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Furulund E, Druckrey-Fiskaaen KT, Carlsen SEL, Madebo T, Fadnes LT, Lid TG. Healthy eating among people on opioid agonist therapy: a qualitative study of patients' experiences and perspectives. BMC Nutr 2024; 10:70. [PMID: 38705977 DOI: 10.1186/s40795-024-00880-8] [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: 02/19/2024] [Accepted: 04/30/2024] [Indexed: 05/07/2024] Open
Abstract
People with substance use disorders often have unhealthy diets, high in sweets and processed foods but low in nutritious items like fruits and vegetables, increasing noncommunicable disease risks. This study investigates healthy eating perceptions and barriers among individuals with opioid use disorder undergoing opioid agonist therapy. Interviews with 14 participants at opioid agonist therapy clinics in Western Norway, using a semi-structured guide and systematic text condensation for analysis, reveal that most participants view their diet as inadequate and express a desire to improve for better health. Barriers to healthy eating included oral health problems, smoking habits, and limited social relations, while economic factors were less of a concern for the participants. Participants did find healthy eating easier when they were in social settings. This study underscores the importance of understanding and addressing these barriers and facilitators to foster healthier eating patterns in this population, potentially enhancing overall health and well-being.
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Affiliation(s)
- Einar Furulund
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway.
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Karl Trygve Druckrey-Fiskaaen
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Siv-Elin Leirvåg Carlsen
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Tesfaye Madebo
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Respiratory Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Lars T Fadnes
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Torgeir Gilje Lid
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
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Franz B, Cronin CE, Lindenfeld Z, Pagan JA, Lai AY, Krawczyk N, Rivera BD, Chang JE. Rural-urban disparities in the availability of hospital-based screening, medications for opioid use disorder, and addiction consult services. J Subst Use Addict Treat 2024; 160:209280. [PMID: 38142042 PMCID: PMC11060933 DOI: 10.1016/j.josat.2023.209280] [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: 07/29/2023] [Revised: 10/07/2023] [Accepted: 12/15/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Hospitals are an ideal setting to stage opioid-related interventions with patients who are hospitalized due to overdose or other substance use-related complications. Transitional opioid programs-which initiate care and provide linkages upon discharge, such as screening, initiation of medications for opioid use disorder, and addiction consult services-have become the gold standard, but implementation has been uneven. The purpose of this study was to assess disparities in the availability of hospital-based transitional opioid programs, across rural and urban hospital settings in the United States. METHODS Using hospital administrative data paired with county-level demographic data, we conducted bivariate and regression analyses to assess rural-urban differences in the availability of transitional opioid services including screening, addiction consult services, and MOUD in U.S general medical centers, controlling for hospital- and community-level factors. Our sample included 2846 general medical hospitals that completed the 2021 American Hospital Association (AHA) Annual Survey of Hospitals. Our primary outcomes were five self-reported measures: whether the hospital provided screening in the ED; provided screening in the inpatient setting; whether the hospital provided addiction consult services in the ED; provided addiction consult services in the inpatient setting; and whether the hospital provided medications for opioid use disorder. RESULTS Rural hospitals did not have lower odds of screening for OUD or other SUDs than urban hospitals, but both micropolitan rural counties and noncore rural counties had significantly lower odds of having addiction consult services in either the ED (OR: 0.74, 95 % CI: 0.58, 0.95; OR: 0.68, 95 % CI: 0.50, 0.91) or inpatient setting (OR: 0.76, 95 % CI: 0.59, 0.97; OR: 0.68, 95 % CI: 0.50, 0.93), respectively, or of offering MOUD (OR: 0.69, 95 % CI: 0.52, 0.90; OR: 0.52, 95 % CI: 0.37, 0.74). CONCLUSIONS Our study suggests that evidence-based interventions, such as medications for opioid use disorder and addiction consult services, are less often available in rural hospitals, which may contribute to rural-urban disparities in health outcomes secondary to OUD. A priority for population health improvement should be developing implementation strategies to support rural hospital adoption of transitional opioid programs.
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Affiliation(s)
- Berkeley Franz
- Ohio University Heritage College of Osteopathic Medicine, Appalachian Institute to Advance Health Equity Science (ADVANCE), United States of America.
| | - Cory E Cronin
- Ohio University College of Social and Public Health, Appalachian Institute to Advance Health Equity Science (ADVANCE), United States of America
| | - Zoe Lindenfeld
- New York University College of Global Public Health, United States of America
| | - Jose A Pagan
- New York University College of Global Public Health, United States of America
| | - Alden Yuanhong Lai
- New York University College of Global Public Health, United States of America
| | - Noa Krawczyk
- New York University Grossman School of Medicine, United States of America
| | - Bianca D Rivera
- New York University Grossman School of Medicine, United States of America
| | - Ji E Chang
- New York University College of Global Public Health, United States of America
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Rojas Bernal LA, Santamaría García H, Castaño Pérez GA. Electrophysiological biomarkers in dual pathology. Rev Colomb Psiquiatr (Engl Ed) 2024:S2530-3120(24)00019-5. [PMID: 38677941 DOI: 10.1016/j.rcpeng.2024.04.003] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/12/2022] [Indexed: 04/29/2024]
Abstract
INTRODUCTION The co-occurrence of substance use disorder with at least one other mental disorder is called dual pathology, which in turn is characterised by heterogeneous symptoms that are difficult to diagnose and have a poor response to treatment. For this reason, the identification and validation of biomarkers is necessary. Within this group, possible electroencephalographic biomarkers have been reported to be useful in diagnosis, treatment and follow-up, both in neuropsychiatric conditions and in substance use disorders. This article aims to review the existing literature on electroencephalographic biomarkers in dual pathology. METHODS A narrative review of the literature. A bibliographic search was performed on the PubMed, Science Direct, OVID, BIREME and Scielo databases, with the keywords: electrophysiological biomarker and substance use disorder, electrophysiological biomarker and mental disorders, biomarker and dual pathology, biomarker and substance use disorder, electroencephalography, and substance use disorder or comorbid mental disorder. RESULTS Given the greater amount of literature found in relation to electroencephalography as a biomarker of mental illness and substance use disorders, and the few articles found on dual pathology, the evidence is organised as a biomarker in psychiatry for the diagnosis and prediction of risk and as a biomarker for dual pathology. CONCLUSIONS Although the evidence is not conclusive, it suggests the existence of a subset of sites and mechanisms where the effects of psychoactive substances and the neurobiology of some mental disorders could overlap or interact.
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Affiliation(s)
| | - Hernando Santamaría García
- Centro de Memoria y Cognición Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia; Departamento de Psiquiatría y Fisiología, Universidad Pontificia Javeriana, Bogotá, Colombia
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Di Gennaro F, Papagni R, Segala FV, Pellegrino C, Panico GG, Frallonardo L, Diella L, Belati A, Santoro CR, Brindicci G, Balena F, Bavaro DF, Montalbò D, Guido G, Calluso L, Di Tullio M, Sgambati M, Fiordelisi D, De Gennaro N, Saracino A. Stigma and mental health among people living with HIV across the COVID-19 pandemic: a cross-sectional study. BMC Infect Dis 2024; 24:423. [PMID: 38649892 PMCID: PMC11034033 DOI: 10.1186/s12879-024-09315-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Mental health (MH) is extremely relevant when referring to people living with a chronic disease, such as people living with HIV (PLWH). In fact - although life expectancy and quality have increased since the advent of antiretroviral therapy (ART) - PLWH carry a high incidence of mental disorders, and this burden has been exacerbated during the COVID-19 pandemic. In this scenario, UNAIDS has set new objectives for 2025, such as the linkage of at least 90% of PLWH to people-centered, context-specific MH services. Aim of this study was to determine the prevalence of MD in PLWH followed at the Clinic of Infectious Diseases of the University of Bari, Italy. METHODS From January 10th to September 10th, 2022, all PLWH patients accessing our outpatient clinic were offered the following standardized tools: HAM-A for anxiety, BDI-II for depression, PC-PTSD-5 for post-traumatic stress disorder, CAGE-AID for alcohol-drug abuse. Factors associated with testing positive to the four MD were explored with a multivariable logistic regression model. RESULTS 578 out of 1110 HIV-patients agreed to receive MH screening, with 141 (24.4%) people resulting positive to at least one MH disorder. HAM-A was positive in 15.8% (n = 91), BDI-II in 18% (n = 104), PC-PTSD-5 in 5% (n = 29) and CAGE in 6.1% (n = 35). The multivariable logistic regression showed a higher probability of being diagnosed with anxiety, depression and post-traumatic stress disorder for PLWH who reported severe stigma, social isolation, psychological deterioration during the COVID-19 pandemic and for those receiving a dolutegravir (DTG)-based regimen. Moreover, history of drug use (OR 1.13; [95% CE 1.06-4.35]), family stigma (2.42 [1.65-3.94]) and social isolation (2.72 [1.55;4.84]) were found to be associated to higher risk for substance use disorder. CONCLUSIONS In this study, stigma was a strong predictor for being diagnosed of a MH disorder among PLWH. Also, the possible role of dolutegravir as a risk factor for the onset of MH disorders should be considered in clinical practice, and MH of patients receiving DTG-containing regimens should be constantly monitored.
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Affiliation(s)
- Francesco Di Gennaro
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Roberta Papagni
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Vladimiro Segala
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy.
| | - Carmen Pellegrino
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Gianfranco Giorgio Panico
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Luisa Frallonardo
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Lucia Diella
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Alessandra Belati
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Carmen Rita Santoro
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Gaetano Brindicci
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Flavia Balena
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Davide Fiore Bavaro
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Domenico Montalbò
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari 'Aldo Moro', Bari, Italy
| | - Giacomo Guido
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | | | | | - Margherita Sgambati
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari 'Aldo Moro', Bari, Italy
| | - Deborah Fiordelisi
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Nicolò De Gennaro
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Annalisa Saracino
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
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Moe J, Koh J, Ma JA, Pei LX, MacLean E, Keech J, Maguire K, Ronsley C, Doyle-Waters MM, Brubacher JR. Screening for harmful substance use in emergency departments: a systematic review. Int J Emerg Med 2024; 17:52. [PMID: 38584266 PMCID: PMC11000386 DOI: 10.1186/s12245-024-00616-2] [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] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 03/15/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Substance use-related emergency department (ED) visits have increased substantially in North America. Screening for substance use in EDs is recommended; best approaches are unclear. This systematic review synthesizes evidence on diagnostic accuracy of ED screening tools to detect harmful substance use. METHODS We included derivation or validation studies, with or without comparator, that included adult (≥ 18 years) ED patients and evaluated screening tools to identify general or specific substance use disorders or harmful use. Our search strategy combined concepts Emergency Department AND Screening AND Substance Use. Trained reviewers assessed title/abstracts and full-text articles for inclusion, extracted data, and assessed risk of bias (QUADAS-2) independently and in duplicate. Reviewers resolved disagreements by discussion. Primary investigators adjudicated if necessary. Heterogeneity precluded meta-analysis. We descriptively summarized results. RESULTS Our search strategy yielded 2696 studies; we included 33. Twenty-one (64%) evaluated a North American population. Fourteen (42%) applied screening among general ED patients. Screening tools were administered by research staff (n = 21), self-administered by patients (n = 10), or non-research healthcare providers (n = 1). Most studies evaluated alcohol use screens (n = 26), most commonly the Alcohol Use Disorders Identification Test (AUDIT; n = 14), Cut down/Annoyed/Guilty/Eye-opener (CAGE; n = 13), and Rapid Alcohol Problems Screen (RAPS/RAPS4/RAPS4-QF; n = 12). Four studies assessing six tools and screening thresholds for alcohol abuse/dependence in North American patients (AUDIT ≥ 8; CAGE ≥ 2; Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-IV-2] ≥ 1; RAPS ≥ 1; National Institute on Alcohol Abuse and Alcoholism [NIAAA]; Tolerance/Worry/Eye-opener/Amnesia/K-Cut down [TWEAK] ≥ 3) reported both sensitivities and specificities ≥ 83%. Two studies evaluating a single alcohol screening question (SASQ) (When was the last time you had more than X drinks in 1 day?, X = 4 for women; X = 5 for men) reported sensitivities 82-85% and specificities 70-77%. Five evaluated screening tools for general substance abuse/dependence (Relax/Alone/Friends/Family/Trouble [RAFFT] ≥ 3, Drug Abuse Screening Test [DAST] ≥ 4, single drug screening question, Alcohol, Smoking and Substance Involvement Screening Test [ASSIST] ≥ 42/18), reporting sensitivities 64%-90% and specificities 61%-100%. Studies' risk of bias were mostly high or uncertain. CONCLUSIONS Six screening tools demonstrated both sensitivities and specificities ≥ 83% for detecting alcohol abuse/dependence in EDs. Tools with the highest sensitivities (AUDIT ≥ 8; RAPS ≥ 1) and that prioritize simplicity and efficiency (SASQ) should be prioritized.
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Affiliation(s)
- Jessica Moe
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Justin Koh
- Department of Emergency Medicine, Queen's University, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Jennifer A Ma
- Department of Emergency Medicine, University of Manitoba, S203 Medical Sciences Building, 750 Bannatyne Avenue, Winnipeg, MB, R3E 0W2, Canada
| | - Lulu X Pei
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Eleanor MacLean
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - James Keech
- School of Medicine, Queen's University, 15 Arch Street, Kingston, ON, K7L 3N6, Canada
| | - Kaitlyn Maguire
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Claire Ronsley
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Mary M Doyle-Waters
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 7th Floor, 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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Furulund E, Madebo T, Druckrey-Fiskaaen KT, Vold JH, Nordbotn MH, Dahl E, Dyrstad SM, Lid TG, Fadnes LT. Integrated exercise program in opioid agonist therapy clinics and effect on psychological distress: study protocol for a randomized controlled trial (BAReAktiv). Trials 2024; 25:155. [PMID: 38424609 PMCID: PMC10905828 DOI: 10.1186/s13063-024-07993-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/16/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Substance use disorder is associated with unhealthy lifestyle choices, resulting in adverse social and health consequences. People with opioid use disorder receiving opioid agonist therapy, in particular, have high morbidity and reduced quality of life. Physical activity is recommended as an adjunctive treatment for people with substance use disorder, but there is minimal evidence from randomized controlled trials on the effects of this among people with substance use disorder receiving opioid agonist therapy. METHODS BAReAktiv is a multicentre randomized controlled trial. The study aims to recruit 324 patients receiving opioid agonist therapy (parallel groups randomized 1:1 to integrated exercise intervention or control, superiority trial). A 16-week group-based integrated exercise intervention with workouts twice a week. The exercise program consists of endurance and resistance training. The target group will be patients 18 years and older receiving opioid agonist therapy in outpatient clinics in several centers in Western Norway. The primary outcome of the study is the effect on psychological distress measured by Hopkins' symptom checklist with ten items. Secondary outcome measures include physical functioning assessed with a 4-min step test, activity level, fatigue symptoms, quality of life, and changes in inflammation markers. This study will provide improved knowledge on the effects of an integrated exercise program in opioid agonist therapy. DISCUSSION Systematically integrating exercise programs for people receiving opioid agonist therapy could lead to a shift towards a stronger focus on health behaviors in outpatient care. Integrating exercise could benefit patient recovery and reduce disease burden. Further scale-up will be considered if the provided exercise program is safe and effective. TRIAL REGISTRATION ClinicalTrials.gov. NCT05242848. Registered on February 16, 2022.
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Affiliation(s)
- Einar Furulund
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway.
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Tesfaye Madebo
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Respiratory Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Karl Trygve Druckrey-Fiskaaen
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jørn Henrik Vold
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Mette Hegland Nordbotn
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
| | - Eivin Dahl
- Department of Addiction, Stavanger University Hospital, Stavanger, Norway
| | - Sindre M Dyrstad
- Department of Education and Sport Science, University of Stavanger, Stavanger, Norway
| | - Torgeir Gilje Lid
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
- Department of Public Health, University of Stavanger, Stavanger, Norway
| | - Lars T Fadnes
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Mezaache S, Cutarella C, Frauger E, Micallef J. Transmucosal fentanyl-related opioid use disorder in a cancer survivor. Therapie 2024:S0040-5957(24)00031-3. [PMID: 38494374 DOI: 10.1016/j.therap.2024.02.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/17/2024] [Accepted: 02/22/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Salim Mezaache
- Service de pharmacologie clinique et pharmacovigilance, centre d'évaluation et d'information sur la pharmacodépendance-addictovigilance (CEIP-A) PACA-Corse, AP-HM Timone, AMU, INS, Inserm UMR1106, 13000 Marseille, France.
| | | | - Elisabeth Frauger
- Service de pharmacologie clinique et pharmacovigilance, centre d'évaluation et d'information sur la pharmacodépendance-addictovigilance (CEIP-A) PACA-Corse, AP-HM Timone, AMU, INS, Inserm UMR1106, 13000 Marseille, France
| | - Joëlle Micallef
- Service de pharmacologie clinique et pharmacovigilance, centre d'évaluation et d'information sur la pharmacodépendance-addictovigilance (CEIP-A) PACA-Corse, AP-HM Timone, AMU, INS, Inserm UMR1106, 13000 Marseille, France
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Razimoghadam M, Yaseri M, Effatpanah M, Daroudi R. Changes in emergency department visits and mortality during the COVID-19 pandemic: a retrospective analysis of 956 hospitals. Arch Public Health 2024; 82:5. [PMID: 38216989 PMCID: PMC10785366 DOI: 10.1186/s13690-023-01234-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/26/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, many non-COVID-19 emergency department (ED) visits were indirectly affected. ED visits and mortality were assessed during different pandemic time periods compared with pre-pandemic. METHODS The study used data from 41 million Iran Health Insurance Organization members. The outcomes were non-COVID-19 ED visits and associated mortality in 956 hospitals. An analysis of ED visits was conducted both for all-cause and cause-specific conditions: cardiovascular diseases (CVD), mental and substance use disorders, unintentional injuries, and self-harm. In addition, total in-hospital ED mortality was analyzed. A negative binomial regression and a Poisson regression with a log link were used to estimate the incidence rate ratio (IRR) of visits and mortality relative risk (RR). RESULTS 1,789,831 ED visits and 12,377 deaths were reported during the study. Pre-pandemic (Sep 2019 to Feb 2020), there were 2,767 non-COVID-19 visits rate per million person-month, which decreased to 1,884 during the first COVID-19 wave with a national lockdown from Feb 20 to Apr 19, 2020 (IRR 0.68, [0.56-0.84]). The non-COVID-19 ED mortality risk was 8.17 per 1,000 visit-month during the pre-pandemic period, rising to 12.80 during the first wave of COVID-19 (RR 1.57, [1.49-165]). Non-COVID-19 ED visit rates decreased during the first pandemic year from Sep 2020 to Feb 2021 (IRR 0.73, [0.63-0.86]), but increased after COVID-19 vaccination two years later from Sep 2021 to Feb 2022 (IRR 1.11, [0.96-0.17]). The total ED mortality risk for non-COVID-19 was significantly higher after the COVID-19 outbreak in the first (RR 1.66, [1.59-1.72]) and second years (RR 1.27, [1.22-1.32]) of the pandemic. The visit incidence rate for mental health and substance use disorders declined from 8.18 per million person-month to 4.57 (IRR 0.53, [0.32 to 0.90]) in the first wave. In the second year, unintentional injury visits increased significantly compared with pre-pandemic (IRR 1.63, [1.30-2.03]). As compared to before the pandemic, there was no significant change in CVD and self-harm visit rates during the pandemic. Cardiac arrest was the leading cause of death in Iran hospitals' EDs. CONCLUSION In the first year of the COVID-19 pandemic, non-COVID-19 hospital ED visits declined and mortality risk increased. Despite two years since the COVID-19 outbreak, non-COVID-19 ED mortality risk remains high.
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Affiliation(s)
- Mahya Razimoghadam
- Department of Health Management, policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Effatpanah
- Pediatric department, School of Medicine, Imam Khomeini hospital, Tehran University of Medical Sciences, Tehran, Iran
- National Center for Health Insurance Research, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Management, policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Sarsembayeva D, Schreuder MJ, Hartman CA. Mapping insomnia symptoms and circadian preferences to mental health problems in men and women across the lifespan. Psychiatry Res 2024; 331:115689. [PMID: 38141267 DOI: 10.1016/j.psychres.2023.115689] [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: 07/27/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 12/25/2023]
Abstract
This study identified subgroups in the general population based on combinations in three night-time insomnia symptoms and four dimensions of circadian preferences ("sleep profiles") and investigated the associations between sleep profiles and nine common mental health problems. The data came from the Lifelines cohort add-on study "Comorbid Conditions of ADHD" and included 37,716 individuals (aged 4-91 years) from the Dutch general population who completed a digital survey. Latent profile analysis was used to identify sleep profiles in twelve age-sex subgroups. Linear regression was used to investigate whether sleep profiles differ in mental health problems. Participants were classified into three sleep profiles: "Healthy Larks", who had early circadian preferences and no insomnia symptoms; "Sleepy Owls" with late circadian preferences and nonrestorative sleep; and "Sleepless Doves" with intermediate circadian preferences and severe insomnia symptoms. Compared to "Healthy Larks", all mental health problems were significantly more severe in "Sleepy Owls" and even worse in "Sleepless Doves". These associations were similar in men and women but weakened with age. However, "Sleepy Owls" and "Sleepless Doves" did not differ in heavy alcohol drinking, drug use, and smoking. Our findings strengthened the evidence for the universal role of healthy sleep in mental wellbeing.
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Affiliation(s)
- Dina Sarsembayeva
- Interdisciplinary Centre Psychopathology and Emotion regulation, University Medical Center Groningen, University of Groningen, Hanzeplein 1 - Entrance 24 (Triade building), Groningen 9700 RB, the Netherlands.
| | - Marieke J Schreuder
- Department of Psychology and Education Sciences, Quantitative Psychology and Individual Differences, KU Leuven, Belgium
| | - Catharina A Hartman
- Interdisciplinary Centre Psychopathology and Emotion regulation, University Medical Center Groningen, University of Groningen, Hanzeplein 1 - Entrance 24 (Triade building), Groningen 9700 RB, the Netherlands
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10
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Alvand S, Amin-Esmaeili M, Poustchi H, Roshandel G, Sadeghi Y, Sharifi V, Kamangar F, Dawsey SM, Freedman ND, Abnet CC, Rahimi-Movaghar A, Malekzadeh R, Etemadi A. Prevalence and determinants of opioid use disorder among long-term opiate users in Golestan Cohort Study. BMC Psychiatry 2023; 23:958. [PMID: 38129791 PMCID: PMC10734090 DOI: 10.1186/s12888-023-05436-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Number of opiate users worldwide has doubled over the past decade, but not all of them are diagnosed with opioid use disorder. We aimed to identify the prevalence and risk factors for OUD after ten years of follow-up. METHODS Among 8,500 chronic opiate users at Golestan Cohort Study baseline (2004-2008), we recalled a random sample of 451 subjects in 2017. We used three questionnaires: a questionnaire about current opiate use including type and route of use, the drug use disorder section of the Composite International Diagnostic Interview lifetime version, and the validated Kessler10 questionnaire. We defined opioid use disorder and its severity based on the DSM-5 criteria and used a cutoff of 12 on Kessler10 questionnaire to define psychological distress. RESULTS Mean age was 61.2 ± 6.6 years (84.7% males) and 58% were diagnosed with opioid use disorder. Starting opiate use at an early age and living in underprivileged conditions were risk factors of opioid use disorder. Individuals with opioid use disorder were twice likely to have psychological distress (OR = 2.25; 95%CI: 1.44-3.52) than the users without it. In multivariate regression, former and current opiate dose and oral use of opiates were independently associated with opioid use disorder. Each ten gram per week increase in opiate dose during the study period almost tripled the odds of opioid use disorder (OR = 3.18; 95%CI: 1.79-5.63). CONCLUSIONS Chronic opiate use led to clinical opioid use disorder in more than half of the users, and this disorder was associated with psychological distress, increasing its physical and mental burden in high-risk groups.
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Affiliation(s)
- Saba Alvand
- Liver and Pancreaticobilliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - 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
| | - Hossein Poustchi
- Liver and Pancreaticobilliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Yasaman Sadeghi
- Liver and Pancreaticobilliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Vandad Sharifi
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA
| | - Sanford M Dawsey
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, 20892, USA
| | - Neal D Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, 20892, USA
| | - Christian C Abnet
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, 20892, USA
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Arash Etemadi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, 20892, USA.
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11
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Settle JR, Smith A, Rausch P. A social media analysis of kratom use to discontinue stimulants. J Addict Dis 2023:1-7. [PMID: 38105430 DOI: 10.1080/10550887.2023.2292304] [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: 12/19/2023]
Abstract
BACKGROUND While FDA-approved treatments exist for opioid use disorder, none are available for stimulant use disorder. Kratom (Mitragyna speciosa), an unregulated plant-derived substance with known opioid- and stimulant-like effects, has been used to self-treat opioid use disorder; however, its use in relation to stimulant use disorder has not been described. OBJECTIVE To understand whether and how individuals use kratom to self-treat stimulant use disorder. METHODS Using a commercially available social listening platform, 3,820 publicly available social media posts published between January 1, 2020, and June 21, 2021, were reviewed for relevance to kratom and stimulant discontinuation. Manual qualitative thematic analysis was conducted on relevant data. RESULTS Among the 398 relevant posts that discussed using kratom to discontinue stimulants, motivations and methods varied considerably. Posts predominantly identified benefits but also negative outcomes of kratom use. Some justified it as necessary despite consequences, while others reported a desire to quit. CONCLUSIONS Although there is some awareness that kratom is used to self-treat opioid use disorder, its use to treat stimulant use disorder is more novel. In the absence of approved treatments, kratom was viewed as a natural and safe way to quit stimulants. Despite some reported success, this study shows self-treatment may pose significant risks, including kratom addiction and physical dependence. Healthcare practitioners, researchers, and public health professionals may benefit from understanding motivations for kratom use, associated benefits and risks, and the importance of discussing kratom use with patients/clients who have stimulant use disorder.
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Affiliation(s)
- Jill R Settle
- U.S. Food & Drug Administration Center for Drug Evaluation and Research Office of Communications, Silver Spring, MD, USA
| | - Alexandria Smith
- U.S. Food & Drug Administration Center for Drug Evaluation and Research Office of Communications, Silver Spring, MD, USA
| | - Paula Rausch
- U.S. Food & Drug Administration Center for Drug Evaluation and Research Office of Communications, Silver Spring, MD, USA
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12
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Alavi SMA, Irani RD, Fattahi P, Pakseresht S. Effects of brief cognitive behavioral therapy on mental health in substance-related disorder: a randomized controlled trial. BMC Psychiatry 2023; 23:924. [PMID: 38066514 PMCID: PMC10709952 DOI: 10.1186/s12888-023-05413-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND & OBJECTIVES Population and aging are major contributing factors influencing the increase in substance use disorder (SUD), which in itself affects mental health, particularly anxiety and depression. Cognitive behavioral therapy (CBT) and pharmacotherapy co-treatment are considered the gold standard for the treatment of SUD. Thus, the present study has been carried out to investigate the efficacy of brief CBT on the general health of opioid users. METHODS A randomized controlled trial (RCT) was conducted with forty opioid users whose addiction was dully confirmed by a psychiatrist at the drop-in center of the Ahvaz Jundishapur University of Medical Sciences. The patients were then randomly divided into two equal groups (n = 20). The control group was treated solely using methadone maintenance therapy (MMT); however, the intervention group underwent four sessions of CBT in addition to MMT. The general health questionnaire (GHQ) consisting of 28 items (Goldberg, 1979) was applied to both groups at the beginning and end of the study. The collected data was analyzed using IBM SPSS ver. 26, and data analysis was carried out using chi-square, t-test, Mann-Whitney, and Poisson regression model. P < 0.05 was statistically significant for all the aforementioned tests. RESULTS The mean age for the control and intervention groups were 37.95 ± 7.64 and 43.85 ± 9.92, respectively (p = 0.042). There was no statistically significant difference in terms of gender and levels of education (p = 0.311 and p = 0.540). Both groups differed statistically regarding marital status and occupation (p = 0.025 and 0.002). There was no significant statistical difference in all subclasses and the total scores of GHQ-28 for both groups, except for anxiety and insomnia in the intervention group (p = 0.038). After applying a Likert scale with a 23-point cut-off score, there was no statistically significant difference in terms of psychosis after intervention in the intervention group (p = 0.077). CONCLUSION The results of the current study show that brief CBT is effective on psychiatric health, especially anxiety and sleep disorders, whereas brief CBT fails to affect the patient's depression, somatic symptoms, and social dysfunction. TRIAL REGISTRATION The Iranian Registry of Clinical Trials (IRCT) approved the study design (IRCT registration number: IRCT20190929044917N1, registration date: 13/01/2020).
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Affiliation(s)
- Seyed Mohammad Amin Alavi
- Faculty of medicine, Ahvaz Jundishapur University of Medical Sciences, Golestan Blvd, Ahvaz, 6135715794, Khuzestan, Iran.
| | | | - Payam Fattahi
- Medical Student, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sirus Pakseresht
- Department of Psychiatry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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13
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Veras Eloy Santos J, Fonseca da Silva NA, Marcolela Andreoli Sartes L, Bohrer Schuch J, Paim Kessler FH, Barbosa Terra M. Psychiatric and obstetric characteristics of pregnant crack users admitted to a referral center in Southern Brazil. J Addict Dis 2023:1-10. [PMID: 38047869 DOI: 10.1080/10550887.2023.2279473] [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: 12/05/2023]
Abstract
BACKGROUND Psychoactive substance use among pregnant women has reached alarmingly high rates. Our aim was to characterize the psychiatric and clinical profiles of pregnant crack users in Brazil. METHODS This was a cross-sectional study of 24 pregnant crack users admitted to a referral hospital for psychiatric disorders in pregnant women, in Porto Alegre, Brazil, over three years. The following instruments were applied: a clinical-obstetric questionnaire; the condensed version of the Addiction Severity Index; a diagnostic interview for psychoactive substance use based on DSM-5; the Mini International Neuropsychiatric Interview for DSM-IV; and the Semi-Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). RESULTS Most patients had severe crack dependence and used other substances, such as tobacco, cannabis, and alcohol. The median duration of crack use was three years, ranging between three and 12 years. Most women subsisted from illegal or informal activities; a fifth had previously been arrested and often had relationship problems. Twenty percent had HIV (n = 5), and 37.5% (n = 9) had syphilis. Borderline personality disorder was the most prevalent mental condition (62.5%), followed by suicidal tendencies (45.8%), hypomanic episodes due to substance use (37.5%), and past major depressive episodes (33.3%). CONCLUSIONS An alarmingly high prevalence of consumption of other drugs, psychiatric disorders, and difficult-to-treat personality disorders was observed in our study. Investigating the psychiatric profile of women who use substances is essential to minimize the impacts on the mother and child, optimize therapeutic approaches to comorbidities, and enable more effective relapse prevention.
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Affiliation(s)
- Jéssica Veras Eloy Santos
- Department of Internal Medicine, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | | | | | - Jaqueline Bohrer Schuch
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felix Henrique Paim Kessler
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mauro Barbosa Terra
- Department of Internal Medicine, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
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14
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Bormann NL, Miskle B, Holdefer P, Arndt S, Lynch AC, Weber AN. Evidence of telescoping in females across two decades of US treatment admissions for injection drug use: 2000-2020. Drug Alcohol Depend Rep 2023; 9:100204. [PMID: 38045494 PMCID: PMC10690569 DOI: 10.1016/j.dadr.2023.100204] [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] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023]
Abstract
Background People who inject drugs (PWID) have an increased risk of soft tissue infection, drug overdose and death. Females may be particularly vulnerable due to barriers to substance use disorder (SUD) treatment entry, stigma, and telescoping, or the greater severity in substance use-related comorbidity and consequences despite a shorter history of use. We set out to identify sex differences in United States injection drug use (IDU). Methods The Treatment Episode Dataset-Admission (2000-2020) provided data to identify PWID undergoing their initial SUD treatment admission. Mann-Whitney U test, chi-square, and Spearman correlations were used for ordinal variables, categorical variables, and to assess similarity of male/female trends over the 21 years, respectively. The probabilistic index (PI) and Cramer's V provided effect sizes for Mann-Whitney U tests and chi-square tests, respectively. Results A total of 13,612,978 records existed for cases entering their initial treatment. Mapping to a history of IDU left 1,458,695 (561,793 females). Females had a higher prevalence among PWID across all 21 years; IDU trends were essentially identical between males and females (r = 0.97). Females endorsed beginning their primary substance later in life (PI = 0.47, p < 0.0001) and entered treatment after a shorter period of substance use (PI = 0.57, p < 0.0001). Conclusions We saw evidence of telescoping among PWID with a SUD entering their initial episode of treatment. Interventions should be implemented prior to the transition to IDU, and this window of opportunity is shortened in females. Utilizing gender-responsive treatment options may be a way to increase treatment-seeking earlier in the disease course.
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Affiliation(s)
- Nicholas L. Bormann
- Department of Psychiatry and Psychology, Mayo Clinic, 404 W Fountain St, Albert Lea, Rochester, MN 56007, USA
| | - Benjamin Miskle
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Pharmacy, University of Iowa, Iowa City, IA, USA
| | - Paul Holdefer
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Stephan Arndt
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Alison C. Lynch
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, University of Iowa, Iowa City, IA, USA
| | - Andrea N. Weber
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
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15
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de Andrade VO, Monteiro BMM, de Souza VCRP, de Souza JCRP. A Systematic Review of Interventions Based on Judeo-Christian Principles for Patients with Substance Dependence. J Relig Health 2023; 62:4316-4333. [PMID: 37369880 DOI: 10.1007/s10943-023-01830-7] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/29/2023]
Abstract
Substance use disorders have significant consequences for patients and those around them. A qualitative systematic review was conducted to examine the effectiveness of religiosity and spirituality (R/S) interventions based on Judeo-Christian principles during the multidisciplinary treatment of patients with substance dependence disorder. Studies of patients of both sexes, at any age, of any nationality, and from any geographic location who were participating in treatment programs with religious elements explicitly tied to Christianity or Judaism were eligible for inclusion. Other religious interventions were excluded. Seven electronic databases were searched to identify eligible intervention studies published in English until August 2021. Two reviewers independently screened studies and extracted data. JBI tools were used to assess risk of bias. Of 146 articles retrieved for full text reading, five were ultimately included in this review published from July 2008 to August 2021. The R/S interventions used in the included studies were music therapy in a religious context, reading of the Bible or Torah, reflexive readings, personal prayer and reflection, and religiously integrated cognitive behavioral psychotherapy with or without a comparison group. Despite the broad search, there were found only a small number of studies and little homogeneity in the data of patients that reported positive impacts of treatments. Well-designed controlled studies are needed to truly investigate the efficacy of Judeo-Christian religious interventions for helping people with substance use problems, so as to strengthen the evidence of the benefits of these type of approaches in the treatment of drug addicts.
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16
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Meehan AA, Jeffers A, Barker J, Ray CM, Laws RL, Fields VL, Miedema SS, Cha S, Cassell CH, DiPietro B, Cary M, Yang M, McLendon H, Marcus R, Mosites E. Barriers to COVID-19 Prevention Measures Among People Experiencing Homelessness with Substance Use Disorder or Serious Mental Illness. J Prev (2022) 2023; 44:663-678. [PMID: 37750981 DOI: 10.1007/s10935-023-00739-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] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 09/27/2023]
Abstract
People experiencing homelessness (PEH) are at disproportionate risk of becoming infected and having severe illness from coronavirus disease 2019 (COVID-19), especially when residing in congregate settings like homeless shelters. Behavioral health problems related to substance use disorder (SUD) and severe mental illness (SMI) may have created additional challenges for PEH to practice prevention measures like mask wearing, physical distancing, handwashing, and quarantine and isolation. The study objective was to understand the perceived barriers PEH face regarding COVID-19 non-pharmaceutical prevention strategies and identify recommendations for overcoming barriers. From August-October 2020, qualitative phone interviews with 50 purposively selected behavioral health professionals across the United States serving PEH with SUD or SMI were conducted. Professionals described that PEH faced barriers to prevention that were structural (e.g., access to necessary resources), behavioral (related to SUD or SMI), or related to the priority of other needs. Recommendations to overcome these barriers included providing free prevention resources (e.g., masks and hand sanitizer), providing education about importance of prevention strategies, and prioritizing access to stable housing. Interviews took place before COVID-19 vaccines were available, so barriers to vaccination are not included in this paper. Findings can help support tailored approaches during COVID-19 and future public health threats.
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Affiliation(s)
- Ashley A Meehan
- Centers for Disease Control and Prevention COVID-19 Emergency Response, Atlanta, Georgia.
| | - Alexiss Jeffers
- Centers for Disease Control and Prevention COVID-19 Emergency Response, Atlanta, Georgia
| | - Jordan Barker
- Centers for Disease Control and Prevention COVID-19 Emergency Response, Atlanta, Georgia
- Oak Ridge Institute for Science and Education (ORISE) Fellow, Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | - Colleen M Ray
- Centers for Disease Control and Prevention COVID-19 Emergency Response, Atlanta, Georgia
| | - Rebecca L Laws
- Centers for Disease Control and Prevention COVID-19 Emergency Response, Atlanta, Georgia
| | - Victoria L Fields
- Centers for Disease Control and Prevention COVID-19 Emergency Response, Atlanta, Georgia
| | - Stephanie S Miedema
- Centers for Disease Control and Prevention COVID-19 Emergency Response, Atlanta, Georgia
| | - Susan Cha
- Centers for Disease Control and Prevention COVID-19 Emergency Response, Atlanta, Georgia
| | - Cynthia H Cassell
- Centers for Disease Control and Prevention COVID-19 Emergency Response, Atlanta, Georgia
| | - Barbara DiPietro
- National Health Care for the Homeless Council, Nashville, TN, USA
| | | | - Maria Yang
- Seattle Downtown Emergency Service Center, Seattle, WA, USA
| | | | - Ruthanne Marcus
- Centers for Disease Control and Prevention COVID-19 Emergency Response, Atlanta, Georgia
| | - Emily Mosites
- Centers for Disease Control and Prevention COVID-19 Emergency Response, Atlanta, Georgia
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17
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Flores J, Taylor B, Hazra A, Pollack H, Pho MT, Schneider J. Stigma towards persons who use methamphetamine: Results from a nationally representative survey of U.S. Adults. Prev Med Rep 2023; 36:102496. [PMID: 38021413 PMCID: PMC10663842 DOI: 10.1016/j.pmedr.2023.102496] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
This study seeks to understand the general adult population's knowledge, attitudes, and stigma towards methamphetamine use and people with a history of methamphetamine use utilizing a cross-sectional national survey. We analyzed data from a cross-sectional survey drawn from AmeriSpeak®, a probability-based ongoing panel of over 35,000 households representative of the U.S. household population. We developed a 10-item social stigma scale, and estimated a multivariable generalized linear regression model for public stigma towards methamphetamine use as our dependent variable and a series of covariates. Six adjusted independent variables were noted to be significantly associated with higher stigma towards methamphetamine use: older age, higher household income, married status, Republican party affiliation, no history of methamphetamine use, and higher racism score. Sex assigned at birth, race (with Black as reference category), education level, and history of arrest or incarceration showed no statistical significance in stigma scores. In a separate regression model limited to people with a history of methamphetamine use (n = 727), notably White respondents had lower stigma compared to Black respondents. Our large population-based survey identified several factors associated with higher stigma towards those who use methamphetamines, including higher racist attitudes which was associated with a higher stigma score and higher internalized stigma amongst Black respondents with a history of methamphetamine use. Given the scope of methamphetamine use in the U.S., addressing stigma, in particular in regard to race, may impact the nation's public health efforts to reduce methamphetamine-associated adverse outcomes.
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Affiliation(s)
- John Flores
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Bruce Taylor
- Public Health Department, NORC at the University of Chicago, Chicago, IL, USA
| | - Aniruddha Hazra
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Harold Pollack
- University of Chicago, Social Service Administration, University of Chicago Crime Lab and Health Lab, Chicago, IL, USA
| | - Mai T Pho
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - John Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA
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18
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Kyster NB, Tranberg K, Osler M, Hjorthøj C, Mårtensson S. The influence of childhood aspirations on the risk of developing psychotic disorders, substance use disorders, and dual diagnosis in adulthood based on the Metropolit 1953 Danish Male Birth Cohort. Eur Child Adolesc Psychiatry 2023; 32:2503-2512. [PMID: 36242645 DOI: 10.1007/s00787-022-02091-7] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/23/2022] [Indexed: 11/30/2022]
Abstract
The study aims to investigate the association of aspiration for future occupation, socioeconomic position, and intellectual abilities with risk of dual diagnosis, psychosis, substance use disorder (SUD) in later life, and to explore if social and intellectual disadvantage modify any effect of childhood aspirations on outcomes. The study included 7177 Danish boys born in 1953. We investigated childhood aspirations (preference regarding future occupation), socioeconomic position (paternal social group), and intellectual abilities (Härnquist intelligence score) on outcomes with dual diagnosis, psychotic disorder, or SUD in Danish registers. Combinations of variables were used for a two-way and three-way analysis (high and low levels of exposure variables). Cox regression with age as the underlying time scale was used for analysis. The separate analysis showed no associations between childhood aspirations and outcomes. Boys with low intelligence scores had an increased risk of developing psychotic disorders (aHR 1.5, 95% CI 1.1-2.1) and SUD (aHR 1.8, 95% CI 1.5-2.1) compared to high intelligence scores. The interaction analyses showed that individuals with a combination of low intelligence score, high aspirations, and/or high paternal social group might have an increased risk of developing dual diagnosis, psychotic disorders, or SUD in later life. This result should be interpreted with caution as interaction variables were not overall significant with the outcome of dual diagnosis or psychotic disorder. The findings suggest that childhood abilities and social position could be associated with the development of psychotic disorders and SUD in later life, however, further studies are needed to address the temporality of the association to gain an understanding of the underlying mechanism of the association.
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Affiliation(s)
- Natacha Blauenfeldt Kyster
- Competence Centre for Dual Diagnosis, Mental Health Centre Sct. Hans, Capital Region of Denmark, Roskilde, Denmark
| | - Katrine Tranberg
- Competence Centre for Dual Diagnosis, Mental Health Centre Sct. Hans, Capital Region of Denmark, Roskilde, Denmark.
- Department of Public Health, Section of General Practice, University of Copenhagen, Copenhagen, Denmark.
| | - Merete Osler
- Center for Clinical Research and Prevention, Frederiksberg/Bispebjerg University Hospital, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Solvej Mårtensson
- Competence Centre for Dual Diagnosis, Mental Health Centre Sct. Hans, Capital Region of Denmark, Roskilde, Denmark
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Perino J, Ramaroson H, Ong N, Lancelot V, Bezin J, Gilleron V, Daveluy A, Tournier M. Psychoactive substance intoxication leading to general hospital admission in young and middle-aged people during and after the first lockdown. Therapie 2023:S0040-5957(23)00186-5. [PMID: 38036330 DOI: 10.1016/j.therap.2023.10.017] [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: 07/13/2023] [Revised: 09/19/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Incidence of hospitalisations related to psychoactive substance (H-PS) intoxication has been strongly decreased during the coronavirus disease 2019 (COVID-19) pandemic especially in young adult and French region of Nouvelle-Aquitaine was mostly concerned. This study aimed to describe (i) the incidence of H-PS in Bordeaux teaching hospital during and after the first 2020 lockdown in adults aged 18-29 years or 30+ then (ii) their characteristics specifically associated with the pandemic period by comparing 2020 with 2017-2019 baseline period. MATERIAL AND METHODS This historical cohort study was conducted in adults admitted to the Bordeaux teaching hospital with main or associated diagnosis codes of intoxication with benzodiazepine, methadone, buprenorphine, codeine, morphine, heroin, cocaine, ecstasy and alcohol. Data were collected locally through the discharge database. Incidence and characteristics of H-PS were described according to patients' age, in 2020 before (01/01-16/03), during (17/03-10/05), and after the first lockdown (11/05-31/07). RESULTS Among the 5,824 stays included over the study period, PS most involved were alcohol and benzodiazepines. Compared to baseline, the decrease in H-PS's incidence was more important in young adults (-40%; nbaseline=450) in comparison to those aged 30+ (-18%; nbaseline=1,101) during the pandemic period, especially during the lockdown compared to 2017 (-59%; n2017=145 vs. -35%; n2017=166) with far decrease in alcohol and ecstasy intoxications. Seriousness of hospitalisation indications was increased regardless of age during the pandemic. Particularly in young adults, the proportion of suicides attempts increased during lockdown compared to the baseline period (almost 50% vs. 29%) and the period after lockdown was associated with 1.7 more-time road accident increased and 3 more-time fights compared with pre-lockdown period. DISCUSSION/CONCLUSION The period following lockdown should be considered at risk H-PS due to accident. Recreational use of alcohol and ecstasy could be a target for minimize serious consequences associated to PS use in young adult.
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Affiliation(s)
- Justine Perino
- Department of Medical Pharmacology, Addictovigilance Center of Bordeaux, University Hospital of Bordeaux, 33000 Bordeaux, France; Inserm, BPH, U1219, University of Bordeaux, 33000 Bordeaux, France; CHU de Bordeaux, 33000 Bordeaux, France.
| | - Hanta Ramaroson
- Service d'information médicale, unité de coordination et d'analyse de l'information médicale - département d'information médicale (UCAIM-DIM), CHU de Bordeaux, 33000 Bordeaux, France
| | - Nathalie Ong
- Service d'information médicale, unité de coordination et d'analyse de l'information médicale - département d'information médicale (UCAIM-DIM), CHU de Bordeaux, 33000 Bordeaux, France
| | | | - Julien Bezin
- Inserm, BPH, U1219, University of Bordeaux, 33000 Bordeaux, France; CHU de Bordeaux, 33000 Bordeaux, France
| | - Véronique Gilleron
- Service d'information médicale, unité de coordination et d'analyse de l'information médicale - département d'information médicale (UCAIM-DIM), CHU de Bordeaux, 33000 Bordeaux, France
| | - Amélie Daveluy
- Department of Medical Pharmacology, Addictovigilance Center of Bordeaux, University Hospital of Bordeaux, 33000 Bordeaux, France; Inserm, BPH, U1219, University of Bordeaux, 33000 Bordeaux, France
| | - Marie Tournier
- Inserm, BPH, U1219, University of Bordeaux, 33000 Bordeaux, France; Hospital Charles-Perrens, 33000 Bordeaux, France
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20
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Fleury MJ, Cao Z, Grenier G, Huỳnh C. Profiles of patients with substance-related disorders who dropped out or not from addiction treatment. Psychiatry Res 2023; 329:115532. [PMID: 37837812 DOI: 10.1016/j.psychres.2023.115532] [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: 05/08/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/16/2023]
Abstract
This longitudinal study identified profiles of patients with substance-related disorders (SRD) who did or did not drop out of specialized addiction treatment, integrating various patterns of outpatient service use. Medical administrative databases of Quebec (Canada) were used to investigate a cohort of 16,179 patients with SRD who received specialized addiction treatment. Latent class analysis identified patient profiles, based on multi-year outpatient service use. Four patient profiles related to treatment dropout were identified: patients who did not drop out and were low service users (Profile 1); patients who did not drop out and were high service users (Profile 2); patients who dropped out and were low service users (Profile 3); patients who dropped out and were high service users (Profile 4). Profile 1 had the best health and social conditions, while Profile 4 had the worst. The risks of being frequent emergency department users, being hospitalized or dying were highest in Profile 4, followed by Profiles 3, 2 and 1. Assertive treatment programs may be suited to Profile 4 and intensive case management programs to Profile 3. Collaborative care with higher psychosocial interventions and regularity of care may be extended to Profile 2 and interventions integrating motivational treatment to Profile 1.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, Canada, H3A 1A1; Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, Canada, H4H 1R3.
| | - Zhirong Cao
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, Canada, H4H 1R3
| | - Guy Grenier
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, Canada, H4H 1R3
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950, rue de Louvain, Montreal, QC, Canada, H2M 2E8
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21
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Galarneau LR, Speed K, Taylor M, Hyshka E. Operating an overdose prevention site within a temporary emergency shelter during the COVID-19 pandemic. Can J Public Health 2023; 114:787-795. [PMID: 37462841 PMCID: PMC10486343 DOI: 10.17269/s41997-023-00803-3] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/13/2023] [Indexed: 09/09/2023]
Abstract
SETTING A temporary emergency shelter was established inside the Commonwealth Stadium in Edmonton, Alberta, to reduce COVID-19 transmission and mitigate health risks among people experiencing homelessness. INTERVENTION A non-profit organization, Boyle Street Community Services, opened an overdose prevention site (OPS) between February and March 2022 inside the temporary emergency shelter. People accessed the shelter-based OPS to consume unregulated drugs (via injection, intranasally, or orally), receive medical aid, access sterile drug use equipment, and be connected to additional health and social supports, without leaving the shelter. We conducted short interviewer-administered surveys with OPS participants to examine participant views and identify suggested improvements. OUTCOMES The shelter-based OPS was accessed a total of 1346 times by 174 unique people. Fentanyl was the most common self-reported drug consumed (59%) and most consumption (99% of episodes) was by injection. OPS staff responded to 66 overdoses and reported no deaths. Survey respondents reported that the shelter-based OPS was convenient, with no need to forfeit their shelter spot or find transportation to another OPS. Respondents indicated that the OPS felt safe and accessible and reported that it reduced drug use in other shelter areas. Participants identified the OPS' exclusion of inhalation as a limitation. IMPLICATIONS People who use unregulated drugs and are experiencing homelessness are at a higher risk of negative health outcomes, which COVID-19 exacerbated. Integrating temporary shelter/housing and harm reduction services may be an innovative way to lower barriers, increase accessibility, and improve well-being for this structurally vulnerable population. Future operators should consider incorporating inhalation services to further reduce service gaps.
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Affiliation(s)
- Lexis R Galarneau
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Inner City Health and Wellness Program, Edmonton, Alberta, Canada
- George Spady Society, Edmonton, Alberta, Canada
| | - Kelsey Speed
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Inner City Health and Wellness Program, Edmonton, Alberta, Canada
| | - Marliss Taylor
- Boyle Street Community Services, Edmonton, Alberta, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
- Inner City Health and Wellness Program, Edmonton, Alberta, Canada.
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Perino J, Demourgues M, Ramaroson H, Bezin J, Micallef J, Miremont-Salamé G, Frauger E, Gilleron V, Ong N, Daveluy A. Increase in hospitalisation-associated methadone intoxication in France following first COVID-19 lockdown. Public Health 2023; 223:1-6. [PMID: 37572562 DOI: 10.1016/j.puhe.2023.07.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES At the beginning of the COVID-19 pandemic, the French Addictovigilance Network drew attention to the need to facilitate access to methadone while ensuring its safe use, in order to avoid the occurrence of overdoses and deaths. The objectives of the study were to assess the impact of the lockdowns on the incidence of methadone-use-related hospitalisations (MUHs) and describe the characteristics of patients and hospitalisations. STUDY DESIGN An interrupted time series using the unobserved components model was performed to predict the monthly incidence of MUHs in 2020 on the basis of previous years' data and compared with MUHs observed. Data were presented with prediction intervals (PI95%). METHODS This retrospective study was conducted on patients hospitalised in France for methadone between 2014 and 2020, using the French national database hospital discharge database. Patients' characteristics and hospitalisations were described over four periods: before lockdown, first lockdown, after first lockdown, and second lockdown. RESULTS Compared to the predictions, a higher incidence of MUH was found during the first lockdown, especially in March 2020 (66 cases vs. 51.3; PI95%: 34-65), and there was a large increase during the month following the end of the first lockdown (79 cases vs. 61; PI95%: 46-75). Coconsumptions (alcohol, cannabis, cocaine) were more frequent during the first lockdown, whereas patients aged over 30 years were more concerned thereafter. The second lockdown did not present any particularity. CONCLUSIONS The first lockdown had a significant impact on the incidence of MUHs. These results confirm the data from the reinforced national monitoring during first lockdown published in 2020, where methadone was the primary substance involved in overdoses and deaths.
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Affiliation(s)
- J Perino
- Service de Pharmacologie Médicale, CHU de Bordeauxx, Centre de Pharmacovigilance de Bordeaux, F-33000 Bordeaux, France; University Bordeaux, INSERM, BPH, U1219, CHU de Bordeaux, F-33000 Bordeaux, France
| | - M Demourgues
- Service de Pharmacologie Médicale, CHU de Bordeauxx, Centre de Pharmacovigilance de Bordeaux, F-33000 Bordeaux, France
| | - H Ramaroson
- Service d'Information Médicale, Unité de Coordination et d'Analyse de l'Information Médicale-département d'Information Médicale (UCAIM-DIM), CHU de Bordeaux, F-33000 Bordeaux, France
| | - J Bezin
- University Bordeaux, INSERM, BPH, U1219, CHU de Bordeaux, F-33000 Bordeaux, France
| | - J Micallef
- Centre d'Addictovigilance, Aix Marseille University, AP-HM, INSERM, Institute Neuroscience System, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | - G Miremont-Salamé
- Service de Pharmacologie Médicale, CHU de Bordeauxx, Centre de Pharmacovigilance de Bordeaux, F-33000 Bordeaux, France; University Bordeaux, INSERM, BPH, U1219, CHU de Bordeaux, F-33000 Bordeaux, France; Service de Pharmacologie Médicale, Centre d'Addictovigilance, CHU de Bordeaux, F-33000 Bordeaux, France
| | - E Frauger
- Centre d'Addictovigilance, Aix Marseille University, AP-HM, INSERM, Institute Neuroscience System, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | - V Gilleron
- Service d'Information Médicale, Unité de Coordination et d'Analyse de l'Information Médicale-département d'Information Médicale (UCAIM-DIM), CHU de Bordeaux, F-33000 Bordeaux, France
| | - N Ong
- Service d'Information Médicale, Unité de Coordination et d'Analyse de l'Information Médicale-département d'Information Médicale (UCAIM-DIM), CHU de Bordeaux, F-33000 Bordeaux, France
| | - A Daveluy
- Service de Pharmacologie Médicale, CHU de Bordeauxx, Centre de Pharmacovigilance de Bordeaux, F-33000 Bordeaux, France; University Bordeaux, INSERM, BPH, U1219, CHU de Bordeaux, F-33000 Bordeaux, France; Service de Pharmacologie Médicale, Centre d'Addictovigilance, CHU de Bordeaux, F-33000 Bordeaux, France.
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Kheirkhah MT, Mokarrami M, Kazemitabar M, Garcia D. Inequalities in care for Iranian women suffering from the comorbidity of substance use and mental illness: The need for integrated treatment. Health Promot Perspect 2023; 13:198-201. [PMID: 37808943 PMCID: PMC10558971 DOI: 10.34172/hpp.2023.24] [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: 02/25/2023] [Accepted: 05/27/2023] [Indexed: 10/10/2023] Open
Abstract
This paper addresses the comorbidity of substance use and mental illness among women in Iran and the barriers they encounter in accessing treatment. Research has demonstrated a higher prevalence of comorbidity of substance use disorders and mental illness among women than men. It has been suggested that women in Iran may face numerous barriers to appropriate care, such as stigma and discrimination associated with substance use. Integrated treatment for co-occurring disorders (CODs) has been highly beneficial and effective; however, personal and structural limitations impede this treatment approach, which explains the need to develop a situation- and culture-specific program. Needs assessment is necessary to achieve an integrated treatment, and the Iranian government should take the lead in this endeavor. However, if this seems unlikely, non-governmental organizations could be called upon to promote it.
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Affiliation(s)
| | - Mehran Mokarrami
- Faculty of Psychology and Education, University of Tehran, Tehran, Iran
| | - Maryam Kazemitabar
- Yale School of Medicine, Yale University, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, USA
| | - Danilo Garcia
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
- Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden
- Department of Psychology, Lund University, Lund, Sweden
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24
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Angarita GA, Pittman B, Nararajan A, Mayerson TF, Parate A, Marlin B, Gueorguieva RR, Potenza MN, Ganesan D, Malison RT. Discriminating cocaine use from other sympathomimetics using wearable electrocardiographic (ECG) sensors. Drug Alcohol Depend 2023; 250:110898. [PMID: 37523916 PMCID: PMC10905422 DOI: 10.1016/j.drugalcdep.2023.110898] [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: 12/28/2022] [Revised: 06/05/2023] [Accepted: 07/09/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Our group has established the feasibility of using on-body electrocardiographic (ECG) sensors to detect cocaine use in the human laboratory. The purpose of the current study was to test whether ECG sensors and features are capable of discriminating cocaine use from other non-cocaine sympathomimetics. METHODS Eleven subjects with cocaine use disorder wore the Zephyr BioHarness™ 3 chest band under six experimental (drug and non-drug) conditions, including 1) laboratory, intravenous cocaine self-administration, 2) after a single oral dose of methylphenidate, 3) during aerobic exercise, 4) during tobacco use (N=7 who smoked tobacco), and 5) during routine activities of daily inpatient living (unit activity). Three ECG-derived feature sets served as primary outcome measures, including 1) the RR interval (i.e., heart rate), 2) a group of ECG interval proxies (i.e., PR, QS, QT and QTc intervals), and 3) the full ECG waveform. Discriminatory power between cocaine and non-cocaine conditions for each of the three outcomes measures was expressed as the area under the receiver operating characteristics (AUROC) curve. RESULTS All three outcomes successfully discriminated cocaine use from unit activity, exercise, tobacco, and methylphenidate conditions with a mean AUROC values ranging from 0.66 to 0.99 and with least squares means values all statistically different/higher than 0.5 among all subjects [F(3, 99) = 3.38, p =0.02] and among those with tobacco use [F(4, 84) = 5.39, p = 0.0007]. CONCLUSIONS These preliminary results support discriminatory power of wearable ECG sensors for detecting cocaine use.
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Affiliation(s)
- Gustavo A Angarita
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT06519, USA; Clinical Neuroscience Research Unit, Connecticut Mental Health Center, 34 Park Street, New Haven, CT06519, USA; Connecticut Mental Health Center, New Haven, CT06519, USA; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT06510, USA.
| | - Brian Pittman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT06519, USA; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT06510, USA
| | - Annamalai Nararajan
- Philips Research North America, Cambridge, MA02141, USA; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT06510, USA
| | - Talia F Mayerson
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT06519, USA; Clinical Neuroscience Research Unit, Connecticut Mental Health Center, 34 Park Street, New Haven, CT06519, USA; Connecticut Mental Health Center, New Haven, CT06519, USA; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT06510, USA
| | - Abhinav Parate
- Manning College of Information and Computer Science, University of Massachusetts, Amherst, MA01003, USA; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT06510, USA; Lumme Health Inc, Boston, MA02210, USA
| | - Benjamin Marlin
- Manning College of Information and Computer Science, University of Massachusetts, Amherst, MA01003, USA; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT06510, USA
| | - Ralitza R Gueorguieva
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT06510, USA; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT06510, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT06519, USA; Connecticut Mental Health Center, New Haven, CT06519, USA; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT06510, USA; Child Study Center, Yale University School of Medicine, New Haven, CT06510, USA; Department of Neuroscience, Yale University, New Haven, CT06510, USA; Connecticut Council on Problem Gambling, Wethersfield, CT06109, USA; Wu Tsai Institute, New Haven, CT06510, USA
| | - Deepak Ganesan
- Manning College of Information and Computer Science, University of Massachusetts, Amherst, MA01003, USA; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT06510, USA
| | - Robert T Malison
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT06519, USA; Clinical Neuroscience Research Unit, Connecticut Mental Health Center, 34 Park Street, New Haven, CT06519, USA; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT06510, USA; Department of Neuroscience, Yale University, New Haven, CT06510, USA
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25
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Stefanovics EA, Potenza MN, Tsai J, Pietrzak RH. Prevalence and Clinical Characteristics of Recreational and At-Risk/Problematic Gambling in a National Sample of U.S. Military Veterans. J Gambl Stud 2023; 39:1077-1097. [PMID: 36378356 DOI: 10.1007/s10899-022-10165-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
Gambling among U.S. military veterans is common, with more extensive involvement linked to gambling disorder and associated problems. This study examined associations between recreational gambling (RG) and at-risk/problem gambling (ARPG), and clinical measures (psychiatric disorders, substance use), behaviors (suicidality, homelessness, arrests) and functioning in a nationally representative sample of U.S. military veterans. Data were analyzed from 4069 veterans who participated in the National Health and Resilience in Veterans Study. Chi-square tests, analyses of variance (ANOVAs) and logistic regressions were conducted to examine unadjusted and adjusted associations between gambling group status and lifetime and current psychiatric diagnoses and behavioral and functioning measures. A significant minority of U.S. veterans reported gambling, with 27.3% (95% confidence interval [CI] 25.5-29.1%) exhibiting RG and 4.9% (95% CI 4.0-5.9%) screening positive for ARPG. The prevalence of ARPG was higher among younger, non-White, male veterans, while RG was more prevalent among retired veterans and those with higher household incomes relative to non-gambling (NG) individuals. ARPG was associated with greater trauma burden, lifetime and current psychiatric diagnoses, mental health treatment, alcohol and drug use disorders, suicidal ideation, homelessness, arrests, and poorer functioning relative to NG and RG, with stronger magnitude differences relative to NG. RG was associated with substance use disorders and arrest histories relative to NG. Results of the current study provide an up-to-date estimate of the current prevalence of RG and ARPG among U.S. veterans and underscore the importance of routine screening and monitoring of gambling problems, as well as interventions for ARPG in this population.
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Affiliation(s)
- Elina A Stefanovics
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- U.S. Department of Veterans Affairs New England Mental Illness Research and Education Clinical Center (MIRECC), VA Connecticut Healthcare System (116A-4), 950 Campbell Avenue, Building 36, West Haven, CT, 06516, USA.
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Yale Child Study Center, Yale University, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Department of Neuroscience, Yale University, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Jack Tsai
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Tampa, FL, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
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Vila-Farinas A, Pérez-Ríos M, Montes-Martínez A, Trinanes-Pego Y, Varela-Lema L. [Considerations for the design and implementation of interventions for the cessation of tobacco, alcohol and cannabis use in pregnancy: A qualitative study]. Aten Primaria 2023; 55:102732. [PMID: 37573833 PMCID: PMC10448272 DOI: 10.1016/j.aprim.2023.102732] [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: 05/12/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVE To explore the opinion of different key stakeholders regarding the requirements that tobacco, alcohol and/or cannabis cessation interventions should meet to be implemented and to be acceptable and useful during pregnancy. DESIGN A qualitative study with phenomenological approach. SITE: The study was conducted in Spain in 2022. PARTICIPANTS Decision makers, health professionals, pregnant women using tobacco, alcohol and/or cannabis and their partners who are also users. METHODS Data were collected through focus groups and in-depth interviews, until discourse saturation was reached and accurately transcribed. Exploratory analysis and inductive open coding were conducted, codes were merged into categories and subcategories were identified. RESULTS Four categories and 18 subcategories were identified. The results suggest that interventions should be multicomponent. Among the interventions most accepted by pregnant women and their partners were specific cessation consultations, information, peer support (although they did not specify how) and financial incentives. Among other options to consider, co-oximetry, proposed by managers to obtain an objective register. CONCLUSIONS The conclusion is that this intervention should be carried out at the level of prenatal care in primary care. There are doubts regarding the frequency, purpose, and follow-up of this multicomponent intervention, as well as the possibility of incorporating couples.
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Affiliation(s)
- Andrea Vila-Farinas
- Departamento de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela , España
| | - Mónica Pérez-Ríos
- Departamento de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela , España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela , España.
| | - Agustín Montes-Martínez
- Departamento de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela , España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela , España
| | - Yolanda Trinanes-Pego
- Unidad de Asesoramiento Científico-técnico (Avalia-t). Agencia Gallega de Conocimiento en Salud (ACIS), Galicia , España
| | - Leonor Varela-Lema
- Departamento de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela , España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela , España
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Bach P, Ti L, Hayashi K, Cui Z, Milloy MJ, Fairbairn N. Trends in cocaine and crystal methamphetamine injection over time in a Canadian setting between 2008 and 2018. J Subst Use Addict Treat 2023; 151:208982. [PMID: 36848997 PMCID: PMC10805263 DOI: 10.1016/j.josat.2023.208982] [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: 01/25/2022] [Revised: 01/01/2023] [Accepted: 02/12/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE Unregulated stimulant use is rising globally, though trends in use of cocaine and crystal methamphetamine (CM), the two most commonly used unregulated stimulants in North America, are poorly characterized in many settings. In this study we examined patterns and associations between the injection of cocaine and CM over time in an urban Canadian setting. METHODS The study collected data from two prospective cohorts of people who inject drugs in Vancouver, Canada, between 2008 and 2018. We applied a time series analysis, using multivariable linear regression to detect relationships between reported CM and cocaine injection and year, controlling for covariates. The study used cross-correlation to evaluate the relative trajectories of each substance over time. RESULTS Among 2056 participants, per annum rates of reported injection cocaine use declined significantly over the duration of this study from 45 % to 18 % (p < 0.001), while rates of CM injection increased from 17 % to 32 % (p < 0.001). Multivariable linear regression showed that recent CM injection was negatively associated with recent cocaine injection (β = -0.609, 95 % CI = -0.750, -0.467). Cross-correlation demonstrated that injection CM use was associated with a decrease in the likelihood of cocaine injection 12 months later (p = 0.002). CONCLUSIONS These findings demonstrate an epidemiological shift in patterns of injection stimulant use, with rising CM injection associated with a corresponding decrease in cocaine injection over time. Strategies are urgently needed that help to treat and reduce harm among the growing population of people who inject CM.
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Affiliation(s)
- Paxton Bach
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; British Columbia Centre on Substance Use, Suite 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada.
| | - Lianping Ti
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; British Columbia Centre on Substance Use, Suite 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Suite 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Zishan Cui
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; British Columbia Centre on Substance Use, Suite 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - M-J Milloy
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; British Columbia Centre on Substance Use, Suite 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Nadia Fairbairn
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; British Columbia Centre on Substance Use, Suite 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
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Ondocsin J, Holm N, Mars SG, Ciccarone D. The motives and methods of methamphetamine and 'heroin' co-use in West Virginia. Harm Reduct J 2023; 20:88. [PMID: 37438812 PMCID: PMC10339587 DOI: 10.1186/s12954-023-00816-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 01/16/2023] [Accepted: 06/22/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Opioid and methamphetamine co-use is increasing across the USA with overdoses involving these drugs also rising. West Virginia (WV) has led the US in opioid overdose death rates since at least 2013 and rising co-use of methamphetamine with opioids has played a greater role in deaths over the last 5 years. METHODS This study used rapid ethnography to examine methods and motivations behind opioids and methamphetamine co-use from the viewpoint of their consumers. Participants (n = 30) were people who injected heroin/fentanyl also using methamphetamine who participated in semi-structured interviews. RESULTS We found multiple methods of co-using opioids and methamphetamine, whether alternately or simultaneously and in varying order. Most prioritized opioids, with motives for using methamphetamine forming three thematic categories: 'intrinsic use', encompassing both inherent pleasure of combined use greater than using both drugs separately or for self-medication of particular conditions; 'opioid assisting use' in which methamphetamine helped people manage their existing heroin/fentanyl use; and 'reluctant or indifferent use' for social participation, reflecting methamphetamine's low cost and easy availability. CONCLUSIONS Methamphetamine serves multiple functions among people using opioids in WV. Beliefs persist that methamphetamine can play a role in preventing and reversing opioid overdose, including some arguments for sequential use being protective of overdose. 'Reluctant' uptake attests to methamphetamine's social use and the influence of supply. The impact on overdose risk of the many varied co-use patterns needs further investigation.
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Affiliation(s)
- Jeff Ondocsin
- Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, MU3E, San Francisco, CA, 94143, USA.
| | - Nicole Holm
- Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, MU3E, San Francisco, CA, 94143, USA
| | - Sarah G Mars
- Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, MU3E, San Francisco, CA, 94143, USA
| | - Daniel Ciccarone
- Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, MU3E, San Francisco, CA, 94143, USA
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Behmer Hansen RA, Behmer Hansen RT, Noureddine C, Behmer VA, Opler D. Reasons for use and experiences of using phenibut, a mixed methods analysis of online reports. Am J Drug Alcohol Abuse 2023; 49:458-469. [PMID: 37184879 DOI: 10.1080/00952990.2023.2204510] [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: 10/30/2022] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 05/16/2023]
Abstract
Background: Phenibut is a drug similar in structure to gabapentin and pregabalin. It is available online without prescription, often marketed as a dietary supplement or amino acid derivative. Little is known about phenibut use despite its increased popularity in the United States over the last decade.Objective: To clarify reasons for taking phenibut, circumstances, and effects of use.Methods: Reports of phenibut, gabapentin, and pregabalin use were downloaded from a publicly-available database, Erowid.org. A mixed methods approach utilizing qualitative content analysis was used.Results: Of 229 reports, 211 were from male authors. People usually purchased phenibut online and reportedly used it for recreation, to manage a medical or psychiatric problem (primarily insomnia, anxiety), as a substitute for other drugs (especially benzodiazepines), to manage withdrawal from another substance (including benzodiazepines, opioids), and/or for performance enhancement. While it shared many reported effects with pregabalin and gabapentin such as anxiolysis, increased talkativeness, and impaired motor coordination, reports of gastrointestinal distress and sedation were more commonly attributed to phenibut. Several people reported difficulty in restricting their use and managing withdrawal.Conclusions: Phenibut reports suggest that phenibut may have some benefits for some people. Use also, however, carries risks of adverse effects, a potentially dangerous withdrawal syndrome, and addiction. Not dissimilar to unprescribed gabapentin or pregabalin, self-medication is a common motive for phenibut use. Physicians should continue to ask their patients about use of any non-prescribed medications, dietary supplements, or "amino acid derivatives."Abbreviation: PWUPh: people who use phenibut; PWUG: people who use gabapentin; PWUPr: people who use pregabalin.
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Affiliation(s)
| | | | - Chaden Noureddine
- Department of Psychiatry, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Virginia A Behmer
- Department of Biology, Case Western Reserve University, Cleveland, OH, USA
| | - Douglas Opler
- Department of Psychiatry, Rutgers New Jersey Medical School, Newark, NJ, USA
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Vold JH, Halmøy A, Chalabianloo F, Pierron MC, Løberg EM, Johansson KA, Fadnes LT. Attention-deficit/hyperactivity disorder (ADHD) symptoms and their relation to diagnosed ADHD, sociodemographic characteristics, and substance use among patients receiving opioid agonist therapy: a Norwegian cohort study. BMC Psychiatry 2023; 23:479. [PMID: 37386438 PMCID: PMC10308780 DOI: 10.1186/s12888-023-04980-w] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 06/22/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) symptoms may challenge sufficient treatment of substance use and mental disorders. The literature on the extent of such symptoms among patients receiving opioid agonist therapy (OAT) is scarce. This study examined ADHD symptoms using the ADHD self-report scale (ASRS) and the association between the 'ASRS-memory' and 'ASRS-attention' scores and substance use and sociodemographic characteristics among patients receiving OAT. METHODS We used data from assessment visits of a cohort of patients in Norway. In total, 701 patients were included from May 2017 to March 2022. All patients responded at least once to two ASRS questions assessing memory and attention, respectively. Ordinal regression analyses were performed to investigate whether the two obtained scores were associated with age, sex, frequent substance use, injecting use, housing status, and educational attainment at baseline, i.e., the first assessment, and over time. The results are presented as odds ratios (OR) with 95% confidence intervals (CI). Additionally, a subsample of 225 patients completed an extended interview, including the ASRS-screener and collection of registered mental disorder diagnoses from the medical records. Standard cutoffs were used to define the presence of each ASRS symptom or a positive ASRS-screener ('ASRS-positive'). RESULTS At baseline, 428 (61%) and 307 (53%) patients scored over the cutoffs on the 'ASRS-memory' and 'ASRS-attention,' respectively. Frequent cannabis use was associated with higher 'ASRS-memory' (OR: 1.7, 95% CI: 1.1-2.6) and 'ASRS-attention' (1.7, 1.1-2.5) scores compared with less or no use at baseline, though reduced score on the 'ASRS-memory' over time (0.7, 0.6-1.0). At baseline, frequent stimulant use (1.8, 1.0-3.2) and low educational attainment (0.1, 0.0-0.8) were associated with higher 'ASRS-memory' scores. In the subsample fulfilling the ASRS-screener, 45% of the patients were 'ASRS-positive,' of whom 13% with a registered ADHD diagnosis. CONCLUSIONS Our findings illustrate a relationship between the ASRS-memory and -attention scores and frequent cannabis and stimulant use. Furthermore, nearly half of the subsample was 'ASRS-positive.' Patients receiving OAT might benefit from being further assessed for ADHD, but improved diagnostic methods are required.
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Affiliation(s)
- Jørn Henrik Vold
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies Vei 65, N-5021 Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Anne Halmøy
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Fatemeh Chalabianloo
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies Vei 65, N-5021 Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Marianne Cook Pierron
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies Vei 65, N-5021 Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Kjell Arne Johansson
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies Vei 65, N-5021 Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies Vei 65, N-5021 Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Dufayet L, Bargel S, Bonnet A, Boukerma AK, Chevallier C, Evrard M, Guillotin S, Loeuillet E, Paradis C, Pouget AM, Reynoard J, Vaucel JA. Gamma-hydroxybutyrate (GHB), 1,4-butanediol (1,4BD), and gamma-butyrolactone (GBL) intoxication: A state-of-the-art review. Regul Toxicol Pharmacol 2023; 142:105435. [PMID: 37343712 DOI: 10.1016/j.yrtph.2023.105435] [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: 12/02/2022] [Revised: 01/13/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
γ-hydroxybutyrate (GHB) is synthesized endogenously from γ-aminobutyric acid (GABA) or exogenously from 1,4-butanediol (butane-1,4-diol; 1,4-BD) or γ-butyrolactone (GBL). GBL, and 1,4-BD are rapidly converted to GHB. The gastric absorption time, volume of distribution, and half-life of GHB are between 5 and 45 min, 0.49 ± 0.9 L/kg, and between 20 and 60 min, respectively. GHB and its analogues have a dose-dependent effect on the activation of GHB receptor, GABA-B, and GABA localized to the central nervous system. After ingestion, most patients present transient neurological disorders (lethal dose: 60 mg/kg). Chronic GHB consumption is associated with disorders of use and a withdrawal syndrome when the consumption is discontinued. GHB, GBL, and 1,4-BD are classified as narcotics but only the use of GHB is controlled internationally. They are used for drug facilitated (sexual) assault, recreational purposes, slamsex, and chemsex. To confirm an exogenous intake or administration of GHB, GBL, or 1-4-BD, the pre-analytical conservation is crucial. The antemortem cutoff doses for detection are 5 and 5-15 mg/L, with detection windows of 6 and 10 h in the blood and urine, respectively Control of GHB is essential to limit the number of users, abuse, associated risks, and death related to their consumption.
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Affiliation(s)
- Laurene Dufayet
- Unité Médico-judiciaire, Hôtel-Dieu, APHP, 75001, Paris, France; Centre Antipoison de Paris - Fédération de Toxicologie (FeTox), Hôpital Fernand-Widal, APHP, 75010, Paris, France; INSERM, UMRS-1144, Faculté de Pharmacie, 75006, Paris, France; UFR de Médecine, Université de Paris, 75010, Paris, France.
| | - Sophie Bargel
- Section Toxicologie - Sécurité Routière, Laboratoire de Police Scientifique de Lille, SNPS, France
| | - Anastasia Bonnet
- Centre Antipoison de Toulouse, CHU de Toulouse, Toulouse, France
| | | | | | - Marion Evrard
- Centre Antipoison de Nancy, CHRU de Nancy, Nancy, France
| | - Sophie Guillotin
- Centre Antipoison de Toulouse, CHU de Toulouse, Toulouse, France
| | | | - Camille Paradis
- Centre Antipoison de Bordeaux CHU de Bordeaux, Bordeaux, France
| | | | - Julien Reynoard
- Pharmacologie Clinique CAP-TV, APHM, Hôpitaux Sud, Marseille, France
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Suen LW, Vittinghoff E, Wu AHB, Ravi A, Coffin PO, Hsue P, Lynch KL, Kazi DS, Riley ED. Multiple substance use and blood pressure in women experiencing homelessness. Addict Behav Rep 2023; 17:100483. [PMID: 36875801 PMCID: PMC9975611 DOI: 10.1016/j.abrep.2023.100483] [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: 08/08/2022] [Revised: 12/15/2022] [Accepted: 02/12/2023] [Indexed: 02/15/2023] Open
Abstract
Background Substance use increases risk of cardiovascular events, particularly among women with additional risk factors like housing instability. While multiple substance use is common among unstably housed individuals, relationships between multiple substance use and cardiovascular risk factors like blood pressure are not well characterized. Methods We conducted a cohort study between 2016 and 2019 to examine associations between multiple substance use and blood pressure in women experiencing homelessness and unstable housing. Participants completed six monthly visits including vital sign assessment, interview, and blood draw to assess toxicology-confirmed substance use (e.g., cocaine, alcohol, opioids) and cardiovascular health. We used linear mixed models to evaluate the outcomes of systolic and diastolic blood pressure (SBP; DBP). Results Mean age was 51.6 years; 74 % were women of color. Prevalence of any substance use was 85 %; 63 % of participants used at least two substances at baseline. Adjusting for race, body mass index and cholesterol, cocaine was the only substance significantly associated with SBP (4.71 mmHg higher; 95 % CI 1.68, 7.74) and DBP (2.83 mmHg higher; 95 % CI 0.72, 4.94). Further analysis found no differences in SBP or DBP between those with concurrent use of other stimulants, depressants, or both with cocaine, compared to those who used cocaine only. Conclusions Cocaine was the only substance associated with higher SBP and DBP, even after accounting for simultaneous use of other substances. Along with interventions to address cocaine use, stimulant use screening during cardiovascular risk assessment and intensive blood pressure management may improve cardiovascular outcomes among women experiencing housing instability.
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Affiliation(s)
- Leslie W Suen
- National Clinician Scholars Program, Philip R. Lee Institute of Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States.,San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Alan H B Wu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Akshay Ravi
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Phillip O Coffin
- Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, United States.,San Francisco Department of Public Health, San Francisco, CA, United States
| | - Priscilla Hsue
- Division of Cardiology, Chan Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Kara L Lynch
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Dhruv S Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Elise D Riley
- Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Razaghi E, Farhoudian A, Pilevari A, Noroozi A, Hooshyari Z, Radfar R, Malekinejad M. Identification of the socio-cultural barriers of drug addiction treatment in Iran. Heliyon 2023; 9:e15566. [PMID: 37131427 PMCID: PMC10149210 DOI: 10.1016/j.heliyon.2023.e15566] [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: 08/18/2022] [Revised: 04/03/2023] [Accepted: 04/13/2023] [Indexed: 05/04/2023] Open
Abstract
Introduction Socio-cultural norms can either be encouraging or a barrier to addiction treatment. More, rigorous research is needed on nonindigenous models in addiction treatment, to better understand the role of socio-cultural differences. Methods The present qualitative study is part of the project, "The Inclusive Assessment of the Barriers of Drug Addiction Treatment Services in Iran," which was conducted in Tehran from 2018 to 2021. The participants consisted of eight people who used drugs, seven individual family members of the people who used drugs participants, seven service providers, and four policymakers. A purposeful sampling method was used for the selection of the participants, and the process continued until reaching the theoretical saturation of data. Analysis used the Graneheim and Lundman methods, classifying primary codes, the sub-themes, and themes were classified according to the similarities and differences between primary codes. Finding The most important socio-cultural barriers to addiction treatment in Iran are: unrealistic expectations of the family and society from the people who use drugs, addiction stigma, mistrust between various components of the treatment system, perceptions that professional substance use disorder treatment is inefficient and low uptake of that treatment, the disturbed relational boundaries between the people who use drugs and their relatives, the interweaving of treatment and ethical and religious principles, low acceptance of maintenance treatments, treatment focusing on short-term outcomes, and presence of facilitating backgrounds of using drugs. Conclusions The Iranian socio-cultural characteristics play an important role in the addiction treatment of the people who use drugs, so it is necessary for treatment interventions to be sensitive to these characteristics.
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Affiliation(s)
- Emran Razaghi
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Farhoudian
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam Pilevari
- Department of Sociology, Kharazmi University, Karaj, Iran
- Corresponding author.
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Science, Tehran, Iran
| | - Zahra Hooshyari
- Department of Geriatric Medicine, Ziaeian Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Radfar
- Department of Neuroscience and Addiction, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Malekinejad
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, USA
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Apuy LFM, Barreto MAB, Merino LAH. Efficacy of bupropion and cognitive behavioral therapy in the treatment of methamphetamine use disorder: a systematic review and meta-analysis. Braz J Psychiatry 2023; 45. [PMID: 36917815 PMCID: PMC10288480 DOI: 10.47626/1516-4446-2022-2979] [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: 11/28/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVES We assessed the efficacy of cognitive behavioral therapy and bupropion compared to cognitive behavioral therapy alone for methamphetamine use disorder. METHODS The selection criteria for this systematic review study with meta-analysis were randomized clinical trials on the efficacy of cognitive behavioral therapy and bupropion in the treatment for methamphetamine use disorder (assessed by urine metabolites). The search was conducted in PubMed, PubMed Central, LILACS, SciELO, Cochrane Library, SCOPUS, Google Scholar, Ovid Medline, Clinicaltrials.gov, and the International Clinical Trials Registry Platform. The primary outcome was relapse. Risk of bias was assessed with the RoB 2 tool. The results of each clinical trial were input into an Excel spreadsheet. We performed a meta-analysis using relative risk and a 95%CI. RESULTS Of the 597 initial articles (498 after removing duplicate records), five were included in the meta-analysis, with an aggregate sample of 539 patients. An overall relative risk of 0.91 (95%CI 0.78-1.05) was estimated for relapse. CONCLUSION Our study limitations included publication bias and heterogeneous populations. We found no evidence that cognitive behavioral therapy and bupropion reduced the risk of relapse compared to cognitive behavioral therapy and placebo.
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Vold JH, Chalabianloo F, Løberg EM, Aas CF, Lim AG, Vickerman P, Johansson KA, Fadnes LT. The efficacy of integrated hepatitis C virus treatment in relieving fatigue in people who inject drugs: a randomized controlled trial. Subst Abuse Treat Prev Policy 2023; 18:25. [PMID: 37095561 PMCID: PMC10123982 DOI: 10.1186/s13011-023-00534-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Most people who inject drugs (PWIDs) suffer from severe fatigue, and chronic hepatitis C virus (HCV) infection may play a role in this. However, there is scarce evidence about interventions that alleviate fatigue among PWIDs. The present study investigated the effect of integrated HCV treatment on fatigue in this population compared to the effect of standard HCV treatment, adjusted for sustained virological response of the HCV treatment. METHODS This multi-center, randomized controlled trial evaluated fatigue as a secondary outcome of integrated HCV treatment (the INTRO-HCV trial). From May 2017 to June 2019, 276 participants in Bergen and Stavanger, Norway, were randomly assigned to receive integrated and standard HCV treatment. Integrated treatment was delivered in eight decentralized outpatient opioid agonist therapy clinics and two community care centers; standard treatment was delivered in specialized infectious disease outpatient clinics at referral hospitals. Fatigue was assessed prior to treatment and 12 weeks after treatment using the nine-item Fatigue Severity Scale (FSS-9). We applied a linear mixed model to evaluate the impact of integrated HCV treatment on changes in FSS-9 (ΔFSS-9) sum scores. RESULTS At baseline, the mean FSS-9 sum score was 46 (standard deviation (SD): 15) for participants on integrated HCV treatment and 41 (SD: 16) for those on standard treatment. Twelve weeks after completed HCV treatment, the mean FSS-9 sum score for participants receiving integrated HCV treatment was 42 (SD: 15) and 40 (SD: 14) for those receiving standard HCV treatment. Integrated HCV treatment did not reduce the FSS-9 scores compared to standard HCV treatment (ΔFSS-9: -3.0, 95% confidence interval (CI): -6.4;0.4). CONCLUSIONS Fatigue is a common symptom among PWIDs. Integrated HCV treatment is at least equal to standard HCV treatment in improving fatigue. TRIAL REGISTRATION ClinicalTrials.gov.no NCT03155906, 16/05/2017.
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Affiliation(s)
- Jørn Henrik Vold
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies Vei 65, N-5021, Bergen, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
| | - Fatemeh Chalabianloo
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies Vei 65, N-5021, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Christer F Aas
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies Vei 65, N-5021, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kjell Arne Johansson
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies Vei 65, N-5021, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies Vei 65, N-5021, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Prochaska JJ, Vogel EA, Chieng A, Baiocchi M, Pajarito S, Pirner M, Darcy A, Robinson A. A relational agent for treating substance use in adults: Protocol for a randomized controlled trial with a psychoeducational comparator. Contemp Clin Trials 2023; 127:107125. [PMID: 36813084 PMCID: PMC10065942 DOI: 10.1016/j.cct.2023.107125] [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: 12/16/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Substance use disorders (SUDs) are prevalent and compromise health and wellbeing. Scalable solutions, such as digital therapeutics, may offer a population-based strategy for addressing SUDs. Two formative studies supported the feasibility and acceptability of the relational agent Woebot, an animated screen-based social robot, for treating SUDs (W-SUDs) in adults. Participants randomized to W-SUDs reduced their substance use occasions from baseline to end-of-treatment (EOT) relative to a waitlist control. OBJECTIVE To further develop the evidence base, the current randomized trial extends follow-up to 1-month post-treatment and will test the efficacy of W-SUDs relative to a psychoeducational control. METHODS This study will recruit, screen, and consent 400 adults online reporting problematic substance use. Following baseline assessment, participants will be randomized to 8 weeks of W-SUDs or a psychoeducational control. Assessments will be conducted at weeks 4, 8 (EOT), and 12 (1-month post-treatment). Primary outcome is past-month number of substance use occasions, summed across all substances. Secondary outcomes are number of heavy drinking days, the percent of days abstinent from all substances, substance use problems, thoughts about abstinence, cravings, confidence to resist substance use, symptoms of depression and anxiety, and work productivity. If significant group differences are found, we will explore moderators and mediators of treatment effects. CONCLUSIONS The current study builds upon emerging evidence of a digital therapeutic for reducing problematic substance use by examining sustained effects and testing against a psychoeducational control condition. If efficacious, the findings have implications for scalable mobile health interventions for reducing problematic substance use. TRIAL REGISTRATION NCT04925570.
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Affiliation(s)
- Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, United States of America.
| | - Erin A Vogel
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, United States of America
| | - Amy Chieng
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, United States of America
| | - Michael Baiocchi
- Department of Epidemiology & Population Health, School of Medicine, Stanford University, United States of America
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Potenza MN, Baldacchino AM. Virtually there and back again: An overview of the 2021 and 2022 Scientific Annual Conferences of the International Society of Addiction Medicine. Drug Alcohol Depend 2023; 245:109805. [PMID: 36827932 DOI: 10.1016/j.drugalcdep.2023.109805] [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: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/21/2023]
Abstract
The International Society of Addiction Medicine (ISAM) has held annual conferences for over 20 years. Conference-related information, including main themes and selected abstracts, have been published regularly. This communication describes the events of the 2021 and 2022 conferences, the second virtual and first in-person/hybrid conference. These conferences were widely attended by addiction medicine professionals from around the world, and multiple topics, both pandemic-related and not, were covered. After a three-year period with two virtual meetings, the 2022 event in Valetta, Malta, provided an opportunity to reunite and discuss current information in person. Albeit with different formats, both meetings provided opportunities for sharing of recent, clinically relevant findings to assist in addressing addictions globally.
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Affiliation(s)
- Marc N Potenza
- Department of Psychiatry and Child Study Center, Yale School of Medicine, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA; Department of Neuroscience and Wu Tsai Institute, Yale University, New Haven, CT, USA.
| | - Alex M Baldacchino
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
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Schuch JB, Becker N, Rabelo-da-Ponte FD, Ornell F, Freitas HJM, Rebelatto FP, Sordi AO, Pechansky F, von Diemen L, Kessler FHP. Assessment of cognitive functioning using the Mini Mental State Examination in men with Alcohol and Crack Cocaine Use Disorder. Trends Psychiatry Psychother 2023; 45:e20220567. [PMID: 36889679 PMCID: PMC10597386 DOI: 10.47626/2237-6089-2022-0567] [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: 09/07/2022] [Accepted: 03/01/2023] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Consumption of substances has been associated with cognitive impairment. The Mini Mental State Examination (MMSE) is an easy-to-apply screening tool used to assess cognitive functions. OBJECTIVES To evaluate the cognitive performance of individuals with alcohol (AUD) and/or crack cocaine use disorder (CUD) and polysubstance use using the MMSE and to investigate the impact of substance use profile and the moderation effect of educational level on MMSE performance. METHODS Cross-sectional study with 508 adult male inpatients diagnosed with substance use disorders (245 with AUD, 85 with CUD, and 178 with polysubstance use). Cognitive performance was assessed using the MMSE scale (total and composite scores). RESULTS Individuals with AUD had worse total MMSE scores and scored worse for all three MMSE components compared to individuals with polysubstance use (p < 0.001, oral/written language comprehension, p < 0.001, attention/memory, and p = 0.007, motor functions). MMSE scores were positively correlated with educational level (p < 0.017), but were not associated with age, recent drug use, or years of drug use. Educational level moderated the impact of substance use on MMSE performance, especially total score and composite language comprehension score. Individuals with a low educational level (≤ 8 years) had worse performance than those with a high educational level (≥ 9 years), mainly in individuals with AUD (p < 0.001). DISCUSSION Individuals with a low educational level and alcohol use are more prone to present cognitive impairment than crack cocaine users, especially involving language aspects. Better-preserved cognitive function could impact treatment adherence and might guide the decision of therapeutic strategies.
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Affiliation(s)
- Jaqueline B Schuch
- Centro de Pesquisa em Álcool e Drogas, Centro Colaborador em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil
| | - Natália Becker
- Centro de Pesquisa em Álcool e Drogas, Centro Colaborador em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. Programa de Pós-Graduação em Distúrbios do Desenvolvimento, Universidade Presbiteriana Mackenzie, São Paulo, SP, Brazil
| | - Francisco Diego Rabelo-da-Ponte
- Centro de Pesquisa em Álcool e Drogas, Centro Colaborador em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil. Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Felipe Ornell
- Centro de Pesquisa em Álcool e Drogas, Centro Colaborador em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil
| | - Hellen J M Freitas
- Centro de Pesquisa em Álcool e Drogas, Centro Colaborador em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Fernando P Rebelatto
- Centro de Pesquisa em Álcool e Drogas, Centro Colaborador em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil
| | - Anne O Sordi
- Centro de Pesquisa em Álcool e Drogas, Centro Colaborador em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Flavio Pechansky
- Centro de Pesquisa em Álcool e Drogas, Centro Colaborador em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil
| | - Lisia von Diemen
- Centro de Pesquisa em Álcool e Drogas, Centro Colaborador em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil
| | - Felix H P Kessler
- Centro de Pesquisa em Álcool e Drogas, Centro Colaborador em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil
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Brothers TD, Walley AY, Rivers-Bowerman H, McLeod M, Genge L. Grayken lessons: between a rock and a hard place? A 37-year-old man with acute liver injury while enrolled in a managed alcohol program for severe alcohol use disorder. Addict Sci Clin Pract 2023; 18:14. [PMID: 36879279 PMCID: PMC9988200 DOI: 10.1186/s13722-023-00370-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
Managed alcohol programs aim to reduce health and social harms associated with severe alcohol use disorder. Here, we describe a young man with severe alcohol use disorder enrolled in a managed alcohol program, who was admitted to hospital with acute liver injury. Fearing that alcohol was contributing, the inpatient care team discontinued the managed alcohol dose in hospital. He was ultimately diagnosed with cephalexin-induced liver injury. After consideration of risks, benefits, and alternative options, the patient and care team jointly decided to restart managed alcohol after hospital discharge. With this case, we describe managed alcohol programs and summarize the emerging evidence-base, including eligibility criteria and outcome measures; we explore clinical and ethical dilemmas in caring for patients with liver disease within managed alcohol programs; and we emphasize principles of harm reduction and patient-centered care when establishing treatment plans for patients with severe alcohol use disorder and unstable housing.
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Affiliation(s)
- Thomas D Brothers
- Department of Medicine, Dalhousie University, Halifax, NS, Canada. .,Institute of Epidemiology and Health Care, UCL Collaborative Centre for Inclusion Health, University College London, London, UK.
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | - Helen Rivers-Bowerman
- Mobile Outreach Street Health (MOSH), North End Community Health Centre, Halifax, NS, Canada
| | - Magnus McLeod
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Leah Genge
- Mobile Outreach Street Health (MOSH), North End Community Health Centre, Halifax, NS, Canada.,Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
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Hulme PA, Wegehaupt M, Kupzyk KA, French JA. An approach for studying the contributions of childhood sexual abuse and HPA axis dysregulation to substance use disorders. Arch Psychiatr Nurs 2023; 42:9-17. [PMID: 36842834 DOI: 10.1016/j.apnu.2022.12.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/25/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
An environmental risk factor for substance abuse and dependence is childhood sexual abuse (CSA). We piloted an approach we developed to test the hypothesis that hypothalamic-pituitary-adrenal (HPA) axis dysregulation from the stress of CSA is a biological mediator. We based our hypothesis on the allostasis model. New admissions to residential treatment for substance use disorders (N = 41) were evaluated for CSA history and two HPA axis regulation measures at baseline, one month, and two months. The two HPA axis regulation measures were morning cortisol level and the dexamethasone suppression test. Five potential covariates were also measured to increase reliability of the findings. Feasibility outcomes were mostly favorable, and included rates of participation (57 %), attrition (46 % at one month and 71 % at two months), and compliance with data collection procedures (87 % for morning cortisol level and 84 % for the dexamethasone suppression test). High attrition rates at one and two months were entirely attributable to high rates of leaving treatment, an important consideration for future studies. Baseline correlations among variables showed a significant negative correlation between dexamethasone suppression and perceived stress, a potential covariate (rho = -0.458). This finding suggests that individuals with lower stress levels have better negative feedback regulation of the HPA axis, which results in the benefit of lower cortisol exposure-a finding congruent with the allostasis model.
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Affiliation(s)
- Polly A Hulme
- College of Nursing, South Dakota State University, 1060 Campanile Ave, Brookings, SD 57007, United States of America.
| | | | - Kevin A Kupzyk
- College of Nursing, University of Nebraska Medical Center, 4111 Dewey Ave., Omaha, NE 68198-5330, United States of America.
| | - Jeffrey A French
- Department of Psychology, University of Nebraska at Omaha, 6001 Dodge Street, Omaha, NE 68182, United States of America.
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Bishop MD, Ioverno S, Russell ST. Sexual minority youth's mental health and substance use: The roles of victimization, cybervictimization, and non-parental adult support. Curr Psychol 2023; 42:5075-5087. [PMID: 38344657 PMCID: PMC10857851 DOI: 10.1007/s12144-021-01812-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 01/03/2023]
Abstract
Victimization is a well-established driver of sexual minority youth's (SMY) mental health and substance use risk. The current study examined and extended this research by exploring how victimization, cybervictimization, and non-parental supportive adults contribute to SMY's vulnerability to poor mental health and substance use. Using data from the first representative sample of Texas youth that measures sexual identity, we analyzed sex-stratified models of the association between sexual identity, mental health, and substance use, and the confounding effects of victimization, cybervictimization, and non-parental adult support. Victimization was more common among SMY and accounted for a greater proportion of sexual identity disparities on mental health and substance use, especially for males. Sexual minority females were more likely to report cybervictimization than heterosexual youth, and cybervictimization was associated with mental health risk. SMY reported fewer available non-parental supportive adults, which was associated with more sadness, suicidality, and polysubstance use. Our study adds to extant evidence that victimization drives SMY's increased susceptibility to mental health and substance use risk. Schools should implement inclusive policies that prohibit bullying based on sexual minority identity and offer professional development opportunities for supporting SMY.
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Affiliation(s)
- Meg D. Bishop
- Department of Human Development and Family Sciences, University of Texas at Austin, 108 E. Dean Keeton St., Stop A2702, Austin, TX 78712, USA
| | - Salvatore Ioverno
- Department of Sociology, Ghent University, St. Pietersnieuwstraat 33, 9000 Ghent, Belgium
| | - Stephen T. Russell
- Department of Human Development and Family Sciences, University of Texas at Austin, 108 E. Dean Keeton St., Stop A2702, Austin, TX 78712, USA
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Farnbach S, Fernando J, Coyte J, Simms M, Hackett ML. "I tried to get help about my addiction but he just gave me tablets:" male Aboriginal drug and alcohol rehabilitation clients' experiences and preferences speaking about substance use in primary care. BMC Prim Care 2023; 24:25. [PMID: 36681795 PMCID: PMC9863190 DOI: 10.1186/s12875-023-01983-0] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Primary healthcare (PHC) services are crucial in supporting people who use substances. The aims of this study were to explore the experiences of Aboriginal males in NSW in treatment for substance use about speaking about their substance use with PHC staff, and their preferences for accessing PHC about their substance use. METHODS Semi-structured interviews with residential drug and alcohol rehabilitation treatment service clients. Thematic analysis was used to develop themes inductively and deductively. Two interviews were independently double coded by an Aboriginal researcher and the project was supported by an Aboriginal Advisory Group. RESULTS Twenty male adults who self-identified as Aboriginal participated (mean age 27 years). Half reported visiting PHC and talking about their substance use before their residential service stay. Two major themes developed: (1) speaking up about substance use or mental health problems linked with substance use, (2) ways to improve access to PHC about substance use. Although some males were offered treatment, some were not, and others had concerns about the treatments offered. CONCLUSION This research highlights opportunities to improve access and to better support Aboriginal males who use substances in PHC. Focus on culturally appropriate PHC and providing staff with training around substance use and treatment options may improve access. It is important to foster culturally appropriate services, develop PHC staff knowledge around substance use, focus on therapeutic relationships and have a range of treatment options available that can be tailored to individual circumstances.
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Affiliation(s)
- Sara Farnbach
- National Drug and Alcohol Research Centre and The George Institute for Global Health, University of New South Wales, Sydney, NSW, 2052, Australia.
| | | | - Joe Coyte
- CEO, The Glen Centre (Ngaimpe), Chittaway Point, Australia
| | - Matthew Simms
- South Coast Medical Service Aboriginal Corporation, Nowra, Australia
| | - Maree L Hackett
- The George Institute for Global Health, UNSW, The University of Central Lancashire, Preston, UK
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Fleury MJ, Cao Z, Grenier G, Huỳnh C. Profiles of quality of outpatient care use, associated sociodemographic and clinical characteristics, and adverse outcomes among patients with substance-related disorders. Subst Abuse Treat Prev Policy 2023; 18:5. [PMID: 36641441 PMCID: PMC9840840 DOI: 10.1186/s13011-022-00511-0] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND This study identified patient profiles in terms of their quality of outpatient care use, associated sociodemographic and clinical characteristics, and adverse outcomes based on frequent emergency department (ED) use, hospitalization, and death from medical causes. METHODS A cohort of 18,215 patients with substance-related disorders (SRD) recruited in addiction treatment centers was investigated using Quebec (Canada) health administrative databases. A latent class analysis was produced, identifying three profiles of quality of outpatient care use, while multinomial and logistic regressions tested associations with patient characteristics and adverse outcomes, respectively. RESULTS Profile 1 patients (47% of the sample), labeled "Low outpatient service users", received low quality of care. They were mainly younger, materially and socially deprived men, some with a criminal history. They had more recent SRD, mainly polysubstance, and less mental disorders (MD) and chronic physical illnesses than other Profiles. Profile 2 patients (36%), labeled "Moderate outpatient service users", received high continuity and intensity of care by general practitioners (GP), while the diversity and regularity in their overall quality of outpatient service was moderate. Compared with Profile 1, they were older, less likely to be unemployed or to live in semi-urban areas, and most had common MD and chronic physical illnesses. Profile 3 patients (17%), labeled "High outpatient service users", received more intensive psychiatric care and higher quality of outpatient care than other Profiles. Most Profile 3 patients lived alone or were single parents, and fewer lived in rural areas or had a history of homelessness, versus Profile 1 patients. They were strongly affected by MD, mostly serious MD and personality disorders. Compared with Profile 1, Profile 3 had more frequent ED use and hospitalizations, followed by Profile 2. No differences in death rates emerged among the profiles. CONCLUSIONS Frequent ED use and hospitalization were strongly related to patient clinical and sociodemographic profiles, and the quality of outpatient services received to the severity of their conditions. Outreach strategies more responsive to patient needs may include motivational interventions and prevention of risky behaviors for Profile 1 patients, collaborative GP-psychiatrist care for Profile 2 patients, and GP care and intensive specialized treatment for Profile 3 patients.
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Affiliation(s)
- Marie-Josée Fleury
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, Quebec, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec, H3A 1A1, Canada.
| | - Zhirong Cao
- grid.412078.80000 0001 2353 5268Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, Quebec H4H 1R3 Canada
| | - Guy Grenier
- grid.412078.80000 0001 2353 5268Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, Quebec H4H 1R3 Canada
| | - Christophe Huỳnh
- grid.459278.50000 0004 4910 4652Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l’Île-de-Montréal, 950 Louvain Est, Montreal, Quebec H2M 2E8 Canada
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Austin EJ, Gojic AJ, Bhatraju EP, Pierce KA, Pickering EI, Tung EL, Scott JD, Hansen RN, Glick SN, Stekler JD, Connolly NC, Villafuerte S, McPadden M, Deutsch S, Ninburg M, Kubiniec R, Williams EC, Tsui JI. Barriers and facilitators to implementing a Pharmacist, Physician, and Patient Navigator-Collaborative Care Model (PPP-CCM) to treat hepatitis C among people who inject drugs. Int J Drug Policy 2023; 111:103924. [PMID: 36521197 PMCID: PMC9868078 DOI: 10.1016/j.drugpo.2022.103924] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/24/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Direct-acting antivirals (DAAs) offer an unprecedented opportunity to eliminate hepatitis C virus (HCV) infection, yet barriers among people who inject drugs (PWID) remain. Having pharmacists provide care through collaborative drug therapy agreements (CDTAs) offers a promising solution. We developed and piloted a Pharmacist, Physician, and Patient Navigator-Collaborative Care Model (PPP-CCM) which utilized pharmacists to directly deliver HCV care at community organizations serving PWID. We conducted formative evaluation of the PPP-CCM pilot to characterize implementation experiences. METHODS The PPP-CCM was implemented from November of 2020 through July of 2022. Formative evaluation team members observed implementation-related meetings and conducted multiple site visits, taking detailed fieldnotes. Fieldnotes were iteratively reviewed to identify barriers and facilitators to implementation and used to inform 7 key informant interviews conducted with programmatic staff at the end of the pilot. All data were analyzed using a Rapid Assessment Process (RAP) guided by the Consolidated Framework for Implementation Research (CFIR). The formative evaluation team shared results with program stakeholders (pharmacists, physicians, and other site staff) to verify and expand on learnings. RESULTS Evaluation of PPP-CCM revealed 5 themes, encompassing all CFIR domains: 1) PPP-CCM was feasible but challenging to deliver efficiently; 2) the pharmacist role and characteristics (e.g., being flexible, available, and patient-centered) were key to PPP-CCM successes; 3) the PPP-CCM team met challenges engaging patients over time, but some team-based strategies helped; 4) community site characteristics (e.g., existing trusting relationships with PWID and physical space that enabled program visibility) were important contributors; and 5) financial barriers may limit PPP-CCM scale-up and sustainability. CONCLUSION PPP-CCM is a novel and promising approach to HCV care delivery for PWID who may previously lack engagement in traditional care models, but careful attention needs to be paid to financial barriers to ensure scalability and sustainability.
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Affiliation(s)
- Elizabeth J Austin
- Department of Health Systems and Population Health, University of Washington, Seattle WA, United States.
| | - Alexander J Gojic
- Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States
| | - Elenore P Bhatraju
- Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States
| | - Kathleen A Pierce
- Department of Pharmacy, University of Washington, Seattle WA, United States; Kelley-Ross Pharmacy Group, Seattle WA, United States
| | - Eleanor I Pickering
- Department of Social and Behavioral Sciences, Yale School of Public Health, United States
| | - Elyse L Tung
- Department of Pharmacy, University of Washington, Seattle WA, United States; Kelley-Ross Pharmacy Group, Seattle WA, United States
| | - John D Scott
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States
| | - Ryan N Hansen
- Department of Pharmacy, University of Washington, Seattle WA, United States; Kelley-Ross Pharmacy Group, Seattle WA, United States
| | - Sara N Glick
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States; HIV/STD Program, Public Health - Seattle & King County, Seattle WA, United States
| | - Joanne D Stekler
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States
| | - Nancy C Connolly
- Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States
| | - Sarah Villafuerte
- Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)
| | - Madison McPadden
- Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)
| | - Sarah Deutsch
- Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)
| | - Michael Ninburg
- Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)
| | | | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington, Seattle WA, United States; Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle WA, United States
| | - Judith I Tsui
- Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States
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Marchand K, Liu G, Mallia E, Ow N, Glowacki K, Hastings KG, Mathias S, Sutherland JM, Barbic S. Impact of the COVID-19 pandemic on alcohol or drug use symptoms and service need among youth: a cross-sectional sample from British Columbia, Canada. Subst Abuse Treat Prev Policy 2022; 17:82. [PMID: 36550587 PMCID: PMC9774070 DOI: 10.1186/s13011-022-00508-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Concerns about youth alcohol and drug use have risen since the declaration of the global COVID-19 pandemic due to the pandemic's impact on known risk and protective factors for substance use. However, the pandemic's immediate and long-term impact on youths' substance use patterns has been less clear. Thus, this study sought to determine how the COVID-19 pandemic impacted alcohol or drug use and its risk and protective factors among youth accessing integrated youth services. METHODS We conducted a repeated cross-sectional study of patient-reported outcomes data collected between May 2018 and February 2022 among youth (n = 6022) ages 10-24 accessing a provincial network of integrated youth services in Canada. The main exposure of interest was the COVID-19 pandemic (March 2020 - February 2022) compared with a pre-pandemic period (May 2018 - February 2020). As measured by the Global Appraisal of Individual Needs - Short Screener, outcomes included the average number of past month alcohol or drug use symptoms and past month likelihood of service need for alcohol/drug use (moderate/high vs. low need). Interrupted time series (ITS) examined change in average monthly alcohol/drug use symptoms between the pre- and pandemic periods. Stratified multivariable logistic regression investigated how the pandemic modified the effects of established risk/protective factors on likelihood of alcohol/drug use service need. RESULTS Fifty-percent of youth met the criteria for moderate/high likelihood of alcohol/drug use service need, with the odds being 2.39 times (95% confidence interval = 2.04, 2.80) greater during the pandemic compared to the pre-pandemic period. Results from the ITS indicated significant immediate effects of the pandemic on monthly substance use symptoms (p = 0.01). Significant risk/protective factors for service need included exposure to violence, engagement in meaningful activities, and self-rated physical and mental health; and the direction of their effects remained consistent across pandemic and pre-pandemic periods. CONCLUSIONS This study demonstrated that the COVID-19 pandemic corresponded with increased alcohol or drug use among youth accessing integrated services. This signals an urgent need for increased clinical capacity in existing youth services and policies that can respond to risk/protective factors for substance use earlier.
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Affiliation(s)
- Kirsten Marchand
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.17091.3e0000 0001 2288 9830Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.498725.5Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Guiping Liu
- grid.17091.3e0000 0001 2288 9830Centre for Health Services and Policy Research, 201- 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Emilie Mallia
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada
| | - Nikki Ow
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.17091.3e0000 0001 2288 9830Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.498725.5Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Krista Glowacki
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.17091.3e0000 0001 2288 9830Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.498725.5Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Katherine G. Hastings
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.17091.3e0000 0001 2288 9830School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Steve Mathias
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.498725.5Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada ,grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1 Canada
| | - Jason M. Sutherland
- grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.498725.5Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada ,grid.17091.3e0000 0001 2288 9830Centre for Health Services and Policy Research, 201- 2206 East Mall, Vancouver, BC V6T 1Z3 Canada ,grid.17091.3e0000 0001 2288 9830School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Skye Barbic
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.17091.3e0000 0001 2288 9830Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.498725.5Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
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Saffari M, Chang KC, Chen JS, Chang CW, Chen IH, Huang SW, Liu CH, Lin CY, Potenza MN. Temporal associations between depressive features and self-stigma in people with substance use disorders related to heroin, amphetamine, and alcohol use: a cross-lagged analysis. BMC Psychiatry 2022; 22:815. [PMID: 36544132 PMCID: PMC9768939 DOI: 10.1186/s12888-022-04468-z] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Depression is a mental health problem and substance use concerns are socially unacceptable behaviors. While depression and substance use may individually impact self-concept and social relationships, their co-occurrence can increase the risk of self-stigmatization. However, there is no evidence regarding how depression and self-stigma may influence each other over time. The aim of the current study was to evaluate the cross-sectional and longitudinal relationships between features of depression and self-stigma in people with substance use disorders. METHODS Overall, 319 individuals with substance use disorders (273 males) with a mean (± SD) age of 42.2 (± 8.9) years were recruited from a psychiatric center in Taiwan by convenience sampling. They were assessed for features of depression and self-stigma at four times over a period of nine months using the depression subscale of the Depression Anxiety Stress Scales (DASS-21) and Self-Stigma Scale-Short S (SSS-S), respectively. Repeated-measures analyses of variance, Pearson correlations and cross-lagged models using structural equation modeling examined cross-sectional and temporal associations between depression and self-stigma. RESULTS Positive cross-sectional associations were found between depressive features and all assessed forms of self-stigma over time (0.13 < r < 0.92). Three models of cross-lagged associations between different forms of self-stigma and depressive features indicated good fit indices (comparative fit index > 0.98). The direction of associations between depressive features towards self-stigma was stronger than the opposite direction. CONCLUSION Positive associations between depressive features and self-stigma were found in people with substance use disorders. Although these associations may be bidirectional longitudinally, the directions from depressive features to self-stigma may be stronger than the reverse directions, suggesting treatment of depression in earlier stages may prevent self-stigmatization and subsequent poor outcomes in people with substance use disorders.
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Affiliation(s)
- Mohsen Saffari
- grid.411521.20000 0000 9975 294XHealth Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- grid.411521.20000 0000 9975 294XHealth Education Department, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Kun-Chia Chang
- grid.454740.6Department of General Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan
- grid.412040.30000 0004 0639 0054Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan , Taiwan
| | - Jung-Sheng Chen
- grid.414686.90000 0004 1797 2180Department of Medical Research, E-Da Hospital, Kaohsiung, Taiwan
| | - Ching-Wen Chang
- grid.412090.e0000 0001 2158 7670Graduate Institute of Social Work, National Taiwan Normal University, Taipei, Taiwan
| | - I-Hua Chen
- grid.412638.a0000 0001 0227 8151Chinese Academy of Education Big Data, Qufu Normal University, Qufu City, Shandong China
| | - Shih-Wei Huang
- grid.411282.c0000 0004 1797 2113Institute of Environmental Toxin and Emerging Contaminant, Cheng Shiu University, Kaohsiung, 83347 Taiwan
- grid.411282.c0000 0004 1797 2113Center for Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung, 83347 Taiwan
| | - Chieh-hsiu Liu
- grid.416911.a0000 0004 0639 1727Department of Family Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Chung-Ying Lin
- grid.64523.360000 0004 0532 3255Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- grid.412040.30000 0004 0639 0054Biostatistics Consulting Center, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
- grid.64523.360000 0004 0532 3255Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- grid.64523.360000 0004 0532 3255Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Marc N. Potenza
- grid.47100.320000000419368710Department of Psychiatry, Yale School of Medicine, New Haven, CT USA
- grid.414671.10000 0000 8938 4936Connecticut Mental Health Center, New Haven, CT USA
- Connecticut Council On Problem Gambling, Wethersfield, CT USA
- grid.47100.320000000419368710Child Study Center, Yale School of Medicine, New Haven, CT USA
- grid.47100.320000000419368710Department of Neuroscience, Yale University, New Haven, CT USA
- grid.47100.320000000419368710Wu Tsai Institute, Yale University, New Haven, CT USA
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Kang KI, Kang CM. Roles and Effects of Peer Recovery Coach Intervention in the Field of Substance Abuse: An Integrative Literature Review. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:256-264. [PMID: 36243312 DOI: 10.1016/j.anr.2022.10.001] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/01/2022] [Accepted: 10/05/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE There are ongoing public initiatives to help substance abusers by involving peer recovery coaches (PRCs) in the field of substance abuse worldwide. This study examines the contents and delivery methods of PRC intervention programs and their effects from the participants' standpoint. METHODS An integrative literature search was conducted in seven electronic databases using English and Korean search terms. Two researchers independently reviewed the extracted papers and rated their quality based on predetermined inclusion and exclusion criteria, resulting in the selection of nine papers. RESULTS Research on PRC participation in substance abuse treatment were predominantly US-based, and all articles derived were quantitative studies. The main roles of PRCs included liaising between treatment and community resources, assisting with stress management and coping skills, counseling and case management, and recovery and recurrence prevention education. In addition, the PRC-delivered intervention was tested with various outcome variables. It reduced participants' substance use and enhanced their treatment adherence rates, self-efficacy, quality of life, and stress control. CONCLUSIONS This study confirmed the need to extend existing studies by testing the effects of PRC-delivered intervention through multidisciplinary efforts in more regions and establishing PRCs' role definition and concretization. The results of this study will serve as significant basic data in developing and applying for nursing intervention programs with PRCs in clinical and community nursing settings in the future.
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Affiliation(s)
- Kyung Im Kang
- College of Nursing, Institute of Health Sciences, Gyeongsang National University, Republic of Korea.
| | - Chan Mi Kang
- Department of Nursing, Dong-Eui Institute of Technology, Republic of Korea.
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Chen IH, Chang KC, Chang CW, Huang SW, Potenza MN, Pakpour AH, Lin CY. Temporal associations between problematic use of the internet and self-stigma among people with substance use disorders: A cross-lagged model across one year. J Psychiatr Res 2022; 156:339-348. [PMID: 36323137 DOI: 10.1016/j.jpsychires.2022.10.044] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/04/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Self-stigma is a common experience for people with substance use disorders (SUDs). Understanding factors associated with self-stigma may aid in intervention development. This study investigated the reciprocal relationship between three types of problematic use of the internet [PUI; i.e. problematic use of social media (PUSM), problematic smartphone use (PSPU), and problematic gaming (PG)] and self-stigma among people with SUDs. This longitudinal study involved five waves of a survey given to individuals with SUDs in Taiwan. A total of 319 participants (85% male), with a mean age of 42.2 years (SD = 8.9), were recruited. The Smartphone Application-Based Addiction Scale, Bergen Social Media Addiction Scale, Internet Gaming Disorder-Short Form, and Self-Stigma Scale-Short Form were used. No significant associations between PUI and self-stigma were found in early waves (i.e., Waves 1 and 2). The earliest significant finding was identified between Wave 2 PSPU (smartphone) and Wave 3 self-stigma. Additionally, Wave 3 PSPU (smartphone) and PG (gaming) were associated with Wave 4 self-stigma, and Wave 4 PSPU (smartphone), PG (gaming), and PUSM (social media) were associated with Wave 5 self-stigma. Therefore, all three types of PUI (internet) may elevate self-stigma at different time points for individuals with SUDs. However, the reciprocal effects between self-stigma and PUI (internet) only occurred in PUSM (social media) at a later stage (i.e., from Wave 4 to Wave 5). In conclusion, people with SUDs who have PUI (internet) are at increased likelihood of developing more self-stigma, which may then increase subsequent PUSM (social media), forming a vicious cycle.
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Affiliation(s)
- I-Hua Chen
- Chinese Academy of Education Big Data, Qufu Normal University, Qufu City, Shandong, China.
| | - Kun-Chia Chang
- Department of General Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan; Department of Natural Biotechnology, Nan Hua University, Chiayi, Taiwan.
| | - Ching-Wen Chang
- Graduate Institute of Social Work, National Taiwan Normal University, Taipei, Taiwan.
| | - Shih-Wei Huang
- Institute of Environmental Toxin and Emerging Contaminant, Cheng Shiu University, Kaohsiung, 83347, Taiwan; Center for Environmental Toxin and Emerging-contaminant Research, Cheng Shiu University, Kaohsiung, 83347, Taiwan.
| | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA; Child Study Center, Yale School of Medicine, New Haven, CT, USA; Department of Neuroscience, Yale University, New Haven, CT, USA; Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Amir H Pakpour
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Balayssac D, Pereira B, Julien E, Chennell P, Brousse G, Laporte C, Authier N, Vennat B. Attitude of community pharmacists toward patients with a substance-related disorder (heroin, alcohol and tobacco), estimation of harmfulness and knowledge of these substances, and continuing education: A pilot cross-sectional study. Ann Pharm Fr 2022; 80:897-905. [PMID: 35667462 DOI: 10.1016/j.pharma.2022.05.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/11/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate attitude of community pharmacists toward patients with a substance-related disorder (heroin, alcohol and tobacco). MATERIAL AND METHODS The attitudes were assessed thanks to the Attitude to Mental Illness Questionnaire (AMIQ) for heroin, alcohol and tobacco-related disorders in three independent groups of pharmacists. Estimation of substance-related harmfulness, knowledge of substance-related disorders and activities/needs for continuing education on substance-related disorders were also recorded. RESULTS Thirty-five pharmacists were included (heroin: 11, alcohol: 10 and tobacco: 14). AMIQ scores for heroin-related disorder were negative and lower than for alcohol (P<0.01) and tobacco (P<0.001). AMIQ scores for alcohol-related disorder were lower than for tobacco (P<0.05). The estimation of heroin-related harmfulness was higher than for alcohol and tobacco (P<0.001). The estimations of knowledge of substance-related disorders were lower for opioid and alcohol than for tobacco (P<0.001). AMIQ scores and the needs for continuing education on each associated addiction showed a positive relation (P<0.01). CONCLUSION Pharmacists had a negative attitude toward heroin and alcohol-related disorders. A positive attitude toward patients with a substance-related disorder was associated with a need for continuing education. Efforts should be made to change attitudes and to promote continuing education on heroin and alcohol-related disorders.
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Affiliation(s)
- D Balayssac
- Inserm U1107, NEURO-DOL, direction de la recherche clinique et de l'innovation, CHU de Clermont-Ferrand, université Clermont-Auvergne, 63000 Clermont-Ferrand, France.
| | - B Pereira
- Direction de la recherche clinique et de l'innovation, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - E Julien
- Université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - P Chennell
- Service de pharmacie, CNRS, Sigma Clermont, ICCF, CHU de Clermont-Ferrand, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - G Brousse
- EA7280, service de psychiatrie B et d'addictologie, UFR de médicine, CHU de Clermont-Ferrand, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - C Laporte
- Département de médecine générale, EA7280, UFR de médicine, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - N Authier
- Inserm U1107, NEURO-DOL, service de pharmacologie médicale, CHU de Clermont-Ferrand, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - B Vennat
- ACCePPT, UFR de pharmacie, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
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Ramazani Y, Nemati A, Moshiri M, Motie MR, Jomehpour H, Etemad L. Gastric Obstruction by Opium Packets: A Case Report. Addict Health 2022; 14:309-311. [PMID: 37559790 PMCID: PMC10408747 DOI: 10.34172/ahj.2022.1336] [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] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/08/2022] [Indexed: 08/11/2023]
Abstract
BACKGROUND We reported a case of gastric obstruction in a body packer who swallowed a large number of opium packets. CASE REPORT A 36-year-old man opium addict visited the emergency department with epigastric pain for three days. He swallowed nearly 90 packets of opium for smuggling purposes four days earlier. He self-administered laxatives. In contrast, many times vomiting, he defecated only four packets and vomited one packet. The abdominal X-rays showed some amounts of fluid-air levels and multiple cylindrical opacities with the double-condom sign, corresponding to the distended stomach. Due to the worsening of his abdominal symptoms, he underwent an urgent laparotomy and 84 packets (4-6 cm in size and 8-10 g/ packet of opium) with a total weight of 870 g. They were wrapped in some layers of plastic and tied at the ends. He was discharged in stable condition. CONCLUSION A large number of ingested drug packets can induce gastrointestinal obstruction.
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Affiliation(s)
- Yeganeh Ramazani
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmad Nemati
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Moshiri
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Clinical Toxicology and Poisoning, Imam Reza (p) Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Motie
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Leila Etemad
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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