Overconsumption Of Drugs Research Articles

Underlying Susceptibility to Eating Disorders and Drug Abuse: Genetic and Pharmacological Aspects of Dopamine D4 Receptors.

The dopamine D4 receptor (DRD4) has a predominant expression in the prefrontal cortex (PFC), brain area strictly involved in the modulation of reward processes related to both food and drug consumption. Additionally, the human DRD4 gene is characterized by a variable number of tandem repeats (VNTR) in the exon 3 and, among the polymorphic variants, the 7-repeat (7R) allele appears as a contributing factor in the neurobiological mechanisms underlying drug abuse, aberrant eating behaviors and related comorbidities. The 7R variant encodes for a receptor with a blunted intracellular response to dopamine, and carriers of this polymorphism might be more tempted to enhance dopamine levels in the brain, through the overconsumption of drugs of abuse or palatable food, considering their reinforcing properties. Moreover, the presence of this polymorphism seems to increase the susceptibility of individuals to engage maladaptive eating patterns in response to negative environmental stimuli. This review is focused on the role of DRD4 and DRD4 genetic polymorphism in these neuropsychiatric disorders in both clinical and preclinical studies. However, further research is needed to better clarify the complex DRD4 role, by using validated preclinical models and novel compounds more selective for DRD4.

“Meditate, Don’t Medicate!” an Analysis of Addict Rap, Black Men’s Social Issues, and J. Cole’s K.O.D. Album

Historically, drugs authenticated and created hip-hop, as the overuse of drugs was used to validate a drug consumption subculture known as “addict rap.” As a rap subgenre, addict rap illustrates deeper issues of drug overconsumption, hip-hop authenticity, and Black hypermasculinity, while claiming the lives of some of its most noteworthy rappers. In response to this rap trend, American rapper J. Cole released his fifth studio album, K.O.D. to present politicized counternarratives to addict rap’s discourses of drug use, hypersexuality, and materialism. Conducting a textual analysis of rap lyrics, this research examined how Cole used the K.O.D. album to: 1) discuss issues of drug addiction and drug use in the Hip-Hop community and 2) address additional social issues facing Black American men. The analysis advanced three dominant themes, which were: 1) addict rappers use drugs to cope with their inner demons and depression, 2) hip-hop drug use is linked to the systemic oppressions facing Black Americans, and 3) healing should come from self-reflection and redemption from God, not from drug use. Ultimately, K.O.D. deconstructed the drug-laden, machismo-infused, images of addict rappers and revealed the harsh realities of being Black, male, drug addicted, and depressed by fame.

Orexin/Hypocretin System: Role in Food and Drug Overconsumption.

The neuropeptide orexin/hypocretin (OX), while largely transcribed within the hypothalamus, is released throughout the brain to affect complex behaviors. Primarily through the hypothalamus itself, OX homeostatically regulates adaptive behaviors needed for survival, including food intake, sleep-wake regulation, mating, and maternal behavior. However, through extrahypothalamic limbic brain regions, OX promotes seeking and intake of rewarding substances of abuse, like palatable food, alcohol, nicotine, and cocaine. This neuropeptide, in turn, is stimulated by the intake of or early life exposure to these substances, forming a nonhomeostatic, positive feedback loop. The specific OX receptor involved in these behaviors, whether adaptive behavior or substance seeking and intake, is dependent on the particular brain region that contributes to them. Thus, we propose that, while the primary function of OX is to maintain arousal for the performance of adaptive behaviors, this neuropeptide system is readily co-opted by rewarding substances that involve positive feedback, ultimately promoting their abuse.

Drug-induced liver injury in obesity

Many countries are facing an epidemic of obesity that can be explained, at least in part, by a sedentary life style and calorie overconsumption. This poses a major issue for public health since obesity primarily enhances the risk of various illnesses such as type 2 diabetes, coronary heart disease, some cancers and nonalcoholic fatty liver disease (NAFLD). Consequently, obese patients are consuming on average more drugs than non-obese individuals [1]. This could pose another medical issue, in particular for hepatologists, since many drugs are able to induce liver injury [2,3]. Moreover, there is growing evidence that obesity and NAFLD can increase the risk of drug-induced liver injury (DILI), at least for some drugs [3,4]. Thus, obese patients could be more prone to develop DILI as a consequence of drug overconsumption and an intrinsic susceptibility of their diseased liver to drug-induced hepatotoxicity. Actually, DILI in obese patients could occur as two distinct clinical settings. Indeed, in the context of obesity and relatedmetabolic diseases, some drugs seem to aggravate pre-existing NAFLD whereas others could induce more frequently an acute hepatitis (Fig. 1). Drugs that could aggravate NAFLD in obese patients are tamoxifen, irinotecan,methotrexate and nucleoside reverse transcriptase inhibitors (NRTIs) such as stavudine and didanosine (Table 1 in Fig. 1) [3,5–7]. Aggravation of NAFLD has also been documented in different animal models with rosiglitazone, tetracycline, phenobarbital and pentoxifylline (Table 1 in Fig. 1) [3,8]. Drugs that could induce acute liver injurymore often in obese individuals are the volatile halogenated anesthetic halothane and isoflurane, acetaminophen (APAP), and other drugs such as losartan, ticlopidine and omeprazole (Table 1 in Fig. 1) [3,9–11]. However, it is noteworthy that the list of drugs in Table 1 is temporary and should expand in the future asDILI in the context of obesity is gaining growing attention. In this ‘‘Snapshot’’ article, I will put forward several potentialmechanismswhereby drugs can bemore hepatotoxic in obese individuals. Since these mechanisms have mostly been discovered during experimental studies, any extrapolation to humans should be done with caution. Drug-induced worsening of NAFLD could be explained by different mechanisms (Fig. 1B). Regarding fatty liver, some drugs could be able to stimulate lipogenesis in steatotic liver, but not

Drug specificity in extended access cocaine and heroin self‐administration

Increased drug availability can precipitate a rapid escalation of drug consumption in both vulnerable humans and laboratory animals. Drug intake escalation is observed across a broad spectrum of drugs of abuse, including stimulants, opiates, ethanol and phencyclidine. Whether and to what extent the processes underlying escalated levels of drug intake vary across different substances is poorly understood. The present study sought to address this question in rats self-administering both cocaine and heroin-two addictive drugs with both common and different neurobiological effects. In experiment 1, we determined how cocaine intake is initially related to heroin intake in non-escalated rats with a limited access to both drugs. In experiment 2, two groups of rats were initially allowed to self-administer either cocaine or heroin for 1 hour per day and then after behavioral stabilization, for 6 hours per day to precipitate drug intake escalation. In each group, dose-injection functions for cocaine and heroin self-administration were generated. In experiment 1, regardless of the dose, rats with a high intake of one drug did not necessarily have a high intake of the alternate drug. In experiment 2, escalated levels of heroin or cocaine self-administration did not generalize to the other drug. This outcome was confirmed in a third drug substitution experiment following different access lengths to cocaine self-administration (i.e. 1, 4 and 8 hours). The processes underlying spontaneous and escalated drug overconsumption appear thus to vary across different drugs of abuse. More research should be devoted in the future to these differences.

Epidemiological Characterization of Drug Overconsumption: The Example of Antidepressants

ABSTRACT The authors present a pharmaco-epidemiological method for the characterization of drug overconsumption. Using the database of a French regional health insurance office, a comparison was made between patients receiving doses higher than recommended and all patients receiving normal doses of two antidepressant drugs (tianeptine and milnacipran). Logistic regression models were used to identify the variables related to overconsumption. The selected variables were different for each antidepressant and provided a good characterization of overconsumption features: insufficient effectiveness and severity of the condition for milnacipran and abuse/misuse for tianeptine. Characterization of overconsumption of antidepressants can be performed using logistic regression models. This method of analysis, which is seldom used in the context of pharmacodependence, makes it possible to explain posology increase.

Stomatologie gériatrique

The practice of stomatology and maxillo-facial surgery in the elderly has become more frequent, in relation with lengthened life expectancy. The management of older patients induces frequent and constraining problems due to the repercussions of ageing on orofacial tissues; these repercussions consist of various intricate diseases that more or less directly interfere with the general disease. Besides, “normal senescence” may not or hardly be distinguished from a pathological state. The frailty of older patients, their uncertain participation, the constraints and risks related to their poly-medication constitute a wide range of problems in their therapeutic management. The risk of under- or over-consumption of drugs is also to be considered, particularly in cutaneous or oral cancerology. Lastly, it should be reminded that in most cases, age-related functional and aesthetic disorders are the main reason for seeking treatment. Consequently, all concerned practitioners (maxillo-facial surgeon, stomatologist, odontologist) have to aim the preservation of these patient's quality of life.

Analysis of the K-Factors of the Spanish Health Care Expenditure in the OECD Context: Level and Forecasted Trend

The paper analyses the commonly argued gap between the Spanish health care expenditure and that of most of the developed countries. Our results do no find this gap for total health expenditure, once we adjust our estimation for some key factors in explaining health spending. But for public health expenditure on a per capita basis we do find a gap between 6 and 12%, well below the results of comparing simple average ratios between Spain and our OECD sample. Comparing again actual versus predicted figures, now for pharmaceutical expenditure, we find an over-consumption of drugs of around 5%. At any rate we conclude that the level of health spending, and social expenditure in general, is the result basically of a political choice. Econometric analysis may help to improve information for decision-making but finally the decision on how much to spend in health care reflects the social values of the community.

How to improve current therapeutic standards in upper respiratory infections: value of fusafungine

Despite guidelines and educational programs, systemic antibiotics and anti-inflammatory drugs are often inappropriately prescribed in upper respiratory tract infections (URTIs), although they are most often of viral origin, generally benign, and self-limiting with spontaneous recovery in more than 80% of cases. Reduced use of systemic antibiotics is crucial in the current context of concern about emerging antibiotic resistance and reducing unnecessary costs associated both with drug over-consumption and with the management of the consequences of antibiotic resistance.Local bacterial or viral infection of the airways induces an early inflammatory reaction. Although this inflammatory reaction has a beneficial effect in the capture and destruction of the pathogens, it can be responsible for deleterious tissue damage and vascular alterations leading to a self-perpetuating cycle of events. A wide array of medicines is available for symptomatic relief of URTIs: many of them are partially effective in reducing symptoms, but none is curative. Localadministration of antibiotics and anti-inflammatory drugs allows drug delivery directly to the target site of infection and inflammation, i.e., the respiratory mucosa, thus enabling a higher concentration of the drug, which results in smaller doses to be given, decreased potential for systemic toxicity, fewer side effects, protection of other flora, and rapid relief. Fusafungine is a naturally occurring peptide antibiotic with anti-inflammatory properties, which selectively targets the tissue reaction and preserves the natural antibacterial and antiviral defences. It is indicated for topical use in nose and throat infections. A recent analysis of French general practitioners' (GPs) prescribing pattern in the field of URTIs has demonstrated that prescription of fusafungine has achieved what many educational programs have failed to do: a significant reduction in the 'real life' prescription of systemic antibiotics and anti-inflammatory drugs, without the side effects of corticosteroids and vasoconstrictive agents, and without impact on microbial ecology.

La surconsommation médicamenteuse des personnes âgées

Aging is a major factor in the over-consumption of drugs: although individuals aged >65years account for approximately 15% of the population, almost one-third of all prescriptions are made out for this age group. This over-consumption is responsible for a number of potential hazards, such as iatrogenic pathology, poor compliance and drug interactions; it is also an economic burden. Most studies report an average of five drugs prescribed per individual, regardless of outpatient or inpatient status. Cardiovascular and psychotropic drugs are the most widely prescribed classes. Analgesic and nonsteroidal anti-inflammatory drugs are also very common. These are also the classes responsible for the highest number of adverse events in the elderly. There are numerous reasons for this over-consumption; in some cases, it is attributable to the patient himself (multiple diseases, deterioration of bodily functions, poor compliance, misuse, etc.), while in others, the prescribing physician, family or professional caregivers are at fault. The development of new drugs and the information made available regarding them can also be implicated. Studies comparing actual prescriptions with reference indications have shown that some are inappropriate: one meta-analysis showed that for 21.3% of patients in institutions and 40% of patients in convalescent homes, at least one prescription was inadequate; and in another analysis, the same applied to 12.5% of patients living at home. The potential seriousness of this over-consumption by elderly patients, even more so than in adults, calls for a detailed analysis of the situation and rational, regularly reviewed, realistic prescribing.

Évolution des traitements médicamenteux des personnes âgées vivant à domicile

Although overprescription and overconsumption of drugs are common in the elderly, their features are still not well known since retrospective data on drug intake in this population is very limited. This study was therefore aimed at assessing the evolution of drug intake in the elderly. In a study undertaken in the context of the PAQUID project, drug intake was assessed in a group of elderly subjects living at home in either Gironde or Dordogne in south-western France. Each subject was visited by an investigator in successively 1988-89, 1991-92, 1993-94, and 1996-97. Three thousand seven hundred and seventy-seven subjects were included in the study since 1988. Their mean age was 75.4 years (CI 95%: 75.2-75.6 years) and the sex ratio was 0.72. Eighty-nine percent of the subjects took at least one drug per day; 49% took one to four drugs per day; and 40% took more then five drugs per day. The total drug consumption showed an increase in drug intake during the 8-year follow-up, whether the subjects were or not dependent according to their IADL score. Analysis of drug intake evolution according to age, sex and daily drug intake at inclusion in the study showed that during follow-up drug intake increased in younger people who had no treatment at study inclusion, while it decreased in older subjects receiving multiple medications. This decrease might be due to either adverse side-effects, drug interactions, or repeated episodes of hospitalization.