Substance Abuse Research Articles

Manufacturer-sponsored drug coupon use and drug-switching behavior among patients with type 2 diabetes.

Patients often use manufacturer-sponsored coupons to reduce their out-of-pocket spending. However, little is known whether coupon use is associated with medication-switching behaviors. To examine if using a manufacturer-sponsored coupon to initiate a medication is associated with patterns of medication-switching behaviors among patients with type 2 diabetes. Using IQVIA's retail pharmacy claims data from October 2017 to September 2019, we analyzed commercially insured patients with type 2 diabetes who had newly started taking the following noninsulin diabetes drugs: generic metformin (nearly no coupon use), Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors (SGLT2, high coupon use), and dipeptidyl peptidase IV inhibitors (DPP-IV inhibitors, moderate coupon use). We assessed if drug-switching behaviors, defined as no switching, switching to a same-class drug, or switching to a drug in a different class, differed among patients who did and did not use coupons to initiate treatments. We performed multinomial logistic regression to estimate the probability of each switching type associated with patients' initial coupon use. Among 9,781 patients in our sample, 83.7% of them initiated treatments with metformin, 8.2% with SGLT2, and 8.1% with DPP-IV inhibitors. The overall switching rate was the lowest for generic metformin (40%) than brand-name drugs (56%-57%). Among the brand-name drug users, patients who used a coupon to initiate these drugs were less likely to switch to any drug compared with patients without coupon use (SGLT2 = -18% [95% CI = -24% to -13%]; DPP-IV inhibitors = -9% [-16% to -2%]). These patients were also less likely to switch to drugs in other competing classes (SGLT2 = -16% [95% CI = -22% to -10%]; DPP-IV inhibitors = -9% [-16% to -2%]). Patients who started their treatment with generic metformin had the lowest rate of drug switching. Using coupons to initiate brand-name drugs in classes with prevalent coupons was associated with reduced medication switching to other class drugs.

The Ross Procedure in Active Infective Endocarditis: A Comparison With Conventional Prostheses

BackgroundThe Ross procedure can be an ideal option in infective endocarditis (IE) due to greater resistance to infection. However, limited literature has highlighted the comparison with conventional prostheses in this setting. MethodsBetween February 2013 and September 2022, 25 patients (median age, 50 years) underwent a Ross procedure for IE (Ross group). The results were compared with those after other aortic valve procedures (aortic valve replacement and aortic root replacement) for IE (n = 37, other group. ResultsThe patients in the Ross group included more intravenous drug users and had more prosthetic valve endocarditis and annular abscess formation compared with the other group. Although cardiopulmonary bypass time and aortic cross-clamp time were significantly longer (P < .001 and P = .003, respectively) and the blood requirements were significantly higher (P = .001) in the Ross group, most postoperative short-term outcomes were equivalent between the 2 groups. During follow-up, 1 patient (4%) required reoperation in the Ross group, whereas 6 patients (16%) required reoperation in the other group. Freedom from composite events was significantly better in the Ross group (P = .04). Multivariable analysis found the Ross procedure, compared with other procedures, was a significant independent protective factor for composite end points (P = .03). ConclusionsFor IE, despite surgical complexity, the Ross procedure yielded short-term outcomes similar to other procedures. In the midterm, the Ross procedure provides a lower reoperation rate, resulting in significantly fewer composite events. The Ross procedure appears to be a better option for patients with IE, but long-term follow-up is necessary.

HCV testing and linkage to care for hepatitis C virus infection for marginalized drug user populations attending a harm reduction service in Bologna, Italy.

Our aim was to estimate the prevalence of HCV in a highly vulnerable population of substance users living with social difficulties and marginality who came into contact with the mobile harm reduction service in the city of Bologna (Northern Italy). Testing was offered in a van (mobile unit) by using a point-of-care HCV antibody test. For the HCV RNA test, the Xpert HCV Viral Load Fingerstick Test was used. Participants with a detectable HCV RNA were accompanied within two weeks to the Infectious Diseases Department Sant' Orsola Hospital Bologna to start HCV treatment. With regard to the main study findings, 54% reported having never been HCV tested before; a prevalence of HCV RNA of 6% among all participants and 22% among those injecting drugs was found; among the HCV RNA positive participants, 80% were accompanied to treatment. Our study suggests that mobile harm reduction services, in networks with healthcare facilities, are able to offer a continuous HCV screening service and linkage to care for people with drug use living in socially marginalized conditions.

Cultural Factors Influencing Substance Abuse among Undergraduates of Tai Solarin University of Education, Nigeria

Over the years, substance abuse has been a major challenge in Tai Solarin University of Education, Ijagun, Ogun State, Nigeria. Some of the reasons for substance abuse among undergraduates include family upbringing, ceremonial exposure, insecurity, anticipation, sex drive and festival usage. Substance abuse among undergraduates caused property damage within educational institution and diminishes the prospects of academic success of undergraduates. While examining the cultural factors that influence substance abuse among undergraduates of Tai Solarin University of Education in Ogun State, a descriptive survey research design was employed. The study utilized a simple random sampling technique to select a sample of eight hundred (800) undergraduates. The researcher used statistical tools such as frequency counts, percentages, and chi-square tests at a significance level of 0.05. The analysis resulted in the rejection of all three hypotheses. The study identified festival, ceremony and religion as significant contributors to substance abuse among Tai Solarin University of Education undergraduates. The study recommends mandatory medical tests for substance abuse at all undergraduate levels and advocates active involvement of health educators in educating students.

Midwifery assessment and interventions protocol for adolescent pregnancy: a Delphi method approach

Background: Adolescence pregnancy poses risks for both mothers and infants, often due to insufficient prenatal care resulting from societal stigmatization and lack of awareness. Around 16 million adolescents aged 15-19 years in the world give birth each year; in Indonesia, the first pregnant women aged &lt;20 years are 45.10%, while in West Sumatra, it is 33.7%. To address this issue, integrated programs and midwifery care have been implemented. However, providing such care to adolescent mothers comes with its own set of challenges.Purpose: This study aims to conduct a midwifery assessment and intervention protocol for adolescent pregnancy.Method: Qualitative approach The Delphi method involved two rounds of evaluation, with twenty-one participants who were independent practice midwives, six midwives involved in the mother and child health program, and nine midwifery lecturers from accredited educational institutions A (excellent). Participants had at least five years of clinical experience and were selected using purposive non-probability sampling. Participants evaluated statements related to midwifery care during the Delphi process. The validity of these statements was determined by participants providing a minimum score of 3, and the Content Validity Ratio (CVR) was calculated. Statements with a CVR greater than 0.8 were considered valid.Results: Based on expert consensus, important assessments for adolescent pregnant women include addressing issues of gender equality and domestic violence, reproductive and sexual health, risks associated with smoking and substance abuse, maintaining a healthy pregnancy, and adequately preparing for labor and parenthood.Conclusion: Midwifery management and midwifery information were deemed valid dimensions of midwifery care; relational care had one invalid item.

Investigating associations between climate change anxiety and mental health impact on vulnerable populations: A qualitative analysis.

Climate anxiety has a negative impact on the mental health and psychological wellbeing of the vulnerable population. The goal is to assess many factors that affect mental health and psychological wellbeing, as well as how climate change affects mental health in Pakistan's vulnerable population. This study provides evidence-based insights on the long- and medium-term impacts of extreme weather events on mental health. We conducted semi-structured interviews with a sample of 72 students aged 10-16 years, employing an exploratory qualitative design. The resulting process identified themes and questions for future research on climate change and its psychological effects on children's mental health. As a result, positive emotions embedded in children's climate strategic actions in parent and community contexts helped to mitigate children's perceptions of negative emotions (such as climate anxiety, phobias, fear, sleep disorders, depression, sadness, and substance abuse). Climate change's effects can have a significant impact on mental health. We will be discussing effective strategies to address the expected mental health issues among children caused by climate change. The discussion paper offers a set of recommendations for addressing the mental health impacts of climate change, including improving mental health support systems, integrating climate change education into services, and developing targeted interventions for vulnerable populations.

Prescription and nonprescription drug misuse and abuse in community pharmacies in Iraq: a cross-sectional survey.

There is little known regarding prescription and nonprescription medicine nonmedical use (abuse and misuse) in Iraq, with limited treatment. Pharmacists could be a valuable source of information in the absence of any national monitoring system. This study aimed to explore Iraqi community pharmacists' perspectives on prescription and nonprescription medicine abuse/misuse, including motives for use and how often they encounter people whom they think are misusing or abusing medicines. A cross-sectional survey was undertaken between November 2020 and February 2021. Community pharmacists in Iraq were asked to complete a prepiloted self-administered questionnaire, distributed through online social media platforms. 300 pharmacists completed the questionnaire. The most commonly reported nonprescription drugs suspected of abuse/misuse were cough and cold medications (n = 80, 26.6%), topical corticosteroids (n = 54, 17.9%), and allergy products (n = 33, 11%). The most common reported prescription drugs suspected of abuse/misuse were systemic antibiotics (n = 111, 36.9%), gabapentinoids (n = 56, 18.6%), and moderate-weak opioids (n = 34, 11.3%). The most commonly method used by pharmacists to limit access to such drugs was responding that the requested medication was unavailable (n = 273, 51.7%), followed by advising on risks (n = 152, 33.2%). Prescription/nonprescription medicine abuse and misuse are suspected in community pharmacies in Iraq. Current methods for controlling the problem are likely to be ineffective in the absence of prescription drug enforcement. Pharmacists could have a more proactive role in managing this issue, networking with other pharmacists, and referring suspected users to support.

Clinical Outcome of Surgical Treatment of Giant Femoral Artery Pseudoaneurysms

Femoral artery was used as an access site for cardiovascular procedures and by IV drug abusers, Femoral Artery Pseudoaneurysm (FAP) was a common complication associated with these procedures. Objective: To evaluate clinical outcome of surgical repair of femoral artery pseudoaneurysms. Methods: The prospective study was conducted in Doctors Hospital, Lahore from October 2022 to October 2023. The study included patients with giant femoral artery pseudoaneurysms who required surgical intervention. Data from a total of 50 patients were included in whom both peripheral vascular interventions and percutaneous cardiac catheterization was performed. Patients were followed up at 1-, 3-, 6- and 12 months postoperatively. SPSS version 23.0 was used for data analysis. Results: All patients underwent open surgical treatment. Of 50 patients, 25 (50%) had SFA pseudoaneurysm, 20 (40%) had CFA pseudoaneurysm and 5 (10%) had PFA pseudoaneurysm. The mean duration of clinical manifestations was 16.30 ± 7.74 days. Surgical repair was successful in all 50 (100%) patients and distal ischemia was fully resolved. There was no case of limb loss or post-operative mortality. One patient had an infection in the groin wound and had raised Total leucocyte count (TLC), which was resolved by early drainage and antibiotic treatment. Patients were followed up at 1, 3, 6, and 12 months and there were no signs of clinical or angiographic evidence of post-operative complications and changes in distal pulse. Conclusion: Surgical repair was first-line treatment for giant FAP. It was clinically feasible and has a high success rate and low complication rate.

Unravelling The Nexus: Social Environment and Peer Influence in Drug Abuse in Lawas, Sarawak

The rising issue of drug abuse in Sarawak, demands urgent attention as the problem shows no signs of abating. The primary goal of this research is to investigate the most influential factor that contributes to the rise in drug abuse in Lawas and how it affects the selected individual social awareness. By delving into this dynamic, the study aims to enhance the comprehension of the issue and, consequently, develop more effective strategies to mitigate its consequences. The research employed qualitative methodology, with in-depth interviews as the primary data collection method. Six participants participated in the in-depth interviews and each referred to using pseudonyms. Participants 1 and 2 are presently enrolled in rehabilitation programs facilitated by the National Anti-Drug Agency (NADA/AADK) division in Limbang. Participants 3, 4, and 5 were selected from the families, relatives, and friends of former addicts. Participant 6 plays a pivotal role as an officer responsible for drug enforcement in Lawas. The study employed social learning theory to gain a comprehensive perspective on the subject matter. The data analysis revealed that the social environment functions as the macro factor, while susceptibility to peer influence serves as the micro factor in drug abuse cases in Lawas and there is a relationship between the factor and the selected individual social awareness. The findings from this research hold immense relevance for a wide spectrum of stakeholders, with a particular emphasis on community and societal development, in addressing the multifaceted challenges posed by drug abuse issues in Lawas, Sarawak.

Silenced, Scarred &amp; Shattered: Unmasking the Wounds of Child Sexual Abuse in Select American Memoirs

The research brings to light the marginalized voices of three American women who have written about their sexual abuse in their respective memoirs Roxane Gay, Hunger: A Memoir of my Body (2017), Nikki Dubose, Washed Away: From Darkness to Light (2016) and Neesha Arter Controlled: The worst Night of my Life and its Aftermath (2015). Using these memoirs as primary data and using thematic analysis the study identified three themes which were further classified into different subthemes. Firstly, the research discovered the challenges faced by the survivors in expressing and communicating about sexual abuse due to fear and shame, the survivors do not come forward because of threats, because of rape stereotypes that permeate the society and the fear of what parents and others might think. Secondly, the research explores the various impact of trauma that is caused by sexual abuse which include shame, guilt and self blame, unworthy self, uncontrollable rage, disruption of safety and trust, isolating themselves from everyone, hostility towards body, destructive behaviours which include eating disorder from Anorexia Nervosa to Binge eating disorder, it also includes self harm and substance abuse. Thirdly, the research focuses on the recovery aspect on how the survivors learn to live with the wounds caused by sexual abuse. It focuses on how the survivors came in terms with the abuse, the conflicting feelings of forgiveness and revenge and how they sought redemption through writing their journey.

Risk Factors for Cardiovascular Diseases among Drug Abusers at a Selected Government Mental Hospital in Bangladesh

Risk Factors for Cardiovascular Diseases among Drug Abusers at a Selected Government Mental Hospital in Bangladesh

Synthesis of bio-based nanolubricant using bimetallic nanoparticles to mitigate the surface deterioration of low carbon steel for metalforming industry

Worldwide industries are drawing their attention to the usage of bio-based substances for their operational purposes. Herein, the bimetallic nanoparticles (Bi-MNPs) were synthesised using a unique combination of Zn–Cr in bio-based mustard oil by green route utilizing wet chemical approach. Synthesised Bi-MNPs (0.12–0.15 wt%) were employed in the synthesis of bimetallic bio-based nanolubricant (Bi-BNL), and the impact was also evaluated on low carbon steel (grade SAE1006). The reduction of Bi-MNPs was carried out by green reducing agents and their stabilisation was confirmed by Fourier transform infrared spectroscopy (FTIR). Whereas, the synthesis of Bi-MNPs was followed by Surface plasma resonance (SPR), average size of Bi-MNPs which was about 60 nm and morphology was established using Scanning electron microscopy (SEM). The efficiency of Bi-BNL and impact of Bi-MNPs on the stability of Bi-BNL was investigated by Dynamic light scattering (DLS), Zeta potential (ZP) and comparative study was carried out with reference lubricant. Interestingly, the kinematic viscosity (KV) values of the lubricants are quite compatible, and have linear relationsip with coefficient of friction which is very suitable to conclude the anti-friction and anti-wearing properties. The KV of bio-based oil was monitored under the criteria of standard test method ASTM D445, and the resultant value was compared with the reference oil. The stability of Bi-BNL and its interaction with low carbon metal sheet was also studied; the outcomes were very impressive due to no rust patches, oil spots and surface deterioration on the metal sheet. The paramount creativity of this research work is the modification of bio-based oil via Bi-MNPs for the synthesis of Bi-BNL that offers the best surface quality of low-carbon steel. Cumulatively, these findings of Bi-BNL could be open up new possibilities to explore the bio-based synthesis of lubricants on a comprehensive scale.

Single and Unhoused Population at Risk for Self-Inflicted Burn Injury: A Retrospective Analysis of an Urban American Burn Center's Experience.

Despite the growing recognition of self-harm as a pressing public health issue, demographic risk factors of self-inflicted burn (SIB) injuries in the U.S. have not been extensively described. In this retrospective study, we seek to identify demographic risk factors and patterns associated with SIB injuries at an urban burn center. Charts were reviewed of patients admitted to a single American Burn Association (ABA)-verified burn unit between 2015 and 2023 with a history of SIB injury, identified with ICD10 code X76.XXXA. Descriptive statistics, Welch's t-test of unequal variances, and Chi-Squared-analysis were performed. A total of 3,212 patients were admitted to our institution for management of acute burn injury, with 94 (2.9%) patients who presented with SIB injury. SIB patients were more likely than the control cohort to be male (p = 0.035), single (p=0.008), unhoused (p < 0.001), live alone (p < 0.001), and have documented psychiatric diagnoses (72.3% vs. 2.1%, p < 0.001). They had larger %TBSA affected (p < 0.001) and higher rates of inhalation injury (p < 0.001). The SIB cohort also showed significantly higher rates of positive urine toxicology results, primarily for stimulants and opiates (p < 0.001). Patients with SIBs had longer hospital stays (21.7 ± 2.6 days vs. 12.0 ± 22.1 days, p = 0.006), higher rates of ICU admission (p < 0.001), and mechanical ventilation requirement (p < 0.001). Mental health support services, substance abuse rehabilitation programs, and community outreach need to be prioritized, especially targeting vulnerable populations such as the unhoused.

Research landscape analysis on dual diagnosis of substance use and mental health disorders: key contributors, research hotspots, and emerging research topics

BackgroundSubstance use disorders (SUDs) and mental health disorders (MHDs) are significant public health challenges with far-reaching consequences on individuals and society. Dual diagnosis, the coexistence of SUDs and MHDs, poses unique complexities and impacts treatment outcomes. A research landscape analysis was conducted to explore the growth, active countries, and active journals in this field, identify research hotspots, and emerging research topics.MethodA systematic research landscape analysis was conducted using Scopus to retrieve articles on dual diagnosis of SUDs and MHDs. Inclusion and exclusion criteria were applied to focus on research articles published in English up to December 2022. Data were processed and mapped using VOSviewer to visualize research trends.ResultsA total of 935 research articles were found. The number of research articles on has been increasing steadily since the mid-1990s, with a peak of publications between 2003 and 2012, followed by a fluctuating steady state from 2013 to 2022. The United States contributed the most articles (62.5%), followed by Canada (9.4%). The Journal of Dual Diagnosis, Journal of Substance Abuse Treatment, and Mental Health and Substance Use Dual Diagnosis were the top active journals in the field. Key research hotspots include the comorbidity of SUDs and MHDs, treatment interventions, quality of life and functioning, epidemiology, and the implications of comorbidity. Emerging research topics include neurobiological and psychosocial aspects, environmental and sociocultural factors, innovative interventions, special populations, and public health implications.ConclusionsThe research landscape analysis provides valuable insights into dual diagnosis research trends, active countries, journals, and emerging topics. Integrated approaches, evidence-based interventions, and targeted policies are crucial for addressing the complex interplay between substance use and mental health disorders and improving patient outcomes.

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.

Scaling the highs, falling to the lows: A qualitative study of women's experiences of drug abuse

This study explores the personal and social impacts of drug abuse on women undergoing addiction treatment in Tehran, Iran. Using a qualitative approach, 25 women aged 17 to 51 were interviewed to understand their experiences with addiction and recovery. The research found that many women started using drugs to escape emotional pain or seek pleasure, but this quickly led to serious consequences. These included social isolation, stigma, loss of their roles as mothers, financial difficulties, and physical decline. Four main themes were identified: the initial attraction to drugs and the subsequent struggle with addiction, the mixed experiences in rehabilitation centers, the broader social consequences of addiction, and the painful transition from the initial pleasure of drug abuse to its harsh realities. The study highlights the influence of cultural and societal norms on these women’s experiences and stresses the need for treatment programs that are sensitive to their specific needs. The findings suggest that effective support for women in similar contexts must address both their physical and emotional recovery, considering the unique challenges they face in a non-Western, Islamic setting.

Adult Pharmacy Costs and Characteristics of Very High-Cost Prescription Drug Users in the United States, 2018–2022

Objective: This study sought to identify: (1) the demographic and clinical characteristics of very high-cost users (defined as patients with pharmaceutical expenditures that were equal to or greater than the 99th percentile), (2) whether or not these characteristics changed over time, (3) sociodemographic and clinical correlates of being very high-cost users, (4) the average pharmaceutical costs of very-high cost users, and (5) the therapeutic classes and medications that contributed to these high costs Background: There are growing public concerns about rising drug costs, in part due to increased availability, greater effectiveness, and market considerations. There is a concentrated portion of patients that accounts for a disproportionately large portion of pharmaceutical expenditures. Methods: A large serial cross-sectional study was conducted with De-identified, member-level pharmacy claims (n = 65,739,791) from a large, national pharmacy benefits manager from January 1, 2018 to December 31, 2022. The main outcome and measures were 2018–2022 pharmaceutical expenditures; amounts were adjusted for inflation to reflect 2022-dollar values. Results: Across the study period, the odds of being classified as a very high-cost user were 1.31 times as high for those 45–64 years old compared with those 18–44 years old (reference category); the odds were 1.42 times as high for males compared with females; 1.13 times as high before those identifying as non-Hispanic Black compared with non-Hispanic white; 1.11 times as high for those enrolled in a health care exchange plan compared with a commercial plan. In addition, very high-cost users lived in areas with higher social needs. Human immunodeficiency virus, inflammatory conditions, multiple sclerosis, and cancer accounted for the largest share of costs among this group. Conclusions: This study identified the unique characteristics of very high-cost pharmaceutical users and identified the top conditions and prescription drugs that drove high pharmaceutical expenditures among this population. These findings are essential to understanding rising pharmaceutical costs in the United States and can help identify the issues and solutions of specific cost drivers within our health care policies.

Drug Abuse Among Adolescents

Drug Abuse Among Adolescents

Evaluation of left ventricular systolic function in opium users by strain echocardiography.

Heart failure is known as a health problem in the world due to its mortality and burdens on the health care system. Studies remain controversial about the effect of opium usage on systolic heart function. Therefore, the aim of this study was to compare systolic left ventricular function in opium users with non-addict people by strain echocardiography and its association with serum apelin level. This case-control study was conducted in 2022 at Shafa Hospital in Kerman, Iran, on 50 opium users who referred to the addiction treatment centres and had no history of other substance usage. The addiction is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and a history of opium consumption for at least 3years. Fifty healthy people (non-opium users) who were matched in terms of age and sex were enrolled as a control group. Demographic information of the participants, including age, gender and amount of opium usage, was recorded by questionnaire. Citrated blood samples were taken from all participants in the study, and serum apelin was measured by the enzyme-linked immunosorbent assay (ELISA) method. They underwent transthoracic echocardiography by an expert cardiologist using the same device (Philips Affiniti 50). Echocardiographic systolic parameters have been recorded and compared between the two groups. In this study, 100 participants, including 50 opium users and 50 non-opium users (as a control group), were investigated. The mean age was 36.4±5.08 in the opium users' group and 34.14±7.2 in the control group. As both groups were matched, there were 8 (16%) women and 42 (84%) men in each of the two groups. The mean amount of ejection fraction (EF) and global longitudinal strain (GLS) were significantly lower in opium users than in the control group (P<0.001). The results also demonstrated that the serum level of apelin in the addicted persons was lower when compared with the non-addicted persons (3.4 vs. 9.7; P<0.001). Evaluation of systolic left ventricular function in opium users by strain echocardiography showed that opium affects the systolic function of the heart, as observed by a significant reduction in EF and GLS. So opium usage can be considered a risk factor for heart failure and needs more attention in preventive cardiology.

Phenibut: A drug with one too many "buts".

Phenibut is a gamma aminobutyric acid derivative with activity at γ-aminobutyric acid (GABA)B, A and β-phenethylamine receptors. It was developed as a drug in the former Soviet Union to overcome anxiety and improve cognitive function in military personnel. In the last decade, it has made inroads into the European and U.S. markets, being marketed for purported nootropic properties. Here, we summarize the current knowledge on phenibut, its toxicology, pharmacology, adverse health effects, and patterns of use. Publications in peer-reviewed journals were searched in PubMed, Web of Science, and Google Scholar databases. Available literature points to adverse side effects associated with intoxication, withdrawal, and addiction to phenibut. Some of these effects can be life-threatening, requiring hospitalization and therapeutic interventions. Supportive efforts are often complicated by a lack of knowledge regarding phenibut's toxicology and pharmacology. Ingestion of phenibut was often associated with concomitant use of other substances of abuse. As control over its online marketing seems unrealistic, current efforts need to be focused on the addition of phenibut to current drug screening tests and the development of generally accepted treatment strategies for phenibut-associated toxicities.