Influence Of Psychoactive Drugs Research Articles

Судово-фармацевтичні дослідження щодо впливу ліків на безпеку, життя та здоров’я учасників дорожнього руху в межах організації фармацевтичної справи, технології ліків, фармацевтичного та медичного права в Україні

Актуальність. У всьому світі дорожньо-транспортні пригоди (ДТП) під впливом лікарських засобів (ЛЗ) є однією з головних причин травмувань, смертності серед учасників дорожнього руху. Безпека руху уявляє собою систему, яка включає наступні складові: людина – стан здоров’я людини – вживання небезпечних ліків різних класифікаційно-правових груп (КПГ) – побічні реакції ліків – транспортний засіб – шлях. Частка дорожньо-транспортних пригод під впливом ліків становить понад 75%, вони є й найбільш суспільно небезпечними, тому що мають тяжкі наслідки, спричиняють невиправну шкоду здоров’ю та смерть потерпілих. Мета дослідження: проаналізувати здобутки судово-фармацевтичних досліджень в Україні щодо впливу ЛЗ на безпеку, життя та здоров’я учасників дорожнього руху в межах організації фармацевтичної справи, технології ліків та фармацевтичного і медичного права в ретроспективному аспекті. Матеріали та методи. Матеріалами імперативного дослідження стали законодавчі, нормативно-правові документи; матеріали становлення наукової школи судової фармації; наукові публікації за темою статті; Інтернет-ресурси, джерела наукової літератури. Для досягнення поставленої мети було застосовано методи судово-фармацевтичного, нормативно-правового, документального, бібліографічного, порівняльного, історичного та графічного аналізу. Результати. Проаналізовано досвід країн світу щодо профілактики та попередження дорожньо-транспортних пригод під впливом ліків. Причини, умови виникнення та наслідки ДТП носять багатофакторний характер і пов’язані з постраждалими (водій-пішохід), транспортним засобом, дорогою, вживанням психоактивних ЛЗ. Розроблено систему організаційно-регуляторних та попереджувальних заходів з надання першої медикаментозної допомоги потерпілим від ДТП. Показано, що існує необхідність проведення науково-обґрунтованих організаційно-правових, клініко-фармакологічних, судово-фармацевтичних та соціально-економічних досліджень щодо причинних зв’язків між побічними реакціями внаслідок вживання ЛЗ різних КПГ, безпекою руху та виникненням ДТП. Вперше в Україні було запропоновано математичну модель щодо встановлення впливу психоактивних ЛЗ на стан водія при керуванні транспортним засобом у залежності від обчислення шляху зупинки автомобіля відповідно до обраної швидкості та зниження реакції водія. Досліджено структуру ДТП, скоєних під впливом психоактивних лікарських препаратів. Висновки. Запропоновано класифікацію медичних аптечок для надання першої медикаментозної допомоги потерпілим при ДТП, яка дозволила обґрунтувати необхідність удосконалення їх як за якісним, так й кількісним складом у залежності від типу транспортного засобу й імовірності виникнення ДТП з тяжкими наслідками. Запропоновано рекомендації стосовно забезпечення інформації про можливість отримання медичної допомоги та систему сигнально-викличного зв’язку на шляхах, маркірування упаковок психоактивних ЛЗ спеціальною позначкою у вигляді червоного трикутника. Доведено про необхідність подальших судово-фармацевтичних досліджень.

Consumption, risk factors, and the impact of psychoactive substances in road transport by professional drivers: a review

Traffic accidents are a serious public health problem, especially in developing countries. Driving under the influence of psychoactive substances, such as illicit drugs, can significantly increase the risk of motor vehicle accidents. This fact potentiates the probability of serious traffic accidents occurring, making it necessary to combat them with seriousness and urgency. Many road traffic crashes are related to sleepiness and/or fatigue. In addition to long driving hours, important contributors to fatigue among professional drivers are insufficient night-time sleep and insufficient rest breaks. Research data on the topic show that several psychoactive drugs alter the motor and cognitive capacity of users, however, most of these studies pointed out such outcomes based on the prevalence of illicit drug use in professional hospitalized drivers. Despite the existence of laws against driving doped, the effectiveness of these laws in controlling the problem is questionable. For this research, the study was conducted to highlight and discuss, by a descriptive review, the consumption of psychoactive substances among professional drivers, and the role of working conditions in the prediction of such use. Data about drug use were obtained in this review aims to contribute for the development of preventive measures, especially public policies on the risks of driving while under the influence of psychoactive drugs.

THE USE OF PSYCHOACTIVE DRUGS AMONG STREET LADIES IN ABA METROPOLIS OF NIGERIA: AN ASSESSMENT OF PUBLIC HEALTH IMPLICATIONS

Introduction: The use of psychoactive drugs among ladies is engaged in on an alarming increase in the postmodern Nigerian society, as it remains one of the public health and social vices that affects the contemporary human community.
 Purpose: The objectives of this study were to identify the drugs mostly abused and to determine the risk behaviours they engage in when under the influence of psychoactive drugs.
 Methodology: This study adopted a cross-sectional approach involving the use of oral interview and a semi- structured questionnaire as the instrument of data collection. This involved 20 interviewees in simple random selection. The data collected were analyzed using a descriptive statistics and statistical test of significance and results presented in charts.
 Findings: Major findings in this study attest to the fact that the mostly abused psychoactive drugs are Cigarette, Indian hemp, tramadol and codeine, cocaine. The use of psychoactive drugs is precursory to mental health challenges, depression, and behavioural abnormalities among younger women. The risk behaviours engaged when under the influence of these psychoactive drugs are aggressiveness/ ready to fight, unrestricted sexual activities, desire for more drug use. Consequently, the study findings maintain that the perpetration of heinous crimes that are carried out in the society cannot be independent of the influence of drugs, since the abused psychoactive drugs alter the normal function of the brain thus affecting the mental health of the user.
 Contribution to theory, practice and policy: Therefore, public health education and promotion with a focus on dissuading the unrestricted circulation and abuse of psychoactive drugs, especially among Aba young ladies is perceived profitable.
 Conclusion and Recommendation: Community awareness regarding drug and substance among women and constant checkmating of the activities of street girls should be carried out.

O-01 “Chemsex” : Drug or Sex Addiction?

“Chemsex” is the term given to the intentional practice of sex under the influence of psychoactive drugs (mainly mephedrone, γ-hydroxybutyrate/γ-butyrolactone and methamphetamine), mostly among men who have sex with men (MSM). These drugs are often combined to facilitate sexual sessions lasting several hours or days with multiple sexual partners due to their potential to induce euphoria, increased energy, disinhibition and enhance sexual arousal.

Subclinical epileptiform activity during sleep in Alzheimer's disease and mild cognitive impairment

ObjectiveRecent findings suggested that subclinical epileptiform activity is prevalent during sleep in a significant proportion of Alzheimer’s Disease (AD) patients. The aims of our study were: (A) comparing the frequency of subclinical epileptiform activity during the sleep in a sample diagnosed with ‘probable’ AD and Mild Cognitive Impairment (MCI) due to AD, and in healthy subjects; (B) evaluating epileptiform EEG activity as a function of different sleep stages within a well-controlled polysomnographic setting. MethodsWe prospectively enrolled 50 ‘probable’ AD patients (73 ± 7.0 years) and 50 subjects with MCI due to AD (72 ± 6.7 years) without history of seizures, comparing them with 50 controls (69 ± 6.7 years). Patients underwent to a full-night video-PSG. ResultsSubclinical epileptiform activity was detected in 6.38% of ‘probable’ AD patients, 11.63% of MCI due to AD subjects and 4.54% of controls (p = 0.43). The comparisons between the three groups for the frequency of epileptiform activity did not reach statistically significant differences neither for total sleep nor for any sleep period considered. ConclusionsOur study shows that, when controlling for sleep stages and the influence of psychoactive drugs, AD patients and MCI due to AD subjects do not exhibit a higher frequency of epileptiform discharges during sleep compared to healthy subjects. SignificanceSubclinical epileptiform activity during sleep does not discriminate ‘probable’ AD from MCI due to AD and healthy controls.

Chemsex is not a barrier to self-reported daily PrEP adherence among PROUD study participants

BackgroundPre-exposure prophylaxis (PrEP) is a novel HIV prevention method whereby HIV-negative individuals take the drugs tenofovir and emtricitabine to prevent HIV acquisition. Optimal adherence is critical for PrEP efficacy. Chemsex describes sexual activity under the influence of psychoactive drugs, in the UK typically; crystal methamphetamine, gamma-hydroxybutyrate(GHB) and/or mephedrone. Chemsex drug use has been associated with increased HIV transmission risk among gay, bisexual and other men who have sex with men (GBM) and poor ART adherence among people living with HIV. This study assessed whether self-reported chemsex events affected self-reported daily PrEP adherence among PROUD study participants. MethodsThe PROUD study was an open-label, randomised controlled trial, conducted in thirteen English sexual health clinics, assessing effectiveness of TruvadaⓇ-PrEP among 544 HIV-negative GBM. The study reported an 86% risk-reduction of HIV from daily PrEP. Participants were asked about chemsex engagement at follow-up visits. Monthly self-reports of missed PrEP tablets were aggregated to assess adherence between visits. Univariable and multivariable regression analyses were performed to test for associations between chemsex and reporting less than seven out of seven intended doses(<7/7ID) in the 7 days before and/or after last condomless anal intercourse(CAI). Results1479 follow-up visit forms and 2260 monthly adherence forms from 388 participants were included in the analyses, with 38.5% visit forms reporting chemsex since last visit and 29.9% follow-up periods reporting <7/7ID. No statistically significant associations were observed between reporting <7/7ID and chemsex (aOR=1.29 [95% CI 0.90–1.87], p = 0.168). Statistically significant associations were seen between reporting <7/7ID and participants perceiving that they would miss PrEP doses during the trial, Asian ethnicity, and reporting unemployment at baseline. ConclusionsThese analyses suggest PrEP remains a feasible and effective HIV prevention method for GBM engaging in chemsex, a practise which is prevalent in this group and has been associated with increased HIV transmission risk.

Everyday hallucinations?: Strong expectations lead to the misperception of faces in visual noise

Visual hallucinations are stigmatized as a symptom of extreme psychological disorder, but in reality even healthy people can experience them during sleep or sensory deprivation, or under the influence of psychoactive drugs. It is difficult to study hallucinations in a laboratory setting because the experience often requires an extreme context. One method of researching hallucination-like phenomena requires a combination of ambiguous sensory input and strong sensory expectations. Previous studies have found that inducing a strong expectation to see faces leads to misperceptions in brief presentations of static Gaussian noise patterns, but detection responses were confounded with acquiescence response bias and physical similarities between specific noise patterns and faces. Here we report a replication (Exp1) and 3 variations of the previous paradigm, in which we attempted to induce misperceptions of faces while systematically removing bias (Exp2–3) and weakening temporal, spatial, and feature expectations (Exp4). Our results indicate that controlling for physical similarities between faces and specific noise patterns significantly decreases biased face detections while keeping a reliable proportion of expectation-influenced responses. Weakening expectations leads to very few face detections in most subjects. Together, the results show that an optimal balance between low bias and high expectations can lead to reliable visual misperceptions in healthy subjects.

First evaluation of the possibility of testing for drugged driving using exhaled breath sampling

Objective: Driving under the influence of psychoactive drugs causes an increased risk for accidents. In combating this, sobriety tests at the roadside are common practice in most countries. Sampling of blood and urine for forensic investigation cannot be done at the roadside and poses practical problems associated with costs and time. An alternative specimen for roadside testing is therefore warranted and the aerosol particles in exhaled breath are one such alternative.Methods: The present study investigated how the exhaled breath sample compared with the routine legal investigations of blood and urine collected from suspects of drugged driving at 2 locations in Sweden. Exhaled breath was collected using a simple filter collection device and analyzed with state-of-the-art mass spectrometry technique.Results: The total number of cases used for this investigation was 67. In 54 of these cases (81%) the results regarding a positive or negative drug test result agreed and in 13 they disagreed. Out of these, the report from the forensic investigation of blood/urine was negative in 21 cases. In 6 of these, analytical findings were made in exhaled breath and these cases were dominated by the detection of amphetamine. In 7 cases a positive drug test from the forensic investigation was not observed in the breath sample and these cases were dominated by detection of tetrahydrocannabinol in blood. In total, 45 samples were positive with breath testing and the number of positives with established forensic methods was 46.Conclusion: The promising results from this study provide support to exhaled breath as a viable specimen for testing of drugged driving. The rapid, easy, and convenient sampling procedure offers the possibility to collect a drug test specimen at the roadside. The analytical investigation must be done in a laboratory at present because of the need for a highly sensitive instrument, which is already in use in forensic laboratories. The analytical work is not more challenging than for blood or oral fluid and should not cause an increase in cost. However, more studies need to be done before exhaled breath drug testing can be applied routinely for drugged driving investigation.

Reducing the risks of chemsex

Chemsex incidence – engaging in sexual intercourse while under the influence of psychoactive drugs – is growing in men who have sex with men. It is crucial to support people with appropriate risk-reduction strategies – and encourage engagement with specialist services

Psychoactive substances in seriously injured drivers in Denmark

This study assesses the presence of a number of psychoactive substances, including alcohol, based on blood samples from 840 seriously injured drivers admitted to five selected hospitals located in five different regions of Denmark. The study was a part of the EU 6th framework program DRUID (Driving Under the Influence of Drugs, Alcohol and Medicines). Blood samples were screened for 30 illegal and legal psychoactive substances and metabolites as well as ethanol. Danish legal limits were used to evaluate the frequency of drivers violating the Danish legislation while limit of quantification (LOQ) was used for monitoring positive drivers. Tramadol is not included in the Danish legislation therefore the general cut off, as decided in the DRUID project was used. Overall, ethanol (18%) was the most frequently identified compound (alone or in combination with other drugs) exceeding the legal limit, which is 0.53g/l in Denmark. The percentage of seriously injured drivers testing positive for medicinal drugs at levels above the Danish legal limit was 6.8%. Benzodiazepines and Z-drugs (6.4%) comprised the majority of this group. One or more illegal drugs (primarily amphetamines and cannabis) were found to be above the Danish legal limit in 4.9% of injured drivers. Young men (median age 31 years) were over-represented among injured drivers who violated Danish law for alcohol and drugs.Diazepam (4.4%), tramadol (3.2%), and clonazepam (3.0%) were the medicinal drugs most frequently detected at levels above LOQ, whereas amphetamines (5.4%) (amphetamine [5.2%] and methamphetamine [1.5%]), tetrahydrocannabinol (3.7%), and cocaine (3.3%), including the metabolite benzoylecgonine, were the most frequently detected illegal drugs. A driver could be positive for more than one substance; therefore, percentages are not mutually exclusive. Poly-drug use was observed in 112 (13%) seriously injured drivers. Tramadol was detected above DRUID cutoffs in 2.1% of seriously injured drivers. This is 3.5 times that observed in a Danish survey of randomly selected drivers. Moreover, illegal and medicinal drug levels above the Danish legal limit were present more than 10 times as frequently as in injured drivers, whereas ethanol was present more than 30 times as frequently than in randomly selected drivers. The results indicate that there is an increased risk in traffic when driving under the influence of psychoactive drugs, especially alcohol in young male drivers.

Intoxicated workers: findings from a national Australian survey

To identify prevalence of alcohol and drug use and intoxication at work. A total of 9,828 Australian workers ≥14 years old. Australia 2007. Work-place alcohol use and drug use, intoxication at work, industry and occupation of employment. Secondary analysis of a large nationally representative survey involving descriptive and weighted multivariate logistic regressions. Differential patterns were identified by drug type, worker characteristics and occupational setting, controlling for demographic variables. Nearly 9% of workers surveyed (8.7%) usually drank alcohol at work and 0.9% usually used drugs at work. Attending work under the influence of alcohol was more prevalent (5.6%) than attending work under the influence of drugs (2.0%), and significantly more likely among young, male, never married workers with no dependent children. Hospitality industry workers were 3.5 times more likely than other workers to drink alcohol and two to three times more likely to use drugs at work or attend work under the influence of alcohol or drugs. Other high-risk industries and occupations included construction, financial services, tradespersons and unskilled workers. More than one in 20 Australian workers admit to having worked under the influence of alcohol and almost one in 50 report attending work under the influence of psychoactive drugs. The rates are higher for some industries, such as the hospitality industry, than others.

Alcohol, illicit and non-illicit psychoactive drug use and road traffic injury in Thailand: A case-control study

The objective of this study was to determine the relationship between alcohol use, psychoactive drug use and road traffic injury (RTI). A case-control study was conducted among drivers in Bangkok, Thailand. Two hundred cases and 849 controls were enrolled between February and November 2006. Cases who sustained a RTI were matched with four controls recruited from petrol stations within a 1-km radius of the reported crash site of the case. A positive alcohol breath test (≥50 mg/dl), and positive tests for the presence of illicit (amphetamine, cocaine, marijuana) and non-illicit psychoactive drugs (antihistamine, benzodiazepine, antidepressants), using gas chromatography/mass spectrometry (GC/MS) were documented as primary measures. There were significantly higher odds of an alcohol breath test ≥50 mg/dl (adjusted odds ratio (OR) 63.6 (95% CI: 25.5–158.9)), illicit psychoactive drugs (adjusted OR 3.4 (95% CI: 1.7–6.6)) and non-illicit psychoactive drug (adjusted OR 3.1 (95% CI: 1.5–6.3)) among cases than controls. Even though driving under the influence of psychoactive drugs has been significantly linked to RTI, its contribution to road safety is much lower than driving under the influence of alcohol. With limited resources, the priority for RTI prevention should be given to control of driving under the influence of alcohol.

Fahrsicherheit und Psychopharmaka

The mobility of many patients often depends on their using a motor vehicle. For this reason studies on their driving ability while under the influence of psychoactive drugs is of great practical relevance. These studies have shown that underlying factors of the illness itself represent a greater problem than drug-induced factors. When assessing pharmacologic effects on neuropsychological functions it has to be taken into account that patients' abilities take some time to stabilize after the acute phase of the disease. Driving ability while under the influence of psychoactive drugs must thus be judged over time. Marked interindividual variations in the reaction to psychoactive drugs always requires individual assessment of driving ability.

Fatal injuries while under the influence of psychoactive drugs: a cross-sectional exploratory study in England

BackgroundStudies of drug-related mortality rarely describe fatal injuries due to psychoactive drug intoxication (FIUI). The main aim of this study was to determine the nature, extent and pattern of FIUI.MethodsThis observational study covered the period January 1999 to December 2001. Data were provided by members of a study panel of coroners in England using a standard protocol. Sources of data for this study included autopsy protocols, death certificates, hospital records, police reports, toxicology reports and inquest transcripts. Inclusion criteria for this were (i) the mention of one or more psychoactive substances as contributing to fatality; and (ii) the presence of a Controlled Drug at post mortem.ResultsA total of 3,803 drug-related deaths of persons aged 16–64 years were reported by the study panel during the three-year period. The study panel accounted for 86% of drug-related deaths in England in this period. There were 147 FIUI cases (119 males, 28 females), giving a proportionate mortality ratio of approximately 4%. The majority of FIUI cases (84%) were aged 16–44 years, with a median age at death of 33 years (Quartile deviation = 7). Fifty-six percent of FIUI occurred in urban areas of England.The population of the study jurisdictions aged 16–64 years contributed 49,545,766 person-years (py) to the study, giving an annual crude rate of 3/1,000,000 person-years (py). Rates for male and females were 4.9 and 1.1/1,000,000 py respectively, giving a male/female rate ratio of 4.5 (95%CI = 2.9–6.8).The rates of intentional and unintentional FIUI were 2 and 1/1,000,000 py respectively. The leading mechanism for intentional FIUI was suffocation while the predominant mechanisms in unintentional FIUI were road traffic accidents and falls. There is a significant difference in the pattern of drug-specific risk between FIUI and fatal poisoning. Risks of intentional FIUI are elevated among Black and Minority Ethnic groups.ConclusionThere are differences in the nature, extent and pattern of intentional and unintentional FIUI that should necessitate targeted prevention strategies. Also, there is an opportunity for cross-discipline collaboration between injury prevention specialists and substance abuse/mental health specialists.

Affective and Anxiety Disorders in Patients with Cancer

Cancer, at all sites and stages (from early diagnosis to terminal phase), has psychological effects in a significant number of patients. Diagnosis of depression and anxiety in this patient population can be difficult and must involve awareness of the symptoms and signs resulting from the cancer itself and antineoplastic therapies, and the differential diagnosis of ‘function’ and ‘organic’ mental disorders. When prescribing psychotropic medications to patients with cancer, particular attention should be paid to drug interactions (e.g. the potential influence of psychoactive drugs on the metabolism of chemotherapeutic agents). Despite provocative reports, it has to be acknowledged that to date, there is no evidence to substantiate the claim of a negative impact of antidepressants on cancer initiation or prognosis. Although studies assessing the comparative effectiveness of psychopharmacological agents are difficult to perform in patients with cancer, the efficacy and tolerability of several antidepressants and anxiolytics have been shown and a mixed approach, combining drug treatments and various forms of psychotherapy, is now widely encouraged. However, a lot of research remains to be conducted in order to better understand the specific relationships between cancer and psychopathology, to identify risk factors and develop preventative strategies and to define a general model of treatment for psychiatric disturbances in patients with cancer.

Drug induced hypovigilance identification by means of an EEG Fractal Dimension Classifier

Event Abstract Back to Event Drug induced hypovigilance identification by means of an EEG Fractal Dimension Classifier Emmanouil Michail1*, Ioanna Chouvarda1 and Nicos Maglaveras1 1 Magdeburg University, Germany Aim: This work aims at identifying drug induced hypovigilance caused by lorazepam administration, a psychoactive drug with hypnotic effects (1). The main objective is to classify subjects who have taken 2.5 mg of lorazepam or placebo based on the brain activity changes that drug administration induces. Methods: EEG data were recorded from 14 healthy male subjects aged between 18 and 40 years. For each subject two different conditions were examined: lorazepam 2.5 mg single administration (verum state) and placebo administration (placebo state) early in the morning. For each of these two conditions EEG was recorded with eyes closed during 3 minutes in resting condition at a sampling frequency of 256Hz. 20 EEG channels were recorded at different times during the first and the second day of the experiment. After artefact removal and filtering, a single Fractal Dimension value was extracted for each 3-minute recording. Higuchi’s method (2) was used, with maximum time interval kmax=15. A linear classifier was applied to FD values of the same time period and EEG channel, in order to automatically classify between placebo and verum state. “Leave one out” cross validation approach was adopted. Results: In almost all subjects, FD has a higher value in verum case than in placebo case at the first 8 hours after drug intake. Some leftover effects are still noticeable 12 hrs after drug administration but not during next morning. Best discriminant results occur 2 hours after drug administration. At that time, classifier reaches 100% accuracy for channels F3, Fz and P4. At the same time, mean specificity over all channels was 97.5% and maximum specificity was 100% whereas, mean sensitivity over all channels was 85% and maximum sensitivity was 92.8571%. Conclusion: The practical application of these findings would be an automatic system able to detect if a subject is under the influence of psychoactive drugs that cause sleepiness. Acknowledgments: Special thanks to the research group of FORENAP for making available the dataset used in this study.