Emerging trends in drugs, addictions, and health最新文献

Background

Patient-physician interactions involve complex interplays between patient and physician autonomy. This is intensified in stigmatised populations, such as anabolic-androgenic steroid (AAS) users. The current study investigated what factors influence clinical interactions between physicians and AAS users, thus providing a holistic understanding of the underlying dynamics.

Methods

For this exploratory two-cohort qualitative study, UK-based physicians (n = 6) and AAS-users (n = 6) were recruited via purposive and snowball sampling. Data were collected using semi-structured interviews. These interviews were audio-recorded, transcribed verbatim, and inductively analysed using reflexive thematic analysis.

Results

Six themes were identified for AAS-using patients (perceived bias and lack of clinical knowledge; perceived power imbalance; riskiness of disclosure; feeling misidentified; experiencing hostility and prejudice; and collaborative clinical interactions) and four for physicians (professional barriers: lack of knowledge, guidelines and resources; preconceptions and prior understandings; direct exposure influences clinical confidence; and professional role quandary). The overall picture suggests primary impactive factors involve stigma management techniques amongst AAS-using patients and coping with clinical uncertainty for physicians.

Conclusions

Blurred lines between enabling versus management impact both the AAS-using patient and the physician. Greater clarity is required regarding what constitutes appropriate management. Further discussion is warranted about the role of physician and patient autonomy. Improving access to healthcare services and expertly guided AAS cessation, if necessary, are vital for effective harm-reduction.

The coronavirus pandemic affected the life of those suffering from addictive behaviors often confined to prolonged periods of self-isolation. To explore the variation of symptoms related to gambling, 46 outpatients of the mental health services in the Trento Province were invited to take part in a phone interview at the start of the national lockdown. Although only 2.17% increased gambling activity during this period, half of the sample (50.00%) experienced irritability, mood fluctuation (43.48%) and anxiety (39.13%). Follow-up studies should assess modifications in their behaviors that occurred after the reopening of gambling venues.

Globally, the rate of injection drug use has increased, leading to a rise in injection-related injuries, infections, disease transmission, and death. Safe consumption facilities (SCFs) were developed with the aim of reducing injection-related disease transmission and death. There is a rapidly growing body of literature related the individual and community level outcomes associated with SCFs that warrants a comprehensive review. Thus, this scoping review examined the impact and effectiveness of SCFs related to: (1) individual outcomes for people who inject drugs; (2) community outcomes associated with SCFs; and (3) the cost-effectiveness of SCFs. The search strategy, developed by the lead author and a social work librarian, followed the PRISMA scoping review extension guidelines. We searched eight databases for peer-reviewed qualitative and quantitative articles published in English over the past decade, returning a total of 1255 articles. After screening, we extracted data from 24 articles. Findings indicate that SCFs were associated with reducing drug use related infection and disease transmission, enhancing access to addiction and other health services, reducing the risk of non-fatal overdoses, and were not associated with a significant increase in drug use, an increased rate of drug-related crime. Both qualitative and quantitative research support SCFs as a cost-effective approach to harm reduction for people who inject drugs with positive community outcomes as well. This review discusses the current state of the evidence and provides recommendations for future research directions.

Introduction

Non-pharmaceutical fentanyl and related drugs (NPF) have contributed to increases in drug-related overdose mortality in the U.S. More data are needed to track the shifting composition of fentanyl-containing drug mixtures. The key aims of the study are to characterize the crime lab data from Montgomery County, Ohio on the increased cases of seized drugs containing mixtures of NPF and tramadol.

Methods

Crime lab data on seized drugs in Montgomery County, Ohio (2015 - 2020) were analyzed to extract information on cases that tested positive for NPF and tramadol. Descriptive statistics are provided to characterize NPF/tramadol mixtures in terms of the quantity, weight, form of the drug seized (powder, tablet, capsule, residue), and the types of fentanyl analogs and other drugs identified.

Results

In December 2017, the first case of NPF/tramadol mixture was identified in the amount of 0.2 g. Subsequently, cases containing NPF/tramadol increased significantly to 149 cases in 2018, 102 in 2019, and 134 in 2020. The total yearly amounts of seized NPF/tramadol mixtures increased to 373.27 g in 2018, 2,601.82 g in 2019, and 13,487.62 g in 2020. The majority (72.6%) of the cases were in powder form. There were 15 other drugs identified along with fentanyl with tramadol mixtures, including heroin (38.8%), 5.7% cocaine (5.7%), and methamphetamine (4.9%).

Conclusions

The addition of tramadol to NPF may be viewed as a harm mitigation strategy but contributes to the overall unpredictability of the illicit drug supply. According to Ohio legal statutes, identification of schedule IV drugs such as tramadol with fentanyl (schedule II) may provide a reduction in drug-related charges from a felony to a misdemeanor. More research is needed to characterize potential sources of tramadol in NPF-containing drugs.

Introduction: Somatic symptom disorder (SSD) is a mental disorder that involves one or more physical symptoms (e.g. palpitations, dizziness, diarrhoea, limb weakness, pain, and pseudo neurological symptoms) accompanied by one or more thoughts, feelings, and/or behaviours related to the somatic symptom(s) resulting in significant distress and/or dysfunction lasting for more than 6 months. At now the SSD can be refractory to psychiatric intervention including antidepressants, antiepileptics, and antipsychotics as well as the effectiveness of many of these treatments is limited. The objective of this study was to report the effectiveness of a third-generation antipsychotic drug brexpiprazole for treatment of a case of SSD together with the serotonin selective reuptake inhibitor (SSRI) fluvoxamine. Methods: A single case study of a 59-year-old female with SSD was here performed. Findings: After 4 weeks of treatment brexpiprazole, together with lamotrigine and fluvoxamine, was here effective in decreasing both depressive and anxiety symptoms, normalising previous unusual thought contents and of related behaviours. The patient reported an overall good response and started to function again in important domains of life. No adverse events occurred. Conclusion: To our knowledge, this is the first case showing Brexpiprazole effective for the treatment of a case of SSD as add-on to other drugs.

The opioid epidemic in the U.S. has resulted in significant costs in human lives as well as to the health care system, employers, and insurers. While there is great motivation and urgency to address the opioid crisis, there are currently few non-opioid pain management medications in the development pipeline. The growing regulatory pressures and stigma surrounding opioids have discouraged investments and research in the pain industry. Using estimates from the literature, our simulations show that a portfolio of pharmaceuticals and medical devices for pain treatment and opioid use disorder, diversified and optimized across different development pathways, yields single digit annualized returns. This suggests that active collaboration between the public and private sectors is needed to incentivize investments in pain research.

The aim of the current overview was to present the existing literature on the recent phenomenon of eSports. Using a multifaceted approach, we focused on its definitions, historical development, and classification, drawing attention to key disputes that exist between scholars. Furthermore, we investigated the debate on whether eSports should be considered a traditional sport or not, with a particular interest in two processes that have contributed to eSports’ development as a culturally-significant addition to the world of sports, as both a game and an occupation: sportification and professionalization. Lastly, we analysed studies on spectatorship and consumption to understand why people watch and play eSports pointing out data about the recent relationship between practice and the possible development of eSport's addiction, gambling, and the related impact on individual health and wellbeing.

Novel Psychoactive Substances newly introduced on the drug market are constantly changing patterns of drug consumption. Among these, Synthetic Cannabinoids (SCs) mainly dominated European seizures in the last years. Quinolin-8-yl 1-(5-fluoropentyl)-1H-indole-3-carboxylate (5F-PB22) and quinolin-8-yl 1-(cyclohexylmethyl)-1H-indole-3-carboxylate (BB-22) are SCs whose abuse has been linked to a range of fatal intoxications and hospitalizations. Therefore, this study aims to investigate and compare in vitro and in vivo pharmacodynamics activity of these quinolinyl ester indoles. In vitro competition binding experiments performed on CD-1 murine and human cannabinoid CB₁ and CB₂ receptors revealed a sub-nanomolar affinity and potency of 5F-PB22 and BB-22. In vivo studies demonstrated that the acute systemic administration of 5F-PB22 and BB-22 (0.001-6 mg/kg) deeply impaired sensorimotor and motor responses, core temperature, breath rate and nociceptive threshold of CD-1 male mice. Pre-treatment with the selective cannabinoid CB₁ receptor antagonist/inverse agonist AM-251 (6 mg/kg) fully prevented the effects of both cannabinoids (at 1 mg/kg) suggesting a CB₁ receptor mediated action. Relying on these findings, this study showed for the first time the pharmaco-toxicological effects of these substances confirming their potential burden on human health. Furthermore, it revealed that the difference of the chemical structures of the two SCs results in their potency related disparities.

Background

Following the Covid-19 pandemic, lockdown strategies have been adopted by many Governments worldwide to stop the spread of the virus. Twelve-step programs for people with substance use disorders (SUDs) as Narcotics Anonymous (NA) experienced forced interruption as well, in some cases organizing online meetings to continue their activities. The purpose of this article is to reflect on concerns and advantages of online setting for 12-step groups.

Methods

We report the experience of an Italian NA participant attending for the first time an online NA group during the Covid-19 pandemic.

Results

The strengths and limitations of the online setting, showing up from the living voice of this participant, are expressed in the light of the present pandemic situation. Together with the general advantages derived from telehealth technologies, specific benefits of the virtual setting for 12-step programs are shown. Concerns are also discussed, as those related to privacy and social presence.

Conclusions

The case highlights many possibilities of the online setting for 12-step programs. On the other hand, it suggests the critical importance of in-person groups to accompany the recovery process. Future outcome research is needed about the combination of these approaches.