False-positive iFOBT in colorectal cancer screening: Association with prescription drug use in The Malaysian Cohort.

Too stressed to cope? A multiple mediation analysis of social bonds, sleep quality, and sleep disturbances in relation to prescription drug use among Chinese high school seniors

Tracing illicit and prescription drug use in a Spanish prison by combining wastewater analysis and pharmaceutical dispensing data.

The purpose of this study is to test the differential exposure hypothesis and the differential vulnerability hypothesis based on the stress-distress paradigm to examine the effects of stressors on drug use. This study hypothesizes that based on the differential exposure hypothesis, stressors influence drug use through the mediation of psychological and social stress coping resources; based on the differential vulnerability hypothesis, psychological and social coping resources interact with stressors to influence drug use; the effects on drug use vary by the types of stressors; the process by which stressors influence drug use varies by the types of drugs; the process by which stressors influence drug use varies by sociodemographic variables. The hypotheses were tested using data from a study on drug use and attitude forward drug(II). Path analysis and regression analysis using the ordinary least squares method were conducted to examine the effects of stressors on prescription drug use, Path analysis based on the censored-inflated model and a generalized linear model based on the Tweedie distribution were conducted to examine the effects of stressors on illicit drug use. The results show that the effects of stressors on drug use are explained by the differential exposure hypothesis; the effects of stressors on drug use is also explained by the differential vulnerability hypothesis; the effects of chronic strain on drug use are more consistent than those of acute life events; prescription drug use is better explained by the stress process than illicit drug use; sociodemographic variables are found to influence the stress process and drug use. The findings suggest that stress is a risk factor for increased drug use, and chronic strain, in particular, increases the use of both prescription and illicit drug; psychological and social stress coping resources serve as deterrents to drug use and particularly applicable to prescription drug use.

Violent Crime Convicted Persons (VCCPs) are at increased risk of somatic health problems over the life course. However, the topic remains insufficiently studied, particularly regarding interactions with healthcare services in high-risk groups over extended periods. This prospective study aimed to explore adverse somatic outcomes in young adult VCCPs with a history of imprisonment and their interactions with healthcare services in Sweden. In the Development of Aggressive Antisocial Behavior Study (DAABS) cohort, male VCCPs aged 18-25 (n = 266) imprisoned for violent and/or 'contact sexual offenses were clinically assessed in 2010-2012 and prospectively followed in Swedish national registries throughout 2017. Information regarding somatic inpatient healthcare utilization (HCU), somatic morbidity, and prescribed drug use was tracked and compared with a general population comparison group (n = 10,000). Baseline risk factors were used to explore prospective somatic inpatient HCU in VCCPs. The DAABS cohort exhibited higher rates of both somatic outpatient (IRR = 1.8 [1.6-2.5]) and inpatient (IRR = 3.3 [2.2-4.9]) healthcare utilization compared with the general population group. They also showed a higher cumulative incidence of injuries of all types (IRR = 3.1 [2.4-4.0]), as well as ambulatory care sensitive conditions (ACSCs) (IRR = 2.2 [1.5-3.2]). Increased rates of prescription drug use were observed for nervous and respiratory systems, whereas reduced rates were especially noted in drugs used for the alimentary tract and metabolism as well as blood and blood forming organs. The DAABS cohort exhibited a severely elevated risk of all-cause mortality (HR 16.1 [9.4-27.8]). Low educational attainment decreased the incidence rate, while foster home placement and the assignment to a persistent offending trajectory increased the incidence rate of somatic inpatient HCU within the cohort. The VCCP cohort exhibited atypical patterns of somatic healthcare utilization, characterized by elevated inpatient and outpatient use, high rates of ACSCs and injuries, and a strikingly increased risk of premature mortality compared with the general population. The atypical nature of this utilization, reflected in the elevated incidence of ACSCs, underscores the need to improve understanding of the group's HCU patterns and the potential barriers to primary care. Enhancing health literacy and reducing barriers to timely and appropriate care are essential steps toward mitigating adverse health outcomes and promoting healthcare equity in this vulnerable population.

Prescription drug misuse disproportionately impacts American Indian communities, yet limited research explores how trust in healthcare settings affects behaviors related to prescription drug use. Using data from a 2017 cross-sectional survey of 781 American Indian adults in the Plains region, this study aims to examine the association between trust in health information provided by physicians and the misuse of prescribed medication, while identifying demographic and structural factors that influence trust levels. To assess trust, the study utilized a tool consisting of questions adapted from the Health Information National Trends (HINTS) survey, which asked respondents to rate how much they trust health and medical information from their doctors. Results showed that 29.3% of participants reported high trust in provider information. Trust was significantly higher among women, individuals with private insurance, and those with a personal healthcare provider. Notably, participants who misused prescription drugs reported significantly lower trust (30.0%) than those who did not (40.0%). The study concludes that while historical trauma influences mistrust, structural factors like continuity of care and regular provider access are vital. Improving patient-provider relationships may reduce medication misuse and associated risks like antibiotic resistance.

Chronic stress is a global issue with detrimental effects on health and productivity, often leading individuals to adopt health‐related coping strategies. This study uses an adapted Job Demands–Resources model to examine how various job demands and resources impact perceived stress and, consequently, the use of legal, prescription, and illegal drugs for enhancement purposes. Utilizing multiple waves from a nationwide sample of the working population in Germany ( N = 7,705), structural equation models reveal that certain job demands increase perceived stress, while several resources mitigate it. Stress mediates the relationship between these factors and the use of legal and prescription drugs for cognitive enhancement. Illegal drug use was only directly impacted by selected job demands and resources. Thereby, this study expands the Job Demands–Resources model's applicability to include health‐related behaviors like drug use. Practically, it calls for multidimensional strategies to prevent potentially health‐endangering drug use, including structural improvements and individual interventions.

Internet gaming disorder (IGD) and nonmedical prescription drug use (NMPDU) are prevalent, co-occurring concerns among young adults. Although prior research links problematic gaming and substance misuse, few studies have examined this relationship in non-college populations or whether student status modifies this association. This study examined the relationship between Gaming Addiction Scale (GAS) score and NMPDU among 1022 Rhode Island young adults aged 18 to 25. In the total sample, 44.6% identified as cisgender heterosexual female, 42.4% as sexual or gender minority (SGM), and 13.0% as cisgender heterosexual male. Multivariable logistic regression estimated the adjusted association between GAS scores and NMPDU, and an interaction term between GAS and student status was tested. Overall, 12.1% reported lifetime NMPDU. Higher GAS scores were associated with increased odds of NMPDU (adjusted odds ratio [AOR] = 1.05; 95% confidence interval [CI]: 1.01-1.09). Student status alone was not significantly associated with NMPDU; however, a significant interaction was observed between GAS and student status (AOR = 1.09, 95% CI: 1.01-1.18, p = 0.031). Higher GAS scores were positively associated with NMPDU, with student status strengthening this association. Findings support screening for problematic gaming, particularly among students, and integrated prevention strategies addressing both behavioral and substance-related risks.

The prodromal phase of amyotrophic lateral sclerosis (ALS) is poorly defined. We aimed to characterize prescription drug use patterns in the pre-diagnostic period by analyzing nationwide prescription data to identify the earliest divergence between individuals who developed ALS and matched healthy controls. We used this divergence as an indirect marker to estimate the onset and duration of the prodrome. We conducted a nested case-control study using nationwide Norwegian registries (2005-2019). ALS cases were individually matched to 100 controls by sex, age, and education level using incidence density sampling. Drug prescription data were gathered from the Norwegian Prescription Database (NorPD). We calculated prescription rates up to 10 years before diagnosis, performed lag-time analyses, and used machine learning to predict ALS based on drug prescription patterns. We identified 2,084 incident patients with ALS and 208,400 matched healthy controls. Overall, changes in prescription patterns occurred 2 to 3 years before ALS diagnosis. Among specific drug groups, 25 of 42 therapeutic drug classes were prescribed more frequently to patients with ALS than matched controls. Muscle relaxants and bone disease treatments were prescribed significantly more frequently 6 and 5 years before diagnosis, respectively. Prescription pattern changes occurred as early as 6 years before ALS diagnosis. These findings are consistent with a prodromal phase preceding the clinical stage of ALS, which may last several years. In contrast, the broad increase in medication use during the final year before diagnosis likely reflects increased health care utilization as patients seek treatment for the various emerging symptoms of the clinically manifest disease. ANN NEUROL 2026.

Background While non-medical use of prescription drugs (NMUPD) differs across sex and age groups, little is known about how NMUPD differs based on overlapping socioeconomic, health, and substance use characteristics. Methods We identified patterns in the probability of NMUPD using chi-square automatic interaction detection (CHAID) analysis. Eighteen sociodemographic, health, and substance use variables were sourced from the 2023 Canadian Substance Use Survey from 32,586 respondents aged 15 and older. Results Overall, 2.2% of our sample engaged in NMUPD. Illegal drug use, self-rated mental health, disability, and student status emerged as key predictors of NMUPD. In a model without specific prescription drug use indicators, we observed the highest probability of NMUPD among individuals who used illegal drugs, particularly youth and young adults with a disability (25.0%). In a model with three specific prescription drug use indicators, males who used illegal drugs, prescription stimulants, and prescription opioids had the highest probability of NMUPD (74.5%). Conclusion Our findings show clear patterns in NMUPD among this general population sample, especially related to illegal drug use, age, sex, disability, and mental health. It is important to consider how sociodemographic, health, and substance use factors work together to shape risks of NMUPD.

BackgroundMedication use during pregnancy is common but safety data remain limited. The FDA previously categorized drugs from A-X, later replaced by the Pregnancy and Lactation Labeling Rule (PLLR), which provides narrative risk summaries, clinical considerations, and supporting data.ObjectiveTo assess the safety of medications prescribed to pregnant women in Midwestern Brazil using both FDA categories and the PLLR.MethodsThis cross-sectional study reviewed medical records of women receiving prenatal care at a university outpatient clinic in Goiânia, Brazil. Patient characteristics, prescribed medications, and trimester of use were recorded. Each drug was classified by FDA categories and evaluated for PLLR structure.ResultsOf 93 women, 76 (81.7%) received at least one prescription (41 drugs; 241 prescriptions), most during the first trimester (61.8%). Supplements were the most frequent (38.6%), followed by analgesics/anti-inflammatory (26.6%) and gastrointestinal agents (17.0%). FDA categories were: 14.6% A, 41.5% B, 29.3% C, and 7.3% D. Under PLLR, 17 drugs (41.5%) had complete information; among 24 incomplete labels, the Data section was most often missing (46.3%), followed by Clinical Considerations (14.6%).ConclusionsMost women received medications, mainly supplements and analgesics. Although FDA categories suggested low apparent risk, PLLR assessment revealed information gaps that limit evidence-based prescribing.

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia although often asymptomatic and undiagnosed. AF is associated with an increased stroke risk that can be mitigated with anticoagulation. Heart rhythm monitoring with implantable loop recorders (ILR) is efficacious in the detection of asymptomatic AF which allows for preventive measures. The study aimed to examine whether screening with ILR and anticoagulation upon AF detection was cost-effective to prevent stroke. The study was designed as a cost-utility analysis alongside a randomised clinical trial. Its perspective was that of the health care and social care sector in Denmark. The time horizon was three years. Participants aged 70-90 years old with additional risk factors for AF and stroke were randomised to receive an ILR with anticoagulation upon detection of AF or to a control group. Quality-of-life (QoL) data were collected with the EQ-5D-5L instrument at baseline, 12, 24 and 36 months of follow-up. Danish tariffs were used to convert to health status measures to a QoL score to estimate quality-adjusted life-years (QALYs). Data on the participants' use of health care, social services and prescription drugs were found in Danish administrative registers. No participants had missing resource use data. Cost of the intervention with ILR was collected during the trial. Multiple imputation was performed to account for missing QoL data. Official tariffs, prices and agreements for health care, social services and medicines were used to estimate costs. All costs were calculated in 2022 prices. The costs and QALYs were discounted using an annual discount rate of 3.5%. Adjusting for 12 months of pre-baseline costs, the mean total discounted cost over the three years of follow up was 21,604 (95% CI 9,553 to 33,655) Danish kroner (DKK) higher in the ILR group than in the control group (1 DKK = 0.13 €). Adjusting for QoL at baseline, participants in the ILR group achieved an average of 2.2944 QALYs compared to 2.2807 QALYs in the control group. This is a difference of 0.0137 QALYs (95% CI -0.0091 to 0.0364). The probability of the ILR screening being cost-effective was less than 26% for defined threshold values for willingness to pay up to one million DKK per QALY gained. Screening for AF in 70-90-years-olds with an implantable loop recorder was not cost-effective within a time horizon of three years.

To identify the patterns and trends in prescription drug use and misuse in patients on opioid agonist treatment. We used data from the OPPIDUM programme, which collects data from patients attending substance abuse treatment facilities. Data collected include use of psychoactive prescription drugs in the past week. In this cross-sectional study, we included patients aged at least 18 years, on opioid agonist treatment and reporting psychoactive prescription drug use in the past week from 2014 to 2023. The outcome was psychoactive prescription drug misuse (i.e., abuse and/or dependence, illegal acquisition and diverted route of administration) in the past week. We conducted disproportionality analyses to identify prescription drugs associated with misuse. We calculated the prevalence of use and misuse for each prescription drug to estimate trends. We included 9631 patients. Misuse was disproportionately reported for morphine (e.g., diverted route of administration: n =580; reporting odds ratio: 224.4 [95% confidence interval: 178.8, 281.7]), methylphenidate (e.g., diverted route of administration: 149; 31.6 [24.1, 41.4]), oxycodone (e.g., diverted route of administration: 24; 20.2 [11.1, 36.8]), clonazepam (e.g., illegal acquisition: 48; 6.0 [4.0, 9.0]) and fentanyl (e.g., diverted route of administration: 6; 5.8 [2.3, 14.8]). Trends in misuse paralleled trends in use for most prescription drugs. The sharpest increase in misuse included abuse and/or dependence (+2366%, from 0.9 per 1000 patients in 2014 to 23.0 per 1000 patients in 2023) for pregabalin. Conversely, the sharpest decrease in misuse included illegal acquisition (-59%, from 82.1 per 1000 patients in 2014 to 33.9 per 1000 patients in 2023) for morphine. In this population, prescription drug misuse primarily included opioid analgesics and increasingly pregabalin. Given the risk of opioid overdose, access to take-home naloxone should be further improved.

Prior authorizations (PAs) help ensure appropriate prescription drug use but can be time-consuming for prescribers, clinic staff, and patients. Having a centralized, pharmacy-led PA process has shown significantly lower time to approval when compared with other decentralized models. However, the administrative impact of processing PA requests for glucagon-like peptide-1 (GLP-1) agonists prescribed for weight loss is unknown. To compare the total staff time spent on GLP-1 agonists prescribed for weight loss vs GLP-1 agonists for diabetes and other prescription medications. This prospective observational study was conducted at UC Davis Health, a large academic health system from October 2024 to April 2025. Six licensed pharmacy technicians from a centralized pharmacy PA team participated in a self-reported time survey. PA tasks were categorized into 3 groups: (1) GLP-1 agonists for weight loss, (2) GLP-1 agonists for diabetes, and (3) top 10 non-GLP-1 agonist medications processed by volume at UC Davis Health. The primary outcome is defined as total hands-on time per PA, measured from PA initiation to removal from the pharmacy technician's work queue following the final decision by the third-party payer. A sample size of 50 PAs per group was selected based on projected mean PA process times of 10 minutes for weight loss GLP-1 agonists and 7 minutes for diabetes GLP-1 agonists (β = 0.2, α = 0.05). The Mann-Whitney U-test was applied to compare continuous variables (hands-on time, cost), whereas the Fisher's exact test was used for dichotomous variables (approval rate). A total of 150 PAs were collected. A self-reported time survey showed that weight loss GLP-1 agonists were associated with a significantly higher mean time per PA (7.1 minutes; 95% CI = 3.4-10.8; P < 0.0001), lower approval rate at 48% vs 90% (odds ratio [OR] = 0.10, 95% CI = 0.04-0.31; P < 0.0001), and higher mean cost per PA ($6.74; 95% CI = 3.21-10.27) compared with diabetes GLP-1 agonist medications. The PA process for weight loss GLP-1 agonists was longer (7.2 minutes; 95% CI = 3.3-11.1), more costly ($6.77; 95% CI = 3.08-10.46), and less likely to be approved (48% vs 90%; OR = 0.17; 95% CI = 0.07-0.44) compared with non-GLP-1 agonist medications. There were no differences between the diabetes GLP-1 agonist and top 10 non-GLP-1 agonist medications. Total hands-on time spent on GLP-1 agonists prescribed for weight loss was significantly longer compared with GLP-1 agonists for diabetes and other non-GLP-1 agonist medications. Additionally, GLP-1 agonists for weight loss had lower approval rates and higher cost per PA.

War-related evacuation is a stressful event that may cause mental health problems, which, in turn, might lead to increases in substance and behavioural addictions. We used data collected online during the Swords of Iron to examine associations between being evacuated during the war, mental health, problematic substance use, and behavioural addictions. Study 1 surveyed young adults (ages 18-26) from various areas of Israel. Measures included self-reported anxiety, depression, problematic consumption of alcohol, cannabis, and prescription drugs, and problematic gambling, gaming, and pornography. Evacuees (n=111) reported higher levels of anxiety, depression, problematic alcohol consumption, and problem gambling than non-evacuees (n=973), with increased depression, problematic alcohol consumption and problem gambling among men. In Study 2, we used data from a quasi-representative sample of Jewish Israelis (ages 18-70), that included the same measures, in addition to problematic social media and internet usage. Findings replicated and extended those of Study 1: evacuees (n=158) had higher rates of problematic use of all the assessed outcomes, compared to those not evacuated (n=2485), with increased problematic use of alcohol, prescription drug, and gambling among men. In both Studies, the results held when controlling for exposure to war stressors and feelings of danger during the war, indicating that evacuation had a unique effect beyond the primary trauma of war. We discuss the limitations of the current research and consider its implications to addiction theory and gender differences in addictions and offer directions for future research and clinical considerations.

The nonmedical use of prescription drugs (NMUPD) through channels outside the healthcare system has emerged as a significant public health issue; however, its clinical implications in overdose cases remain underexplored in Japan. This study aimed to elucidate the prevalence and characteristics of NMUPD in patients with acute drug overdose. In this observational study, we retrospectively studied patients with overdose who were admitted to a tertiary emergency department in Japan between April 2017 and March 2024. Patients were categorized into the NMUPD group (obtained drugs via nonmedical routes, such as family, acquaintances, the Internet, and unauthorized workplace access) and prescribed group. Demographic, clinical, and overdose-related variables were compared between the groups. Statistical analyses included the chi-square and Mann-Whitney U tests, with multiple imputation for missing data. Among the 416 patients with overdose, 7.9% met the NMUPD criteria. The primary sources of NMUPD were family members, followed by friends/acquaintances, Internet purchases, and unauthorized pharmacy access. The NMUPD group showed significantly higher rates of alcohol coingestion (p = 0.029) and absence of psychiatric diagnoses (p = 0.009). Benzodiazepines predominated in both groups, with frequent use of non-benzodiazepine and antidepressants. This study revealed that NMUPD occurs even within Japan's tightly regulated healthcare system, primarily via informal sources such as patients' families and friends. NMUPD was linked to alcohol coingestion and limited psychiatric follow-ups. NMUPD involved several commonly prescribed psychotropic drug classes rather than a single class.

Rectal cancer survivors are at risk of late adverse effects that impair quality of life. This study evaluates the cost-utility of a patient-led follow-up programme introduced in the Danish FURCA randomised controlled trial (RCT), aimed at improving patient outcomes and optimising healthcare resource use compared to standard hospital-based follow-up. The cost-utility analysis was performed from a societal perspective over a 3-year horizon, incorporating healthcare costs, prescription drug use, productivity losses, all derived from Danish register data, and quality-adjusted life years (QALYs) derived from RCT-collected EQ-5D-5L data. Incremental cost-effectiveness was assessed using regression models and non-parametric bootstrapping, with subgroup and sensitivity analyses exploring heterogeneity in outcomes. A total of 336 patients were randomised to intervention and control groups. Over 3 years, mean healthcare costs were €40,208 for the intervention group and €41,190 for the control group (difference -€980; 95% CI -€7120 to €5159). Mean QALYs were 2.24 and 2.20, respectively (difference 0.028; 95% CI -0.106 to 0.163). The incremental cost-effectiveness ratio was -€35,048 per QALY gained, indicating dominance. Scatterplots of bootstrapped incremental cost-effectiveness ratios (ICERs) revealed iterations in all four quadrants, reflecting substantial uncertainty in both costs and effects. The probability of cost-effectiveness at a €30,000 threshold was below 70%. Patient-led follow-up resulted in comparable QALYs and costs relative to standard hospital-based follow-up. The probability of cost-effectiveness at a conventional willingness-to-pay threshold reached up to 70%. Patient-led models may enable tailored delivery of specialist care to patients with greatest need, alongside balanced resource utilisation.

Substance use disorder (SUD) is a rapidly growing public health challenge in developing countries across socioeconomic divides. In sub-Saharan Africa, the situation of SUD is particularly concerning and largely unexplored, with projections indicating a worsening trend. This study seeks to fill the gap by generating insights into the multifaceted nature of alcohol and drug use disorders among a young adult population in Nigeria. This is a cross-sectional survey of 192 current students at a university of a metropolitan city in North-Western Nigeria, using the NIDA-Modified ASSIST version 2.0, adapted from the Alcohol, Smoking and Substance Involvement Screening Test. About half of the participants (49.7%) were heavy drinkers, 36.5% and 56.8% reported past year tobacco smoking and use of prescription drugs for non-medical reasons, but only 7.4% had used illegal drugs daily in the past year. Cannabis and sedatives were the most used substances in the lifetime (56.2% and 47.9%, respectively) and past 3 months (52.4% and 51.1%, respectively). Men had greater odds of substance use in their lifetime (odds ratio 4.167, 95% CI 1.61-10.77; d.f. = 1, P = 0.003) and past three months (odds ratio 6.059, 95% CI 2.20-16.69; d.f. = 1, P ≤ 0.001), compared with women. The burden of SUD remains a major public health concern in Nigeria despite existing legislation, regulations and policies in the country. There is an urgent need improve diagnostic, treatment and preventative resources by engaging a massive public health campaign to alert the public of the dangers of SUD.

This study investigates how the public announcement of very high levels of the toxic chemicals PFAS in the drinking water in Kallinge, Sweden, impacted the health of local residents. By leveraging the unexpected timing of the announcement and utilizing high-frequency individual-level healthcare data, we can isolate the effects of the information shock independently of any toxic effects of PFAS exposure. Despite numerous reports of distress and concern among those affected, our analysis reveals no significant increase in health care utilization following the announcement, as measured by prescription drug use and specialist healthcare visits. This finding holds true even when specifically examining mental health-related care, prescriptions of antidepressants, and sleeping medications. Overall, our results suggest that both the affected community and public authorities managed the situation effectively, mitigating potential health consequences related to anxiety.

State legislations mandating prescriber use of Prescription Drug Monitoring Programs (PDMPs) may have the unintended consequence of restricting opioid analgesics to patients dying of cancer. This study aims to assess associations of comprehensive PDMP mandates with opioid-related outcomes for patients dying of cancer, overall and by decedent race and ethnicity. Study population were Medicare decedents who were age 66 years or older, diagnosed with breast, colorectal, lung, or prostate cancer, and died of cancer in 2011-2019. This cross-sectional study used SEER-Medicare data and a difference-in-differences design. Study sample included decedents from 10 states with an operating PDMP on January 1, 2011. Outcomes included the dichotomous event of having one or more opioid days, total and daily morphine milligram equivalents (MMEs) if having opioids, near the end of life. Generalized linear models were estimated for dichotomous (logit link function) and continuous (log) outcomes. This study included 115,256 decedents. Comprehensive PDMP mandates were associated with modest reductions in the rate of one or more opioid days (from 45.1% to 43.9%, difference = 0.011 [95% CI, -0.019 to -0.003]), total dose (from 1,600.6 to 1,521.0 MMEs, difference = 79.6 [95% CI, -131.5 to -27.6]), and daily dose from all opioids (from 75.7 to 72.9 MMEs, difference = 2.7 [95% CI, -5.1 to -0.4]). Compared with non-Hispanic White decedents, Black decedents experienced a four-fold reduction, and Asian/Pacific Islander decedents experienced a two-fold reduction, in the rate of one or more opioid days. Comprehensive PDMP mandates were associated with modest reductions in opioid analgesics dispensed to Medicare patients dying of cancer. Non-Hispanic Black and Asian/Pacific Islander decedents experienced larger reductions.