Abuse Of Other Drugs Research Articles

From the party to the therapy – MDMA as an alternative for the existing methods of Post-traumatic Stress Disorder treatment

Introduction: Post-traumatic Stress Disorder (PTSD) is a mental illness caused by exposure to a traumatic event. The current treatment includes trauma-focused psychotherapy along with selective serotonin reuptake inhibitors (SSRI). It is estimated that for about 40-60% of patients it does not bring the desired improvement, which prompted scientists to look for new methods of pharmacotherapy. The most promising compound is MDMA. Material and methods: The purpose of this paper is to review publications from years 2020-2022 available on the PubMed platform about using MDMA in PTSD treatment, using words: MDMA, PTSD, MDMA and PTSD. Discussion: MDMA (3,4-methylenedioxymethamphetamine) is a psychoactive substance that increases brain levels of serotonin, dopamine and norepinephrine. Studies show that this treatment reduces symptoms of severe PTSD, comparing to placebo and current treatment. Patients reported improvement in terms of well-being, number of nightmares, sleep disorders, self-perception or interpersonal relationships. The positive effects of MDMA therapy were long-lasting. They persisted for 12 months after the end of treatment. According to research, MDMA reduces the symptoms of concomitant disorders, e.g. of eating disorders or by reducing alcohol consumption, without increasing the risk of abuse of other substances or MDMA itself. In addition, MDMA is believed to improve psychotherapy by allowing patients to revisit the traumatic event without negative symptoms. Side effects of therapy are less serious and occur less often than in the case of previously used SSRIs. Conclusions: Abovementioned observations show that MDMA-assisted PTSD psychotherapy is a promising alternative to the existing methods and brings hope for patients with the most severe or treatment-resistant course. Keywords: MDMA, N-Methyl-3,4-methylenedioxyamphetamine, MDMA-assisted psychotherapy, PTSD

Alprazolam

Although alprazolam is approved only for use in panic disorder and generalized anxiety disorder, it is used for numerous other conditions, not only by psychiatrists but also by medical professionals in general. This commentary critically analyzes the use of alprazolam. A narrative review approach was adopted, using relevant articles and textbooks, to compile pertinent literature for the aforementioned topic. Among all its adverse reactions, the most bothersome concern about the use of alprazolam is its potential for abuse and dependence. This can be attributed to certain unique pharmacokinetic and pharmacodynamic properties of this benzodiazepine. Also, the withdrawal triggered by use of alprazolam is challenging to treat. Alternate pharmacological and non-pharmacological strategies for use in anxiety and insomnia are available, which might be safer than alprazolam. Also, policy changes can serve as an answer to curb alprazolam abuse to some extent. Alprazolam might still be a good choice for individuals who do not have a history of abuse of other substances, with adequate psychoeducation and close monitoring of their usage pattern. There is a need to reconsider the need for long-term use of benzodiazepines in general, and alprazolam in particular. However, they still might be an appropriate choice in individuals where abuse and dependence are less likely.

ETHER - a partially forgotten anesthetic

INTRODUCTION: Ether is the common name for diethylether (CH3-CH2-O-CH2-CH3). It is a colorless, volatile and highly flammable liquid with a characteristic pungent odor. It was widely used as an anesthetic in the past and is now a component of solvents. 
 PURPOSE OF THE WORK: The purpose of this paper is to introduce ether as a potentially forgotten substance in the world of Western medicine. Its history, current use, potential for abuse for narcotic purposes, addiction, and the benefits of anesthesia with this agent in impoverished countries.
 DESCRIPTION OF THE STATE OF KNOWLEDGE: Ether was first synthesized in 1540 by Valerius Cordus. Ether is characterized by rapid absorption, rapid distribution in the central nervous system and rapid, short-lasting effects. Ether has high solubility in blood/gas, which slows both induction and recovery of anesthesia. In developing countries, it is suggested that ether be used as an intraoperative analgesia. But it should be remembered, despite the new psychoactive substances, other inexpensive and readily available intoxicants can be found, among them ether. It has been noted in numerous publications that abuse of ether is associated with abuse of other drugs and/or alcohol dependence.
 SUMMARY: It is important to remember that ether compounds are widespread. People struggling with the urge to abuse substances can get these substances easily and cheaply. On the other hand, ether anesthesia is a great solution for developing countries. There are situations there that due to lack of funds, some operations are carried out without anesthesia. Ether is cheap, and administering anesthesia with it is quite simple, and could give wonderful relief to these patients.

Forensic Toxicology Analysis of Suicidal Hanging Deaths in Eastern Province-Saudi Arabia

Background: Suicide is a multifaceted phenomenon with multiple underlying risk factors, including alcoholand/or abuse of other drugs and psychiatric illnesses. Toxicological analysis is of crucial importance even inhanging deaths where the cause of death seems to be ‘obvious’. Objective: To investigate hanging suicidedeaths, focusing on toxicological findings in their postmortem specimens, over a period of six years in theEastern Province, Saudi Arabia. Methods: The suicidal hanging deaths in the period from 2014 to 2019were retrospectively studied from autopsy and toxicology analysis reports. Results: Of the investigated 75hanging suicides, 64 (85.3%) were males and 11 (14.7%) were females. Most of the cases were in the agegroup between 31 and 40 years of age (36%). Non-Saudi nationals (57, 76%) much prevailed over Saudipeople (18, 24%) and the highest is the Indian population (27, 36%), followed by Saudi nationals (18, 24%).Ethanol was the commonest detected substance in the studied specimens (45, 60%). Cannabis ranked thesecond (14, 18.6%) followed by antipsychotic drugs (10, 13.3%) and amphetamine (7, 9. 3%).Conclusion:The precise statistical mortality database for hanging suicides deaths may provide a valuable evidence forthe importance of postmortem toxicology analysis and the role of alcohol and its effect on the aggressivebehavior, human health and mortality. In the current study, Ethanol was the highest detected substance in thestudied specimens (45, 60%), with predominance of non-Saudi Indian males.

Establishing the content validity of the Prescription Opioid Misuse and Abuse Questionnaire (POMAQ) among chronic pain patients

Objectives Content validation is essential in the development of patient-reported instruments to ensure relevancy and understandability. The aim was to evaluate patient understanding of the Prescription Opioid Misuse and Abuse Questionnaire (POMAQ) using cognitive interviewing among adults with chronic moderate to severe pain. Methods This qualitative study involved a one-time in-clinic visit to conduct one-on-one cognitive interviews among participants with chronic moderate to severe pain from four groups: (1) Known Opioid Abuse; (2) Known Abuse of Other Substances (e.g. alcohol, benzodiazepines); (3) Opioid Non-abuse; and (4) No Chronic Opioid Use. Patients were recruited from 6 US clinical centers. Concept elicitation questions regarding misuse and abuse were asked at interview start; the POMAQ was completed via a web interface followed by a cognitive interview regarding POMAQ items and response options. Results 56 patients were enrolled. Mean age was 48.7 ± 12.3 years; 57% female; 80% Caucasian; mean duration of chronic pain was 11.2 ± 8.2 years with lower back pain predominating at 75%. Overall, the POMAQ was well-understood and received positive feedback. A few (n = 6, 11%) expressed concerns about completing the POMAQ using a secure internet site as they either indicated they were not computer savvy (n = 3, 5%) or were concerned about internet security (n = 3, 5%). Minor wording modifications were made to the POMAQ to enhance clarity and understanding of the POMAQ. Conclusions The POMAQ demonstrated content validity among patients with moderate to severe chronic pain and is undergoing psychometric evaluation among a larger cohort of patients.

Acute Nicotine Exposure Alters Ventral Tegmental Area Inhibitory Transmission and Promotes Diazepam Consumption.

Nicotine use increases the risk for subsequent abuse of other addictive drugs, but the biological basis underlying this risk remains largely unknown. Interactions between nicotine and other drugs of abuse may arise from nicotine-induced neural adaptations in the mesolimbic dopamine (DA) system, a common pathway for the reinforcing effects of many addictive substances. Previous work identified nicotine-induced neuroadaptations that alter inhibitory transmission in the ventral tegmental area (VTA). Here, we test whether nicotine-induced dysregulation of GABAergic signaling within the VTA increases the vulnerability for benzodiazepine abuse that has been reported in smokers. We demonstrate in rats that nicotine exposure dysregulates diazepam-induced inhibition of VTA GABA neurons and increases diazepam consumption. In VTA GABA neurons, nicotine impaired KCC2-mediated chloride extrusion, depolarized the GABAA reversal potential, and shifted the pharmacological effect of diazepam on GABA neurons from inhibition toward excitation. In parallel, nicotine-related alterations in GABA signaling observed ex vivo were associated with enhanced diazepam-induced inhibition of lateral VTA DA neurons in vivo. Targeting KCC2 with the agonist CLP290 normalized diazepam-induced effects on VTA GABA transmission and reduced diazepam consumption following nicotine administration to the control level. Together, our results provide insights into midbrain circuit alterations resulting from nicotine exposure that contribute to the abuse of other drugs, such as benzodiazepines.

Assessment of sexual behaviour and fertility indices in male rabbits following chronic codeine use.

Codeine is the latest trend of drug abuse, particularly in Nigeria and regarded as the gateway to the abuse of other substances. The present study examined the effects of graded doses of codeine on sexual behaviour and fertility profile. Rabbits were either administered normal saline (0.2mL), 4mg/kg b.w of codeine (low dose), or 10mg/kg b.w of codeine (high dose) p.o for 6weeks. Findings of the study showed that codeine administration significantly increased libido as witnessed by significantly short mount latency (ML), intromission latency (IL), post-ejaculatory interval (PEI) and significantly increased mount frequency (MF), intromission frequency (IF) and ejaculation latency (EL). Furthermore, codeine caused a marked rise in penile reflexes evident by a significant increase in erections, quick flips, long flips and total penile reflexes. However, copulatory efficiency and fertility index were significantly lower in codeine-treated groups when compared with the control. Serum levels of testosterone were also significantly lower in the treated groups. The present study demonstrates that codeine-induced enhancement of sexual performance is via a testosterone-independent mechanism. It also reveals that although codeine enhances copulatory locomotor activity, it is a potential risk factor for infertility.

38 - GENOME-WIDE META-ANALYSIS OF >14,000 ALCOHOL DEPENDENT INDIVIDUALS HIGHLIGHTS PSYCHIATRIC COMORBIDITIES

Background Excessive alcohol use is a leading contributor to morbidity and mortality. 12% of drinkers meet criteria for Alcohol Dependence (AD), a serious psychiatric disorder characterized by tolerance, withdrawal, loss of control over drinking and excessive alcohol consumption despite negative consequences. Alcohol Dependence (AD) is heritable and previous studies have implicated functional variants in alcohol dehydrogenase genes ADH1B and ADH1C and loci elsewhere (with less support), but relatively little is known about the full polygenic architecture of AD. Methods Genotype data were collected for 12,798 individuals with alcohol dependence (DSM-IV diagnosis or equivalent) and 29,087 controls from 22 studies. Each study was strictly QCed, stratified by ancestry (N=35,605 European ancestry, 6,208 African ancestry), and imputed using standardized pipelines for case/control (N=16,296) and family-based (N=22,912) cohorts. GWAS were performed for each cohort, with family-based studies analyzed using generalized estimating equations (GEE) or logistic mixed models to control for family structure as appropriate. Results were then aggregated in genome-wide meta-analysis along with summary statistics from 5 additional studies (total 14,519 cases, 37,295 controls for meta-analysis). We evaluated heterogeneity by sex, ethnicity (European vs. African ancestry), and study ascertainment (case/control vs. family-based). In addition to the primary GWAS, we characterize the genome-wide pattern of results through analysis of partitioned heritability and genetic correlation with AD-related traits using LD score regression, using the European ancestry cohorts. Results In initial results, one locus reached genome-wide significance (ADH1B rs1229984, p=1.8e-11), replicating previous work. We applied trans-ethnic meta-analysis models to improve fine-mapping of variants in the region. Different lead variants in the ADH1B locus between the European and African ancestry analyses are observed and are consistent with differences in allele frequency and linkage disequilibrium rather than effect size. There was little evidence for genome-wide heterogeneity of effects by sex, ethnicity, or study design. Comparing the GWAS of AD to related traits identified significant genetic correlation with several psychiatric disorders, including schizophrenia (rg=.36, p=2.4e-10), ADHD (rg=.44, p=.0003), and depressive symptoms (rg=.60, p=6.1e-7). The results are also strongly correlated with GWAS of alcohol consumption (rg=.71, p=6.8e-6), and use of cigarettes (rg=.58, p=2.5e-6) and cannabis (rg=.73, p=.003). Similar to other psychiatric disorders, partitioned heritability analysis suggests that common variant risk for AD is strongly enriched in evolutionarily conserved regions of the genome (28-fold enrichment, p=.008). Discussion To our knowledge, the current results represent the largest GWAS of DSM-IV AD to date. In addition to replicating previous associations with ADH1B, suggestive evidence for association of AD with a novel intergenic locus on chromosome 3 is awaiting replication. The genetic correlation results strongly suggest substantial overlap in genetic risk with other psychiatric disorders and with use and abuse of other substances.

The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research

The National Academies of Sciences, Engineering, and Medicine has published “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research,” which summarizes available scientific literature on the therapeutic effects of cannabis, other health effects, cannabis use and abuse and research opportunities. The 468-page book serves as an excellent initial source on the current state of research and provides summaries and recommendations for further research on a number of topics. While not exhaustive, this resource provides an excellent starting place for medical regulators, who face a complex landscape of often-confiicting information when addressing the topic of cannabis for medical use. It is a remarkably approachable, well-organized snapshot of the current state of research on these topics.Particularly helpful for the clinician is the section on the therapeutic effects of cannabis, including a summary of current research and strength of recommendations for cannabis use in the treatment of 21 medical conditions. These topics range from chronic pain to Huntington's Disease and Schizophrenia. As with all sections, the authors provide here an identification of research gaps, a summary and references to primary literature. This section is particularly useful for helping guide policy decisions, as in many state and local jurisdictions there is vigorous debate regarding the expansion of medical indications for cannabis. The references to medical literature (both primary literature and systematic reviews) provide insight into which conditions likely are benefited by the use of cannabis. For example, the authors note that oral cannabinoids are found to be modestly effective antiemetics for chemotherapy-induced nausea and vomiting and patient-reported spasticity in multiple sclerosis patients. However, they also acknowledge that there is “insufficient evidence to support the conclusion that cannabinoids are an effective treatment for cancers, including glioma.”For medical regulators, the section on other health effects of cannabis is particularly helpful. Here, regulators will find in-depth discussion of current literature on a variety of topics, including cannabis and its effect on cancer, cardio-metabolic risk, respiratory disease and immunity. Notable is a summary of cancer risks associated with cannabis use. Interestingly, there is limited evidence of a statistical association with cannabis use and germ cell tumors, but not esophageal or lung cancers. From a public health perspective, topics also include associated abuse of other drugs and association with injury and death.In keeping with the well-organized nature of this work, each chapter concludes with a single-page highlighted “Summary of Chapter Conclusion.” For the busy reader, this summary provides an evidence-based summary of the topic in bullet-point format.Finally, the book touches on cannabis research priorities, noting that they should include population-health impacts, basic science studies regarding harms and benefits and social effects on behavioral change. Challenges and barriers to research include regulatory and supply issues, funding issues and policy divides between state and federal regulations. While this section is likely most applicable to researchers and universities, it provides a glimpse of likely future work to be done.Recognizing that regulatory and policy decisions are undertaken after careful consideration of many available information sources, this reference book is a very valuable addition to discussions regarding cannabis for medical use. By collecting and summarizing — and critiquing by level of evidence — currently available research, this work fills a need for an approachable and organized reference.

Substance Abuse Among Medical Students – A Survey in a Medical College in Nepal

Introduction: Substance use among medical students could impact on the conduct, safety and efficiency of future doctors. Despite serious medico legal, ethical and political ramifications, there is paucity of published article on the subject, especially from Nepal.
 Objective: We aimed to explore the patterns of substance abuse among a sample of Medical students from Nepalgunj Medical College.
 Materials and Methods: A cross-sectional survey of medical students from Nepalgunj Medical College was done using a brief questionnaire schedule to identify current and lifetime use of tobacco, alcohol, cannabis and abuse of other drugs. An operational definition of substance abuse was made, 28 % of students fell within that criterion.
 Results: Male substance abusers 81% exceeded female abusers 19%. Substances most commonly abused were alcohol 60%, minor tranquilizers 48%, and tobacco 35%, and only 11% abused cannabis. While most students were multidrug users, there was a low frequency of daily drug use. A general lifetime (occasional use) prevalence of substance use of 56% was found. Drugs consumed on a daily basis were alcohol 2% and tobacco 6%. The prevalence of drug use was highest among the fourth and final year students.
 Conclusion: The majority of students were occasional abusers; there was no evidence of physical dependence. This study provides a snapshot of the problem of substance use among medical students of Nepal. Further research is needed to study nationwide patterns of substance use among medical students, and to identify important determinants and reinforce preventive measures. Strategies need to be developed for supporting students with a substance use problem.

Complicaciones del uso de la heroína parenteral: artículo de revisión

This literature review sought to collect information on complications of parenteral use of heroin. Scientific articles, reviews, and case reports were selected from Scielo, Lilacs, and Medline databases. Heroin is a psychoactive substance and its use has mental and physical health consequences; among the most common physical consequences are blood-borne infectious diseases such as HIV, hepatitis B and C, skin infections, tuberculosis, pulmonary embolism, and renal disease. Other frequent complications include mental disorders, such as depression, personality disorders, and the concomitant abuse of other substances, such as cannabis and cocaine. It is important for nurses to be aware of the complications of heroin use in order to plan comprehensive processes and develop nursing programs that reduce the risks and harm resulting from use of the substance.

Repeated transcranial direct current stimulation reduces food craving in Wistar rats

It has been suggested that food craving—an intense desire to consume a specific food (particularly foods high in sugar and fat)—can lead to obesity. This behavior has also been associated with abuse of other substances, such as drugs. Both drugs and food cause dependence by acting on brain circuitry involved in reward, motivation, and decision-making processes. The dorsolateral prefrontal cortex (DLPFC) can be activated following evocation and is implicated in alterations in food behavior and craving. Transcranial direct current stimulation (tDCS), a noninvasive brain stimulation technique capable of modulates brain activity significantly, has emerged as a promising treatment to inhibit craving. This technique is considered safe and inexpensive; however, there is scant research using animal models. Such studies could help elucidate the behavioral and molecular mechanisms of eating disorders, including food craving. The aim of our study was to evaluate palatable food consumption in rats receiving tDCS treatment (anode right/cathode left). Eighteen adult male Wistar rats were randomized by weight and divided into three groups (n = 6/group): control, with no stimulation; sham, receiving daily 30 s tDCS (500 μA) sessions for 8 consecutive days; and tDCS, receiving daily 20 min tDCS (500 μA) sessions for 8 consecutive days. All rats were evaluated for locomotor activity and anxiety-like behavior. A palatable food consumption test was performed at baseline and on treatment completion (24 h after the last tDCS session) under fasting and feeding conditions and showed that tDCS decreased food craving, thus corroborating human studies. This result confirms the important role of the prefrontal cortex in food behavior, which can be modulated by noninvasive brain stimulation.

Residential and outpatient treatment completion for substance use disorders in the U.S.: Moderation analysis by demographics and drug of choice

BackgroundThis study investigates the impact of residential versus outpatient treatment setting on treatment completion, and how this impact might vary by demographic characteristics and drug of choice, using a national sample of publicly funded substance abuse programs in the United States. MethodsThis is a retrospective analysis using data extracted from the 2011 Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Episode Data Set (TEDS-D). A total of 318,924 cases were analyzed using logistic regression, fixed-effects logistic regression, and moderated fixed-effects logistic regression. ResultsResidential programs reported a 65% completion rate compared to 52% for outpatient settings. After controlling for other confounding factors, clients in residential treatment were nearly three times as likely as clients in outpatient treatment to complete treatment. The effect of residential treatment on treatment completion was not significantly moderated by gender, but it was for age, drug of choice, and race/ethnicity. Residential compared to outpatient treatment increased the likelihood of completion to a greater degree for older clients, Whites, and opioid abusers, as compared to younger clients, non-Whites, and alcohol and other substance users, respectively. ConclusionWe speculate that for opioid abusers, as compared to abusers of other drugs, residential treatment settings provide greater protection from environmental and social triggers that may lead to relapse and non-completion of treatment. Greater use of residential treatment should be explored for opioid users in particular.

Mandatory toxicological examination: controversies

The United Nations has declared the period from 2011 to 2020 as the Decade of Action for Traffic Safety. The World Health Organization indicates that in most Latin America countries, alcohol consumption is responsible for about 8% of all existing diseases. Worldwide 35% to 50% of all serious vehicule crashes are alcohol related (JORGE, ADURA, 2012-2013). Brazil has a practical system of control to catch drunk drivers, while the abuse of other substances while driving have passed unscathed. Legal and documentary research. Samples shall be taken from hair, or in cases of alopecia, fingernails to be used for screening the Radioimmunoassay and enzyme immunoassay. In Brazil, the National Traffic Council determined a wide toxicology system of detection for consumption of psychoactive substances in the occasion of the medical exam to the obtainment of the professional driver’s license. The medical expert should consider the candidate unfit temporarily for vehicular driving, in case the examination accuses abuse of the following substances: marijuana, cocaine, crack, heroin, opiates, ecstasy or other substances that impair the drivers performance.The Brazilian Association of Traffic Medicine is against this resolution. Through an extensive review of the scientific literature, they could not find any study to justify the need of mandatory substance abuse assessment for drivers or applicants when undergoing the medical exam. The adequacy of this resolution is controversial. Currently, toxicological analysis of substances that alter the performance of the driver are used worldwide in addition to other actions such as checking the medical condition of the driver. A stricter control of the traffic laws should provide greater effectiveness in reducing road accidents.

Visual Hallucinations in Psychiatry's Interconsultation: Charles Bonnet Syndrome

Sometimes psychiatrists don't take account in medical issues in psychiatric patients although it is a classical item we should deal with in everyday practice. One of more interesting issues in psychiatry are visual hallucinations. We report a case about a 49 years old man patient without psychiatric antecedents and visual hallucinations which had started suddenly, so that we reviewed literature about somatic illnesses with visual hallucinations. This patient had a visual disability caused by glaucoma, he didn't have any other psychotic symptomatology, had reality judgment preserved and criticized properly this hallucinations. Finally he was diagnosed of Charles Bonnet syndrome and his symptomatology remitted with Risperidone, but a few weeks later the patient presented some side effects, so that it was necessary to change to Aripiprazole with better response and sustained remission. Charles Bonnet syndrome is characterized by complex, recurrent or persistent visual hallucinations in visually impaired individuals without cognitive or psychiatric disorders. It mainly affects elderly patients affected by macular degeneration associated with age, glaucoma or cataracts but can be found also in some psychiatric and neurological disorders such as abuse of alcohol (delirium tremens) or abuse of other substances, dementia, narcolepsy or long-term sleep deprivation, epilepsy, Parkinson's disease, brain tumors, migraine or even infection by Epstein-Barr virus in mononucleosis. It is considered that this phenomenology represents cortical release phenomena due to deafferentation of visual association areas of the cerebral cortex.

Marijuana and Psychosis: The Effects of Adolescent Abuse of Marijuana and other Drugs in a Group of Forensic Psychiatric Patients

The use of cannabis, in the form of marijuana and related products, has been on the increase in the US and elsewhere in recent years; a significant proportion of this increase stems from use by adolescents of age 17 or less [1]. Abuse of other drugs, such as Ecstasy (methylenedioxy methamphetamine), PCP (phencyclidine), cocaine, opiates and various hallucinogenic compounds), has also been on the rise, especially in young persons. Some have considered cannabis as a “gateway” to abuse of these other drugs [2], though such an evolution is by no means inevitable, since there are other users of cannabis who do not expand their range to include some of the other compounds.

Prescription drug abuse: from epidemiology to public policy

Prescription drug abuse has reached an epidemic level in the United States. The prevalence of prescription drug abuse escalated rapidly beginning in the late 1990s, requiring a significant increase in research to better understand the nature and treatment of this problem. Since this time, a research literature has begun to develop and has provided important information about how prescription drug abuse is similar to, and different from the abuse of other substances. This introduction to a special issue of the Journal of Substance Abuse Treatment on prescription drug abuse provides an overview of the current status of the research literature in this area. The papers in this special issue include a sampling of the latest research on the epidemiology, clinical correlates, treatment, and public policy considerations of prescription drug abuse. Although much has been learned about prescription drug abuse in recent years, this research remains in early stages, particularly with respect to understanding effective treatments for this population. Future research priorities include studies on the interaction of prescription drugs with other licit and illicit substances, the impact of prescription drug abuse across the lifespan, the optimal treatment for prescription drug abuse and co-occurring conditions, and effective public policy initiatives for reducing prescription drug abuse.

Pain management perceptions among prescription opioid dependent individuals

BackgroundNearly two-thirds of prescription opioid dependent individuals report chronic pain conditions as both an initial and current motivation for prescription opioid use. However, to date, limited information exists regarding perceptions of the adequacy of pain management and pain management behaviors among prescription opioid dependent individuals with a history of treatment for chronic pain. MethodsThe current study examined perceptions of the medical management of chronic pain among community-recruited individuals (N=39) who met DSM-IV-TR criteria for current prescription opioid dependence and reported a history of treatment for chronic pain. Prescription opioid dependence, symptoms of depression, and pain management perceptions were assessed using the Structured Clinical Interview for DSM disorders, Beck Depression Inventory, and the Pain Management Questionnaire, respectively. ResultsReports of insufficient pain management were common (46.2%), as was utilization of emergency room services for pain management (56.4%). Nearly half reported a physician as their initial source (46.2%) and pain management as their primary initial reason for prescription opioid use (53.8%), whereas 35.9% reported pain relief as their primary reason for current prescription opioid use. Symptoms of depression were common (51.3%), as was comorbid abuse of other substances and history of treatment for substance abuse. ConclusionsResults highlight the complicated clinical presentation and prevalent perception of the under-treatment of pain among this population. Findings underscore the importance of interdisciplinary approaches to managing the complex presentation of chronic pain patients with comorbid prescription opioid dependence. Implications for future research are discussed.

Risk Factors for Drug-Resistant Tuberculosis

Objective: Drug resistance is considered one of the main threats for tuberculosis control. Our aim was to identify risk factors for drug resistance in tuberculosis patients in the Northern Portugal. Study Design and Methods: Retrospective case-control study. The medical records and drug susceptibility test data from TB patients diagnosed between 31 March 2009 and 1 April 2010 were examined. We enrolled 119 patients with any drug resistance to first line anti-TB drugs and 238 with drug-susceptible TB, matched by age group. Variables analyzed included: gender, country of origin, employment situation, site of disease, previous treatment, presence of diabetes mellitus, HIV infection, alcohol abuse, intravenous drug use, abuse of other drugs and smoking habits. Multivariate conditional logistic regression was used to identify independent predictors for drug-resistant TB. Results: Diabetes mellitus [adjusted odds ratio (OR): 3.54; 95% CI: 1.45 - 8.66], intravenous drug use (OR: 4.77; 95% CI: 1.24 - 18.32) and previous TB treatment (OR: 2.48; 95% CI: 1.12 - 5.49) were found to be risk factors for drug-resistant disease development. Conclusions: Diabetes mellitus, prior tuberculosis treatment, and intravenous drug use were risk factors for drug-resistant disease. The association between diabetes and drug-resistant TB should be further explored. Identifying clinical predictors of drug resistance can allow prompt identification of patients at risk for drug-resistant TB.

Toxicology findings in suicides: Concentrations of ethanol and other drugs in femoral blood in victims of hanging and poisoning in relation to age and gender of the deceased

Over-consumption of alcohol and/or abuse of other drugs are closely linked to attempted or completed suicides. In this retrospective 10-year study (2001–2010), we compared the toxicology findings in hanging suicides (n = 4551) with drug poisoning (intoxication) suicides (n = 2468). The mean age of hanging deaths was 49 ± 19 y (±SD) and 80% were male, compared with a mean age of 52 ± 17 y and 47% males for the intoxication deaths. Poly-drug use was more common in poisoning suicides with an average of 3.6 drugs/case compared with 1.8 drugs/case in hangings. Moreover, 31% of hangings were negative for alcohol and/or drugs. Alcohol was detected (>0.20 g/L) in femoral blood in 30% of hanging suicides (mean 1.39 g/L) and 36% of drug poisonings (mean 1.39 g/L). The median BACs did not depend on the person's age or gender (p > 0.05). Ethanol, paracetamol, citalopram, diazepam, propiomazine, alimemazine and zopiclone were amongst the top-ten drugs detected in both methods of suicide. With the exception of ethanol, the concentrations of drugs in blood were considerably higher in the poisoning deaths, as might be expected. Regardless of the method of suicide, antidepressants and/or antipsychotics were common findings, which could implicate mental health as a significant suicide risk factor.