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

Background

HIV prevalence rate among people who inject drugs (PWIDs) in Myanmar is marginally high (34.9%). HIV transmission can be reduced and prevented through harm reduction programs such as methadone maintenance treatment (MMT) and needle syringe exchange program (NSEP). We sought to determine the relationship between methadone dose and injecting behaviours among clients enrolled in the MMT program in Myanmar.

Method

A total of 210 MMT clients, who had a minimum of six-month methadone treatment history, were recruited from five cities through stratified random sampling for this cross-sectional study. A semi-structured questionnaire with the timeline flow back (TLFB) scale was administered. Respondents were also screened for illicit drug use.

Results

Almost two-thirds (63.5%, n=132) received less than or equal to 80mg/day of methadone dose, and 36.5% (n=76) received more than 80mg of methadone daily, while the sample average daily methadone dose in this study was 83mg (ranging from 20mg to 300mg per day). The results indicated that methadone dose was associated with having HIV infection, antiretroviral therapy (ART) and tuberculosis (TB) treatment history, heroin injection history in the last 30 days, needle sharing history, addiction severity on employment, as well as THC (cannabis) and benzodiazepine use history (p<0.05). In addition, those who received a high methadone dose (more than 80mg/day) reduced their heroin injection use by 4 times compared to heroin injection frequency of respondents on low methadone dose (injection IRR=0.0029 vs. 0.0118, p=0.0000). Meanwhile, those who had HIV on high methadone dose were 2.6 times more likely to report reduction in risky injecting behaviours compared to low methadone dose.

Conclusion

A higher dose of methadone on prescription (more than 80mg/day) seems to reduce risky HIV injecting behaviours among both HIV negative and positive clients in MMT programs in Myanmar.

Introduction

In societies that place a great emphasis on physical appearance and body aestheticism, the use of image enhancing drugs (IEDs) has become increasingly widespread. Of particular concern is the use of skin lightening drugs, which might contain undisclosed and harmful ingredients of potential adulterated nature. These products are frequently advertised on social media platforms and elsewhere and used without medical consultation.

Methods

An explorative literature search was carried out in PubMed, Scopus, CINHAL, and ProQuest to better understand the motivational risk factors associated with skin lightening and assess their relation to body image, self-esteem, and other psychological disorders. All studies published until December 2020 were included in the review.

Results

A number of non-psychological factors can be associated with this practice. These include: (a) sociocultural i.e., achieve different social and cultural benefits, and (b) skin conditions such as hyperpigmentation lesions. Conversely, psychological factors can be correlated to (a) low self-esteem, (b) body image disturbances, and (c) other psychological factors like history of trauma and depressive symptoms.

Conclusion

Skin lightening remains a poorly studied and understood multifactorial phenomenon. More extensive research is needed to improve current clinical practice and raise public awareness on this dangerous practice.

Background

Hepatitis C virus (HCV) infection is a leading cause of hepatitis C, liver cancer, and cirrhosis. It is treatable with directing acting antivrials (DAAs), yet still accounts for over 580,000 global deaths annually. Due to the nature of transmission and particular risk factors, men living with HIV who have sex with other men (HIV+ MSM) are disportionately burdened. Whilst HCV is a statutorily notifiable disaease in England and a virtually complete registry exists, data specific to MSM are not captured, leaving gaps in our knowledge of HCV trends among HIV+ MSM.

Methods

This paper aims to investigate the HCV prevalence and incidence among HIV+ MSM in England through a systematic review of academic literature.

Results

The systematic review resulted in six articles. Evidence suggests that incidence has generally risen between 2002-2015 and declined between 2015-2018, which may be attributed to the introduction of DAAs. The range of reported prevalences varied from 2.2%-9.9% , the most recent estimate being 4.24% in 2018.

Conclusions

This review's deficiency is the non-existent record of behavioural risk factors across the studies. Most studies recruited HIV+ MSM from HIV clinics, an arguably robust sampling method considering that 90% of those living with HIV in England are engaged in care at an HIV clinic. The gaps in the academic literature and national surveillance for HCV among HIV+ MSM demonstrate this group to be disproportionately under-studied. National surveillance ought to record HCV cases and risk factors specific to HIV+ MSM to better inform interventions.

The recreational use of inhalants among teenagers and other vulnerable individuals is a growing cause of concern for clinicians. Products, such as computer dusters and spray cleaners containing highly toxic compounds, are being used to obtain immediate euphoric effects with significant health risks. In this article we provide an overview of this new drug trend and present a case report of a 14-year-old girl, who was admitted at our Addiction Treatment Unit (Ser.D) in Trento (Italy) after inhalant use. The lack of literature in the field suggests the need for further investigations on such hazardous practices and more targeted prevention approaches aimed at informing adolescents, parents and clinicians working with them.

Background

The market of sport supplements is expanding worldwide. Such phenomenon is often supported by captivating marketing strategies and social media advertising providing unscientifically founded claims, thus raising safety concerns. The aim of our study is to provide a comprehensive analysis of the online market, patterns of use, perceived risks and other safety issues on supplement use as reported in online fitness communities.

Methods

A mixed method approach was employed. An automatized web-based monitoring tool (Brand24®) was used to track the most popular supplements and related discussions according to the number of interactions between users and shares; the number and category of websites; the social media reach; and the most popular hashtags. Results were assessed through a netnographic qualitative analysis of online fitness fora, to identify motivations of intake, self-reported side effects andthe overall safety perception reliability of supplements information online.

Results

A social media reach of over four million individuals, inclusive of 18595 posts, emerged from our search. The most cited supplements were “Whey Protein”, “Branched Chain Amino-Acid”, “Creatine”, “Multivitamin supplements” and “Nitric Oxide boosters”. Supplements were mainly taken for muscle gain (23%), increase energy (17%), and weight loss (8%). Although the web narrative on supplementation was overall positive, a wide range of side effects were reported by 19% of fitness fora users. These included acne (9%), water retention (9%), stomach pain (9%), rashes (7%), erectile dysfunctions (7%) and weight gain (5%). Concerns about contamination (47%), counterfeit content (17%) and the presence of hidden ingredients (11%) were also recorded.

Conclusions

In a poorly regulated context, where unsolicited social media posts have replaced the typical advice provided by professionals, efforts should be made to ensure the reliability of the provided information to avoid the insurgence of unwanted adverse effects and safeguard public health.

Aims

Bipolar disorders (BDs) and eating disorders (EDs) are both common and severe mental illness and present wide areas of symptomatological overlap. The present study aims to focus on the most significant aspects of this comorbidity.

Methods

This review summarizes epidemiology, aethiopathology, prognostic impact, assessment, treatment of comorbidity between BDs and EDs, and comorbidity between bipolar or eating disorders and other psychiatric disorders. We have reviewed articles published in PubMed/Medline, Scopus, Embase, ScienceDirect from 2005 to 2020 concerning comorbidity between eating and bipolar disorders, and systematic reviews or metanalysis on comorbidities between EDs or BDs and other psychiatric disorders.

Results

Studies that specifically evaluate the prevalence of EDs in patients with bipolar disorder are more than the studies that investigate the opposite. In BDs, binge eating disorder (BED) represents the most common eating disorder with a prevalence ranging from 8,8% to 28,8%, whereas BN has a prevalence ranging from 4,8% to 10%, and AN from 1% to 7,4%. Instead, in ED patients, prevalence of bipolar disorders ranges from 11,5% to 68.1%.

The relationship between EDs and BDs has not been yet investigated enough and consequently has not been totally understood. The presence of EDs has been considered as a marker of clinical severity in patients with bipolar disorders, whereas the presence of bipolar disorder in patients with EDs seems not to have a considerable effect on the age at onset of ED symptoms and on their severity. Comorbidities between EDs or BDs and other psychiatric disorders were also examined.

Discussion

Given the strong co-occurrence of eating and bipolar disorder, the treatment for one of these should consider that the other one may co-exist, and therefore should focus on both of them. In patients suffering from one of these disorders, the early screening for the other one should be made. As for pharmacological treatment, it is mandatory to consider that pharmacological treatment effective for one of the two disorders could worsen symptoms of the other, for instance many psychotropic medications could cause weight gain. Further studies are needed to reach an early diagnosis through the development of screening tools, and to deepen aspects of this comorbidity that remain still unknown with particular regard to pharmacological treatment and to biopsychological aspects that might be useful in determining the aetiopathology.

Objective

Cannabis use is criminalized in Malaysia under existing drug laws, despite the prevailing contrasting views towards cannabis regulation. We sought to determine the motives for using cannabis, perceptions regarding the risks of using it, and the legal ramifications related to its use among employed graduates in Malaysia.

Design

Twenty-three employed graduates were recruited through snow-ball sampling for this qualitative study. The interviews were recorded, transcribed verbatim and analyzed based on the respondents’ testimonies.

Results

The majority were females (52%, n=12/23), and Malay (57%, n=13/23). Nearly 87% (n=20/23) were single (including one divorcee). The respondents’ mean age was 30.9 years (SD=5.2), and the mean age at which cannabis was first used was 20.5 years (SD=3.1). The majority used cannabis for recreational (60%, n=16/23), and medicinal (30%) purposes. Cannabis use was associated with perceived positive effects and the belief that it is a safe substance. It was also regarded to be safer than conventional pharmacotherapy in treating self-disclosed psychological symptoms. The few who wanted but had difficulty abstaining from cannabis use avoided seeking treatment due to the fear of prejudice from treatment providers. Users also felt that drug laws are being applied unevenly to favour the well-connected. In general, users want a more liberalized approach to cannabis use.

Conclusions

The use of cannabis among educated, employed individuals persists because they remain functional and appear to be unharmed by extended use. They are either unconcerned or unaware of the negative side of cannabis use. Making them aware of the negatives in an intelligent and fact-based manner will help them make informed decisions.

Media reports indicate that New Psychoactive Substances (NPS) is widespread in Nigeria and Africa, but little empirical research has been conducted on this. Also, contemporary studies on NPS have focused on Global North, precluding Africa. This may not be unrelated to the ‘non-classical packaging’ of NPS in homemade herbal mixtures and drug cocktails in the continent. This mini-review highlights the types of non-classical NPS available in Nigeria and calls for comprehensive and coordinated research that will map onto the availability, types, patterns, and motives for taking NPS among Nigerians to be conducted. This will facilitate the design of evidence-based harm reduction strategies to mitigate the challenges posed by NPS. Various substances that are packaged in non-classical forms and used ‘to get high’ are readily available. Some users take Gutter-Water (a cocktail of tramadol, cannabis, codeine, and vodka) and Monkey-Tail (a cocktail of homemade gin, cannabis seeds, leaves, stems, and roots) while others use ‘La Casera Apple Drink’ (carbonated soft drink) mixed with ‘Tom-Tom’ (menthol-flavoured candy). Other available non-conventional substances include smoking the whitish part of lizard dung or dry human faeces, dry cassava and pawpaw leaf/seeds, Zakami (Datura metel) seeds, Moringa (Zogale) leaf and inhaling/sniffing burnt tyres, hydrogen sulphide gas (sewer gas) and nail polish. Furthermore, we found that some people drink a mixture of bleach (sodium hypochlorite solution) and carbonated soft drinks and 10-day old urine as psychoactive substances. The motivations for the use of these substances include pleasure and prolonged intoxication. Studies should be conducted in all the regions of Nigeria and Africa to determine the availability, types, and extent to which NPS and other non-classical substances are available and used. This will facilitate the inclusion of these NPS to the World Drug Report and help in designing public health interventions in these settings.

Background

Although the diffusion of novel synthetic opioids has become a worldwide phenomenon, their prevalence of use in Italy seems to be limited. Existing national data is mainly derived by anamnestic surveyslacking of toxicological validation and not always disclosing the use of these compounds, which might remain under-diagnosed.

Methods

an assessment of the metabolites of the main synthetic opioids on hair samples was carried out among patients admitted at the Addiction Treatment Unit of Trento. The analytical approach included: (a) screening by means of immunoenzymatic method for fentanyl, fentanyl analogs and oxicodone; (b) confirmation of the samples resulted positive for fentanyl and oxicodone by means of HPLC-MS/; (c) search and dosage detection of Tramadol by means of HPLC-MS/MS.

Results

3 out of 309 analysed samples were found positive: one was positive to Fentanyl and two to 4-ANPP. In the same cohort, 6 samples were also found positive for Oxycodone . Tramadol was searched in 189 samples and 12 of them resulted positive.

Discussion and conclusion

Those found positive were mainly young adults engaging in dangerous patterns of use and lacking awareness of risks. The phenomenon requires further consideration by health professionals. Training and more evidence-based information on synthetic opioids as well as other Novel Psychoactive Substances (NPS) are urgently needed.