Risky Drug Research Articles

Fetal Exposure to Risky Drugs: Analysis of Antenatal Clinic Prescriptions in a Nigerian Tertiary Care Hospital

Objective: To assess fetal outcomes after in-utero exposure to unsafe drugs.Methods: This was a retrospective cohort study using data from medical records of pregnant women who received antenatal care over a two-year period (2019/2020). Inclusion was based on identification of prescription of potentially risky medications during pregnancy. Medication records, as well as delivery data, were extracted for analysis. The Australian drug evaluation committee classification system of risky medications was used for analysis.Results: Results showed that 44 – 65% of medicines prescribed in pregnancy carry significant risks to fetal wellbeing. Fetal outcomes showed high levels of low birth weight, still birth, and early neonatal death. The common medicines prescribed irrationally in pregnancy were, among others, antibiotics, ACEIs, NSAIDs, Biguanides, and opiates, all of which are associated with adverse fetal outcomes.Conclusion: There is a high level of fetal exposure to risky medications and adverse delivery outcomes. There is a need to improve prescription through prescriber training and awareness raising on existing guidelines on good prescribing practice for pregnant women.

Comparison of primary care prescriptions for old and very old hypertensive patients.

Elderly and very elderly individuals might be subject to different approaches for the treatment of hypertension. We aimed to compare drug utilization in hypertensive old patients and very old patients in primary care, along with the evaluation of potentially inappropriate drug prescribing. In this cross-sectional study, we compared prescriptions of 65-79-year-old (old patient prescriptions [OPP], n = 433,988) vs. ≥80-year-old (very old patient prescriptions [VOPP], n = 134,079) with "essential hypertension" diagnosis, issued by 3:1 systematically-sampled primary care physicians (n = 1431) in İstanbul throughout 2016. Drug utilization patterns and distribution of antihypertensives based on drug class and combination status were evaluated. Frequency of potentially inappropriate drugs per Beers Criteria were identified and compared. Antihypertensive monotherapy practice was less common in OPP than VOPP (43.3% vs. 45.3%; p < 0.001). In both groups,the most commonly prescribed drugs were beta-blockers for monotherapy (37.4% vs. 33.1%, p < 0.001) and thiazide diuretics for combined therapy (69.8% vs. 67.4%, p < 0.001). Metoprolol was the most commonly prescribed antihypertensive both in OPP and VOPP (15.3% vs. 14.8%). Furosemide was ranked 10th in OPP and 3rd in VOPP (2.7% vs. 5.5%). Cardiovascular system drugs were the most commonly encountered potentially inappropriate medications in both groups (263.9 vs. 283.4 per 10,000 prescriptions, p = 0.004). Regarding antihypertensive drugs, 2.2% of those in OPP and 2.4% of those in VOPP were identified as potentially inappropriate (p = 0.002). Prescribing preferences to old and very old patients mostly showed slight differences. Almost half of prescriptions comprising antihypertensive monotherapy might imply hesitancy to prescribe combinations. Overuse of risky drugs such as furosemide in both groups, especially in the very elderly, requires more attention.

Remote Screening for Alcohol, Smoking, and Substance Involvement by Sex, Age, Lockdown Condition, and Psychological Care-Seeking in the Primary Care Setting during the COVID-19 Pandemic in México.

The COVID-19 pandemic has created a psychoactive substance use crisis in many countries, including México. Remote valid tools to identify high-risk groups in need for treatment are a prerequisite for cost-effective interventions in primary care settings. To determine the validity and correlates of the remote applications of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) with sex, age, and psychological care-seeking, offered remotely in primary settings, during the COVID-19 pandemic in Mexico, a total sample of 19,109 Mexicans, with an average age of 34.38years (SD = 12.28, range = 18-80), 65.8% of whom were women (n = 12,578), 29.6% in lockdown (5,660), 39.8% in partial lockdown (7,611), 30.60% not in lockdown (5,838), and 14.75% of whom were seeking psychological care (n = 2,819), completed ASSIST through a programmed Web application. The dimensionality of the scale to verify construct validity evidence was achieved through a confirmatory factor analysis model (CFA). We represented the distribution of subjects by sex, age, lockdown condition, and psychological care-seeking, based on their lifetime consumption in 2021. We also compared the total distribution by consumption risk level and recommended type of intervention, psychological care-seeking, and age. The tool included ten dimensions (one for each substance, such as tobacco use), confirmed through the CFA. In general, our findings indicated that men reported high lifetime psychoactive substance use and risky drug use levels. A high percentage of 18 to 19-year-old women reported lifetime tobacco and alcohol use. Additionally, a high number of all-age women reported lifetime sedative and opioid use. Also, a high proportion of partially lockdown participants reported lifetime drug use. Moreover, a high percentage of subjects seeking psychological care were at a moderate and high risk of drug use, which required brief or intensive treatment. Our findings indicate that it was possible to validate the factor structure of the programmed ASSIST for remote use. More men than women reported high lifetime psychoactive substance use and risky levels because of their consumption. At the same time, younger women reported similar and even higher lifetime tobacco, alcohol, and cocaine use than same-age men. More all-age women reported lifetime use of sedatives than all-age men. More all-age partially lockdown participants reported lifetime use of drugs. In general, subjects at greater risk and those requiring psychological care are more likely to seek care. Community and primary care screening will make it possible to implement effective early interventions to reduce the substance use risks associated with health emergencies. Future studies are required to determine the diagnosis of substance use disorders to evaluate the cut-off points in the screening test to discriminate between the presence and absence of symptoms and evaluate the effect of remote psychological care.

Impaired driving and other risky drug use and sex behaviors: a cross-sectional examination of high-risk rural women incarcerated in jail

Background: Despite women accounting for an increasing proportion of impaired drivers and higher rates of impaired driving and road fatalities in rural areas, little is known about rural women who drive impaired and their other risky behavior. Objective: The present study assessed the association between impaired driving history, risky substance use, and other drug- and sex-related risk behaviors in a sample of high-risk rural women incarcerated in jail. Methods: Four hundred women from three rural jails provided information about their impaired driving, drug use, injection drug use practices, and sex risk behaviors. Groups were stratified on whether they self-reported impaired driving in the year prior to incarceration. Impaired drivers (n = 260, M = 31.90 years old) were compared to women who did not drive impaired (n = 131, M = 34.42 years old) using MANCOVA and logistic regression analyses. Results: Impaired drivers had significantly (p < .05) higher substance use severity scores for cannabis, sedatives, and prescription opioids. Furthermore, impaired drivers were significantly (p < .05) more likely to have been the passenger of an impaired driver (78.08% vs. 53.44%), been an injection drug user (69.62% vs. 41.98%), had a casual sex partner (47.31% vs. 25.95%), and traded sex for drugs or money (31.15% vs. 15.27%) in the year prior to incarceration. Conclusions: This study found a consistent association between past year impaired driving and a range of drug- and sex-related risk behaviors in a sample of high-risk rural women incarcerated in jail. These findings highlight an opportunity to intervene in criminal justice settings to reduce multiple health risk behaviors.

İlaç alerjisi olan hastalarda otoantikor sıklığı

Introduction: This study is aimed to analyze the autoantibody frequency in patients with drug allergy. Descriptive, observational research on drug allergy will contribute to the creation of new hypotheses about the pathophysiology of autoimmunity.Methods: The data of patients who were registered in the Training and Research Hospital database until the end of December 31, 2018 and diagnosed with drug allergy were retrospectively evaluated. Overall, 617 adult patients who had been diagnosed as “allergy status to drugs,” according to ICD 10, and had had at least one autoantibody result were included in the study.Results: The frequency of having at least one autoantibody varied between 0% and 92.1%. The most commonly detected autoantibody was rheumatoid factor (RF) (n = 241; 92.1%). The second most common one was anti-tissue transglutaminase IgA antibody (Anti-tTG-IgA) (n=22; 68.2%). The frequencies of anti-thyroglobulin (Anti-TG), anti-thyroid peroxidase (anti-TPO), and anti-double stranded DNA (Anti-dsDNA) were 65.2% (n = 155), 59.7% (n = 159), and 43.6% (n= 55), respectively.Conclusions: Many drugs can trigger the development of autoantibodies with no progression to autoimmune disease. Autoantibodies should be suspected in patients with allergies to medications. Observational research on drug allergy will contribute to the creation of new hypotheses about the pathophysiology of autoimmunity. Numerous studies in this area can enable us to discuss the widespread use of risky drugs in a more objective way. We think that our study will shed light on the relationship between drug reaction and autoimmune diseases.Keywords: Autoantibodies, autoimmunity, drug allergy, drug hypersensitivity

Machine learning approaches to identify profiles and predictors of psychosocial discomfort among Italian college students

Introduction. College students live a crucial period of transition from late adolescence to adulthood when they have to deal with important stressful tasks. Thus, university often represents a stressful environment, pushing students to cope with a high academic pressure. As a result, this period constitutes a sensitive age for the onset of mental disorders. Typically, students are not aware of the early signs of their own compromised mental health until symptoms aggravate to an overt disorder. Therefore, it is important to timely detect subthreshold symptoms mostly related to generic mental distress. Objective. First, to assess psychophysical well-being and mental distress among college students in northern Italy, and to detect predictors, among socio-demographic and academic characteristics, and risky drug use of these two outcomes. Method. The study involved 13,886 students who received an email explaining the purpose of the e-research. The questionnaires used were the General Health Questionnaire (GHQ-12), the University Stress Scale (USS), and a modified version of World Health Organization-ASSIST v3.0. Results. 3,754 students completed the web-survey. Students showed poor well-being and mental distress. The strongest predictor of mental distress and compromised well-being was physical health, followed by sex, study field, risky drug use, and academic performance concerns. Discussion and conclusion. This study shows that it is very important to promote in college students healthy behaviors in order to increase their physical exercise and reduce substance use. Moreover, it would be desirable to improve academic counselling facilities as an important front-line service to intercept mental health issues among young adults.

From machine learning to deep learning: A comprehensive study of alcohol and drug use disorder

This study aims to train and validate machine learning and deep learning models to identify patients with risky alcohol and drug misuse in a Screening, Brief Intervention, and Referral to Treatment (SBIRT) program. An observational cohort of 6978 adults was admitted in the western region of Alabama at three medical facilities between January and December of 2019. Data were cleaned and pre-processed using data imputation techniques and an augmented sampling data method. The primary analysis involved the multi-class classification of alcohol and drug misuse. Our study shows that accurate identification of alcohol and drug use screening instrument scores was best accomplished with mixed-effects models following the imputation of missing data using the Generative Adversarial Imputation Networks (GAIN) method and then followed by applying the Synthetic Minority Over-sampling TEchnique-Nominal Continuous (SMOTE-NC) data augmentation method. Although mixed models are commonly employed in studies of electronic health records (EHRs), using the GAIN method followed by SMOTE-NC for diagnosing alcohol and drug use disorder is novel and original.

The potential of intervention-based community development programs in reducing multiple health risk behaviors among adolescent: A scoping review of the latest RCTs.

Background: Adolescents are more likely than adults to engage in risky health behaviors such as smoking, drinking, and sexual activity. Community development plays a role in reducing adolescents’ personal, cognitive, and social skill deficits. A review of the effectiveness of community-development interventions is required to advance our understanding of how the intervention reduce health risk behaviors. This study analyze type and effectiveness of adolescents’ community development programs reduce multiple health risk behaviors among adolescents.Methods: This scoping review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). With a date range of 2015–2021, searches were conducted in PubMed, EBSCO, and ProQuest using keywords (((Life skill education) OR (community development)) AND ((health risk behavior) OR (risk behavior)) AND ((adolescent) OR (adolescence) OR (teenagers) OR (teens) OR (youth))). After title and abstract checking, full-text retrieval, and data extraction, data were synthesized based on the main objectives. The most important data were tabulated. Results: Most studies showed that community development–based interventions effectively reduce adolescents’ health risk behaviors, including risky sexual behaviors, drug and alcohol use. Interventions were carried out in schools, places of worship, and communities, involving adolescents, educational institutions, health professionals, religious leaders, and families. Conclusion: This review can assist community health nurses, policymakers, researchers, and teachers in developing and implementing effective community-development programs that ensure knowledge, attitudes, and skills transfer to reduce health risk behaviors.

Does cannabis testing in the military drive synthetic cannabinoid use? Self-reported use motivations among justice-involved veterans

Though synthetic cannabinoid receptor agonists (SCRAs) were controlled after being introduced as a 'legal high,' SCRAs likely remain appealing to individuals subject to routine drug screens as not all testing programs consistently include SCRAs. Military populations have been linked to SCRAs due to the unconfirmed supposition that testing protocols led many to substitute SCRAs for cannabis. This study aimed to explore SCRA use prevalence, correlates, and use motivations among veterans, with a particular focus on whether United States military personnel substituted SCRAs for cannabis to subvert testing protocols.All veterans appearing in one of eight civilian criminal courts in three U.S. states were invited to answer questionnaire items related to military service, court functionality, and substance use. Of the 579 veterans eligible, 54.9% chose to participate, yielding a cross-sectional sample of 318 veterans charged with a criminal offense by civilian authorities.Sixty-five (21.3%) justice-involved veterans reported lifetime SCRA use. Use while within the military was reported by 15.0% of veterans enlisting after 2008. Only eight (12.3%) reported SCRAs were used as a substitute for cannabis. Boredom (36.9%), experimentation (27.7%), and social aspects of SCRA use (32.3%) were more commonly reported motives. Logistic regression models indicated that use of cannabis (aPR=2.06, p<.05), hallucinogens (aPR=2.50, p<.01), and SCRAs (aPR=2.49, p<.05) while in the military were risk factors for SCRA use after leaving the military, whereas older age at time of military exist was a protective factor (aPR=.87, p<.01) CONCLUSIONS: Drug testing programs within the military do not appear to have the unintended consequence of routing individuals to more risky drugs; however, SCRAs appear to have been an underappreciated problem within the military. Further, use extends beyond the military with many only initiating use after discharge, suggesting SCRA use may jeopardize the health of veterans post-service.

Substance use in the emergency department: Screening for risky drug use, using the ASSIST-Lite.

Substance use is a common contributing factor to emergency department (ED) presentations. While screening, brief intervention, and referral to treatment for alcohol and tobacco is common in ED settings, it is not routinely conducted for illicit substances. This study aimed to deploy the ASSIST-Lite to screen for risky use of alcohol and other drugs in the ED, to identify differences in risk based on between demographic characteristics. All ED attenders, aged 18 years or older, deemed well enough to participate were approached. Recruitment occurred at the Royal Adelaide Hospital ED between May and June 2017. Participants were asked to self-complete the ASSIST-Lite in the ED waiting room. Overall, 632 people were approached, of which 479 (75.8%) agreed to participate. Alcohol (72.2%), tobacco (27.1%) and cannabis (15.2%) were most commonly reported. Eighty-nine participants reported moderate- or high-risk use of two substances, and a further 49 individuals reported moderate- or high-risk use of three or more substances. Across most substances, age, gender and employment status was associated with risky substance use, with higher likelihood of risk reported by males, unemployed and younger participants. Unemployment was also significantly associated with increased risk severity for both moderate and high-risk illicit use. The rate of risky illicit and polysubstance use found here highlight the need more focused research in ED settings. The findings also provide support for more routine screening, and early intervention approaches; and suggest the need for active referral pathways through an alcohol and other drug consultation liaison service.

Proceedings of the 17th Annual International INEBRIA Conference

Proceedings of the 17th Annual International INEBRIA Conference

A case-control study of healthcare disparities in sex and gender minority patients with breast cancer.

6517 Background: Disparities in the quality of diagnosis and treatment of breast cancer in sex and gender minority (SGM) populations are largely undefined. Only 24% of studies funded by the National Cancer Institute capture data on sexual orientation, while only 10% capture data on gender identity. To address this gap, the National Academies 2020 Report calls for adding sexual orientation and gender identity (SOGI) to ongoing data collection efforts. This case-control study matching SGM patients with breast cancer to cisgender heterosexual controls is the result of linking SOGI data to the Stanford University Healthcare (SHC) Oncoshare breast cancer database, which integrates data from the electronic medical record (EMR) and California Cancer Registry. Methods: An initial database query across the SHC EMR was performed for charts containing SOGI terms in patients with breast cancer seen in SHC Oncology. 686 charts were identified for manual review and after eliminating false positives, the sample was reduced to 92 SGM patients, who were then matched by year of diagnosis, age, stage, ER-status, and HER-2 status to cisgender heterosexual controls within Oncoshare. Additional data on demographics, diagnosis, treatment, and relapse were then manually abstracted from the EMR. Results: The SGM cohort was comprised of 80% lesbians, 13% bisexuals and 6% transgender men. The median age at diagnosis across both groups was 49. SGM patients were 72% white, 4% Asian, 12% Black or Latinx 6% other compared to 63% white, 24% Asian, 6% Black or Latinx, 6% other in the controls (p = 0.0006). Thirteen percent and 32% of SGM patients engaged in risky alcohol and illicit drug use respectively, compared to 3% and 6% of controls (p = 0.028; p &lt; 0.0001). Estrogen exposure risk factors including median age of menarche, first delivery, menopause, and use of exogenous estrogens were balanced between the two groups, but SGM patients had fewer children (median 0 vs 2, p &lt; 0.0001). There was a delay in time to diagnosis from symptom onset in SGM patients versus controls (median 64 days vs 37 days, p = 0.043). There was no difference in surgical approach, use of post-lumpectomy radiation, or use of neoadjuvant chemotherapy for stage III disease. However, SGM patients were less likely to undergo chest reconstruction (55% vs 82%, p = 0.0098) and if ER+, to complete ≥5 years of ER-directed therapy (53% vs 72%, p = 0.048). SGM patients used more alternative medicine (46% vs 29%, p = 0.033) and had a higher rate of documented refusal of recommended oncologic treatments (38% vs 21%, p = 0.0088). Correspondingly, SGM patients experienced a higher recurrence rate (31% vs 14%, p = 0.0124). Conclusions: To our knowledge, this is the first study to examine quality of diagnosis and treatment of breast cancer in SGM patients. Several novel potential healthcare disparities are identified, which should be further evaluated in population-based studies to inform interventions.

How to avoid medication errors

Medication errors in cancer care are higher due to complex and risky drugs and therapies, so nurses need to know how to reduce errors

Regulatory Considerations Specific to Liposome Drug Development as Complex Drug Products

Nearly a half-century after original liposome discovery as a prospective lipid pharmaceutical carrier, the global liposomal drug delivery market has increased dramatically, with an annual market growth rate of 13.2%, valued at ∼$6,993 million by 2027. As an intrinsically complex delivery system, liposomal formulations face much greater characterization and regulatory review challenges than traditional small molecule drugs and biologics. Due to rapid liposomal drug development, both European Medicines Agency (EMA) and US Food and Drug Administration (FDA) now provide regulatory guidance for new liposomal drug application reviews. The expanding global liposome drug market and associated driving forces for increased research and development (R&amp;amp;D) in novel liposomal products are key factors propelling liposomal drug interests. We review and compare EU and US regulations on liposomal drug submissions, and provide insights into regulatory strategies throughout the entire liposomal drug development process. This addresses current gaps noted between liposome-based drug development in research labs and current regulatory guidance for liposomal drug approvals in order to facilitate more efficient, less costly, and less risky complex drug development.

Medications with Potential for Fetal Risk Prescribed to Veterans.

Background: Women service members of the past 20 years experienced high rates of traumatizing events resulting in pharmacological treatment. Post-military lives may include having children. Typically, Veterans Health Administration (VHA) patients' pregnancies are managed outside the VHA. This study examined medication exposures during pregnancy. Materials and Methods: The Center for Maternal and Infant Outcomes Research in Translation (COMFORT) study collected primary survey data and linked secondary health care data from the VHA from 2015 to 2021. Medication fills and covariates were extracted for three 9-month periods: preconception, pregnancy, and postpartum. Multiple regression assessed factors associated with use during pregnancy of selective serotonin reuptake inhibitor (SSRI)/serotonin norepinephrine reuptake inhibitor (SNRI) or of non-recommended, potentially risky drugs, and of discontinuation of those medications from prepregnancy to pregnancy. Results: The cohort comprised 501 women-29% Black, 65% White, and 6% other races, of whom 63% had 50%-100% service-connected disability. During pregnancy, 36% had a pain-related disorder, 19% major depression, and 18% post-traumatic stress disorder. The median number of drug classes prescribed during pregnancy was 5. The use of SSRI/SNRI antidepressants dropped from 36% preconception to 26% during pregnancy including new starts; 15% discontinued SSRI/SNRI. Comorbidity predicted medication use. Depression predicted discontinuing SSRI/SNRI during pregnancy; no predictors of discontinuing potentially risky drugs were identified. Conclusions: Based on prescriptions filled within the VHA only-ignoring potential community-based fills-women veterans were prescribed numerous medications during pregnancy and discontinued antidepressants alarmingly. Veterans of childbearing potential should receive counseling about medication use before pregnancy occurs. Their non-VHA obstetricians and VHA providers should share information to optimize outcomes, reviewing medications as soon as pregnancy is detected as well as after pregnancy concludes.

Development of a decision tree for the pharmacy-led consultation of elderly patients with haematological malignancies.

Elderly patients with haematological malignancies are a population at risk of iatrogenic for whom these activities could optimize therapeutic management. However, the limitation of human resources requires optimization of the process in order to improve the efficiency of pharmaceutical activities. The objective was to build a decision tree to optimize the pharmaceutical consultation in these population within a multidisciplinary team in haematology. Pharmaceutical consultations were proposed to elderly subjects with haematological malignancies followed up in a haematology day hospitalization at the University Hospital of Limoges. Risk factors for prescribing risky drugs in this population were determined by logistic regression models. A decision tree was constructed based on these results and by agreement between pharmacist, geriatrician and hematologist. Female gender (aOR[CI95%] = 1.71 [1.14-2.57]), polypharmacy (aOR[CI95%] = 1.89 [1.14-3.13]), hyper-polypharmacy (aOR[CI95%] = 5.73 [3.03-10.84]) and moderate cholinergic load (aOR[CI95%] = 2.15 [1.04-4.45]) were risk factors for the prescription of inappropriate medicine. Female gender (aOR[CI95%] = 1.55 [1.02-2.35]) and hyper-polypharmacy (aOR[CI95%] = 6.19 [1-1.28]) were risk factors for prescribing anticholinergic drugs or anticoagulants; in contrast, frailty status was a protective factor for prescribing anticholinergics (aOR[CI95%] = 0.51 [0.33-0.81]). Prioritization of pharmaceutical consultations is based on frailty status, prescription of a target drug and polypharmacy. Pharmaceutical consultations during the day hospitalization of elderly subjects with hematological diseases allow to propose therapeutic optimizations. The prioritization proposed in our study would increase the efficiency of pharmaceutical activities in order to improve quality and safety throughout the care pathway of these patients.

Evaluation of drug-drug interactions among patients with metastatic prostate cancer in routine care.

111 Background: Prostate cancer often occurs in an elderly population, at higher risk of drug-drug interactions (DDIs). There is a medical need to increase the knowledge of DDI prevalence and their severity among patients coming from routine care. This study used a prospective approach with the aim to quantify and describe DDIs in medical prescription of prostate cancer treatments. Methods: DDIs were assessed from two perspectives: 1) “real DDI” between the patient’s comedications and the actual anti-cancer agent prescribed; 2) “modelized DDI” between the patient’s comedications and drugs that have proven activity in metastatic endocrine sensitive prostate cancer (MESPC) or castrate resistant prostate cancer (CRPC) settings with positive phase 3 trial and gained EMA approval. French national thesaurus, Micromedex software and complementary manual analysis by pharmacist were used to identified DDIs. Clinical relevance of DDIs was scored using the validated scale of Hatoum. Results: A total of 91 patients were included, 15% of whom were participating in a clinical trial. Some imbalances were observed between patients from clinical trial and routine care (age, ECOG, MESPC/MCRPC). The median number of comedications used per patient was 6 [1-16]. Among real DDI, Enzalutamide was the anticancer agent with the higher risk of interaction (18-54% of patients). In modelized DDI, Enzalutamide and Apalutamide were the two most risky drugs (35-76% and 22-73% depending on Micromedex or Thesaurus analyze). Not all DDIs discovered were clinically significant according to Hatoum scale. Conclusions: DDIs are frequents, according to Micromedex and National Thesaurus tools but pharmacist and physician advices are essentials to determine their potential impacts.

Availability of informal social support and the impact on health services utilization among women in community corrections who engage in substance use and risky sexual behavior: New York City, 2009\u20132012

BackgroundWomen under community supervision in the U.S. experience high rates of substance use and HIV/STDs and face multiple barriers to healthcare services. Informal social support, provided by family, friends, and other peers, is important for reducing drug and sexual risk behaviors and improving utilization of healthcare services. The availability of informal social support and the impact on receipt of healthcare services among the growing and highly vulnerable population of sexually-active and drug- and justice-involved women has not been documented. Among this population, this study aims to: 1) describe characteristics of informal social support, including the prevalence of different types, size of networks, and frequency of receiving support; and 2) longitudinally examine the impact of informal social support on receipt of healthcare services, including drug or alcohol counseling/treatment, HIV or STD counseling/education, birth control counseling/education, reproductive healthcare, and individual counseling over a 12-month period.ResultsThe sample included 306 women in community supervision programs in New York, New York, USA, with a recent history of substance use and risky sexual behavior. At baseline, 96.1% of women reported having at least one friend or family member with whom they could discuss personal or emotional problems, 92.5% had support for tangible aid or service, 83.0% had support for sexual risk reduction, and 80.0% had support for substance use risk reduction. Women with support for substance use risk reduction were more likely than women without this type of support to receive all health services analyzed in this study. Having support for sexual risk reduction was also positively associated will receipt of all services, except reproductive healthcare. Having support for personal or emotional problems was only associated with receiving drug or alcohol counseling or treatment, while having support for tangible aid or service did not impact receipt of any health services.ConclusionsEngagement of sexually-active and drug- and justice-involved women in health services should address the availability and strengthening of informal social support, particularly ensuring individuals’ informal networks allow for discussions on the harms of risky sexual and drug use behaviors.Trial registrationClinicalTrials.govNCT01784809. Registered 6 February 2013 - Retrospectively registered.

A qualitative investigation exploring why dance festivals are risky environments for drug use and potential adverse outcomes

BackgroundDance festivals have been shown to be high-risk events for use of drugs such as ecstasy/MDMA and possible adverse effects associated with use. However, few studies have examined what makes festivals such risky environments. We aimed to determine festival-specific risk factors for adverse outcomes related to drug use.MethodsIn-depth interviews were conducted with 35 key informants in North America who deemed themselves experts in new psychoactive substances, and identified as drug checkers, sellers, or experienced users. Interviews were coded in an inductive manner, and we conducted thematic analysis to identify relevant themes.ResultsWe identified four main themes focusing on festival attendance as a risk factor for risky drug use and related outcomes: attendees inexperienced with electronic dance music parties and party drugs, risky drug purchasing, risky drug use practices, and festival-specific environmental risk factors. Festivals attract a wide array of people not experienced with party drugs, yet drugs like ecstasy are commonly sought by such individuals inside festivals. Relying on strangers inside to purchase drugs is a risk factor for purchasing adulterated product. Fear of security/police at festivals leads to risky drug-taking such as ingesting one’s full batch of drugs at the entrance. These risks are compounded by environmental factors including crowding, hot temperature, and lack of water (which lead to dehydration), long/consecutive event days (which can lead to exhaustion), and inadequate medical emergency response.ConclusionsWe determined modifiable risk factors which can both inform future research and future prevention and harm reduction efforts in this scene.

Patients discharged after opioid overdose may not always get prescriptions for naloxone or buprenorphine

Patients discharged after opioid overdose may not always get prescriptions for naloxone or buprenorphine