Journal of psychoactive drugs最新文献

Pregabalin (PGB) has been commonly subjected to diversion, from being a prescription drug to a recreational drug. In this study, pregabalin use (which is one of the substances subject to control in Turkey) and the concomitant use of other substances in cases admitted to the Izmir Forensic Medicine Institute was evaluated. Samples from 15,259 cases were screened, between June 2017 and December 2018, for the presence of PGB, and PGB positive cases were further analyzed. Of all cases screened, PGB was detected in 3.2% (n = 487). The mean age of PGB positive cases was 29.24 ± 10.34 years old (min: 14, max: 84), and 94% of them were male. Cannabis metabolite THC-COOH was the most common substance detected in the blood samples following PGB. Overall, 8 other substances were commonly used along with PGB. These substances were cannabis, morphine, hydromorphone, codeine, hydrocodone, heroin, paracetamol, and naproxen. Finally, we observed similar results in urine analysis. This research provides systematic data for PGB use in forensic cases in Turkey. The study findings indicate that PGB and multiple drug use increased over time, and providers should be particularly careful when prescribing PGB.

Although opioid agonist treatment (OAT) has several beneficial effects, the issue of optimal treatment length remains unresolved. It is plausible that caregivers' attitudes toward treatment length are of importance to whether, how and when tapering off will take place. In this study, we investigated caregivers' attitudes toward treatment length by interviewing 15 caregivers from a variety of professions working in seven OAT treatment programs in Sweden. Data were analyzed using applied thematic analysis. The participants were generally hesitant concerning the idea of tapering off. Few of them had experiences of patients tapering off successfully. Many of them never brought up the subject unless the patient did so her-/himself. Only younger, socially stable patients were perceived to be suitable for tapering off. Participants also expressed a need among staff for education and ethical discussions on treatment length. A person-centered focus may be promoted by recurrently discussing treatment goals and by co-operating with patients to map the recovery capital of those interested in tapering. To further support caregivers in developing person-centered care, more knowledge of opioid use disorder and professional and interprofessional discussions of caregivers' own attitudes and beliefs are paramount.

Evidence suggests that psilocybin has therapeutic benefit for treating depression. However, there is little consensus regarding the mechanism by which psilocybin elicits antidepressant effects. This systematic review summarizes existing evidence. Ovid MEDLINE, EMBASE, psychINFO, and Web of Science were searched, for both human and animal studies, using a combination of MeSH Terms and free-text keywords in September 2021. No other mood disorders or psychiatric diagnoses were included. Original papers in English were included. The PRISMA framework was followed for the screening of papers. Two researchers screened the retrieved articles from the literature search, and a third researcher resolved any conflicts. Of 2,193 papers identified, 49 were selected for full-text review. 14 articles were included in the qualitative synthesis. Six supported psilocybin's mechanism of antidepressant action via changes to serotonin or glutamate receptor activity and three papers found an increase in synaptogenesis. Thirteen papers investigated changes in non-receptor or pathway-specific brain activity. Five papers found changes in functional connectivity or neurotransmission, most commonly in the hippocampus or prefrontal cortex. Several neuroreceptors, neurotransmitters, and brain areas are thought to be involved in psilocybin's ability to mitigate depressive symptoms. Psilocybin appears to alter cerebral blood flow to the amygdala and prefrontal cortex, but the evidence on changes in functional connectivity and specific receptor activity remains sparse. The lack of consensus between studies suggests that psilocybin's mechanism of action may involve a variety of pathways, demonstrating the need for more studies on psilocybin's mechanism of action as an antidepressant.

Misuse of prescription and non-prescription stimulants and related overdose deaths represent a growing public health crisis that warrants immediate intervention. We examined 100 posts and their respective comments from a public, recovery-oriented Reddit community in January 2021 to explore content related to DSM-V stimulant use disorder symptoms, access and barriers to recovery, and peer support. Using inductive and deductive methods, a codebook was developed with the following primary themes: 1) DSM-V Symptoms and Risk Factors, 2) Stigma/Shame, 3) Seeking Advice or Information, 4) Supportive or Unsupportive Comments. In 37% of posts community members reported taking high doses and engaging in prolonged misuse of stimulants. Nearly half of posts in the sample (46%) were seeking advice for recovery, but 42% noted fear of withdrawal symptoms or a loss of productivity (18%) as barriers to abstinence or a reduction in use. Concerns related to stigma, shame, hiding use from others (30%), and comorbid mental health conditions (34%) were also noted. Social media content analysis allows for insight into information about lived experiences of individuals struggling with substance use disorders. Future online interventions should address recovery barriers related to stigma and shame as well as fears associated with the physical and psychological impact of quitting stimulant misuse.

Limited research has resulted in conflicting views on the risks versus benefits associated with kratom use. Despite no federal policy in the United States, individual states have implemented diverging policies through kratom bans, and legalization and regulation through Kratom Consumer Protection Acts (KCPAs). The Survey of Non-Medical Use of Prescription Drugs (NMURx) Program employs nationally-representative, repeated cross-sectional surveys on drug use. In 2021, weighted prevalence of past-12 month kratom use was compared across three state legal frameworks: no overarching state policy, KCPAs, and state bans. There was lower estimated prevalence of kratom use in banned states (prevalence: 0.75% (0.44, 1.06) relative to states with a KCPA (1.20% (0.89, 1.51)), and relative to states with no policies (1.04% (0.94, 1.13), though odds of use were not significantly associated with policy type. Kratom use was significantly associated with medicated treatment for opioid use disorder. While there were observed differences in the prevalence of past-12 month kratom use by state policy type, low uptake mitigated meaningful distinctions by limiting statistical precision, and potentially confounding effects, such as accessibility online. Future kratom-related policy decisions should be informed through evidence-based research.

Healthcare professionals are exposed to stressful situations that may favor substance use vulnerability. This systematic review aims to synthesize the risk and protective factors associated with use, abuse, and dependence of alcohol, tobacco, psychoactive drugs, and cannabis in healthcare professionals. Following PRISMA recommendations, a systematic search was performed in PsycINFO, Web of Science, PubMed/MEDLINE, Embase, Scopus, and Cochrane Library. The search yielded 1523 studies, of which 19 were selected. The identified risk factors were demographic factors (i.e. male gender, and single/divorced marital status), psychopathological factors, social factors, positive attitudes toward drugs, unhealthy lifestyle habits, the COVID-19 pandemic, and the coexistence of the use of several substances. The protective factors were demographic factors (i.e. ethnicity and having dependent children), healthy lifestyle habits, and workplace anti-drug policies (i.e. restriction of tobacco use). These findings highlight the need for preventive actions against drug use in healthcare professionals to improve their health and reduce the possible negative impact on their healthcare practice. Knowledge of modifiable risk and protective factors allows their incorporation as components in preventive actions, and non-modifiable factors (e.g. demographic variables) may contribute to the detection of groups of greater vulnerability to propose selective prevention actions in this population.

Many cannabis users report therapeutic benefits from cannabis consumption, even when not recommended by a physician. To date, few data on therapeutic users of cannabis in France are available. Using a cross-sectional survey held in 2020, we collected sociodemographic, health and substance use data from 4150 daily cannabis users in France. We used multivariable logistic regression to assess factors associated with exclusive therapeutic use of cannabis. Approximately 10% (n = 453) of the participants reported using cannabis exclusively for therapeutic purposes. Exclusive therapeutic users of cannabis differed from non-exclusive (i.e. recreational and mixed) users, especially regarding age (aOR [95%CI] = 1.01 [1.00-1.02]), employment (aOR = 0.61 [0.47-0.79]), urban area of residence (aOR = 0.75 [0.60-0.94]), physical (aOR = 2.95 [2.34-3.70]) and mental health condition (aOR = 2.63 [1.99-3.49]), mode of cannabis administration (non-smoked, aOR = 1.89 [1.22-2.95); smoked with little tobacco, aOR = 1.39 [1.09-1.76]), frequency of cannabis use (aOR = 1.04 [1.01-1.06]), home cultivation (aOR = 1.56 [1.13-2.15]), at-ridsk alcohol use (aOR = 0.68 [0.54-0.84]), and previous-month opiate use (aOR = 1.67 [1.22-2.30]). A greater understanding of the distinct profiles of regular cannabis users could inform harm reduction strategies and care access for this population. Further studies are needed to better understand the boundaries between therapeutic and recreational use.

Ecstasy/Molly/MDMA is a widely used substance often taken in combination with other drugs in different contexts. The current study assessed ecstasy use patterns, concurrent substance use and the context of ecstasy use among an international sample of adults (N = 1,732). Participants were 87% white, 81% male, 42% college educated, 72% employed, with a mean age of 25.7 (SD = 8.3). Using the modified UNCOPE, risk for ecstasy use disorder was 22% overall, and significantly higher among younger individuals and those with greater frequency and quantity of use. Participants reporting risky ecstasy use endorsed significantly higher use of alcohol, nicotine/tobacco, cannabis, cocaine, amphetamine, benzodiazepines, and ketamine compared to those at lower risk. Great Britain (aOR = 1.86; 95% CI [1.24, 2.81]) and Nordic countries (aOR = 1.97; 95% CI [1.11, 3.47]) were approximately 2 times more likely to exhibit risk for ecstasy use disorder than the United States, Canada, Germany, and Australia/New Zealand. Taking ecstasy at home emerged as a common setting followed by electronic dance music events and music festivals. The UNCOPE may be a useful clinical tool for detecting problematic ecstasy use. Harm reduction interventions for ecstasy should target young people, substance co-administration, and context of use.

Neighborhood disorder is a risk factor for substance use, but research is limited with regard to the effect of such disorder on polydrug use. Further, research on potential mechanisms underlying this relationship is similarly limited. The current study examined the direct effect of neighborhood disorder on drug use variety and examined deviant peer association and depressive symptoms as mediators among a sample of justice-involved youth. The first three waves of the Pathways to Desistance study were analyzed. Generalized structural equation modeling was used to test for direct and indirect effects of interest. A bootstrap resampling process was used to compute standard errors and significance of hypothesized mediation effects. Findings indicated that greater levels of neighborhood disorder were associated with increased drug use variety. This effect was attenuated by 15% when mediating pathways were included in the model. Only deviant peer association significantly mediated this relationship and accounted for the majority of the total mediating effect. These results indicated that justice-involved youth exposed to neighborhood disorder are at elevated risk for polydrug use and that increased deviant peer association helps to explain this relationship.

We aimed to examine whether treatment retention, abstinence, and adherence to buprenorphine-naloxone (BNX) differ among individuals with opioid dependence (OD) across three common categories of opioids- heroin, opium, and low-potency pharmaceutical. In a retrospective cohort study, we analyzed outpatient treatment records from March 2020 through February 2022. Opioid category was determined by lifetime and current opioid use. We defined treatment retention as weeks of uninterrupted clinic attendance. Abstinence and BNX adherence were calculated by weeks of extra-medical opioid-negative and buprenorphine-positive urine screening from treatment initiation. Four-hundred-thirteen patients were eligible; 406 (98.3%) were included in the final analysis. Two-hundred-ninety (71.4%) patients were dependent on heroin; 66 (16.3%) were natural opioid dependent, and 50 (12.3%) were dependent on low-potency pharmaceutical opioids. BNX effectiveness in treatment retention, abstinence, and adherence did not differ in patients dependent on heroin, natural, and low-potency pharmaceutical opioids. Patients on ≥8 mg daily BNX had better retention and adherence than those on <8 mg daily. Patients from lower socioeconomic status (SES) had higher odds of retention, abstinence, and adherence than those from upper/middle SES. Treatment outcomes on BNX did not differ across opioid categories. However, BNX should be dosed adequately.