Misuse Of Other Substances Research Articles

The association between cannabis use and subjective memory complaints in older adults in the United States.

The U.S. population is aging and increasing numbers of older adults are using cannabis. Cognitive decline is common in older age and subjective memory complaints (SMC) have been associated with increased risk for dementia. While residual cognitive effects of cannabis use at younger ages are well understood, the links between cannabis use and cognition in older adults is less clear. The present study represents the first population-level analysis of cannabis use and SMC in older adults in the U.S. We used the National Survey of Drug Use and Health (NSDUH) dataset to evaluate SMC in respondents over age 50 (N = 26,399) according to past-year cannabis use. Results revealed that 13.2% (95%CI: 11.5%-15.0%) of those who reported cannabis use also reported SMC, compared to 6.4% (95%CI: 6.1%-6.8%) among individuals with no cannabis use. Logistic regression revealed a two-fold increase (OR = 2.21, 95%CI: 1.88-2.60) of reporting SMC in respondents who had used cannabis in the past year, which was attenuated (OR = 1.38, 95%CI: 1.10-1.72) when controlling for additional factors. Other covariates, including physical health conditions, misuse of other substances, and mental illness also significantly contributed to SMC outcomes. Cannabis use represents a modifiable lifestyle factor that has potential for both risk and protective properties that may impact the trajectory of cognitive decline in older age. These hypothesis generating results are important for characterizing and contextualizing population-level trends related to cannabis use and SMC in older adults.

The Prevalence of Substance Misuse and its Effects among Omani College Students: A Cross-sectional Study.

ObjectivesMany studies have confirmed that the use of alcohol, tobacco, and cannabis is prevalent among university students. This study aimed to assess the prevalence of substance misuse among college students in Oman, identifying the most commonly used substances, and reviewing the effect of substance misuse on the students’ performance.MethodsThis cross-sectional study was conducted in a higher learning institution in an urban setting in Oman from April 2018 to December 2018. A descriptive, self-administered online questionnaire, the Alcohol, Smoking, and Substance Involvement Screening Test, version 3.0 (Arabic version), adapted from the World Health Organization was sent to 12 000 students at the college. The sample size was calculated using online software (Raosoft), with a margin of error of 5% and a confidence level of 95%.ResultsA total of 375 students responded (response rate = 3.1%). The overall lifetime prevalence for any substance misuse (including tobacco and alcohol) among the participants was 41.3%, with the overall prevalence without tobacco or alcohol at 29.9%. Tobacco was the most common substance used, with a prevalence of around 23.5%, followed by alcohol at 10.7%. Male students had a significantly higher rate of substance abuse, for any substance, compared to female students (p < 0.001). There was a significant correlation between tobacco use, alcohol misuse, and misuse of other substances. Most of the adverse effects attributed to substance misuse reported by the respondents in this study were social (27.7%) and health-related (25.8%) problems. The impact of substance abuse on their performance was also high (23.8%). Furthermore, 15.4% of the respondents had financial problems, and 4.7%% were struggling with legal issues. Notably, only 49.1% of the respondents perceived that substance misuse was a serious problem.ConclusionsAlthough college students are expected to be more aware of the negative impacts of substance misuse, this study found a high prevalence of smoking, alcohol, and other substance misuses among the group of Omani college students. Further research in this field is essential, and the results of this study have shed light on a critical problem among Omani college students. It is hoped that the findings of this study will be used and built on in future research to recognize students at risk of substance misuse from early school life, leading to early intervention, and potentially preventing the possible negative consequences.

Misuse and dependence of dimenhydrinate: A mixed studies systematic review

BackgroundDimenhydrinate (DMH) is an antihistamine used to treat nausea and vomiting. Although widely available in pharmacies as an over the counter medication, there have been reports of potential DMH tolerance and dependence and a possible euphoric potential accompanying heavy use (>100 mg/day). Despite the potential for misuse, there is a gap in the literature concerning patterns, characteristics, and potential mechanisms of DMH misuse. AimsThis review aimed to synthesize evidence on the pharmacology, clinical effects, and management of DMH misuse and dependence to inform clinical decision making and relevant drug policy. MethodsWe conducted a systematic review in accordance with the PRISMA guidelines and using Cochrane collaboration methods. We searched seven databases from their inception through July 2019. To be included in the review, studies needed to measure or focus on one or more dimensions of morbidity or mortality related to the misuse of DMH. Quantitative, qualitative and mixed-method studies were included in order to capture the breadth of possible studies. Studies were excluded if they did not fit into the conceptual framework of the study of if they focused primarily on the misuse of other substances. A narrative synthesis of study findings was pursued given the limited capacity for a quantitative meta-analysis. FindingsWe identified 24 studies, which described a range of neuropsychiatric sequelae related to DMH consumption, including seizures, psychosis, depression, intoxication (resembling anticholinergic syndrome) and withdrawal. The sedative and euphoric properties, readily available nature, and low cost of DMH appear to facilitate DMH dependence, which were more commonly reported among individuals who had concurrent psychiatric disorders, displaying symptoms such as low motivation, poor concentration, and delirium. The overall quality of studies identified by this review was low—largely because the majority of studies were case reports or review articles, with few intervention or cohort studies. ConclusionsThere is some evidence to suggest the existence of DMH-related syndromes involving intoxication, withdrawal, and dependence, more commonly among long-term, heavy DMH consumers. However, higher quality studies are needed to confirm preliminary findings that there may be a biological basis for such syndromes.

Prescription opioid misuse among middle-aged and older adults in the United States, 2015–2016

Adults ≥50 years of age have high rates of prescription opioid use. The purpose of this study is to estimate the prevalence and correlates of prescription opioid misuse among middle-aged and older adults in the United States who use prescription opioids. Data from adults age ≥ 50 from the two most recent cohorts (2015 and 2016) of the National Survey of Drug Use and Health were examined (N = 17,608). Characteristics of past-year prescription opioid misusers, including demographics, substance use, depression, chronic disease, and emergency department (ED) use, were compared to adults who used prescription opioids as prescribed in the past year and non-users. We used multivariable logistic regression to determine correlates of prescription opioid misuse among adults who used prescription opioids. Among the entire sample, 61.4% reported no past-year prescription opioid use, 36.0% reported past-year prescription opioid use without misuse, and 2.5% reported past-year prescription opioid misuse. Among past-year prescription opioid users, 6.6% reported misuse. Past-year misuse was higher among males, adults age 50–64, misusers of prescription sedatives, stimulants, and tranquilizers, users of other substances (i.e., tobacco, marijuana, cocaine), and those with alcohol use disorder. Past-year misuse was lower among adults with 2 or more chronic diseases. Past-year prescription misuse of sedatives (AOR 4.08 [95% CI 2.05–8.12]), stimulants (AOR 3.88 [95% CI 2.00–7.53]), and tranquilizers (AOR 10.02 [95% CI 6.48–15.50]) were all associated with past-year opioid misuse. Characteristics of opioid misusers determined in this study—particularly misuse of other substances—may help determine middle-aged and older adults at risk for prescription opioid misuse.

When Treatment Turns to Addiction: Emerging Issues in Over-the-Counter and Prescription Drug Abuse

As the availability of both over-the-counter and prescription medications has grown, medications that were previously classified as “harmless” are now being misused. Detection of misuse of other substances can be difficult as many are not found on typical screens. In this article, we discuss promethazine, quetiapine, loperamide, bupropion, zolpidem, and gabapentin, and our current understanding of their misuse and the characteristics of their addictive properties if known. Although we know much about their clinical indications, the reasons and reinforcing properties leading to their misuse is largely unknown. With this article, we also hope to raise clinician awareness for the potential medical consequences and psychotropic effects stemming from the misuse of these drugs. [ Psychiatr Ann. 2018;48(8):379–383.]

Psychoactive substance use in specialized psychiatric care patients.

Objective Life expectancy of psychiatric patients is markedly shorter compared to the general population, likely partly due to smoking or misuse of other substances. We investigated prevalence and correlates of substance use among psychiatric patients. Methods Within the Helsinki University Psychiatric Consortium Study, data were collected on substance use (alcohol, smoking, and illicit drugs) among patients with schizophrenia or schizoaffective disorder (n = 113), bipolar (n = 99), or depressive disorder (n = 188). Clinical diagnoses of substance use were recorded, and information on smoking, hazardous alcohol use, or misuse of other substances was obtained using questionnaires. Results One-fourth (27.7%) of the patients had clinical diagnoses of substance use disorders. In addition, in the Alcohol Use Disorders Identification Test, 43.1% had hazardous alcohol use and 38.4% were daily smokers. All substance use was more common in men than in women. Bipolar patients had the highest prevalence of alcohol use disorders and hazardous use, whereas those with schizophrenia or schizoaffective disorder were more often daily smokers. In regression analyses, self-reported alcohol consumption was associated with symptoms of anxiety and borderline personality disorder and low conscientiousness. No associations emerged for smoking. Conclusions The vast majority of psychiatric care patients have a diagnosed substance use disorder, hazardous alcohol use, or smoke daily, males more often than females. Bipolar patients have the highest rates of alcohol misuse, schizophrenia or schizoaffective disorder patients of smoking. Alcohol use may associate with symptoms of anxiety, borderline personality disorder, and low conscientiousness. Preventive and treatment efforts specifically targeted at harmful substance use among psychiatric patients are necessary.

432 Characteristics and Predictors of Tramadol Misuse Results from the 2015 National Survey on Drug Use and Health

The non-medical use of prescription medications, especially opioids, continues to be a serious public health concern impacting emergency departments, with the death rate from synthetic opioids increasing by 72.2% from 2014 - 2015. Tramadol prescriptions have increased substantially over the last decade, including by emergency physicians. The objective of the current study is to determine the predictors of tramadol misuse by utilizing the nationally representative National Survey of Drug Use and Health (NSDUH) data. NSDUH, managed by Substance Abuse and Mental Health Services Administration (SAMHSA), is the annual public use self-report based dataset collecting information on the nature and extent of substance use and misuse in the US. The 2015 NSDUH data files were analyzed for this study using a cross-sectional study design. The respondents were classified into two groups, past year tramadol users, and misusers, based on the screening questions assessing past year use and misuse of tramadol products. The prevalence of selected demographic, clinical factors and substance use and abuse, including prescription medications, was assessed descriptively for the two population groups using cross-tabulated frequencies and chi-sq tests. Logistic regression methods were used to outline the predictors of tramadol abuse adjusting for the selected covariates. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were reported. Overall, the 2015 NSDUH survey comprised of 57,146 respondents, of which 3,211 respondents (5.6%) reported using tramadol products over the last year. Among the total tramadol users, 439 (13.7%) respondents reported misusing these products in the previous year. The prevalence of tramadol misuse in the total 2015 NSDUH sample was 0.8%. The proportion of males (40.3% vs 32.7%, p=0.001), unmarried (75.9% vs 61.3%, p<0.001), non-Hispanic whites (69% vs 65%, p=0.01), and Hispanics (14.9% vs 9.3%, p=0.0001) was higher in past year tramadol misusers. The use and misuse of other substances in the previous year was more prevalent in the tramadol misusers. Tramadol misuse was significantly more likely among previous year users of oxycodone (OR: 2.45, 95% CI: 1.52 - 3.96, p=0.0002), and morphine (OR: 4.46, 95% CI: 2.04 - 9.73, p=0.0002), while hydrocodone and morphine users had a 40% and 52% decreased risk, respectively. Previous year oxycodone misuse (OR: 1.79, 95% CI: 1.07 - 2.99, p=0.01), morphine misuse (OR: 4.71, 95% CI: 2.07 - 10.73, p=0.0002), sedative misuse (OR: 2.76, 95% CI: 1.31 - 5.83, p=0.007), and heavy alcohol use (OR: 1.79, 95% CI: 1.10 - 2.94, p=0.01) were significant predictors of tramadol misuse. In contrast, the risk of tramadol misuse was significantly lower in the ages 26 - 34 years (OR: 0.46, 95% CI: 0.22 - 0.98, p=0.04), and non-Hispanic Native Americans (OR: 0.46, 95% CI: 0.22 - 0.98, p=0.04). Tramadol is often prescribed in the emergency department. The results indicate a substantial prevalence of tramadol misuse based on the analysis of a nationally representative sample of survey respondents. Prominent demographic and clinical differences exist in the respondents who reported using and misusing tramadol products. Certain opioids were highlighted as predictors of tramadol misuse. Emergency physicians should be aware of the potential of tramadol misuse and potential predictive factors of such misuse.

Substance misuse in life and death in a 2-year cohort of suicides.

Although substance misuse is a key risk factor in suicide, relatively little is known about the relationship between lifetime misuse and misuse at the time of suicide. To examine the relationship between substance misuse and subsequent suicide. Linkage of coroners' reports to primary care records for 403 suicides occurring over 2 years. With alcohol misuse, 67% of the cohort had previously sought help for alcohol problems and 39% were intoxicated at the time of suicide. Regarding misuse of other substances, 54% of the cohort was tested. Almost one in four (38%) tested positive, defined as an excess of drugs over the prescribed therapeutic dosage and/or detection of illicit substances. Those tested were more likely to be young and have a history of drug misuse. A deeper understanding of the relationship between substance misuse and suicide could contribute to prevention initiatives. Furthermore, standardised toxicology screening processes would avoid diminishing the importance of psychosocial factors involved in suicide as a 'cause of death'.

Cognitive control in opioid dependence and methadone maintenance treatment.

BackgroundSubstance misuse is associated with cognitive dysfunction. We used a stop signal task to examine deficits in cognitive control in individuals with opioid dependence (OD). We examined how response inhibition and post-error slowing are compromised and whether methadone maintenance treatment (MMT), abstinence duration, and psychiatric comorbidity are related to these measures in individuals with OD.MethodsTwo-hundred-and-sixty-four men with OD who were incarcerated at a detention center and abstinent for up to 2 months (n = 108) or at a correctional facility and abstinent for approximately 6 months (n = 156), 65 OD men under MMT at a psychiatric clinic, and 64 age and education matched healthy control (HC) participants were assessed. We computed the stop signal reaction time (SSRT) to index the capacity of response inhibition and post-error slowing (PES) to represent error-related behavioral adjustment, as in our previous work. We examined group effects with analyses of variance and covariance analyses, followed by planned comparisons. Specifically, we compared OD and HC participants to examine the effects of opioid dependence and MMT and compared OD sub-groups to examine the effects of abstinence duration and psychiatric comorbidity.ResultsThe SSRT was significantly prolonged in OD but not MMT individuals, as compared to HC. The extent of post-error slowing diminished in OD and MMT, as compared to HC (trend; p = 0.061), and there was no difference between the OD and MMT groups. Individuals in longer abstinence were no less impaired in these measures. Furthermore, these results remained when psychiatric comorbidities including misuse of other substances were accounted for.ConclusionsMethadone treatment appears to be associated with relatively intact cognitive control in opioid dependent individuals. MMT may facilitate public health by augmenting cognitive control and thereby mitigating risky behaviors in heroin addicts.

Drug use among drivers who drank on alcohol outlets from Porto Alegre, Brazil

BackgroundDriving under the influence of multiple substances is a public health concern, but there is little epidemiological data about their combined use and putative impact on driving in low and middle-income countries where traffic crashes have been clustering in recent years. The aim of this study is to estimate the prevalence of alcohol and drug use – as well as their associated factors – among drivers in the context of alcohol outlets (AOs). MethodsA probability three-stage sample survey was conducted in Porto Alegre, Brazil. Individuals who were leaving AO were screened, with the selection of 683 drivers who met the inclusion criteria. Drivers answered a structured interview, were breathalyzed, and had their saliva collected for drug screening. Prevalences were assessed using domain estimation and logistic regression models assessed covariates associated with substance use. FindingsBenzodiazepines 3.9% (SE 2.13) and cocaine 3.8% (SE 1.3) were the most frequently detected drugs in saliva. Among drivers who were going to drive, 11% had at least one drug identified by the saliva drug screening, 0.4% two, and 0.1% three drugs in addition to alcohol. In multivariable analyses, having a blood alcohol concentration (BAC)>0.06% was found to be associated with a 3.64 times (CI 95% 1.79–7.39) higher chance of drug detection, compared with interviewees with lower BACs. ConclusionsTo drive under the influence of multiple substances is likely to be found in this setting, highlighting an association between harmful patterns of consume of alcohol and the misuse of other substances.

Mendelian randomization: A novel test of the gateway hypothesis and models of gene–environment interplay

To determine if drinking behavior in adolescence provides a "gateway" leading to the misuse of other psychoactive substances and antisocial behavior, we genotyped 180 Asian adolescent adoptees to determine if they inherited the deficient from of the aldehyde dehydrogenase 2 (ALDH2) enzyme that is important in the metabolism of alcohol. Based on the gateway model, we hypothesized that those with normal enzyme activity (70% of the sample) who began to misuse alcohol would also misuse other drugs and display antisocial tendencies. Those with the enzyme deficiency (30%), because they experience unpleasant side effects associated with drinking, were expected to show less evidence of alcohol misuse and thus be less likely to progress to the misuse of other substances or engage in antisocial acts. Consistent with previous research, we found that ALDH2 deficiency was significantly associated with lower rates of drinking and getting drunk but not with ever having tried alcohol. Contrary to the gateway model, we found no evidence that ALDH2 deficiency was associated with lower rates of nonalcohol substance use or antisociality. Finally, in an examination of factors that may moderate the impact of the metabolic protection because of ALDH2 deficiency, we identified siblings rather than parents as the major source of familial environmental effect on adolescent drinking.

School-based programmes to prevent alcohol, tobacco and other drug use

Substance use and abuse are important public health problems in the USA and throughout the world. In many developed countries, the initial stages of substance use typically include experimentation with alcohol, tobacco, or marijuana with one's peer group during adolescence. While there have been gradual decreases in the use of these substances in recent years among youth in the USA and other countries, increases have been observed in the use and misuse of other substances, such as the misuse of prescription drugs and over-the-counter cough medications in the USA. From a developmental perspective, data shows that rates of alcohol, tobacco, marijuana, and other illicit drug use typically escalate during adolescence and peak during young adulthood, corresponding with the increased freedom and independence of this time of life. Substance use decreases for most young people as they take on adult responsibilities, although a proportion will continue or increase their use and develop substance use problems. Given what we know about the onset and progression of substance use, implementing preventive interventions during early adolescence is critical. Most drug prevention or education programmes take place in school settings. A variety of theory-based school-based drug prevention programmes have been developed and tested. The most effective programmes are delivered interactively and teach skills to help young people refuse drug offers, resist pro-drug influences, correct misperceptions that drug use is normative, and enhance social and personal competence skills. A key challenge is to identify mechanisms for the wide dissemination of evidence-based drug preventive interventions and ways to train providers to implement programmes effectively and thoroughly.

Demographic and clinical features of adolescents and young adults with alcohol-related disorders admitted to the Psychiatric Emergency Room

To determine the incidence of alcohol related problems (ARP) among adolescents admitted to the Psychiatric Emergency Room (PER) and to describe the demographic and clinical characteristics. The study was a retrospective review of admissions to the PER, where we reviewed the psychiatric records of all of the 14-30 year olds admitted to the PER during the three-month period between April 1st, 2003 and June 30th, 2003. Demographic and clinical data of subjects with and without ARP were compared. During the three-month time period, 108 patients between the age of 14 and 30 were admitted to the PER. 14 (13.2%) of these had ARP, and ARP tended to occur more in males (chi2 = 3.81; df=l; p = 0.05). The number of psychiatric diagnoses among those who had ARP was significantly higher than among those who did not have ARP (t = -3.12; df=104; p = 0.002). ARP were found to be associated with personality disorder and misuse of other substances. 37.5% of those adolescents and young adults with ARP had a personality disorder, while 13% of those without ARP had a personality disorder (chi2 = 4.64; df=1; p = 0.03). 50% of those with ARP consumed (an)other substance/s, while 12.0% of those patients without ARP consumed (an)other substance/s (chi2 = l2.48; df=1; p < 0.001). Of the female adolescents and young adults with ARP, 50% were admitted to PER after an episode of self-poisoning. ARP in young adults admitted to the PER for acute psychiatric care are associated with greater psychiatric comorbidity, especially personality disorders. In females, ARP may be associated with an increased risk for self-poisoning. Adequate detection of ARP in the PER could promote earlier specific interventions specifically tailored to ARP among adolescents and young adults.