Assessment Of Drug Use Research Articles

Design, implementation, and first-year outcomes of a value-based drug formulary.

Value-based insurance design attempts to align drug copayment tier with value rather than cost. Previous implementations of value-based insurance design have lowered copayments for drugs indicated for select "high value" conditions and have found modest improvements in medication adherence. However, these implementations have generally not resulted in cost savings to the health plan, suggesting a need for increased copayments for "low value" drugs. Further, previous implementations have assigned equal copayment reductions to all drugs within a therapeutic area without assessing the value of individual drugs. Aligning the individual drug's copayment to its specific value may yield greater clinical and economic benefits. In 2010, Premera Blue Cross, a large not-for-profit health plan in the Pacific Northwest, implemented a value-based drug formulary (VBF) that explicitly uses cost-effectiveness analyses after safety and efficacy reviews to estimate the value of each individual drug. Concurrently, Premera increased copayments for existing tiers. To describe and evaluate the design, implementation, and first-year outcomes of the VBF. We compared observed pharmacy cost per member per month in the year following the VBF implementation with 2 comparator groups: (1) observed pharmacy costs in the year prior to implementation, and (2) expected costs if no changes were made to the pharmacy benefits. Expected costs were generated by applying autoregressive integrated moving averages to pharmacy costs over the previous 36 months. We used an interrupted time series analysis to assess drug use and adherence among individuals with diabetes, hypertension, or dyslipidemia compared with a group of members in plans that did not implement a VBF. Pharmacy costs decreased by 3% compared with the 12 months prior and 11% compared with expected costs. There was no significant decline in medication use or adherence to treatments for patients with diabetes, hypertension, or dyslipidemia. The VBF and copayment changes enabled pharmacy plan cost savings without negatively affecting utilization in key disease states.

A longitudinal study of hepatitis C virus testing and infection status notification on behaviour change in people who inject drugs

BackgroundHepatitis C virus (HCV) testing and counselling have the potential to impact individual behaviour and transmission dynamics at the population level. Evidence of the impact of an HCV-positive status notification...

Interhemispheric insular and inferior frontal connectivity are associated with substance abuse in a psychiatric population

Substance abuse is highly comorbid with major psychiatric disorders. While the neural underpinnings of drug abuse have been studied extensively, most existing studies compare drug users without comorbidities and healthy, non-user controls. Such studies do not generalize well to typical patients with substance abuse disorders. Therefore, we studied a population of psychiatric inpatients (n = 151) with a range of mental illnesses. Psychiatric disorders were diagnosed via structured interviews. Sixty-five percent of patients met criteria for at least one substance use disorder. Patients were recruited for resting state functional connectivity (RSFC) and diffusion tensor imaging (DTI) experiments to examine the interhemispheric connectivity between brain regions hypothesized to be involved in drug addiction, namely: the inferior, medial, and superior frontal gyri; insula; striatum; and anterior cingulate cortex. The World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test (WHOA) questionnaire was used to further assess drug use. An association between use of tobacco, alcohol, cocaine, sedatives, and hallucinogens with increased insular interhemispheric connectivity was observed. In addition, increased inferior frontal gyrus interhemispheric connectivity was associated with amphetamine and inhalant use. Our results suggest that increased inter-hemispheric insula connectivity is associated with the use of several drugs of abuse. Importantly, psychiatric inpatients without a history of drug dependence were used as an ecologically valid control group rather than the more typical comparison between “mentally ill vs. healthy control” populations. We suggest that dysfunction of interhemispheric connectivity of the insula and to a lesser extent of the inferior frontal gyrus, are related to drug abuse in psychiatric populations.

Impact of heavy drinking among drug users identified by screening in primary care

Substance abuse is highly comorbid with major psychiatric disorders. While the neural underpinnings of drug abuse have been studied extensively, most existing studies compare drug users without comorbidities and healthy, non-user controls. Such studies do not generalize well to typical patients with substance abuse disorders. Therefore, we studied a population of psychiatric inpatients (n = 151) with a range of mental illnesses. Psychiatric disorders were diagnosed via structured interviews. Sixty-five percent of patients met criteria for at least one substance use disorder. Patients were recruited for resting state functional connectivity (RSFC) and diffusion tensor imaging (DTI) experiments to examine the interhemispheric connectivity between brain regions hypothesized to be involved in drug addiction, namely: the inferior, medial, and superior frontal gyri; insula; striatum; and anterior cingulate cortex. The World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test (WHOA) questionnaire was used to further assess drug use. An association between use of tobacco, alcohol, cocaine, sedatives, and hallucinogens with increased insular interhemispheric connectivity was observed. In addition, increased inferior frontal gyrus interhemispheric connectivity was associated with amphetamine and inhalant use. Our results suggest that increased inter-hemispheric insula connectivity is associated with the use of several drugs of abuse. Importantly, psychiatric inpatients without a history of drug dependence were used as an ecologically valid control group rather than the more typical comparison between “mentally ill vs. healthy control” populations. We suggest that dysfunction of interhemispheric connectivity of the insula and to a lesser extent of the inferior frontal gyrus, are related to drug abuse in psychiatric populations.

Borderline Personality Disorder symptoms and HIV risk behaviors among African-American incarcerated men

Aims: In order to expand HIV epidemiology knowledge regarding the influence of psychopathology, we assessed associations between Borderline Personality Disorder (BPD) symptoms and HIV risk behaviors among incarceratedmen. BPD is not typically examined by HIV epidemiologists or in males. Methods: Data were collected during the baseline (in-prison) survey of Project DISRUPT, an ongoing cohort study of African American men being released from prison in North Carolina who were in primary committed relationships at the time of incarceration (n=159). We assessed drug use and sexual risk in the six months before incarceration and BPD symptoms using a five item scale measuring the severity of distress/problems over the past 30 days causedbybehaviors suchasworry that someone is planning to leave you; those scoring in the 75th percentile were considered to have elevated BPD symptoms. Associations between elevated BPD symptoms and drug and sex risk outcomes were estimated. Results: After adjusting for age, pre-incarceration concern about being able to pay bills, and depressive symptoms, BPD symptoms were associated with multiple partnerships (OR 3.17, 95fl CI: 1.33–7.58), concurrent sex partnerships (OR: 3.42, 95fl CI: 1.48–7.91), drug use with sex partners (OR 5.24, 95fl CI: 1.29–21.39), having sex while high (OR 3.88, 95fl CI: 1.45–10.38), crack/cocaine use (OR 4.66, 95fl CI 1.62–13.45), and ecstasy use (OR 4.43, 95fl CI 1.39–14.10). Associations between BPD symptoms and sex risk variables were attenuated but remained significant when controlling for crack/cocaine and ecstasy use, suggesting BPD symptomsmay increase sex risk in part by contributing to drug use. Conclusions: BPD symptomology is a strong HIV risk correlate and should be considered in future HIV prevention studies among men. Financial support: NIDA R01DA028766. The content does not necessarily represent the views of NIDA.

Capturing illicit drug use where and when it happens: an ecological momentary assessment of the social, physical and activity environment of using versus craving illicit drugs.

To understand the environmental and contextual influences of illicit cocaine and heroin use and craving using mobile health (mHealth) methods. Interactive mHealth methods of ecological momentary assessment (EMA) were utilized in the Exposure Assessment in Current Time (EXACT) study to assess drug use and craving among urban drug users in real time. Participants were provided with mobile devices and asked to self-report every time they either craved (without using) or used heroin or cocaine for 30 days from November 2008 through May 2013. Baltimore, MD, USA. A total of 109 participants from the AIDS Linked to the IntraVenous Experience (ALIVE) study. For each drug use or craving event, participants answered questions concerning their drug use, current mood and their social, physical and activity environments. Odds ratios (OR) of drug use versus craving were obtained from logistic regression models with generalized estimating equations of all reported events. Participants were a median of 48.5 years old, 90% African American, 52% male and 59% HIV-infected. Participants were significantly more likely to report use rather than craving drugs if they were with someone who was using drugs [adjusted odds ratio (aOR) = 1.45, 95% confidence interval (CI) = 1.13, 1.86), in an abandoned space (aOR = 6.65, 95% CI = 1.78, 24.84) or walking/wandering (aOR = 1.68, 95% CI = 1.11, 2.54). Craving drugs was associated with being with a child (aOR = 0.26, 95% CI = 0.12, 0.59), eating (aOR = 0.54, 95% CI = 0.34, 0.85) or being at the doctor's office (aOR = 0.31, 95% CI = 0.12, 0.80). There are distinct drug using and craving environments among urban drug users, which may provide a framework for developing real-time context-sensitive interventions.

Current drug use and lack of HIV virologic suppression: point-of-care urine drug screen versus self-report

BackgroundThere have been inconsistent findings on the association between current drug use and HIV disease progression and virologic suppression. Drug use was often measured using self-report of historical use. Objective measurement of current drug use is preferred.MethodsIn this cross-sectional study, we assessed drug use through Computer-Assisted Self Interviews (CASI) and point-of-care urine drug screen (UDS) among 225 HIV-infected patients, and evaluated the association between current drug use and virologic suppression.ResultsAbout half (54%) of participants had a positive UDS, with a lower self-reported rate by CASI (42%) (Kappa score = 0.59). By UDS, 36.0% were positive for marijuana, 25.8% for cocaine, 7.6% for opiates, and 2.2% for methamphetamine or amphetamine. Factors associated with virologic suppression (plasma HIV RNA <50 copies/mL) were Caucasian race (P = 0.03), higher CD4 count (P < 0.01), current use of antiretroviral therapy (ART) (P < 0.01), and a negative UDS (P < 0.01). Among 178 current ART users, a positive UDS remained significantly associated with lower likelihood of virologic suppression (P = 0.04).ConclusionsUDS had good agreement with CASI in detecting frequently used drugs such as marijuana and cocaine. UDS at routine clinic visits may provide “real-time” prognostic information to optimize management.

What screening tools effectively identify drug use?

Evidence-based answer No trials directly compare screening instruments against each other. However, 4 brief, standardized questionnaires (ASSIST, CAGE-AID, CRAFFT, and SQS), validated in primary care settings to assess drug use, have an average sensitivity of 85% and specificity of 80%. The CRAAFT questionnaire is used for assessing drug use, in adolescents and young adults. The SQS uses 1 question to identify adults with a current drug use disorder (SOR: B, systematic reviews of crosssectional studies).

O9: Segmental hair analysis from patients in opiate substitution treatment is useful to investigate drug use history, abstinence and compliance with treatment

Introduction The present study aimed to use the syringe exchange setting in order to facilitate transfer or heroin users into evidence-based substitution treatment with methadone or buprenorphinenaloxone. Out-of-treatment heroin-dependent patients were recruited from a syringe exchange program and actively referred to a research substitution treatment facility. Among 75 patients who were included and underwent baseline evaluation, 71 were successfully referred and started treatment. Segmental hair analysis was used to investigate previous drug abuse, abstinence from drugs of abuse during treatment as well as to confirm compliance to substitution treatment. Hair samples were taken at admission and then after approximately 3 months of treatment. Methods Hair samples were segmented into 5 segments (5, 5, 5, 10, 10 mm) and subjected to qualitative UHPLC-TOF screening for 30 drugs of abuse to elucidate previous drug use patterns. Hair samples were also segmented into 5 segments, washed and quantitation of mu-agonists and sedatives were performed using LC-MSMS including the substitution medications methadone and buprenorphine. Results Base line results from the UHPLC-TOF screening indicated an extensive poly-drug abuse of different opioids including heroin (74%), methadone (79%), fentanyl (16%), buprenorphine (16%) and tramadol (26%) as well as use of stimulants such as amphetamine (32%) together with sedatives (74%) of both the common benzodiazepine group and zopiclone and zolpidem. The segmental analysis showed even or decreasing concentrations of 6-acetylmorphine in the hair confirming continuous use of heroin but suggesting infrequent use or lower doses prior to inclusion. After the initiation of treatment the use of illicit opioids decreased dramatically and most subjects abstained from heroin when given methadone or buprenorphine. 50% had no positive segment during the treatment period and 15% were only positive in one or two of the distal segments which could be interpreted as remnants from dormant hair. However, the use of benzodiazepines and other sedatives (80%) was very common during treatment with alprazolam and clonazepam as the most frequent encounters. The mean methadone dose was 85 mg/d (N=12) and the mean concentrations of EDDP and methadone were 0.46 ng/mg and 8.8 ng/mg, respectively. The concentrations of methadone in hair did not correlate to the dose between subjects but there were clear relationships within patients when doses were escalated during titration. Three patients continued to use heroin and two continued their use of amphetamine. In two of these subjects the methadone concentrations from decreased to half the initial concentrations suggesting that the prescribed dose was diverted rather than taken. Buprenorphine was only detected in 1 patient and norbuprenorphine in 3 patients even though doses between 8 and 24 mg/d was given (N=7). Conclusion We conclude that segmental hair analysis was a good clinical tool to assess drug use histories prior to inclusion into substitution treatment and to prove abstinence from other drugs during treatment. The dose concentration relationship was weak but may be used within a patient to investigate dose changes or non-compliance for methadone. We believe that data from living subjects entering treatment may provide a basis for interpretation of acute heroin overdoses where abstinence have been suggested as a major factor contributing to death.

Problemas escolares e o consumo de álcool e outras drogas entre adolescentes

A relação entre problemas escolares e o uso de álcool, tabaco e drogas ilícitas em 965 adolescentes dos municípios de Jacareí e Diadema (SP) foi avaliada pelo instrumento de autopreenchimento Drug Use Screening Inventory. Este instrumento avalia o consumo de drogas e problemas a ele relacionados. O uso de substâncias foi associado a repetências, falta de concentração, notas baixas, desejo de abandonar a escola, sentir-se entediado no ambiente escolar, não fazer os deveres, faltar/chegar atrasado e prejuízos acadêmicos decorrentes do uso de drogas. A combinação do uso de álcool e tabaco foi associada a mais problemas escolares do que os encontrados em usuários exclusivos de álcool. Os problemas associados a esta combinação foram semelhantes aos observados em usuários de drogas ilícitas. Gostar da escola foi um fator protetor contra o uso de substâncias. Os resultados mostram a importância de se atentar para o relato de consumo das drogas lícitas combinadas.

Differentiation between consumption and external contamination when testing for cocaine and cannabis in hair samples.

It is possible for hair to be externally contaminated by drugs like cannabis or cocaine, which are smoked or snorted. Three steps are commonly employed to minimize the chance of external contamination causing misinterpretation of the results of a hair test. The first consists of decontamination of hair samples by washing the hair before analysis, the second is the use of cut-off levels, and the third is the detection of both the parent drugs and appropriate levels of their metabolite(s) in the hair sample. We propose an additional step for the assessment of drug use using hair samples combined with decontamination data. Hair samples from 186 drug users were analyzed along with their wash residues by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The results of the hair analysis of the 140 samples for cocaine showed that 85.5% (N=89) of the samples passed 'cocaine use' criteria for metabolites ratios and 12.5% (N=13) for wash residue criteria (<10% of cocaine in the wash residue) leading to conclusive interpretation. Only two cases (1.9%) had an uncertain conclusion of drug consumption because cocaine levels in the wash residue were >10% of the levels in the hair. The results of the cannabis set of samples (N=46) were not as clear-cut, as a comparatively large number of samples (15.2%) had relatively high levels of THC in the wash residues. To use this approach, it is important that laboratories testing drugs in hair samples can demonstrate that the method utilized does not generate significant levels of the cocaine metabolites.

Use of medication in elderly people don't institutionalized

Misuse of drugs in the elderly is a rampant public health problem. We conducted a cross-sectional study using a self-administered survey to assess drug use and inadedequate prescription among noninstotunilazed elderly patients in the city of La Plata, Argentina in 2009. The total number of respondents was 215. The average number of drugs used per person was 3.19 ± 2.02, polypharmacy was present in 24.1 % of subjects. Potentially inappropriate medications (MPI) were given in 25.5 %, 31.9 % and 30.0 % of the patients, according to Beers criteria, Priscus list, and STOPP criteria, respectively. This research found that potentially inappropriate prescribing is common and there is a growing need for a list of potentially inappropriate medications, as appropriate to each situation, that considers situations where treatment is suboptimal.

Uso de medicamentos en adultos mayores no institucionalizados

Misuse of drugs in the elderly is a rampant public health problem. We conducted a cross-sectional study using a self-administered survey to assess drug use and inadedequate prescription among noninstotunilazed elderly patients in the city of La Plata, Argentina in 2009. The total number of respondents was 215. The average number of drugs used per person was 3.19 ± 2.02, polypharmacy was present in 24.1 % of subjects. Potentially inappropriate medications (MPI) were given in 25.5 %, 31.9 % and 30.0 % of the patients, according to Beers criteria, Priscus list, and STOPP criteria, respectively. This research found that potentially inappropriate prescribing is common and there is a growing need for a list of potentially inappropriate medications, as appropriate to each situation, that considers situations where treatment is suboptimal.

Safe havens and rough waters: Networks, place, and the navigation of risk among injection drug-using Malaysian fishermen

BackgroundHIV prevalence among Malaysian fishermen is ten times that of the general population. Fishing boats are a key place where drug use occurs, but we know little about how these environments shape HIV risk behaviour. Utilizing Rhodes’ ‘risk environment’ framework, we assessed drug use contexts and how characteristics of place associated with fishing and fishermen's social networks served as key axes along which drug use and HIV risk behaviour occurred. MethodsData were collected during 2009–2011 in Kuantan, a fishing port on the eastern coast of Malaysia, and include 28 in-depth interviews and 398 surveys collected using RDS. Logistic regression was used to determine the effect of occupational, network and risk environment characteristics on unsafe injection behaviour and access to clean needles/syringes; qualitative data were coded and analyzed thematically. ResultsDrug injecting was common and occurred on boats, often with other crewmembers. Captains and crewmembers were aware of drug use. Unsafe injection practices were significantly associated with having a larger proportion of drug injectors in network (OR=3.510, 95% CI=1.053–11.700) and having a captain provide drugs for work (OR=2.777, 95% CI=1.018–7.576). Size of fishermen network (OR=0.987, 95% CI=0.977–0.996), crewmembers’ knowledge of drug use (OR=7.234, 95% CI=1.430–36.604), and having a captain provide drugs for work (OR=0.134, 95% CI=0.025–0.720) predicted access to clean needles/syringes. Qualitative analyses revealed that occupational culture and social relationships on boats drove drug use and HIV risk. ConclusionsWhile marginalized in broader society, the acceptance of drug use within the fishing community created occupational networks of risk. Fishing boats were spaces of both risk and safety; where drug users participated in the formal economy, but also where HIV risk behaviour occurred. Understanding the interplay between social networks and place is essential for developing HIV prevention and harm reduction policies appropriate for the unique needs of this fishing population.

Concordance between self-reported substance use and toxicology among HIV-infected and uninfected at risk youth

BackgroundSubstance use by youth living with HIV (YLWH) is a concern, given potential interactions with virus-associated immune suppression and adverse effects on risk behaviors, neurocognition, and adherence. Self-report substance use measures provide efficient cost-effective assessments. Analyses describe self-reported substance use among YLWH and examine agreement with toxicology assays. MethodsSeventy-eight youth age 18–24 years (87% male, 71% African–American) with behaviorally acquired HIV-1 infection and 55 uninfected youth completed the Alcohol, Smoking, and Substance Involvement Screening Test to assess drug use frequency, including tobacco, marijuana, cocaine, and alcohol, over the prior three months. Elisa-based toxicology assays were used to detect 27 substances in plasma. Chi-square tests compared substance use between YLWH and uninfected youth; Kappa statistics compared agreement between self-report and toxicology. ResultsYLWH reported marijuana (49%), tobacco (56%), and alcohol (87%) use, with 20%, 28% and 3% reporting daily use of each substance, respectively; other substance use was uncommon. Uninfected youth reported less tobacco use but otherwise similar substance use. All youth who reported daily use of marijuana or tobacco had positive plasma toxicology results, while concordance decreased with less frequent self-reported use. Among youth reporting no substance use, few tested positive (4% YLWH, 2% uninfected youth for cannabis; 8%YLWH for tobacco). ConclusionsYouth report high rates of marijuana, tobacco, and alcohol use. Concordance between self-report and toxicology for marijuana and tobacco use, particularly for daily users, supports self-report as a valid indicator of substance use in research studies of youth with or without HIV-1 infection.

Progress in Cue Exposure Therapy for the Treatment of Addictive Disorders: A Review Update

Objectives: To evaluate the role of cue exposure therapy in addiction treatment. Methods: A Pubmed/PsycInfo literature search was performed for cue exposure treatments for addictions from 2002 to 2009. Findings: We located sixteen cue exposure therapy studies involving multiple addictions that were conducted between 2002 and 2009. Four of these studies consisted of clinical efficacy trials that assessed drug use after Cue Exposure Therapy (CET). In three of the four trials, cue exposure was no better or worse than the comparison therapy. Two trials showed somewhat worse retention in those receiving CET and one appeared to have higher relapse rates in those receiving CET. We did not find evidence of safety concerns in any of the four trials. Several promising methodological innovations included use of virtual reality, medication augmentation, investigation of renewal effects, use of fMRI methods, and study of individual differences. Conclusions: Superior efficacy for CET over other forms of general treatment has not been demonstrated. However, research in this area may yet be advanced through adequately powered, multi-site CET trials combining multiple methodological innovations including investigation of individual differences and medication augmentation. Until such trials are conducted, cue exposure treatment for addiction will remain a speculative and uncommonly used therapy in clinical settings.

Estimating daily and diurnal variations of illicit drug use in Hong Kong: A pilot study of using wastewater analysis in an Asian metropolitan city

The measurement of illicit drug metabolites in raw wastewater is increasingly being adopted as an approach to objectively monitor population-level drug use, and is an effective complement to traditional epidemiological methods. As such, it has been widely applied in western countries. In this study, we utilised this approach to assess drug use patterns over nine days during April 2011 in Hong Kong. Raw wastewater samples were collected from the largest wastewater treatment plant serving a community of approximately 3.5 million people and analysed for excreted drug residues including cocaine, ketamine, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA) and key metabolites using liquid chromatography coupled with tandem mass spectrometry. The overall drug use pattern determined by wastewater analysis was consistent with that have seen amongst people coming into contact with services in relation to substance use; among our target drugs, ketamine (estimated consumption: 1400–1600mg/day/1000 people) was the predominant drug followed by methamphetamine (180–200mg/day/1000 people), cocaine (160–180mg/day/1000 people) and MDMA (not detected). The levels of these drugs were relatively steady throughout the monitoring period. Analysing samples at higher temporal resolution provided data on diurnal variations of drug residue loads. Elevated ratios of cocaine to benzoylecgonine were identified unexpectedly in three samples during the evening and night, providing evidence for potential dumping events of cocaine. This study provides the first application of wastewater analysis to quantitatively evaluate daily drug use in an Asian metropolitan community. Our data reinforces the benefit of wastewater monitoring to health and law enforcement authorities for strategic planning and evaluation of drug intervention strategies.

Assessment of drug use pattern using WHO prescribing indicators at Hawassa University Teaching and Referral Hospital, south Ethiopia: a cross-sectional study.

BackgroundTo promote rational drug use in developing countries, it is important to assess drug use pattern using the World Health Organization (WHO) drug use indicators. The aim of this study was to assess the drug prescription patterns at the Medical Outpatient Pharmacy of Hawassa University Teaching and Referral Hospital, using some of the WHO core drug use indicators.MethodsA descriptive, quantitative, and cross-sectional survey was conducted to determine the current prescribing practices at Hawassa University Teaching and Referral Hospital. The sample was selected using systematic random sampling. 1290 patient encounters were reviewed retrospectively for a 2-year period from September 2007 to September 2009. Data were collected from prescriptions and Prescription registration books retained in the pharmacy.ResultThe average number of drugs prescribed per encounter or mean was 1.9 (SD 0.91) with a range between 1 and 4. The percentage of encounters in which an antibiotic or injection was prescribed was 58.1% (n = 749) and 38.1% (n = 491), respectively. The Percentage of drugs prescribed by generic name and from an essential drug list was 98.7% (n=2419) and 96.6% (n=2367), respectively. The most commonly prescribed forms of antibiotics were amoxicillin (16.4%), ampicillin (15%), gentamicin (14.9%) and chloramphenicol (11.6%). On the other hand, the most commonly prescribed injections were ampicillin (21.4%), cloxacillin (13.4%), crystalline penicillin (12.4%), ceftriaxon (9.8%) gentamicin (9.8%), diclofenac (9.4%), chloramphenicol 41 (8.4%) and furosemide 25 (5.1%).ConclusionOn the basis of the finding of this study, the prescribing practices for antibiotic and injection shows deviation from the standard recommended by WHO. These two commonly overused and costly forms of drug therapy need to be regulated closely. Drug use evaluation should be done for some of the antibiotics to check whether they were appropriately prescribed or not. On the other hand, polypharmacy, generic prescribing and prescribing from EDL were not found to be a problem in this study. Teaching hospitals have a special responsibility to society to promote rational prescribing by their staff and, through them, the future generations of doctors.

Adolescent inhalant use and executive cognitive functioning

This study investigates the association between inhalant use and executive cognitive functioning (ECF) and processing speed (PS) in 754 adjudicated poly-substance users on a series of neuropsychological tests. Poly-substance users who used inhalants (PSI = 262) and poly-substance users who did not use inhalants (PSO = 492) neuropsychological tests scores were compared. Hispanic Americans comprised 72% of the participants; European Americans, African Americans and Asian Americans comprised 28% of the participants. Standardized neuropsychological tests were used to assess ECF and PS. Psychosocial and substance abuse standardized surveys were used to assess drug use severity and psychosocial problems associated with substance use. Multiple Analysis of Covariance shows that PSI users who used inhalants performed worse on ECF and PS measures in comparison to non-inhalant poly-substance users (PSO). PSI users were younger, used more drugs and had more psychiatric admissions than PSO users. PSI users initiate substances at a younger age and experienced more ECF and PS deficits, and behavioural problems in comparison to PSO users. The results of this study suggest that PS has direct effect on ECF and psychosocial outcomes in PSI users.

Evaluation of the drug utilization pattern at a regional psychiatric hospital, in Benin city, Nigeria

Background: Drug utilization research facilitates the rational use of drugs and suggests measures to improve prescribing habits. Irrational use of drugs is a global problem affecting patient care. It results in increased mortality, morbidity, adverse drug events, and wastage of economic resources. Objectives: To evaluate the pattern of drug utilization at a regional neuropsychiatric hospital, in Benin City, Nigeria using some of the World Health Organization (WHO) prescribing indicators. Materials and Methods: Data was obtained retrospectively from a review of 5400 outpatient prescriptions between September 2007 and August 2012. Data were analyzed using the WHO guideline for assessment of drug use in health facilities. The number of DDD per one thousand inhabitants per day was calculated from data on the number and size of dispensed drugs obtained from the out-patient pharmacy. Drug Utilization 90% (DU 90%) method was used to evaluate the quality of drug prescribing. Results: An average of 2.88 drugs was prescribed per encounter, 94.38% of the drugs were prescribed using their generic names, and the percentage of encounters with antibiotics prescribed was 3.2% while 99.2% of all the drugs prescribed were prescribed from the essential drugs list. The drugs whose utilization accounted for about 90% of the entire drug use (DU 90%) were; haloperidol (15.5%), amitriptyline (22.3%), benzhexol (12.6%), trifluoperazine (20.3%), chlorpromazine (15.2%), and carbamazepine (7.9%). Haloperidol was the most utilized drug in this setting with a DDD per 1000 inhabitants per day of 5. In about 70% of the prescriptions encountered, all the drugs prescribed were available from the hospital pharmacy. Conclusion: This study found that polypharmacy was commonly practiced while haloperidol was the most utilized psychotropic agent at the study facility.