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

Background

In Western societies, individuals are increasingly exposed to external stimuli and performance demands. Some individuals are more susceptible than others to both negative and positive environmental conditions. Specifically, high « sensory processing sensitivity » (SPS) can make it difficult to adjust to certain demands. Psychoactive substance use can sometimes be used as a means to reduce external stimulation, but to date there have been few community based studies on this topic.

Methods

We used data from the 2018 French TEMPO based cohort study (n = 862 adults, 25–44 years) to study the relationship between sensory processing sensitivity and use of psychoactive substances including tobacco (regular use), alcohol (AUDIT), cannabis (CAST), and illicit drugs (lifetime use). To ascertain SPS, we used the 12-item Highly Sensitive Person (HSP) scale questionnaire. Data were analysed using logistic regression models adjusted on participants’ demographic characteristics, including gender, age, marital status, educational level, employment status, as well as juvenile history of externalizing problems in 1991 or 1999.

Results

High SPS was observed among 14% of subjects. No association was observed between SPS and psychotropic use. Nevertheless, each additional point on the SPS score was associated with a 20% increase in the odds of alcohol abuse, which came close to statistical significance.

Conclusions

In the community based TEMPO cohort study, we observed no association between SPS and psychotropic substance use among adults. Additional studies in younger samples would be of interest to test the role of this trait on the onset of substance-related difficulties.

Background

Chemsex refers to the use of drugs (e.g. mephedrone, gamma-hydroxybutyrate (GHB)/gamma-butyrolactone (GBL), methamphetamine, and ketamine) before or during sexual activity. Men who have sex with men (MSM) are a population in which chemsex engagement is prevalent. This poses risks of harm for mental and psychosocial health resulting in the use of healthcare services. This review aims to analyse the extent to which current prevention and harm reduction strategies concerning chemsex meet the healthcare needs of MSM who engage in chemsex in France, Germany, the Netherlands, Spain, and the United Kingdom.

Methods

Published papers reporting prevention and harm reduction interventions concerning MSM who engage in chemsex were identified through PubMed and Scopus. By utilising a holistic care perspective, data was synthesised concerning social norms within the MSM community, experiences with care providers, healthcare needs, experienced barriers to seek care, and structural barriers to providing care.

Results

Literature search identified 154 unique publications, of which 17 were included in the data synthesis. The cultural acceptance of drug use in both sexual and non-sexual contexts is high within the MSM community. Whereas there is a lack of awareness of chemsex-specific care by sexual health clinics (SHCs), standard drug and health clinics are often experienced negatively. The ability of SHCs to offer support tailored to the needs of MSM who engage in chemsex is often limited by lack of training or lack of referral chains.

Conclusion

As the MSM community and especially MSM who engage in chemsex are quick to adapt to new drug trends, it is important to increase support system resilience for chemsex care. There is a need for training, interorganisational cooperation, and expertise sharing and awareness of quality chemsex services and information. Integrated chemsex care, rapid referral chains, and their evaluations are required to align provided care with healthcare preferences.

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.