Drug Misuse Problems Research Articles

The influence of the built environment on drug misuse and abuse

Drug misuse and overdoses (DMO) continue to rise in the United States and around the world. As the COVID-19 pandemic lockdown brought America to a standstill, the drug overdose epidemic took a sharp turn for the worse. Poorly built environments have been said to pose greater risks for substance use. The inequitable race and socioeconomic status distribution of the built environment might be tipping drug overdose and deaths toward minority populations. This review examined the contribution of the built environment to drug misuse and overdose to identify further research and policy needs. Databases like PubMed and Google Scholar were searched for peer-reviewed empirical studies in the English language published from 2010 to March 2021. MeSH search terms were built environment, overdose, drug, and drug overdose. Using the PRISMA flow diagram of article selection, title, and abstract screening plus text narrative synthesis of included articles were done. The built environment features making it more conducive to initiating and maintaining DMO included disinvestment, geographical context (urban versus rural), spatial characteristics of the built environment, easy access to drugs, low access to interventions, and built-environment-associated environmental and social stressors. Built environment features play some roles in drug misuse problems. Policies and programs are needed that place the built environment at the centre of health, drug overdose prevention, and harm reduction, provide increased treatment facilities for addicted persons, ensure stricter opioid prescription measures, and address poverty as well as hopelessness due to disinvestment.

Evaluation of an infographic: prescription drug misuse among older adults in Saskatchewan

ABSTRACT Background Misuse of prescription drugs leads to morbidity and mortality. Prescription drug misuse among older adults over the age of 60 years is an understudied area which needs attention and one of the best methods to spread awareness is through infographics. The main objective of this study was to develop and evaluate an infographic on the extent of prescription drug misuse problems among older adults over the age of 60 years in Saskatchewan, Canada. Methods A mixed-method approach was used for this study which involved an online survey and development of an infographic. The survey was administered between October and November 2022. Survey participants were asked about their drug use habits. An infographic was created based on the results. Two focus groups which consisted of seven individuals were carried out to evaluate the infographic over Zoom. Questions were asked based on three themes (content, presentation, and reflection). Results Data from the focus group was used to revise the infographic. The majority of participants in the focus group indicated that the infographic was useful in getting the message across to the public and would be beneficial in various health care settings.

Reaching out to patients with alcohol and drug misuse problems.

Jeff Fernandez, Lead Alcohol and Drug Nurse, Alcohol and Drug Liaison Team, Royal Free Foundation Trust, London (jfernandez@nhs.net). The team was the Gold Award winner in the Gastrointestinal Nurse of the Year category in the BJN Awards 2023.

Policy Analysis for Prevention of the Danger of Drugs Abuse for Young Generation

The possibilities and challenges of youth development nowadays are followed by serious drug misuse problems among the younger generation, which continue to endanger the existence of youth as the holder of the leadership baton in attaining the nation's objectives. It has been demonstrated that drug misuse and illegal trafficking harm the nation's future. Therefore, the purpose of this study is to develop alternative strategies and policy recommendations that are acceptable and successful in preventing the dangers of teenage drug misuse. Using the analytical technique of Strategic Assumption Surfacing and Testing, the outcomes were analyzed (SAST). The data utilized are both primary and secondary and pertain to teenage drug addiction. This research focuses on five districts and cities in West Java and DKI Jakarta. The findings indicate that the prevalence of substance misuse in Indonesia remains relatively high. Therefore, efforts have been made at both the central and regional levels to combat the hazards of drug usage. There are five aspects of prevention that must be considered. Coordinate and synergize the implementation of an action plan program that can describe the model and form of anti-drug cadre training beginning with planning, implementing, monitoring, and evaluating, as well as integrating with other programs at the central and regional levels, is required to address these issues. regions as well as a defined road map for post-training anti-drug cadres as sustainable P4GN agents of change.

Audit of epilepsy healthcare provision in a large UK category B prison

PurposeWe reviewed all prisoners diagnosed with epilepsy within a large UK category B prison: collecting demographic information and the prevalence and nature of their seizure disorder; and reviewed standards of their epilepsy healthcare provision. Previous work has highlighted poorer seizure control and limited access to specialist services in this patient group. MethodsFifty-five male prisoners with a previously established diagnosis of epilepsy were identified by the prison healthcare manager during the six-month audit period. Anonymised audit data was collected during clinical interviews undertaken by members of a regional specialist epilepsy service and recorded on a standardised proforma. Data collection occurred during six prison visits within the audit period. ResultsPoint prevalence of epilepsy was 2%. Data suggest that demographics are complex and challenging in this patient group. We found increased rates of alcohol (40%) and drug (82%) misuse and mental health problems (85.5%). Just over one third of cases were prescribed medications with potential for misuse (diversion). Further optimization of anti-seizure medication (ASM) regimens was required in 67.3% of the study sample, with only 12.7% of cases being free of seizures for the last 12 months. Access to specialist epilepsy services was limited; only 38.2% had a specialist review in the last 12 months. Most cases (76.4%) did not recall receiving guidance on precautions that should be taken regarding duties or cell arrangements in relation to having a diagnosis of epilepsy. ConclusionsTighter collaboration between prison healthcare and local NHS specialist services is recommended to optimise epilepsy healthcare in UK prison settings.

Prevalence and Correlates of Prescription Drug Misuse in a Nationwide Population Survey in Taiwan.

Background: Prescription drug misuse (PDM) is a critical mental health issue relating to psychiatric morbidity. This study investigated the prevalence of PDM and its associated psychopathology and psychosocial factors in the general population in Taiwan. Methods: The survey randomly selected a representative sample >15 year-olds using the stratified proportional randomization method. The measurements included demographic variables, previous experience with PDM, self-rated physical and mental health, health self-efficacy, risk factors for suicidality, and psychological distress. Results: The weighted one-year prevalence of PDM was 8.5% (n = 180) among 2126 participants. Those with psychological distress and lifetime suicide ideation (23.3%) or suicide attempts (5.0%) were significantly associated with PDM. PDM was also prevalent among those with poorer self-rated health and lower self-efficacy. Insomnia (OR = 1.52), depression (OR = 1.77), and low self-efficacy (OR = 2.29) had higher odds of PDM after adjustment in the logistic regression model. Conclusions: Individuals who misused prescription drugs had a higher prevalence of psychological distress and suicidality and lower levels of self-rated health. Prescription drug misuse problems should be screened for early prevention when prescribing medications for people with insomnia, depression, or lower perceived health beliefs or conditions.

Shortfalls of funding for general practice in deprived areas.

In April 2019 the Haxby Group, through a contract tender process, acquired two surgeries in a deprived area of Hull, Yorkshire. These are specifically located in Calvert and Newington with approximately 10 000 patients. This, in addition to six sites in York and three other sites in Hull, with centralised administrative services, make up the Haxby Group. The transformative process that has followed has highlighted many positive outcomes from the use of at-scale general practice and diversifying the workforce but has become increasingly hindered by funding deficits. In particular the use of the Carr-Hill formula and Quality and Outcomes Framework (QOF)-driven payments negatively impact a practice’s ability to provide appropriate care in deprived populations. The population served by this new contract is predominantly young (Figure 1). The area, like most of Hull, is especially high on the Index of Multiple Deprivation, scoring 43.7, compared with 28.1 at another Haxby practice in Hull and 10.4 in York. As is often seen in deprived areas, there is a high incidence of drug and alcohol misuse plus mental health problems. Alongside this, 9.0% of the patients are recorded with obesity and 55.9% as smokers. However, given the average age of the population, most chronic diseases have a prevalence below the clinical commissioning group (CCG) and national averages (Table 1). Figure 1. Patient age distribution in years of males (blue) and females (red) at Calvert and Newington in 2019. View this table: Table 1. Comparison of prevalence data for major comorbidities in Calvert and Newington, nationally,8 …

A public health approach to reducing violence: Can data linkage help to reduce demand on blue light services?

Scotland has witnessed a remarkable reduction in violent crime in recent years. In part, the success of this reduction has been attributed to a ‘public health’ approach, which includes improvements in partnership working across multiple agencies – especially law enforcement and public health. Nevertheless, the emergency services continue to deal with a high volume of violent incidents, an increasing number of which involve some aspect of underlying vulnerability. Policy makers are keen to understand more about how aspects of vulnerability impact on violent crime, especially as this is a primary driver for policies like the public health approach to reducing violence.
 In a project that brings together stakeholders from the Scottish Government, Police Scotland and the Scottish Ambulance Service, the Scottish Centre for Administrative Data Research aims to examine patterns of ambulance callouts and/or hospital admissions involving people who experience violence. The study, which will link together a range of health datasets, will bring together data about violence-related incidents with wider information about an individual’s history of drug misuse, alcohol-related conditions and mental health problems. The study will also examine the extent to which violence and vulnerability contribute to increasing risk of premature death.
 This paper will focus on the development of the research proposal and the opportunities and challenges of trying to bring together data from different emergency service organisations. If possible, it will present preliminary findings from the research. It is anticipated that this study will support the development of further violence prevention policies in Scotland, especially in terms of helping to identify opportunities for better partnership working and points of intervention that could reduce demand on blue light services to deal with violent incidents.

Interventions for drug-using offenders with co-occurring mental health problems.

Interventions for drug-using offenders with co-occurring mental health problems.

Children and Young People Who Die by Suicide: Childhood-Related Antecedents, Gender Differences and Service Contact

Background: Suicide rates in young people are rising. We sought to understand the stresses young people face before they take their lives, their contact with services that could be preventive and whether these factors differ in girls and boys. Methods: We identified a three-year UK national consecutive case series of deaths by suicide in people aged 10-19, based on national mortality data. We extracted information on factors preceding suicide from official investigations, primarily inquests. Outcomes: There were 595 suicides by young people during the study period, almost 200 per year; most were male (425, 71%). Suicide rates increased significantly from the mid-teens. We obtained data on factors preceding suicide for 544 (91%). A number of previous and recent stresses were reported including witnessing domestic violence, bullying, self-harm, bereavement (including by suicide), and academic pressures. These factors were generally more common in girls while drug misuse and workplace problems were more common in boys. 42 (8%) were looked after children. 28 (5%) young people had identified as LGBT. We found suicide-related internet use in 128 (24%), most often searching for information on suicide method. 329 (60%) had been in contact with specialist children's services at some time, and this was more common in girls. Interpretation: Several stressors precede suicide by young people, particularly girls, and are important in a multi-agency approach to prevention in education, social care, health services, and the third sector. Some of these factors may also have contributed to the recent rise. Funding Statement: The Healthcare Quality Improvement Partnership Declaration of Interests: LA chairs the National Suicide Prevention Strategy Advisory Group at the Department of Health and Social Care in England; NK is a member of the Group. NK chaired the guideline development group for the 2012 National Institute for Health and Clinical Excellence (NICE) guidelines on the longer term management of self-harm and currently chairs the guideline development group for the NICE depression in adults’ guidelines. All other authors declare no competing interests. Ethical Approval Statement: The study received approval from the National Research Ethics Service (NRES) Committee North West (Greater Manchester South, UK). Exemption under Section 251 of the NHS Act 2006, enabling access to confidential and identifiable information without informed consent in the interest of improving care, was obtained from the Health Research Authority Confidentiality Advisory Group (HRA-CAG) and the Public Benefit and Privacy Panel for Health and Social Care (PBPP).

Pregabalin misuse-related ambulance attendances in Victoria, 2012-2017: characteristics of patients and attendances.

To compare changes in pregabalin prescribing and misuse-related ambulance attendances; to characterise the patients attended by paramedics for pregabalin misuse-related harms; to assess the association of pregabalin misuse with use of other sedatives and with suicidal ideation and self-harm; to compare the characteristics of pregabalin misuse-related harms in people who misuse pregabalin according to whether or not they also used other sedatives. Retrospective analysis of data on ambulance attendances in Victoria, January 2012 - December 2017, for which pregabalin misuse-related harms were a contributing factor. Rates of pregabalin misuse-related ambulance attendances, pregabalin prescription rates (each 6-monthly); patient characteristics, including age, sex, history of drug misuse or psychiatric problems, concurrent use of other sedatives, and current suicidal ideation and self-harm. There were 1201 pregabalin misuse-related attendances during the study period; the rate increased from 0.28 cases per 100000 population in the first half of 2012 to 3.32 cases per 100000 in the second half of 2017. The attendance rate was strongly correlated with prescription rates in Australia (r= 0.90; P=0.001). 593 attendances (49%) were for people with a history that may have contraindicated prescribing pregabalin. Pregabalin was frequently misused with other sedatives (812 attendances, 68%), particularly benzodiazepines (440, 37%); 472 attendances (39%) were associated with suicide attempts. People who misused pregabalin with other sedatives more frequently presented with moderate to severe impairments of consciousness, but the frequency of suicide attempts was similar whether other sedatives were concurrently used or not. Rates of pregabalin misuse-related ambulance attendances in Victoria have increased markedly over the past 6 years. Caution is required when prescribing pregabalin for people taking other sedatives. Limiting the dispensing of this drug may reduce the risks associated with its misuse.

Jordanian community pharmacists’ experience regarding prescription and nonprescription drug abuse and misuse in Jordan – An update

ABSTRACTBackground: The problem of prescription and nonprescription drug abuse and misuse is well known worldwide. It has been 8 years since this problem has been investigated in Jordan. Objectives: This study aims to investigate the abuse/misuse of drugs sold with or without a prescription in community pharmacies in Jordan in 2014 and to document any changes that may have aroused in the past 8 years. Methods: A cross-sectional survey using a structured questionnaire based on one used previously in 2006 was sent to a stratified random sample of 320 community pharmacies. Data were managed and analyzed in SPSS. Results: A total of 290 questionnaires were completed (response rate = 92.4%). The pharmacists named 727 nonprescription and 372 prescription drugs as being suspected of abuse, each classified into 6 categories. New products have appeared on the list such as: ophthalmic drops (n = 39, 13.4%) and the anti-epileptic; Lyrica (pregabalin; n = 19, 6.5%). Other drugs previously on the 2008 list like misoprostol have retracted in 2014 (from 7.1% to 1.3%). Conclusion: Patterns of suspected prescription and nonprescription drug abuse/misuse have slightly changed in Jordan over time, with new drugs emerging and previous ones disappearing from the list.

Implementing personal health budgets in England: a user-led approach to substance misuse.

Personal health budgets (PHBs) in England have been viewed as a vehicle for developing a personalised patient‐based strategy within the substance misuse care pathway. In 2009, the Department of Health announced a 3‐year pilot programme of PHBs to explore opportunities offered by this new initiative across a number of long‐term health conditions, and commissioned an independent evaluation to run alongside as well as a separate study involving two pilot sites that were implementing PHBs within the substance misuse service. The study included a quantitative and qualitative strand. The qualitative strand involved 20 semi‐structured interviews among organisational representatives at two time points (10 at each time point) between 2011 and 2012 which are the focus for this current paper. Overall, organisational representatives believed that PHBs had a positive impact on budget‐holders with a drug and/or alcohol misuse problem, their families and the health and social care system. However, a number of concerns were discussed, many of which seemed to stem from the initial change management process during the early implementation stage of the pilot programme. This study provides guidance on how to implement and offer PHBs within the substance misuse care pathway: individuals potentially would benefit from receiving their PHB post‐detox rather than at a crisis point; PHBs have the potential to improve the link to after‐care services, and direct payments can provide greater choice and control, but sufficient protocols are required.

Influences of motivational contexts on prescription drug misuse and related drug problems

Prescription drug misuse has emerged as a significant problem among young adults. While the effects of motivational contexts have been demonstrated for illicit drugs, the role of motivational contexts in prescription drug misuse remains understudied. Using data from 400 young adults recruited via time–space sampling, we examined the role of motivational contexts in the frequency of misuse of three prescription drug types as well as drug-related problems and symptoms of dependency. Both negative and positive motivations to use drugs are associated with increases in prescription drug misuse frequency. Only negative motivations are associated directly with drug problems and drug dependence, as well as indirectly via prescription pain killer misuse. Addressing positive and negative motivational contexts of prescription drug misuse may not only provide a means to reduce misuse and implement harm reduction measures, but may also inform the content of treatment plans for young adults with prescription drug misuse problems.

A neuro-fuzzy decision support model for therapy of heart failure

Most medical decision support systems focus on diagnosis with little emphasis on therapy to the effect that though an accurate diagnosis is undertaken patients still have problems of drug misuse as a result of inaccurate therapy. The purpose of this paper is to design an assistive model for therapy of heart failure using artificial neural networks (ANN). Artificial neural networks have been found to be a very veritable tool in learning from existing datasets and based on the results, can perform accurate prediction on the data it has not encountered before through generalisation. It was based on this that 134 datasets on heart failure were collected from three hospitals and trained in a feed forward back propagation learning neural networks. This was further refined through the fuzzy system and some decision support filters. Results obtained from the neuro-fuzzy system indicate that the model has the ability to refine and enhance the physician’s ability to prescribe an appropriate therapy based on the diagnosis. This study is one of the few attempts at utilising soft computing technology in the diagnosis and therapy of cardiovascular diseases. The authors had previously developed neuro-fuzzy models for diagnosis of heart failure.

Considerations in providing shared‐care psychological treatment for clients who have alcohol or other drug misuse problems

BackgroundMany people who have alcohol or other drug (AOD) misuse problems also have comorbid psychosocial and behavioural problems such as depression, anxiety, unstable treatment motivation, sleep disorders, chronic pain, post‐traumatic stress disorder, and suboptimal medication adherence. Agencies which provide treatment for such people commonly have limited resources for effectively addressing these problems.MethodsA telephone survey of psychologists and clinical psychologists in 12 New South Wales (NSW) postcode areas was conducted to investigate attitudes towards providing treatment for AOD clients.ResultsThe participation rate was 67%, and 61% of participants indicated they were “definitely” (52%) or “probably” (9%) interested in providing services for AOD clients. Thirty‐nine per-cent of interested participants indicated that they would always be willing to bulk‐bill Medicare to cover services for AOD clients, and only 7% of interested psychologists indicated that they would never be willing. Almost two thirds of interested participants indicated a delay of no more than one week to see new clients.ConclusionsIt would be worthwhile and feasible for private‐practice psychologists and clinical psychologists to develop shared‐care arrangements with AOD treatment providers and other related health services. We believe they should endeavour to do so, and we offer suggestions to assist in addressing that goal.

Drug Misuse Among University Students in the UK: Implications for Prevention

Aims: The aim of the research was to identify the types of drugs currently being used by university students, their involvement in multiple drug misuse and drug combinations, and the consequences of drug misuse in terms of associated harms. Methods: The research was based on an email survey of all first- and second-year students registered as undergraduates at a university in south Wales during October 2012. Results: The results of the research showed that drug misuse on the university campus studied was widespread in terms of the types and patterns of drug misuse. The most troublesome findings concern the high levels of multiple drug use, the use of some of the most dangerous drugs (including crack and powder cocaine and heroin, as well as ketamine), and the list of recorded harms experienced as a result of drug misuse. Conclusions: The article concludes that little attention has been paid outside of the United States to drug use among university students or to interventions designed to prevent it. However, there are signs that government policy in the United Kingdom is beginning to pay attention to the specific problems of drug misuse among university students.

Meeting the needs of young people in hospital

Adolescent and young adult (AYA) health has been on the agenda for some time,1 with no shortage of reports and guidelines highlighting the importance of developing clinical services for young...

Beyond the paper trail: using technology to reduce escalating harms from opioid prescribing in Australia

The paper highlights the extent of pharmaceutical drug misuse problems in Australia and explores how pharmaceutical opioid misuse could be reduced by implementation of a technological tool: a prescription co-ordination program (PCP). The paper explores how enhancements to existing computer-assisted clinical decision support systems through real-time, on-line information to prescribers, pharmacists and regulators could address drug-seeking and improve the quality use of medicines. Trends in national and international prescription opioid use and related harms are examined with attention directed to drug-seeking behaviour and intentional misuse. The international literature concerning PCPs is reviewed and implications for technological advances in Australia are outlined. Australia has a burgeoning problem associated with the misuse of pharmaceutical opioids. There is increased recognition of a range of iatrogenic harms. A number of factors limit Australia's response capacity including lack of technological capacity to provide on-line, real-time information for prescribers and pharmacists. Providing prescribers, pharmacists and regulators with on-line, real-time information about patients' prescription opioid use will improve the quality use of medicines. A national system is required to co-ordinate data on Pharmaceutical Benefits Scheme, Repatriation Pharmaceutical Benefits Scheme and unsubsidised medicines, including private prescriptions. Pharmaceutical opioids are not the only medicines subject to misuse and therefore the need to capture data on other relevant medicines is also addressed.

Interventions for alcohol and drug problems in outpatient settings: A systematic review

Research evidence indicates a high prevalence of substance abuse among patients presenting in general hospital settings. Such misuse of alcohol and illicit drugs has a major impact on population health and on costs to health services and to society at large. This review aimed to identify the interventions for alcohol or illicit drug misuse problems that have been evaluated for hospital outpatient populations. Thirteen electronic databases including MEDLINE, EMBASE and PsycInfo were searched for published and unpublished studies in any language up to August 2011. Reference lists of included studies and reviews were also hand-searched. We included randomised and controlled clinical trials of any intervention for adult participants identified as having alcohol and/or drug problems presenting to hospital outpatient settings other than addiction or psychiatric units. Participants could be attending hospital for any reason other than treatment for substance abuse. A narrative synthesis was conducted. There is some evidence to suggest that interventions based on motivational techniques might be effective in treatment of alcohol misuse in oral-maxillofacial clinics but not in general outpatient departments. The evidence is insufficient to allow any conclusions to be derived on the effectiveness of interventions in the treatment of drug misuse and combined alcohol-drug misuse in outpatient settings. Further research is needed to investigate interventions for alcohol and drug misuse in outpatient settings. Additionally, problems remain in terms of study quality. Procedures to ensure the rigour of a study were often poorly reported.