor these adulterants at electronic music festivals and to implement prevention, treatment, and harm reduction public policies. Naloxone distribution and drug-assisted therapies should be part of government programs in Mexico.
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Affiliation(s)
- Silvia L Cruz
- Department of Pharmacobiology, Center for Research and Advanced Studies (Cinvestav), Mexico City, Mexico
- Opioids Working Group. Global Studies Seminar, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Miguel Bencomo-Cruz
- Substance Analysis Program-Deliberar A. C. and ReverdeSer Collective A. C., Mexico City, Mexico
| | - María E Medina-Mora
- Opioids Working Group. Global Studies Seminar, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
- Faculty of Psychology Director, National Autonomous University of Mexico, Mexico City, Mexico
- National Institute of Psychiatry Ramon de la Fuente Muñiz (INPRFM), Calzada México-Xochimilco 101 Col. San Lorenzo Huipulco, 14370, Mexico City, Mexico
| | - Fabiola Vázquez-Quiroz
- National Institute of Psychiatry Ramon de la Fuente Muñiz (INPRFM), Calzada México-Xochimilco 101 Col. San Lorenzo Huipulco, 14370, Mexico City, Mexico
| | - Clara Fleiz-Bautista
- Opioids Working Group. Global Studies Seminar, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico.
- National Institute of Psychiatry Ramon de la Fuente Muñiz (INPRFM), Calzada México-Xochimilco 101 Col. San Lorenzo Huipulco, 14370, Mexico City, Mexico.
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17
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Saliba M, Wilton A, Hagen K, Romanowicz M. A complex case of young child with ADHD, developmental delay who developed seronegative autoimmune encephalitis exacerbated by stimulants. Brain Behav Immun Health 2023; 34:100692. [PMID: 37842135 PMCID: PMC10569956 DOI: 10.1016/j.bbih.2023.100692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/07/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023] Open
Abstract
Autoimmune encephalitis (AE) is a group of disorders characterized by a wide clinical spectrum ranging from the typical limbic encephalitis to more complex neuropsychiatric symptoms including abnormal movements, psychosis, deficits in memory and cognition, dysautonomia, seizures, or coma. Psychiatric symptoms can occur early in the disease progress or manifest during its course. These symptoms are challenging and often slow down the diagnosis of AE. This is a crucial aspect considering that early diagnosis and management of AE are critical for a good outcome. However, there is a lack in studies outlining the exact symptomatology and specific appropriate care that would allow clinicians to achieve an early diagnosis and management. Additionally, AE in children mostly presents with neuropsychiatric symptoms and diagnosis is especially challenging in kids because of their limited capacity in describing their symptoms, the normal childhood behavioral changes and the possibility of a comorbid psychiatric diagnosis. We present a complex case of seronegative AE with comorbid ADHD (Attention Deficit Hyperactivity Disorder) and anxiety in a young six-year-old girl.
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Affiliation(s)
- M. Saliba
- Dept. of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - A. Wilton
- Dept. of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - K. Hagen
- Dept. of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - M. Romanowicz
- Dept. of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Pince CL, Whiting KE, Wang T, Lékó AH, Farinelli LA, Cooper D, Farokhnia M, Vendruscolo LF, Leggio L. Role of aldosterone and mineralocorticoid receptor (MR) in addiction: A scoping review. Neurosci Biobehav Rev 2023; 154:105427. [PMID: 37858908 PMCID: PMC10865927 DOI: 10.1016/j.neubiorev.2023.105427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/24/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
Abstract
Preclinical and human studies suggest a role of aldosterone and mineralocorticoid receptor (MR) in addiction. This scoping review aimed to summarize (1) the relationship between alcohol and other substance use disorders (ASUDs) and dysfunctions of the aldosterone and MR, and (2) how pharmacological manipulations of MR may affect ASUD-related outcomes. Our search in four databases (MEDLINE, Embase, Web of Science, and Cochrane Library) indicated that most studies focused on the relationship between aldosterone, MR, and alcohol (n = 30), with the rest focused on opioids (n = 5), nicotine (n = 9), and other addictive substances (n = 9). Despite some inconsistencies, the overall results suggest peripheral and central dysregulations of aldosterone and MR in several species and that these dysregulations depended on the pattern of drug exposure and genetic factors. We conclude that MR antagonism may be a promising target in ASUD, yet future studies are warranted.
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Affiliation(s)
- Claire L Pince
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, 251 Bayview Blvd, Suite 200, Baltimore, MD 21224, USA; Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, 251 Bayview Blvd, Suite 200, Baltimore, MD 21224, USA; Stress & Addiction Neuroscience Unit, Integrative Neuroscience Research Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, 251 Bayview Blvd, Suite 200, Baltimore, MD 21224, USA
| | - Kimberly E Whiting
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, 251 Bayview Blvd, Suite 200, Baltimore, MD 21224, USA; Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, 251 Bayview Blvd, Suite 200, Baltimore, MD 21224, USA
| | - Tammy Wang
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, 251 Bayview Blvd, Suite 200, Baltimore, MD 21224, USA
| | - András H Lékó
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, 251 Bayview Blvd, Suite 200, Baltimore, MD 21224, USA; Center on Compulsive Behaviors, Intramural Research Program, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lisa A Farinelli
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, 251 Bayview Blvd, Suite 200, Baltimore, MD 21224, USA
| | - Diane Cooper
- Office of Research Services, Division of Library Services, National Institutes of Health, Building 10, Bethesda, MD 20892, USA
| | - Mehdi Farokhnia
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, 251 Bayview Blvd, Suite 200, Baltimore, MD 21224, USA
| | - Leandro F Vendruscolo
- Stress & Addiction Neuroscience Unit, Integrative Neuroscience Research Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, 251 Bayview Blvd, Suite 200, Baltimore, MD 21224, USA.
| | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, 251 Bayview Blvd, Suite 200, Baltimore, MD 21224, USA.
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Freese TE, Rutkowski BA, Peck JA, Urada D, Clark HW, Bland AN, Friedman J, Rawson RA. Recovery incentives program: California's contingency management benefit. Prev Med 2023; 176:107703. [PMID: 37717741 DOI: 10.1016/j.ypmed.2023.107703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE The role of methamphetamine and cocaine use in California's drug poisoning (overdose) crisis has dramatically increased in the past five (5) years and has disproportionately affected American Indian, Alaska Native, and Black Californians. No FDA-approved medications currently exist for the treatment of individuals with stimulant use disorder (StimUD). Outside the Veteran's Administration, the Recovery Incentives Program: California's Contingency Management Benefit is the first large scale implementation of contingency management (CM). CM is the behavioral treatment with the most evidence and largest effect sizes for StimUD. METHODS The Program uses a CM protocol where participants can receive a maximum of $599 over a six-month period, contingent upon 36 stimulant-negative urine test results. Urine tests are conducted using a set of approved, CLIA-waived, point-of-care urine drug tests (UDTs). To ensure fidelity to the CM protocol and to prevent fraud, waste, and abuse, all aspects of incentive accounting and distribution are managed electronically via a custom-developed software system. Incentive distribution utilizes electronic gift cards. A significant innovation of the project is the conceptualization of the CM Coordinator, a designated and highly trained and supervised individual responsible for all aspects of CM operation in a specific site. RESULTS AND CONCLUSIONS The California Department of Health Care Services contracted with UCLA to develop and implement a robust evaluation of the Program; goals include evaluating the effectiveness of real-world implementation and facilitating quality improvement. The project will likely significantly impact the use of CM for StimUD nationally and may well reduce stimulant-related drug poisoning deaths.
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Affiliation(s)
- Thomas E Freese
- UCLA Division of Addiction Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA, United States of America.
| | - Beth A Rutkowski
- UCLA Division of Addiction Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA, United States of America
| | - James A Peck
- UCLA Division of Addiction Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA, United States of America
| | - Darren Urada
- UCLA Division of Addiction Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA, United States of America
| | - H Westley Clark
- Motivational Incentives Policy Group, United States of America
| | - Anton Nigusse Bland
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States of America
| | - Joseph Friedman
- Center for Social Medicine and Humanities, University of California, Los Angeles, CA, United States of America
| | - Richard A Rawson
- UCLA Division of Addiction Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA, United States of America; Motivational Incentives Policy Group, United States of America; Vermont Center on Behavior and Health, Center on Rural Addictions, Burlington, VT, United States of America; Department of Psychiatry, University of Vermont, Burlington, VT, United States of America
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Rawson RA, Erath TG, Clark HW. The fourth wave of the overdose crisis: Examining the prominent role of psychomotor stimulants with and without fentanyl. Prev Med 2023; 176:107625. [PMID: 37468073 DOI: 10.1016/j.ypmed.2023.107625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
The current overdose and broader public health crisis involving illicit drug use is often referred to as the "opioid" or "fentanyl" crisis. Clearly there is extensive data on the profound damage done by opioids over the past 20 years and specifically by fentanyl in the past 5 years. However, there is an extensive array of data that suggests there is more to the current crisis than opioids/fentanyl. Much recent evidence indicates that methamphetamine and cocaine are playing a substantial and increasing role in the illicit drug crisis in the US-the 4th wave. This paper reviews data that illustrate the role of psychomotor stimulants in fatal overdoses, nonfatal overdoses, and emergency department visits. Despite the major detrimental role that stimulants are having on the public health in the US in 2023, there is virtually no evidence-based treatment available in practice for people with stimulant use disorder (StimUD). Although there are no medications with FDA-approval for the treatment of StimUD, there is a behavioral treatment, contingency management (CM), with over 3 decades of robust research supporting its efficacy for individuals with StimUD. Despite the overwhelming evidence supporting CM, it is not being widely used in routine treatment outside the VA healthcare system. This paper reviews some of the (a) evidence for CM, (b) CM protocol design elements that require consideration, (c) current obstacles to the widespread implementation of CM, and (d) strategies for addressing these obstacles. Overcoming these obstacles is a priority to allow routine use of CM as a treatment for StimUD.
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Affiliation(s)
- Richard A Rawson
- Vermont Center on Behavior and Health, Burlington, VT, United States of America; Department of Psychiatry, University of Vermont, Burlington, VT, United States of America; Motivational Incentives Policy Group, United States of America.
| | - Tyler G Erath
- Vermont Center on Behavior and Health, Burlington, VT, United States of America; Department of Psychiatry, University of Vermont, Burlington, VT, United States of America; Motivational Incentives Policy Group, United States of America
| | - H Westley Clark
- Motivational Incentives Policy Group, United States of America
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21
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Bunting AM, Krawczyk N, Lippincott T, Gu Y, Arya S, Nagappala S, Meacham MC. Trends in Fentanyl Content on Reddit Substance Use Forums, 2013-2021. J Gen Intern Med 2023; 38:3283-3287. [PMID: 37296360 PMCID: PMC10255938 DOI: 10.1007/s11606-023-08256-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Fentanyl is a pressing concern in the current drug supply. Social media data can provide access to near real-time understanding of drug trends that may complement official mortality data. DESIGN The total number of fentanyl-related posts and the total number of posts for eight drug subreddit categories (alcohol, cannabis, hallucinogens, multi-drug, opioids, over the counter, sedatives, stimulants) were collected from 2013 to 2021 using the Pushshift Reddit dataset. The proportion of fentanyl-related posts as a fragment of total subreddit posts was examined. Linear regressions described the rate of change in post volume over time. RESULTS Overall, fentanyl-related content increased across drug-related subreddits from 2013 to 2021 (1292% increase, linear trend p ≤ 0.001). Opioid subreddits (30.62 per 1000 posts, linear trend p ≤ 0.001) had the most fentanyl-related content during the examined time period. Multi-drug (5.95 per 1000; p ≤ 0.01), sedative (3.23 per 1000, p ≤ 0.01), and stimulant (1.60 per 1000, p ≤ 0.01) subreddits also had substantial increases in fentanyl-related content. The greatest increases occurred in the multi-drug (1067% 2013:2021) and stimulant (1862% 2014:2021) subreddits. CONCLUSION Fentanyl-related posts on Reddit trended upward, with the fastest rate of change for multi-substance and stimulant subreddits. Beyond opioids, harm reduction and public health messaging should ensure inclusion of individuals who use other drugs.
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Affiliation(s)
- Amanda M Bunting
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Noa Krawczyk
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Thomas Lippincott
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Yuanqi Gu
- Department of Public Health Nutrition, School of Global Public Health, New York University, NYC, NY, USA
| | - Simran Arya
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Suhas Nagappala
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Meredith C Meacham
- Department of Psychiatry & Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
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22
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Estadt AT, Miller WC, Kline D, Whitney BM, Young AM, Todd Korthuis P, Stopka TJ, Feinberg J, Zule WA, Pho MT, Friedmann PD, Westergaard RP, Eagen KV, Seaman A, Ma J, Go VF, Lancaster KE. Associations of hepatitis C virus (HCV) antibody positivity with opioid, stimulant, and polysubstance injection among people who inject drugs (PWID) in rural U.S. communities. International Journal of Drug Policy 2023:104222. [PMID: 37806839 PMCID: PMC10997735 DOI: 10.1016/j.drugpo.2023.104222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 09/18/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND People who inject drugs (PWID) in the rural U.S. often inject stimulants, alone or with opioids. The impact of these substance use patterns may influence HCV risk behaviors. This analysis examines the associations of HCV antibody positivity with injecting only opioids, only stimulants (methamphetamine/cocaine), and opioids and stimulants together among rural PWID. METHODS The Rural Opioid Initiative (ROI) consists of eight research sites that enrolled people who use drugs in rural communities in ten U.S. states from 2018 to 2020. This cross-sectional analysis included adult participants who resided in a study area and injected any drug in the past 30 days. The primary outcome was HCV antibody positivity. The exposure of interest was injection drug use classified as only opioids, only stimulants, separate injections of opioids and stimulants, and same-syringe injection of both in the past 30 days. We used multivariable log-binomial regression with generalized linear mixed models to generate prevalence ratios (P.R.) adjusted for demographics, injection history, health insurance, and substance use treatment. RESULTS Among 3,084 participants enrolled in the ROI, 1,982 met inclusion criteria. Most participants injected opioids and stimulants in the same syringe (34%) or separately (21%), followed by injecting only stimulants (26%), and injecting only opioids (19%). Half (51%) were HCV antibody positive. Compared to people who injected only stimulants, HCV antibody positivity was more prevalent among people who injected opioids alone (aPR=1.62, 95% CI:(1.29-2.03)), injected both opioids and stimulants separately (aPR=1.61, 95% CI:(1.32-1.95)), and in the same syringe (aPR=1.54, 95% CI:(1.28-1.85)). CONCLUSION HCV antibody positivity, indicating prior exposure, was highest among those who had recently injected opioids, alone or with stimulants. Additional nucleic acid testing is necessary to confirm active infection. More research is needed to determine the underlying causes of HCV antibody positivity by injection use.
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Affiliation(s)
- Angela T Estadt
- Ohio State University, College of Public Health, Division of Epidemiology, United States.
| | - William C Miller
- Ohio State University, College of Public Health, Division of Epidemiology, United States; Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - David Kline
- Wake Forest University School of Medicine, Division of Public Health Sciences, Department of Biostatistics and Data Science, United States
| | | | - April M Young
- University of Kentucky, Department of Epidemiology and Environmental Health, Center on Drug and Alcohol Research, United States
| | - P Todd Korthuis
- Oregon Health & Science University, Department of Medicine, Section of Addiction Medicine, United States
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, United States
| | - Judith Feinberg
- West Virginia University School of Medicine, Departments of Behavioral Medicine and Psychiatry and Medicine/Infectious Diseases, United States
| | - William A Zule
- RTI International, Research Triangle Park, NC, United States
| | - Mai T Pho
- University of Chicago, Department of Medicine, United States
| | - Peter D Friedmann
- University of Massachusetts Medical School-Baystate and Baystate Health, United States
| | - Ryan P Westergaard
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of Infectious Diseases, United States
| | - Kellene V Eagen
- University of Wisconsin - Madison, School of Medicine and Public Health, Department of Family Medicine and Community Health, United States
| | - Andrew Seaman
- Oregon Health & Science University, School of Medicine, United States
| | - Jimmy Ma
- University of Washington, Department of Medicine, Division of Allergy and Infectious Diseases, United States
| | - Vivian F Go
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, United States
| | - Kathryn E Lancaster
- Ohio State University, College of Public Health, Division of Epidemiology, United States; Division of Public Health Sciences, Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
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23
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Haeny AM, McCuistian C, Burlew AK, Ruglass LM, Espinosa A, Jordan A, Roundtree C, Lopez J, Morgan-López AA. Integrative data analysis of clinical trials network studies to examine the impact of psychosocial treatments for black people who use cocaine: Study protocol. Contemp Clin Trials 2023; 133:107329. [PMID: 37652354 PMCID: PMC10635737 DOI: 10.1016/j.cct.2023.107329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Cocaine overdose death rates among Black people are higher than that of any other racial/ethnic group, attributable to synthetic opioids in the cocaine supply. Understanding the most effective psychostimulant use treatment interventions for Black people is a high priority. While some interventions have proven effective for the general population, their comparative effectiveness among Black people remains unknown. To address this gap, our NIDA-funded Clinical Trials Network (CTN) study (0125), will use Integrative Data Analysis (IDA) to examine treatment effectiveness across 9 CTN studies. This manuscript describes the study protocol for CTN-0125. METHODS Of the 59 completed randomized clinical trials in the CTN with available datasets, nine met our inclusion criteria: 1) behavioral intervention, 2) targeted cocaine use or use disorder, 3) included sub-samples of participants who self-identified as Black and 4) included outcome measures of cocaine and psychostimulant use and consequences. We aim to 1) estimate scale scores of cocaine use severity while considering study-level measurement non-invariance, 2) compare the effectiveness of psychosocial treatments for psychostimulant use, and 3) explore individual (e.g., concomitant opioid use, age, sex, employment, pre-treatment psychiatric status) and study-level moderators (e.g., attendance/retention) to evaluate subgroup differences in treatment effectiveness. CONCLUSION The NIDA CTN provides a unique collection of studies that can offer insight into what interventions are most efficacious for Black people. Findings from our CTN-0125 study have the potential to substantially inform treatment approaches specifically designed for Black people who use psychostimulants.
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Affiliation(s)
- Angela M Haeny
- Department of Psychiatry, Yale School of Medicine, United States of America
| | - Caravella McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, United States of America.
| | - A Kathleen Burlew
- Department of Psychology, University of Cincinnati, United States of America
| | - Lesia M Ruglass
- Department of Psychology, The City College of New York and The Graduate Center, CUNY, United States of America
| | - Adriana Espinosa
- Department of Psychology, The City College of New York and The Graduate Center, CUNY, United States of America
| | - Ayana Jordan
- Department of Psychiatry, Department of Population Health, NYU Grossman School of Medicine, United States of America
| | | | - Joel Lopez
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, United States of America
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Byrne C, Guenter D. Treatments for ADHD in adults in jails, prisons and correctional settings: a scoping review of the literature. Health Justice 2023; 11:36. [PMID: 37676388 PMCID: PMC10486076 DOI: 10.1186/s40352-023-00234-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/31/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Attention-Deficit / Hyperactivity Disorder (ADHD) is prevalent at a higher rate in correctional settings than in the general population. Treatment of ADHD in this environment is challenging as stimulants, the most common treatment for ADHD, require cautious prescribing in the context of frequent substance use disorders (SUD) and diversion in the institutional setting. In addition, both pharmacological and non-pharmacological treatment approaches require significant staff resources. The aim of this scoping review is to map and summarize all literature addressing treatment of ADHD specifically in correctional settings, synthesize the evidence supporting various approaches, and highlight areas for future research. Due to the limited number of primary research studies addressing this question directly, we chose a scoping review methodology that would allow us to explore what kinds of studies and literature exist and include all types of articles directly related to our question. RESULTS Five-hundred sixty-five relevant articles were screened. Thirty-two articles were included in the final review. Eleven of the articles reported primary research. Five of these articles were based on three randomized controlled trials. Among randomized controlled trials on the effect of stimulants, inclusion criteria, outcome measures and effectiveness varied widely. Non-male and non-white populations were under-represented. Among review articles and recommendations opinion was inconsistent, with some recommending stimulants as first-line treatment and others recommending they be avoided altogether. The effect of non-stimulant medications was examined in 2 small studies. The only non-pharmacological treatment examined was dialectical behavior therapy, and only feasibility was reported. Four articles provided practice recommendations from consensus or expert opinion. Two of these recommended stimulants as first-line treatment, and two recommended stimulants as treatment of last resort. CONCLUSIONS We found a diverse but shallow literature addressing our research question. Primary research in the corrections setting is limited and varies in inclusion criteria, outcomes studied, and effectiveness. Recommendations on treatment are inconsistent. Future research should address methods of diagnosis, the role of non-stimulants, non-pharmacological interventions, non-male and non-white people who are incarcerated (PWAI), and effects of treatment method on patients, staff and other PWAI. Better research and guidance on treating ADHD has potential to improve health of PWAI, the institutional environment, and resource utilization.
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Affiliation(s)
- Cory Byrne
- School of Interdisciplinary Science, Faculty of Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Dale Guenter
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main St W, Hamilton, ON, L8P 1H6, Canada.
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Stipaničev D, Dragun Z, Repec S, Ivanković D, Barac F, Kiralj Z, Kralj T, Valić D. Dynamics of drug contamination of the river-water in the rural, semirural and urban areas of the Mrežnica River in Croatia during COVID-19 pandemic (2020-2021). Environ Sci Pollut Res Int 2023; 30:93652-93666. [PMID: 37515617 DOI: 10.1007/s11356-023-28845-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/14/2023] [Indexed: 07/31/2023]
Abstract
Increased contamination of aquatic ecosystems with pharmaceuticals could have been expected due to the COVID-19 pandemic. Surface water from three domains (rural, semirural, urban) of the Mrežnica River (Croatia) was screened for 253 pharmaceuticals by SPE-UHPLC-MS/MS. At the beginning of the pandemic, the highest concentration of drugs (excluding veterinary) was detected at urban site (291.4 ng/L), followed by semirural (186.5 ng/L) and rural (141.6 ng/L). With the progression of pandemic, contamination increase was observed at all sites, but it was the most obvious at semirural (approximately 400-700 ng/L). The most pronounced concentration increases were observed for non-opioid analgesics, especially ibuprofen. In September 2021, the first notable occurrence of opioid analgesics was recorded. The most represented group of pharmaceuticals at the start of the pandemic (May 2020) was generally stimulants (caffeine, cotinine). In September 2021, the predominant group was analgesics at all sites (45-84%), whereas stimulants decreased to undetectable levels. The results of this study indicated that the epidemiological measures and medical treatments that were widely imposed/applied caused notable increase of the surface water contamination with drugs of a small river with limited dilution capacity, indirectly pointing to the changes that occurred in the behaviour and habits of the inhabitants of the affected areas.
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Affiliation(s)
- Draženka Stipaničev
- Josip Juraj Strossmayer Water Institute, Central Water Laboratory, Ulica grada Vukovara 220, Zagreb, Croatia
| | - Zrinka Dragun
- Ruđer Bošković Institute, Division for Marine and Environmental Research, Bijenička cesta 54, Zagreb, Croatia.
| | - Siniša Repec
- Josip Juraj Strossmayer Water Institute, Central Water Laboratory, Ulica grada Vukovara 220, Zagreb, Croatia
| | - Dušica Ivanković
- Ruđer Bošković Institute, Division for Marine and Environmental Research, Bijenička cesta 54, Zagreb, Croatia
| | - Fran Barac
- Ruđer Bošković Institute, Division for Marine and Environmental Research, Bijenička cesta 54, Zagreb, Croatia
| | - Zoran Kiralj
- Ruđer Bošković Institute, Division for Marine and Environmental Research, Bijenička cesta 54, Zagreb, Croatia
| | - Tomislav Kralj
- Ruđer Bošković Institute, Division for Marine and Environmental Research, Bijenička cesta 54, Zagreb, Croatia
| | - Damir Valić
- Ruđer Bošković Institute, Division for Marine and Environmental Research, Bijenička cesta 54, Zagreb, Croatia
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Kidd JD, Smiley SL, Coffin PO, Carmody TJ, Levin FR, Nunes EV, Shoptaw SJ, Trivedi MH. Sexual orientation differences among men in a randomized clinical trial of extended-release naltrexone and bupropion for methamphetamine use disorder. Drug Alcohol Depend 2023; 250:110899. [PMID: 37478502 PMCID: PMC10530262 DOI: 10.1016/j.drugalcdep.2023.110899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Methamphetamine use disorder (MethUD) disproportionately affects men who have sex exclusively with men or with men and women (collectively MSM/W), compared to men who have sex with women (MSW). This study is the first MethUD medication trial to compare treatment effect for these groups, hypothesizing that extended-release injectable naltrexone 380mg every 3 weeks plus oral extended-release bupropion 450mg daily would be less effective for MSM/W than MSW. METHODS Data come from men (N = 246) in a multi-site, double-blind, randomized, placebo-controlled trial with sequential parallel comparison design. In Stage 1 (6-weeks), participants were randomized to active treatment or placebo. In Stage 2 (6-weeks), Stage 1 placebo non-responders were rerandomized. Treatment response was ≥3 methamphetamine-negative urine samples, out of four obtained at the end of Stages 1 and 2. Treatment effect was the active-versus-placebo between-group difference in the weighted average Stages 1 and 2 responses. RESULTS MSM/W (n = 151) were more likely than MSW (n = 95) to be Hispanic, college-educated, and living with HIV. Adjusting for demographics, among MSM/W, response rates were 13.95 % (active treatment) and 2.78 % (placebo) in Stage 1; 23.26 % (active treatment) and 4.26 % (placebo) in Stage 2. Among MSW, response rates were 7.69 % (active treatment) and 5.80 % (placebo) in Stage 1; 3.57 % (active treatment) and 0 % (placebo) in Stage 2. Treatment effect was significantly larger for MSM/W (h = 0.1479) than MSW (h = 0.0227) (p = 0.04). CONCLUSIONS Findings suggest efficacy of extended-release naltrexone plus bupropion for MSM/W, a population heavily burdened by MethUD. While a secondary outcome, this intriguing finding merits testing in prospective trials.
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Affiliation(s)
- Jeremy D Kidd
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY10032, USA.
| | - Sabrina L Smiley
- San Diego State University School of Public Health, 5500 Campanile Drive, San Diego, CA92182, USA.
| | - Phillip O Coffin
- Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA94143, USA; San Francisco Department of Health, 101 Grove Street, San Francisco, CA94102, USA.
| | - Thomas J Carmody
- Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX75390, USA.
| | - Frances R Levin
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY10032, USA.
| | - Edward V Nunes
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY10032, USA.
| | - Steven J Shoptaw
- Department of Family Medicine, University of California Los Angeles, 10880 Wilshire Boulevard, Los Angeles, CA90024, USA.
| | - Madhukar H Trivedi
- Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX75390, USA.
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Coray RC, Berberat J, Zimmermann J, Seifritz E, Stock AK, Beste C, Cole DM, Unschuld PG, Quednow BB. Striatal Iron Deposition in Recreational MDMA (Ecstasy) Users. Biol Psychiatry Cogn Neurosci Neuroimaging 2023; 8:956-966. [PMID: 36848948 DOI: 10.1016/j.bpsc.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/30/2022] [Accepted: 02/17/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND The common club drug MDMA (also known as ecstasy) enhances mood, sensory perception, energy, sociability, and euphoria. While MDMA has been shown to produce neurotoxicity in animal models, research on its potential neurotoxic effects in humans is inconclusive and has focused primarily on the serotonin system. METHODS We investigated 34 regular, largely pure MDMA users for signs of premature neurodegenerative processes in the form of increased iron load in comparison to a group of 36 age-, sex-, and education-matched MDMA-naïve control subjects. We used quantitative susceptibility mapping, a novel tool able to detect even small tissue (nonheme) iron accumulations. Cortical and relevant subcortical gray matter structures were grouped into 8 regions of interest and analyzed. RESULTS Significantly increased iron deposition in the striatum was evident in the MDMA user group. The effect survived correction for multiple comparisons and remained after controlling for relevant confounding factors, including age, smoking, and stimulant co-use. Although no significant linear relationship between measurements of the amounts of MDMA intake (hair analysis and self-reports) and quantitative susceptibility mapping values was observed, increased striatal iron deposition might nevertheless point to MDMA-induced neurotoxic processes. Additional factors (hyperthermia and simultaneous co-use of other substances) that possibly amplify neurotoxic effects of MDMA during the state of acute intoxication are discussed. CONCLUSIONS The demonstrated increased striatal iron accumulation may indicate that regular MDMA users have an increased risk potential for neurodegenerative diseases with progressing age.
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Affiliation(s)
- Rebecca C Coray
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, Eidgenössische Technische Hochschule Zurich and University of Zurich, Zurich, Switzerland.
| | - Jatta Berberat
- Geriatric Psychiatry, Department of Psychiatry, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland; Institute of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Josua Zimmermann
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, Eidgenössische Technische Hochschule Zurich and University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ann-Kathrin Stock
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - David M Cole
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, Eidgenössische Technische Hochschule Zurich and University of Zurich, Zurich, Switzerland; Translational Psychiatry Lab, University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
| | - Paul G Unschuld
- Geriatric Psychiatry, Department of Psychiatry, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Boris B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, Eidgenössische Technische Hochschule Zurich and University of Zurich, Zurich, Switzerland
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Feelemyer JP, Richard E, Khan MR, Scheidell JD, Caniglia EC, Manandhar-Sasaki P, Ban KF, Charles D, Braithwaite RS. Does the Association Between Stimulant use and High Risk Sexual Behavior Vary by Injection Drug Use, Sexual Minority Status, or HIV Infection Status? A Meta-analysis. AIDS Behav 2023; 27:2883-2890. [PMID: 36786937 PMCID: PMC10423740 DOI: 10.1007/s10461-023-04012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 02/15/2023]
Abstract
There is strong evidence linking stimulant use, namely methamphetamine use, to sexual risk behavior among sexual minority men (SMM); we do not, however, have a good understanding of this relationship among other at-risk populations. In this study, we systematically reviewed associations between stimulant use (i.e., methamphetamine, crack cocaine, cocaine) and sexual risk behaviors among populations facing elevated risk of HIV transmission and acquisition (i.e., SMM, people who inject drugs (PWID), and people living with HIV/AIDS (PLWH)). Random-effects meta-analyses and sensitivity analyses that included crude and adjusted estimates separately were conducted to evaluate the impact of potential confounding variables. The results showed strong relationships between stimulant use and condomless sex, transactional sex, and multiple sexual partners. Results were broadly consistent when analyses were stratified by type of stimulant (methamphetamine, crack cocaine, and other stimulants) and risk group. Sensitivity analyses with confounding variables did not greatly impact results. The results indicate that stimulant use is associated with numerous sexual risk behaviors regardless of risk group, suggesting prevention efforts focused on reducing methamphetamine-related HIV risk should target a range of at-risk populations.
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Affiliation(s)
- Jonathan P Feelemyer
- Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA.
| | | | - Maria R Khan
- Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA
| | - Joy D Scheidell
- Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA
| | - Ellen C Caniglia
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Prima Manandhar-Sasaki
- Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA
| | - Kaoon Francois Ban
- Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA
| | - Dyanna Charles
- Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA
| | - Ronald Scott Braithwaite
- Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA
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Price O, Sutherland R, Man N, Bruno R, Dietze P, Salom C, Akhurst J, Peacock A. Trends and psychosocial correlates of same day polysubstance use among people who inject drugs in Australia, 2012-2022. Int J Drug Policy 2023:104150. [PMID: 37541925 DOI: 10.1016/j.drugpo.2023.104150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Polysubstance use is associated with negative health and social outcomes among people who inject drugs. We aimed to describe trends in polysubstance use and identify psychosocial correlates and associated drug use risk behaviours. We defined polysubstance use as intentional same day use of more than one of three drug classes: opioids, other non-opioid depressants (hereafter 'depressants'), and stimulants. METHODS We used 10 years (2012-2022, excluding 2020) of data from annual surveys in Australian capital cities with people who inject drugs (N=5657) to construct five mutually exclusive polysubstance use profiles: opioid-depressant, opioid-stimulant, stimulant-depressant, opioid-stimulant-depressant, and single drug class use. We examined time trends using the Mann Kendall test and identified correlates using multinomial logistic regression. RESULTS Same day polysubstance use was relatively common among this sample (43.6%). Opioid-depressant use was the most frequent polysubstance use profile, but this decreased over the study period (32.6% to 13.3%, p<0.001). This aligned with observed decreases in use of pharmaceutical opioids (p<0.001), opioid agonist treatment (p=0.007), and benzodiazepines (p=0.001). There was no evidence for any trend in the other polysubstance use profiles, although single drug class use increased (51.9% to 64.7%, p=0.031). The different polysubstance use profiles were variously associated with psychosocial factors, including unstable housing and very high psychological distress, and other drug use risk behaviours, including non-fatal overdose, receptive and/or distributive needle sharing, and reusing one's own needles. CONCLUSION Same day polysubstance use has remained relatively common among this sample over time, although the typology has changed. Collectively, our findings point to diverse drug use patterns among people who inject drugs and reiterate the need for a range of harm reduction, treatment, and support options.
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Affiliation(s)
- Olivia Price
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia.
| | - Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Nicola Man
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | - Paul Dietze
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; National Drug Research Institute, Curtin University, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne Australia
| | - Caroline Salom
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - Jane Akhurst
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; School of Psychological Sciences, University of Tasmania, Hobart, Australia
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Blair CS, Javanbakht M, Comulada WS, Bolan R, Shoptaw S, Gorbach PM, Needleman J. Comparing Factors Associated with Increased Stimulant Use in Relation to HIV Status Using a Machine Learning and Prediction Modeling Approach. Prev Sci 2023; 24:1102-1114. [PMID: 37328629 PMCID: PMC10795486 DOI: 10.1007/s11121-023-01561-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Abstract
Stimulant use is an important driver of HIV/STI transmission among men who have sex with men (MSM). Evaluating factors associated with increased stimulant use is critical to inform HIV prevention programming efforts. This study seeks to use machine learning variable selection techniques to determine characteristics associated with increased stimulant use and whether these factors differ by HIV status. Data from a longitudinal cohort of predominantly Black/Latinx MSM in Los Angeles, CA was used. Every 6 months from 8/2014-12/2020, participants underwent STI testing and completed surveys evaluating the following: demographics, substance use, sexual risk behaviors, and last partnership characteristics. Least absolute shrinkage and selection operator (lasso) was used to select variables and create predictive models for an interval increase in self-reported stimulant use across study visits. Mixed-effects logistic regression was then used to describe associations between selected variables and the same outcome. Models were also stratified based on HIV status to evaluate differences in predictors associated with increased stimulant use. Among 2095 study visits from 467 MSM, increased stimulant use was reported at 20.9% (n = 438) visits. Increased stimulant use was positively associated with unstable housing (adjusted [a]OR 1.81; 95% CI 1.27-2.57), STI diagnosis (1.59; 1.14-2.21), transactional sex (2.30; 1.60-3.30), and last partner stimulant use (2.21; 1.62-3.00). Among MSM living with HIV, increased stimulant use was associated with binge drinking, vaping/cigarette use (aOR 1.99; 95% CI 1.36-2.92), and regular use of poppers (2.28; 1.38-3.76). Among HIV-negative MSM, increased stimulant use was associated with participating in group sex while intoxicated (aOR 1.81; 95% CI 1.04-3.18), transactional sex (2.53; 1.40-2.55), and last partner injection drug use (1.96; 1.02-3.74). Our findings demonstrate that lasso can be a useful tool for variable selection and creation of predictive models. These results indicate that risk behaviors associated with increased stimulant use may differ based on HIV status and suggest that co-substance use and partnership contexts should be considered in the development of HIV prevention/treatment interventions.
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Affiliation(s)
- Cheríe S Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS 52-215, Los Angeles, CA, 90095, USA.
| | - Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - W Scott Comulada
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Robert Bolan
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS 52-215, Los Angeles, CA, 90095, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Jack Needleman
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Moon KJ, Bryant I, Trinh A, Hasenstab KA, Carter B, Barclay R, Nawaz S. Differential risks of syringe service program participants in Central Ohio: a latent class analysis. Harm Reduct J 2023; 20:97. [PMID: 37507721 PMCID: PMC10386257 DOI: 10.1186/s12954-023-00824-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Significant heterogeneity exists among people who use drugs (PWUD). We identify distinct profiles of syringe service program (SSP) clients to (a) evaluate differential risk factors across subgroups and (b) inform harm reduction programming. METHODS Latent class analysis (LCA) was applied to identify subgroups of participants (N = 3418) in a SSP in Columbus, Ohio, from 2019 to 2021. Demographics (age, sex, race/ethnicity, sexual orientation, housing status) and drug use characteristics (substance[s] used, syringe gauge, needle length, using alone, mixing drugs, sharing supplies, reducing use, self-reported perceptions on the impact of use, and treatment/support resources) were used as indicators to define latent classes. A five-class LCA model was developed, and logistic regression was then employed to compare risk factors at program initiation and at follow-up visits between latent classes. RESULTS Five latent classes were identified: (1) heterosexual males using opioids/stimulants with housing instability and limited resources for treatment/support (16.1%), (2) heterosexual individuals using opioids with stable housing and resources for treatment/support (33.1%), (3) individuals using methamphetamine (12.4%), (4) young white individuals using opioids/methamphetamine (20.5%), and (5) females using opioids/cocaine (17.9%). Class 2 served as the reference group for logistic regression models, and at the time of entry, class 1 was more likely to report history of substance use treatment, overdose, HCV, sharing supplies, and mixing drugs, with persistently higher odds of sharing supplies and mixing drugs at follow-up. Class 3 was more likely to report history of overdose, sharing supplies, and mixing drugs, but outcomes at follow-up were comparable. Class 4 was the least likely to report history of overdose, HCV, and mixing drugs, but the most likely to report HIV. Class 5 was more likely to report history of substance use treatment, overdose, HCV, sharing supplies, and mixing drugs at entry, and higher reports of accessing substance use treatment and testing positive for HCV persisted at follow-up. CONCLUSIONS Considerable heterogeneity exists among PWUD, leading to differential risk factors that may persist throughout engagement in harm reduction services. LCA can identify distinct profiles of PWUD accessing services to tailor interventions that address risks, improve outcomes, and mitigate disparities.
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Affiliation(s)
- Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies (HOPES), The Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Ian Bryant
- Center for Health Outcomes and Policy Evaluation Studies (HOPES), The Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Anne Trinh
- Center for Health Outcomes and Policy Evaluation Studies (HOPES), The Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Kathryn A Hasenstab
- Center for Health Outcomes and Policy Evaluation Studies (HOPES), The Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | | | | | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies (HOPES), The Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA.
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, USA.
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Hamed MA, Ekundina VO, Akhigbe RE. Psychoactive drugs and male fertility: impacts and mechanisms. Reprod Biol Endocrinol 2023; 21:69. [PMID: 37507788 PMCID: PMC10375764 DOI: 10.1186/s12958-023-01098-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/03/2023] [Indexed: 07/30/2023] Open
Abstract
Although psychoactive drugs have their therapeutic values, they have been implicated in the pathogenesis of male infertility. This study highlights psychoactive drugs reported to impair male fertility, their impacts, and associated mechanisms. Published data from scholarly peer-reviewed journals were used for the present study. Papers were assessed through AJOL, DOAJ, Google Scholar, PubMed/PubMed Central, and Scopus using Medical Subjects Heading (MeSH) indexes and relevant keywords. Psychoactive drugs negatively affect male reproductive functions, including sexual urge, androgen synthesis, spermatogenesis, and sperm quality. These drugs directly induce testicular toxicity by promoting ROS-dependent testicular and sperm oxidative damage, inflammation, and apoptosis, and they also suppress the hypothalamic-pituitary-testicular axis. This results in the suppression of circulating androgen, impaired spermatogenesis, and reduced sperm quality. In conclusion, psychoactive drug abuse not only harms male sexual and erectile function as well as testicular functions, viz., testosterone concentration, spermatogenesis, and sperm quality, but it also alters testicular histoarchitecture through a cascade of events via multiple pathways. Therefore, offering adequate and effective measures against psychoactive drug-induced male infertility remains pertinent.
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Affiliation(s)
- Moses Agbomhere Hamed
- Department of Medical Laboratory Science, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria.
- The Brainwill Laboratory, Osogbo, Osun State, Nigeria.
- Reproductive Biology and Toxicology Research Laboratories, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria.
| | | | - Roland Eghoghosoa Akhigbe
- Reproductive Biology and Toxicology Research Laboratories, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria
- Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
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Tschudi L, Fischer SKM, Perlov E, Baumgartner MR, Soyka M, Müller TJ, Seifritz E, Mutschler J. Concomitant Drug Use among Opioid-Dependent Patients with and without Attention Deficit Hyperactivity Disorder: Does Methylphenidate Merit a Trial? Eur Addict Res 2023; 29:305-312. [PMID: 37517394 DOI: 10.1159/000531008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/28/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Concomitant drug use is common among opioid-dependent patients in maintenance therapy. Attention deficit hyperactivity disorder (ADHD), a common comorbidity among opioid users, is associated with a higher risk of concomitant drug use. Earlier studies showed that methylphenidate (MPH) can reduce cocaine consumption among patients with ADHD. The use of MPH as an agonist-replacement or maintenance therapy in cocaine-dependent patients without ADHD is also common in Switzerland, despite a lack of supporting evidence. The aim of this study was to assess concomitant cocaine, amphetamine, MDMA, MPH, and heroin use among patients in opioid maintenance therapy either with or without comorbid ADHD. We expected stimulant consumption to be higher in patients with cocaine dependence and comorbid ADHD and that use of MPH would not lead to a reduction in cocaine consumption in patients without ADHD. We therefore evaluated correlations between use of MPH and cocaine consumption and between MPH consumption and cocaine craving within the two groups. METHODS This cross-sectional study included 94 opioid-dependent patients in maintenance therapy in an outpatient department of the Psychiatric Hospital of Zurich. The patients were divided into two groups based on comorbid ADHD; a group with ADHD (N = 27) and a group without ADHD (N = 67). Drug use was assessed using 3-month hair analysis. RESULTS We did not find significant differences in the number of patients using cocaine, amphetamine, MDMA, or heroin between groups with or without ADHD. With respect to cocaine use, 85.2 percent of patients in the ADHD group and 73.1 percent in the non-ADHD group were users. The non-ADHD group showed a significant positive correlation between the concentration of MPH and cocaine in hair samples (p < 0.05), and a positive correlation between cocaine craving and the concentration of MPH in hair samples (p = 0.065). These two trends were not evident in the ADHD group. CONCLUSION Among patients without ADHD, use of MPH correlates with higher cocaine consumption and craving. Conversely, no significant correlation was found between MPH and cocaine use in patients with ADHD. Our study adds to the evidence that MPH confers negative effects in cocaine users without ADHD and should thus have no place in the treatment of these patients.
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Affiliation(s)
- Letizia Tschudi
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Sebastian Karl Maximilian Fischer
- Psychiatric Services Lucerne, Lucerne, Switzerland
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians University of Munich, Munich, Germany
| | | | - Markus R Baumgartner
- Zurich Institute of Forensic Medicine, Center for Forensic Hair Analysis, University of Zurich, Zurich, Switzerland
| | - Michael Soyka
- Department of Psychiatry and Psychotherapy, University Hospital of Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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de Lucca MS, Pimentel MEO, Raimundo CKO, Henriques BD, Moreira TR, Cardoso SA, de Miranda DM. Brain-derived neurotrophic factor (BDNF) levels in children and adolescents before and after stimulant use a systematic review and metanalysis. Prog Neuropsychopharmacol Biol Psychiatry 2023; 125:110761. [PMID: 37044279 DOI: 10.1016/j.pnpbp.2023.110761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/02/2023] [Accepted: 04/06/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder associated with cognitive, social, and academic impairment. Neurotrophins, particularly brain-derived neurotrophic factor (BDNF), have been implicated in the pathophysiology of ADHD and response to stimulant treatment. This review aims to investigate the relationship between BDNF levels in ADHD before and after treatment with stimulants in childhood. METHODS This systematic review followed PRISMA-P guidelines and included 19 studies from PubMed, EMBASE, Cochrane, Capes Periodic, and Lilacs databases. The studies were evaluated for risk of bias and level of evidence. RESULTS There was no significant difference in peripheral BDNF levels in ADHD children before or after methylphenidate treatment. Additionally, there was no statistically significant difference in BDNF levels between children with ADHD and controls. DISCUSSION Understanding the role of BDNF in ADHD may provide insight into the disorder's pathophysiology and facilitate the development of biological markers for clinical use. CONCLUSION Our findings suggest that BDNF levels are not significantly affected by methylphenidate treatment in ADHD children and do not differ from controls. SYSTEMATIC REVIEW REGISTRATION "Brain-derived neurotrophic factor (BDNF) levels in children and adolescents before and after stimulant use: a systematic review". Number CRD42021261519.
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Affiliation(s)
- Marina Silva de Lucca
- Department of Medicine and Nursing, Federal University of Viçosa, MG CEP 36.570 -900, Brazil; Postgraduate Program in Health Sciences at the Federal University of Minas Gerais, MG CEP 30.130-100, Brazil.
| | | | | | - Bruno David Henriques
- Department of Medicine and Nursing, Federal University of Viçosa, MG CEP 36.570 -900, Brazil
| | - Tiago Ricardo Moreira
- Department of Medicine and Nursing, Federal University of Viçosa, MG CEP 36.570 -900, Brazil
| | - Sílvia Almeida Cardoso
- Department of Medicine and Nursing, Federal University of Viçosa, MG CEP 36.570 -900, Brazil.
| | - Débora Marques de Miranda
- Postgraduate Program in Health Sciences at the Federal University of Minas Gerais, MG CEP 30.130-100, Brazil
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Schifano F, Vento A, Scherbaum N, Guirguis A. Stimulant and hallucinogenic novel psychoactive substances; an update. Expert Rev Clin Pharmacol 2023; 16:1109-1123. [PMID: 37968919 DOI: 10.1080/17512433.2023.2279192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/31/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION The renewed interest in considering a range of stimulants, psychedelics and dissociatives as therapeutics emphasizes the need to draft an updated overview of these drugs' clinical and pharmacological issues. AREAS COVERED The focus here was on: stimulants (e.g. amphetamines, methamphetamine, and pseudoephedrine; phenethylamines; synthetic cathinones; benzofurans; piperazines; aminoindanes; aminorex derivatives; phenmetrazine derivatives; phenidates); classical (e.g. ergolines; tryptamines; psychedelic phenethylamines), and atypical (e.g. PCP/ketamine-like dissociatives) psychedelics.Stimulant and psychedelics are associated with: a) increased central DA levels (psychedelic phenethylamines, synthetic cathinones and stimulants); b) 5-HT receptor subtypes' activation (psychedelic phenethylamines; recent tryptamine and lysergamide derivatives); and c) antagonist activity at NMDA receptors, (phencyclidine-like dissociatives). EXPERT OPINION Clinicians should be regularly informed about the range of NPS and their medical, psychobiological and psychopathological risks both in the acute and long term. Future research should focus on an integrative model in which pro-drug websites' analyses are combined with advanced research approaches, including computational chemistry studies so that in vitro and in vivo preclinical studies of index novel psychoactives can be organized. The future of psychedelic research should focus on identifying robust study designs to convincingly assess the potential therapeutic benefits of psychedelics, molecules likely to present with limited dependence liability levels.
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Affiliation(s)
- F Schifano
- Psychopharmacology Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Herts (UK)
| | - A Vento
- Mental Health Department, Addiction Observatory (Osservatorio sulle dipendenze)- NonProfit Association - Rome, Rome, Italy
| | - N Scherbaum
- LVR-University Hospital, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - A Guirguis
- Psychopharmacology Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Herts (UK)
- Pharmacy, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Wales, UK
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Jones AA, Shearer RD, Segel JE, Santos-Lozada A, Strong-Jones S, Vest N, Teixeira da Silva D, Khatri UG, Winkelman TNA. Opioid and stimulant attributed treatment admissions and fatal overdoses: Using national surveillance data to examine the intersection of race, sex, and polysubstance use, 1992-2020. Drug Alcohol Depend 2023; 249:109946. [PMID: 37354584 PMCID: PMC10375360 DOI: 10.1016/j.drugalcdep.2023.109946] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND We use national surveillance data to evaluate race/ethnicity by sex/gender differences and trends in substance use treatment admissions and overdose deaths involving opioid and stimulant use. METHODS We used data (1992-2019) from the Treatment Episode Dataset-Admissions to identify treatment admissions and the Center for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (1999-2020) to identify overdose deaths. We assessed treatment admissions and related drug overdose deaths per 100,000 adults by sex and race/ethnicity for opioid and stimulant groups: cocaine, opioid, methamphetamines, cocaine and opioid use, cocaine and methamphetamines, and opioid and methamphetamines. RESULTS We found significant variations in treatment admissions and deaths by race/ethnicity and sex/gender. Cocaine-related treatment admissions and deaths were most prevalent among Non-Hispanic Black individuals over the study years, yet lower rates were evident among individuals from other racial/ethnic groups. Notably, Non-Hispanic Black men experienced larger increases in cocaine-only admissions than men of other racial/ethnic groups between 1992 and 2019. Men had higher opioid and stimulant treatment admissions and overdose deaths than women. We observed skyrocketing methamphetamine deaths among American Indian/Native Alaskan men and women from 1992 to 2019. DISCUSSION Steep increases in overdose deaths fueled by methamphetamines among Non-Hispanic Native Americans and cocaine among Non-Hispanic Black individuals suggest a need for more effective interventions to curb stimulant use. Variations by race/ethnicity and sex/gender also suggest interventions should be developed through an intersectionality lens.
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Affiliation(s)
- A A Jones
- Department of Human Development and Family Studies and Family Studies, The Pennsylvania State University, University Park, PA16801, USA; Consortium for Substance Use and Addiction, The Pennsylvania State University, University Park, PA16801, USA.
| | - R D Shearer
- Department of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - J E Segel
- Consortium for Substance Use and Addiction, The Pennsylvania State University, University Park, PA16801, USA; Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA16801, USA; Department of Public Health Sciences, The Pennsylvania State University, University Park, PA16801, USA
| | - A Santos-Lozada
- Department of Human Development and Family Studies and Family Studies, The Pennsylvania State University, University Park, PA16801, USA
| | - S Strong-Jones
- Department of Human Development and Family Studies and Family Studies, The Pennsylvania State University, University Park, PA16801, USA
| | - N Vest
- Department of Community and Health Sciences, School of Public Health, Boston University, Boston, MA02118, USA
| | - D Teixeira da Silva
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA, USA
| | - U G Khatri
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - T N A Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN 55415, USA; Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN 55415, USA
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Jean FAM, Moulin F, Schwartz AN, Castel L, Montagni I, Macalli M, Notredame CE, Côté SM, Galéra C. Association between ADHD symptoms and illicit stimulants use following 1 year among French university students of the i-Share cohort. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02499-9. [PMID: 37268785 DOI: 10.1007/s00127-023-02499-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 05/24/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE Although attention deficit hyperactivity disorder (ADHD) has been associated with illicit stimulants use, less is known about their prospective association in university students. We aimed to examine the association between ADHD symptoms at inclusion and illicit stimulants use following 1 year among university students. METHODS The i-Share cohort recruited French students from February 2013 to July 2020. The study included 4270 participants. The Adult ADHD Self-Report Scale (ASRS) was used to evaluate ADHD symptoms at inclusion. Illicit stimulants use was assessed at inclusion and 1 year after inclusion. Multivariable logistic regressions were conducted to assess the association between ADHD symptoms at inclusion and illicit stimulants use following 1 year. RESULTS High levels of ADHD symptoms at inclusion were associated with a greater probability of illicit stimulants use following 1 year (adjusted OR: 2.42 (1.51-3.8)). The adjusted odds ratio was 2.7 (1.08-7.84) among participants who had used illicit stimulant at least once (continuation) and 2.25 (1.04-4.37) among participants who had never used illicit stimulants at inclusion (initiation). CONCLUSION High levels of ADHD symptoms are a feature that may promote both initiation and continuation of illicit stimulants use among university students. Our findings suggest that university students with high levels of ADHD symptoms may benefit from screening to help identify those at risk of illicit stimulants use.
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Affiliation(s)
- François A M Jean
- Department of Psychiatry, Dr Jean Eric Techer Hospital, Calais, France
- University of Bordeaux, Bordeaux, France
- Bordeaux Population Heltch Research Center, UMR1219, HEALTHY Team, National Institute of Health and Medical Research (Institut National de La Santé Et de La Recherche Médicale-INSERM), Bordeaux, France
| | - Flore Moulin
- University of Bordeaux, Bordeaux, France
- Bordeaux Population Heltch Research Center, UMR1219, HEALTHY Team, National Institute of Health and Medical Research (Institut National de La Santé Et de La Recherche Médicale-INSERM), Bordeaux, France
| | - Ashlyn N Schwartz
- University of Bordeaux, Bordeaux, France
- Bordeaux Population Heltch Research Center, UMR1219, HEALTHY Team, National Institute of Health and Medical Research (Institut National de La Santé Et de La Recherche Médicale-INSERM), Bordeaux, France
- Department of Public Health, University of Tennessee, Knoxville, USA
| | - Laura Castel
- University of Bordeaux, Bordeaux, France
- Bordeaux Population Heltch Research Center, UMR1219, HEALTHY Team, National Institute of Health and Medical Research (Institut National de La Santé Et de La Recherche Médicale-INSERM), Bordeaux, France
| | - Ilaria Montagni
- University of Bordeaux, Bordeaux, France
- Bordeaux Population Heltch Research Center, UMR1219, HEALTHY Team, National Institute of Health and Medical Research (Institut National de La Santé Et de La Recherche Médicale-INSERM), Bordeaux, France
| | - Mélissa Macalli
- University of Bordeaux, Bordeaux, France
- Bordeaux Population Heltch Research Center, UMR1219, HEALTHY Team, National Institute of Health and Medical Research (Institut National de La Santé Et de La Recherche Médicale-INSERM), Bordeaux, France
| | - Charles-Edouard Notredame
- University of Lille, Lille, France
- PSY Lab, Lille Neuroscience & Cognition Centre, INSERM U1172, National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale-INSERM), Lille, France
- Teaching Hospital of Lille (Centre Hospitalier Universitaire de Lille-CHU de Lille), Lille, France
| | - Sylvana M Côté
- University of Bordeaux, Bordeaux, France
- Bordeaux Population Heltch Research Center, UMR1219, HEALTHY Team, National Institute of Health and Medical Research (Institut National de La Santé Et de La Recherche Médicale-INSERM), Bordeaux, France
- University of Montreal, Montreal, Canada
| | - Cédric Galéra
- University of Bordeaux, Bordeaux, France.
- Bordeaux Population Heltch Research Center, UMR1219, HEALTHY Team, National Institute of Health and Medical Research (Institut National de La Santé Et de La Recherche Médicale-INSERM), Bordeaux, France.
- Charles Perrens Hospital, Bordeaux, France.
- Pôle Universitaire de Psychiatrie de L'enfant et de L'adolescent, Centre Hospitalier Charles-Perrens, 146Bis, rue Léo-Saignat, 33076, Bordeaux, France.
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Macmadu A, Banks AJ, Hallowell BD, Scagos RP, Hadland SE, Chambers LC, Marshall BDL. Receipt of Prescription Psycho stimulants and Stimulant-Involved Fatal Overdose: A Population-Based Case-Control Study. Subst Use Misuse 2023; 58:1163-1167. [PMID: 37170622 DOI: 10.1080/10826084.2023.2212037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background: Rates of psychostimulant use, misuse, and hospitalization have increased markedly over the past decade. The objective of this study was to estimate the association between receipt of a psychostimulant prescription in the past year and fatal, unintentional psychostimulant-involved overdose. Methods: We conducted a population-based case-control study using linked, state-level databases from the Rhode Island Department of Health. Cases were defined as Rhode Island residents who experienced a fatal, unintentional drug overdose involving a psychostimulant, and controls included non-psychostimulant involved fatal overdoses occurring between May 1, 2017 and May 31, 2020 The primary exposure of interest was receipt of a psychostimulant prescription within 12 months prior to death, ascertained through linkage to the state's prescription drug monitoring program. Conditional logistic regression was used to estimate unadjusted and adjusted odds ratios. Results: Of 894 eligible overdose fatalities, the majority were white/non-Hispanic (72%), mean age was 43 years, and most resided in Providence County (69%). A total of 39 (4%) involved a psychostimulant. After adjusting for year of death and matching by sex, age, and county of residence, cases had 4.1 (95% confidence interval: 1.6, 10.6) times the odds of receiving a prescription stimulant in the past year compared to controls. Conclusions: Our findings suggest that there is a strong, positive association between prescription psychostimulant receipt and psychostimulant-involved fatal overdose. In response to an evolving polysubstance use landscape, current harm reductions measures, including naloxone training, fentanyl test strip distribution, and overdose education, should be expanded to include patients who receive psychostimulant prescriptions.
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Affiliation(s)
| | - Alexandra J Banks
- Brown University School of Public Health, Providence, Rhode Island, USA
| | | | - Rachel P Scagos
- Rhode Island Department of Health, Providence, Rhode Island, USA
| | - Scott E Hadland
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Laura C Chambers
- Rhode Island Department of Health, Providence, Rhode Island, USA
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Smith KE, Rogers JM, Feldman JD. Kratom's Emergence and Persistence Within the US Polydrug Epidemic. Curr Addict Rep 2023; 10:262-271. [PMID: 37266191 PMCID: PMC10111073 DOI: 10.1007/s40429-023-00476-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 06/03/2023]
Abstract
Purpose of Review Use of "kratom" products, derived from the bioactive botanical Mitragyna speciosa have increased amidst US polydrug use epidemics. Kratom alkaloids interact with opioid, serotonergic, adrenergic, and other receptors and regular users have described experiencing a wide range of effects. Some with polydrug use histories have reported using kratom as a substitute for other drugs or to nonmedically self-manage substance use disorder (SUD) symptoms. Data describing this remain scare and come from self-report. We review this literature describing kratom use as a drug substitute, or as a nonmedical "self-treatment" for attenuating dependence or SUD symptoms. Recent Findings Kratom products have been documented as being used as a licit and illicit opioid substitute. Use to reduce alcohol or stimulant consumption is less well documented. Although prior and current polydrug use appear common among a some kratom users, it is unclear if co-use is contemporaneous or concomitant. Temporal order of use initiation is typically undocumented. Use for energy and recreation are also increasingly reported. Summary Data on kratom consumption come primarily from self-report with significant limitations. Until controlled human laboratory studies have been conducted, we can presently only describe what is known about human kratom use based on self-report. Such data describe real-world kratom use, leaving unaddressed human abuse liability or therapeutic potential of kratom alkaloids. Clinicians should be mindful of use motivations among people with SUD histories, sensitively assessing use. The paucity of data highlights the urgent need to increase funding and research for understanding kratom's effects in humans.
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Affiliation(s)
- Kirsten Elin Smith
- Real-world Assessment, Prediction, and Treatment Unit, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, 251 Bayview Blvd., Suite 200, Room 01B340, Baltimore, MD 21224 USA
| | - Jeffrey M. Rogers
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA USA
| | - Jeffrey D. Feldman
- Real-world Assessment, Prediction, and Treatment Unit, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, 251 Bayview Blvd., Suite 200, Room 01B340, Baltimore, MD 21224 USA
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Ziv-Baran T, Zacay G, Modan-Moses D, Reingold SM, Mekori E, Levy-Shraga Y. Increased fracture risk among children diagnosed with attention- deficit/hyperactivity disorder: a large matched cohort study. Eur J Pediatr 2023:10.1007/s00431-023-04929-x. [PMID: 37004585 DOI: 10.1007/s00431-023-04929-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 04/04/2023]
Abstract
To analyse the risk of fractures among children with attention-deficit/hyperactivity disorder (ADHD) compared with matched children without ADHD; and to evaluate the impact of pharmacological treatment. This registry-based cohort study included 31,330 children diagnosed with ADHD and a comparison group of 62,660 children matched by age, sex, population sector and socioeconomic status. Demographic and clinical information was extracted from the electronic database of Meuhedet, a health maintenance organization. Fracture events between 2-18 years of age were identified by coded diagnoses. The overall fracture incidence rate was 334 per 10,000 patient-years (PY) in the ADHD group and 284 per 10,000 PY in the comparison group (p < 0.001). Among boys, the fracture incidence rates were 388 per 10,000 PY and 327 per 10,000 PY (p < 0.001), for the respective groups. Among girls, the rates were lower in both groups compared to boys, but higher in the ADHD compared to the matched group (246 vs 203 per 10,000 PY, p < 0.001). Among the children with ADHD, the hazard ratios (HR) to have a fracture were similar in boys (1.18, 95%CI 1.15-1.22, p < 0.001) and girls (1.22, 95%CI 1.16-1.28, p < 0.001). Children with ADHD were also at increased risk for two and three fractures; the hazard ratios (HRs) were 1.32 (95%CI 1.26-1.38, p < 0.001) and 1.35 (95%CI 1.24-1.46, p < 0.001), respectively. In a multivariable model of the children with ADHD, pharmacological treatment was associated with reduced fracture risk (HR 0.90, 95%CI 0.82-0.98, p < 0.001) after adjustment for sex, resident socioeconomic status and population sector. Conclusion: Children with ADHD had greater fracture risk than a matched group without ADHD. Pharmacological treatment for ADHD may decrease this risk. What is Known: • Children with attention-deficit/hyperactivity disorder (ADHD) may be more prone to injuries and fractures than children without ADHD. What is New: • Children with ADHD were 1.2 times more likely to have a fracture than children with similar characteristics, without ADHD. The increased risk for fractures was even greater for two and three fractures (hazard ratios 1.32 and 1.35, respectively). • Our study suggests a positive effect of pharmacological treatment for ADHD in reducing fracture risk.
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Affiliation(s)
- Tomer Ziv-Baran
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galia Zacay
- Meuhedet Health Services, Tel Aviv, Israel
- Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Dalit Modan-Moses
- Meuhedet Health Services, Tel Aviv, Israel
- Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Childrens Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Stephen M Reingold
- Meuhedet Health Services, Tel Aviv, Israel
- Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Ehud Mekori
- Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
- Child and Adolescent Psychiatry Division, The Edmond and Lily Safra Childrens Hospital, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Israel
| | - Yael Levy-Shraga
- Meuhedet Health Services, Tel Aviv, Israel.
- Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel.
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Childrens Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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Glidden E, Suen K, Mustaquim D, Vivolo-Kantor A, Brent J, Wax P, Aldy K. Characterization of Nonfatal Opioid, Cocaine, Methamphetamine, and Polydrug Exposure and Clinical Presentations Reported to the Toxicology Investigators Consortium Core Registry, January 2010-December 2021. J Med Toxicol 2023; 19:180-189. [PMID: 36650409 PMCID: PMC10050626 DOI: 10.1007/s13181-022-00924-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/22/2022] [Accepted: 12/08/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION To characterize and compare opioid-only, cocaine-only, methamphetamine-only, opioid-and-cocaine exposure, and opioid-and-methamphetamine exposure and to examine clinical presentations, leading to a better understanding of overdose effects involving these drug exposures. METHODS We examined drug exposures in the Toxicology Investigators Consortium (ToxIC) Core Registry from January 2010 to December 2021, a case registry of patients presenting to participating healthcare sites that receive a medical toxicology consultation. Demographic and clinical presentations of opioid-only, cocaine-only, methamphetamine-only, and opioid-and-cocaine exposure, and opioid-and-methamphetamine exposure consultations were described; differences between single and polydrug exposure subgroups were calculated to determine statistical significance. Clinical presentations associated with exposures were evaluated through calculated adjusted relative risk. RESULTS A total of 3,883 consultations involved opioids, cocaine, methamphetamine, opioid-and-cocaine exposure, or opioid-and-methamphetamine exposure. Opioid-only (n = 2,268, 58.4%) and methamphetamine-only (n = 712, 18.3%) comprised most consultations. There were significant differences in clinical presentations between exposure subgroups. Opioid-and-cocaine exposure consultations were 8.15 times as likely to present with a sympathomimetic toxidrome than opioid-only. Conversely, opioid-and-cocaine exposure and opioid-and-methamphetamine exposure were 0.32 and 0.42 times as likely to present with a sympathomimetic toxidrome compared to cocaine-only and methamphetamine-only consultations, respectively. Opioid-and-cocaine exposure was 0.67 and opioid-and-methamphetamine exposure was 0.74 times as likely to present with respiratory depression compared to opioid-only consultations. Similarly, opioid-and-cocaine exposure was 0.71 and opioid-and-methamphetamine exposure was 0.78 times as likely to present with CNS depression compared to opioid-only consultations. CONCLUSIONS Used in combination, opioids and stimulants may mask typical clinical presentations of one another, misattributing incorrect drugs to overdose in both clinical treatment and public health surveillance.
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Affiliation(s)
- Emily Glidden
- National Network of Public Health Institutes, New Orleans, LA USA
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Kyle Suen
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA USA
- Department of Emergency Medicine, Division of Medical Toxicology, Emory School of Medicine, Atlanta, GA USA
| | - Desiree Mustaquim
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Alana Vivolo-Kantor
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Jeffery Brent
- University of Colorado School of Medicine, Aurora, CO USA
| | - Paul Wax
- University of Texas Southwestern Medical Center, Dallas, TX USA
- American College of Medical Toxicology, Phoenix, AZ USA
| | - Kim Aldy
- University of Texas Southwestern Medical Center, Dallas, TX USA
- American College of Medical Toxicology, Phoenix, AZ USA
| | - On behalf of the Toxicology Investigators Consortium (ToxIC) Study Group
- National Network of Public Health Institutes, New Orleans, LA USA
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA USA
- Department of Emergency Medicine, Division of Medical Toxicology, Emory School of Medicine, Atlanta, GA USA
- University of Colorado School of Medicine, Aurora, CO USA
- University of Texas Southwestern Medical Center, Dallas, TX USA
- American College of Medical Toxicology, Phoenix, AZ USA
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Breland H, Larkins S, Antonini V, Freese T, McGovern M, Dunn J, Rawson R. Stimulant use among patients in opioid treatment settings: Provider perspectives. J Subst Use Addict Treat 2023:209012. [PMID: 36931604 DOI: 10.1016/j.josat.2023.209012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 01/20/2023] [Accepted: 03/05/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION Methadone maintenance therapy (MMT) has been a pillar of opioid addiction treatment. Opioid treatment programs (OTPs) have been faced with an escalating threat of stimulant use and related overdose deaths among patients. We know little about how providers currently address stimulant use while maintaining treatment for opioid use disorder. METHODS We conducted 5 focus groups with 36 providers (n = 11 prescribers; 25 behavioral health staff), and collected an additional 46 surveys (n = 7 prescribers; 12 administrators; 27 behavioral health staff). Questions focused on perceptions of patient stimulant use and interventions. We applied inductive analysis to identify themes relevant to identification of stimulant use, use trends, intervention approaches, and perceived needs to improve care. RESULTS Providers indicated a trend of rising stimulant use among patients, especially those experiencing homelessness or comorbid health conditions. They reported a range of approaches to patient screening and intervention, including medication and harm reduction, improving treatment engagement, increasing level of care, and providing incentives. Providers expressed less agreement as to which of these interventions were effective, and though providers saw stimulant use as a common and severe problem, they reported little problem recognition and interest in treatment from their patients. A particular concern of providers was the prevalence and danger of synthetic opioids, such as fentanyl. They sought more research and resources to identify effective interventions and medications to address these issues. Also notable was an interest in contingency management (CM) and use of reinforcements/rewards to encourage stimulant use reduction. CONCLUSION Providers face challenges in treating patients who use both opioids and stimulants. Although methadone is available to treat opioid use, no such "silver bullet" exists for stimulant use disorder. The rise in stimulant and synthetic opioid (e.g., fentanyl) combination products is presenting an extraordinary challenge for providers whose patients are at unprecedented risk for overdose. Providing OTPs with more resources to address polysubstance use is critical. Existing research indicates strong support for CM in OTPs, but providers reported regulatory and financial barriers to implementation. Further research should develop effective interventions that are accessible to providers in OTPs.
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Affiliation(s)
- Haley Breland
- Integrated Substance Abuse Programs, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sherry Larkins
- Integrated Substance Abuse Programs, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Valerie Antonini
- Integrated Substance Abuse Programs, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Thomas Freese
- Integrated Substance Abuse Programs, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Mark McGovern
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Julia Dunn
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Richard Rawson
- Integrated Substance Abuse Programs, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Vilca SJ, Margetts AV, Pollock TA, Tuesta LM. Transcriptional and epigenetic regulation of microglia in substance use disorders. Mol Cell Neurosci 2023; 125:103838. [PMID: 36893849 DOI: 10.1016/j.mcn.2023.103838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
Microglia are widely known for their role in immune surveillance and for their ability to refine neurocircuitry during development, but a growing body of evidence suggests that microglia may also play a complementary role to neurons in regulating the behavioral aspects of substance use disorders. While many of these efforts have focused on changes in microglial gene expression associated with drug-taking, epigenetic regulation of these changes has yet to be fully understood. This review provides recent evidence supporting the role of microglia in various aspects of substance use disorder, with particular focus on changes to the microglial transcriptome and the potential epigenetic mechanisms driving these changes. Further, this review discusses the latest technical advances in low-input chromatin profiling and highlights the current challenges for studying these novel molecular mechanisms in microglia.
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Affiliation(s)
- Samara J Vilca
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, United States of America; Center for Therapeutic Innovation, University of Miami Miller School of Medicine, Miami, FL 33136, United States of America
| | - Alexander V Margetts
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, United States of America; Center for Therapeutic Innovation, University of Miami Miller School of Medicine, Miami, FL 33136, United States of America; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, United States of America
| | - Tate A Pollock
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, United States of America; Center for Therapeutic Innovation, University of Miami Miller School of Medicine, Miami, FL 33136, United States of America
| | - Luis M Tuesta
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, United States of America; Center for Therapeutic Innovation, University of Miami Miller School of Medicine, Miami, FL 33136, United States of America; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, United States of America.
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Majarwitz DJ, Perumareddi P. Attention-Deficit/Hyperactivity Disorder Across the Spectrum: From Childhood to Adulthood. Prim Care 2023; 50:21-36. [PMID: 36822725 DOI: 10.1016/j.pop.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Attention-deficit hyperactivity disorder is a neurodevelopmental disorder involving dysregulation of multiple neural circuits, manifesting in symptoms such as inattention, impulsivity, and hyperactivity. Diagnosis requires onset of symptoms before age 12 years. However, symptoms often persist throughout lifetime, although they may change over time. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition formally lists the clinical criteria. Management involves pharmacologic agents, such as stimulant and/or nonstimulant medications, and providers should monitor closely for any adverse effects. Nonpharmacologic interventions may be implemented and can be used in conjunction with pharmacotherapy, although medications should be at the forefront of treatment.
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Affiliation(s)
- Daniel J Majarwitz
- Department of Psychiatry and Behavioral Medicine, East Carolina University, 905 Johns Hopkins Dr, Greenville, NC 27834, USA
| | - Parvathi Perumareddi
- Department of Medicine, Schmidt College of Medicine at Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431, USA.
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Bray BC, Watson DP, Salisbury-Afshar E, Taylor L, McGuire A. Patterns of opioid use behaviors among patients seen in the emergency department: Latent class analysis of baseline data from the POINT pragmatic trial. J Subst Use Addict Treat 2023; 146:208979. [PMID: 36880900 PMCID: PMC9992925 DOI: 10.1016/j.josat.2023.208979] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/09/2022] [Accepted: 02/05/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION The nation's overdose epidemic has been characterized by increasingly potent opioids resulting in more emergency department (ED) encounters over time. ED-based opioid use interventions are growing in popularity; however, they tend to treat people who use opioids as a homogenous population. The current study sought to understand heterogeneity among people who use opioids who encounter the ED by identifying qualitatively different subgroups among participants in an opioid use intervention clinical trial at baseline and examining associations between subgroup membership and multiple correlates. METHODS Participants were from a larger pragmatic clinical trial of the Planned Outreach, Intervention, Naloxone, and Treatment (POINT) intervention (n = 212; 59.2 % male, 85.3 % Non-Hispanic White, mean age = 36.6 years). The study employed latent class analysis (LCA) using five indicators of opioid use behavior: preference for opioids, preference for stimulants, usually use drugs alone, injection drug use, and opioid-related problem at ED encounter. Correlates of interest included participants' demographics, prescription histories, health care contact histories, and recovery capital (e.g., social support, naloxone knowledge). RESULTS The study identified three classes: (1) noninjecting opioid preferers, (2) injecting opioid and stimulant preferers, and (3) social nonopioid preferers. We identified limited significant differences in correlates across the classes: differences existed for select demographics, prescription histories, and recovery capital but not for health care contact histories. For example, members of Class 1 were the most likely to be a race/ethnicity other than non-Hispanic White, oldest on average, and most likely to have received a benzodiazepine prescription, whereas members of Class 2 had the highest average barriers to treatment and members of Class 3 were the least likely to have been diagnosed with a major mental health illness and had the lowest average barriers to treatment. CONCLUSIONS LCA identified distinct subgroups among POINT trial participants. Knowledge of such subgroups assists with the development of better-targeted interventions and can help staff to identify the most appropriate treatment and recovery pathways for patients.
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Affiliation(s)
- Bethany C Bray
- Institute for Health Research and Policy, The University of Illinois at Chicago, 1747 W Roosevelt Road, Chicago, IL 60608, United States.
| | - Dennis P Watson
- Chestnut Health Systems, Lighthouse Institute, 221 W Walton Street, Chicago, IL 60610, United States.
| | - Elizabeth Salisbury-Afshar
- Department of Family Medicine and Community Health, University of Wisconsin Madison School of Medicine and Public Health, 1100 Delaplaine Court, Room 3835, Madison, WI 53715, United States.
| | - Lisa Taylor
- Chestnut Health Systems, Lighthouse Institute, 221 W Walton Street, Chicago, IL 60610, United States; Jane Addams School of Social Work, The University of Illinois at Chicago, 1040 W Harrison Street, Chicago, IL 60607, United States
| | - Alan McGuire
- Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, Indianapolis, IN 46202, United States; Center for Health Information and Communication, Health Services Research and Development, Richard L. Roudebush Veterans Affairs Medical Center, 1481 W 10th Street, Indianapolis, IN 46202, United States; Department of Psychology, School of Science, Indiana University Purdue University Indianapolis, 402 N Blackford Dr., Indianapolis, IN 46202, United States.
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Cook RR, Foot C, Arah OA, Humphreys K, Rudolph KE, Luo SX, Tsui JI, Levander XA, Korthuis PT. Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations. Addict Sci Clin Pract 2023; 18:11. [PMID: 36788634 PMCID: PMC9930351 DOI: 10.1186/s13722-023-00364-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Co-use of stimulants and opioids is rapidly increasing. Randomized clinical trials (RCTs) have established the efficacy of medications for opioid use disorder (MOUD), but stimulant use may decrease the likelihood of initiating MOUD treatment. Furthermore, trial participants may not represent "real-world" populations who would benefit from treatment. METHODS We conducted a two-stage analysis. First, associations between stimulant use (time-varying urine drug screens for cocaine, methamphetamine, or amphetamines) and initiation of buprenorphine or extended-release naltrexone (XR-NTX) were estimated across two RCTs (CTN-0051 X:BOT and CTN-0067 CHOICES) using adjusted Cox regression models. Second, results were generalized to three target populations who would benefit from MOUD: Housed adults identifying the need for OUD treatment, as characterized by the National Survey on Drug Use and Health (NSDUH); adults entering OUD treatment, as characterized by Treatment Episodes Dataset (TEDS); and adults living in rural regions of the U.S. with high rates of injection drug use, as characterized by the Rural Opioids Initiative (ROI). Generalizability analyses adjusted for differences in demographic characteristics, substance use, housing status, and depression between RCT and target populations using inverse probability of selection weighting. RESULTS Analyses included 673 clinical trial participants, 139 NSDUH respondents (weighted to represent 661,650 people), 71,751 TEDS treatment episodes, and 1,933 ROI participants. The majority were aged 30-49 years, male, and non-Hispanic White. In RCTs, stimulant use reduced the likelihood of MOUD initiation by 32% (adjusted HR [aHR] = 0.68, 95% CI 0.49-0.94, p = 0.019). Stimulant use associations were slightly attenuated and non-significant among housed adults needing treatment (25% reduction, aHR = 0.75, 0.48-1.18, p = 0.215) and adults entering OUD treatment (28% reduction, aHR = 0.72, 0.51-1.01, p = 0.061). The association was more pronounced, but still non-significant among rural people injecting drugs (39% reduction, aHR = 0.61, 0.35-1.06, p = 0.081). Stimulant use had a larger negative impact on XR-NTX initiation compared to buprenorphine, especially in the rural population (76% reduction, aHR = 0.24, 0.08-0.69, p = 0.008). CONCLUSIONS Stimulant use is a barrier to buprenorphine or XR-NTX initiation in clinical trials and real-world populations that would benefit from OUD treatment. Interventions to address stimulant use among patients with OUD are urgently needed, especially among rural people injecting drugs, who already suffer from limited access to MOUD.
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Affiliation(s)
- R R Cook
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Sam Jackson Hall, Suite 3370, 3245 SW Pavilion Loop, Portland, OR, 97239, USA.
| | - C Foot
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Sam Jackson Hall, Suite 3370, 3245 SW Pavilion Loop, Portland, OR, 97239, USA
| | - O A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Division of Physical Sciences, Department of Statistics, UCLA College, Los Angeles, CA, USA
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - K Humphreys
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - K E Rudolph
- Department of Epidemiology, School of Public Health, Columbia University, New York, NY, USA
| | - S X Luo
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University, New York, USA
| | - J I Tsui
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - X A Levander
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Sam Jackson Hall, Suite 3370, 3245 SW Pavilion Loop, Portland, OR, 97239, USA
| | - P T Korthuis
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Sam Jackson Hall, Suite 3370, 3245 SW Pavilion Loop, Portland, OR, 97239, USA
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StepjanoviĆ D, Hall W, Leung J. Illicit drug use and violence. Handb Clin Neurol 2023; 197:121-145. [PMID: 37633705 DOI: 10.1016/b978-0-12-821375-9.00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
This chapter reviews evidence on the relationship between illicit drug use and violence, specifically cannabis, stimulant drugs, and opioids. It summarizes findings of systematic reviews of evidence on cannabis, stimulant drugs, and opioids. It also examines evidence from epidemiological studies of drug use among violent offenders and of violence among persons who use drugs, intervention studies, animal studies, human laboratory studies, and human neuroimaging studies. More studies have examined cannabis because of its higher prevalence of use. There is an association between cannabis use and violence, suggestive evidence of a dose-response relationship between the frequency of cannabis use and violence, and a stronger association in persons with psychoses. There is similar emerging evidence on stimulant use and violence, but evidence on opioids is very limited. There is limited and mixed evidence from intervention studies that reducing drug use reduces violence. Animal and human studies provide potential biological explanations for these associations. The association between cannabis use and violence is most consistent but limited by study heterogeneity and lack of control for potential confounders. It is unclear whether these associations are causal or reflect reverse causation or the effects of confounding.
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Affiliation(s)
- Daniel StepjanoviĆ
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, QLD, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, QLD, Australia.
| | - Janni Leung
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, QLD, Australia
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Idrees I, Bellato A, Cortese S, Groom MJ. The effects of stimulant and non-stimulant medications on the autonomic nervous system (ANS) functioning in people with ADHD: A systematic review and meta-analysis. Neurosci Biobehav Rev 2023; 144:104968. [PMID: 36427764 DOI: 10.1016/j.neubiorev.2022.104968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/12/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022]
Abstract
We carried out a systematic review and meta-analysis to investigate the effects of stimulant and non-stimulant medications on autonomic functioning in people with ADHD (PROSPERO: CRD42020212439). We searched (9th August 2021) PsycInfo, MEDLINE, EMBASE, Web of Science and The Cochrane Library, for randomised and non-randomised studies reporting indices of autonomic activity, (electrodermal, pupillometry and cardiac), pre- and post-medication exposure in people meeting DSM/ICD criteria for ADHD. In the narrative syntheses, we included 5 electrodermal studies, 1 pupillometry study and 57 studies investigating heart rate and blood pressure. In the meta-analyses, 29 studies were included on blood pressure and 32 on heart rate. Administration of stimulants, and to a lesser degree, non-stimulants increased heart rate and blood pressure in people with ADHD. Similarly, an upregulation of arousal, reflected in increased electrodermal activity and pupil diameter was observed following stimulant use. Yet, the methodological diversity of studies presented in this review reinforces the need for more standardised and rigorous research to fully understand the relationship between arousal, medication, and behaviour in ADHD.
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Affiliation(s)
- Iman Idrees
- Academic Unit of Mental Health & Clinical Neurosciences, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK.
| | - Alessio Bellato
- School of Psychology, University of Nottingham Malaysia, Malaysia
| | - Samuele Cortese
- Academic Unit of Mental Health & Clinical Neurosciences, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK; Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
| | - Madeleine J Groom
- Academic Unit of Mental Health & Clinical Neurosciences, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK
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Latronica JR, Tuan WJ, Clegg TJ, Silvis ML, Bone C. Cardiovascular Outcomes Among Older Individuals With Depression Prescribed Amphetamines: A Retrospective Cohort Study. J Gerontol A Biol Sci Med Sci 2022; 77:2459-2463. [PMID: 35137053 DOI: 10.1093/gerona/glac033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Prescription amphetamines are utilized for treatment of depression in older adults, yet cardiovascular risks in this population are not well described. The purpose of this study is to evaluate risk of cardiovascular events among adults aged 65 and older with depression who were prescribed amphetamines. METHODS We conducted a retrospective matched cohort study utilizing the TriNetx database and statistical software. The 1:1 propensity score matching technique was performed using logistic regression to balance the baseline characteristics of the population. Inclusion criteria were a diagnosis of depression and age 65 years and older. We excluded individuals with an adverse cardiovascular event or diagnosis of attention deficit and hyperactivity disorder prior to enrollment. Individuals were followed from January 1, 2018 to December 31, 2020. Those prescribed an amphetamine were considered exposed and others served as controls. We used descriptive statistics and calculated risk ratios to assess the relationship between amphetamine prescriptions and cardiovascular events in these cohorts. RESULTS There were 4 434 included in the exposed cohort and 4 434 matched controls in the unexposed group. The cohort exposed to amphetamines had higher high-density lipoprotein along with lower low-density lipoprotein, total cholesterol, hemoglobin A1C, systolic blood pressure, and body mass index than the control group, but increased risk of cardiovascular events (risk ratio: 8.9; 95% confidence interval: 6.39, 12.48). CONCLUSIONS Amphetamines offer potential benefits to people with depression; however, these data suggest increased risk of cardiovascular events among older individuals. Additional research is warranted to fully characterize risk among subpopulations of older adults and inform patient-provider decision making.
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Affiliation(s)
- James R Latronica
- Department of Psychiatry and Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Wen Jan Tuan
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Taylor J Clegg
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Matthew L Silvis
- Penn State Milton S. Hershey Medical Center, Department of Family and Community Medicine; Department of Orthopedics and Rehabilitation, Hershey, Pennsylvania, USA
| | - Curtis Bone
- Penn State Milton S. Hershey Medical Center, Department of Family and Community Medicine, Hershey, Pennsylvania, USA
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Shearer RD, Jones A, Howell BA, Segel JE, Winkelman TNA. Associations between prescription and illicit stimulant and opioid use in the United States, 2015-2020. J Subst Abuse Treat 2022; 143:108894. [PMID: 36206585 PMCID: PMC9706463 DOI: 10.1016/j.jsat.2022.108894] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/09/2022] [Accepted: 09/23/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Overdose deaths involving opioids and stimulants continue to reach unprecedented levels in the United States. Although significant attention has been paid to the relationship between prescription and illicit opioid use, little work has focused on the association between prescription and illicit stimulant use. Thus, this study explores characteristics of those who use or misuse prescription stimulants and/or opioids and associations with use of cocaine, methamphetamine, and heroin. METHODS We used 2015-2020 data from the National Survey on Drug Use and Health. Using adjusted multivariable logistic regression, we estimated the associations between past year prescription stimulant or prescription opioid prescribed use and misuse; various demographic characteristics; and past-year cocaine, methamphetamine, or heroin use. RESULTS From 2015 to 2020, 4.9 and 9.8 million US adults annually reported misusing prescription stimulants and opioids, respectively. Individuals who misused prescription stimulants were more likely to be ages 18-25 (45.8 %; 95 % CI: 44.0-47.5) than individuals who misused prescription opioids (21.7 %; 95 % CI: 20.7-22.7). We observed higher rates of cocaine use among individuals reporting prescription stimulant misuse (12.0 %; 95 % CI: 11.0-12.9) compared to those reporting prescription opioid misuse (5.7 %; 95 % CI: 5.1-6.3, p < 0.001). Heroin use was more common among individuals with prescription opioid misuse (2.1 %; 95 % CI: 1.7-2.2) than prescription stimulant misuse (0.6 %; 95 % CI: 0.4-0.7, p < 0.001). However, rates of methamphetamine use among individuals with prescription stimulant misuse (2.4 %; 95 % CI: 1.9-3.0) did not differ from individuals with prescription opioid misuse (2.1 %; 95 % CI: 1.7-2.5, p = 0.67). CONCLUSIONS Prescription stimulant misuse, compared to prescription opioid misuse, was associated with higher levels of cocaine use but not methamphetamine use. Treatment providers should consider screening for other substance use disorders among people who report prescription stimulant use or misuse. Additional research should seek to understand the mechanism underlying the different associations between prescription stimulant misuse and cocaine or methamphetamine use.
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Affiliation(s)
- Riley D Shearer
- University of Minnesota School of Public Health, 420 Delaware St SE, Mayo Building B681, Minneapolis, MN 55455, USA; Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN 55415, USA.
| | - Abenaa Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Benjamin A Howell
- SEICHE Center for Health & Justice, Yale School of Medicine, 333 Cedar St, New Haven 06510, USA; Section of General Internal Medicine, Yale School of Medicine, PO Box 208025, New Haven, CT 06520, USA
| | - Joel E Segel
- Department of Health Policy and Administration, Penn State University, University Park, PA, USA; Penn State Cancer Institute, Penn State College of Medicine, Hershey, PA, USA
| | - Tyler N A Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN 55415, USA; Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, 716 S 7th St, Minneapolis, MN 55415, USA
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