Drug Abuse Screening Research Articles

EFFECTIVENESS OF AN ALTERNATIVE PROTOCOL TO FACE SUBSTANCE USE DISORDER AND SYMPTOMS OF COMORBID DEPRESSION

Introduction: There is scarcity of studies in the national and international literature on alternative protocols to pharmacological and psychotherapeutic intervention for the treatment of Substance Use Disorder (SUD) and symptoms of comorbid depression. This study aimed to develop a protocol based on alternative therapies through mindfulness meditation, reiki, acupuncture and auriculotherapy to improve substance use problems and symptoms of comorbid depression. Method: This is a randomized single-blind controlled study. The final sample consisted of 18 participants randomized divided into two groups of nine participants: experimental and control. Participants were evaluated by four validated instruments during the screening process and after the intervention. The instruments were: Beck Depression Scale (BDI), Depression, Anxiety and Stress Scale (DASS-21), Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST-10) and Brazilian Economic Classification Criteria (CCEB). Results: the results of the analysis indicate a significant reduction in the pattern of alcohol consumption (p <0.001); other drugs related problems (p<0.001); symptoms of depression (p<0.001); anxiety (p<0.001) and stress (p<0.001) between the two distinct groups (experimental and control) after the intervention. Conclusion: The protocol proposed in this study was effective in reducing the pattern of problems related to alcohol and other drugs, in addition to being effective in reducing symptoms of depression, stress and anxiety.

“Eco-friendly HPLC method for analysis of dipyrone and hyoscine in different matrices with biomonitoring”

A selective, precise, and accurate reversed HPLC method has been developed and validated for simultaneous separation and determination of two veterinary drugs, dipyrone and hyoscine, in their combined dosage form in the presence of their official impurities, namely 4-aminoantipyrine and tropic acid, in addition to the formulated preservative: phenol. The linearity range was found to be (1.00–35.00 µg/mL) for dipyrone and (2.50–50.00 µg/mL) for hyoscine. It exhibited a satisfactory linearity regression R (0.9999) for both drugs with LOD 0.22 µg/mL and 0.72 µg/mL and LOQ 0.65 µg/mL and 2.19 µg/mL for dipyrone and hyoscine, respectively. Additionally, the two cited drugs were also determined in the presence of dipyrone active metabolite 4-aminoantipyrine using diclofenac as an internal standard in bovine urine. The linearity range was found to be (15–75 µg/mL) for dipyrone, (2.5–60 µg/mL) for hyoscine, and (2.5–60 µg/mL) for 4-aminoantipyrine with linearity regression R (0.9999–0.9998). The LLOQ (15, 2.5, 2.5 µg/mL), LQC (45, 7.5, 7.5 µg/mL), MQC (55, 25, 25 µg/mL), and HQC (60, 50 50 µg/mL) were determined for dipyrone, hyoscine and 4-aminoantipyrine, respectively. UV detection was carried out at 220 nm. The method was validated according to the ICH guidelines, as well as according to FDA guidelines for determining both drugs in bioanalytical matrices and both proved accuracy and precision. A statistical comparison was made between the results obtained and those obtained by the reported method, showing no significant difference in accuracy and precision at p = 0.05. The suggested method was proved eco-friendly through a greenness assessment using two different tools (The analytical eco-scale scored 83, and the AGREE-Analytical Greenness Metric approach scored 0.83). The suggested method can be used in the routine work of quality control labs, screening for drug abuse, and ensuring clean sport for horse racing.

Sexual Dysfunction, Marital Adjustment, and Quality of Life Among Male Persons with Alcohol Dependence Syndrome Attending Tertiary Healthcare Institution in Northeast India: A Cross-Sectional Study

Background: Sexual dysfunction is one of the major problems associated with the chronic use of alcohol. Sexual dysfunction is also significantly associated with marital adjustment and quality of life. Aim and objectives: To determine the prevalence of sexual dysfunction and its association with marital adjustment and quality of life among persons with alcohol dependence syndrome (ADS) and to compare with the healthy control group. Materials and methods: The present study used a cross-sectional, comparative, and descriptive research design. A purposive sampling technique was used to select the sample of 128 (64 patients with ADS and 64 healthy control persons) between the ages of 21 and 50, from the Department of Addiction Medicine, LGB Regional Institute of Mental Health (LGBRIMH), Tezpur, Assam. Sociodemographic and clinical data sheet, the Arizona Sexual Experience Scale (ASEX), the Severity of Alcohol Dependence Questionnaire (SDAQ), the Alcohol Use Disorders Identification Test (AUDIT), the International Index of Erectile Dysfunction (IIED), and The Drug Abuse Screening Test scales (DAST) were used. Results: The study revealed a higher prevalence of sexual dysfunction in the ADS group (64%) compared to the healthy control group (35.9%) (Chi-square = 46.916; p < .001). Marital satisfaction was significantly lower in the ADS group than in the healthy control group (Fisher’s exact test = 76.932; p < .001). Quality of life was also diminished in the ADS group, particularly in the physical ( t = −5.310; p <.001), social ( t = −4.481; p < .001), and environmental domains ( t = −4.250; p < .001). Furthermore, sexual dysfunction exhibited a significant negative correlation with marital adjustment ( r = −0.676; p < .01) and all domains of quality of life [physical domain ( r = −0.235; p < .001), social domain ( r = −0.383; p < .001), and environmental domain ( r = −0.383; p < .001)]. Conclusion: The prevalence of sexual dysfunction and erectile dysfunction was high in persons with alcohol dependence syndrome as compared to the healthy control group and it has a relationship with marital adjustment and quality of life. The findings highlight the importance of screening and evaluating sexual dysfunction in individuals with alcohol dependence. Comprehensive pharmacological and nonpharmacological services are warranted to address the unique needs of this population, promoting both recovery from alcohol dependence and improvement in overall quality of life.

Psychometric Synthesis of the Drug Abuse Screening Test (DAST) Versions

Problem Statement Among individuals aged 12 years or older, 14.3% (40.0 million) reporting the use of an illicit drug in the previous year. Given the prevalence of drug abuse, it is increasingly important to determine effective screening practices, treatment procedures, and best practices among various subpopulations to identify drug use-related consequences. The DAST is one of the most commonly used and accurate drug screening tests. Method This psychometric synthesis of four versions of the Drug Abuse Screening Test (DAST-10, DAST-20, DAST-28, DAST-A) provided aggregated evidence from 346 articles over 40 years of published literature for score reliability, structure, diagnostic, and convergent validity, and descriptive statistics, all with the goal of informing counseling and medical practice and research. Results Results indicated adequate internal consistency (α = 0.81–0.84 across all four versions) and mostly medium to large effect size convergent correlations with comparison measures. Aggregated diagnostic validity data indicate optimal cutoff scores of 7 for DAST-10, 8 for DAST-20, 10 for DAST-28, and 6 for DAST-A. Discussion The DAST-10 appears the best choice for practical and psychometric reasons. Additional studies of the various DAST versions are needed to expand use across participant demographics. Public Statement of Relevance Drug use continues to be a societal problem and mental health practitioners need effective screening practices, treatment procedures, and best practices among various subpopulations to identify drug use-related consequences. This study synthesized 40 years of research on the four versions of the Drug Abuse Screening Test (DAST-10, DAST-20, DAST-28, DAST-A) and found acceptable levels of score reliability and validity for screening purposes.

Beyond American College of Surgeons Verification: Quality Metrics Associated with High Performance at Level I and II Trauma Centers.

The American College of Surgeons (ACS) Committee on Trauma has established a framework for trauma center quality improvement. Despite efforts, recent studies show persistent variation in patient outcomes across national trauma centers. We aimed to investigate whether risk-adjusted mortality varies at the hospital level and if high-performing centers demonstrate better adherence to ACS Verification, Review, and Consultation (VRC) program quality measures. We analyzed data from the 2018-2021 ACS TQIP Participant Use Files, focusing on adult admissions at ACS-verified Level I or II trauma centers for blunt, penetrating, or isolated traumatic brain injury. We used mixed-effects models to assess center-specific risk-adjusted mortality and identified high-performing centers (HPTC), defined as those with the lowest decile of overall risk-adjusted mortality. We compared patient and hospital characteristics, outcomes, and adherence to ACS-VRC quality measures between HPTC and non-HPTC. Over the study period, 1,498,602 patients across 442 Level I and II trauma centers met inclusion criteria: 65.3% presenting with blunt injury, 9.3% with penetrating injury, and 25.4% with isolated TBI. Management at HPTC was associated with lower odds of major complications, failure-to-rescue and takeback. Furthermore, HPTC status was associated with increased odds of adherence to several ACS-VRC quality measures, including balanced resuscitation (Odds Ratio [OR] 1.40, 95%Confidence Interval [CI] 1.29-1.51), appropriate pediatric admissions (OR 1.88, 95%CI 1.07-3.68), and substance abuse screening (AOR 1.14, 95%CI 1.12-1.16). Significant variation in risk-adjusted mortality persists across trauma centers. Given the association between adherence to quality measures and high-performance, multidisciplinary efforts to refine and implement guidelines are warranted.

Psychometric properties of the modified Drug Abuse Screening Test Sinhala version (DAST-SL): evaluation of reliability and validity in Sri Lanka

BackgroundPsychoactive drug use is an important public health issue in Sri Lanka as it causes substantial health, social and economic burden to the country. Screening for substance use disorders in people who use drugs is vital in preventive health care, as it can help to identify problematic use early. Screening can aid in referring those in need, for the most appropriate treatment and care. Thus, preventing them from developing severe substance use disorders with complications. The Drug Abuse Screening Test (DAST-10) is an evidence-based tool widely used to assess the severity of psychoactive drug use. This study aimed to culturally adapt and evaluate the validity and reliability of the Drug Abuse Screening Test (DAST-10) in Sri Lanka.MethodsThe DAST-10 was culturally adapted, and the nine-item Sinhala version (DAST-SL) was validated using exploratory and confirmatory factor analysis. The validation study was conducted in the Kandy district among people who use drugs, recruited using respondent-driven sampling. Criterion validity of the questionnaire was assessed by taking the diagnosis by a psychiatrist as the gold standard. Cut-off values for the modified questionnaire were developed by constructing Receiver Operating Characteristic (ROC) curves. The reliability of the DAST-SL was assessed by measuring its internal consistency and test re-test reliability.ResultsThe validated DAST-SL demonstrated a one-factor model. A cut-off value of ≥ 2 demonstrated the presence of substance use disorder and had a sensitivity of 98.7%, specificity of 91.7%, a positive predictive value of 98.8% and a negative predictive value of 91.3%. The area under the curve of the ROC curve was 0.98. A cut-off score of ≤ 1 was considered a low level of problems associated with drug use. The DAST-SL score of 2–3 demonstrated a moderate level of problem severity, a score of 4–6 demonstrated a substantial level of problems, and a score of ≥ 7 demonstrated a severe level of drug-related problems. The questionnaire demonstrated high reliability with an internal consistency of 0.80 determined by Kuder–Richardson Formula-20 and an inter-class correlation coefficient of 0.97 for test re-test reliability.ConclusionThe DAST-SL questionnaire is a valid and reliable tool to screen for drug use problem severity in people who use drugs in Sri Lanka.

Web-Based, Human-Guided, or Computer-Guided Transdiagnostic Cognitive Behavioral Therapy in University Students With Anxiety and Depression: Randomized Controlled Trial.

Internet-based cognitive behavioral interventions (iCBTs) are efficacious treatments for depression and anxiety. However, it is unknown whether adding human guidance is feasible and beneficial within a large educational setting. This study aims to potentially demonstrate the superiority of 2 variants of a transdiagnostic iCBT program (human-guided and computer-guided iCBT) over care as usual (CAU) in a large sample of university students and the superiority of human-guided iCBT over computer-guided iCBT. A total of 801 students with elevated levels of anxiety, depression, or both from a large university in the Netherlands were recruited as participants and randomized to 1 of 3 conditions: human-guided iCBT, computer-guided iCBT, and CAU. The primary outcome measures were depression (Patient Health Questionnaire) and anxiety (Generalized Anxiety Disorder scale). Secondary outcomes included substance use-related problems (Alcohol Use Disorder Identification Test and Drug Abuse Screening Test-10 items). Linear mixed models were used to estimate the effects of time, treatment group, and their interactions (slopes). The primary research question was whether the 3 conditions differed in improvement over 3 time points (baseline, midtreatment, and after treatment) in terms of depression and anxiety symptoms. Results were analyzed according to the intention-to-treat principle using multiple imputation. Patients were followed exploratively from baseline to 6 and 12 months. In both short-term and long-term analyses, the slopes for the 3 conditions did not differ significantly in terms of depression and anxiety, although both web-based interventions were marginally more efficacious than CAU over 6 months (P values between .02 and .03). All groups showed significant improvement over time (P<.001). For the secondary outcomes, only significant improvements over time (across and not between groups) were found for drug use (P<.001). Significant differences were found in terms of adherence, indicating that participants in the human-guided condition did more sessions than those in the computer-guided condition (P=.002). The transdiagnostic iCBT program offers a practical, feasible, and efficacious alternative to usual care to tackle mental health problems in a large university setting. There is no indication that human guidance should be preferred over technological guidance. The potential preference of human support also depends on the scale of implementation and cost-effectiveness, which need to be addressed in future trials. International Clinical Trials Registry Platform NL7328/NTR7544; https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON26795.

The mediating role of self-control on the relations between adverse childhood experiences and substance use among adolescents in Uganda.

Adverse childhood experiences (ACEs) are established risk factors for undesirable consequences in adolescence and early adulthood, including substance use and a lack of self-control. Based on the Social Bonds Theory (SBT), this study aims to expand our knowledge of the pathways from ACEs and self-control to substance use in adolescence and early adulthood. The extent to which self-control mediates the association between ACEs and substance use was examined in a cross-sectional survey of 358 adolescents and young adults (N = 234, 65.5% girls, mean age 17.7, SD 0.58, range 15-18). Data were gathered using the Adverse Childhood Experiences (ACE-10) questionnaire, the Drug Abuse Screening Test (DAST-10), and the 10-item self-control scale to assess childhood adversity, substance use, and self-control, respectively. ACEs were widely reported and significantly associated with substance use and a lack of self-control. Self-control strongly predicted substance use, independent of ACEs. Among those reporting no ACEs, one to two, three to four, and five or more, there were significant variations in the respondents' substance use (F(3, 400) = 12.69, p = 0.001). Self-control explained 51.2% (95% confidence interval [CI]: 41, 61%) of the associations between ACEs and substance use as assessed by linear regression. Self-control is key to understanding why adolescents and young adults with a history of childhood adversity indulge in substance use. Therefore, there is a need to advocate for psychological interventions such as cognitive and behavioural therapy that have demonstrated efficacy in promoting self-control in adolescents and young adults.

Associations of Interpersonal Trauma, Distress Intolerance, and Posttraumatic Stress Symptoms With Recent Problem Opioid Use in a Non-Clinical Sample of Women

Exposure to potentially traumatic events (PTE), higher rates of Posttraumatic Stress Disorder (PTSD) and higher distress intolerance have been associated separately with opioid misuse in clinical samples. Adult women who reported past year misuse of a prescription drug were recruited on Prolific Academic (ProA) to participate in an online survey ( n = 154). Measures included the Trauma History Questionnaire (THQ) for lifetime trauma histories, PTSD Checklist for DSM-5 (PCL-5), Distress Intolerance (DI), NIDA-Modified ASSIST, and the Drug Abuse Screening Test (DAST-10). In a multinomial logistic regression model, experiencing a potentially traumatic event involving interpersonal victimization, having higher distress intolerance, and having greater PTSD symptoms, were significantly associated with drug use class. In particular, higher distress intolerance was associated with problem opioid use relative to problem use of other drugs. Distress intolerance is a potentially salient and modifiable target for mental health and substance use interventions.

The state of mental health among Ebola virus disease survivors through a cross-sectional study in Sierra Leone

BackgroundThe West African Ebola virus disease (EVD) epidemic resulted in >28 000 disease cases and >11 000 fatalities. The unprecedented number of survivors from this epidemic has raised questions about...

Examining the Measurement Invariance and Psychometrics of the Drug Abuse Screening Test for Adolescents (DAST-A) in Justice-Involved Youth

Substance abuse is a serious mental health concern and reoffense risk factor for justice-involved youth. The Drug Abuse Screening Test for Adolescents (DAST-A) is used to assess drug abuse in different contexts, yet its psychometric properties have not yet been thoroughly explored in youth justice samples. We examined the measurement invariance and psychometrics of the DAST-A in a diverse sample of 741 justice-involved youth ( Nyoung men = 636). The tool showed strong reliability in the overall sample and subgroups (ω = .88–.94), and good convergent and concurrent validity. Logistic regression results indicated that, with each unit increase in DAST-A score, the odds of an substance use disorder (SUD) diagnosis increased by 23% (overall sample). The predictive validity findings were more robust for White youth than Black youth and as a result, a different cut-off score was explored for Black youth. The DAST-A demonstrated measurement invariance across gender and race. Practice implications are discussed.

Assessing Priorities in a Statewide Cardiovascular and Diabetes Health Collaborative Based on the Results of a Needs Assessment: Cross-Sectional Survey Study.

The Ohio Cardiovascular and Diabetes Health Collaborative (Cardi-OH) unites general and subspecialty medical staff at the 7 medical schools in Ohio with community and public health partnerships to improve cardiovascular and diabetes health outcomes and eliminate disparities in Ohio's Medicaid population. Although statewide collaboratives exist to address health improvements, few deploy needs assessments to inform their work. Cardi-OH conducts an annual needs assessment to identify high-priority clinical topics, screening practices, policy changes for home monitoring devices and referrals, and preferences for the dissemination and implementation of evidence-based best practices. The results of the statewide needs assessment could also be used by others interested in disseminating best practices to primary care teams. A cross-sectional survey was distributed electronically via REDCap (Research Electronic Data Capture; Vanderbilt University) to both Cardi-OH grant-funded and non-grant-funded members (ie, people who have engaged with Cardi-OH but are not funded by the grant). In total, 88% (103/117) of Cardi-OH grant-funded members and 8.14% (98/1204) of non-grant-funded members completed the needs assessment survey. Of these, 51.5% (53/103) of Cardi-OH grant-funded members and 47% (46/98) of non-grant-funded members provided direct clinical care. The top cardiovascular medicine and diabetes clinical topics for Cardi-OH grant-funded members (clinical and nonclinical) were lifestyle prescriptions (50/103, 48.5%), atypical diabetes (38/103, 36.9%), COVID-19 and cardiovascular disease (CVD; 38/103, 36.9%), and mental health and CVD (38/103, 36.9%). For non-grant-funded members, the top topics were lifestyle prescriptions (53/98, 54%), mental health and CVD (39/98, 40%), alcohol and CVD (27/98, 28%), and cardiovascular complications (27/98, 28%). Regarding social determinants of health, Cardi-OH grant-funded members prioritized 3 topics: weight bias and stigma (44/103, 42.7%), family-focused interventions (40/103, 38.8%), and adverse childhood events (37/103, 35.9%). Non-grant-funded members' choices were family-focused interventions (51/98, 52%), implicit bias (43/98, 44%), and adverse childhood events (39/98, 40%). Assessment of other risk factors for CVD and diabetes across grant- and non-grant-funded members revealed screening for social determinants of health in approximately 50% of patients in each practice, whereas some frequency of depression and substance abuse screening occurred in 80% to 90% of the patients. Access to best practice home monitoring devices was challenging, with 30% (16/53) and 41% (19/46) of clinical grant-funded and non-grant-funded members reporting challenges in obtaining home blood pressure monitoring devices and 68% (36/53) and 43% (20/46) reporting challenges with continuous glucose monitors. Cardi-OH grant- and non-grant-funded members shared the following high-priority topics: lifestyle prescriptions, CVD and mental health, family-focused interventions, alcohol and CVD, and adverse childhood experiences. Identifying high-priority educational topics and preferred delivery modalities for evidence-based materials is essential for ensuring that the dissemination of resources is practical and useful for providers.

Screening for harmful substance use in emergency departments: a systematic review

BackgroundSubstance use-related emergency department (ED) visits have increased substantially in North America. Screening for substance use in EDs is recommended; best approaches are unclear. This systematic review synthesizes evidence on diagnostic accuracy of ED screening tools to detect harmful substance use.MethodsWe included derivation or validation studies, with or without comparator, that included adult (≥ 18 years) ED patients and evaluated screening tools to identify general or specific substance use disorders or harmful use. Our search strategy combined concepts Emergency Department AND Screening AND Substance Use. Trained reviewers assessed title/abstracts and full-text articles for inclusion, extracted data, and assessed risk of bias (QUADAS-2) independently and in duplicate. Reviewers resolved disagreements by discussion. Primary investigators adjudicated if necessary. Heterogeneity precluded meta-analysis. We descriptively summarized results.ResultsOur search strategy yielded 2696 studies; we included 33. Twenty-one (64%) evaluated a North American population. Fourteen (42%) applied screening among general ED patients. Screening tools were administered by research staff (n = 21), self-administered by patients (n = 10), or non-research healthcare providers (n = 1). Most studies evaluated alcohol use screens (n = 26), most commonly the Alcohol Use Disorders Identification Test (AUDIT; n = 14), Cut down/Annoyed/Guilty/Eye-opener (CAGE; n = 13), and Rapid Alcohol Problems Screen (RAPS/RAPS4/RAPS4-QF; n = 12). Four studies assessing six tools and screening thresholds for alcohol abuse/dependence in North American patients (AUDIT ≥ 8; CAGE ≥ 2; Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-IV-2] ≥ 1; RAPS ≥ 1; National Institute on Alcohol Abuse and Alcoholism [NIAAA]; Tolerance/Worry/Eye-opener/Amnesia/K-Cut down [TWEAK] ≥ 3) reported both sensitivities and specificities ≥ 83%. Two studies evaluating a single alcohol screening question (SASQ) (When was the last time you had more than X drinks in 1 day?, X = 4 for women; X = 5 for men) reported sensitivities 82–85% and specificities 70–77%. Five evaluated screening tools for general substance abuse/dependence (Relax/Alone/Friends/Family/Trouble [RAFFT] ≥ 3, Drug Abuse Screening Test [DAST] ≥ 4, single drug screening question, Alcohol, Smoking and Substance Involvement Screening Test [ASSIST] ≥ 42/18), reporting sensitivities 64%-90% and specificities 61%-100%. Studies’ risk of bias were mostly high or uncertain.ConclusionsSix screening tools demonstrated both sensitivities and specificities ≥ 83% for detecting alcohol abuse/dependence in EDs. Tools with the highest sensitivities (AUDIT ≥ 8; RAPS ≥ 1) and that prioritize simplicity and efficiency (SASQ) should be prioritized.

False-Positive Urine Drug Screening in a Patient on Quetiapine

IntroductionUrine drug tests are commonly used in psychiatry settings, mainly for the purpose of screening for substance abuse and excluding drug-induced psychiatric disorders. When carefully interpreted, these tests offer critical information for clinical judgement. However, certain psychotropic medications can trigger false-positive results in common urine drug screenings. For example, aripiprazole has been reported to cause false-positive urine amphetamine test results, and haloperidol has been associated with false-positive urine drug tests for lysergic acid diethylamide (LSD). It is clinically significant to recognize some false-positive urine drug results and interpret certain results cautiously in clinical settings.ObjectivesWe present a case of false-positive urine drug screening for tricyclic antidepressant (TCA) in a patient on quetiapine and aim to highlight the importance of accurate result interpretation in urine drug tests.MethodsDetails of the case were described. Information was gathered based on medical records.ResultsMr. A, a 25-year-old construction worker, first presented at our hospital’s emergency room on a Saturday in January 2023. He was brought by the police because he was aggressive and mentioned his colleagues were monitoring him. Being a foreigner, he did not have any prior medical records in our hospital. Urgent blood tests were performed, and organic causes were ruled out. He was started on quetiapine and lorazepam in the emergency room and was then admitted to our hospital.A urine drug test was ordered on the following Monday, the third day of his admission. Surprisingly his urine drug screening revealed positive results for TCA and benzodiazepines. Initially as the patient was psychotic and could not give reliable history, we considered a few differential diagnoses, such as schizoaffective disorder and major depressive disorder with psychotic features, based on the presumption that TCA had been prescribed by the psychiatrist in Mr. A’s home country. After further treatment, Mr. A became less psychotic and was able to share that he had a past psychiatric history of schizophrenia, but he had stopped antipsychotic medications four months ago.ConclusionsThis case report described a false-positive urine drug test for TCA while the patient was taking quetiapine. In this case, initially other diagnoses, such as schizoaffective disorder, were considered based on the incorrect assumption that patient was taking TCA.False positive urine drug results can be confusing and misleading for clinicians. This report underscores the possibility of such false positives arising from quetiapine and emphasizes the critical importance of careful result interpretation.Disclosure of InterestNone Declared

Psychotropic substance use among medical residents: prevalence and characteristics

Introduction Psychotropic substance use among medical residents represents a critical concern due to its potential impact on patient care and practitioner well-being. This topic looks into the prevalence and characteristics of psychotropic substance use, including prescription medications and illicit drugs, among individuals pursuing medical residency. Understanding the scope of the problem and its distinctive features is essential for developing targeted interventions and support mechanisms within the medical community.ObjectivesTo assess psychotropic substance use among medical residents, describe its characteristics and determine the prevalence of problematic use.MethodsWe conducted a cross-sectional and descriptive studyamong Tunisian medical residents over a three-month period (August - September 2022) using an online survey. Different specialties and levels of residency were included. An online self-questionnaire was used including a data collection form and the DAST-10 (Drug Abuse Screening Test) scale. The data was analyzed using the SPSS 20th version softwareResultsAmong the 80 residents in our study, 19 (23.8%) reported psychotropic substance use, and 12 (15%) reportedthat they had misused psychotropic drugs at least once in their lives (without a prescription and/or with a prescription but not following the instructions). The most commonly psychotropic drugs used were benzodiazepines, followed by amphetamines, analgesics, anesthetics, and pregabalin (28%, 16%, 12%, 12%, 12%, respectively). Consumption was regular for 41.7% of those who reported psychotropic drugs misuse. The initiation of psychotropic use followed a desire to experiment various substances (41.7%), a medical prescription (33.3%), or their availability due to medical practice (25%). Self-medication and recreational use were the most common reasons for use (41.7% each). Furthermore, 31.6% of consumers revealed a problematic substance use as assessed by the DAST-10 scale.ConclusionsOur study showed a concerning prevalence of psychotropic substance use among medical residents, benzodiazepines being the most prevalent. Notably, 15% acknowledged misuse and a significant proportion displayed problematic substance use. These results highlight the potential health risks and the importance of addressing this issue within the medical community.Disclosure of InterestNone Declared

Motives for MDMA Use: A Comparative Study with Alcohol and Cannabis

IntroductionWhile research on drug use motives has primarily focused on widely used substances like alcohol, tobacco, and cannabis, understanding the motivations behind MDMA use is crucial for developing targeted therapeutic, preventive, and harm reduction strategies.ObjectivesThe objective of this study is to present the findings of an online survey that evaluates the motives behind the use of 3,4-methylenedioxymethamphetamine (MDMA) and draws comparisons between these motives and those for alcohol and cannabis consumption.Methods Data were collected through an online survey, available in both English and French, with 99 participants. The survey included five sections, including a substance abuse screening test (ASSIST) and the Pahnke-Richards Mystical Experience Questionnaire. The primary focus was on motives for MDMA use, assessed using an adapted version of the Marijuana Motives Measure (MMM), comparing them with alcohol and cannabis motives.Results The most reported motive for MDMA use was enhancement, followed by expansion motives. Social motives were the third most common, while coping motives ranked fourth, and conformity was the least common motive. Comparisons with alcohol and cannabis use motives revealed differences in motives for each substance. MDMA showed a unique pattern of motives.ConclusionsEnhancement emerged as the most prevalent motive for MDMA use, consistent with previous research on MDMA motive use. Expansion motives, which involve altering perceptions and increasing self-awareness, ranked second, reflecting the growing interest in MDMA-assisted therapy for conditions like PTSD. Surprisingly, social motives were less common for MDMA compared to alcohol and cannabis, suggesting unique social dynamics associated with MDMA use. Conformity motives were also less significant for MDMA users, possibly due to the age of initiation and user maturity. Understanding the motives behind MDMA use is essential for designing effective interventions and harm reduction strategies. The distinct motives for MDMA, as compared to alcohol and cannabis, highlight the need for tailored approaches to address its use. Further research should explore the complex interplay of motives, age of initiation, social context, and cultural factors to inform comprehensive strategies related to MDMA use.Disclosure of InterestNone Declared

DRUG AND ALCOHOL USE IN ORTHOPAEDIC TRAUMA PATIENTS: A PROSPECTIVE STUDY

The objective of this study is to prospectively investigate the prevalence, patterns, and correlates of drug and alcohol use among orthopaedic trauma patients. After the ethical approval from the institutional review board, this cross-sectional study was conducted at Jinnah Postgraduate Medical Center from 01/09/23 to 29/02/24. Baseline data was collected upon admission and included demographic information (such as age and gender) and a comprehensive assessment of substance use history. Substance use was assessed using validated screening tools, including the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Abuse Screening Test (DAST), to capture patterns of alcohol and drug use, frequency, duration, and any previous treatment history for substance use disorders. In the present study, the prevalence of drug and alcohol use among the orthopedic traumatic participants was (40%). Among them, the majority (51%) were using alcohol, followed by marijuana use (25%), and then cocaine (11%). The means of hospital stay of participants in substance non-users and users (2.4±0.8 vs. 6.83±1.1; P&lt;0.0001). Pre-injury alcohol and drug use appear to correlate with extended hospital stays among patients with traumatic orthopaedic injuries.

Prevalence and associated factors of substance use disorders among people who use drugs: a population-based cross-sectional study in the Western Province of Sri Lanka

Introduction: This study aimed to assess the prevalence of substance use disorders and associated factors among people who use drugs in the Western Province of Sri Lanka. Methods: A cross-sectional study was conducted in the Western Province of Sri Lanka, using a respondent-driven sampling technique. Sampling was initiated with 20 seeds and peers were recruited by peers through handing out coupons. The number of recruited participants was proportional to the estimated number of people who use drugs in each district of Western Province. A total of 870 people who use drugs participated in the study. A validated Sinhala version of the Drug Abuse Screening Test was used to assess the drug use severity among the participants and a pre-tested validated questionnaire was used to collect data to assess the associated factors. RDS Analyst software version 0.64 was used to assess frequency estimates. To assess factors associated with substance use disorders multiple logistic regression analysis was performed using SPSS software version 22. Results: The median age of the study sample was 39 years. The incidence of substance use disorder among the sample was 88.4%. Being employed, using heroin as a psychoactive drug, using drugs daily, using more than one drug, being a heavy alcohol user, buying drugs, stealing money or exchanging goods to get drugs, spending a substantial amount per month on drugs (Rs &gt; 40,001), past or present medical history of tuberculosis and those who had disclosed their drug use behavior to their immediate family were found to be significantly associated with an increased risk of having a substance use disorder. Conclusion: A high prevalence of substance use disorder was found in the sample with multiple economic, behavioral, and health-related risk factors.

Integration of Substance Use Screening Into the Electronic Health Record for Adolescent Trauma Patients: A Quality Improvement Project.

Adolescent substance abuse is a well-acknowledged and increasing concern. Screening brief intervention and referral to treatment for alcohol and drug use in adolescent trauma is a requirement, but program implementation remains a challenge for many trauma centers. This study aims to examine the effect of an integrated electronic health record screening tool and staff training on screening, brief intervention, and referral to treatment compliance in adolescent trauma. This is a single-center, pre- and postintervention study of substance use screening compliance in adolescent trauma patients (age 12-21) conducted at a Level I pediatric trauma center in the Southeastern United States following the integration of the CRAFFT substance abuse screening tool into the electronic health record. The study compared 12months of preintervention data (January 2021 through January 2022) to 15months of postintervention data (February 2022 through May 2023). A total of N =241 patients met inclusion criteria, of which most were male, n =168 (69.7%), White n =185 (76.8%), and Hispanic n =179 (74.3%). Screening compliance increased from preintervention 81% to postintervention 92%. Our study demonstrates that integrating a digital screening tool into the electronic health record resulted in an average increased screening compliance of 11%.

Typologies of alcohol and other drug-related risk among lesbian, gay, bisexual, transgender (trans) and queer adults.

Prevalence and patterns of alcohol and other drug (AOD) use among specific lesbian, gay, bisexual, transgender (trans) and queer (LGBTQ+) subpopulations are well established. However, patterns of substance-related risk have been less thoroughly explored. This study aimed to determine typologies AOD risk among LGBTQ+ adults in Australia. Latent class analyses were performed to determine distinct patterns of AOD risk (n = 6835), as measured by the Alcohol Use Disorder Identification Test and Drug Abuse Screening Tool. Demographic characteristics, experience of harassment, assault and/or threats, mental wellbeing and LGBTQ+ connectedness were compared across emergent classes. AOD risk was characterised as 'no risk' (13.3% of sample), 'low risk' (15.1%), 'moderate risk' (alcohol + other drugs; 30.1%), or 'moderate alcohol only risk' (41.5%). The 'moderate risk' class was the most likely class to report recent sexual assault, verbal abuse, harassment and physical threats compared to other classes, while those in the 'moderate alcohol only risk' group were least likely to report these experiences of all classes. However, both the 'moderate risk' and 'moderate alcohol risk only' classes reported greater mental wellbeing and LGBTQ+ connectedness compared to the 'no risk' and 'low risk' classes. Our findings indicate that level of AOD risk is not uniform among some LGBTQ+ adults, nor is the distribution of harms experienced by them. Tailored harm-reduction interventions may be fruitful in attenuating harms based on risk profile; most specifically, LGBTQ+ individuals engaging in moderately risky concurrent AOD use.