Individual Drug Use Research Articles

Disappearance of Tramadol and THC-COOH in Hair After Discontinuation of Abuse. Two Different Profiles.

The retrospective calendar of an individual's drug use requires a multisectional analysis in which the length of hair, corresponding to the full temporal window available, is cut into shorter sections to measure drug use during shorter periods of time (generally 1 cm corresponds to ~1 month). Segmental hair analysis is used to verify both previous drug history and recent enforced abstinence. However, after drug discontinuation, the fresh new hair growth segment cannot be immediately negative, due to the contribution of dormant hair. The objective of the study was to test hair samples from chronic tramadol and cannabis users after the discontinuation of both drugs and to evaluate the delay to wait until the hair will become negative. Hair specimens were obtained from eight subjects with a known history of tramadol abuse. Hair was collected 3-6 months after tramadol discontinuation. Tramadol was tested by liquid chromatography coupled to tandem mass spectrometry (LC-MS-MS) with a LOQ at 5 pg/mg. A second set of hair specimens were obtained from 15 subjects with a known history of cannabis abuse. Hair was collected 6-9 months after cannabis discontinuation. THC-COOH was tested by LC-MS-MS with a LOQ at 0.2 pg/mg. The hair stands were cut into L × 1 cm segments, according to their length (L), and tested for the respective drug. It was asked to each subject to clearly indicate the date of drug discontinuation. Assuming a rate of hair growth of 1 cm/month, the segment corresponding to the time of last drug use was calculated. The older segment just before this one was considered as the 100% of the response. THC-COOH and tramadol concentrations in this segment ranged from 2.3 to 8.9 and 895 to 21,010 pg/mg, respectively. After cessation of drug consumption, the presence of both drugs in new growing hair segments continued for a certain period with a more or less broad transition zone. Negative hair results were obtained ~3-4 and 6-7 months after cessation of tramadol and cannabis abuse.

Compulsive Alcohol Seeking Results from a Failure to Disengage Dorsolateral Striatal Control over Behavior.

The acquisition of drug, including alcohol, use is associated with activation of the mesolimbic dopamine system. However, over the course of drug exposure the control over drug seeking progressively devolves to anterior dorsal striatum (aDLS) dopamine-dependent mechanisms. The causal importance of this functional recruitment of aDLS in the switch from controlled to compulsive drug use in vulnerable individuals remains to be established. Here we tested the hypothesis that individual differences in the susceptibility to aDLS dopamine-dependent control over alcohol seeking predicts and underlies the development of compulsive alcohol seeking. Male alcohol-preferring rats, the alcohol-preferring phenotype of which was confirmed in an intermittent two-bottle choice procedure, were implanted bilaterally with cannulae above the aDLS and trained instrumentally on a seeking-taking chained schedule of alcohol reinforcement until some individuals developed compulsive seeking behavior. The susceptibility to aDLS dopamine control over behavior was investigated before and after the development of compulsivity by measuring the extent to which bilateral aDLS infusions of the dopamine receptor antagonist α-flupenthixol (0, 5, 10, and 15 μg/side) decreased alcohol seeking at different stages of training, as follows: (1) after acquisition of instrumental taking responses for alcohol; (2) after alcohol-seeking behavior was well established; and (3) after the development of punishment-resistant alcohol seeking. Only alcohol-seeking, not alcohol-taking, responses became dependent on aDLS dopamine. Further, marked individual differences in the susceptibility of alcohol seeking to aDLS dopamine receptor blockade actually predicted the vulnerability to develop compulsive alcohol seeking, but only in subjects dependent on aDLS dopamine-dependent control.SIGNIFICANCE STATEMENT Over the course of addictive drug exposure, there is a transition in the control over drug seeking from ventral to anterior dorsal striatum (aDLS) dopamine-dependent mechanisms, but it is unclear whether this is causally involved in the development of compulsive drug seeking. We tested the hypothesis that individual differences in the reliance of alcohol seeking on aDLS dopamine predicts and underlies the emergence of compulsive alcohol seeking. We identified individual differences in the reliance of well established alcohol seeking, but not taking behavior, on aDLS mechanisms and also showed that this predicted the subsequent development of compulsive alcohol-seeking behavior. Thus, those individuals in whom alcohol seeking depended on aDLS mechanisms were vulnerable subsequently to display compulsivity.

Between the Substance Agency and the User’s Control. Instrumental Drug Use Among Drug Users in Warsaw

The focus of this article is on instrumental drug use and the problem of agency in interaction with psychoactive substances. Most of the Euro-American discourse formed around drug use stresses the individual loss of self-control related to drug use. This paper is located within those critical studies of drug use, which challenge the notion that regular drug users are deprived of agency in their interaction with psychoactive substances. During my fieldwork among drug users in Warsaw, I got the impression that psychoactive substances can be treated as a tool for altering the state of the human mind, which can be employed in various ways and controlled by the user. Still, this tool is a dangerous one and cannot always be fully subject to human agency. Based on case studies, I analyse the functions of drugs for the users and their intentions regarding use. The ethnographic exploration of individual drug use trajectories is a starting point for the further consideration of the process of negotiating agency with psychoactive substances.

Encouraging Testing of Partners for Persons Newly Diagnosed With Hepatitis C

To the Editor: The Centers for Disease Control and Prevention recommends increased testing for hepatitis C virus (HCV) infection.1 Testing linked with effective curative therapy results in significant decreases in morbidity and mortality and is cost-effective.2,3 The Centers for Disease Control and Prevention reports that HCV is transmitted by needle sharing, sharing of drug paraphernalia, and less efficiently through sexual transmission.4 Therefore, it makes sense that sexual partners and others who are exposed to blood through drug use or other means should be encouraged to receive counseling and testing for HCV. However, none of the public health recommendations regarding testing recommend that providers counsel HCV-infected persons to inform and encourage their partners to be tested for HCV. Historically, encouraging partner testing has been an important tool to identify undiagnosed HIV infection and to encourage testing among higher-risk social networks. Recommendations to test needle sharing and drug paraphernalia sharing partners, as well as sexual partners for HCV (coupled with appropriate counseling about the low likelihood of sexual infection), have the potential to increase testing among individuals at higher risk. Many persons infected with HCV remain undiagnosed; therefore, this is a potential new strategy to increase testing among those unaware of their infection.5 As a start, encouraging partner testing with appropriate counseling should be recommended to individuals diagnosed with HCV. Further research regarding ethical, effective, and cost-effective, community-based interventions to enhance HCV testing among drug use and sexual partners of HCV-infected individuals is needed. Katherine M. Dunham Brown University Providence, RILauri Bazerman, MS The Miriam Hospital Providence, RICurt G. Beckwith, MD The Miriam Hospital and Division of Infectious Diseases Alpert Medical School of Brown University Providence, RIBenjamin P. Linas, MD, MPHJoshua Barocas, MD Division of Infectious Diseases Boston Medical Center and Boston University School of Medicine Boston, MATimothy P. Flanigan, MD The Miriam Hospital and Division of Infectious Diseases Alpert Medical School of Brown University Providence, RI [email protected]

Continuous positive airway pressure therapy for obstructive sleep apnoea and psychotropic drug use: a retrospective observational matched-cohort study

Patients with obstructive sleep apnoea (OSA) frequently present symptoms of depression, anxiety and insomnia and continuous positive airway pressure (CPAP) can improve these symptoms. Using a real-world administrative database, we analysed the trend of psychotropic drug use (antidepressants, anxiolytics and hypnotics) on a long-term period in OSA individuals before-after CPAP initiation. A total of 869 OSA individuals to whom psychotropic drugs were prescribed were followed for 4 years. They were matched to 2,607 non-OSA individuals, who were similar in terms of demographics, chronic diseases and care consumption. Generalized estimating equations models were used to compare psychotropic drug defined daily doses (DDD). Results showed no significant differences in mean trends of psychotropic drug DDD between OSA individuals and non-OSA matched controls during the three years following CPAP initiation. Only time had a significant effect on DDD, which decreased in both groups: −9% in Y1 and −17% in Y3, compared to Y0 (p-values < 0.0001). Hence, CPAP therapy does not result in an earlier decrease of psychotropic drug use in OSA individuals compared to non-OSA matched controls. Further studies are needed to analyse long-term psychotropic drug use, particularly in non-adherent OSA individuals.

Risk of ischemic stroke and the use of individual non-steroidal anti-inflammatory drugs: A multi-country European database study within the SOS Project

Background and purposeA multi-country European study using data from six healthcare databases from four countries was performed to evaluate in a large study population (>32 million) the risk of ischemic stroke (IS) associated with individual NSAIDs and to assess the impact of risk factors of IS and co-medication.MethodsCase-control study nested in a cohort of new NSAID users. For each case, up to 100 sex- and age-matched controls were selected and confounder-adjusted odds ratios for current use of individual NSAIDs compared to past use calculated.Results49,170 cases of IS were observed among 4,593,778 new NSAID users. Use of coxibs (odds ratio 1.08, 95%-confidence interval 1.02–1.15) and use of traditional NSAIDs (1.16, 1.12–1.19) were associated with an increased risk of IS. Among 32 individual NSAIDs evaluated, the highest significant risk of IS was observed for ketorolac (1.46, 1.19–1.78), but significantly increased risks (in decreasing order) were also found for diclofenac, indomethacin, rofecoxib, ibuprofen, nimesulide, diclofenac with misoprostol, and piroxicam. IS risk associated with NSAID use was generally higher in persons of younger age, males, and those with a prior history of IS.ConclusionsRisk of IS differs between individual NSAIDs and appears to be higher in patients with a prior history of IS or transient ischemic attack (TIA), in younger or male patients. Co-medication with aspirin, other antiplatelets or anticoagulants might mitigate this risk. The small to moderate observed risk increase (by 13–46%) associated with NSAIDs use represents a public health concern due to widespread NSAID usage.

Use of N-nitrosodimethylamine (NDMA) contaminated valsartan products and risk of cancer: Danish nationwide cohort study

ObjectiveTo perform an expedited assessment of cancer risk associated with exposure to N-nitrosodimethylamine (NDMA) through contaminated valsartan products.DesignNationwide cohort study.SettingDanish health registries on individual level prescription drug use, cancer occurrence,...

Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis

Treatment outcomes for multidrug-resistant tuberculosis remain poor. We aimed to estimate the association of treatment success and death with the use of individual drugs, and the optimal number and duration of treatment with those drugs in patients with multidrug-resistant tuberculosis. In this individual patient data meta-analysis, we searched MEDLINE, Embase, and the Cochrane Library to identify potentially eligible observational and experimental studies published between Jan 1, 2009, and April 30, 2016. We also searched reference lists from all systematic reviews of treatment of multidrug-resistant tuberculosis published since 2009. To be eligible, studies had to report original results, with end of treatment outcomes (treatment completion [success], failure, or relapse) in cohorts of at least 25 adults (aged >18 years). We used anonymised individual patient data from eligible studies, provided by study investigators, regarding clinical characteristics, treatment, and outcomes. Using propensity score-matched generalised mixed effects logistic, or linear regression, we calculated adjusted odds ratios and adjusted risk differences for success or death during treatment, for specific drugs currently used to treat multidrug-resistant tuberculosis, as well as the number of drugs used and treatment duration. Of 12 030 patients from 25 countries in 50 studies, 7346 (61%) had treatment success, 1017 (8%) had failure or relapse, and 1729 (14%) died. Compared with failure or relapse, treatment success was positively associated with the use of linezolid (adjusted risk difference 0·15, 95% CI 0·11 to 0·18), levofloxacin (0·15, 0·13 to 0·18), carbapenems (0·14, 0·06 to 0·21), moxifloxacin (0·11, 0·08 to 0·14), bedaquiline (0·10, 0·05 to 0·14), and clofazimine (0·06, 0·01 to 0·10). There was a significant association between reduced mortality and use of linezolid (-0·20, -0·23 to -0·16), levofloxacin (-0·06, -0·09 to -0·04), moxifloxacin (-0·07, -0·10 to -0·04), or bedaquiline (-0·14, -0·19 to -0·10). Compared with regimens without any injectable drug, amikacin provided modest benefits, but kanamycin and capreomycin were associated with worse outcomes. The remaining drugs were associated with slight or no improvements in outcomes. Treatment outcomes were significantly worse for most drugs if they were used despite in-vitro resistance. The optimal number of effective drugs seemed to be five in the initial phase, and four in the continuation phase. In these adjusted analyses, heterogeneity, based on a simulated I2 method, was high for approximately half the estimates for specific drugs, although relatively low for number of drugs and durations analyses. Although inferences are limited by the observational nature of these data, treatment outcomes were significantly better with use of linezolid, later generation fluoroquinolones, bedaquiline, clofazimine, and carbapenems for treatment of multidrug-resistant tuberculosis. These findings emphasise the need for trials to ascertain the optimal combination and duration of these drugs for treatment of this condition. American Thoracic Society, Canadian Institutes of Health Research, US Centers for Disease Control and Prevention, European Respiratory Society, Infectious Diseases Society of America.

The Action Representation Elicited by Different Types of Drug-Related Cues in Heroin-Abstinent Individuals.

Drug related cue-induced reactivity plays a significant role in maintaining drug use and relapse in addicted individuals. The activation of Dorsolateral striatum-Sensorimotor system (DLS-SM) has been suggested as an important route through which drug cues may induce automatic drug using behavior. The current study used fMRI to investigate the reactivity of heroin abstinent individuals to different types of cues, to clarify the characteristics of the cues that induce the activation of the sensorimotor area. Forty heroin-dependent abstinent individuals and 29 healthy subjects were recruited to perform the heroin cue-reactivity task during fMRI. The participants’ subjective craving and physical signs were evaluated before and after scanning. Whole-brain analysis showed that compared to drug use tool and drug cues, cues related to drug use action were more likely to activate posterior central gyrus, para-hippocampus, supra marginal gyrus, superior parietal lobule (SPL) and inferior parietal lobule (IPL). These areas are involved in motor preparation and output, indicating that the sensorimotor area is also an important neural basis of craving and automatic drug using behavior, and may mediate craving and drug seeking behavior. Our findings thus suggest that cues related to drug using action may induce automatic drug seeking behavior more than cues related only to the drug itself.

Towards a continuum of care concerning chemsex issues.

In response to the apparent rise in chemsex in the Netherlands Mainline Foundation interviewed 27 MSM about their crystal meth use and/or experience with injecting in a sexual context. These men were interviewed about their motivation for methamphetamine use, their sexual risk-taking behaviour, methods and context of their drug use, and their information- and care needs. In 2015 this resulted in the status report Tina and Slamming: MSM, Crystal Meth Use and Intravenous Drug Use in a Sexual Context. Following the publication of this report Mainline foundation has been offering harm-reduction intervention for MSM and promoting the development of a continuum of care by building networks, training professionals and investing in advocacy. In our view, a continuum of care means the availability of a sufficient level of qualitative and effective preventive interventions, harm reduction services and treatment facilities that are connected, can track and intervene in the 'lifecycle' of individual drug use, and are easily accessible by the target group. This case study describes the various interventions of Mainline foundation, that make up their continuum of care approach concerning chemsex issues.

Mirtazapine impairs acquisition and reinstatement of cocaine-induced place preference in rats

Exposure to cues previously associated with drug use and the environment can trigger intense craving and drug-seeking, often leading to relapse in individuals with substance use disorders. Several studies suggest that the decrease in the effects of the cues and the environment could help maintain abstinence from drug use in individuals abusing drugs. Mirtazapine, an antagonist of the noradrenergic (NE) α2 receptor and the 5-HT2A/C and 5-HT3 receptors has demonstrated efficacy in reducing the rewarding effect of different drugs.The purpose of the present study was to investigate whether the mirtazapine, blocks the acquisition and reinstatement of cocaine-induced conditioned place preference (CPP). In this study, 120 Wistar male rats were utilized and we use the CPP as a behavioral tool to measure the context-rewarding effect of an unconditioned stimulus such as cocaine. Mirtazapine was dosed for 30 or 60 consecutive days prior to treatment with cocaine or during the extinction phase. We found that dosing with mirtazapine for 30 consecutive days caused a time-related reduction in acquisition or reinstatement of preference for the cocaine-paired chamber. When the duration of treatment is increased (60 days), reductions in preference for the cocaine-paired chamber were potentiated.These observations support its potential clinical anti-addictive properties against drugs.

Alcohol Use and HIV Risk Within Social Networks of MSM Sex Workers in the Dominican Republic.

To examine how alcohol-related HIV risk behaviors within MSM sex workers' social networks (SN) may be associated with individual risk behaviors, respondent-driven and venue-based sampling were used to collect demographic, behavioral and SN characteristics among MSM sex workers in Santo Domingo and Boca Chica (N=220). The majority of participants reported problem drinking (71.0%) or alcohol use at their last sexual encounter (71.4%). Self-reported problem drinking was associated with SN characteristics (at least one member who recently got drunk aOR=7.5, no religious/spiritual adviser aOR=3.0, non-sexual network density aOR=0.9), while self-reported alcohol use at last sex was associated with individual (drug use at last sex aOR=4.4) and SN characteristics (at least one member with previous HIV/STI testing aOR=4.7). Dominican MSM sex workers reported high alcohol use, which may increase their risk for HIV. A better understanding of SN factors associated with individual risk behaviors can helpguide appropriate intervention development.

Abstinence reverses EEG-indexed attention bias between drug-related and pleasant stimuli in cocaine-addicted individuals.

Increased attention bias toward drug-related cues over non-drug-related intrinsically pleasant reinforcers is a hallmark of drug addiction. In this study we used the late positive potential (LPP) to investigate whether such increased attention bias toward drug-related relative to non-drug-related cues changes over a protracted period of reduced drug use in treatment-seeking individuals with a cocaine use disorder (CUD). Treatment-seeking individuals with CUD and matched healthy controls passively viewed a series of pleasant, neutral and drug-related pictures while their event-related potentials were recorded at baseline (≤ 3 weeks after treatment initiation) and at 6-month follow-up (only CUD). We included 19 treatment-seeking individuals with CUD and 18 matched controls in our analyses. The results showed a reversal in attention bias (i.e., LPP amplitude) from baseline (i.e., drug > pleasant) to follow-up (i.e., pleasant > drug) driven by an increased attentional engagement with pleasant pictures; this LPP reversal was paralleled by a concomitant reduction in self-reported wanting and craving for cocaine in the CUD group. Furthermore, reduced attention bias toward drug-related cues (relative to pleasant cues) was correlated with longer duration of abstinence at baseline, and the extent of its longitudinal reversal was correlated with decreased craving at follow-up, providing support for abstinence as a putative mechanism of this bottom-up attentional change. A limited sample size and the use of the same set of pictures at baseline and follow-up were the major limitations of this study. Results collectively indicate that, by tracking with drug abstinence, LPP in response to drug-related relative to pleasant cues may serve as an indicator of clinical progress in treatment-seeking individuals with CUD.

Psychedelic drug use in healthy individuals: A review of benefits, costs, and implications for drug policy

The potential of psychedelic drugs in the treatment of mental health problems is increasingly being recognized. However, relatively little thrust has been given to the suggestion that individuals without any mental health problems may benefit from using psychedelic drugs, and that they may have a right to do so. This review considers contemporary research into the use of psychedelic drugs in healthy individuals, including neurobiological and subjective effects. In line with findings suggesting positive effects in the treatment of mental health problems, such research highlights the potential of psychedelic drugs for the enhancement of wellbeing even in healthy individuals. The relatively low risk associated with usage does not appear to align with stringent drug laws that impose heavy penalties for their use. Some policy implications, and suggestions for future research, are considered.

Sixteen-year nationwide trends in antithrombotic drug use in Denmark and its correlation with landmark studies

ObjectiveAntithrombotic drugs are widely used in the prevention and treatment of cardiovascular diseases; yet, nationwide long-term usage trends remain unexplored. We examined long-term trends in the use of antithrombotic drugs...

The association between psychosocial and structural-level stressors and HIV injection drug risk behavior among Malaysian fishermen: A cross-sectional study.

BackgroundMalaysian fishermen have been identified as a key-affected HIV population with HIV rates 10 times higher than national rates. A number of studies have identified that psychosocial and structural-level stressors increase HIV injection drug risk behaviors. The purpose of this paper is to examine psychosocial and structural-level stressors of injection drug use and HIV injection drug risk behaviors among Malaysian fishermen.MethodsThe study employs a cross-sectional design using respondent driven sampling methods. The sample includes 406 fishermen from Pahang state, Malaysia. Using multivariate logistic regressions, we examined the relationship between individual (depression), social (adverse interactions with the police), and structural (poverty-related) stressors and injection drug use and risky injection drug use (e.g.., receptive and non-receptive needle sharing, frontloading and back-loading, or sharing drugs from a common container).ResultsParticipants below the poverty line had significantly lower odds of injection drug use (OR 0.52, 95 % CI: 0.27-0.99, p = 0.047) and risky injection drug use behavior (OR 0.48, 95 % CI: 0.25-0.93, p = 0.030). In addition, participants with an arrest history had higher odds of injection use (OR 19.58, 95 % CI: 9.81-39.10, p < 0.001) and risky injection drug use (OR 16.25, 95 % CI: 4.73-55.85, p < 0.001). Participants with depression had significantly higher odds of engaging in risky injection drug use behavior (OR 3.26, 95 % 1.39-7.67, p = 0.007). Focusing on participants with a history of injection drug use, we found that participants with depression were significantly more likely to engage in risky drug use compared to participants below the depression cutoff (OR 3.45, 95 % CI: 1.23-9.66, p < 0.02).ConclusionsFindings underscore the need to address psychosocial and structural-level stressors among Malaysian fishermen to reduce HIV injection drug risk behaviors.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3125-7) contains supplementary material, which is available to authorized users.

An Original Stepwise Multilevel Logistic Regression Analysis of Discriminatory Accuracy: The Case of Neighbourhoods and Health.

Background and AimMany multilevel logistic regression analyses of “neighbourhood and health” focus on interpreting measures of associations (e.g., odds ratio, OR). In contrast, multilevel analysis of variance is rarely considered. We propose an original stepwise analytical approach that distinguishes between “specific” (measures of association) and “general” (measures of variance) contextual effects. Performing two empirical examples we illustrate the methodology, interpret the results and discuss the implications of this kind of analysis in public health.MethodsWe analyse 43,291 individuals residing in 218 neighbourhoods in the city of Malmö, Sweden in 2006. We study two individual outcomes (psychotropic drug use and choice of private vs. public general practitioner, GP) for which the relative importance of neighbourhood as a source of individual variation differs substantially. In Step 1 of the analysis, we evaluate the OR and the area under the receiver operating characteristic (AUC) curve for individual-level covariates (i.e., age, sex and individual low income). In Step 2, we assess general contextual effects using the AUC. Finally, in Step 3 the OR for a specific neighbourhood characteristic (i.e., neighbourhood income) is interpreted jointly with the proportional change in variance (i.e., PCV) and the proportion of ORs in the opposite direction (POOR) statistics.ResultsFor both outcomes, information on individual characteristics (Step 1) provide a low discriminatory accuracy (AUC = 0.616 for psychotropic drugs; = 0.600 for choosing a private GP). Accounting for neighbourhood of residence (Step 2) only improved the AUC for choosing a private GP (+0.295 units). High neighbourhood income (Step 3) was strongly associated to choosing a private GP (OR = 3.50) but the PCV was only 11% and the POOR 33%.ConclusionApplying an innovative stepwise multilevel analysis, we observed that, in Malmö, the neighbourhood context per se had a negligible influence on individual use of psychotropic drugs, but appears to strongly condition individual choice of a private GP. However, the latter was only modestly explained by the socioeconomic circumstances of the neighbourhoods. Our analyses are based on real data and provide useful information for understanding neighbourhood level influences in general and on individual use of psychotropic drugs and choice of GP in particular. However, our primary aim is to illustrate how to perform and interpret a multilevel analysis of individual heterogeneity in social epidemiology and public health. Our study shows that neighbourhood “effects” are not properly quantified by reporting differences between neighbourhood averages but rather by measuring the share of the individual heterogeneity that exists at the neighbourhood level.

Analysis of drug use in institutionalized individuals with intellectual disability and tube feeding

Objectives: Little is known about the medication used by people with intellectual disabilities (ID) and enteral feeding tube (EFT). However, in light of the complexity associated with drug administration through EFT, data on medication use in this population may be helpful in the development of practical guidelines and staff training initiatives.Methods: A cross-sectional, observational study was conducted in six Belgian residential care facilities (RCFs) for individuals with ID. Anonymized medication records of all residents receiving chronic medication through EFT were collected (n = 156). All chronic drugs were categorized according to the ATC classification, and medication records were checked for potential major drug–drug interactions (DDI).Results: The 156 residents used a total of 1029 chronic drugs via EFT, with a median of six drugs per resident (range 1–14). A total of 148 different drug molecules were identified, belonging to 38 main ATC therapeutic groups (ATC level 2). Antiepileptics, drugs for constipation and drugs for acid-related disorders were the most frequently used groups. Seventy-four of the 156 screened medication records (47%) contained at least one potential DDI; in total, 116 potential interactions were identified, which represent 38 different interacting drug pairs.Conclusion: This study describes medication use through EFT among people with ID in Belgian RCFs, with antiepileptics being the most frequently used group. Our study also demonstrated that a high number of drugs is administered through EFT, and that the number of potential DDIs is high. These observations warrant an increased attention for drug administration through the EFT in individuals with ID.

Fármacos e Doenças Crônicas em idosos hipertensos e/ou diabéticos praticantes de exercícios físicos

O objetivo foi analisar a incidência de doenças crônicas não transmissíveis (DCNT) e a utilização de fármacos em idosos hipertensos e/ou diabéticos praticantes regulares de exercício físico. Como método, o estudo de campo, epidemiológico e transversal sobre DCNT e a utilização de fármacos em indivíduos com 60 anos ou mais de idade, praticantes regulares de exercício físico e diagnosticados com Hipertensão Arterial Sistêmica (HAS) e/ou Diabetes Mellitus (DM). Avaliaram-se 223 idosos, sendo 14,8% (n=33) do sexo masculino e 85,2% (n=190) do sexo feminino. A idade média foi de 69,8±6,9 anos. Em relação à frequência semanal dos exercícios, observou-se que 57,8% os praticavam de 1 a 2 vezes por semana; 33,6%, de 3 a 4 vezes; e 8,5%, de 5 a 7 vezes na semana. Quanto ao uso de fármacos, 142 tipos foram relatados, dentre estes, destacaram-se os anti-hipertensivos, hipolipemiantes, antidepressivos, psicotrópicos cerebrais, hipoglicemiantes e supressores de absorção óssea. Dentre as DNCT investigadas, destacaram-se o DM, a HAS, as dislipidemias e o hipotireoidismo. Na correlação entre o tempo de exercício físico e o número de fármacos pôde-se observar forte correlação estatística (r=0,0848), enquanto para as DCNT, esta correlação foi moderada (r=0,0593). Concluiu-se que, com o envelhecimento, observa-se um aumento da prevalência de DCNT, uma diminuição da prática de exercício físico, e um aumento no consumo de fármacos. Foi demonstrada uma maior adesão do sexo feminino na prática de exercício físico, mas quanto maior a idade, menor a adesão, e que os idosos praticantes de exercício físico por mais tempo consumiam menos fármacos e apresentavam menos DCNT.

Recreational drug use among individuals living with HIV in Europe: review of the prevalence, comparison with the general population and HIV guidelines recommendations

Background: Adherence problems, interactions and higher rate of risk activities have been observed in HIV individuals using recreational drugs. Our aim was to describe recreational drug use in both HIV individuals and general population in Europe, and to assess at what extent HIV guidelines address this issue.Methods: Data on recreational drug use across Europe were obtained from the European Monitoring Centre for Drugs and Drug Addiction for the general population, and through Pubmed search. for HIV patients. We assessed the incorporation of recreational drug issues in HIV treatment guidelines for the following topics: (a) recreational drugs; (b) adherence to antiretrovirals; (c) interactions; (d) transmission risk. Guidelines included: World Health Organization; European Aids Clinical Society; U.S. Department of Health and Human Services; International Antiviral Society-USA; and seven European national guidelines.Results: 29 countries reported recreational drug use in general population. The highest prevalences were observed for Cannabis (i.e., 8–10% in Spain, France, and Czech Republic) followed by cocaine, amphetamines and ecstasy. The 13 studies selected in the systematic review showed a great variability in recreational drug use on the HIV population. Apart from classical recreational drugs, we found a relevant use of new drugs including sexual experience enhancers. Polydrug consumption was about 50% in some studies. Most guidelines included general information about recreational drugs, showing great variability on the inclusion of the evaluated topics. We found more specific, evidence-based recommendations on interactions, followed by medication adherence and transmission risk.Conclusions: Available data on the people living with HIV suggest a higher use of recreational drugs than in the general population, which is already relevant. However, recreational drug issues should be included or addressed more thoroughly in most guidelines.