Drug Consumption Research Articles

Impact of Regulatory Interventions on Ulipristal Acetate 5 mg (Esmya) Use in Spain: An Interrupted Time-Series Analysis.

Since late 2017, the use of ulipristal acetate 5 mg (UPA; Proprietary name: Esmya) has been under review in the European Union, due to an emerging hepatic risk. In February 2018 and in July 2018, the Spanish Agency of Medicines and Medical Devices and the marketing authorization holder put two risk minimization measures (RMM) in place, in order to inform about new safety information and to mitigate this risk. This study aims to assess RMM effectiveness in Spain, by performing an interrupted time-series (ITS) analyses, between 2014 and 2019. Two quasi-experimental ITS analyses to examine the use of UPA before and after the RMM release were performed: (a) an ecological study using aggregated data from a drug consumption database; and (b) a study using primary healthcare data gathered from electronic clinical records. Regulatory interventions were associated with an immediate and significant decrease level of DID (the number of DDD dispensed per 100 000 inhabitants and day) and incidence. The DID was 70% less than expected 12 months after the interventions. This value was 59% for the incidence. However, a change in the slope was not observed and the use started rising again in the last segment of the study period. Despite RMM had an immediate strong impact on UPA use, the last segment upward trend in the long-term might have been affected by the lack of comparable therapeutic alternatives. Further studies should be performed to confirm the increase trend observed and analyze subsequent measures and additional data.

Impact of reduced sampling frequency of illicit drug wastewater monitoring in the Netherlands

Drug consumption estimates are traditionally based on surveys or information from police seizures. Alternatively, residues of illicit drugs in untreated wastewater (influent) can be used to calculate mass loads and subsequently estimate drug consumption in the community throughout the week. For this purpose, wastewater is commonly sampled for seven consecutive days within the Sewage analysis CORe group Europe (SCORE), while other sampling schemes may be implemented in long-term studies outside this consortium. The current study demonstrates how sampling frequency of illicit drug residues in the influent of wastewater treatment plants (WWTPs) affects the derived weekly average. Thirty WWTPs were sampled over the course of 12 years and influents were analyzed for five drugs (metabolites): 3,4-methylenedioxymethamphetamine (MDMA), methamphetamine, amphetamine, benzoylecgonine (a metabolite of cocaine), and 11-nor-9-Carboxy tetrahydrocannabinol (THC-COOH). Subsequently, small and large WWTPs were grouped with a threshold of 100,000 inhabitants. After data curation, standardized loads were calculated (mg/d per 1000 inhabitants). Weekly averages of loads of the drug residues were calculated based on six scenarios (sampling one to six weekdays) and compared to the weekly average in the control situation (sampling seven weekdays) in a Monte Carlo simulation. Results indicate that drug residues with more dynamic loads over a week require more frequent sampling. The analysis illustrates that a decreased sampling frequency (4 or 5 days per week) still leads to a representative weekly average for all drugs tested when a deviation up to a factor of 1.25 is deemed acceptable. However, knowledge on typical levels is necessary to define outliers. We therefore recommend to study dynamics in drug residue loads for WWTPs before reducing sampling frequency in long term monitoring programs.

Syringe services program staff and participant perspectives on changing drug consumption behaviors in response to xylazine adulteration

BackgroundXylazine is an increasingly common adulterant in the North American unregulated drug supply that is associated with adverse health outcomes (e.g., skin infections, overdose). However, there are significant knowledge gaps regarding how xylazine was initially identified and how syringe services program (SSP) staff and clients (people who use drugs) responded to its emergence.MethodsFrom June–July 2023, we conducted qualitative interviews with medical (e.g., clinicians) and frontline SSP staff (e.g., outreach workers) and adult clients with a history of injection drug use at a Miami-based SSP. Inductive memos identified emergent codes; thematic analysis involving team consensus established final themes.ResultsFrom interviews with SSP staff (n = 8) and clients (n = 17), xylazine emergence was identified at different times, in various ways. Initially, during summer 2022, clients identified a “tranquilizer-like substance” that worsened sedation and withdrawal and caused wounds. SSP medical staff later identified this adulterant as xylazine by treating new medical cases and through diverse information-sharing networks that included professional societies and news sources; however, frontline SSP staff and clients needed additional educational resources about xylazine and its side effects. With limited guidance on how to reduce harm from xylazine, SSP clients altered their drug consumption routes, reduced drug use, and relied on peers’ experiences with the drug supply to protect themselves. Some individuals also reported preferring xylazine-adulterated opioids and increasing their drug use, including the use of stimulants to avoid over sedation.ConclusionsXylazine’s emergence characterizes the current era of unprecedented shifts in the unregulated drug supply. We found that xylazine spurred important behavioral changes among people who use drugs (e.g., transitioning from injecting to smoking). Incorporating these experiences into early drug warning surveillance systems and scaling up drug-checking services and safer smoking supply distribution could help mitigate significant health harms caused by xylazine and other emergent adulterants.

Наркотики в армии: постановка вопроса и попытка переосмысления данной проблемы в мировом масштабе. Часть I

The purpose of the study is to study the determinants (social, moral, behavioral, psychophysiological, purely pathological, etc.) that can motivate military personnel to consume illegal psychoactive substances. An additional goal is the desire to give an objective assessment of the attempts of Western politicians to create a “universal soldier”, and in fact, a kamikaze of the 21st century (“suicide bomber-drug addict”). Research methods: the theoretical and methodological basis of the work is a set of philosophical, criminological, socio-psychological, medical-biological and political science approaches through which the problem of drug addiction in the military environment is studied. The criminological concept of causality and the interdisciplinary approach to the study of drug crime were most widely used in the process of writing this article. Conclusions: despite the fact that military personnel are an organic part of society, drug addiction in the army should be considered as a rather specific social phenomenon. Drug consumption in the military environment (at the micro level) shows an upward trend only in cases where the psychological and pedagogical support of personnel is not carried out professionally enough, and the discipline and microclimate in the team “leave much to be desired.” In general (already at the macro level), the determination of drug use by military personnel is determined by the influence of social, socio-economic, political, cultural (subcultural), psychological (including ethnopsychological) and medical and biological factors. The problems of drug addiction among personnel are more relevant for NATO countries than for Russia (which over many centuries has developed its own, unique approach to educating defenders of the Fatherland). The experiments of Western specialists on “mind control” of military personnel using all kinds of drugs (stimulants) and neurochips deserve close attention. Such activities (directed to harm people) should be recognized as inhumane and illegal. Scientific and practical significance of the study: The scientific novelty and theoretical significance of the research results lies in the fact that it provides a clinical and psychological interpretation of the aggressive and violent behavior of military personnel who abuse psychotropic substances and narcotic drugs (using the example of personnel of the armies of foreign states). The practical significance of this article lies in the fact that the conclusions and recommendations formulated in it can contribute to the development of measures to optimize educational and psychological-pedagogical work with military personnel of the Russian army, for the early identification of persons both distributing prohibited psychoactive substances among colleagues and regularly using them.

Putting tendencies and trajectories to work: useful tools for engaging with accounts of change and recovery?

Dominant understandings of recovery emphasise personal responsibility for initiating and sustaining changes in people's subjectivities and relationships to alcohol and other drugs. However, this potentially obscures the complexities and temporalities of change processes and the range of socio-material elements involved. Addressing this gap, critical drug studies scholars have productively employed the concepts of tendencies and trajectories to analyse how past events of drug consumption flow into current and future consumption events. Critiquing notions of personal responsibility within recovery processes, we apply the concepts of tendencies and trajectories to help explain recovery's emergence and continuities. Doing so helps decentre the individual as the agent responsible for improved capacity by broadening the perspective of developing health and wellbeing. In this paper, we provide a qualitative analysis of interviews with fourteen people with lived recovery experiences within an urban-rural setting in Melbourne, Australia. This analysis illustrates how recovery tendencies and trajectories are cultivated through repeated actions, habits, and practices over time. Applying the concept of trajectories to change narratives reveals how accumulated moments precede and follow turning points, supporting shifts in consumption patterns. These moments are not necessarily connected but, when considered collectively, contribute to a recovery trajectory and assemblage of health. In reflecting on the affordances of thinking, researching and doing with recovery tendencies and trajectories, we argue that analysing tendencies and trajectories illuminate opportunities where change lies within an endless combination of human and non-human forces. Applying these concepts to recovery research, practice, and policy engages with temporal and socio-material elements of recovery, offering a more emancipatory approach than is currently provided by common recovery theories and approaches that assume individuals are personally responsible for change.

Neurokinin-1 receptors in the nucleus accumbens shell influence sensitivity to social defeat stress and stress-induced alcohol consumption in male mice

Chronic social defeat stress (SDS) is a widely employed preclinical model of depression involving repeated exposure to physical defeats using a resident-intruder model in male mice. Exposure to SDS induces depressive-like phenotypes including anhedonia, social withdrawal, and increased drug and alcohol consumption. Previously, we found that expression of the neurokinin-1 receptor (NK1R) is increased in the nucleus accumbens (NAC) of mice that are sensitive to this stressor and increase their alcohol intake. The NK1R is the endogenous receptor for the neuropeptide substance P (SP) and plays a prominent role in stress, anxiety, and addiction. In the present study, we assessed changes in NK1R protein levels in the NAC shell and implemented viral vector strategies to demonstrate a functional role of the NK1R in sensitivity to SDS. Specifically, we found that NK1R protein levels were increased in the NAC shell following SDS exposure. Next, we found that NK1R overexpression in the NAC shell increased the sensitivity to SDS and stress-induced alcohol consumption. Together, these experiments provide evidence for a role of the NK1R in the NAC shell in the sensitivity to SDS and the subsequent escalation in alcohol intake.

A comparative analysis of anti-seizure drugs consumption released for free or with a discount

Aim – to conduct a comparative analysis of the structure of consumption of anti-seizure drugs dispensed free of charge or at a discount for the period of 2017-2021 at the regional level. Material and methods. The data was collected from the works of domestic and foreign scientists in the field of preferential drug provision, as well as regulatory and organizational documentation on pharmaceutical activities. Preferential prescriptions issued for the period from 2017 to 2021 in the Orel region were analyzed. The ATC/DDD methodology was used to estimate the consumption. Results. It was revealed that preferential anti-seizure drugs were mainly taken by people aged 40-64 years. In 2017-2018, the consumption of anticonvulsants was higher in women. In 2019-2021, the consumption level was higher in men. Most of the anti-seizure drugs consumers were federal beneficiaries, usually disabled people of group II. The highest value of consumption among the top 5 INNs of antiepileptic drugs during the study period was observed for phenobarbital. The drugs containing valproic acid, topiramate and carbamazepine were characterized by increasing consumption throughout the study period. For benzobarbital, a pattern of consumption stability was revealed. Conclusion. The ATC/DDD analysis of the consumption structure for anti-seizure drugs within the program of subsidized drug provision for the population made it possible to identify the objective data on the dynamics of consumption for various generations. In order to reduce the consumption of drugs with an unfavorable safety profile, it is necessary to conduct training seminars for doctors of the relevant profile.

Ubiquity and ecological risks of conjugated steroids cannot be overlooked: First evidence from estuarine sediments

Steroids, renowned for endocrine-disrupting capabilities, have garnered significant research interest, predominantly centered on their parent forms. This study was the first to explore the composition, spatiotemporal characteristics, sources, mass inventories, and ecological risks of steroids in free and conjugated forms in estuarine sediments. Seventeen steroids were identified in sediments with the total levels of 1.3–4.3 ng/g. Most natural steroids and metabolites existed in free forms, while synthetic ones predominantly stored in conjugates. Environmental factors exerted limited impacts on steroid distribution. Raw domestic wastewater, drug consumption, and mariculture may be leading steroid sources in estuarine sediments, with total mean mass inventories of 177–219 μg/m2. The predominant contributors to the ecological risk were cortisol, prednisolone, 20α-dihydroprogesterone, 20β-dihydroprogesterone, and progesterone. This research gives the first insight into the understanding of conjugated steroids in the marine environment, and advocates for more studies on the fate and ecotoxicology of conjugated steroids.

Assessment of illicit drug use in Seoul, the capital of South Korea for 21 days by wastewater-based epidemiology

22 illicit drugs were monitored in Seoul, the capital of South Korea for 21 days using wastewater-based epidemiology to assess the drug usage patterns for the first time by region and social status. Among the targeted compounds, 10 were detected, with consistent detection of methamphetamine in samples over the entire sampling period. In addition, ketamine had the highest estimated consumption rate at 47.5 mg/day/1000 people, followed by methamphetamine at 12.5 mg/day/1000 people. Methamphetamine and MDMA(3,4-methylenedioxymethamphetamine) exhibited relatively stable daily patterns, with coefficients of variation of 7.03 %, and 13.4 % respectively. Furthermore, no statistically significant differences were observed between weekends and weekdays for all compounds (Mann-Whitney Rank Sum test, p > 0.05). Statistically significant regional differences in drug consumption were observed for methamphetamine, MDMA, and ketamine (Mann-Whitney Rank Sum test, p < 0.05). These differences were found to be related to average annual income and educational levels.

Contamination of a drug consumption room with drugs and potential risks for social health care workers

BackgroundStudies have shown that contamination of surfaces by illicit drugs frequently occurs in forensic laboratories when manipulating seized samples as well as in pharmacies and hospitals when preparing medicinal drugs. In this project, we extended these studies to a Drug Consumption Room to investigate drug levels and possible exposure of the staff members.MethodsWe investigated pre and post cleaning contamination by heroin and cocaine and their degradation products 6-monoacetylmorphine and benzoylecgonine on different surfaces (tables, counters, computers and door handles) and in the ambient air. We also collected urine and hair samples from staff members to check for potential short and long term contaminations.ResultsMedium to heavy contamination has been detected on most surfaces and door handles; as expected, air contamination was particularly high in the smoking room. Drug levels were < LOD to very low in the urine and the hair samples of staff members tested.ConclusionThe cleaning efficiency of the surfaces, carried out by staff and drug users after drug consumption, was often not satisfactory. The very low drug levels in hair indicate that acute health risks for staff members are low.

Prevalence of Drugs of Abuse and Cognitive Enhancer Consumption Monitored in Grab Samples and Composite Wastewater via Orbitrap Mass Spectrometry Analysis.

Wastewater (WW)-based epidemiology is an approach for the objective surveillance of the consumption of (illicit) drugs in populations. The aims of this study were to monitor drugs of abuse, cognitive enhancers, and their metabolites as biomarkers in influent WW. Data obtained from different sampling points and mean daily loads were compared with previously published data. The prevalence of analytes was monitored in WW grab samples collected monthly over 22 months at two sampling points and 24 h composite WW samples collected over 2 weeks at a WW treatment plant in the same city. Quantification was performed using a previously validated and published method based on solid-phase extraction followed by liquid chromatography coupled with high-resolution tandem mass spectrometry. Grab samples allowed for frequent detection of ritalinic acid and sporadic detection of drugs of abuse. The daily mean loads calculated for 24 h WW composite samples were in accordance with data published in an international study. Furthermore, loads of amphetamine and methamphetamine increased compared with those observed in a previously published study from 2014. This study showed frequent quantification of ritalinic acid in the grab samples, while drugs of abuse were commonly quantified in the composite WW samples. Daily mean loads were in accordance with trends reported for Germany.

Психосексуальность подростков, злоупотребляющих психоактивными веществами

&lt;p&gt;&lt;strong&gt;Relevance.&lt;/strong&gt; There is a sufficient number of studies dedicated to risky sexual behavior and the consumption of drugs among teens. Fever features are described of psychosexual behavior of teens who use drugs, emotionally cognitive patterns that are influencing teen sexual behavior. Research purpose. To analyze the characteristics of psychosexuality in teens who consume drugs. &lt;strong&gt;Material and methods&lt;/strong&gt;. The sample consisted of 78 people with their age varying from 14 to 20. Experimental group: 39 people with an average age of 15,8&amp;plusmn;1,37 (20 females and 19 males abusing drugs) 1) socio-demographic questionnaire; 2) questionnaire on the use of drugs; 3) ayzenka sexual attitudes questionnaire; 4) questionnaire &amp;laquo;what is your intimacy quotient&amp;raquo;; 5) questionnaire on negative childhood experience (ace); 6) young&amp;rsquo;s scheme questionnaire (ysq s3r). &lt;strong&gt;Results and conclusion.&lt;/strong&gt; Teens who are consuming drugs are experiencing difficulties in constructing close and trustworthy relationships, shy and lack confidence, tend to see their partner as an object to receive pleasure from. Statistics tell us that they were abused or had problems in their family. An early study of maladaptive schemes allowed us to describe a unique cognitive-behavioral portrait of teens who are abusing drugs. Teens belief in the unreliability and instability of significant others makes it difficult to develop intimate relationships. Underdeveloped ability to manage and regulate their life without the help of others. Presence of tendencies towards protest behavior ad distancing.&lt;/p&gt;

Risky Weapon Carrying Behaviors, Youth Violence, and Substance Use Among Young Black Males in Chicago: A Cross-sectional Analysis.

. The study evaluates the prevalence of risky weapon-carrying behaviors (WCB) among YBM in Chicago and examines their associations with various forms of direct and vicarious violence-youth violence, community violence, and partner abuse-as well as substance use and substance-related aggression. . We performed Pearson Chi-square tests and multivariable negative binomial regression analysis on cross-sectional data from 266 violence-involved young Black males (YBM) in Chicago. This data was collected using a modified version of the Centers for Disease Control and Prevention's Youth Risk Behavior Survey. Our dependent variable, weapon-carrying behavior, was measured by the frequency of weapon carrying, including items such as guns, knives, and clubs, over the past year. . In a sample of 266 YBM (ages 15-24, 99% African American), the mean age was 18.32 ±3.10 years, and 42.7% had some high school education. The 30-day weapon-carrying incidence was 17.3%, with 19.1% threatening someone with a weapon ≥ 2-3 times in the past year. About one-third engaged in partner violence (30.4%), primarily psychological (36.7%) and physical (28.3%) abuse. Approximately 64.8% experienced some form of violence or aggression in the past year, and 76.4% witnessed community violence. Over 20.8% reported binge drinking, and 43.6% engaged in illicit drug use, with 37.2% participating in or initiating violent acts following alcohol or drug consumption. Negative binomial regression results revealed that exposure to direct and vicarious violence, along with substance use, significantly increased the likelihood of carrying weapons. Specific risk factors such as recent threats or injuries, witnessing violence, involvement in physical altercations, and substance-related aggression significantly predict WCB. Age and relationship dynamics also critically influence these behaviors. Additionally, for each year of age, the risk for WCB increased by 22%. This study identified significant associations between different types of violence, substance use, and risky WCB among YBM in Chicago. The results underscore the need for comprehensive, culturally sensitive, multifaceted interventions addressing both individual and psychosocial factors behind risky WCB. These interventions are crucial for reducing gun violence and improving urban community safety, offering vital data to inform policies and interventions for youth protection in similar environments.

Heterogeneous Trajectories in Post-Disaster Drug Use Across Different Race/Ethnicity and Income Strata: Focus on Natural Hazards During COVID-19.

During the COVID-19 pandemic, climate-related natural hazards, such as wildfires, storms/hurricanes, and others (e.g., earthquakes, tornadoes), further disrupted the normal functioning of US residents. The co-occurrence of natural disasters and COVID-19 created unprecedentedly elevated levels of stress, especially to the racial/ethnic minorities and lower-income households. This study examines how natural disasters related to recreational drug use during COVID-19 and whether the relation is heterogeneous across different subgroups categorized by race/ethnicity and household income. This study used the data from the biweekly online surveys of the Understanding America Study (UAS) and analyzed the drug use behaviors of 966 US adults between April 29 and December 31, 2020. This study found that middle-income adults (household income ranging from $50,000 to $149,999), serving as the reference group, generally exhibited a significant reduction in drug consumption during or after disaster events. However, compared to the middle-income group, White and Black adults with household income lower than $50,000 showed 142% and 88% more frequent drug use when experiencing storms/hurricanes. This disparity widened in the following weeks. Additionally, lower-income Hispanics showed 74% more frequent drug use compared to the middle-income group in the weeks following wildfire incidents. The study's findings shed light on the risk of drug misuse during the co-occurrence of climate and public health crises, emphasizing the disproportionate risk among lower-income racial/ethnic minorities amid the pandemic and natural disasters.

Drug Consumption and Hydration Status: Analysis of the Associations in an Elder Population.

Hydration status plays a key role in healthy ageing, and it is potentially affected by several factors, including drug consumption. However, research on this issue to date is scarce, especially in highly vulnerable groups, such as the elderly. We aimed to study the relationship linking hydration status, analysed by means of a validated questionnaire, 24 h urine analysis, body composition assessment, and drug consumption in a sample of old adults. A total of 144 elders were included in the study. Cardiovascular drug consumption was significantly associated with a lower water intake in men (β = -0.282, p = 0.029). Moreover, urinary analysis revealed that total drug intake as well as the consumption of diuretics and cardiovascular drugs were associated with poorer hydration status, whereas genito-urinary drugs were associated with an opposite effect, and these results were confirmed in terms of body composition. Hence, total drug consumption (β = -0.205), diuretic (β = -0.408), cardiovascular (β = -0.297), and genito-urinary drugs (β = 0.298) were significantly associated (p < 0.05) with total body water. The obtained results confirmed the impact of chronic treatment with certain drugs on hydration status. Nutritional interventions may be of great interest in certain population groups in order to prevent complications due to altered hydration status.

Cannabidiol (CBD) Listed as a Drug of Abuse by the Italian Health Ministry: Expert Opinion

: In August 2023, the Italian Health Ministry listed cannabidiol (CBD) as a drug of abuse. This rekindled the debate on the medical and non-medical use of cannabis. The most discussed topics are risks related to the use of cannabis, the decriminalization/legalization of recreational cannabis, and use of cannabis-based drugs for medical purposes. The decision to include CBD in the “Unique Text for drugs of abuse” (DPR.309/1990), along with the already included main psychoactive component of cannabis, delta-9-tetrahydrocannabinol (THC), is not particularly relevant to such ongoing discussions. Even when it comes to cannabis-based drugs for medical purposes, such a decision will have a minimum impact on CBD-based medical prescriptions. Instead, a high economic impact is expected on CBD-based products sold online or in specific shops, including the so-called “cannabis-light”, formally sold as a “technological product” for collection purposes but used as over-the-counter drugs for the treatment of several medical conditions. Cannabis-light products have reduced regular drug consumption by about 10%. Also, they are not entirely safe, as the actual content of THC may significantly differ from the one stated, carrying unexpected health risks. Further, CBD is likely not a drug with addictive potential; however, its uncontrolled use for medical purposes needs to be regulated as the court battles are ongoing.

Subclinical hypomanic experiences in young adults after sleep deprivation are independent of depressive disorders, chronotype or 5-HTTLPR polymorphism

Introduction The acute antidepressant effect of sleep deprivation (SD) in patients with depressive disorders has been studied for more than 60 years. However, hypomanic mood swings after partial or total SD have also been described in people without diagnosed mental disorders. Studying this phenomenon in the general population may yield insights about the mechanisms of therapeutic SD, mania and bipolar disorders. Methods A cross-sectional sample of young adults was recruited and classified into those who described having regularly occurring subclinical hypomanic experiences (ROHE) after SD and those who did not. History of psychiatric and physical illness, with screening for depression and mania, as well as alcohol or drug consumption, family history of depressive disorders or suicide, 5-HTTLPR polymorphism, and MEQ-SA chronotype were collected. Results A total of 251 participants were included; 39.0% indicated regularly having subclinical hypomanic experiences after SD. These experiences were not associated with depressive or mania screening, history of psychiatric illness, family history, 5-HTTLPR polymorphism, or MEQ-SA chronotype. Conclusions ROHE after non-therapeutic SD seem to be a relatively common phenomenon in young adults, independent of depressive mood state. Our results suggest that therapeutic SD may depend on a physiological phenomenon of subclinical affective disturbance after SD that affects a part of the general population, independent of psychiatric diagnosis. Further studies could elucidate associated factors and contribute to our understanding of (hypo-)manic mood states.

Protective or potentially harmful? Altering drug consumption behaviors in response to xylazine adulteration.

Xylazine is an increasingly common adulterant in the North American unregulated drug supply that is associated with adverse health outcomes (e.g., skin infections, overdose). However, there are significant knowledge gaps regarding how xylazine was initially identified and how syringe services program (SSP) staff and clients (people who use drugs) responded to its emergence. From June-July 2023, we conducted qualitative interviews with medical (e.g., clinicians) and frontline SSP staff (e.g., outreach workers) and adult clients with a history of injection drug use at a Miami-based SSP. Inductive memos identified emergent codes; thematic analysis involving team consensus established final themes. From interviews with SSP staff (n = 8) and clients (n = 17), xylazine emergence was identified at different times, in various ways. Initially, during summer 2022, clients identified a "tranquilizer-like substance" that worsened sedation and withdrawal and caused wounds. SSP medical staff later identified this adulterant as xylazine by treating new medical cases and through diverse information-sharing networks that included professional societies and news sources; however, frontline SSP staff and clients needed additional educational resources about xylazine and its side effects. With limited guidance on how to reduce harm from xylazine, SSP clients altered their drug consumption routes, reduced drug use, and relied on peers' experiences with the drug supply to protect themselves. Some individuals also reported preferring xylazine-adulterated opioids and increasing their drug use, including the use of stimulants to avoid over sedation. Xylazine's emergence characterizes the current era of unprecedented shifts in the unregulated drug supply. We found that xylazine spurred important behavioral changes among people who use drugs (e.g., transitioning from injecting to smoking). Incorporating these experiences into early drug warning surveillance systems and scaling up drug-checking services and safer smoking supply distribution could help mitigate significant health harms caused by xylazine and other emergent adulterants.

Comparison of the use of remifentanil in infusion and patient-controlled methods for sedation purposes

Aims: In this study, the infusion and patient-controlled with PCA device use of remifentanil used for sedation were compared in patients who were planned to undergo spermatic vein ligation under local anesthesia. Methods: Thirty patient between the ages of 15-45 who were in the ASA I-II group were included in the study. They were randomly divided into 3 groups: continuous infusion (Group I), patient-controlled sedation (Group P) and control group (Group C). All patients were premedicated with 0.07 mg/kg midazolam intravenously (IV). 0.1 µg/kg/min remifentanil was given to Group I, 0.5 µg/kg bolus remifentanil was given to Group P, and physiological saline was given to Group C via a PCA (patient-controlled analgesia) device. The patients' hemodynamic parameters, sedation levels, anxiety scores, drug consumption amounts, patient satisfaction and side effects were recorded in the intraoperative and postoperative periods. During the operation, 2-3 L/min oxygen was administered via mask to patients whose SpO2 fell below 93%. Results: Respiratory depression was more common in Group I but respiratory rate did not fall below 8 in any group. In Group I, 7 patient, in Group P, 4 patient required intraoperative oxygen. The total amount of drug consumed was 64.4 µg in Group P and 147.5 µg in Group I. Although the number of PCA requests was not different, 4 patients in Group I, 2 patients in Group P and 1 patient in Group C never pressed the device. In terms of patient satisfaction, 30% of the patients in Group I said it was excellent, while in Group C it was not evaluated as perfect. The number of patients who evaluated the method as excellent and very good was higher in Group P than Group I. Conclusion: Remifentanil sedation with a PCA device can be used safely compared to infusion in patients undergoing spermatic vein ligation under local anesthesia.

Evaluating the Efficacy and Safety of Antihypertensive Drugs in the Treatment of Congenital Heart Disease in Paediatric Patients: A Comprehensive Study

CHD is the most common of all congenital anomalies causing mortality among children, characterized by structural abnormalities present at birth that vary in severity and complexity. Increased cardiac workload due to CHD may stipulate a growth delay in the affected children. The complexity of treatment is further compounded by medication errors, and hence, rigorous strategies of evaluation and management become necessary. This study was conducted to determine antihypertensive drug consumption patterns and to evaluate their therapeutic efficacy among 92 patients with CHD to meet the evaluation criteria, including appropriateness of treatment for the condition of the patient, adherence to indications, accuracy of dosage, and drug use practice. Females constituted the highest proportion of patients at 53.26 percent, infants were the most common age group at 43.48 percent, and Atrial seal defect accounted for 22.5 percent of the CHD patients. The antihypertensive drugs predominantly prescribed are Furosemide, used by 44.9% of the subjects, followed by Captopril, used by 30.3%, and Spironolactone, used by 10.1%. Therapy was evaluated for its effectiveness; appropriateness, both for the patient's indications and drug usage, was found to be very high, at 98.9% and 97.8%, respectively, whereas adherence to prescribed dosage was relatively lower at 62.7%. This study points toward further challenges in the management of antihypertensive treatment among children with CHD. It needs combined efforts by a pediatric cardiologist, pharmacist, nurse, and caregiver for total care to reduce the risk from treatment. Continuous monitoring and alterations in the plan of treatment, coupled with education, could be significant in optimizing medication adherence to improve long-term health outcomes in CHD children. The research done in this field, at large, improves pediatric cardiology practice to reduce morbidity and mortality rates associated with congenital heart disease around the world.