Substance Abuse and Rehabilitation最新文献

Background: The COVID-19 pandemic led to increased loneliness, emotional stress, and idleness due to job losses and school closures which can drive substance use among vulnerable populations like youths. Uganda has been identified as one of the countries with the highest alcohol consumption in Africa. Alcohol predisposes to a number of health concerns including mental health disorders, cardiovascular diseases among others. This study assessed the impact of the COVID-19 lockdown on alcohol consumption among youths in Kampala, Uganda.

Methods: A quantitative cross-sectional study among randomly selected youth aged 18-35 years living in the five divisions of Kampala. Participation was strictly after informed consent was obtained. 381 youths were interviewed, both students and non-students were included in the study. The AUDIT-C questionnaire was used to measure the frequency and quantity. Frequent was defined as six or more drinks a week.

Results: We enrolled 381 participants in the study with a mean age of 26±4.6 years. More than half (60%) of the participants were male. 71% lived with family during the lockdown. Of the 64% that were employed before the lockdown, 54% lost their jobs. At least 42.5% of the participants reported alcohol consumption during the lockdown. Males consumed twice as much alcohol as females. Generally, the level of alcohol consumption decreased during the COVID-19 pandemic as the percentage of participants consuming alcohol dropped from 47.5% to 42.8%. Despite the overall decrease in the number of participants consuming alcohol, there was an increase in the frequency and amount of alcohol consumed on occasion during the pandemic.

Conclusion: Fewer youths consumed alcohol during the COVID-19 lockdown in Kampala, Uganda. However, those who did significantly increased their drinking amount and frequency. Male youths, those living with friends, and those with poor self-perceived mental health were more likely to increase their alcohol intake. Further investigation into increased alcohol consumption among youths post-COVID is necessary to understand the extent and long-term health implications.

Background: Datura metel is reported to induce hallucinations and mental disorders.

Objective: This study investigates the neurotoxic effects of Datura metel stramonium hydroethanolic root extract on the hippocampus and cerebral cortex of adult rats using biochemical, histological and immunohistochemical techniques.

Methodology: Twenty five adult rats were assigned to 5 groups (n = 5 each). Group A - negative control, group B (lead positive control). Groups C, D, and E exposed to 150 mg/kg, 300 mg/kg and 600 mg/kg body weight of extracts for 14 days once daily, respectively. Histology, biochemistry and immunohistochemical techniques were used to study cell injury in the brain tissue.

Results: Biochemical alterations were observed in superoxide dismutase (SOD), Malondialdehyde (MDA), Glutathionine S-transferase (GST) and Catalase among the experimental groups. Catalase was statistically significant at P<0.05. Histology reveals neurons damage, depletion and vacuolation. NFP and NSE were over expressed in the experimental groups.

Discussion: Oral administration of Datura metel root extracts at high concentration alters the antioxidant enzymes activity and body weight. Extracts cause cortex and hippocampus neurotoxicity through heightened oxidative stress.

Conclusion: Datura metel root extract is a neurotoxic agent and causes depopulation of hippocampus and cerebral cortex neurons. The use of this plant should be highly regulated to reduce neuropathies associated with consumption.

Background: Many studies indicate that high and multiple doses of anabolic-androgenic steroids (AAS) for athletic enhancement can result in serious and irreversible adverse effects. A study that includes laboratory blood testing to evaluate the direct effects of AAS agents among users has not been previously undertaken. The purpose of this study was to investigate the adverse effects of the use of AAS by athletes and to determine whether AAS use leads to changes in certain blood parameters.

Methods: This is an observational study consisting of two stages. First, the participants completed an online questionnaire assessing sociodemographic characteristics, and knowledge and attitudes towards AAS. Second, volunteers underwent laboratory blood testing. Analysis was conducted using frequency distributions and percentages of responses across various variables.

Results: Thirty-one individuals completed the online questionnaire, 18 of whom continued to stage 2, where blood samples were taken to trace any changes in blood parameters. All the participants were male, with an age range of 24-45 years. The results showed that 94% of the participants used AAS for nontherapeutic purposes. Most participants reported that they take a combination of AAS (96%), as well as in combination with other supplements (74%). The most used combination was testosterone plus growth hormone (45%), and the most used supplements were liver protectors (84%). Seventy-four percent of the participants reported side effects, and 28% had received a medical diagnosis, such as hypertension, hyperlipidemia or an infertility. High levels of testosterone, prolactin, alanine transaminase (ALT), aspartate transferase (AST) and lipid profile, and low luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were observed.

Conclusion: The unsupervised use of AAS alone or in combination with other hormones and/or supplements may lead to adverse effects. Further studies with larger samples are needed to draw significant conclusions about the safety of using AAS.

Background: Opioid-based medications are powerful analgesics commonly prescribed for pain management, but they are also highly addictive. The over-prescription of opioids analgesics has triggered current opioid crisis, which now has expanded to heroin and illicit synthetic opioids like fentanyl and its analogues. The side effects of fentanyl abuse have been well recognized, yet the underlying molecular adaptations across brain regions upon fentanyl exposure remain elusive.

Methods: The transmission electron microscopy (TEM) and next-generation RNA-sequencing (RNA-seq) were used to investigate the ultrastructure synaptic alterations and transcriptional profiling changes of reward and sensory brain regions in mice after fentanyl exposure.

Results: The naloxone-precipitated acute withdrawal symptoms were observed in mice exposed to fentanyl. Results of TEM showed an increase in the number of synapses, widening of synaptic gaps, and thickening of postsynaptic density in the NAc of the fentanyl addiction mice, accompanied by obvious mitochondrial swelling. RNA-seq identified differentially expressed genes (DEGs) in prefrontal cortex of mice brains after fentanyl exposure, and the expression of some addiction-related genes such as Calm4, Cdh1, Drd1/2/3/4, F2rl2, Gabra6, Ht2cr, Oprk1 and Rxfp3 showed the most striking changes among experimental groups. KEGG enrichment analysis indicated that these DEGs were related to the development of addiction behavior, dopaminergic/GABAergic/serotonergic synapse, synapse assembly/synaptic plasticity/synaptic vesicle cycle, cAMP/MAPK signaling pathway, neuroactive ligand-receptor interactions. These transcriptomic changes may be correlated with the structural and behavioral changes observed in fentanyl-exposed mice.

Discussion: The findings of this study contribute to a better understanding of the molecular mechanism of addiction behavior, which is essential for the development of optimized therapy strategies for addicts.

Purpose: Telehealth use has grown tremendously since the onset of the COVID-19 pandemic. While the benefits of virtual care delivery are numerous, little is known about patient experiences in group treatment settings when members join both virtually and in person with the counselor (a hybrid model). We sought to fill this gap by comparing patient survey data across care delivery models.

Patients and methods: Adult patients with a substance use disorder enrolled at one of seven intensive outpatient (IOP) programs in rural Minnesota voluntarily completed a questionnaire assessing patient satisfaction, perceived therapeutic alliance, group cohesion, and insight gained from treatment. Starting 7/1/2021, groups were either all virtual, all in-person, or a hybrid model. The survey began on 1/1/2022. Analysis of covariance (ANCOVA) tested for differences among treatment groups. Separate models were used for each survey question, where the dependent variable was the survey response, the test of interest being treatment group-type, with covariates of length of stay and age. Model estimates and model-based standard deviations were used to calculate the Cohen's d effect size.

Results: Survey results from a total of 1037 individuals were included, one survey per respondent. Data was deidentified upon receipt of the survey, preventing specific demographic comparisons. For the hybrid groups, no significant differences were noted with survey responses relative to in-person, with negligible to small effect sizes seen. When comparing virtual to in-person, virtual was rated as significantly worse than in-person on 6 of the 8 questions; effect size estimates exceeded the small effect size cut-off, and the 95% CI exceeded the moderate cut-off.

Conclusion: Creating a group model where patients can attend both virtually and in-person together appears to improve perceived therapeutic alliance, group cohesion, and treatment insight, compared to virtual-only groups, which may have a negative effect relative to in-person.

Background: The opioid epidemic has severely impacted the US over the last 15 years. Buprenorphine is a partial opioid agonist indicated for the treatment of opioid use disorder (OUD) and is recognized as an effective treatment when taken as prescribed. However, adherence rates have been low in real-world settings. Blister-packaging has been shown to promote medication adherence across a variety of disease states, although it has never been studied in OUD.

Methods: An economic analysis was conducted to assess the impact of increased adherence of blister-packaged buprenorphine on health care resource utilization (HCRU) and health care costs for 10,000 patients initiating therapy for OUD. The model analyzed a commercially insured population within the US over a one-year time horizon. Medication adherence was defined in the model as proportion of days covered (PDC) of at least 80%. Literature-based references were used to inform both the impact of blister-packaging on the number of patients who became adherent as well as the impact of medication adherence on HCRU and health care costs. Model input uncertainty was assessed in one-way sensitivity analyses.

Results: With the implementation of blister-packaging buprenorphine, adherence rates increased from 37.1% of patients in the pre-intervention period to 45.3%, resulting in an additional 818 patients becoming adherent post-intervention. The increase in adherence led to a reduction of medical costs of $12,138,757 (-$1,214 per-patient (PP)). Specifically, inpatient costs decreased by $7,127,073 (-$713 PP) while outpatient costs decreased by $5,013,319 (-$501 PP). Pharmacy costs increased by $3,432,705 ($343 PP). Despite the increase in pharmacy costs, total health care costs saw a reduction of $8,559,684 (-$856 PP).

Conclusion: Blister-packaging buprenorphine for treatment of OUD has potential to improve medication adherence and health outcomes while reducing HCRU and health care costs. Future studies are necessary to assess the real-world application and impact of blister-packaging buprenorphine for OUD across various patient populations and health care settings.

The misuse of and dependency on prescription opioids represents a significant crisis at the national level, impacting not only the health of the public but also the societal and economic well-being. There is a critical need for strategies to reduce the dosage of prescribed opioids to limit opioid-associated adverse effects and lower the risk of addiction development in patients experiencing chronic pain. Opioid-sparing medications, when co-administered with opioids, enable a reduced opioid dose without loss of efficacy. This suggests the potential for using opioid adjunct drugs in opioid tapering, whereby opioid doses are lowered incrementally in a systematic manner to improve a patient's safety profile or quality of life. The objective of this report is two-fold: 1) to illustrate the potential for adjunct drugs in opioid tapering, and 2) to describe the steps needed to be taken to develop a framework for the use of adjunct drugs in opioid tapering. This can provide the impetus for further investigation into opioid tapering and the development of improved clinical care. The proposed project implements knowledge synthesis methods to develop the framework for a new paradigm of opioid drug tapering that incorporates opioid dosage reductions with adjunct drugs. Framework development is organized into three major phases: 1) Adjunct drug characterization, 2) Assessment of the opioid-sparing effect, and 3) Usability of data for clinicians. The knowledge gained from this project can provide a foundation for improved analgesia protocols for opioids and adjunctive drug therapy.

Introduction: Opioid use disorder (OUD) and opioid overdose (OD) have shown to be strongly associated with alcohol use disorder (AUD). As a potential target population for secondary prevention, we examined the incidence and timing of OUD/OD among clients seeking treatment for alcohol problems and how this has changed over the three waves of the opioid epidemic corresponding to the primary opioid involved in fatal ODs, prescription painkillers (2007-2009), heroin (2010-2012), and fentanyl (2013-2016). We also examined social determinants of health as predictors of OUD/OD.

Methods: Clients (N = 59,186) presenting for a first treatment for alcohol use problems were extracted from the Client Data System (CDS) of the New York State Office of Addiction Services and Support (OASAS) and New York State (NYS) Medicaid Data Warehouse. Using this cohort, we employed the Kaplan-Meier method to determine the survival probabilities for patients admitted in each of the three waves of the epidemic.

Results: Patients in Cohort 3 (2013-2016) were diagnosed with OUD/OD more rapidly than patients in Cohort 1 (2007-2009) or Cohort 2 (2010-2012), although the overall estimated OUD/OD rate was comparable across the three cohorts.

Discussion: These findings provide a useful estimate of the incidence and the expected time frame of an opioid use disorder in clients with an alcohol use problem. Moreover, it suggests that as the opioid epidemic progressed, OUD/OD developed more rapidly but the overall prevalence did not increase.

Purpose: A large treatment gap exists for people who could benefit from medications for opioid use disorder (MOUD). People OUD accessing services in harm reduction and community-based organizations often have difficulty engaging in MOUD at opioid treatment programs and traditional health care settings. We conducted a study to test the impacts of a community-based medications first model of care in six Washington (WA) State communities that provided drop-in MOUD access.

Participants and methods: Participants included people newly prescribed MOUD. Settings included harm reduction and homeless services programs. A prospective cohort analysis tested the impacts of the intervention on MOUD and care utilization. Intervention impacts on mortality were tested via a synthetic comparison group analysis matching on demographics, MOUD history, and geography using WA State agency administrative data.

Results: 825 people were enrolled in the study of whom 813 were matched to state records for care utilization and outcomes. Cohort analyses indicated significant increases for days' supply of buprenorphine, months with any MOUD, and months with any buprenorphine for people previously on buprenorphine (all results p<0.05). Months with an emergency department overdose did not change. Months with an inpatient hospital stay increased (p<0.05). The annual death rate in the first year for the intervention group was 0.45% (3 out of 664) versus 2.2% (222 out of 9893) in the comparison group in the 12 months; a relative risk of 0.323 (95% CI 0.11-0.94).

Conclusion: Findings indicated a significant increase in MOUD for the intervention group and a lower mortality rate relative to the comparison group. The COVID-19 epidemic and rapid increase in non-pharmaceutical-fentanyl may have lessened the intervention impact as measured in the cohort analysis. Study findings support expanding access to a third model of low barrier MOUD care alongside opioid treatment programs and traditional health care settings.