Increased Drug Use Research Articles

Mandatory Drug Testing of Dental Students: To Test or Not to Test

An educational institution's decision to test or not test its students for drug use is controversial and complex. Although negative consequences of substance use disorder are well known, the consumption of prohibited substances continues to increase in young adults. Given the awareness of increasing drug use on college campuses and the potential impact on future health care professionals, issues associated with mandatory drug testing of dental students warrant investigation. The purpose of this Point/Counterpoint article is to present opposing viewpoints on whether mandatory student drug testing (MSDT) should be implemented for dental students. Viewpoint 1 affirms that MSDT is legal, ensures public safety, is recognized as a need in health care education, promotes professional and ethical responsibility, and is cost‐effective. Viewpoint 2 asserts that MSDT has not been proven to be an effective deterrent for student drug use and it poses risks and costs for both institutions and students, ranging from potential violation of students' civil liberties to the consequences of false positive tests. This article's presentation of the recent literature on both sides of this issue provides dental educators with pertinent information for considering implementation of MSDT in their institutions.

The Proper use of Inhalers in a Third Step Hospital and its Effect on Treatment: Original Study

Objective: The percentage of asthma patients that use their inhalers with the correct technique ranges between 10 and 60. Inappropriate use of inhaler leads to disuse of drug, diminished disease control and increased drug use. In this study, we aimed to determine the effect of proper inhaler therapy on the treatment and control of asthma and the effect of proper inhaler use on hospitalization due to asthma. Method: One hundred and sixty five asthma patients over 18 years of age that applied to either in- or out-patient clinics of a university hospital, that had a diagnosis of asthma according to the criteria of the Global Initiative for Asthma (GINA) and had been attack-free for at least one month were included. Patients were told to use their inhalers and any misuse were noted. Patients were put through the Asthma Control Test (ACT). Their forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and peak expiratory flow (PEF) values were also noted. Their hospitalization status for asthma in the last year was assessed and recorded. Results: One hundred patients used their asthma inhalers correctly, while 65 did not. Those that used their inhalers correctly had significantly higher ACT (p=0,0001), FEV1% (p=0,001) and PEF% (p=0,014). Discussion: Patients must be informed and trained for the correct use of their inhaler drugs. Patients seem to be under-informed on this subject and there are serious mistakes of use for all inhaler types. Correct use of inhalers leads to better control of disease, lower rate of asthma-related hospitalization, less drug waste and decreased treatment cost.

Old-for-Grade Status and Suicide Risk in U.S. High School Students

Health-risk behaviors associated with increased risk of suicide are more prevalent in old-for-grade students compared to age-appropriate-for-grade peers; however, the association between old-for-grade status and suicidal behavior is largely unknown. This study investigated sex-specific differences in suicidal ideation, planning, attempts, and other risk behaviors by old-for-grade status. Secondary analyses utilizing bivariate and logistic regression methods for complex samples were conducted using data from the 2011, 2013, and 2015 National Youth Risk Behavior Survey for 16,579 female and 17,282 male high school students in grades 9 through 11. Among both males and females, students considered old-for-grade reported increased drug use, feeling sad/hopeless, violence, sexual activity, and limited/no seatbelt use compared with their peers. Old-for-grade students were also more likely to report a suicide attempt with increased suicidal ideation and planning observed only in old-for-grade males. Associations between old-for-grade status and suicide risk–related outcomes were attenuated in both sexes after adjusting for demographic characteristics and other health-risk behaviors. Findings suggest that common risk factors (e.g., sadness, substance use) may explain increased rates of suicidal behaviors in old-for-grade students.

Program Sehat Tanpa Napza untuk Meningkatkan Drug Use Resistance Self Efficacy: Prevensi Primer Penyalahgunaan Napza pada Remaja

This research aimed to assess the influence of program sehat tanpa napza on drug use resistance self efficacy. Quasi experiment (untreated control group design with dependent pretest and posttest) was used as the design of the study. The participants of this study were eight grader students from two junior high schools in Yogyakarta, which X junior high school was the experimental group and Y junior high school was the control group. Drug use resistance self efficacy was measured with drug use resistance self efficacy scale modified from Carpenter (2006). The data was analyzed with anova mixed design using SPSS. The result show that Program Sehat Tanpa Napza was not significantly increased drug use resistance self efficacy in experimental group of adolescent compared with control group (F = 1.056; p > 0.05). However, adolescent’s drug use resistance self efficacy in experimental group were increased significantly.

Multimorbidity in Asthma, Allergic Conditions and COPD Increase Disease Severity, Drug Use and Costs: The Finnish Pharmacy Survey

Background: Asthma, allergic conditions, and COPD overlap, but the effect of them and their combinations on disease severity, need for drugs, use of healthcare, and costs is poorly known. Objective: To study how different allergic diseases co-occur in asthma and allergy patients and evaluate the use of medication well as drug and healthcare costs. Methods: Nationwide Allergy Barometer Survey was carried out in the Finnish pharmacies during 1 week in September 2016. Altogether, 956 patients (5–75 years) who purchased asthma or allergy drugs with prescription participated in 351 pharmacies. Results: Of the participants, 78% reported physician-diagnosed asthma, 57% allergic rhinitis, 24% atopic eczema, 21% food allergy, 20% allergic conjunctivitis, 8% anaphylaxis, and 8% COPD. One-third of the patients had at least three conditions, and multimorbidity was common across all age groups. Disease severity increased with the number of coexisting conditions, and asthma severity also with age. Patients with asthma alone used on average 3.8 drugs with the annual costs of EUR 661. This increased to 4.9 drugs and EUR 847 in asthmatics with multimorbidity. For all participants, costs of drugs and healthcare services together during the preceding year were on average EUR 1,214, of which 56% were drug costs. The costs doubled to EUR 2,714 in 65 subjects (7%) who had both asthma and COPD. Conclusions: In asthma and allergy, multimorbidity and polypharmacy are major concerns. Disease severity, drug use, and costs increased with multimorbid conditions. To reduce the burden, allergy management should be better integrated and more comprehensive.

Increased Drug Use Linked to Doubling of Syphilis Rate

Since 2000, when syphilis rates in the U.S. reached a nadir, rates have increased, with the initial surge occurring among men who have sex with men.

Needle and Syringe Programs in Rural Areas: Addressing the Intravenous Drug Use Epidemic

BackgroundOpioid use has reached epidemic proportions in rural communities in the United States and injection of drugs is commonly used. As a result of shared or reusing needles and syringes, the risk for contracting blood-borne diseases is significantly increased. Rural areas face many social and attitudinal barriers regarding syringe exchange programs (SEPs).ObjectiveThis article describes national trends for drug injection problems in rural areas and discusses effectiveness of needle and SEPs as a harm reduction healthcare policy. Ethical and practical considerations in the implementation of SEPs are also presented.MethodThe rehabilitation literature was reviewed on trends in substance abuse and intravenous (IV) drug use in rural areas to identify the status and need for SEPs to address risk factors of infectious diseases resulting from needle sharing and reusing of needles.FindingsIV drug use in rural communities has reached epidemic proportions with resulting dramatic increases in hepatitis C and B and incidence of HIV. Yet, many rural communities continue to object to the implementation of SEPs due to fears that such programs will increase drug use and crime in the community.ConclusionIV drug use is a critical public health issue for users and non-IV users in rural communities, and is increasingly becoming an issue about which rural rehabilitation counselors will need to be informed. For the sake of public health, SEPs should be recognized as an economical, ethical, and effective factor in the larger response to the epidemic of IV drug use in rural America.

Evaluation of Malnutrition among Elderly People Living in Nursing Homes by Mini Nutritional Assessment Short Form (MNA-SF) in Turkey

Background: Average life expectancy increases year after year throughout the world. The Mini Nutritional Assessment (MNA) test is one of the most extensively applied tools for identifying the nutritional risks in elderly people. Here, we assess the nutritional status of elderlies accommodated in nursing homes by the MNA-SF test. Methods: A cross-sectional study of 773 elderly individuals living in nursing homes was conducted to evaluate their nutritional status, using the mini nutritional assessment questionnaire (MNA-SF), in Turkey. Results: In this cross-sectional study, 773 elderly individuals were included. Of these, 404 (52.27%) were men and 369 (47.73%) women. Of all subjects, 8.4% were malnourished, 37% at risk of malnutrition, and 54.6% well nourished. In terms of frequency of subjects at risk of malnutrition (43.6% in women and 30.9% in men) and well-nourished (47.2% in women and 61.4% in men), there was a statistically significant difference between women and men (p Conclusion: This study reveals that nursing home residents are at increased risk of malnutrition, and this problem is associated with weight loss, increased drug use, health status, and decline in physical activity and food intake.

Association of Self-Reported Abscess With High-Risk Injection-Related Behaviors Among Young Persons Who Inject Drugs.

Abscess is a common source of morbidity for people who inject drugs. We used data from the Study to Assess Hepatitis C Risk to measure prevalence of abscess and identify factors associated with the history of abscess. Of 541 participants, 388 (72%) were male and 149 (28%) were female. Almost half (n = 258, 48%) reported ever having an abscess. Persons who inject drugs with an abscess history were significantly more likely to have more injection partners (p = .01), inject heroin daily (p < .05), and share cookers (p = .001) and less likely to report using new syringes with each injection (p = .02). Most reported self-treating their last abscess and increasing drug use when having an abscess. High-risk injection-related activity was associated not only with infections such as HIV and hepatitis C virus but also with abscess. Nurses should screen patients presenting with abscess for high-risk practices and provide prevention education.

Evaluation of pharmacist interventions and commonly used medications in the geriatric ward of a teaching hospital in Turkey: a retrospective study.

PurposeAging increases the prevalence of diseases. The elderly population is consequently often exposed to complex medication regimens. Increased drug use is one of the main reasons for drug-related problems (DRPs). The primary objective of this study was to define and classify DRPs, pharmacist interventions, and frequently prescribed medications in relation to possible DRPs in patients admitted to the geriatric ward of a teaching hospital in Turkey.Patients and methodsPharmacist medication review reports for 200 orders of 91 patients (mean age: 80.33±0.46) were analyzed retrospectively.ResultsA total of 1,632 medications were assessed and 329 interventions were proposed for possible DRPs in 156 orders. A total of 87.5% of the patients used five or more drugs (mean: 8.17±0.23). The number of DRPs per order was higher when polypharmacy was present (1.04±0.15 vs 1.66±0.11, P<0.05). In 71.31% of the cases, adverse drug events were recognized as the problem. The principal cause of possible DRPs was determined as drug interactions (40.12%). Only 22 potentially inappropriate medications were prescribed. The most common interventions included monitoring drug therapy (31.0%), stopping the drug (20.06%), and changing dosage (13.98%). The acceptance rate of pharmacist interventions by treating geriatrician was 85.41%. The most frequently prescribed drugs were for the nervous system, alimentary tract and metabolism, and cardiovascular system (n=358, 314, and 304, respectively). The pharmaceutical forms of 23 drugs were deemed inappropriate by pharmacists.ConclusionClinical pharmacy services are still not properly implemented in Turkey. The study highlights ways in which clinical pharmacy services can be instrumental in a geriatric ward. The high acceptance rates of pharmacist recommendations concerning a wide variety of DRPs and different classes of drugs indicate that advanced collaboration among geriatricians and pharmacists is possible in interdisciplinary geriatric assessment teams in Turkey.

Bendito tú eres entre todos los bandidos: el culto transfronterizo a Jesús Malverde (siglos XIX-XXI)

The purpose of this article is to analyze the religious aspect of the drug trafficking culture, in particular, the devotion to the popular saint Jesus Malverde in Mexico between the 19th and 21st centuries. The guiding hypothesis is that the worship of this saint has been resignified since the 1970s as a response to a stronger repressive apparatus against drugs due to the increase in drug use in the United States. The Malverdian cult was adopted by the drug trafficking culture in the most ostensive way, and it has crossed geographic and cultural borders.

Necessity and methods of sexual education in the elderly population

Major improvements in health care have allowed people in the modern era to lead longer, healthier, and more active lives. The current generation of over-60s are more active than previous generations at the same age. In South Korea, the elderly population (65 years of age or older) has grown to more than 14% of the general population, meaning that we are already in the era of an ‘aged society’ and are transitioning into a super-aged society. Therefore, health issues in the elderly population cannot be ignored, and should be adequately addressed as soon as possible. Sexual health has become an important issue in the elderly that cannot be neglected, according to studies on sexual attitudes and behavior in older adults. As the quality of health improves in the elderly population, requests for proper sexual education and sexual health-related services have become more common. This pattern of increased sexual activity, partially driven by pharmacological advances in the treatment of sexual dysfunction and hormonal replacement products, has also led to increases in drug use and sexually transmitted infections (STIs). Responses to sexual health and education issues for the elderly currently remain ill-structured, as the significance of these issues is often ignored, largely due to incorrect assumptions about sexuality and sexual health among the elderly. Stronger requirements should be implemented for properly structured education and management systems regarding awareness, risk perception, and preventive strategies for safe sex among the elderly population in Korea.

Difference Between Men and Women in Drug Use Disorders

For a long time, drug-abuse disorders were related to men. Women were less involved in drug abuse. They were even not allowed to speak about it openly. Nonetheless, in the last ten years, there has been great transformation resulting in increased drug use among women. However, despite the changes, contemporary clinical practice is greatly dominated by male studies irrespective of the succinct differences in drug use disorders between the men and the women. Therefore, the main objective of the research is to bridge the gap by discussing the differences between men and women in drug use disorders. Using eight novel studies, the research examines the variances pointing out clear differences between the men and women. The study discovered that gender differences are similar for all drug use disorders. The reviews revealed that women are more likely to get addicted compared to men. Additionally, their escalation is much quicker than that of men. Women stabilize at higher doses while men stabilize at minimal doses. Moreover, the side-effects of drugs are higher in women than men. Also, women are more susceptible to relapse than men.

Psychotropic substance abuses and academic attainments of learners from randomly selected school environments and reviews of previous joint studies at KNUST in Ghana

Psychotropic effects of substance abuse on academic attainments was studied from a cross sectional descriptive survey from January to June, 2010 in Bosomtwi and Atwima Kwanwoma Districts. Entirely thirteen beneficiaries of School Health Education Programmes (SHEP) interventions between 5 to 10 years intervals, sub-divided into ten Junior High (JHS), and three public Senior High (SHS) were randomly selected based on learners’ gender ratios using questionnaire and instructional guidelines approved by the school authorities for interview of 600 (258 females and 342 males) respondents. Majority (42 to 94%) were victims of coffee and alcohol abuse while 31% were implicated for marijuana, amphetamine, cocaine and heroin. About 56% resorted to drugs hoping to improve their academic performances with 11% consequently developing truant behaviors and abysmal achievements. Family members and friends often lured/provided money for 61% of learner’s drug purchase while 96% were addicted averagely at 11.5 years old. Proportionately, 51% males were abusing drugs against 45% females. Likelihood ratio of abuse amongst genders cohorts were both asymptotically (P&lt;0.07) and linearly (P&lt;0.4) not significantly different. Substance abuse problems worsened in divorced marriages and single parent families where financial constraints and inadequate care compel learners to depend on drugs as probable solution to their depression and stress. The overall analysis revealed little improvement on learners’ academic performances with increased drug use. Parent Teacher Associations need to strengthen the implementation of child care monitoring interventions in homes and schools to curtail rampant drug abuse problems through pilot School Health Education Programmes (SHEP).

Impact of probation interventions on drug use outcomes for youths under probation supervision

Use of drugs and alcohol by justice-involved youths is a longstanding concern for juvenile justice policy-makers and researchers. However, little explored in this research is how the tactics and strategies employed by probation officers with this population impacts drug use outcomes. This study explored the effects of four types of probation strategies (positive pressure, negative pressure, parental involvement, treatment referrals) on 12-month drug use trajectories in a sample of 144 youths under probation supervision. Multilevel negative binomial regression models found that positive pressures (incentives & rewards) reduced drug use when negative pressures (threats & confrontation) were minimized. More frequent parental involvement early in the course of probation was associated with reduced drug use for girls, and was associated with increased drug use for both boys and girls later during the probation period. Finally, early referral to drug treatment programs was associated with reduced drug use outcomes. These findings suggest practical program and policy strategies to reduce drug use among probation-involved youths.

Opinion of health professionals and drug users before the forthcoming opening of the first drug consumption room in Paris: a quantitative cross-sectional study

BackgroundOn the brink of the opening of the first French drug consumption room in Paris, the general opinion of the local involved health care professionals and drug users was not known. The objective of this study was to determine their expectations and to search for influencing factors.MethodWe carried out a quantitative cross-sectional study. A multiple choice questionnaire was proposed to the surrounding willing general practitioners (GPs) and pharmacists, to the emergency doctors of Lariboisière hospital, and to the professionals of the harm reduction facilities and their drug users (PWUD). For each question, there was a choice between seven answers, from “− 3” (very negative impact) to “+ 3” (very positive impact). The influence of the characteristics of each group on its mean answers was explored by Mann-Whitney, Kruskal-Wallis, and Spearman’s tests.ResultsThe median expectations among the groups of responding GPs (N = 62), other health care professionals (N = 82), and PWUD (N = 57) were mainly positive. They thought that the drug consumption room (DCR) would improve the health of PWUD, reduce their at-risk behaviors, would not increase drug use or drug dealing in the neighborhood, and would reduce nuisance in the public space. Only the group of GPs expressed that the DCR could decrease the quietness of the neighborhood, and only the group of PWUD had higher expectations that the DCR would decrease the number of arrests and the number of violent behavior. GPs’ expectations were significantly better in terms of health improvement of PWUD and reducing their precariousness if they had a previous experience in addiction medicine (Mann-Whitney, p = 0.004 and p = 0.019), with a longer practice (Spearman’s rho, p = 0.021 and p = 0.009), and if they were currently prescribing opioid substitution treatments (Mann-Whitney, p = 0.030 and p = 0.002).Among non-GPs, those who were working in addiction medicine centers had significantly better expectations than pharmacists, and the professionals of the local emergency department had intermediate expectations.ConclusionsHealth care professionals and drug users had a positive opinion of the to-be-created Parisian drug consumption room. Experience in addiction medicine influenced positively health professionals’ expectations.

Drug screening and changing marijuana policy: Validation of new single question drug screening tools

BackgroundIllicit drug use is common in U.S. medical settings. A validated Single Drug Screening Question (SDSQ) containing the word “illegal” is widely used. As marijuana policies change, the present wording may not perform as expected in states legalizing use. This study compares the performance of the validated SDSQ with three different SDSQ wordings. MethodsPatients, 18 years and older, presenting to a U.S. hospital emergency department were asked to complete a survey containing the existing SDSQ, three new SDSQ versions without the word “illegal,” and the Mini International Neuropsychiatric Interview. Patients were also encouraged to provide a sample for saliva drug testing. ResultsOf 297 eligible patients, 200 (67.3%) completed the survey and 141 (70.5% of interview participants) completed saliva testing. Overlapping confidence intervals on the Area Under the Curve (AUC) analysis confirmed that sensitivities of all SDSQs were statistically similar for detecting self-reported drug use (65–71%). Combining questionnaire and saliva testing increased drug use detection by 2% and resulted in lower SDSQ sensitivity (58–67%). Specificities were 99–100%. The SDSQ with the highest sensitivity was: “In the last twelve months, did you smoke pot (marijuana), use another street drug, or use a prescription medication “recreationally” (just for the feeling, or using more than prescribed)?” ConclusionsAll four SDSQs demonstrated acceptable sensitivity and high specificity. Removing the term ‘illegal’ does not result in higher, or lower, reported drug use, though results could vary in states with legalized marijuana. Future research should replicate this study in one or more of these states.

PHP159 - PUBLIC HEALTH AND ECONOMIC VALUE OF A NATIONWIDE PATIENT BLOOD MANAGEMENT PROGRAM

Patient Blood Management (PBM) is an evidence-based, multidisciplinary approach aiming to optimize patients’ own blood in order to improve clinical outcomes and healthcare expenditure. This research set out to assess the public health and economic value of a nationwide PBM program in Portugal. A mathematical decision-model was developed to estimate the impact of a nationwide PBM program over a one-year time horizon. Hospital-attended patients from the following therapeutic areas were considered: surgery (orthopaedic/cardiac/urologic), cardiology, oncology, gastrointestinal bleeding, abnormal uterine bleeding, haemodialysis, inflammatory bowel disease and pregnancy. Model inputs, obtained from Portuguese national health databases and literature review, included effectiveness and cost data on PBM strategies, transfusion utilization, hospitalization, mortality, physician visits and drug use. Model structure and inputs were validated by a national expert panel. For an estimated 384,704 patients eligible for PBM strategies, a reduction in the proportion of red blood cell (RBC) transfused patients of 51.2% could be obtained (-17,202 patients), associated with a reduction in the number of transfused RBC units of 57.3% (-65,214 units). Due to an estimated 8.4% and 37.3% decrease in hospital length of stay and readmissions, respectively, 233,141 in-hospital days could be avoided. Furthermore, in-hospital mortality could reduce by 594 cases, resulting in 1,481 life-years gained. Although an increase in drug use and physician visits would lead to an estimated additional €24.1 million in costs, these would be counterbalanced by €91.9 million in savings, mainly due to €70.4 million in hospitalization costs and €17.6 million in RBC transfusions. Net savings of over €67.7 million could be expected, equivalent to a 6.3% reduction in the public expenditure of this population. The implementation of a nationwide PBM program in Portugal could result in a substantial improvement in public health outcomes with high economic value to the national health system.

Witnessing violence in early secondary school predicts subsequent student impairment

BackgroundPast research suggests that adolescents who witness violence are at risk of adjustment problems. However, few studies have implemented a longitudinal design and have accounted for direct experiences of victimisation...

Preventive parenting intervention during childhood and young black adults' unhealthful behaviors: a randomized controlled trial.

Lifestyle variables such as drug use and excessive weight gain contribute to adult morbidity and mortality. This study was designed to determine whether participation in a preventive intervention designed to enhance supportive parenting can reduce drug use and body mass index (BMI) in young Black adults from disadvantaged neighborhoods. This study was conducted in the rural southeastern United States. Black parents and their 11-year-old children (517 families) were assigned randomly to the Strong African American Families (SAAF) prevention trial or a control condition. Data assessing neighborhood socioeconomic status and supportive parenting were obtained when the youths were ages 11 and 16. When youths were ages 19-21 and 25, drug use and BMI were measured. As hypothesized, significant three-way interactions were detected among neighborhood disadvantage, prevention condition, and gender for BMI (B=3.341, p=.009, 95% CI [0.832, 5.849]) and substance use (B=-0.169, p=.049, 95% CI [-0.337, -0.001]). Living in a disadvantaged neighborhood during adolescence was associated with increased drug use among young men in the control group (simple-slope=0.215, p<.003) but not among those in the SAAF condition (simple-slope=0.030, p=.650). Neighborhood disadvantage was associated with elevated BMI among young women in the control group (simple-slope=3.343, p<.001), but not in the SAAF condition (simple-slope=0.204, p=.820). The results suggest that participation during childhood in a preventive intervention to enhance supportive parenting can ameliorate the effects of life in a disadvantaged neighborhood on men's drug use and women's BMI across ages 19-25years. These findings suggest a possible role for parenting enhancement programs in narrowing health disparities.