Narcotic Use Research Articles

Narcotic Use under Probation and Parole Supervision - A longitudinal Study of Risk-group-specific Recidivism under Abstinence Conditions

The aim of this long-term study was to record substance-specific prevalences of illegal use of narcotics despite court-imposed abstinence requirements. Urine assays were obtained by a public health department on the basis of administrative assistance for the probation department of a district court. The individual and valid allocation of these urine samples was ensured using a proven marker system. After postal dispatch, laboratory chemical analyses for narcotics residues were carried out in an external laboratory via enzyme immunoassay and validation by mass spectrography in the case of positive narcotics results. On the basis of all available routine data, a pooled data set covering a total of fourteen consecutive calendar years (2006-2019) was generated digitally and evaluated anonymously. From a total of 380 subjects (female: 13% versus male: 87%; average age: 30.4 years), 13,500 individual narcotic substance analyses from 2,941 urine samples were available. In 2.7% of all individual analyses, at least one of eight potential narcotic substances was detected, whereby the highest overall prevalences in the sense of a relapse were found for cannabis with 3.7% and for opiates with 2.4%. In contrast, there were almost no residues for barbiturates and LSD and no positive evidence for buprenorphine and PCP. As expected, most relapses in all narcotics groups were found in the age groups from 18 to 35 years. Strikingly, more women than men violated the court abstinence order with amphetamines, while relapses with the other seven narcotics groups occurred predominantly among men. In the course of the entire observation period, the most marked fluctuations in relapse rates were found for cannabis, opiates and cocaine. The use of narcotic substances during probation and parole supervision does not appear to be a rare occurrence and has received little professional attention. Increased attention to this group-specific recidivism and more studies on this topic should help reduce this deficit.

Socialization of the Dangers of Drugs and Drug Crime Patterns to High School Students as an Effort to Make Teenagers Clean from Drugs in Pelalawan Regency

The use of narcotics and illegal drugs (narcotics) among teenagers is considered to be caused by several things, including because Indonesia is located between three continents and considering the development of science and technology, the influence of globalization, very advanced transportation flows and rapid technological developments. very sophisticated as a target dynamic for illicit drug trafficking. Drug abuse and illicit trafficking is an increasingly widespread, complex and complicated problem faced by the Indonesian people recently, because it can cause various negative impacts, especially among the younger generation, such as health problems, social and economic problems, and also politics. Drugs have a very broad negative impact both physically, psychologically, economically, socially, culturally, on defense and security, and others. Those who use drugs will feel dependent after continuous use. The drug problem in Indonesia is still something that is urgent and complex. In the last decade this problem has become widespread. This is proven by the significant increase in the number of drug abusers or addicts, along with the increasing disclosure of drug crime cases with increasingly diverse patterns and increasingly massive syndicate networks. The impact of drug abuse not only threatens the survival and future of the abuser, but also the future of the nation and state, regardless of social, economic strata, age or level of education. Various efforts to overcome the growth of drug addicts have been made, but have been hampered by weak laws.

The Protection of Human Rights in the Case of Non-Criminal Narcotics Users

Introduction: Narcotics use as a complex global issue has an impact on human rights, especially in the context of criminal law. Although some countries, including Indonesia, are beginning to recognize human rights protections in non-criminal narcotics use, the main challenge is striking a balance between strict regulation and appropriate protection for individuals who need narcotics for treatment or non-criminal purposes. Purposes of the Research: The aim of this research is to analyze relevant laws and regulations and related practices in protecting human rights in the case of non-criminal narcotics users. Methods of the Research: This research uses normative legal research methods to analyze laws and regulations related to non-criminal narcotics use. Data sources include statutory documents, court decisions, and legal literature. Data analysis will look for patterns and evaluate regulatory compliance with human rights principles.Results of the Research: To protect human rights in cases of non-criminal narcotics use in Indonesia, legislation plays an important role, although challenges such as abuse of power and social stigma remain. Cooperation between government, NGOs and civil society is needed to implement existing regulations and increase public understanding of human rights. Indonesia needs to find a balance between strict narcotics regulations and protecting individual rights. This involves clear definitions for “non-criminal” narcotics, fair law enforcement, as well as safeguarding individual privacy. The challenges involve racial and social injustice in drug law enforcement and require an evidence-based approach that engages diverse stakeholders. Continuous research and analysis is needed to support better policies to address the narcotics problem.

PENYULUHAN BAHAYA PECANDU NARKOTIKA DAN KORBAN PENYALAHGUNAAN NARKOTIKA

Narcotics and narcotics addicts after Article 1 Paragraph 6 of the Regulation of the Minister of Health of the Republic of Indonesia Number 2415/Kemenkes/Per/XII/2011 concerning Medical Rehabilitation of Drug Addicts, Abusers and Victims of Narcotics Abuse is someone who accidentally uses narcotics because they are persuaded, deceived, deceived, forced , and/or threatened to use narcotics. Rehabilitation is here to provide protection for addicts and victims of narcotics abuse by giving them the opportunity to recover and continue their lives in society, especially narcotics abuse. The Government has made various efforts to prevent narcotics in Indonesia. This is to prevent the circulation of narcotics and narcotics addicts from becoming more devastating. Based on this, we from the Group 3 KKN Team at Darma Agung University carried out community assistance activities in an effort to formulate narcotics education on the use of narcotics. The aim of implementing this service KKN is to provide knowledge and understanding to the public about the types and dangers of narcotics as well as rehabilitation of narcotics addicts. The expected target in this Community Service Community Service Program is to increase public knowledge about narcotics abuse rehabilitation and provide information to the public about the member institutions involved.

Unveiling the Controversy: Legal Analysis of Juvenile Narcotics Use for Medical Purposes

ABSTRACT Purpose of the study: This research aimed to fill gap by detailing the arguments around legal responsibility of juvenile narcotics use that are not intended for recreational purposes, but rather for medical purposes. This seeks to contribute to the growing literature on restorative justice in Indonesia, particularly for the development of the juvenile justice system. Methodology: This study examined the phenomenon of narcotics uses in the self-medication context, particularly among youth, utilizing the normative legal research method and bolstered by a case study (Judicial Decision). It also utilized the statutory approach, which involved an in-depth analysis of applicable legal provisions regarding juvenile crimes and narcotics. Results: While conceptual analysis found that there are many connections between the emerging trend of self-diagnosis and self-medication with narcotics use among children, yet the normative support to deal with this phenomenon through restorative justice remains poor. The impact of the lack of normative support is shown in the judicial decision, in which restorative justice through the application of diversion was applied incautiously, blurring children’s well-being; disturbed by medical issue at first and later worsened by marijuana addiction. Applications of this study: The study can be an instrumental reference in guiding legal reforms, shaping healthcare policies for juvenile narcotic use, and providing information on educational and awareness programs that distinguish between medical and non-medical use of narcotics by minors. Novelty/Originality of this study: The originality of this study lies in its specific accent on the intersection of juvenile law, narcotics use, and medical treatment, which is a relatively underexplored area in legal research in Indonesia. It is also found in its analysis of a decision of a juvenile court regarding the use and possession of narcotics. Keywords: Legal Responsibility, Medical Purposes, Narcotics Crime, Restorative Justice, Case Study ABSTRAK Tujuan: Penelitian ini bertujuan untuk mengisi kesenjangan dengan menjelaskan argumen seputar tanggung jawab hukum penggunaan narkotika oleh anak di bawah umur yang tidak dimaksudkan untuk tujuan rekreasi, melainkan untuk tujuan medis. Penelitian ini juga dilakukan untuk berkontribusi terhadap berkembangnya literatur mengenai keadilan restoratif di Indonesia, khususnya untuk pengembangan sistem peradilan anak. Metodologi: Studi ini mengkaji fenomena penggunaan narkotika dalam konteks swamedikasi, terutama di kalangan anak-anak, dengan menggunakan metode penelitian hukum normatif yang didukung oleh studi kasus (Putusan Pengadilan). Studi ini juga menggunakan pendekatan undang-undang, yang melibatkan analisis mendalam terhadap ketentuan hukum yang ada mengenai tindak pidana remaja dan narkotika. Temuan: Analisis konseptual menunjukkan bahwa meskipun terdapat banyak keterkaitan antara tren berkembangnya swadiagnosis dan swamedikasi dengan penggunaan narkotika di kalangan anak-anak, dukungan normatif untuk mengatasi fenomena ini melalui keadilan restoratif masih kurang. Dampak dari kurangnya dukungan normatif ini terlihat dalam putusan pengadilan di mana keadilan restoratif melalui penerapan diversi diterapkan dengan tergesa-gesa, tanpa fokus pada kesejahteraan anak, yang awalnya terganggu oleh masalah medisnya dan kemudian memburuk akibat kecanduan ganja. Kegunaan: Studi ini dapat menjadi referensi penting dalam reformasi hukum, membentuk kebijakan kesehatan yang berkaitan dengan penggunaan narkotika pada anak, dan menginformasikan program pendidikan dan kesadaran yang membedakan antara penggunaan narkotika untuk tujuan medis dan non-medis oleh anak di bawah umur. Kebaruan/Orisinalitas: Orisinalitas penelitian ini terletak pada fokus spesifiknya pada titik temu antara hukum peradilan anak, penggunaan narkotika, dan perawatan medis, yang merupakan area yang kurang dieksplorasi dalam penelitian IndonesiaIndonesia. Orisinalitas juga terletak pada analisisnya terhadap putusan pengadilan anak mengenai penggunaan dan kepemilikan narkotika. Kata Kunci: Tanggung Jawab Hukum, Tujuan Medis, Kejahatan Narkotika, Keadilan Restoratif, Studi Kasus

Granting Of Criminal Sanctions Against Children Consumpting Narcotics

This research aims to describe the regulation of Narcotics criminal acts according to positive law in Indonesia and those responsible for criminal sanctions against children who use Narcotics according to Law Number 35 of 2009 concerning Narcotics’ This research is normative legal research, descriptive in nature, statutory approach, consisting of primary, secondary and tertiary legal materials. Qualitative analysis is carried out systematically in order to get answers to problems. The results of the study stated that the regulation of narcotics crimes began with Law No. 9 of 1976 which prohibited the manufacture, storage, distribution and use of narcotics. Then Law No. 22 of 1997 with a wider scope, the criminal threat is made worse in the form of the death penalty. Then Law no. 35 of 2009, prohibits possessing, storing, controlling or providing Narcotics and Narcotics Precursors; the act of producing, importing, exporting, or releasing Narcotics and Narcotics precursor; acts in the form of offering to sell, sell, buy, receive, become an intermediary in buying and selling, exchanging, or handing over Narcotics and Narcotics precursors; and acts in the form of bringing, sending, transporting or transiting Narcotics and precursors. Criminal sanctions for children who use Narcotics are regulated in Law No. 3 of 1997 concerning Juvenile Courts and Law No. 35. Children who commit Narcotics crimes can be sentenced under Article 127 of Law No. 35 of 2009 in conjunction with Article 22 of Law No. 3 of 1997 amended to Law No. 11 of 2012 concerning the Juvenile Criminal Justice System. Prison sentence that can be written off for Narcotics children is no longer than ½ (one half) of the maximum prison sentence for adults.

Pertanggungjawaban Pidana Penanam Ganja Berdasarkan Undang-Undang tentang Narkotika

Purpose: Narcotics abuse is a chronic problem that plagues Indonesia. Narcotics are not intended for purposes other than medical purposes. However, there are still people who still dare to plant marijuana trees which are strictly prohibited as regulated in Articles 111 and 112 Paragraph 1 of Law Number 35 of 2009 concerning Narcotics which explains the prohibition on growing marijuana unlawfully. The formulation of the problem in this research is first, How is Narcotics Crime Regulated in Indonesia? Second, what is the criminal responsibility of marijuana growers according to Law Number 35 of 2009 concerning Narcotics? The aim of the research is to answer this research problem. Methodology: The type of research used is normative legal research which refers to research studies on statutory regulations combined with primary, secondary and tertiary legal materials. The data collection technique is by using Library Research. The nature of the research is descriptive analysis. Results: The research results show that Indonesia has strict regulations that do not legalize narcotics carelessly, the prohibition is regulated in Article 111 Paragraphs 1, 2 and 112 Paragraphs 1, 2 of Law 35 of 2009 concerning Narcotics. Second, every person who without right or against the law plants, maintains, owns, stores, controls or provides narcotics in the form of plants legally and convincingly can be held criminally liable. In conclusion, Indonesia as a legal country has strict regulations to protect the young generation of the Indonesian nation from the dangers of narcotics abuse. Every person who owns, processes and distributes narcotics against their rights can be held liable for imprisonment for a minimum of 4 years, a maximum of 12 years, a fine of at least 800 million and a maximum of 8 billion rupiah. Limitation: This research is to explain and/or describe and describe all data obtained from data sources related to criminal liability for marijuana growers. Contribution: Indonesia does not legalize the use of narcotics against the law. If this happens, they can be held criminally liable.

Enhanced Recovery after Surgery Protocol Decreases Length of Stay and Postoperative Narcotic Use in Microvascular Breast Reconstruction

Background: Enhanced recovery after surgery (ERAS) protocols have demonstrated efficacy following microvascular breast reconstruction. This study assesses the impact of an ERAS protocol following microvascular breast reconstruction at a high-volume center. Methods: The ERAS protocol introduced preoperative counseling, multimodal analgesia, early diet resumption, and early mobilization to our microvascular breast reconstruction procedures. Data, including length of stay, body mass index, inpatient narcotic use, outpatient narcotic prescriptions, inpatient pain scores, and complications, were prospectively collected for all patients undergoing microvascular breast reconstruction between April 2019 and July 2021. Traditional pathway patients who underwent reconstruction immediately before ERAS implementation were retrospectively reviewed as controls. Results: The study included 200 patients, 99 in traditional versus 101 in ERAS. Groups were similar in body mass index, age (median age: traditional, 54.0 versus ERAS, 50.0) and bilateral reconstruction rates (59.6% versus 61.4%). ERAS patients had significantly shorter lengths of stay, with 96.0% being discharged by postoperative day (POD) 3, and 88.9% of the traditional cohort were discharged on POD 4 (P < 0.0001). Inpatient milligram morphine equivalents (MMEs) were smaller by 54.3% in the ERAS cohort (median MME: 154.2 versus 70.4, P < 0.0001). Additionally, ERAS patients were prescribed significantly fewer narcotics upon discharge (median MME: 337.5 versus 150.0, P < 0.0001). ERAS had a lower pain average on POD 0–3; however, this finding was not statistically significant. Conclusion: Implementing an ERAS protocol at a high-volume microvascular breast reconstruction center reduced length of stay and postoperative narcotic usage, without increasing pain or perioperative complications.

“The Utility of Preoperative Acetaminophen in Reducing Postoperative Pain and Narcotic Use in Patients Undergoing Cosmetic Breast Augmentations, During a National Opiate Crisis”

Background:Preoperative use of acetaminophen has become widely adopted across the surgical subspecialties in attempt to maximize analgesia and minimize postoperative narcotic requirements. Whether or not acetaminophen use has an influence on these outcomes in cosmetic breast augmentation needs to be studied. Objectives: The aim of this study was to compare the differences in reported pain and narcotic use between patients undergoing breast augmentations who received preoperative oral acetaminophen and those who did not. Methods: This was a prospective, single-center study including 59 patients undergoing primary breast augmentation which were divided into 2 groups: control group (did not receive acetaminophen) and a study group (received 1000 g PO acetaminophen), all medications were administered prior to surgery. A self-reported survey was received from all patients which included pain scores as well as number of narcotics taken. Results: Data analysis indicated that the only statistically significant difference in pain was on postoperative day 2 (POD2), with patients who did not receive PO tylenol reporting more pain. There was no significant difference in the number of narcotics required between either group. Conclusions: It appears that preoperative PO acetaminophen did not significantly influence the amount of postoperative narcotic use. The only difference in reported pain was on POD2 and was higher in those who did not receive preoperative acetaminophen. It seems that PO acetaminophen is an inexpensive way of improving postoperative pain in patients undergoing cosmetic breast augmentation; however, it does not reduce narcotic use.

Assessment of opioid use following septorhinoplasty and its association with pain catastrophizing

PurposeAnxiety towards pain is correlated with increased post-surgical pain and assessed with the “Pain Catastrophizing Scale” (PCS). We assess patient reported pain and opioid usage following septorhinoplasty and their association with the PCS. MethodsThis prospective cohort study enrolled patients over 18 years of age undergoing open septorhinoplasty on an outpatient basis at a single academic institution. Participants completed the PCS preoperatively and recorded post-operative pain and analgesic use with a daily online based survey through post-operative day 5. Total opioid use and highest pain rating are assessed. ResultsPostoperative pain was assessed in 34 patients with a median age of 37 years (Range: 22-62y). The average highest pain rating was 6.2/10 (σ = 2.03) and occurred on post-operative day 2. A median of 20 5-mg narcotic tablets (Range: 10–25) was prescribed to study participants though only an average of 7.25 (Range: 0–15) were reported as used. Medical comorbidities and surgical characteristics, including history of anxiety, cosmetic indication, surgical revision, use of osteotomies, Doyle splints, costal or conchal cartilage grafts, or inferior turbinate reduction, were not associated with increased pain or narcotic use. Those using >10 tablets scored higher on the PCS ([10.6] v. [4.8], p = 0.025). ConclusionMost patients require <10, 5 mg opioid tablets following septorhinoplasty. Surgeons should attempt to decrease opioid prescriptions while considering that patients with significant anxiety towards pain may report higher narcotic needs.

Does Anesthesiologist Experience Influence Early Postoperative Outcomes Following Orthognathic Surgery?

Anesthesia provider experience impacts nausea and vomiting in other surgical specialties but its influence within orthognathic surgery remains unclear. The study purpose was to evaluate whether anesthesiologist experience with orthognathic surgery impacts postoperative outcomes, including nausea, emesis, narcotic use, and perioperative adverse events, for patients undergoing orthognathic surgery. This is a retrospective cohort study of subjects aged 12 to 35years old who underwent orthognathic surgery, including Le Fort 1 osteotomy±bilateral sagittal split osteotomy, at Boston Children's Hospital from August 2018 to January 2022. Subjects were excluded if they had incomplete medical records, a syndromic diagnosis, or a hospital stay of greater than 2days. The predictor variable was attending anesthesia provider experience with orthognathic surgery. Providers were classified as experienced or inexperienced, with experienced providers defined as having anesthetized ≥10 orthognathic operations during the study period. The primary outcome variable was postoperative nausea. Secondary outcome variables were emesis, narcotic use in the hospital, and perioperative adverse events within 30days of their operation. Study covariates included age, sex, race, comorbidities (body mass index, history of psychiatric illness, cleft lip and/or palate, chronic pain, postoperative nausea/vomiting, gastrointestinal conditions), enhanced recovery after surgery protocol enrollment, and intraoperative factors (operation performed, anesthesia/procedure times, estimated blood loss, intravenous fluid and narcotic administration, and anesthesiologist's years in practice). χ2 and unpaired t-tests were used to compare primary predictor and covariates against outcome variables. A P-value <.05 was considered significant. There were 118 subjects included in the study after 4 were excluded (51.7% female, mean age 19.1±3.30years). There were 71 operations performed by 5 experienced anesthesiologists (mean cases/provider 15.4±5.95) and 47 cases by 22 different inexperienced providers (mean cases/provider 1.91±1.16). The nausea rate was 52.1% for experienced providers and 53.2% for inexperienced providers (P=.909). There were no statistically significant associations between anesthesiologist experience and any outcome variable (P>.341). Anesthesia providers' experience with orthognathic surgery did not significantly influence postoperative nausea, emesis, narcotic use, or perioperative adverse events.

Complication rates and efficacy of single-injection vs. continuous interscalene nerve block: a prospective evaluation following arthroscopic primary rotator cuff repair without a concomitant open procedure

To compare the complications and efficacy of pain relief of the interscalene anesthetic block using either a single-injection (SI) vs. a continuous, indwelling catheter (CIC) for arthroscopic rotator cuff repair surgery. Patients undergoing primary, arthroscopic rotator cuff repair without concomitant open procedure or biceps tenodesis were prospectively enrolled by 4 fellowship-trained sports medicine and shoulder surgeons. Patients received either a SI or CIC preoperatively based on surgeon preference. Patients were contacted by phone to complete a standard questionnaire on postoperative days (PODs) 1, 3, 7, 14, and 28. Patients were asked to rate the efficacy of their subjective pain relief (scale of 0-10), document issues with the catheter, describe analgesic usage, and report pharmacological and medical complications. The primary outcome was measured as complication rate. Postoperative narcotic use, patient satisfaction, and visual analog scale pain scores were measured as secondary outcomes. Seventy patients were enrolled, 33 CIC patients (13 male, 20 female, mean age 61±8 years) and 37 SI patients (20 male, 17 female, mean age 59±10 years). There were significantly more injection/insertion site complications in the CIC group (48%) vs. the SI group (11%, P=.001). The incidence of motor weakness was higher in the CIC group on POD 1 (P=.034), but not at any subsequent time points. On POD 1, CIC patients had a clinically significantly lower pain score compared to SI (3.2 vs. 5.4; P=.020). Similar scores were observed at subsequent time points until POD 28, when CIC again had a lower pain score (0.8 vs. 2.7; P=.005). However, this did not reach clinical significance. All patients in both groups rated a satisfaction of 9 or 10 (scale 0-10) with the anesthesia provided by their nerve block. CIC interscalene nerve blocks had an increased risk for injection site complications and minor complications in the immediate postoperative period when using the CIC for arthroscopic rotator cuff repair without any concomitant open procedures. CIC blocks demonstrated clinically significant superior pain relief on POD 1 but were equal to SI blocks at every time point thereafter. Superior pain relief of CIC at POD 28 was not clinically significant. CIC catheters do not appear to markedly decrease the use of postoperative narcotics. Despite this trend in complication rates and pain scores, all patients in both groups were satisfied with their nerve block.

HPB P01 Evaluating quality of life outcomes following Total Pancreatectomy and Islet Autotransplant for Chronic Pancreatitis

Abstract Background Chronic Pancreatitis (CP) is a debilitating condition that is associated with significant patient morbidity. The disease is characterised by chronic abdominal pain that is recurring and relapsing, which subsequently has a significant impact on the patients’ quality of life. In addition to the stigma associated with the disease, patients often undergo social isolation and are unable to maintain functional status. Total Pancreatectomy and Islet Auto transplant for Chronic Pancreatitis (TPIAT) serves as opportunity to alleviate the pain whilst preserving endocrine function. Our aim was to evaluate whether TPIAT also improved patients quality of life. Methods A retrospective review of all patients referred to the TPIAT service in Oxford between 2019 -2022 was performed. Clinical information was recorded regarding patient demographics, aetiology and previous treatment of CP, intraoperative data (islet yield secured) and post operative complication rate. Long term endocrine function, analgesic use and quality of life was formally assessed. Results Of the 39 patients referred to the service, 23 (59%) were listed for TPIAT. TPIAT was successfully performed in 21 patients. The median age of this cohort was 22. Hereditary pancreatitis was the most frequent aetiology in 48%. The median length of stay post procedure was 12.5 days. During the last follow up, freestyle libre interrogation highlighted that 79% of patients had blood sugars within the target range. A significant reduction in analgesia use was noted (p=0.001), in addition to a marked reduction in opiate based analgesics (p=0.001). Resolution of pancreatic pain was also significantly apparent in the cohort (p=0.001). Conclusions TPIAT for CP serves as an effective treatment strategy as it provides symptomatic relief for patients, reduces long term narcotic use, permits glycaemic control and improves quality of life for patients.

Intracapsular Versus Total Tonsillectomy in Patients with Trisomy 21.

Intracapsular tonsillectomy and adenoidectomy (iTA) has become a popular alternative to extracapsular tonsillectomy and adenoidectomy (TT) for the treatment of pediatric obstructive sleep apnea (OSA) due to improved recovery and fewer complications. The objective of this study was to compare surgical recovery and impact on OSA of iTA versus TT in patients with Trisomy 21 (T21). This is a case series with chart review of all T21 patients who underwent iTA or TT at our institution between July 1, 2015 and August 15, 2022. Data collected included demographics, comorbidities, preoperative sleep studies, intraoperative data, complications and recovery, postoperative sleep studies, and follow-up data. There were 62 (21.7%) patients who underwent iTA and 224 (78.3%) patients who underwent TT. The iTA group had significantly lower pain scores (p < 0.001), decreased use of narcotics (p < 0.001), shorter length of stay (p = 0.003), and faster return to oral intake (p = 0.01) during their postoperative hospital admission, and fewer 30-day complications (p = 0.009) compared to the TA group. Both groups showed significant improvements in their sleep studies. For 41 (66.1%) of iTA patients who had follow-up, median follow-up was 1.8 years and for 169 (75.4%) TT patients, median follow-up was 2.6 years. At follow-up, 21 of 41 (51.2%) iTA patients and 83 of 169 (49.1%) TT patients exhibited OSA symptoms (p = 0.084) and tonsillar regrowth was not significantly different between the two groups (p = 0.12). Patients with T21 experience less pain and fewer postoperative respiratory complications from iTA than from TT. The short-term impact of iTA versus TT on OSA, as measured by poysomnography, does not differ between the two techniques. 3 Laryngoscope, 134:2430-2437, 2024.

Sosialisasi Penyuluhan Hukum Tentang Bahaya Narkotika Bagi Kalangan Remaja Di SMPN 2 Wanayasa Kabupaten Purwakarta

The problem of narcotics in Indonesia is still something that is urgent and complex. In the last decade this problem has become widespread. Evidenced by the significant increase in the number of narcotics abusers or addicts, as the disclosure of narcotics crime cases increases, the pattern is increasingly diverse and the syndicate network is increasingly massive. The Indonesian people, and even the world community, in general, are currently facing a very worrying situation due to the widespread illegal use of various types of narcotics. This concern is getting sharpened due to the rampant illicit trafficking of narcotics which has spread to all levels of society, including among the younger generation. This will greatly affect the life of the nation and state in the future. The behavior of some teenagers who have clearly ignored the values, norms and laws that apply in people's lives is one of the reasons for the rampant use of narcotics among the younger generation. In everyday life in the midst of society there are still many teenagers who still abuse narcotics.

Detroit Interventional Pain Assessment Scale: A Pain Score and Method for Measuring and Evaluating Post-Operative Pain Management-A Prospective Study.

Background and Objectives: Orthopedic surgeons commonly prescribe opioids, surpassing all medical specialties. Our objective was to develop a pain management scale that captures medication use, patient-reported pain scores, and helps orthopedic surgeons evaluate their post-operative prescribing practice. Materials and Methods: An IRB-approved prospective study followed 502 post-operative orthopedic surgery patients over a six-month period. All patients were surveyed in an orthopedic clinic at a Level 1 US Trauma Center, during a routine follow-up. Patient pain satisfaction was assessed using the validated Interventional Pain Assessment (IPA) scale, which uses three categories: 0 (no pain), 1 (tolerable pain), and 2 (intolerable pain). Daily narcotic use was translated to morphine milligram equivalents (MMEs) using the Michigan Automated Prescription System (MAPS) narcotics registry. When patient pain satisfaction and narcotic usage were combined, this scale was called the Detroit Interventional Pain Assessment (DIPA) scale. Results: The five classes based on common prescription and usage of narcotics in this cohort include the following: A (no pain medication), B (over-the-counter medication), C (occasional use of short-acting narcotics 1-30 MMEs), D (consistent/regular use of short-acting narcotics 31-79 MMEs), and E (long-duration or stronger short-acting narcotics 80+ MMEs). Patients were most satisfied with their pain management at six weeks (80.5%) and three months (75.65%), and least satisfied at two weeks (62.5%) and six months (60.9%). Additional information displayed on the DIPA graph revealed there was a significant decrease in the percentage of patients on narcotics at two weeks (65.2%) to six months (32.6%) at p < 0.001. Conclusions: The DIPA pain scale shows the relationship between patient pain perception and opioid prescription/usage, while also tracking prescriber tendencies. Providers were able to visualize their post-operative pain management progression at each designated clinic visit with corresponding alphabetical daily MME categories. In this study, results suggest that surgeons were not effective at managing the pain of patients at two weeks post-operative, which is attributed to an inadequate number of pain pills prescribed upon discharge. Overall, the DIPA graph signaled that better pain management interventions are necessitated in periods with lower efficiency scores.

Improved perioperative narcotic usage patterns in patients undergoing robotic-assisted compared to manual total hip arthroplasty

BackgroundRobot-assisted total hip arthroplasty (RA-THA) improves accuracy in achieving the planned acetabular cup positioning compared to conventional manual THA (mTHA), but optimal dosage for peri-RA-THA and mTHA pain relief remains unclear. This study aimed to compare pain control with opioids between patients undergoing direct anterior approach THA with the use of a novel, fluoroscopic-assisted RA-THA system compared to opioid consumption associated with fluoroscopic-assisted, manual technique.MethodsRetrospective cohort analysis was performed on a consecutive series of patients who received mTHA and fluoroscopy-based RA-THA. The average amount of postoperative narcotics in morphine milligram equivalents (MME) given to each cohort was compared, including during the in-hospital and post-discharge periods. Analyses were performed on the overall cohort, as well as stratified by opioid-naïve and opioid-tolerant patients.ResultsThe RA-THA cohort had significantly lower total postoperative narcotic use compared to the mTHA cohort (103.7 vs. 127.8 MME; P < 0.05). This difference was similarly seen amongst opioid-tolerant patients (123.6 vs. 181.3 MME; P < 0.05). The RA-THA cohort had lower total in-hospital narcotics use compared to the mTHA cohort (42.3 vs. 66.4 MME; P < 0.05), consistent across opioid-naïve and opioid-tolerant patients. No differences were seen in post-discharge opioid use between groups.ConclusionsFluoroscopy-based RA-THA is associated with lower postoperative opioid use, including during the immediate perioperative period, when compared to manual techniques. This may have importance in rapid recovery protocols and mitigating episode burden of care.

RRx-001 potentially reduces financial toxicity for patients and caregivers in head and neck cancer.

31 Background: Of all the toxicities that result from the treatment of head and neck cancer, perhaps the most insidious is financial burden or “out-of-pocket (OOP) expenses” for patients and their caregivers otherwise known as financial toxicity (FT) which is associated with decreased treatment adherence and poor clinical outcomes. A huge unmet need is interventions and strategies to mitigate this problem. Methods: PREVLAR was a Phase 2 study that randomized 53 head and neck cancer patients 1:1 to receive four doses of RRx-001 prior to the start of intensity modulated radiation therapy (IMRT) in 2.0-2.2 Gy fractions/weekday to a cumulative radiation dose of up to 72 Gy plus cisplatin administered either weekly (40 mg/m2) or tri-weekly (100 mg/m2) vs. cisplatin plus IMRT alone (control). The primary outcome was the incidence of severe oral mucositis. Adverse events were evaluated using NCTCAEv5 criteria. Results: The RRx-001 pre-treatment paradigm with four doses (“four before and no more”) dramatically reduced the incidence and duration of severe oral mucositis and associated grade 3-4 adverse events. These anti-toxicity effects translated to a shorter duration of hospitalization, less narcotic use, and less feeding tube placements. Extrapolating from cost estimates in the literature, we project a per patient total cost savings estimate of $12,500 - $22,500 with RRx-001 use based on an average 30% reduction in Grade 3-4 adverse events, a 50% reduction in hospital stay duration, and a 50% reduction in feeding tube placement. Conclusions: The RRx-001 “four before and no more” pre-treatment dosing regimen is not only convenient for patients and their caregivers but also reduces several toxicities including, most likely, financial toxicity. This is likely to bolster its adoption once RRx-001 becomes part of the medical armamentarium for the treatment of SOM. We plan more rigorously to test the effect of RRx-001 on financial toxicity in an upcoming Phase 2b trial in head and neck cancer called KEVLARx, n = 216. Clinical trial information: NCT03515538 .

Strategi Preventif Penggunaan NAPZA Berbasis Pemberdayaan (Studi Kasus Pondok Pesantren Al-Isti'anah Kabupaten Pati)

The use of Narcotics, Alcohol, Psychotropic Substances, and Other Addictive Substances (NAPZA) has become a serious problem in various segments of society, including among students in Islamic boarding schools. This research aims to develop and analyze empowerment-based prevention strategies for NAPZA use at the Al-Isti'anah Boarding School in Pati Regency. The study adopts a qualitative approach with a case study research design. Data were collected through in-depth interviews with the leaders of the boarding school, teachers, and students. Additionally, participatory observation and document analysis were conducted to obtain a comprehensive overview of the context and dynamics within the boarding school. The results of the research indicate that Al-Isti'anah Boarding School has implemented various empowerment-based prevention strategies for NAPZA use. These strategies include the establishment of educational programs on the dangers of NAPZA, the development of social skills, the cultivation of religious and moral values, and the creation of an environment that supports and reinforces healthy lifestyle choices. Empowerment is achieved by actively involving all stakeholders, including leaders, teachers, students, and families. Various activities such as archery, wood carving, local food cultivation, and graphic design of calligraphy are conducted to divert specific concentrations on the negative impacts of NAPZA use.

Gabapentin May Not Decrease Opioid Use in Pediatric Enhanced Recovery After Surgery Protocols

IntroductionIn adults, the use of gabapentin in Enhanced Recovery After Surgery (ERAS) protocols is associated with increased morbidity and clinically insignificant improvement in postoperative pain control. Furthermore, there are limited data supporting its use in pediatric ERAS protocols. MethodsA single-institution retrospective study was performed to examine the correlation of gabapentin use and postoperative outcomes among children who underwent elective general, urologic, and orthopedic surgeries. Because gabapentin was removed from our institutional ERAS protocols in August 2020, we compared eligible patients from January 2018 to September 2021 using univariate and multivariable analysis. Due to heterogeneity between the treatment groups, a propensity score–matched analysis was also performed. Significance was defined as P < 0.05. ResultsIn this study, 196 patients were included, with 91 (46.4%) who received gabapentin and 105 (53.6%) who did not. When used in combination with opioids, gabapentin was not associated with a reduction in the amount of opioids consumed (β = −0.4, 95% confidence interval = −1.9, 1.1). Instead, children who received gabapentin had increased odds of requiring oxygen supplementation (odds ratio = 3.1, 95% confidence interval = 1.2, 9.0), but this finding did not persist after propensity score–matched analysis. ConclusionsThe use of gabapentin in multimodal pain regimens in children following elective surgery was not associated with a decrease in postoperative narcotic use. Inclusion of gabapentin in perioperative pain medication protocols should be further evaluated with prospective studies.