Abuse of drug substances and resultant overdose deaths are no longer very straightforward—viz., attributable to a single chemical entity of known purity. The reality is that most overdose deaths involve polysubstance...Abuse of drug substances and resultant overdose deaths are no longer very straightforward—viz., attributable to a single chemical entity of known purity. The reality is that most overdose deaths involve polysubstance use (i.e., the use of combinations of substances). Further, the combinations are often of unknown purity, and even of unknown composition. Overdose deaths are at all-time highs. The depressing statistics are monitored and reported by several international and governmental organizations such as the WHO (World Health Organization), CDC (Centers for Disease Control and Prevention), several Institutes of the NIH (National Institutes of Health), Regulators, and Enforcement Agencies (e.g., DEA). The information is disseminated for free for review and use. But it is our observation that although numeric presentation is helpful and adequate for professionals, the non-expert and the visual learner often find a visual representation clearer and compelling. With this in mind, we present the “gestalt” of polysubstance use and overdose using available maps of the data. The previous article in the series considered the opioids. This one considers amphetamines and cocaine, and places the rise in opioid-associated overdose deaths in the context of other abused drugs.展开更多
Background: Prenatal exposure to fentanyl may lead to Neonatal Abstinence Syndrome (NAS), a constellation of symptoms observed when newborns begin withdrawing from addictive substances such as opioids. The use of umbi...Background: Prenatal exposure to fentanyl may lead to Neonatal Abstinence Syndrome (NAS), a constellation of symptoms observed when newborns begin withdrawing from addictive substances such as opioids. The use of umbilical cord tissue segments (UC) for newborn toxicology has been increasing due to its apparent long detection window, sensitivity, and ease of collection. However, very little has been reported in the literature concerning the prevalence of in utero exposure to fentanyl and co-exposure with other commonly abused substances. Specific aim: The specific aims of this retrospective study are twofold. We will report prevalence of neonatal exposure to fentanyl for a nationwide high-risk population using UC submitted to a national reference laboratory for routine forensic toxicology analysis and the co-exposure patterns observed for these fentanyl-exposed neonates. Methods: A secondary analysis was performed using historical data for UC received between January 1, 2020 and December 31, 2020 for routine forensic toxicology analysis. Results: During the study period, our laboratory received 23,104 UC for analysis and 9667 (41.8%) of those UC were positive for at least one drug. The prevalence of fentanyl detection was 1.9% (n = 429). Of these 429 specimens there were 407 UC where both fentanyl and norfentanyl were detected. There were 14 UC where only fentanyl was detected and 8 UC where only norfentanyl was detected. When detected, the median concentrations of fentanyl and norfentanyl were 4029 pg/g (IQR: 1696, 9230 pg/g) and 10,756 pg/mg (IQR: 3925, 25,288 pg/g), respectively. Of the 429 positive fentanyl and/or norfentanyl UC, 33 (7.7%) were only positive for fentanyl and/or norfentanyl. Of the 396 polypositive UC, morphine was the highest co-exposure with 243 UC (56.6%) being positive for both fentanyls and morphine. The second most prevalent co-exposure observed was methamphetamine/amphetamine (n = 173;40.3%) followed by cannabinoids (n = 113;26.3%) and benzoylecgonine (cocaine metabolite;n = 106;24.7%). Conclusions: Nonmedical use of fentanyl is an alarming trend in this country including this maternal demographic reported here. Fentanyl was typically found with other commonly abused substances.展开更多
Polysubstance (combinations of substances) abuse and overdose deaths now surpass mono-substance abuse and overdose deaths. Several international and governmental organizations such as the WHO (World Health Organizatio...Polysubstance (combinations of substances) abuse and overdose deaths now surpass mono-substance abuse and overdose deaths. Several international and governmental organizations such as the WHO (World Health Organization), CDC (Centers for Disease Control and Prevention), several of the Institutes of the NIH (National Institutes of Health), Regulators, and Enforcement Agencies, among others, track and provide a valuable source of statistical information about drug (prescription and illicit) (mis)use and overdose. The information is disseminated free to stakeholders and the general public for use. Although the numeric presentations of the data are helpful and adequate for professionals, the non-expert and the visual learner often find visual representation more clear and more compelling. With this in mind, the aim of this study was to present polysubstance use and overdose using visual maps of the available data. This article considers the opioids.展开更多
Introduction: Nursing students’ experiences during the pandemic provoked social isolation, the way to learn and every context increasing their stress and anxiety leading to drug use and abuse, among others. Problem-b...Introduction: Nursing students’ experiences during the pandemic provoked social isolation, the way to learn and every context increasing their stress and anxiety leading to drug use and abuse, among others. Problem-based learning (PBL) is a pedagogic strategy to strengthen significant learning;then the objective was to establish PBL influence in nursing students’ experiences on drug use and abuse during COVID-19 contingency. Methods: Qualitative, phenomenological and descriptive paradigm, 12 female and male nursing students aged 20 - 24 years old from the 5<sup>th</sup> and 6<sup>th</sup> semesters participated. Information collection was through semi-structured interview and a deep one in four cases. A guide of questions about: How the pandemic impacted your life? How did you face it? And what did you learn during this process? Those questions were used. Qualitative data analysis was based on De Souza Minayo, and signed informed consent was obtained from participants. Results: Students’ experiences allowed four categories to emerge, with six sub-categories. Category I. Students’ experiences on drug use and abuse facing the sanitary contingency;Category II. Students’ skills development to identify a problem and design of appropriate solutions;Category III. Developing skills to favor interpersonal relationships;Category IV. Influence of PBL in nursing students’ experiences on drug use and abuse during the COVID-19 contingency. Conclusion: PBL favored analysis and thoughts in nursing students’ experiences on drug use and abuse during the COVID-19 contingency, they worked collaboratively, developed resilience to daily life situations, and implemented stress coping strategies with their significant learning, which diminished their risk behavior.展开更多
The purpose of this study was to describe the prevalence of co-occurring polysubstance use and to examine the differences in physical disease between polysubstance users and single/no substance users with mental disor...The purpose of this study was to describe the prevalence of co-occurring polysubstance use and to examine the differences in physical disease between polysubstance users and single/no substance users with mental disorders. This retrospective cross-sectional study included 1949 clinical records of psychiatric patients from 11 residential treatment programs between 2007 and 2011. Demographic variables, psychiatric diagnoses, and data on substance use and physical disease were obtained from the clinical records. Chi-square analyses were used to examine substance use difference in the prevalence of each physical disease category. This study found that the prevalence of co-occurring polysubstance use was 53.5%. Chi-square analyses identified that co-occurring polysubstance users reported more respiratory, digestive, musculoskeletal, and HIV/AIDS diseases but less endocrine diseases than single/no substance users. Therefore, integrated treatment programs for treating patients with co-occurring substance use and physical disease should be developed and expanded for this high-risk group.展开更多
BACKGROUND Problematic Internet use(PIU)or Internet addiction has been recognized to be a behavioral addiction characterized by excessive or poorly controlled preoccupations,urges,or behaviors regarding computer use a...BACKGROUND Problematic Internet use(PIU)or Internet addiction has been recognized to be a behavioral addiction characterized by excessive or poorly controlled preoccupations,urges,or behaviors regarding computer use and Internet access that leads to impairment or distress resembling substance abuse.AIM To investigate the prevalence and characteristics of Internet use and abuse in a group of drug addicts from Southern Italy,by means of a specific questionnaire[“Questionario sull’Utilizzo delle Nuove Tecnologie”(QUNT)].METHODS All subjects(183)were heavy smokers,almost 50%of them used heroin and/or opioid compounds,30%alcohol,10%cannabis,8%cocaine,and 5%were polydrug users.Almost 10%of the individuals were also suffering from gambling disorder.RESULTS The time spent online was more than 4 hours a day in the total sample,with a slight prevalence in male subjects.Cocaine and cannabis users spent more than 6 hours online,significantly more than opioid and alcohol abusers.Distribution of the QUNT factors was not different in both sexes.Cocaine users showed higher scores at the“loss of control”,“pornography addiction”,and“addiction to social networks”factors,for the stimulant effect of this substance.Moreover,15 out of the total 17 cocaine users were pathological gamblers.Positive and statistically significant relationships were observed between some QUNT factors and body mass index.CONCLUSION These findings indicate that PIU is less severe in subjects taking sedative substances,such as heroin/opioids and alcohol,than in subjects taking stimulants.Alternatively,it may be used as a“stimulant”trigger in cocaine and cannabis users.Flattening effect of abuse drugs was noted on possible sex-related differences in QUNT items.We observed a sort of“protective”effect of a love relationship and/or living together with a partner,as those engaged subjects showed lower scores on different items than single subjects or those living alone.The relationship between time spent online(and related sedentary lifestyle)and body mass index would suggest that Internet use might be a contributing factor to increasing weight gain and obesity amongst adolescents and young adults worldwide.Our findings also highlighted the specific vulnerability of drug addicts who use stimulants,rather than sedative compounds,to other kinds of behavioral addictions,such as gambling disorder.展开更多
BACKGROUND: Inadvertent intra-arterial injection of illicit substances is a known complication of injection drug use and can lead to severe complications, including infection, ischemia and compartment syndrome. Identi...BACKGROUND: Inadvertent intra-arterial injection of illicit substances is a known complication of injection drug use and can lead to severe complications, including infection, ischemia and compartment syndrome. Identifying complications of intra-arterial injection can be difficult, as clinical manifestations overlap with other more common conditions such as cellulitis and soft tissue infection, and a history of injection drug use is frequently not disclosed.METHODS: A 37-year-old male patient presented with 24 hours of right hand pain, erythema and swelling. Despite classic "track marks", he denied a history of injection drug use, and vascular insults were not initially considered. After failing to respond to three days of aggressive treatment for suspected deep-space infection, an arteriogram demonstrated findings consistent with digital ischemia of embolic etiology.RESULTS: As a result of the delay in diagnosis, the lesion was not amenable to reperfusion and the patient required amputation of the distal digit.CONCLUSION: Practitioners should be alert to the possibility of intra-arterial injection and resulting complications when evaluating unusual extremity infections or unexplained ischemic symptoms, even in the absence of a definite history of injection drug use.展开更多
Alcohol use disorder is a complex and heterogeneous phenomenon that can be studied from several points of view by focusing on its different components.Alcohol is a hepatotoxin whose metabolism creates profound alterat...Alcohol use disorder is a complex and heterogeneous phenomenon that can be studied from several points of view by focusing on its different components.Alcohol is a hepatotoxin whose metabolism creates profound alterations within the hepatocyte.The liver is the central organ in the metabolism of alcohol,a process that also involves other organs and tissues such as the brain,heart and muscles,but the most relevant organ is the liver.The anatomopathological alterations in the liver associated with the prolonged use of alcohol range from the simple accumulation of neutral fats in the hepatocytes,to cirrhosis and hepatocellular carcinoma.Alcohol abuse frequently leads to liver disease such as steatosis,steatohepatitis,fibrosis,cirrhosis,and tumors.Following the spread of coronavirus disease 2019(COVID-19),there was an increase in alcohol consumption,probably linked to the months of lockdown and smart working.It is known that social isolation leads to a considerable increase in stress,and it is also recognized that high levels of stress can result in an increase in alcohol intake.Cirrhotic patients or subjects with liver cancer are immunocompromised,so they may be more exposed to COVID-19 infection with a worse prognosis.This review focuses on the fact that the COVID-19 pandemic has made the emergence of alcohol-induced liver damage a major medical and social problem.展开更多
A systematic field survey of 6,567 urban and rural residents out of 3.000 households, through cluster sampling among Beijing residents, was collaborativelv conducted. The results reveal that benzodiazepine has been wi...A systematic field survey of 6,567 urban and rural residents out of 3.000 households, through cluster sampling among Beijing residents, was collaborativelv conducted. The results reveal that benzodiazepine has been widely prescribed and its rate of usage for 1 year is 61.82%. whereas rate of de-展开更多
Patients with chronic pancreatitis often experience severe,unrelenting abdominal pain,which can significantly impact their quality of life.Pain control,therefore,remains central to the overall management of chronic pa...Patients with chronic pancreatitis often experience severe,unrelenting abdominal pain,which can significantly impact their quality of life.Pain control,therefore,remains central to the overall management of chronic pancreatitis.Most of the strategies aimed at treating the pain of chronic pancreatitis are based on expert opinion and vary from one institution to another,as there are no uniform guidelines to direct a stepwise approach towards achieving this goal.In this editorial,we comment on best practice strategies targeted towards pain control in chronic pancreatitis,specifically highlighting the use of opioid medications in this patient population.We discuss various safe and efficacious prescription monitoring practices in this article.展开更多
Research has indicated that child maltreatment is associated with an increased likelihood of mental disorders and suicidal ideation and attempts that continues into adulthood. The purpose of this paper is to provide a...Research has indicated that child maltreatment is associated with an increased likelihood of mental disorders and suicidal ideation and attempts that continues into adulthood. The purpose of this paper is to provide a synopsis of the recent published research from 2006 to 2010 on the association between child maltreatment and Axis I mental disorders and suicidal ideation and attempts. The databases MEDLINE and PsycINFO were searched for relevant and high quality citations up to October 2010. The results indicated that all types of child maltreatment examined are linked to reduced mental health. A general noted trend in the literature is that earlier age of onset of child maltreatment is associated with poorer mental health outcomes. Sex differences do exist with some disorders being more likely among males (e.g., anti-social behaviour) and other more likely among females (e.g., depression, PTSD, substance use disorders) following child maltreatment.展开更多
<span style="font-family:Verdana;">The </span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">opioid crisis</span><sp...<span style="font-family:Verdana;">The </span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">opioid crisis</span><span style="font-family:Verdana;">”</span><span style="font-family:""><span style="font-family:Verdana;"> has had a tremendous impact not only on its victims, but also on the practice of medicine, pain patients, and society in general. Unfortunately, efforts to “stem the tide” have not been successful at reducing overdose deaths. Counterbalancing the many ardent efforts to eliminate overdose deaths (such as the current widespread availability and use of opioid-receptor antagonists such as naloxone) is influx of the illicit fentanoids (</span><i><span style="font-family:Verdana;">i.e</span></i><span style="font-family:Verdana;">., fentanyl and analogs). In addition to their high-potency, the fentanoids differ in surprising ways from more “traditional” opioids such as morphine and heroin. This uniqueness contributes to a reduced effectiveness of opioid receptor antagonists in the treatment of opioid overdose. Further greatly complicating overdose treatment is polysubstance abuse (e.g., an opioid plus a benzodiaze</span><span style="font-family:Verdana;">pine). The non-opioid in the combination is not responsive to an opio</span><span style="font-family:Verdana;">id-recep</span></span><span style="font-family:Verdana;">- </span><span style="font-family:""><span style="font-family:Verdana;">tor antagonist, which imparts additional challenges. Thus, the new reality in</span><span style="font-family:Verdana;">troduces complications that negatively impact efforts to reverse </span></span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">opioid</span><span style="font-family:Verdana;">”</span><span style="font-family:""><span style="font-family:Verdana;"> overdose. New approaches to improve outcomes in individuals who experience </span><span style="font-family:Verdana;">respiratory depression due to fentanoid-induced or polysubstance-induced</span><span style="font-family:Verdana;"> over</span></span><span style="font-family:Verdana;">- </span><span style="font-family:Verdana;">dose are needed. Approaches that harmonize with the new reality, perhaps something like a non-opioid </span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">agnostic</span><span style="font-family:Verdana;">”</span><span style="font-family:Verdana;"> pharmacologic ventilatory stimulant, would provide a welcome addition to the current choices.</span>展开更多
Background: The majority of Veterans Affair(VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status.Methods: Veterans...Background: The majority of Veterans Affair(VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status.Methods: Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview. Mental health status, including posttraumatic stress disorder(PTSD), major depression, alcohol abuse and mental health global severity, were assessed using structured interviews. Psychiatric service use was based on self-reported utilization in the past 12 months. Results were compared between veterans residing in rural and non-rural areas. Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors.Results: A total of 1730 subjects(55% of the eligible veterans) responded to the survey and 1692 of them had complete geocode information. Those that did not have this information(n=38), were excluded from some analyses. Veterans residing in rural areas were older, more often of the white race, married, and experienced fewer stressful events. In comparison to those residing in non-rural areas, veterans residing in rural areas had lower global mental health severity scores;they also had fewer mental health visits. In multivariate logistic regression, rural residence was associated with lower service use, but not with PTSD, major depression, alcohol abuse, and global mental health severity score after adjusting confounding factors(e.g., age, gender, marital status and education).Conclusions: Rural residence is associated with lower mental health service use, but not with poor mental health in veterans with former warzone deployment, suggesting rural residence is possibly protective.展开更多
Polysubstance Abuse (PSA) greatly complicates an attempt to implicate a single drug as sole cause of an overdose death. Since PSA now occurs in the majority of cases of drug overdoses, many or most overdose deaths are...Polysubstance Abuse (PSA) greatly complicates an attempt to implicate a single drug as sole cause of an overdose death. Since PSA now occurs in the majority of cases of drug overdoses, many or most overdose deaths are polysubstance overdose deaths. And since many of the substances involved in a polysubstance Overdose Death (POD) are Central Nervous System (CNS) depressants, many of which can cause overdose death themselves, or synergistically with opioids, it is somewhat puzzling that prescription opioids have been singled out as the cause of these deaths—without reference to PSA. This is particularly puzzling in light of the fact that the issues of PSA and POD have been recognized and discussed in the literature since at least the 1960’s and before. We therefore here consider the question: are we facing an “opioid” crisis or, instead, a “polysubstance crisis”? And we wonder if the issue has been over-simplified, to the detriment of the individuals affected, and to society more broadly. There is a need for an “agnostic” respiratory stimulant that can reverse polysubstance-induced respiratory depression.展开更多
Drug abuse by pregnant women is one of the significant problems for mothers and their neonates.This study aimed to investigate the effects of maternal substance use disorder during pregnancy on neonatal developmental ...Drug abuse by pregnant women is one of the significant problems for mothers and their neonates.This study aimed to investigate the effects of maternal substance use disorder during pregnancy on neonatal developmental criteria.In a case-control study,clinical records of 90 neonates diagnosed with neonatal abstinence syndrome who were admitted to NICU in one of four hospitals affiliated with Shahid-Beheshti University of Medical Sciences in Tehran,Iran between 2017 and 2020 were compared to 90 neonates without neonatal abstinence syndrome(control group).Demographic information and data for neonatal developmental characteristics and complications were extracted from the clinical records of this convenience sample.Data for the type and method of maternal substance use during pregnancy were collected through a telephone call with mothers.Our data showed that the prevalence of drug addiction was 1.8%among pregnant women,and the most common drugs used by mothers were opium(n=45%,50%),amphetamine(n=30%,33%),and methadone(n=14%,16%).Neonates with abstinence syndrome had a higher prevalence of transient tachypnea of the newborn(TTN)(P=0.004),and a prevalence of being admitted to NICU(P=0.05)and for a longer duration(P<0.001).Their mothers had a higher prevalence of having pre-eclampsia(P=0.010).Using morphine vs.amphetamine showed no difference based on their effects on mothers and neonates.Substance use during pregnancy increased the prevalence of pregnancy complications(pre-eclampsia)and neonatal complications(TTN and prevalence and duration of hospitalization).Therefore,planning for the development of health policies to raise awareness among women and more broadly,all members of the community,is important to prevent the tendency to engage in this potentially high-risk behavior.展开更多
文摘Abuse of drug substances and resultant overdose deaths are no longer very straightforward—viz., attributable to a single chemical entity of known purity. The reality is that most overdose deaths involve polysubstance use (i.e., the use of combinations of substances). Further, the combinations are often of unknown purity, and even of unknown composition. Overdose deaths are at all-time highs. The depressing statistics are monitored and reported by several international and governmental organizations such as the WHO (World Health Organization), CDC (Centers for Disease Control and Prevention), several Institutes of the NIH (National Institutes of Health), Regulators, and Enforcement Agencies (e.g., DEA). The information is disseminated for free for review and use. But it is our observation that although numeric presentation is helpful and adequate for professionals, the non-expert and the visual learner often find a visual representation clearer and compelling. With this in mind, we present the “gestalt” of polysubstance use and overdose using available maps of the data. The previous article in the series considered the opioids. This one considers amphetamines and cocaine, and places the rise in opioid-associated overdose deaths in the context of other abused drugs.
文摘Background: Prenatal exposure to fentanyl may lead to Neonatal Abstinence Syndrome (NAS), a constellation of symptoms observed when newborns begin withdrawing from addictive substances such as opioids. The use of umbilical cord tissue segments (UC) for newborn toxicology has been increasing due to its apparent long detection window, sensitivity, and ease of collection. However, very little has been reported in the literature concerning the prevalence of in utero exposure to fentanyl and co-exposure with other commonly abused substances. Specific aim: The specific aims of this retrospective study are twofold. We will report prevalence of neonatal exposure to fentanyl for a nationwide high-risk population using UC submitted to a national reference laboratory for routine forensic toxicology analysis and the co-exposure patterns observed for these fentanyl-exposed neonates. Methods: A secondary analysis was performed using historical data for UC received between January 1, 2020 and December 31, 2020 for routine forensic toxicology analysis. Results: During the study period, our laboratory received 23,104 UC for analysis and 9667 (41.8%) of those UC were positive for at least one drug. The prevalence of fentanyl detection was 1.9% (n = 429). Of these 429 specimens there were 407 UC where both fentanyl and norfentanyl were detected. There were 14 UC where only fentanyl was detected and 8 UC where only norfentanyl was detected. When detected, the median concentrations of fentanyl and norfentanyl were 4029 pg/g (IQR: 1696, 9230 pg/g) and 10,756 pg/mg (IQR: 3925, 25,288 pg/g), respectively. Of the 429 positive fentanyl and/or norfentanyl UC, 33 (7.7%) were only positive for fentanyl and/or norfentanyl. Of the 396 polypositive UC, morphine was the highest co-exposure with 243 UC (56.6%) being positive for both fentanyls and morphine. The second most prevalent co-exposure observed was methamphetamine/amphetamine (n = 173;40.3%) followed by cannabinoids (n = 113;26.3%) and benzoylecgonine (cocaine metabolite;n = 106;24.7%). Conclusions: Nonmedical use of fentanyl is an alarming trend in this country including this maternal demographic reported here. Fentanyl was typically found with other commonly abused substances.
文摘Polysubstance (combinations of substances) abuse and overdose deaths now surpass mono-substance abuse and overdose deaths. Several international and governmental organizations such as the WHO (World Health Organization), CDC (Centers for Disease Control and Prevention), several of the Institutes of the NIH (National Institutes of Health), Regulators, and Enforcement Agencies, among others, track and provide a valuable source of statistical information about drug (prescription and illicit) (mis)use and overdose. The information is disseminated free to stakeholders and the general public for use. Although the numeric presentations of the data are helpful and adequate for professionals, the non-expert and the visual learner often find visual representation more clear and more compelling. With this in mind, the aim of this study was to present polysubstance use and overdose using visual maps of the available data. This article considers the opioids.
文摘Introduction: Nursing students’ experiences during the pandemic provoked social isolation, the way to learn and every context increasing their stress and anxiety leading to drug use and abuse, among others. Problem-based learning (PBL) is a pedagogic strategy to strengthen significant learning;then the objective was to establish PBL influence in nursing students’ experiences on drug use and abuse during COVID-19 contingency. Methods: Qualitative, phenomenological and descriptive paradigm, 12 female and male nursing students aged 20 - 24 years old from the 5<sup>th</sup> and 6<sup>th</sup> semesters participated. Information collection was through semi-structured interview and a deep one in four cases. A guide of questions about: How the pandemic impacted your life? How did you face it? And what did you learn during this process? Those questions were used. Qualitative data analysis was based on De Souza Minayo, and signed informed consent was obtained from participants. Results: Students’ experiences allowed four categories to emerge, with six sub-categories. Category I. Students’ experiences on drug use and abuse facing the sanitary contingency;Category II. Students’ skills development to identify a problem and design of appropriate solutions;Category III. Developing skills to favor interpersonal relationships;Category IV. Influence of PBL in nursing students’ experiences on drug use and abuse during the COVID-19 contingency. Conclusion: PBL favored analysis and thoughts in nursing students’ experiences on drug use and abuse during the COVID-19 contingency, they worked collaboratively, developed resilience to daily life situations, and implemented stress coping strategies with their significant learning, which diminished their risk behavior.
文摘The purpose of this study was to describe the prevalence of co-occurring polysubstance use and to examine the differences in physical disease between polysubstance users and single/no substance users with mental disorders. This retrospective cross-sectional study included 1949 clinical records of psychiatric patients from 11 residential treatment programs between 2007 and 2011. Demographic variables, psychiatric diagnoses, and data on substance use and physical disease were obtained from the clinical records. Chi-square analyses were used to examine substance use difference in the prevalence of each physical disease category. This study found that the prevalence of co-occurring polysubstance use was 53.5%. Chi-square analyses identified that co-occurring polysubstance users reported more respiratory, digestive, musculoskeletal, and HIV/AIDS diseases but less endocrine diseases than single/no substance users. Therefore, integrated treatment programs for treating patients with co-occurring substance use and physical disease should be developed and expanded for this high-risk group.
基金Supported by A grant from “Regione Calabria”,Italy
文摘BACKGROUND Problematic Internet use(PIU)or Internet addiction has been recognized to be a behavioral addiction characterized by excessive or poorly controlled preoccupations,urges,or behaviors regarding computer use and Internet access that leads to impairment or distress resembling substance abuse.AIM To investigate the prevalence and characteristics of Internet use and abuse in a group of drug addicts from Southern Italy,by means of a specific questionnaire[“Questionario sull’Utilizzo delle Nuove Tecnologie”(QUNT)].METHODS All subjects(183)were heavy smokers,almost 50%of them used heroin and/or opioid compounds,30%alcohol,10%cannabis,8%cocaine,and 5%were polydrug users.Almost 10%of the individuals were also suffering from gambling disorder.RESULTS The time spent online was more than 4 hours a day in the total sample,with a slight prevalence in male subjects.Cocaine and cannabis users spent more than 6 hours online,significantly more than opioid and alcohol abusers.Distribution of the QUNT factors was not different in both sexes.Cocaine users showed higher scores at the“loss of control”,“pornography addiction”,and“addiction to social networks”factors,for the stimulant effect of this substance.Moreover,15 out of the total 17 cocaine users were pathological gamblers.Positive and statistically significant relationships were observed between some QUNT factors and body mass index.CONCLUSION These findings indicate that PIU is less severe in subjects taking sedative substances,such as heroin/opioids and alcohol,than in subjects taking stimulants.Alternatively,it may be used as a“stimulant”trigger in cocaine and cannabis users.Flattening effect of abuse drugs was noted on possible sex-related differences in QUNT items.We observed a sort of“protective”effect of a love relationship and/or living together with a partner,as those engaged subjects showed lower scores on different items than single subjects or those living alone.The relationship between time spent online(and related sedentary lifestyle)and body mass index would suggest that Internet use might be a contributing factor to increasing weight gain and obesity amongst adolescents and young adults worldwide.Our findings also highlighted the specific vulnerability of drug addicts who use stimulants,rather than sedative compounds,to other kinds of behavioral addictions,such as gambling disorder.
文摘BACKGROUND: Inadvertent intra-arterial injection of illicit substances is a known complication of injection drug use and can lead to severe complications, including infection, ischemia and compartment syndrome. Identifying complications of intra-arterial injection can be difficult, as clinical manifestations overlap with other more common conditions such as cellulitis and soft tissue infection, and a history of injection drug use is frequently not disclosed.METHODS: A 37-year-old male patient presented with 24 hours of right hand pain, erythema and swelling. Despite classic "track marks", he denied a history of injection drug use, and vascular insults were not initially considered. After failing to respond to three days of aggressive treatment for suspected deep-space infection, an arteriogram demonstrated findings consistent with digital ischemia of embolic etiology.RESULTS: As a result of the delay in diagnosis, the lesion was not amenable to reperfusion and the patient required amputation of the distal digit.CONCLUSION: Practitioners should be alert to the possibility of intra-arterial injection and resulting complications when evaluating unusual extremity infections or unexplained ischemic symptoms, even in the absence of a definite history of injection drug use.
文摘Alcohol use disorder is a complex and heterogeneous phenomenon that can be studied from several points of view by focusing on its different components.Alcohol is a hepatotoxin whose metabolism creates profound alterations within the hepatocyte.The liver is the central organ in the metabolism of alcohol,a process that also involves other organs and tissues such as the brain,heart and muscles,but the most relevant organ is the liver.The anatomopathological alterations in the liver associated with the prolonged use of alcohol range from the simple accumulation of neutral fats in the hepatocytes,to cirrhosis and hepatocellular carcinoma.Alcohol abuse frequently leads to liver disease such as steatosis,steatohepatitis,fibrosis,cirrhosis,and tumors.Following the spread of coronavirus disease 2019(COVID-19),there was an increase in alcohol consumption,probably linked to the months of lockdown and smart working.It is known that social isolation leads to a considerable increase in stress,and it is also recognized that high levels of stress can result in an increase in alcohol intake.Cirrhotic patients or subjects with liver cancer are immunocompromised,so they may be more exposed to COVID-19 infection with a worse prognosis.This review focuses on the fact that the COVID-19 pandemic has made the emergence of alcohol-induced liver damage a major medical and social problem.
文摘A systematic field survey of 6,567 urban and rural residents out of 3.000 households, through cluster sampling among Beijing residents, was collaborativelv conducted. The results reveal that benzodiazepine has been widely prescribed and its rate of usage for 1 year is 61.82%. whereas rate of de-
文摘Patients with chronic pancreatitis often experience severe,unrelenting abdominal pain,which can significantly impact their quality of life.Pain control,therefore,remains central to the overall management of chronic pancreatitis.Most of the strategies aimed at treating the pain of chronic pancreatitis are based on expert opinion and vary from one institution to another,as there are no uniform guidelines to direct a stepwise approach towards achieving this goal.In this editorial,we comment on best practice strategies targeted towards pain control in chronic pancreatitis,specifically highlighting the use of opioid medications in this patient population.We discuss various safe and efficacious prescription monitoring practices in this article.
文摘Research has indicated that child maltreatment is associated with an increased likelihood of mental disorders and suicidal ideation and attempts that continues into adulthood. The purpose of this paper is to provide a synopsis of the recent published research from 2006 to 2010 on the association between child maltreatment and Axis I mental disorders and suicidal ideation and attempts. The databases MEDLINE and PsycINFO were searched for relevant and high quality citations up to October 2010. The results indicated that all types of child maltreatment examined are linked to reduced mental health. A general noted trend in the literature is that earlier age of onset of child maltreatment is associated with poorer mental health outcomes. Sex differences do exist with some disorders being more likely among males (e.g., anti-social behaviour) and other more likely among females (e.g., depression, PTSD, substance use disorders) following child maltreatment.
文摘<span style="font-family:Verdana;">The </span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">opioid crisis</span><span style="font-family:Verdana;">”</span><span style="font-family:""><span style="font-family:Verdana;"> has had a tremendous impact not only on its victims, but also on the practice of medicine, pain patients, and society in general. Unfortunately, efforts to “stem the tide” have not been successful at reducing overdose deaths. Counterbalancing the many ardent efforts to eliminate overdose deaths (such as the current widespread availability and use of opioid-receptor antagonists such as naloxone) is influx of the illicit fentanoids (</span><i><span style="font-family:Verdana;">i.e</span></i><span style="font-family:Verdana;">., fentanyl and analogs). In addition to their high-potency, the fentanoids differ in surprising ways from more “traditional” opioids such as morphine and heroin. This uniqueness contributes to a reduced effectiveness of opioid receptor antagonists in the treatment of opioid overdose. Further greatly complicating overdose treatment is polysubstance abuse (e.g., an opioid plus a benzodiaze</span><span style="font-family:Verdana;">pine). The non-opioid in the combination is not responsive to an opio</span><span style="font-family:Verdana;">id-recep</span></span><span style="font-family:Verdana;">- </span><span style="font-family:""><span style="font-family:Verdana;">tor antagonist, which imparts additional challenges. Thus, the new reality in</span><span style="font-family:Verdana;">troduces complications that negatively impact efforts to reverse </span></span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">opioid</span><span style="font-family:Verdana;">”</span><span style="font-family:""><span style="font-family:Verdana;"> overdose. New approaches to improve outcomes in individuals who experience </span><span style="font-family:Verdana;">respiratory depression due to fentanoid-induced or polysubstance-induced</span><span style="font-family:Verdana;"> over</span></span><span style="font-family:Verdana;">- </span><span style="font-family:Verdana;">dose are needed. Approaches that harmonize with the new reality, perhaps something like a non-opioid </span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">agnostic</span><span style="font-family:Verdana;">”</span><span style="font-family:Verdana;"> pharmacologic ventilatory stimulant, would provide a welcome addition to the current choices.</span>
基金Geisinger Auxiliary Fundthe Kline&Ditty Health Fund+2 种基金the National Institute of Mental Health (Grant No. R21-MH-086317)the Wounded Warrior OrganizationDepartment of Defense (W81XWH-15-1-0506) to Dr. Joseph A. Boscarino。
文摘Background: The majority of Veterans Affair(VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status.Methods: Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview. Mental health status, including posttraumatic stress disorder(PTSD), major depression, alcohol abuse and mental health global severity, were assessed using structured interviews. Psychiatric service use was based on self-reported utilization in the past 12 months. Results were compared between veterans residing in rural and non-rural areas. Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors.Results: A total of 1730 subjects(55% of the eligible veterans) responded to the survey and 1692 of them had complete geocode information. Those that did not have this information(n=38), were excluded from some analyses. Veterans residing in rural areas were older, more often of the white race, married, and experienced fewer stressful events. In comparison to those residing in non-rural areas, veterans residing in rural areas had lower global mental health severity scores;they also had fewer mental health visits. In multivariate logistic regression, rural residence was associated with lower service use, but not with PTSD, major depression, alcohol abuse, and global mental health severity score after adjusting confounding factors(e.g., age, gender, marital status and education).Conclusions: Rural residence is associated with lower mental health service use, but not with poor mental health in veterans with former warzone deployment, suggesting rural residence is possibly protective.
文摘Polysubstance Abuse (PSA) greatly complicates an attempt to implicate a single drug as sole cause of an overdose death. Since PSA now occurs in the majority of cases of drug overdoses, many or most overdose deaths are polysubstance overdose deaths. And since many of the substances involved in a polysubstance Overdose Death (POD) are Central Nervous System (CNS) depressants, many of which can cause overdose death themselves, or synergistically with opioids, it is somewhat puzzling that prescription opioids have been singled out as the cause of these deaths—without reference to PSA. This is particularly puzzling in light of the fact that the issues of PSA and POD have been recognized and discussed in the literature since at least the 1960’s and before. We therefore here consider the question: are we facing an “opioid” crisis or, instead, a “polysubstance crisis”? And we wonder if the issue has been over-simplified, to the detriment of the individuals affected, and to society more broadly. There is a need for an “agnostic” respiratory stimulant that can reverse polysubstance-induced respiratory depression.
文摘Drug abuse by pregnant women is one of the significant problems for mothers and their neonates.This study aimed to investigate the effects of maternal substance use disorder during pregnancy on neonatal developmental criteria.In a case-control study,clinical records of 90 neonates diagnosed with neonatal abstinence syndrome who were admitted to NICU in one of four hospitals affiliated with Shahid-Beheshti University of Medical Sciences in Tehran,Iran between 2017 and 2020 were compared to 90 neonates without neonatal abstinence syndrome(control group).Demographic information and data for neonatal developmental characteristics and complications were extracted from the clinical records of this convenience sample.Data for the type and method of maternal substance use during pregnancy were collected through a telephone call with mothers.Our data showed that the prevalence of drug addiction was 1.8%among pregnant women,and the most common drugs used by mothers were opium(n=45%,50%),amphetamine(n=30%,33%),and methadone(n=14%,16%).Neonates with abstinence syndrome had a higher prevalence of transient tachypnea of the newborn(TTN)(P=0.004),and a prevalence of being admitted to NICU(P=0.05)and for a longer duration(P<0.001).Their mothers had a higher prevalence of having pre-eclampsia(P=0.010).Using morphine vs.amphetamine showed no difference based on their effects on mothers and neonates.Substance use during pregnancy increased the prevalence of pregnancy complications(pre-eclampsia)and neonatal complications(TTN and prevalence and duration of hospitalization).Therefore,planning for the development of health policies to raise awareness among women and more broadly,all members of the community,is important to prevent the tendency to engage in this potentially high-risk behavior.
