Polydrug Research Articles

Opioid use, prescribing and fatal overdose patterns among racial/ethnic minorities in the United States: A scoping review and conceptual risk environment model.

To date, there has been no synthesis of research addressing the scale and nuances of the opioid epidemic in racial/ethnic minority populations in the United States that considers the independent and joint impacts of dynamics such as structural disadvantage, provider bias, health literacy, cultural norms and various other risk factors. Using the "risk environment" framework, we conducted a scoping review on PubMed, Embase and Google Scholar of peer-reviewed literature and governmental reports published between January 2000 and February 2024 on the nature and scale of opioid use, opioid prescribing patterns, and fatal overdoses among racial/ethnic minorities in the United States, while also examining macro, meso and individual-level risk factors. Results from this review illuminate a growing, but fragmented, literature lacking standardisation in racial/ethnic classification and case reporting, specifically in regards to Indigenous and Asian subpopulations. This literature broadly illustrates racial/ethnic minorities' increasing nonmedical use of opioids, heightened burdens of fatal overdoses, specifically in relation to polydrug use and synthetic opioids, with notable elevations among Black/Latino subgroups, in addition uneven opioid prescribing patterns. Moreover, the literature implicates a variety of unique risk environments corresponding to dynamics such as residential segregation, provider bias, overpolicing, acculturative stress, patient distrust, and limited access to mental health care services and drug treatment resources, including medications for opioid use disorder. There has been a lack of rigorous, targeted study on racial/ethnic minorities who use opioids, but evidence highlights burgeoning increases in usage, especially polydrug/synthetic opioid use, and disparities in prescriptions and fatal overdose risk-phenomena tied to multi-level forms of entrenched disenfranchisement. There is a need for further research on the complex, overlapping risk environments ofracial/ethnic minorities who use opioids, including deeper inclusion of Indigenous and Asian individuals, and efforts to generate greater methodological synergies in population classification and reporting guidelines.

Recreational use of psychedelics at music festivals: Motivation, nature of experiences and learnings

AbstractThe present research study investigated the phenomenon of recreational use of psychedelics at music festivals, analysing whether the resulting experiences could possibly be recognized as valuable in terms of preventive mental health strategies. Quantitative (online survey) and qualitative (interviews) research methods have been combined to illuminate 3 main topics: motivation for the setting choice; the nature of the resulting experiences & their influence on people's lives; learnings from psychedelic experiences at music festivals (PEMF).Among other findings, motivation evolved around fun, enhancing the sensory exploration of the world, and deepening the connection to its diverse parts through engagement with art, nature and other beings. Factors, distinguishing music festivals from other settings, were significant for the setting choice (non-controllability of the environment, community & connection aspect, diversity & richness of the surroundings, pharmacological specifics). Remarkably, the non-controllability of the environment, otherwise avoided in the psychedelic research, contributed to the life-changing effects of PEMF. Exploration of their nature showed that, mostly rooted in poly-drug use, the enjoyable were clearly dominating over the challenging ones. The mystical PEMF appeared to be surprisingly common. Participants shared the related life-changing effects, centred around changed perception (increased empathy, awareness, acceptance; new perspectives, etc.) and changed behaviours (increased mindfulness in all life areas; making different life choices; changed approach to relationships, etc.). Except for post MDMA recovery, a positive impact of PEMF on mental health and the emotional state of the participants was reported, referring to increased levels of happiness, compassion, awe, trust and to emotional balance. This study showed the potential value of PEMF in terms of preventive mental health strategies in various forms. Acknowledging these findings as well as the existence of potential risks for triggering psychiatric conditions, de-stigmatization of recreational use could help introduce meaningful changes, including substance testing availability, prioritization of education as well as mandatory welfare and harm reduction services on-site.

Broad evidence of xylazine in the UK illicit drug market beyond heroin supplies: Triangulating from toxicology, drug-testing and law enforcement.

Xylazine is a non-opioid sedative which has spread rapidly throughout the US illicit drug supply. This study aimed to describe the spread of xylazine throughout the UK illicit drug supply. Xylazine detections in human biological samples were collated from toxicology laboratories operating in the United Kingdom with the date, location, case type, xylazine concentration and co-detected drugs (with quantifications where performed) detailed, where permitted, by the corresponding coroner. Drug-testing cases positive for xylazine were collated from the Welsh Emerging Drugs and Identification of Novel Substances (WEDINOS) drug-testing postal service with the date, location, purchase intent and co-detected drugs detailed. Drug seizures made by UK law enforcement were communicated by the Office for Health Improvement and Disparities with the date and location detailed. By the end of August 2023, xylazine was detected in 35 cases from throughout toxicology, drug-testing and drug seizure sources covering England, Scotland and Wales. There were no cases reported from Northern Ireland. Xylazine was detected in biological samples from 16 people. In most cases where full toxicology results were provided, xylazine was detected with heroin and/or a strong opioid (n = nine of 11), but this polydrug use pattern was not evident in all cases (n = two of 11), suggesting a wider circulation of xylazine in the UK illicit drug market beyond heroin supplies. Evidence from WEDINOS supports this claim, as all 14 drug samples (100%) submitted from across the UK contained xylazine; however, in none of these cases was heroin the purchase intent but rather counterfeit prescription medication tablets (n = 11 of 14), tetrahydrocannabinol (THC) vapes (n = two of 14) or white powder (n = one of 14). Additional evidence for the spread of illicit xylazine comes from five drug seizures made by law enforcement. Xylazine has penetrated the UK illicit drug market and is not limited to heroin supplies.

Dual diagnosis of bipolar disorder and substance use disorder – type of substance used and its impact on treatment adherence and maintenance of abstinence

IntroductionSubstance use disorder is a common comorbidity with bipolar disorder, delaying its diagnosis and making treatment of both disorders more complex and challenging.ObjectivesWe aim to analyze the types of substances used by patients with bipolar disorder and to find if there’s a relationship between the substance used both with treatment adherence and maintenance of abstinence.MethodsWe collected, retrospectively, data from the hospital platform and analyzed it on SPSS Statistics 26, along with a literature review. Our study looks over 3 years, and all patients analyzed have a dual diagnosis of both bipolar disorder and substance use disorder and were hospitalized in the psychiatric ward of a tertiary university hospital.Results There were 2384 hospitalizations in the Coimbra’s University Hospital psychiatric ward, and 88 hospitalizations were coded with a dual diagnosis of bipolar disorder and substance use disorder.Tobacco was the substance more consumed by the patients (53.4%), followed by alcohol (46.6%) and cannabinoids (30.7%). In 18.2% of the patients was identified consumption of cocaine and in 6.8% there was an abuse of opioids. It is important to highlight that 20.5% of the patients used 2 or more substances at the same time.Regarding adherence to treatment for both their bipolar disorder and substance use disorder, in 25% of the patients, there wasn’t a satisfactory compliance with the treatment prescribed.In the group of patients with polydrug use, half of them didn’t comply with the treatment. In the patients consuming only one substance, we found out that 30% of patients who use alcohol didn’t adhere to the treatment, while around 13% of the patients using cannabinoids didn’t comply with the suggested treatment.The relationship between the type of substance used and treatment adherence was statistically significant with a p=0.004 (considering p<0.05).Regarding abstinence from consumption, around 42% of the patients keep using at least one substance. In the group with polydrug use, around 65% of the patients were not abstinent in the last appointments, while in the cannabinoids users’ group around 50% of them were still using the drug. In the group with patients using alcohol, around 43% of them are not abstinent.The relationship between the type of substance used and maintenance of abstinence was found to be statistically significant with a p=0.037 (considering p<0.05).ConclusionsSubstance use disorder can have a huge impact on adherence to treatment, worsening the prognosis of the comorbid bipolar disorder. On the other hand, this dual diagnosis can impact the maintenance of abstinence.Early detection of both diagnosis and simultaneous treatment from an early phase are essential to improve the prognosis of both diseases.Disclosure of InterestNone Declared

Developing strategic foresight for drug policy: trends, scenarios, and implications

Background This study utilized foresight analysis to project drug policy trends and challenges in Finland up to 2030. It aimed to develop scenarios and strategies for addressing critical issues and to explore alternative policy options. Methods A comprehensive methodology was employed, including scope analysis, horizon scanning, trend analysis, and scenario building along with the expert panels. This approach facilitated the identification and categorization of trends into mega-trends, emerging trends, and weak signals, ensuring a robust and inclusive analysis. Results Key findings include mega-trends, such as changing drug policies and rising economic burdens. Emerging trends highlight the increase in synthetic, polydrug, and prescription drug use, vulnerability in certain subgroups, and growing drug-related mortality. Weak signals point to the advent of online drug marketplaces and new treatment methods. Past foresight studies agree on market growth and policy inertia but diverge on resource allocation and older generation targeting. Conclusion Developed scenarios and strategies address issues like increasing drug prevalence, service gaps, and market diversification, advocating for integrated approaches in demand reduction, governance, law enforcement, environmental protection, and harm reduction services. This research highlights the significance of participatory foresight methods in shaping Finnish drug policy, offering valuable insights for future trajectories and affirming the importance of foresight in this field.

Performance of Fentanyl Immunoassays in an ED Patient Population.

Fentanyl is a synthetic opioid fueling the current opioid crisis in the United States. While emergency department (ED) visits due to opioid-related overdoses, injection complications, and withdrawals become increasingly more frequent, fentanyl is not detected in routine toxicology testing. We evaluated 2 FDA-approved fentanyl immunoassays in a sampled ED population. De-identified, remnant urine specimens (n = 213) collected from patients presenting to a large ED were analyzed using ARK Fentanyl II (ARK II) and Immunalysis SEFRIA (SEFRIA) fentanyl immunoassays on an Architect c16000 (Abbott) analyzer. All discrepant specimens were evaluated by LC-MS/MS. Additionally, polysubstance abuse patterns and trends were analyzed. While intra-assay imprecision was comparable for ARK II and SEFRIA, inter-assay imprecision for ARK II and SEFRIA varied from 8.0% to 1.8% and from 37% to 12.5%, respectively. SEFRIA had a marginally higher false-positivity rate (3%) than ARK II (1%). Both assays had equivalent sensitivity of 95%, with ARK II (99%) having greater specificity than SEFRIA (97%). Fentanyl was detected in 13.7% of drug-panel-positive patient samples and most frequently observed in patients also testing positive for amphetamines and cocaine. Notably, fentanyl was detected in 5.3% of patient samples that were negative for all other drugs in our standard toxicology panel. A sizable portion of drug-positive samples from our ED were positive for fentanyl, with a subset of patients testing positive for fentanyl alone. Implementation of fentanyl testing into routine toxicology panels can elucidate polysubstance abuse paradigms and capture ED patients that would go undetected in standard panels.

The Effect of Different Factors on Poly(lactic-co-glycolic acid) Nanoparticle Properties and Drug Release Behaviors When Co-Loaded with Hydrophilic and Hydrophobic Drugs.

Poly(lactic-co-glycolic acid) nanoparticles (PLGA NPs) are versatile drug nanocarriers with a wide spectrum of applications owing to their extensive advantages, including biodegradability, non-toxic side effects, and low immunogenicity. Among the numerous nanoparticle preparation methods available for PLGA NPs (the hydrophobic polymer), one of the most extensively utilized preparations is the sonicated-emulsified solvent evaporation method, owing to its simplicity, speed, convenience, and cost-effectiveness. Nevertheless, several factors can influence the outcomes, such as the types of concentration of the surfactants and organic solvents, as well as the volume of the aqueous phase. The objective of this article is to explore the influence of these factors on the properties of PLGA NPs and their drug release behavior following encapsulation. Herein, PLGA NPs were fabricated using bovine serum albumin (BSA) as a surfactant to investigate the impact of influencing factors, including different water-soluble organic solvents such as propylene carbonate (PC), ethyl acetate (PA), and dichloromethane (DCM). Notably, the size of PLGA NPs was smaller in the EA group compared to that in the DCM group. Moreover, PLGA NPs showed excellent stability, ascribed to the presence of the BSA surfactant. Furthermore, PLGA NPs were co-loaded with varying concentrations of hydrophilic drugs (doxorubicin hydrochloride) and hydrophobic drugs (celecoxib), and exhibited pH-sensitive drug release behavior in PBS with pH 7.4 and pH 5.5.

Abstract MP03: Social Adversities and Mortality in HIV and Heart Failure Patients: A Multi-Center Retrospective Cohort Study From Public Hospitals in New York City

Introduction: Individuals living with HIV often face heightened social challenges, particularly in the context of heart failure, turning their chronic disease management into uphill battle. Yet, current literature provides limited insight into how social adversities impact the outcome of HIV heart failure population. This study aims to investigate the relationship between overall mortality and lifetime social adversities in patients diagnosed with HIV and heart failure. Methods: This study utilized data from the New York City Health + Hospitals HIV Heart Failure (NYC 4H) retrospective cohort, encompassing records from eleven major New York City Health + Hospitals. Patients were recruited from both inpatient and clinic hospital visits between 7/2017 and 6/2022. Those under the age of 18 and with baseline cancer were excluded from the study. Social adversities were meticulously assessed through licensed social workers' psychosocial assessment notes. The cohort was categorized into groups based on their number of exposures to social adversities (0, 1-2, >2). We evaluated the association between social adversities and overall mortality using hazard ratios (HR) employing Cox proportional hazards models. The analysis was adjusted for age, sex, race, co-morbidity, CD4 counts, HIV viral load, and activities of daily living (ADL). Result: The analysis included a total of 668 patients, comprising 400 males and 268 females. Over an average 4-year follow-up period, 112 deaths were identified. We found that 244 patients (36.5%) encountered at least one social adversity, and 125 patients (18.7%) faced more than one social adversity. After adjusting for covariates, exposure to any adversity was significantly associated with an 89% increase in risk for overall mortality compared to those without (HR 1.89, 95% Confidence Interval [CI] [1.23,2.90], p=0.004) during follow-up period. Patients exposed to one to two adversities had 1.57 times risk (HR 1.57, 95%CI [1.05,2.43], p=0.027) comparing to those without any social adversities. Patients who have more than two social adversities had 2.83 times overall mortality risk (HR 2.83, 95%CI [1.69,4.74], p<0.001) compared to those without. Particularly, significant associations were observed among individuals facing food deprivation (HR 3.58, p<0.001), lacking family support (HR 2.80, p<0.001), engaging in polysubstance abuse (HR 1.72, p<0.01), and suffering from mental illness (HR 1.64, p<0.05). Conclusion: Our study demonstrates a significant correlation between social adversities and higher mortality rates among HIV-related heart failure patients. Notably, factors such as food deprivation, lack of family support, polysubstance abuse, and mental illness emerged as pivotal contributors to this association, underscoring the need for comprehensive social evaluation and support within this vulnerable population.

Abstract P275: Long-Term Mortality Prediction Model for HIV Patients With Heart Failure: Analysis From a Multi-Center Cohort Database in New York City Health + Hospitals

Introduction: Given the intricate interplay of HIV infection and heart failure (HF), conventional mortality prediction models for general heart failure may prove insufficient for this specific population. Our objective is to assess the fitness of current HF death prediction models and develop a prediction model tailored to the unique challenges of long-term mortality risk in HIV patients with heart failure. Method: The statistical models were developed through New York City Health + Hospitals HIV Heart failure (NYC 4H) retrospective cohort. Demographic and medical factors were obtained through chart reviews, while social adversities were assessed via licensed social workers' psychosocial assessment notes. Patients with baseline cancer, no baseline ejection fraction (EF), or those below 18 years of age were excluded from the study. Multivariable logistic regression models were constructed to predict the risk of overall death. Model 1 was derived from the existing MAGGIC Risk prediction model for general heart failure patients. Model 2 employed backward step-wise selection from NYC 4H cohort for HIV HF biologic factors, functional status, medical and interventional treatment to predict mortality risk. Model 3 further adjusted for single significant social factors and insurance. Model comparison was performed using the area under the ROC curve. Result: The study comprised 597 HIV heart failure patients, averaging 61.1 years in age. Over the 4-year follow-up, 102 deaths (17.1%) were recorded. Model 1 (MAGGIC Risk prediction model) had an AUC of 0.72. Model 2, which included backward-selected variables such as age, race, HIV viral load at baseline and follow-up, CD4 count at baseline, EF at baseline, smoking status, chronic obstructive pulmonary disease, pulmonary hypertension, peripheral arterial disease, chronic kidney disease, activities of daily living, obesity, implantable cardioverter-defibrillator implantation, and the total number of guideline-directed medical therapy, significantly improved the AUC to 0.85. Incorporating social factors such as exposure to any lifetime adversities, specific adversities (lack of family support, polysubstance abuse, and mental illness), and insurance status, model 3 raised the AUC to 0.88. In heart failure with reduced EF (HFrEF) subset (n=502), Model 2 and Model 3 achieved AUCs of 0.88 and 0.90, respectively. Conclusion: HIV heart failure patients exhibit unique mortality prediction factors compared to general heart failure patients without HIV infection. Considering the high burden of social adversities, socioeconomic factors can enhance the predictive yield of models within this specific population.

Managing the Dual Diagnosis Dilemma of Bipolar Disorder and Substance Abuse in Clinical Settings

Objective: Drug addiction is a chronic mental disorder that significantly impacts all aspects of an individual’s life, and substance use disorder in patients with bipolar disorder. The objective of this study is to assess the frequency of substance abuse among patients with bipolar spectrum disorder. Method: This cross-sectional study evaluated the frequency of bipolar spectrum disorder in patients taking methadone through various screening measures, including Mini Mental State Examination (MMSE), DSM IV criteria, Mood Disorders Questionnaire (MDQ), Goodwin and Ghaemi’s criteria, and Akiskal classification for bipolar disorders. Results: Out of the total 197 participants in the study, 77 were identified as individuals engaging in poly-substance abuse. The investigation assessed the frequency of bipolar spectrum disorder based on various diagnostic criteria: 24% according to DSM-IV criteria, 29.9% using MDQ, 29.9% based on Ghaemi and Goodwin’s criteria, and the highest rate at 48.2% when applying Akiskal’s classification. Conclusions: This study highlights the high frequency of bipolar disorder among individuals with substance use disorder, especially those with concomitant depression. Therefore, it is crucial to pay special attention to individuals with substance use disorder with co-existing bipolar disorder.

Patterns of polydrug use among Black Americans who misuse opioids.

In the United States, opioid-related deaths involving polydrug use are now more prevalent than those involving only opioids. What often goes unnoticed is that deaths involving more than one substance are increasing more rapidly among Black Americans than Whites. Unfortunately, little research attention is paid to understanding opioid-related polydrug use patterns among Black Americans. As a result, less is known regarding which drug combinations are most common among this population and their reasons for co-using certain drugs. Therefore, the objective of this mixed methods study was to identify which substances were most commonly co-used with opioids among Black Americans, while also capturing their motives for combining opioids with other drugs. This study used data from the Florida Minority Health Study, a mixed-methods project that included online surveys (n = 303) and qualitative in-depth interviews (n = 30) of Black Americans who misuse opioids. Data collection was conducted from August 2021 to February 2022 throughout Southwest Florida. Analyses revealed that opioids were most commonly combined with alcohol, cocaine, and methamphetamine, respectively. Opioids were co-used with alcohol in an attempt to enhance the desired effect (i.e., intoxication), while stimulants and opioids were combined to counteract the undesirable side effects of the other. This study begins to answer the question of which/why substances are combined with opioids among Black Americans and should inform behavioral health interventions targeted at this population. Data on this topic are especially timely as the United States goes through the current fourth wave of the opioid crisis that is characterized by deaths due to polydrug use. These findings invite further study using nationally representative data to determine the extent to which polydrug using patterns differ across racial/ethnic groups.

Characterizing major depressive disorder and substance use disorder using heatmaps and variable interactions: The utility of operant behavior and brain structure relationships.

Rates of depression and addiction have risen drastically over the past decade, but the lack of integrative techniques remains a barrier to accurate diagnoses of these mental illnesses. Changes in reward/aversion behavior and corresponding brain structures have been identified in those with major depressive disorder (MDD) and cocaine-dependence polysubstance abuse disorder (CD). Assessment of statistical interactions between computational behavior and brain structure may quantitatively segregate MDD and CD. Here, 111 participants [40 controls (CTRL), 25 MDD, 46 CD] underwent structural brain MRI and completed an operant keypress task to produce computational judgment metrics. Three analyses were performed: (1) linear regression to evaluate groupwise (CTRL v. MDD v. CD) differences in structure-behavior associations, (2) qualitative and quantitative heatmap assessment of structure-behavior association patterns, and (3) the k-nearest neighbor machine learning approach using brain structure and keypress variable inputs to discriminate groups. This study yielded three primary findings. First, CTRL, MDD, and CD participants had distinct structure-behavior linear relationships, with only 7.8% of associations overlapping between any two groups. Second, the three groups had statistically distinct slopes and qualitatively distinct association patterns. Third, a machine learning approach could discriminate between CTRL and CD, but not MDD participants. These findings demonstrate that variable interactions between computational behavior and brain structure, and the patterns of these interactions, segregate MDD and CD. This work raises the hypothesis that analysis of interactions between operant tasks and structural neuroimaging might aide in the objective classification of MDD, CD and other mental health conditions.

Prevalence and factors associated with polydrug use among clients seeking treatment for alcohol misuse.

The aim of this paper was to examine the client and psychosocial characteristics associated with polydrug use in patients with alcohol misuse as their primary drug of concern (PDC) seeking treatment from substance use treatment centres. Self-report surveys were undertaken with clients attending 1 of 34 community-based substance use treatment centres across Australia with alcohol as their PDC. Survey items included client's socio-demographic characteristics, level of alcohol dependence, use of other drugs including tobacco, health and wellbeing factors including health-related quality of life. The factors associated with polydrug use (alcohol use concurrent with at least one other drug) were examined. In a sample of 1130 clients seeking treatment primarily for alcohol problems, 71% reported also using another drug. The most frequently used drug was tobacco (50%) followed by cannabis (21%) and benzodiazepines (15%). Excluding tobacco use, 35% of participants reported polydrug use. Factors associated with any polydrug use were younger age, lower education levels, lower levels of mental health related quality of life and housing risk (i.e., risk of eviction or experienced homelessness in past 4 weeks). When tobacco was excluded, factors associated with polydrug use were age, lower physical and mental health-related quality of life, and housing risk. Most adults seeking treatment for alcohol misuse as their PDC reported using another drug in addition to alcohol. Treatment services should be designed accordingly to maximise the likelihood of treatment engagement and success.

The influence of transformations in supply on methamphetamine initiation among people injecting opioids in the United States

BackgroundCo-use of methamphetamine (MA) and opioids (pharmaceutical pills, heroin and fentanyls) has increased in the United States and is represented in rising mortality. Although coinciding with the import of low cost, high potency and purity methamphetamine, the relationship between supply and demand in propelling this polydrug use is not well understood. We consider the influence of macro changes in supply on the uptake of opioid and methamphetamine co-use by injection at the level of individual drug and injection initiation in West Virginia, a state which leads the US in drug overdose mortality.MethodWe recruited n = 30 people for semi-structured interviews who self-reported injecting heroin/fentanyl and using methamphetamine by any route at a West Virginia syringe service program and through snowball sampling. Interviews were recorded and transcripts analyzed using a thematic approach. Ethnographic observation was also conducted and recorded in fieldnotes. Sequence of substance and mode of use initiation and use trajectories for opioids and stimulants were charted for each participant.ResultsA clear pattern of individual drug initiation emerged that matched each successive supply wave of the US overdose epidemic: 25 participants had initiated opioid use with pills, followed by heroin, often mixed with/replaced by fentanyl, and subsequently added methamphetamine use. For participants, the supply and consumption of opioid analgesics had set in motion a series of steps leading to the addition of stimulant injection to existing opioid injecting repertoires. Unlike other studies that have found a birth cohort effect in patterns of initiation, participants showed the same sequence across age groups. Considerations of economy, availability, dependence, tolerance and the erosion of taboos that marked transitions from opioid pills to heroin injection influenced these subsequent trajectories in novel ways. The form, timing and extent of opioid and stimulant consumption was influenced by four stages of the changing drug supply, which in turn reflected back on demand.ConclusionTransformations in the social meaning and supply of methamphetamine enabled these transitions while other desired, non-injectable drugs were difficult to obtain. We discuss policy implications of injectable drugs’ market dominance at this location and possible interventions.

Association between the severity of neurocognitive disorders and the seriousness of falls in the elderly

Falls cause severe morbidity and mortality in people over 65 years old in all countries. Cognitive frailty is considered to be one of the risk factors for falls in the elderly. Approximately 60% of the elderly with neurocognitive disorders fall annually and this is two times more compared to elderly with no cognitive impairment. We already know that neurocognitive disorders and their severity are a risk factor for falls in older people. Few studies are conducted to investigate the association between the severity of neurocognitive disorders and the severity of falls. This study is therefore interested in investigating the association between the severity of neurocognitive disorders and the serious falls in the elderly. This is a non-interventional retrospective study of 100 patients admitted for fall in a geriatric hospital. The correlation between MMSE and fall severity remains uncertain. Serious falls are more frequent in patients with Parkinsonian syndromes, but this result is not statically significant. Polypharmacy remains very prevalent in our population with 70% of patients having more than four drugs. Polydrug use in our study was very high, with 70% of patients taking more than four medications. We did not find a statistically significant association between the severity of neurocognitive disorders evaluated with the MMSE and the serious falls. More studies with tailored neurocognitive testing are needed to investigate the link between executive function disorders and the serious of falls.

The Transition of Sociodemographic and Substance Abuse Characteristics, Pairwise Co-occurrences and Factors Associated with Polysubstance Use Among US Adolescents and Young Adults.

Substance abuse by adolescents and young adults is a major public health issue. This study aimed to (i) show the transition of sociodemographic and substance abuse characteristics from 1992 to 2017 among US adolescents and young adults, (ii) evaluate the likelihood of co-occurrence of substances, and (iii) identify significant sociodemographic characteristics in association with polysubstance abuse. This study extracted data for adolescents and young adults from 1992 and 2017 Treatment Episode Data Set-Admission (TEDS-A) datasets. The extracted sample included 337858 admissions in 1992 and 333322 in 2017. Both years experienced significant admissions. A significant transition in 2017 compared to 1992 was evident in education, living status, and ethnicity. Substance-specific transition showed alcohol was dominant in 1992, while marijuana/ hashish was dominant in 2017. Also, heroin, other opiates/synthetics, and methamphetamine experienced an increase, while cocaine/crack decreased. The pairwise co-occurrences exhibited a considerable variation in the likelihood of using one substance given another one. The odds ratios (ORs) obtained from generalized ordered logit models showed significantly higher odds of one or more substances with age, while education showed the opposite scenario. A mixed effect of gender was evident in 1992, whereas females were significantly less likely with one or more substances than males in 2017. Other significant vulnerable groups were those not in the labor force, homeless, white, and Mexican Americans. The findings may help to understand the overall changes between 1992 and 2017 and take necessary measures to reduce the burden of this public health problem.

The relationship between the Hopkins symptom checklist-10 and diagnoses of anxiety and depression among inpatients with substance use disorders

Introduction The Hopkins Symptom Checklist-10 (HSCL-10) is a self-report inventory of anxiety and depression symptoms that may assist clinicians in screening for clinical conditions among patients with substance use disorder (SUD). We examined the HSCL-10 as a screening tool for anxiety and depressive disorders within a general population of SUD inpatients. Methods We used data from a cohort study of 611 SUD inpatients. Receiver operating characteristic (ROC) analyses were conducted, with and without covariates, to evaluate the potential of the HSCL-10 as a screening tool. This was explored using any anxiety disorder, especially posttraumatic stress disorder (PTSD), and any mood disorder, especially major depressive disorders, as the outcome criteria. Candidate covariates included gender, age, education, polydrug use and treatment center. Results: The HSCL-10 had a moderate ability to identify caseness (i.e. having or not having a clinical diagnosis) according to each outcome criterion, with the area under the ROC curve (AUC) varying from 0.64 to 0.66. Adding relevant covariates markedly enhanced the instrument’s ability to identify those who met the criteria for any anxiety disorder (AUC = 0.77), especially PTSD (AUC = 0.82). Conclusion In a real-world clinical setting, the HSCL-10 has fair-to-good clinical utility for identifying SUD inpatients who have comorbid clinical symptoms of anxiety disorders or PTSD, when combined with common background variables. The HSCL-10, a brief self-report screening tool, may serve as an efficient proxy for comprehensive interviews used in research and for clinical anxiety symptom screening among patients with SUD.

Paraneoplastic Limbic Encephalitis From a Carotid Body Paraganglioma Presenting as Persistent and Worsening Confusion

Background: Paraneoplastic Syndromes (PNS) are rare conditions in which patients experience a variety of symptoms from altered immune systems due to underlying malignancy. Paraneoplastic Limbic Encephalitis (PLE) is a subtype of PNS in which autoantibodies to cancer cells cross-react with cells in the central nervous system, particularly in the medial temporal lobe. Here we present a 38-year-old, previously normal male who presented with persistent and worsening confusion and was diagnosed with a very rare PLE secondary to a carotid body paraganglioma. Case: A 38-year-old male with medical history of hypertension and polysubstance abuse was admitted initially for confusion, arm weakness, and memory loss. He denied having headache, fever, chills, or neck stiffness. Further history obtained from family revealed he was previously cognitively intact. Imaging was consistent with carotid body paraganglioma and limbic encephalitis. A 5-day course of high dose steroids and plasmapheresis was initiated. Plasmapheresis was performed every other day for 5 treatments with marked improvement in mental and renal function at the time of the third treatment. Biopsies obtained were consistent with carotid body paraganglioma and surrounding lymphadenopathy was negative for disease. Embolization was performed with subsequent excision of the tumor and eventual resolution of symptoms. Conclusion: This is to our knowledge the first documented case of paraneoplastic limbic encephalitis associated with a carotid body paraganglioma. Our patient had improved following resection of the underlying paraganglioma and experienced short-term improvement with high-dose steroids and plasmapheresi

Identification of clobromazolam in Australian emergency department intoxications using data-independent high-resolution mass spectrometry and the HighResNPS.com database.

The proliferation of novel psychoactive substances (NPSs) continues to challenge toxicology laboratories. In particular, the United Nations Office on Drugs and Crime considers designer benzodiazepines to be a current primary threat among all NPSs. Herein, we report detection of a new emerging designer benzodiazepine, clobromazolam, using high-resolution mass spectrometry and untargeted data acquisition in combination with a "suspect screening" method built from the crowd-sourced HighResNPS.com database. Our laboratory first detected clobromazolam in emergency department presenting intoxications included within the Emerging Drugs Network of Australia-Victoria project in the state of Victoria, Australia, from April 2022 to March 2023. Clobromazolam was the most frequent designer benzodiazepine detected in this cohort (100/993 cases, 10%). No patients reported intentional administration of clobromazolam, although over half reported exposure to alprazolam, which was detected in only 7% of cases. Polydrug use was prevalent (98%), with phenazepam (45%), methylamphetamine (71%) and other benzodiazepines (60%) most frequently co-detected. This is the first case series published in the literature concerning clobromazolam in clinical patients. The identification of clobromazolam in patients presenting to emergency departments in Victoria demonstrates how high-resolution mass spectrometry coupled with the HighResNPS.com database can be a valuable tool to assist toxicology laboratories in keeping abreast of emerging psychoactive drug use.

Xylazine co-occurrence with illicit fentanyl is a growing threat in the Deep South: a retrospective study of decedent data

BackgroundXylazine is a dangerous veterinary sedative found mainly in illicit fentanyl in the Northeast and Midwest. Its role in the Deep South overdose crisis is not well-characterized.MethodsWe conducted a retrospective review of autopsy data in Jefferson County, Alabama to identify trends in xylazine prevalence among people who fatally overdosed from June 2019 through June 2023.Results165 decedents met inclusion criteria. While the first identified xylazine-associated overdose was in June 2019, xylazine has become consistently prevalent since January 2021. All cases of xylazine-associated fatal overdoses were accompanied by fentanyl, and most (75.4%) involved poly-drug stimulant use. The average age was 42.2, and most decedents were white (58.8%) and male (68.5%). Overall, 18.2% of people were unhoused at the time of death.DiscussionXylazine is prevalent in the Deep South. Efforts to promote harm reduction, publicly viewable drug supply trends, and legalization of drug checking and syringe service programs should be prioritized.