Drug and alcohol review最新文献

Introduction: Many countries, including Aotearoa New Zealand, have socioeconomic and ethnic inequities in alcohol outlet density, yet the potential contribution of alcohol licensing systems is almost unexplored. After licensing reforms in Aotearoa in 2012, community groups and Māori (the Indigenous people) continued to struggle to influence decisions, prompting calls for reform and authority for Māori reflecting Te Tiriti o Waitangi obligations. This study explored factors in the failure of public objections in under-resourced neighbourhoods.

Methods: In a descriptive, multimethod qualitative study, we analysed eight decisions to grant off-licence approvals in socioeconomically deprived areas. Each licence was opposed. Hearing participants and local residents were interviewed. Data were thematically analysed to identify factors affecting objector influence, alignment with Indigenous rights and residents' awareness of alcohol issues and licensing processes.

Results: Residents identified relevant local harms but were largely unaware of opportunities to object. Objectors faced structural barriers to accessing and influencing hearings that were exacerbated by resource challenges, including travel costs, lost income, competing social issues and limited legal representation. Evidence of area deprivation supported objectors' arguments regarding risk, but a lack of official data on harms undermined them. Māori input was excluded by legal barriers and failures to recognise relevant rights and elements of culture.

Discussion and conclusions: Structural barriers, including racism, restricted the influence of under-resourced communities and Māori in licensing decisions and weakened risk assessment, which may hinder community efforts to reduce their disproportionate exposure to alcohol outlets. Licensing systems should be reviewed from equity and Indigenous perspectives.

Introduction: Nitazenes are a group of potent synthetic opioids that have had increasing prominence as novel psychoactive drugs in the last 5 years. We describe emergency department nitazene-related presentations.

Methods: This is a prospective series of patients with analytically confirmed nitazene presentations identified by the Emerging Drugs Network of Australia and Emerging Drugs Network of Australia Victoria. Both studies' databases were searched between July 2020 and February 2024 with clinical data and blood nitazene concentrations abstracted.

Results: There were 32 presentations, 23 (72%) males, with a median age of 31 years (range 18-63 years). Only five (16%) intentionally ingested a nitazene, with most (12, 38%) believing they had taken alternative opioids. Co-exposures occurred in 31 (97%), mostly metamfetamine. Naloxone was administered in 23 (72%) presentations, with a median total dose of intravenous naloxone within 1 h post hospital presentation of 400 μg (interquartile range [IQR] 160-450 μg). Four (13%) received a naloxone infusion. Thirteen (41%) were admitted to the intensive care unit. The median length of stay was 17 h (IQR 7-39 h). Protonitazene was the commonest nitazene detected in 23 (72%) presentations with a median concentration of 2.0 mg/L (range 0.7-15 mg/L). The lowest concentration of protonitazene in a patient that received naloxone was 0.7 mg/L.

Discussion and conclusions: Most patients were unaware they were using nitazenes. Given their potency, this has important implications for harm, particularly in those not intentionally using opioids. Nitazene exposure was mostly unintentional. Naloxone use was common and standard dosing regimens appeared effective in most cases.

Issues: Alcohol consumption can cause physical, psychological and social problems that can result in hospitalisations. Screening in hospitals helps to determine which patients should be given interventions. In this review, we aimed to summarise the diagnostic test accuracy (DTA) of screening instruments for problematic alcohol use among adults in hospitals.

Approach: We searched three databases for studies that assessed validated screening instruments for problematic alcohol use among hospitalised adults. We used the Quality Assessment of Diagnostic Accuracy Studies 2 tool to evaluate the risk of bias.

Key findings: We included 20 studies in the review. In 11 studies performed in the emergency departments, 5 instruments had a high DTA: the AUDIT, the AUDIT-C, the RAPS4-QF, the 2-question screener and HOLD 5. In the eight studies with inpatients, three instruments had a high DTA: the AUDIT, CAGE-C and CAGE +10 items. Finally, only one of the included studies evaluated outpatients; the authors reported a high DTA for the AUDIT-C.

Implication and conclusions: The results indicate that the AUDIT is an appropriate screening instrument for both inpatients and patients in the emergency department. Moreover, for patients in the emergency department, the AUDIT-C and the RAPS4-QF can be used. More research is needed on outpatients, and several screening instruments have only been validated with one study (i.e., the 2-question screener, DSM-IV-2, HOLD 5, CAGE-C and CAGE +10 questions).

Introduction: In January 2020, the government of the Australian Capital Territory (ACT) decriminalised the possession and cultivation of cannabis for personal use. This study explored the driving-related attitudes, beliefs and behaviours of ACT residents who are legally cultivating and consuming cannabis.

Methods: A two-part cross-sectional study was conducted. Part-1: Cannabis users residing in the ACT were invited to complete an online survey. Part-2: Survey respondents who reported 'currently growing' cannabis were invited to submit a sample of their home-grown cannabis for phytocannabinoid analysis. Data from Parts 1 and 2 were used to estimate participants' usual Δ⁹-tetrahydrocannabinol (THC) intakes.

Results: N = 385 cannabis users completed all or part of the online survey and N = 52 submitted cannabis samples for phytocannabinoid analysis. Most participants (N = 224/330; 67.9%) reported waiting ≥7 h following cannabis use before driving. However, 21.5% (N = 71/330) reported waiting ≤3 h. These individuals had the highest cannabis and THC intakes of the sample (where known). Further analyses revealed that individuals who expressed less concern about roadside drug testing and the effects of non-medicinal and medicinal cannabis on driving, and who used cannabis more frequently, in larger amounts, and exclusively for non-medicinal purposes were more likely to report shorter 'wait times'.

Discussion and conclusion: A small proportion of cannabis users in the ACT appear to be driving shortly (i.e., ≤3 h) after consuming considerable quantities of cannabis and THC. This behaviour puts them at risk of driving while impaired and incurring legal sanctions. Interventions alerting these individuals to these possible risks are, therefore, warranted.

Introduction: Alcohol use during pregnancy is a significant public health concern due to its adverse outcomes for the mother and developing fetus. This study aims to estimate the national and state-wise prevalence of alcohol use during pregnancy in India and examine associated social, demographic and health-related correlates using data from the National Family Health Survey (NFHS-5) conducted in 2019-2020.

Methods: Data from NFHS-5, a large-scale, nationally representative survey, were analysed. The survey included comprehensive interviews with 724,115 women aged 15-49 years, covering all 28 states and 8 union territories of India. The main outcome was self-reported alcohol use during the respondents' current or most recent pregnancy. Explanatory variables included age, economic status, education level, tribal affiliation, urban/rural residence, planned/unplanned pregnancy, adequacy of antenatal care and tobacco use. Statistical analyses included chi-square tests for unadjusted comparisons and logistic regression for adjusted odds ratios (AOR).

Results: The prevalence of alcohol use during pregnancy was 1.26% nationally, with significant regional variations. The highest prevalence rates were in Arunachal Pradesh (13.03%), Chhattisgarh (5.77%) and Assam (5.62%). Key correlates included belonging to Scheduled Tribes (AOR 7.987, 95% CI 5.73-11.134), having no education (AOR 1.733, 95% CI 1.025-2.931) and tobacco use (AOR 3.389, 95% CI 2.647-4.338). Regional analysis showed the highest adjusted odds for the Northeast (AOR 19.753, 95% CI 4.87-80.116) region.

Discussion and conclusions: Alcohol use during pregnancy in India shows significant regional and socio-demographic disparities. The findings highlight the need for targeted public health interventions and policies, particularly in high-risk groups and regions.

Introduction: In Canada, the COVID-19 pandemic collided with an ongoing overdose crisis driven by a toxic unregulated drug supply. Public health guidance intended to limit transmission of COVID-19 (e.g., social distancing) directly contradicted guidance responding to the ongoing overdose crisis (e.g., never use drugs alone), exacerbating harms among people reliant on the toxic unregulated drug supply. While existing literature characterises many harms associated with consuming unregulated drugs during COVID-19, less is known about the specific impacts on women. We explored the perspectives of women who use unregulated drugs and experienced socio-economic marginalisation on how the COVID-19 environment shaped their overdose risk in British Columbia, Canada.

Methods: We conducted semi-structured interviews remotely with 45 participants between May 2020 and September 2021, and analysed the data thematically using a social violence framework.

Results: Participants identified contamination of the unregulated drug supply, particularly with benzodiazepines, as a significant driver of overdose and gendered violence among women who use drugs. 'Social distancing' guidelines (e.g., guest restrictions in supportive housing, reduced capacity in harm reduction services) compounded these risks and resulted in more women using drugs alone, reducing opportunities for timely overdose intervention. In response, participants practiced individualised acts of caregiving (e.g., establishing informal networks that regularly check on each other) to mitigate the risks of overdose and gendered violence for themselves and their community.

Discussion and conclusions: These intersecting health crises perpetuated individualised approaches to addressing the risks of overdose and gendered violence, rather than addressing underlying social and structural drivers of these risks.

Issues: Creating and implementing a plan to successfully quit smoking likely requires executive function (EF) skills such as inhibition, cognitive flexibility, attention and working memory. This scoping review consolidates the research evidence evaluating the role of EF in smoking cessation.

Approach: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), researchers and a medical librarian searched PubMed, EMBASE, ERIC, CINAHL and PSYCINFO in June 2022, hand-search in September 2022 using relevant MeSH terms, and an updated search was completed in August 2024.

Key findings: Fifteen articles were included. Self-regulation was the most frequently evaluated EF across all studies. Performance on measures of impulsivity was most frequently related to successful smoking cessation. Across studies, performance on measures in areas of attention, working memory, cognitive flexibility and higher-level EF was variable as it relates to smoking cessation success. There was considerable variability in the measures used to evaluate EF and definitions of cessation success. Across studies, very little research evaluates higher-level EF.

Implications and conclusion: Differences in EF and cessation measures make comparisons across studies difficult. Future work is needed utilising common assessment and outcome measures that will improve our understanding of the complex cognitive skills needed for successful cessation. Particular consideration should be given to higher-level EFs including reasoning, planning, problem-solving and decision-making.

Introduction: It is well established that a gradient exists among cigarette smokers, such that smoking is more prevalent among individuals who are of lower socio-economic status (SES). In this study, we examined whether a similar SES gradient exists among electronic cigarette (e-cigarette) using youth and adults in three Canadian jurisdictions.

Methods: A secondary analysis of data from Ontario, Quebec and Yukon respondents (n = 58,592) to the 2017-2018 Canadian Community Health Survey was conducted. Unadjusted and adjusted logistic regression models explored SES measures: total and relative household income, and education level, separately on use of e-cigarettes or cigarettes in the past 30 days. Models adjusted for additional socio-demographic and psychosocial covariates.

Results: A significant inverse SES gradient existed for cigarette smoking based on education and income variables, with higher education and income associated with decreasing consumption in a stepwise manner. No SES gradient was observed for e-cigarettes.

Discussion and conclusions: While a robust SES gradient was observed among cigarette smokers, no gradient for e-cigarette use was observed. Explanations for these findings may be linked to perceptions that e-cigarettes are healthier, have convenient designs and appealing flavours, and less stigmatised. As more becomes known about potential harms from e-cigarettes, effective interventions may be needed to prevent the emergence of a gradient that disproportionately affects those at lowest income and education levels. Continued monitoring of e-cigarette use patterns across SES groups is necessary for public health.

Introduction: Alcohol's harms to others (AHTO) refers to the negative effects experienced by individuals other than the drinker. This study investigates the prevalence and risk factors of AHTOs among US college students (sophomores/juniors), based on the first national probability-based survey conducted in 20 years.

Methods: We assessed AHTOs in the fall of 2021 from 1918 participants across 46 US schools, weighting the data to reflect the US undergraduate sophomore/junior population. We combined survey weights and prevalence estimates to approximate the number of sophomores/juniors in the US college population who experienced each AHTO. Once weighted, the sampling method was designed to be representative of sophomores/juniors. We used multivariate logistic regression with clustered standard errors to estimate the likelihood of each AHTO domain and any AHTO for demographic and behavioural risk and protective factors.

Results: Half (53.5%) of our sample reported experiencing at least one AHTO, which corresponds to nearly 6 million US sophomores/juniors. Students who were White; attended 4-year schools; identified as cisfemale or transgender, gender nonconforming, or 2+ identities; of higher socioeconomic status (as indicated by parent's highest level of education); lived with roommates; and/or participated in Greek organisations or intercollegiate athletics had a higher likelihood of AHTOs.

Discussion and conclusions: Our findings demonstrate that AHTOs, including academic, physical and sexual harms, are prevalent on college campuses. These results suggest that colleges likely underestimate the impact of alcohol on their students. Therefore, broadening and strengthening campus and state-level policies and strategies to prevent and reduce these harms effectively are needed.

Introduction: Alcohol consumption is a global health issue linked to over 200 diseases and accounts for 5.3% of all deaths annually. We aimed to determine the sociodemographic factors associated with alcohol consumption among Cambodian women and men aged 15-49 years.

Methods: We used data from the 2022 Cambodia Demographic and Health Survey, including 19,496 women and 8825 men aged 15-49. Multiple logistic regressions were performed using STATA V18 to examine factors associated with alcohol consumption.

Results: Nearly 70% of men (95% CI 67.6-70.9) and 16.3% of women (95% CI 15.3-17.3) reported consuming alcohol in the past months. Among men, predictors of alcohol consumption, including those aged 19-24 years, had higher odds of consuming alcohol than the younger ages ≤18 years (AOR 2.14; 95% CI 1.65-2.77). Married men consumed alcohol more than unmarried men and smokers had higher odds of alcohol use than non-smokers with AOR 1.80 (95% CI 1.52-2.14). Similar patterns were found among women, including increased ages, marriage and smoking were predictors of alcohol consumption.

Discussion and conclusions: The study highlights the high prevalence of alcohol consumption among the Cambodian adult population, particularly among men. For both sexes, increased ages greater than 18 years, those who were married, had jobs, and smoking were the main predictors of alcohol consumption. Health promotion efforts should be focused on younger adults aged 19-24, who are increasingly engaging in risky behaviours, including alcohol intake and smoking, by raising awareness about the health consequences of harmful alcohol consumption.