Misuse of alprazolam among people who inject drugs: A prescription for harm?

Abstract

s / Drug and Alcohol Dependence 146 (2015) e202–e284 e233 Longitudinal trajectories of disinhibitory personality and behavioral constructs across early to middle adolescence Victoria Brown, Anahi Collado, Julia Felton, Julia M. Shadur, Laura MacPherson, Carl W. Lejuez Psychology, University of Maryland, College Park, College Park, MD, United States Aims: Adolescent substance use and abuse show associations with increases in disinhibitory constructs, including sensation seeking (SS), risk taking propensity (RTP), and impulsivity. However, the trajectories of these constructs from early to middle adolescence remain largely unexplored. We aimed to provide an investigation of the course of these disinhibitory constructs from early to middle adolescence. In doing so, we examined race and gender in relation to construct changes over time. Methods: The studyconsistedof277early adolescents recruited as part of a 5-year longitudinal study (44% girls; 49% White, 35% Black; Mage at first wave=11.00). RTP, impulsivity, and SS were assessed using well-established assessments including the Balloon Analogue Risk Task – Youth version, Eysenck Impulsivity Subscale version, and the Brief Sensation Seeking Scale, respectively. Followup assessments were conducted annually for 5 consecutive years. Results: Hierarchical Linear Modeling analyses showed that sensation seeking increased in a linear fashion (B=0.83, SE =0.37, p=0.03), whereas RTP and impulsivity demonstrated curvilinear changes (B=−0.80, SE =0.18, p<0.001 and B=−0.32, SE =0.08, p< .001, respectively). Specifically, RTP increased in the first four waves of assessment but did not show changes at the last assessment wave. Impulsivity, on the other hand peaked at wave four before subsequently declining. A comparison between females and males and Black and White adolescents suggested that these groups’ trajectories were similar. Conclusions: These findings replicate and extend earlier work indicating that these risk factors increase across early adolescence and begin to level-off during middle adolescence. Understanding the natural course of these disinhibitory core constructs is critical in directing future work on the prevention and intervention of adolescent substance use and abuse. Financial support: University of Maryland, College Park. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.100 Misuse of alprazolam among people who inject drugs: A prescription for harm? Raimondo Bruno1,2, Siobhan Reddel3, Paul Dietze3, Barbara de Graaff1, Suzanne Nielsen2, Lucy Burns2 1 School of Medicine, University of Tasmania, Hobart, TAS, Australia 2 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia 3 Burnet Institute, Centre for Population Health, Melbourne, VIC, Australia Aims: Alprazolam prescriptions have dramatically increased in Australia, with use doubling in a decade (6 DDD/1000 population/day in 2011). Due to increased morbidity in overdose and evidenceofmisuse, alprazolamwill beplaced in ahigher regulatory schedule than other benzodiazepines from 2014. We aim to examine the extent of alprazolamuse in an Australian national sample of peoplewho inject drugs, and to determinewhether alprazolamuse is associated with harms beyond that associated with use of other benzodiazepines. Methods: Cross-sectional face-to-face interviews with 1599 frequent (at least monthly) injecting drug consumers (IDU) in 2011–12. Results: In the preceding six months, 36% reported no benzodiazepine use, 24% benzodiazepines other than alprazolam; and 41% reported illicit alprazolam use. One-fifth (23%) reported daily benzodiazepine use. Eight percent had recently injected benzodiazepines, typically this was alprazolam (7%). Multivariate regression models, controlling for demographics, demonstrated that, compared to those who had used non-alprazolam benzodiazepines, IDU that did not take benzodiazepines had higher levels of physical andmental functioning (SF-12). Compared to IDU using other benzodiazepines, alprazolamusersweremore likely engaged with opiate substitution treatment (AOR1.54), to havepoorermental health (SF-12), and to have committed crime in the past month (AOR 1.62) or been arrested (AOR 1.75). Hierarchical regression modelling demonstrated that the association between extent of alprazolam use and crime remained even after controlling for the extent of use of all other types of benzodiazepines. Conclusions: Alprazolam is associated with incrementally greater harm than other benzodiazepines. Given this, its attractiveness to IDU, and the absence of additional therapeutic benefit over other drugs in this class, particular caution to its use in this population is warranted. Financial support: Australian Government Department of Health and Ageing. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.101 Reproductive health needs among drug treatment clients Marthe Bryant-Genevier1, Lindsay Appel1, Katrina D. Mark1, Mishka Terplan1,2 1 Obstetrics Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, United States 2 Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United