Decrease In Drug Use Research Articles

Part 1: The Theoretical Basis for Recovery-Oriented Management of Substance Use Disorders in Primary Care.

There is strong evidence in the literature that screening and brief counseling interventions are effective in detecting alcohol problems and decreasing alcohol consumption among patients in primary care settings but somewhat weaker evidence regarding screening and brief intervention for drug problems. In 2014, two published studies made news and caused concern among proponents of substance Screening, Brief Intervention and Referral to Treatment (SBIRT) programs, when their authors concluded that brief interventions were not effective for decreasing drug use among primary care patients identified through screening, and advised that widespread adoption of screening and brief intervention for drug use was not warranted.An evaluation of the theoretical foundations for evidence-based SBIRT services was conducted to produce possible explanations for why traditional SBIRT works well for individuals with unhealthy alcohol use but not as well for those with more serious substance use disorders, including drug use and alcohol/drug dependence. Smith and Liehr's evaluation framework for middle-range theory was utilized to analyze the Chronic Care Model, which was featured prominently in early SBIRT literature, and the newer Recovery Management model, which provides a philosophical framework for organizing modern addictions services and quality-of-life enhancements (Part 1 of this two-part series).Programs are more likely to succeed if guided by theory, and examination of relevant components of theory-based interventions can be useful in developing practical strategies for meeting program objectives. A new, theory-based, recovery-oriented framework for primary care SBIRT is introduced in Part 2 ("SBIRT+RM(C): A Proposed Model for Recovery-Oriented Primary Care").

Avaliação da prática de terapia complementar espiritual/religiosa em saúde mental

Several studies have been published on the impact of religious and spiritual beliefs and practi ces on mental health. Based on the evidence available, strategies have been proposed to sti mulate the spiritual dimension of pati ents, focusing primarily oncoping with diff erent diseases. However, few studies have assessed the possible eff ects and mechanisms of acti on of religious/spiritual interventi ons (RSIs) through randomized clinical trials. According to the literature, RSIs have obtained similar or bett er results than other complementary treatment approaches, including reducti on of anxiety and stress symptoms, decrease in drug use, a lower degree of emoti onal exhausti on in health professionals, and a tendency to less depressive symptoms. Because interventi ons can be very heterogeneous, there has been a discussion about standardizing the contents of RSIs, in an att empt to make both the training of facilitators and the materials off ered to pati ents more uniform. Also, it is possible to observe an increased att enti on to the methodological design of this type of interventi on, with studies showing more robust methodologies. The search for and assessment of these new interventi onscan help in the development of more integrative strategies and facilitate complementary treatment in mental health.

Correlates and Experiences of HIV Stigma in Prisoners Living With HIV in Indonesia: A Mixed-Method Analysis

In Indonesia, the syndemic nature of HIV, drug use, and incarceration may influence experiences of stigma for HIV-infected prisoners. This mixed-method study explores HIV stigma in prisoners living with HIV in Indonesia. Randomly selected male HIV-infected prisoners (n = 102) from two large prisons in Jakarta completed in-depth interviews and a structured HIV stigma survey. Quantitative results found four groups of HIV-infected prisoners with significantly higher HIV stigma levels, including those: (a) with drug-related offenses, (b) seeking help to decrease drug use, (c) diagnosed with HIV before the current incarceration, and (d) who had not disclosed their HIV status to family members or friends. Qualitative results highlighted the prominent role of HIV stigma in decisions to disclose HIV status to family members, partners, and other prisoners. Interventions should address HIV stigma in HIV-infected prisoners in Indonesia to achieve HIV treatment as prevention goals.

The effect of drug use disorder onset, remission or persistence on an individual's personal social network.

Drug use disorders (DUD) have strong associations with numerous social problems. However, little is known concerning differences between individuals who experience DUD onset, persistence or remission. While the literature is fairly clear on who is most likely to experience DUD onset and persistence, many correlates of DUD remission, including personal social networks, lack the empirical foundation to utilize them in evidence-based intervention or prevention efforts. While small, community samples suggest DUD remission is associated with growth in personal social networks, this conclusion is in need of larger population studies to justify. This study used Waves 1 and 2 of the National Epidemiologic Study on Alcohol and Related Conditions (NESARC) to examine whether DUD status is a correlate of personal social networks. Multivariate models showed DUD onset and DUD persistence were related to smaller personal social networks. However, individuals who experience DUD remission showed personal social networks similar to persons who never experienced a DUD. As one of the first empirical studies of personal social networks among individuals with different stages of DUD using nationally representative data, these findings suggest that by decreasing drug use, personal social networks may be increased, which is a strong trait associated with the social influence necessary with maintaining DUD recovery.

Comorbidity of alcohol dependence with other psychiatric disorders. Part I. Epidemiology of dual diagnosis

The paper is a review of the literature on the comorbidity of alcohol dependence with other psychiatric disorders. A condition when alcohol dependence is accompanied by another mental disorder is much more common than it is commonly believed. It is estimated that more than one third of people diagnosed with mental disorders, abuses or is dependent on psychoactive substances, especially alcohol; among alcohol-dependent patients 37% suffer from other mental disorders. Alcohol dependence is associated with increased risk of mood disorders - more than three times higher, depression - almost four times higher, bipolar disorder - more than six times higher, anxiety disorders in general - more than twice, generalized anxiety disorder - more than four times higher, panic disorders - almost double, posttraumatic stress disorder - more than twice. Underestimating of comorbidity is an important problem during treatment of such population of patients. Social skills training can improve a stress management and decrease alcohol and drug use among dual diagnosed patients.

Place managers in entertainment districts: the role of third party policing in shaping place manager actions

The police play an important role in the control of drug and alcohol problems in entertainment districts. Their role, however, in partnership approaches to crime control in entertainment districts is not well understood. In this paper, we explore how a police-led partnership (the Liquor Enforcement and Proactive Strategies programme – LEAPS) shaped licensed venue managers' and owners' (whom we refer to as ‘place managers’) perceptions of crime and disorder and how LEAPS then activates place managers to take some responsibility for controlling crime and disorder problems. Using a survey of the population of place managers in an entertainment district in Brisbane, Australia before and after the implementation of LEAPS, our study reveals that place managers perceived a decrease in drug use, prostitution and chroming, yet perceptions of the incidence of underage drinking, social disorder and fighting increased. Results also show an increase in the number of self-reported proactive behaviours taken by place managers who considered illicit and licit drugs to be a problem. Results suggest that the role of place managers is instrumental for enhancing police responses to drug and alcohol problems in entertainment districts. We conclude that LEAPS officers are well placed to co-opt place managers into taking further responsibility for crime problems in and around their drinking establishments.

Drug Use Trajectories After a Randomized Controlled Trial of MTFC: Associations with Partner Drug Use.

Trajectories of drug use were examined in a sample of women with prior juvenile-justice system involvement. One hundred fifty-three young women who participated in a randomized controlled trial of Multidimensional Treatment Foster Care (MTFC) in adolescence were assessed on five occasions over a 24-month period in young adulthood (mean age = 22.29 years at T1). Participants assigned to the MTFC condition during adolescence reported greater decreases in drug use than girls assigned to the treatment as usual (TAU) condition. Partner drug use was significantly associated with women's concurrent drug use, although participants in the MTFC condition were more resilient to partner drug use than in the TAU condition. Implications for drug use prevention and intervention programs during adolescence are discussed.

Patterns and determinants of cardiovascular drug utilization in coronary care unit patients of a tertiary care hospital

BackgroundA wide variation exists in the patterns of pharmacotherapy among patients admitted with cardiovascular diseases. Very few studies have evaluated the potential determinants of drug utilization. Our objective was to evaluate the clinical characteristics and patterns of cardiovascular drug utilization among patients in coronary care unit (CCU) and assess the determinants of cardiovascular drug use among patients with coronary artery disease (CAD). MethodsIn this retrospective cohort study, the medical records of CCU patients were reviewed independently by two trained physicians over one year. Patients were analyzed as two groups – those with CAD and without CAD. Multivariate logistic regression was done to identify the determinants of cardiovascular drug utilization in the CAD group. ResultsOf 574 patients, 65% were males, 57% were <60 years. The five commonly prescribed drug classes were platelet inhibitors (88.7%), statins (76.3%), ACE-inhibitors/Angiotensin receptor blockers (72%), beta-blockers (58%) and heparin (57%). Poly-pharmacy (>5 drugs) was noticed in 71% of patients. A majority of patients had diagnosis of CAD (72.6%). CAD patients received significantly higher median number of drugs and had longer duration of CCU stay (p < 0.0001). Renal dysfunction for ACE-inhibitors [0.18 (0.09–0.36)], ST-elevation myocardial infarction for calcium channel blockers [0.29 (0.09–0.93)] and brady-arrhythmias for beta-blockers [0.3 (0.2–0.7)] were identified as determinants of decreased drug use in CAD group. ConclusionPredominance of male gender, age <60 and poly-pharmacy was observed in CCU. Antithrombotics, statins, ACE-inhibitors/Angiotensin receptor blockers and beta-blockers were the most frequently prescribed drugs. Clinical co-morbidities (renal dysfunction, arrhythmias) decreased the utilization of ACE-inhibitors, beta-blockers among CAD patients.

Outcome assessment of a triangular clinic as a harm reduction intervention in Rajaee-Shahr Prison, Iran

BackgroundTransmission of the human immunodeficiency virus (HIV) among incarcerated injection drug users (IDU) is a health epidemic in the Islamic Republic of Iran. Triangular clinics (TCs) were established in prisons as a harm reduction measure to decrease the risk of HIV transmission and other blood-borne infections. The objective of this study was to assess the immediate outcomes of one TC among male IDUs in Iran’s Rajaee-Shahr prison.MethodsThis study was conducted in two stages between 2003 and 2005. In the preparatory stage, focus group data was collected to update the prison’s TC education and medical interventions and construct the self-report questionnaire. In stage two, 150 male IDUs were recruited in a closed cohort study design to assess the immediate outcome of the TC. Participants were measured at baseline and followed up to six months to measure their drug use, attitude toward and knowledge of high risk behaviours, serological conversion for HIV, HBV and HCV, and engagement in risky behaviors. The TC outcomes were determined through random urine analysis testing, a self-administered questionnaire and behaviour report cards, and viral infection testing.ResultsThe findings of the urine analyses indicated a minimal yet consistent decrease in drug use over the six months. The pre and post- self-administered questionnaire data relayed a modest change in IDU risky behaviours associated with sexual practices; this was greater in comparison to the knowledge and attitude measures. It was determined that age may have a detrimental effect as may viral infections (HIV and HBV) on knowledge, attitude and behavior change. Both education and employment may have a protective effect. Data collected from the self-report behaviour cards similarly showed a modest reduction in high risk practices. At the six month follow-up, only one case became HIV positive, 9 HCV and 17 HBV.ConclusionsConsidering that HIV is concentrated among Iranian prisoners who inject drugs at a high level, the results of this study indicate that TCs are a possible effective intervention. However, many prisoners continued with risky behaviors even if they were participating in harm reduction measures, such as methadone maintenance therapy.

A proposal to evaluate mechanistic efficacy of hallucinogens in addiction treatment

Current treatments for addiction are frequently ineffective. Hallucinogenic therapy has been indicated as helpful for a range of substance use disorders, yet this approach remains understudied and publicly unavailable. It is nonetheless a promising treatment, which has significant, long-term beneficial effects with single doses and a profile characterized by general safety, low toxicity, and non-addictiveness. However, pharmacological interventions, such as hallucinogens, should not be offered if the same effects (e.g. psychological insights/mystical experiences) and outcomes (e.g. decreased drug use) could be achieved absent pharmacological intervention. To date, there have been no clinical comparisons of drug-induced altered states with non-drug-induced states for addiction treatment. We propose and then outline a clinical trial to address this gap in knowledge. The proposed design would evaluate abstinence outcomes in a population of prescription opioid abusers after exposure to one of three conditions: a drug-induced altered state using psilocybin, a non-drug-induced altered state via hyperventilation (Holotropic Breathwork), and an active placebo with niacin. The outcomes of such a study would reveal important differences in therapeutic potential by discriminating hallucinogen-dependent effects from those psychological effects resulting from altered states.

Venue-level correlates of female sex worker registration status: A multilevel analysis of bars in Tijuana, Mexico

In Tijuana, Mexico, sex work is regulated by the municipal government, through registration cards issued to female sex workers (FSWs) for an annual fee. Registration has been associated with decreased drug use and increase condom use and HIV testing. Previously, it was demonstrated that FSWs operating in bars were more likely than street-based FSWs to be registered. This implies that certain venues may be more accessible to local authorities for the enforcement of this type of programme. Taking a novel multilevel approach, we examined whether venue characteristics of bars reflecting greater organised management and visibility affect registration status of FSWs. In an analysis of venue-level characteristics, predictors of being registered were availability of free condoms at work and distance to the main sex strip; however, these were not independently associated after inclusion of FSWs' income, illicit drug use and history of HIV testing. Our findings suggest that sex work regulations may inadvertently exclude venues in which the more vulnerable and less visible FSWs, such as injection drug users and those with limited financial resources, are situated. Efforts to revise or reconsider sex work regulations to ensure that they best promote FSWs' health, human and labour rights are recommended.

The effect of framing incentives as either losses or gains with contingency management for smoking cessation

Cumulative prospect theory predicts that losses motivate behavior more than equal gains. Contingency management procedures effectively reduce drug use by placing incentives in direct competition with the drug taking behavior. Therefore, framing incentives as losses, rather than gains should decrease drug use to a greater extent, given equivalent incentives. We examined whether contingent vouchers described as either losses or gains differentially affected smoking abstinence rates. Over 5 consecutive days, participants could either gain $75 per day for verified abstinence or lose $75 per day (initial endowment=$375) for continuing to smoke. As a result, loss-framed participants were more likely to achieve at least one day of abstinence. There was a trend towards loss-framed participants reducing the amount smoked more than gain-framed participants. However, participants in the gain-framed group were more likely to maintain abstinence, once initiated. The results partially support cumulative prospect theory and suggest additional ways to initiate behavior change using incentives, outside of using larger magnitude incentives in contingency management procedures.

The ‘war on drugs’ has failed: Is decriminalisation of drug use a solution to the problem in South Africa?

This article engages in the debate surrounding decriminalisation of drug use and whether this is a possible solution to the problem of drug use in South Africa – a question becoming more prevalent in global discussions about drug policy and its efficacy. We argue that two aspects must be addressed when evaluating a policy: its philosophical justification and its efficacy. We find that criminalising drugs may be justified by the public harm principle, but it does not effectively achieve the purpose of preventing and decreasing drug use and associated burdens. Thus, we argue that prohibition is a constitutional limitation, but does not necessarily achieve its purpose in the least repressive or most effective way. Finally, we suggest that a solution to the drug problem will have to address the health needs of the drug user and the context, particularly socio-economic, of drug use. Decriminalisation could theoretically do this by changing society’s perception of drug users, thus helping to promote a human rights-based, public health-orientated approach to the drug problem in South Africa.

Therapeutic outcomes and immunological effects of sublingual immunotherapy for Japanese cedar pollinosis

SummaryIn Japan, about a quarter of the population has Japanese cedar pollinosis. One promising treatment is sublingual immunotherapy, which is under clinical investigation in Japan and not yet covered by the national health insurance system. Since 2005, we have treated more than 200 patients with Japanese cedar pollinosis. We found that sublingual immunotherapy is more effective than drug treatment, but less effective than subcutaneous immunotherapy. Moreover, patients receiving sublingual immunotherapy or subcutaneous immunotherapy use fewer concomitant medications than patients receiving drug treatment. Therefore, sublingual immunotherapy seems to be effective and associated with decreased drug use. The effect of sublingual immunotherapy seems to increase with increasing duration of treatment; the treatment seems to be more effective when continued for ≥4 years than when discontinued after 3 years. We aimed to elucidate the mechanism of action of sublingual immunotherapy. We found that sublingual immunotherapy increases the percentage of interleukin (IL)‐10–producing inducible regulatory T cells, and that IL‐10 is involved in the immune response to Japanese cedar pollen. Furthermore, levels of antigen‐specific immunoglobulin G4 are increased in the cedar pollen season in patients receiving sublingual immunotherapy, and serum levels of IL‐33 are increased in non‐responders. Our findings should contribute to the further development of sublingual immunotherapy for Japanese cedar pollinosis.

U.S. Evaluation of Mexican Drug War Efforts: Short-Termed and Short-Sighted

Is the drug war being won in Mexico? How can success be measured? This study argues that evaluation of multiple measures over an extended time period is required to gauge success. However, current US analysis evaluates Mexican presidential administrations and their efforts primarily on a year-to-year basis. As a result, US assessments tend to link lack of success to the Mexican government and its actions or inaction. Long-term evaluation, though, reveals that Mexican administrations have adopted most of the drug war strategies and tactics advocated by the US. These policy recommendations, though, have not proven successful. There has been no sustained reduction in drug purity, no permanent increase in drug prices, nor any long-term decrease in drug use in the US. This broader, more extended evaluation calls into question the possibility that a supply-side approach can ever be successful.

Impact of FDA drug risk communications on health care utilization and health behaviors: a systematic review.

To review literature on the impact of The Food and Drug Administration (FDA) drug risk communications on medication utilization, health care services use, and health outcomes. The authors searched MEDLINE and the Web of Science for manuscripts published between January 1990 and November 2010 that included terms related to drug utilization, the FDA, and advisories or warnings. We manually searched bibliographies and works citing selected articles and consulted with experts to guide study selection. Studies were included if they involved an empirical analysis evaluating the impact of an FDA risk communication. We extracted the drug(s) analyzed, relevant FDA communication(s), data source, analytical method, and main outcome(s) assessed. Of the 1432 records screened, 49 studies were included. These studies covered 16 medicines or therapeutic classes; one third examined communications regarding antidepressants. Most used medical or pharmacy claims and a few rigorously examined patient-provider communication, decision making, or risk perceptions. Advisories recommending increased clinical or laboratory monitoring generally led to decreased drug use, but only modest, short-term increases in monitoring. Communications targeting specific subpopulations often spilled over to other groups. Repeated or sequential advisories tended to have larger but delayed effects and decreased incident more than prevalent use. Drug-specific warnings were associated with particularly large decreases in utilization, although the magnitude of substitution within therapeutic classes varied across clinical contexts. Although some FDA drug risk communications had immediate and strong impacts, many had either delayed or had no impact on health care utilization or health behaviors. These data demonstrate the complexity of using risk communication to improve the quality and safety of prescription drug use, and suggest the importance of continued assessments of the effect of future advisories and label changes. Identifying factors that are associated with rapid and sustained responses to risk communications will be important for informing future risk communication efforts.

Prevalência e fatores associados à percepção negativa da saúde em pessoas idosas no Brasil

To analyze the factors associated with negative health perception in older Brazilians. Population study of a cross-sectional sample, conducted in 2009 in three cities of Brazil. The stratified simple random sample consisted of 909 adults between 60 and 91 years of age. A gross and multivariate analysis by estimated prevalence rate (PR) using Poisson regression with calculation of adjusted prevalence ratios, p < 0.05 was performed to identify factors associated with negative perception of health (NPH). The prevalence of NPH was 49.6%. After the multivariate association, a certain association for men with older age PR = 1.03 (Cl = 1.01 to 1.06), risk of malnutrition PR = 1.66 (CI = 1.13 to 2.43) and disability PR = 1.79 (CI = 1.21 to 1.77) was observed. For women, the association was with taking more than two medications PR = 1.41 (CI = 1.13 to 2.52), hypertension PR = 1.52 (CI = 1.43 to 1.97) and functional disability PR = 1.36 (CI = 1.13 to 1.86). Nearly half of the elderly have NHP, therefore preventive actions that decrease drug use and encourage behaviors toward better nutritional conditions should be tied to public policies in order to promote the functional independence and well-being of the elderly.

Measuring the effectiveness of homeopathic care through objective and shared indicators

To test a methodology to evaluate, at population level, the effectiveness of homeopathic treatment through standard objective public health indicators. Indicators of hospitalization and drug use were obtained from the Health Statistical Documentation System of Tuscany for two homeopathic centers in the Local Health Authority of Pisa, Italy. We compared homeopathic users with the general population in the same area and by comparing patients before and after homeopathic treatment. The homeopathic patients used less drugs than the reference population, this effect was more evident for patients with repeated homeopathic consultations. A significant decrease in drug use was found on comparing the same patients before and after homeopathic treatment. Hospitalization indicators tended to favour patients who had received homeopathic treatment but were not always statistically significant. This paper demonstrates a new methodological approach to assess the effectiveness of a therapeutic modality, without ad-hoc clinical trials. This methodology can be used by public health institutions in which non-conventional medicines are integrated into the public health care system.

P2-257 Social determinants and high risk behaviours in drug users under methadone treatment in Golestan province, North Iran

IntroductionDrug users' health is a product of drug-effects and risk behaviours. Social determinants can shape some health behaviours. There has been little research on social determinants and risk behaviours related...

A Method to Quantify Illicit Intake of Drugs from Urine: Methamphetamine

Qualitative urinalysis can verify abstinence of drug misuse but cannot detect changes in drug intake. For drugs with slow elimination, such as methamphetamine (MA), a single episode of abuse can result in up to 5 days of positive urine drug screens. Thus, interventions that produce substantial decreases in drug use but do not achieve almost complete abstinence are classified as ineffective. Using nonpharmacologic doses of deuterium-labeled l-methamphetamine (l-MA-d(3)) we have developed a simple, robust method that reliably estimates changes in MA intake. Twelve subjects were dosed with 5 mg of l-MA-d(3) daily and challenged with 15, 30, and 45 mg of nonlabeled d-MA (d-MA-d(0)) after reaching plasma steady status of l-MA-d(3). Urinary concentration ratios of d-MA-d(0) to l-MA-d(3) provided clear separation of the administered doses with as little as 15-mg dose increments. Administered doses could not be resolved using d-MA-d(0) concentrations alone. In conclusion, the urinary [d-MA-d(0)]:[l-MA-d(3)] provides a quantitative, continuous measure of illicit MA exposure. The method reliably detects small, clinically relevant changes in illicit MA intake from random urine specimens, is amenable to deployment in clinical trials, and can be used to quantify patterns of MA abuse.