Indicators Of Drug Use Research Articles

Analysis of Mental Health and Drug Use in the Top 21 Most Populated U.S. States

Introduction: Most people in the United States live busy stressful lives which can lead to significant health challenges, especially to one’s mental health. After years of being ignored and stigmatized, mental illness has been given the recognition it deserves. It is now associated with the overall health of a person and treated seriously. The same could be said about substance abuse disorder though on a lesser scale. This paper attempts to understand the relationship between drug use and mental health illness differentiated across age groups. The understanding of these causations and relationships could help us better understand the rate and triggers of mental illness in the United States. Methods: We used data from a 2023 survey, which contains a total of 69,850 completed interviews. The data collected were taken from each state individually with each of them implementing the same survey to collect responses. Instead of looking at all fifty states, we decided to analyze only the highest twenty- one most populated states. Various non-parametric tests were used to analyze age groups and their rate of mental health illnesses and drug use within the country. Results: We found that tobacco use is associated with mental illness, while alcohol use is associated with attempted suicide. It appears that indicators of drug use are not homogeneous across states for either age group. We also found that the alcohol consumption is related to a declining proportion of attempted suicides. Conclusion: In this research we found a significant association between drug use and inidcators of mental illness. The association differed across different age groups and also across states. Since we found that the alcohol consumption is related to a declining proportion of attempted suicides, it will be interesting to explore why this is the case and what could be observed to decrease suicidal rates.

Searching for Essential Genes and Targeted Drugs Common to Breast Cancer and Osteoarthritis.

It is documented that osteoarthritis can promote the progression of breast cancer (BC). This study aims to search for the essential genes associated with breast cancer (BC) and osteoarthritis (OA), explore the relationship between epithelial-mesenchymal transition (EMT)- related genes and the two diseases, and identify the candidate drugs. The genes related to both BC and OA were determined by text mining. Protein-protein Interaction (PPI) analysis was carried out, and as a result, the exported genes were found to be related to EMT. PPI and the correlation of mRNA of these genes were also analyzed. Different kinds of enrichment analyses were performed on these genes. A prognostic analysis was performed on these genes for examining their expression levels at different pathological stages, in different tissues, and in different immune cells. Drug-gene interaction database was employed for potential drug discovery. A total number of 1422 genes were identified as common to BC and OA and 58 genes were found to be related to EMT. We found that HDAC2 and TGFBR1 were significantly poor in overall survival. High expression of HDAC2 plays a vital role in the increase of pathological stages. Four immune cells might play a role in this process. Fifty-seven drugs were identified that could potentially have therapeutic effects. EMT may be one of the mechanisms by which OA affects BC. Using the drugs can have potential therapeutic effects, which may benefit patients with both diseases and broaden the indications for drug use.

Evaluation of Drug Use in Three Secondary Health Facilities in Liberia Using the World Health Organization Indicators

Background: Effective and quality healthcare is achieved through rational drug use. The consequences of irrational drug use manifest as drug related problems like unnecessary drug prescription, ineffective therapy, inappropriate dose and adverse drug reactions. Objectives: To evaluate drug use and drug related problems in three secondary health facilities in Liberia. Methods: A retrospective analysis of 1200 prescriptions was conducted in the outpatient section of Liberia Government Hospital (LGH), Redemption Hospital (RH) and James Davis Junior Hospital (JDJH) to assess drug use with the WHO drug use indicators followed by assessment of drug-related problems (DRP) using the DRP-Registration Form 8.0. A prospective cross-sectional study was then conducted to evaluate consultation and dispensing time, and the availability of essential drugs list. Data were analysed by one-way analysis of variance using Statistical Package for Social Sciences (SPSS) version 20.0. Results were expressed as mean ± SD and values were considered significant at P < 0.05. Results: The average numbers of medicines per prescription were 4.5 ±1.3, 3.6 ±1.1, and 3.7 ± 1.2 in LGH, RH and JDJH hospitals respectively (WHO value-1.6-1.8). The percentages of encounters with antibiotics were 77.5%, 74.3% and 82.5% respectively (WHO value - 20.0% - 26.8%). Observed DRPs were more in LGH for ‘no indication for drug use’ (6.50%) and ‘prescription of more drugs than clinically indicated’ (4.75%) while JDJH recorded more ‘inappropriate medication per established guidelines’ (4.00%) and ‘preventive/synergic drug not given for clinical indication’ (5.50%). Conclusion: Irrational use of drugs existed in all the three hospitals studied.

Quantitative Assessment of High School Students' Poly-drug Use: Related Social Aspects and School Dropout.

Poly-drug use has increased in recent decades, especially in young drugusing groups. Classic epidemiological indicators of drug use, such as prevalence and incidence of users of specific substances, are not adequate as measures of the possible harms of poly-drug use. We applied poly-drug use indicators, based on substance-specific harm scores reported by van Amsterdam and Nutt in 2015, to data from high school student surveys, showing their usefulness in identifying high-risk drug consumption. Analysing the 'correlation' between high-risk drug use of high school students and school dropout allows the evaluation of adopted prevention policies and may suggest more suitable approaches. Each drug user is characterized by two specific scores: overall frequency of use of substances during the period of interest (FUS) and poly-drug use score (PDS). The poly-drug use score is a weighted average of the harm scores of the individual substances used multiplied by their respective frequencies of use. The PDS increases with the frequency of use, with the number of substances used, and with the specific harm scores of each substance. This indicator consists of two components, one representing the health harm score toward self and the other the social harm score toward others. The indicators have been applied to sample data involving youth population, specifically the ESPAD®Italia survey data on high school students conducted annually in Italy. The trends of poly-drug use at different ages of students, 15-19 years, over time, and gender have been studied. The results have been linked to educational outcomes, early school leaving and social aspects, making it possible to assess present prevention interventions and suggest appropriate planning of future prevention interventions. Poly-drug use indicators allow a comprehensive quantitative evaluation of the risks of drug use. The analysis of the links between heavy use of drugs, school performance and dropout, and the social variables that influence them, shown in this work, suggests how best to plan secondary or indicated prevention interventions at school. The problem of including "new" NPS in analyses is also briefly discussed.

Bias amplification of unobserved confounding in pharmacoepidemiological studies using indication-based sampling.

Estimating causal effects in observational pharmacoepidemiology is a challenging task, as it is often plagued by confounding by indication. Restricting the sample to those with an indication for drug use is a commonly performed procedure; indication-based sampling ensures that the exposed and unexposed are exchangeable on the indication-limiting the potential for confounding by indication. However, indication-based sampling has received little scrutiny, despite the hazards of exposure-related covariate control. Using simulations of varying levels of confounding and applied examples we describe bias amplification under indication-based sampling. We demonstrate that indication-based sampling in the presence of unobserved confounding can give rise to bias amplification, a self-inflicted phenomenon where one inflates pre-existing bias through inappropriate covariate control. Additionally, we show that indication-based sampling generally leads to a greater net bias than alternative approaches, such as regression adjustment. Finally, we expand on how bias amplification should be reasoned about when distinct clinically relevant effects on the outcome among those with an indication exist (effect-heterogeneity). We conclude that studies using indication-based sampling should have robust justification - and that it should by no means be considered unbiased to adopt such approaches. As such, we suggest that future observational studies stay wary of bias amplification when considering drug indications.

Drugs Prescribing Trends in Three Polyclinics in Benghazi-Libya 2020

Background: There is an efforts made to improve drug prescribing practices in developing countries. The aim of present work was to comparing prescribing indicators, patient care, and missing information on prescriptions and identifying and assessing drug use patterns in three polyclinics in Benghazi city, Libya. Methods: In this descriptive cross section study a random sample of 1522 prescriptions were selected from three polyclinics include Ras-Ebida, Khalid Ibn-Elwalid and Al-Kish, over 4 months (July-October 2020). The data was collected through predesigned questionnaire. The prescriptions were analyzed for the following indicators: prescribing indicators, patient-care indicators and drug-use indicators. Results: A total of 1522 prescriptions (average = 507.3/clinic) were collected from the three polyclinics including 2329 prescribed (average = 1.4/prescription) items. Percentage of drugs prescribed with generic name was 0.0%, the percentage of prescriptions with antibiotics was 46.3%. The average of prescriptions of injections was 0.84. The average consultation time is 3.4 min and the average dispensing time was found to be 24 seconds. Major classes of drugs prescribed included analgesics, antibiotics, drugs used in medicine & derma clinics, ophthalmic drugs, minerals & vitamins, anti-inflammatory drugs, antihistaminic and antifungal drugs. The most prescribed analgesic was paracetamol (94.4%) and antibiotic was Augmentin (50.3%). In regarding prescribed drug in medicine clinics was found lisinopril (32.0%) and ophthalmic drug was cusicrom (36.8%). In addition, the majorities of prescribed vitamin were vitamin C (81.0%), for GIT drug was omeprazole (59.3%), and for dermatology was Fucidin (56.3%). While most prescribed anti-inflammatory was aspirin (52.4%), antihistaminic was loratidine (97.0%), for antifungal drug was flagyl (58.0%). Conclusion: Despite the efforts being made to improve prescribing habits and to rationalize the use of drugs, the obtained results confirm the deficiencies as reported earlier and suggest that methods of intervention should be initiated to improve prescribing trends in these polyclinics.

Penggunaan Sitostatika Pada Pasien Kanker Dewasa Di Ruang Kemoterapi RSUP Fatmawati Periode Bulan Januari Sampai Juni Tahun 2020

Chemotherapy is one of the treatment modalities for systemic cancer which is often chosen, especially to treat advanced, local and metastatic cancers. The administration of cytostatics is carried out in a special room to avoid exposure to cytostatics and for the safety of patients and officers giving cytostatics. The administration of cytostatics is adjusted to the diagnosis of cancer. Therefore, the researcher wanted to know how the use of cytostatics in cancer patients in the Chemotherapy room of Fatmawati Hospital, especially in adult patients.
 This study aims to determine the characteristics of adult cancer patients who undergo chemotherapy in the chemotherapy room, and the use of cytostatics based on drug class and type, and how the characteristics of adult patients relate to the use of cytostatics.
 The research method was carried out by taking data from adult patients diagnosed with cancer and administering chemotherapy from January to June 2020 in the chemotherapy room by paying attention to inclusion and exclusion criteria.
 The results showed 1272 adult patients who administered chemotherapy and 3785 cytostatic preparations from January to June 2020. From the evaluation, it was found that the most cancer patient characteristics based on gender were 78.22% women with an age range of ≥40 - 60 years of 60.14 % and the most disease diagnoses were breast cancer at 50.63%. The use of cytostatics based on group is antimetabolite with pyrimidine analogues (Fuorouracil (5-FU) and Gemcitabine) and folic acid analogues (Methotrexate) with a value of 28.22%. The highest use of cytostatic types was Fluorouracil (5-FU), which was 19.47%. The relationship between patient characteristics and use of cytostatics is in gender, age and indication of drug use (disease diagnosis).
 The results of this study are very useful considering the scarcity of literature due to the limited implementation units that carry out the provision of sitostatics such as Fatmawati General Hospital. Therefore, it can be suggested for further research related to the relationship between drug use and cancer diagnosis in the context of drug availability and cost analysis, as well as evaluation of the side effects that occur when administering cytostatics through documented interviews with patients.
 Keyword : Chemotherapy, Sitostatics, Cancer, Fatmawati General Hospital.

S1039 Tofacitinib-Associated Adverse Vascular Events Reported to the Federal Adverse Event Reporting System (FAERS) Database

Introduction: Tofacitinib, an intracellular tyrosine kinase (Jak-Kinase) inhibitor, is approved by the U.S. Food and Drug Administration (FDA) for active rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ulcerative colitis (UC). In 2019, the FDA released a safety alert for the risk of blood clots and death in patients receiving tofacitinib. In 2021, Black Box Warnings were issued for low dose (5mg BID) and high dose (10mg BID) tofacitinib, for increased risk of serious heart-related adverse events (AEs) and cancer. Methods: FAERS is a database of voluntarily reported AEs used for post-marketing surveillance of medications. 8,863,077 FAERS reports from January 2018 to September 2021 were examined. Of these, there were 84,225 reports of tofacitinib-related AEs. Using MeDRA terminology, reports of cardiovascular (CV) AEs emphasized in recent black box warnings (Pulmonary Embolism, Deep Vein Thrombosis, Cerebral Thrombosis, Cerebral Venous Thrombosis, and Cerebral Vascular Occlusion) were reviewed. There were 650 CV AEs reported in the study period. Demographics, cumulative dosage, indications for drug use, outcomes, reactions, and reporter trends were analyzed. Reporter odds ratio (ROR) for all reporting groups (physicians, lawyers, community, pharmacists, etc.) were calculated. ROR >1 indicates interference in reporting. Results: The most common indication for tofacitinib was RA 43,386 (52%) of reports. Hospitalization occurred in 10,182/84,225 (12.0%) of reports. There were 3,856 (5%) reports when tofacitinib was indicated for UC. 42,671 (51%) of AEs occurred in subjects 36-64 years old. Females represented 65,806 (78%) of reports. Physicians were 13% of reporters while consumers accounted for 59% of reporters, (ROR = 1.52; 95%; CI = 1.49-1.54). CV specific AEs concerning Tofacitinib accounted for 650/84,225 (0.77%) of reports. Lawyer reporting demonstrated a sharp rise in 2021. Lawyer reports accounted for 70/170 (41%) CV AEs in 2021(ROR = 942; 95%; CI = 505-1757). Conclusion: Interference of the reporting of tofacitinib-related CV AEs to FAERS appears to be occurring, initially by excess consumer reporting and more recently by lawyers. The effect of reporting bias on the use of tofacitinib in the clinical setting requires further investigation.Figure 1.: Tofacitinib Cardiovascular AEs by Reporter Type

The association of potentially inappropriate medications, polypharmacy and anticholinergic burden with readmission and emergency room revisit after discharge: A hospital-based retrospective cohort study.

While certain drug-use indicators are known to be associated with clinical outcomes, the relationship is unclear for some highly prevalent conditions in in patients aged ≥65 years. We examine correlations between 3 drug-use indicators and postdischarge healthcare services use by older patients according to the presence of dementia, advanced age and frailty. This retrospective cohort study analysed data collected from hospital electronic health records between April and December 2017. Potentially inappropriate medications (PIMs) and anticholinergic burden were assessed using the 2015 Beers Criteria and anticholinergic cognitive burden scale (ACBS) score. Minor and major polypharmacy were defined as the use of 5-9 and ≥10 drugs, respectively. Outcomes were set as emergency room revisits and readmissions at 1, 3 and 6months postdischarge. The correlation between drug-use indicators and outcomes was analysed by multivariable logistic regression. The final cohort included 3061 patients for the analysis, and 2930, 2671 and 2560 patients were followed up to 1, 3 and 6months after discharge. After controlling for confounders, all 3 drug-use indicators were significantly associated with readmission and emergency room revisits except for the relationship between PIMs and readmission within 6months. These associations were significantly observed among patients without dementia, aged >80 years and with frailty. PIMs, polypharmacy and anticholinergic burden are common at discharge and correlate with future use of healthcare services. In older patients, the absence of dementia, advanced age and frailty should be given extra consideration with regard to medication safety.

Relative hydroxy-cocaine concentrations a possible marker for cocaine use?

Determination of cocaine use through hair analysis has been the subject of much controversy. While cocaine can be readily detected in the hair of a cocaine user it can also be present due to external contamination. Several strategies have been suggested to differentiate the two using various analytes such as cocaine, benzoylecgonine (BZE), norcocaine (NC) and BZE/cocaine ratios as markers of cocaine use. However, each strategy thus far has been proven unsuccessful at distinguishing drug use from contamination. Hydroxylated metabolites, and especially para-hydroxy-cocaine (p-OHC) and meta-hydroxy-cocaine (m-OHC) have been suggested as markers of drug use. As low concentrations of p-OHC and m-OHC have been reported in externally contaminated hair, the mere presence of these metabolites is not proof of drug use. The aim of this study was to evaluate the ratios p-OHC/cocaine and m-OHC/cocaine as an indicator of drug use by reviewing data from contaminated specimens and drug user specimens analyzed by multiple laboratories. Contaminated samples were prepared by fortifying negative hair with powder cocaine (1.25 mg/g) followed by treatment with artificial sweat, drying and shampooing. An aliquot was then washed with a published extended wash procedure using isopropanol followed by phosphate buffer/BSA creating two different samples. Cocaine, p-OHC and m-OHC were quantified in multiple replicates ( n = 2–5) of these samples by two different laboratories using different methods. In addition, 20 cocaine positive hair samples collected from drug users in a treatment program were analyzed by the same laboratories (10 each). In the contaminated samples, eight replicates were positive for all analytes. The median p-OHC/cocaine and m-OHC/cocaine ratios were 0.013% (range 0.007–0.019%) and 0.018% (0.011–0.034%), respectively. In cocaine positive drug user hair ( n = 20) the median p-OHC/cocaine and m-OHC/cocaine ratios were 0.538% (range 0.093–6.975%) and 0.867% (0.133–2.502%), respectively. For p-OHC/cocaine and m-OHC/cocaine there were three and five-fold difference between the lowest ratio in a drug user specimen and the highest ratio in a contaminated sample, respectively. This is a limited study and should be interpreted carefully. Powdered contamination is only one of many types of contamination, and the range of potential ratios in various contamination scenarios must be explored before a cutoff ratio can be established. In addition, there is a concern that p-OHC and m-OHC could be present at low concentrations in street cocaine which could lead to elevated ratios after external contamination. The results of this study are remarkably similar to those from a German study (Scholz, Journal of Analytical Toxicology, 2019, 43, 543–552). After in-vivo contamination with street cocaine, they report median p-OHC/cocaine and m-OHC/cocaine ratios of 0.03% (0.01–0.08%) and 0.05% (range 0.02–0.1%), respectively. In drug user specimens respective median ratios were 0.7% (0.07–8.3%) and 0.8% (0.06–3.2%). This similarity is indicative of validity across analytical methods and between different contamination models. The results indicate that p-OHC/cocaine and/or m-OHC/cocaine ratios have some potential for differentiating between cocaine use and external contamination in hair analysis, but further studies are needed to determine the highest ratios that can be observed after external contamination.

Development and validation of a case-finding algorithm for the identification of non-small cell lung cancers in a region-wide Italian pathology registry.

PurposeTo develop and validate a case-finding algorithm for the identification of Non-Small Cell Lung Cancer (NSCLC) cases in a region-wide Italian pathology registry (PR).Materials and methodsData collected between 2009 and 2017 in the PR and the Pharmacy Database of the University Hospital of Siena and the PR of Tuscany region were used. A NSCLC-identification algorithm based on free-text keywords and SNOMED morphology and topography codes was designed and tested on data from Siena: indication for drug use (i.e. NSCLC) was the reference standard for sensitivity (SE); positive predictive value (PPV) was estimated through manual review. Algorithm modifications were then tested to improve algorithm performance: PPV was calculated against validated dataset from PR of Siena; a range of SE [min-max] was estimated in PR of Tuscany using analytical formulae that assumed NSCLC incidence equal either to 80% or 90% of overall lung cancer incidence recorded in Tuscany. The algorithm modification with the best performance was chosen as the final version of the algorithm. A random sample of 200 cases was extracted from the PR of Tuscany for manual review.ResultsThe first version of the algorithm showed a PPV of 74.7% and SE of 79% in PR of Siena. The final version of the algorithm had a SE in PR of Tuscany that grew with calendar time (2009 = [24.7%-28%]; 2017 = [57.9%-65.1%]) and a PPV of 93%.ConclusionsThe final NSCLC-finding algorithm showed with very high PPV. SE was in line with the expected contribution of PR to overall cases captured in the regional Cancer Registry, with a trend of increase over calendar time. Given the promising algorithm validity and the wide use of SNOMED terminology in electronic pathology records, the proposed algorithm is expected to be easily adapted to other electronic databases for (pharmaco)epidemiology purposes.

Pattern of utilization, disease presentation, and medication prescribing and dispensing at 51 primary healthcare centers during the Hajj mass gathering

BackgroundThe majority of pilgrims seeking healthcare during Hajj are seen at primary healthcare centers (PHCCs). Data on the utilization of these facilities during Hajj can aid in directing optimal health services delivery and allocation of resources during the pilgrimage.MethodWe investigated the pattern of disease presentation, caseload, and medication prescribing and dispensing at 51 PHCCs during the 2019 Hajj. Data on patients’ demographics, diagnoses, and prescribed medications were retrieved from each PHCC’s electronic records and analyzed. Data were also used to calculate six of the World Health Organization (WHO) indicators for drug use at these facilities.ResultsData were captured for 99,367 patients who were mostly Hajj pilgrims (95.4%), male (69.1%) from the Eastern Mediterranean (60.8%) and had a mean age of 46.6 years (SD = 14.9). Most patients (85.2%) were seen in Mina and towards the end of Hajj. The majority of patients (96.0%) had a single diagnosis; most commonly, respiratory (45.0%), musculoskeletal (17.2%), and skin (10.5%) diseases. Patients were prescribed 223,964 medications, mostly analgesics (25.1%), antibacterials for systemic use (16.5%), anti-inflammatory and antirheumatic products (16.4%), and cough and cold preparations (11.9%). On average, 2.25 (SD = 0.94) medications were prescribed per consultation, with low (1.3%) prevalence of polypharmacy. An antibiotic and an injectable were prescribed in 43.6 and 2.67% of patient encounters, respectively. Most (92.7%) of the prescribed drugs were actually dispensed, in an average time of 8.06 min (SD = 41.4). All PHCCs had a copy of the essential drugs list available, on which all the prescribed drugs appeared.ConclusionRespiratory illnesses are the main reason for PHCCs visits during Hajj, and analgesics and antibiotics are the most common medications prescribed to pilgrims. Our results, including the calculated WHO drug use indicators, contribute to evidence-based optimization of primary healthcare services during Hajj.

Assessment of medicine use based on WHO drug-use indicators in public health facilities of the South Indian Union Territory.

To assess medicine use based on World Health Organization (WHO) core drug-use indicators in selected public health facilities of the South Indian Union Territory. A prospective cross-sectional study was conducted for period of one year (from March 2019 to February 2020) in 10 selected public health facilities based on the WHO document How to investigate drug use in health facilities. Total 900 prescriptions were analysed to study prescribing, patient care and health facility indicators. The results were compared with the WHO standard measures. The overall average number of drugs per prescription was 3.2. Percentage of prescriptions with antibiotics and injections were found to be 36.6 and 11.4%, respectively. Percentage of drugs prescribed by generic name was 74.6%. Percentage of drugs prescribed from the National List of Essential Medicine was 93.3%. Average consultation and dispensing time were found to be 3.9minutes and 49.3seconds, respectively. The percentage of drugs dispensed in this study was 98.5 and 61.6% of medicines were properly labelled; 76.7% of patients had correct knowledge of each medicine dispensed to them. Mean availability of key essential medicine was 73.4%. Indicators such as percentage of drugs prescribed from the National List of Essential Medicine, availability of copy of essential medicine list and percentage of drugs dispensed were found to be as per WHO optimal value. Indicators such as average number of drugs per prescription, average consultation and dispensing time and percentage of medicines labelled were found below optimal value and need to be improved.

Rational mucolytic therapy in respiratory diseases: clinical interpretation of pharmacological properties for informed choice

Respiratory diseases remain a common group of diseases in the practice of general physicians and pulmonologists. Currently, there are various treatment protocols for patients with respiratory diseases, where one of the pharmacological groups is mucolytic drugs. They affect the physical and chemical properties of sputum by splitting complex mucins, which leads to its liquefaction. Indications for use of drugs of this group are clinical conditions, in which there is a cough with thick, viscous, difficult to detach sputum. The article discusses the possibility of treating several respiratory diseases with mucolytic therapy, provides a comparative characteristic of drugs of this pharmacological group. The clinical and pharmacological effects of erdosteine are discussed in detail: mucolytic, antioxidant, anti-inflammatory, immunomodulatory. These properties of the drug are extremely important in clinical practice conditions, because in addition to the mucolytic properties themselves, the patient has many adverse processes due to inflammation. All this is associated with additional damaging factors regarding the tissues and may also indicate an increased risk of complications. Thus, the multipurpose effects of the mucolytic erdosteine in various respiratory tract diseases are presented. In addition to acute respiratory viral diseases, the clinical experience of using erdosteine in chronic obstructive pulmonary disease is discussed in detail. The most important indicator to assess the effectiveness of drugs used in this disease is the reduction in the number of exacerbations per year and the severity of the course of the exacerbation. The conclusions, which are given according to the results of a number of studies, determine significant advantages in the use of erdosteine as mucolytic therapy.

Exploring the external validity of survey data with triangulation: A case study from the Norwegian Offender Mental Health and Addiction (NorMA) Study

Objectives This paper demonstrates how to investigate the external validity of a study sample by triangulating survey and registry data, using data from the Norwegian Offender Mental Health and Addiction (NorMA) Study as a case. Methods We use survey data from the NorMA study ( n = 1495), including the NorMA cohort ( n = 733), and data from the Norwegian Prison Registry on all people imprisoned on 1 September 2013 ( n = 3386). Triangulation was performed by (1) comparing the NorMA cohort to those lost to follow-up ( n = 762), using survey data from the NorMA study. Secondly, we compared the NorMA cohort to the one-day population, using data from the Norwegian Prison Registry. We also stratified the one-day sample by possession of a Norwegian personal identification number (PIN). Results We found differences in birthplace, imprisonment and drug use between the NorMA cohort, lost to follow-up and the one-day population. Twenty-three percent of the one-day population did not have a Norwegian PIN. The NorMA cohort was more similar to those with a Norwegian PIN in the one-day population. Our triangulation demonstrates that 56–62% of the Norwegian prison population had an indication of drug use before imprisonment. Conclusions The NorMA cohort was overall representative of the one-day prison population holding a Norwegian PIN and less representative of prisoners without a Norwegian PIN. Using this method provides tangible inputs on the strengths and limitations of a study sample and can be a feasible method to investigate the external validity of survey data.

Illicit drug use in Reykjavik by wastewater-based epidemiology

Estimation of illicit drug use on a community level by wastewater-based epidemiology (WBE) is both an objective and reliable way to establish near real-time results. Wastewater samples were collected at eleven timepoints in Reykjavik from 2017 to 2020. The use of commonly abused illicit drugs in Iceland (amphetamine, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), cocaine, and cannabis) was estimated. Solid phase extraction and ultra-high performance liquid chromatography coupled to tandem mass spectrometry was used for analysis. Estimated amphetamine and methamphetamine use showed signs of an increase from 2017 to 2020 with amphetamine being the dominant stimulant on the market. MDMA use remained stable from 2017 to 2020. Results showed a large increase in cocaine use from 2017 to 2019 but interestingly, a marked decrease in 2020 during the COVID-19 pandemic. Cannabis use was stable from 2017 to 2019 but showed signs of an increase during the pandemic in 2020. Results by WBE corresponded with data based on two other indicators of drug use, seizure data and driving under the influence cases. Both temporal and spatial trends in illicit drug use were successfully estimated by using WBE, complimenting other indicators which provided a comprehensive picture of drug abuse in Reykjavik.

Evaluation of Drug Use at Pasar Merah Public Health Center in Medan

Evaluation of drug use is one of the clinical pharmacy services at Public Health Center. Evaluation of the drugs use must refer to the indicators of drug use.This study aimed to determine the average number of drugs in each prescription, the percentage of prescribed generic drugs, the percentage of prescribed antibiotics, the percentage of injection, and the percentage of drugs prescribed from the DOEN (List of National Essential Medicines) at Pasar Merah Public Health Center Medan. This research was a retrospective descriptive study carried out by collecting data from the available documents as well as interviews with the head of Medan Pasar Merah Public Health Center and drug management officers.Through the research, it was found that the average number of drugs in each prescription was still high, not in accordance with the prescribed standards, the percentage of generic drugs prescribed was not good, the percentage of prescribed antibiotics was quite high, the percentage of injections prescribed did not meet the percentage indicator of injection prescription, and the percentage of drugs prescribed from the DOEN at Pasar Merah Medan Public Health Center was quite good. This study concludes that the use of drugs in Pasar Merah Medan Public Health Center has not met the indicator of drug use

Pharmacy Hydroxyurea Education Materials for Patients with Sickle Cell Disease: An Environmental Scan and Assessment of Accuracy

BACKGROUND: Hydroxyurea (HU) remains a cornerstone of sickle cell disease (SCD) therapy however its clinical efficacy may be limited by poor patient acceptance and adherence. While barriers to HU use are multifold, patients often relay fears relating to potential side effects of HU as a contributor to drug non-adherence. A common source of information on HU side effects is the patient information handouts (PIHs) that are routinely distributed by pharmacies when dispensing a prescription. We sought to formally evaluate the content and accuracy of HU pharmacy PIHs, including comparison of content with a reference standard PIH developed by the Canadian Haemoglobinopathy Association.METHODS: We obtained a comprehensive list of all accredited pharmacies in Ontario, Canada in 2016 from the Ontario College of Pharmacists (OCP), which totalled 4,150 pharmacies. A representative sample of pharmacies were subsequently contacted by telephone or in-person to obtain pharmacy PIHs on HU. PIHs were assessed according to listed uses of HU, number of inaccurate statements, essential statements based on comparison to the CanHaem reference standard PIH, and reading level (using Flesch-Kincaid and SMOG scales).RESULTS: Six unique HU PIHs were identified, which represented approximately 95% of Ontario pharmacies; PIH A and B were used by 58% and 36.7% of pharmacies, respectively (Table 1). While most of the PIHs listed uses for HU (60% of Ontario pharmacies in total), only 58.3% identified SCD as an indication for drug use. All PIHs contained statements that could be classified as inaccurate and misleading. The number of inaccurate statements ranged from 2-5 per PIH; 95% of distributed PIHs had an average of 4 inaccurate statements per handout. The most frequently encountered inaccuracy related to development of cancer in patients taking HU, namely acute leukemia. Additional inaccuracies included special handling precautions, vaccine inefficacy and overstating the likelihood of developing rare side effects such as, “deadly bleeding problems and infections,” hepatic insufficiency and infertility.On average, pharmacy PIHs included 45% of essential statements present within the reference standard HU patient handout. Missing information themes involved use of HU for management of SCD and specifically, benefits of HU in preventing SCD complications, long term safety data on HU and differentiation between common and uncommon side effects of HU use.The reading level of each pharmacy PIH was also assessed and compared to the grade 6 reading level formally advised for written patient information materials by the National Work Group on Literacy and Health. The average reading level across pharmacy PIHs was 7.85 and 7.83 according to the Flesch Kincaid and SMOG scales, respectively. However, 58% of Ontario pharmacies distributed PIHs with a reading level of 9.2 and 8.2 (Flesch Kincaid and SMOG, respectively) in comparison to the grade 6.2 and 6.7 (Flesch Kincaid and SMOG, respectively) reading level of the CanHaem PIH.CONCLUSION: SCD patients in Ontario who are prescribed HU are likely to receive written information materials from pharmacies that contain inaccurate and misleading statements weighted heavily toward risks of HU therapy and run contrary to published literature. Moreover, the PIHs reviewed in this study contained only 45% of the content deemed necessary for patient education on HU by a panel of experts in SCD. Oftentimes, this information requires a comprehension level beyond that recommended for patients. Through the itemization of written information provided to patients when obtaining their HU prescription, this study identifies a potential gap in the care of SCD patients and an opportunity to improve on the quality of HU PIHs to help patients make well-informed decisions about their health. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Reginal features of modern narcotization in the Russian Federation

The purpose of this work is to analyze regional characteristics of drug use in the Russian Federation in order to form a general picture of the spread of drug use in the country and to develop effective anti-drug policy measures that meet the challenges of the current drug situation. The regions of the Russian Federation that have, according to statistics, the maximum and minimum indicators of drug use are considered. The results of the analysis of current medical statistics (indicators for the number of people with the first-time established drug dependence syndrome, as well as the number of people with the first-time established diagnosis of “harmful (with harmful consequences) drug use”, the number of cases of acute drug poisoning, etc.), law enforcement statistics (indicators for the number of registered crimes in the field of illicit drug trafficking, the number of seized drugs, the structure of the most common drugs, etc.). A secondary analysis of specialized literature, as well as data from research conducted by the sector of sociology of deviant behavior of the Federal Center of Theoretical and Applied Sociology of the Russian Academy of Sciences. The problem of drug abuse in various regions of our country does not lose its urgency to this day. The presence of a huge territory that unites numerous regions that are diverse in their characteristics causes the polarization of indicators of drug use within the country. Based on the results of the work, conclusions were obtained about the most risky regional features in the drug sphere, as well as regional features that act as a kind of protective factors against the spread of drug use.

Marijuana, Methamphetamine Confiscations Rose During COVID-19 Pandemic

Back to table of contents Previous article Next article Clinical & ResearchFull AccessMarijuana, Methamphetamine Confiscations Rose During COVID-19 PandemicTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:28 Apr 2021https://doi.org/10.1176/appi.pn.2021.5.9AbstractDrug seizures by law enforcement dipped in the early days of the pandemic, then rebounded last summer.iStock/iKaleb KroetschLaw enforcement confiscation of illegal drugs dipped early in the COVID-19 pandemic, then began to rise, according to a study in Drug and Alcohol Dependence. These changes were most pronounced for marijuana and methamphetamine, where seizures of these drugs exceeded pre-COVID-19 numbers in August of last year.“While drug seizures aren’t a great indicator of drug use, they can serve as an indicator for drug availability,” said lead author Joseph J. Palamar, Ph.D., M.P.H., an associate professor in the Department of Population Health at New York University Langone Medical Center.Palamar and colleagues analyzed law enforcement seizures of illegal drugs in five key regions in the Office of National Drug Control Policy’s High Intensity Drug Trafficking Areas Program: Chicago, Ohio, New Mexico, North Florida, and Washington, D.C./Baltimore. They examined monthly seizure trends in confiscations of cocaine, fentanyl, heroin, marijuana, and methamphetamine from March 2019 (one year before the COVID-19 pandemic) to September 2020.The overall number of seizures was less in April 2020 compared with March 2019, and then began to climb. In August 2020, there were 2,088 drug confiscations overall compared with 1,777 in June 2019, the peak of pre-pandemic seizures.Drug confiscations should not be taken as an indication of drug use, but of drug availability, says Joseph J. Palamar, Ph.D., M.P.H.New York University Langone Health“I wasn’t surprised that the number of seizures decreased early in the pandemic, but I was a bit surprised that seizures in late summer of 2020 surpassed peaks in 2019,” Palamar told Psychiatric News. “It makes me wonder whether drug availability has really increased that much or if law enforcement merely caught up from [re]laxed activity earlier in the pandemic.”Marijuana and methamphetamine seizures drove the overall increase in drug confiscations. Marijuana confiscations climbed to 665 in August 2020, compared with a pre-pandemic high of 614 in March 2019. Law enforcement seized 11,194 kg of marijuana in August 2020, compared with the highest pre-COVID weight of 4,744 kg in December 2019. Methamphetamine seizures also increased after an initial decline early in the pandemic. In August 2020 there were 476 methamphetamine confiscations, compared with 385 in June 2019. However, the weight of methamphetamine seized did not significantly change. Before the pandemic hit, marijuana and methamphetamine confiscations had been declining, but the rebound in confiscations of both drugs in the summer of 2020 were enough to derail the downward trend.Fentanyl seizures dipped in April 2020 and then rebounded. However, the April decline was not enough to disrupt an overall upward trend in confiscations from the beginning of the study, leading the researchers to conclude that fentanyl confiscations have increased over time. Cocaine and heroin seizures dipped at the start of the pandemic and then rebounded, but confiscations of both drugs declined over time.Palamar emphasized that drug confiscations should not be considered an indication of illicit drug use. However, some of the data in this study may dovetail with those of studies that track use.“Some studies suggest that a lot of people who already used marijuana increased use during the pandemic. If this is the case, then there may be higher demand, even if the increase in demand is based on the same people who [used marijuana before the pandemic],” he said. “Methamphetamine use has [also] been increasing again in recent years, especially among people who use heroin.”This study was supported by the National Institute on Drug Abuse. ■“Shifts in Drug Seizures in the United States During the COVID-19 Pandemic” is posted here. ISSUES NewArchived