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Surgery Oct 2023The "vices-paradox" describes the paradoxical association between illicit substance use and decreased mortality risk in trauma patients. Cocaine's vasoconstrictive...
BACKGROUND
The "vices-paradox" describes the paradoxical association between illicit substance use and decreased mortality risk in trauma patients. Cocaine's vasoconstrictive effects may decrease hemorrhage but also increase the risk of thromboembolic complications. To clarify the effects of cocaine use on trauma patients, we compared the risk of mortality and thromboembolic complications in patients screening positive for cocaine with those screening negative.
METHODS
We searched the Trauma Quality Improvement Program database to identify patients 18 years and over who had presented with a drug and alcohol screen on admission between 2017 and 2019. After excluding all patients who had tested positive for alcohol and substances other than cocaine, we then compared the clinical outcomes of patients who were positive and negative for cocaine use.
RESULTS
Of the 312,553 patients identified, 11,942 (3.82%) had tested positive for cocaine. Cocaine users were significantly more likely to present with stab (8.0% vs 3.1%) or gunshot wounds (8.0% vs 3.0%) but had lower rates of mortality (3.6% vs 4.7%), myocardial infarction (0.1% vs 0.2%,) and cerebrovascular accident (0.3% vs 0.4%,). After controlling for covariates, the risk of death, myocardial infarction, and cerebrovascular accident did not significantly differ between cocaine and non-cocaine users.
CONCLUSION
Trauma patients positive for cocaine have similar risks of death and thromboembolic complications and so have a similar prognosis to patients negative for all drugs or alcohol, indicating that the "vices-paradox" does not apply to cocaine use. However, these patients more commonly present after penetrating trauma, suggesting cocaine use in hazardous environments.
Topics: Humans; Adolescent; Adult; Wounds, Gunshot; Cocaine-Related Disorders; Substance-Related Disorders; Cocaine; Ethanol; Stroke; Myocardial Infarction
PubMed: 37495463
DOI: 10.1016/j.surg.2023.06.024 -
Der Nervenarzt Jul 2023Anxiety disorders are frequent, with a 12-month prevalence of 14%, tend to be chronic, and display a high comorbidity with substance abuse disorders. Anxiety and... (Review)
Review
Anxiety disorders are frequent, with a 12-month prevalence of 14%, tend to be chronic, and display a high comorbidity with substance abuse disorders. Anxiety and substance abuse disorders are associated with a pronounced individual as well as socioeconomic burden. This article reviews the epidemiological, etiological, and clinical aspects of the dual diagnosis of anxiety and substance abuse disorders, with a particular focus on alcohol and cannabis. The treatment comprises nonpharmacological strategies, mainly cognitive behavioral therapy combined with elements of motivational interviewing (MI) and pharmacological management with antidepressants; however, the use of selective serotonin reuptake inhibitors (SSRI)/serotonin and noradrenaline reuptake inhibitors (SNRI) is not unreservedly recommended. The use of gabapentinoids requires careful risk-benefit consideration because of their potential for abuse and dependence in substance abuse disorders. Benzodiazepines are reserved exclusively for crisis management. Rapid diagnosis and treatment initiation targeting both disorders are essential for successful treatment of comorbid anxiety and substance abuse disorders.
Topics: Humans; Cannabis; Anxiety Disorders; Anxiety; Substance-Related Disorders; Antidepressive Agents; Ethanol
PubMed: 37341771
DOI: 10.1007/s00115-023-01502-7 -
Drug and Alcohol Review Jul 2023Despite long-standing recommendations to integrate mental health care and alcohol and other drug (AOD) treatment, no prior study has synthesised evidence on the impact... (Review)
Review
ISSUES
Despite long-standing recommendations to integrate mental health care and alcohol and other drug (AOD) treatment, no prior study has synthesised evidence on the impact of physically co-locating these specialist services on health outcomes.
APPROACH
We searched Medline, PsycINFO, Embase, Web of Science and CINAHL for studies examining health outcomes associated with co-located outpatient mental health care and AOD specialist treatment for adults with a dual diagnosis of substance use disorder and mental illness. Due to diversity in study designs, patient populations and outcome measures among the included studies, we conducted a narrative synthesis. Risk of bias was assessed using the MASTER scale.
KEY FINDINGS
Twenty-eight studies met our inclusion criteria. We found provisional evidence that integrated care that includes co-located mental health care and AOD specialist treatment is associated with reductions in substance use and related harms and mental health symptom severity, improved quality of life, decreased emergency department presentations/hospital admissions and reduced health system expenditure. Many studies had a relatively high risk of bias and it was not possible to disaggregate the independent effect of physical co-location from other common aspects of integrated care models such as care coordination and the integration of service processes.
IMPLICATIONS
There are few high-quality, peer-reviewed studies establishing the impact of co-located mental health care and AOD specialist treatment on health outcomes. Further research is required to inform policy, guide implementation and optimise practice.
CONCLUSION
Integrated care that includes the co-location of mental health care and AOD specialist treatment may yield health and economic benefits.
Topics: Adult; Humans; Mental Health; Outpatients; Quality of Life; Substance-Related Disorders; Outcome Assessment, Health Care
PubMed: 37015828
DOI: 10.1111/dar.13651 -
The Journal of Clinical Investigation Jun 2024Lifetime and temporal co-occurrence of substance use disorders (SUDs) is common and compared with individual SUDs is characterized by greater severity, additional... (Review)
Review
Lifetime and temporal co-occurrence of substance use disorders (SUDs) is common and compared with individual SUDs is characterized by greater severity, additional psychiatric comorbidities, and worse outcomes. Here, we review evidence for the role of generalized genetic liability to various SUDs. Coaggregation of SUDs has familial contributions, with twin studies suggesting a strong contribution of additive genetic influences undergirding use disorders for a variety of substances (including alcohol, nicotine, cannabis, and others). GWAS have documented similarly large genetic correlations between alcohol, cannabis, and opioid use disorders. Extending these findings, recent studies have identified multiple genomic loci that contribute to common risk for these SUDs and problematic tobacco use, implicating dopaminergic regulatory and neuronal development mechanisms in the pathophysiology of generalized SUD genetic liability, with certain signals demonstrating cross-species and translational validity. Overlap with genetic signals for other externalizing behaviors, while substantial, does not explain the entirety of the generalized genetic signal for SUD. Polygenic scores (PGS) derived from the generalized genetic liability to SUDs outperform PGS for individual SUDs in prediction of serious mental health and medical comorbidities. Going forward, it will be important to further elucidate the etiology of generalized SUD genetic liability by incorporating additional SUDs, evaluating clinical presentation across the lifespan, and increasing the granularity of investigation (e.g., specific transdiagnostic criteria) to ultimately improve the nosology, prevention, and treatment of SUDs.
Topics: Humans; Substance-Related Disorders; Genome-Wide Association Study; Genetic Predisposition to Disease; Multifactorial Inheritance
PubMed: 38828723
DOI: 10.1172/JCI172881 -
Journal of Affective Disorders Sep 2024Ketamine and esketamine have been proven to be effective in treating adults with treatment resistant depression (TRD). Preliminary evidence indicates that, when combined...
INTRODUCTION
Ketamine and esketamine have been proven to be effective in treating adults with treatment resistant depression (TRD). Preliminary evidence indicates that, when combined with behavioral and psychological interventions, both agents may offer benefits for individuals with substance use disorder (SUD) and alcohol use disorder (AUD). Notwithstanding, concerns have been raised as to whether either or both agents are associated with abuse and/or gateway activity.
METHODS
Herein, we evaluate disproportionate reporting expressed as reporting odds ratios (ROR) for esketamine and ketamine. The outcomes of interest include alcohol problem, alcoholism, alcohol abuse, substance dependence, SUD, substance abuse, drug dependence, drug use disorder and drug abuse as codified by the Medical Dictionary for Regulatory Activities (MedDRA) within the FAERS. The IC025 values were significant for ketamine in cases of alcohol abuse (0.28), substance dependence (1.88), substance use disorder (0.996), substance abuse (0.61), drug dependence (0.56), drug use disorder (1.17) and drug abuse (1.22). Additionally, oxycontin showed significant IC025 values for substance dependence (0.067), substance use disorder (0.094), substance abuse (0.035), and drug dependence (0.27).
RESULTS
We observed significant increases in the reporting odds ratios (RORs) for ketamine with respect to various outcomes: alcohol abuse (ROR 2.84, 95 % CI 1.53-5.28; p = 0.0010), substance dependence (ROR 18.72, 95 % CI 8.49-41.30; p ≤ 0.0001), SUD (ROR 11.40, 95 % CI 4.24-30.65; p ≤ 0.0001), substance abuse (ROR 2.29, 95 % CI 1.73-3.04; p ≤ 0.0001), drug dependence (ROR 1.99, 95 % CI 1.64-2.42; p ≤ 0.0001), drug use disorder (ROR 4.50, 2.94-6.88; p ≤ 0.0001) and drug abuse (ROR 3.72, 3.36-4.12; p ≤ 0.0001). For esketamine, we observed that the ROR was significantly reduced for substance abuse (ROR 0.37, 95 % CI 0.22-0.63; p = 0.0003), drug dependence (ROR 0.13, 95 % CI 0.076-0.23; p ≤ 0.0001) and drug abuse (ROR 0.048, 95 % CI 0.030-0.078; p ≤ 0.0001). To our knowledge, this is the first report of spontaneous adverse events related to these outcomes of interest in the FAERS.
CONCLUSION
Mixed RORs were observed across aspects of SUD and AUD for both ketamine and esketamine. Due to limitations in the FAERS, establishing causal links between new onset alcohol and substance misuse with either agent remains inconclusive. Possible beneficial effects on measures of SUD and AUD were observed. It is currently unclear, but possible, whether both agents have differential ameliorative effects across dimensions of SUD and AUD, which is a focus of ongoing research.
Topics: Ketamine; Humans; Substance-Related Disorders; United States; Alcoholism; Adult; United States Food and Drug Administration; Male; Adverse Drug Reaction Reporting Systems; Female; Depressive Disorder, Treatment-Resistant; Antidepressive Agents; Middle Aged
PubMed: 38795777
DOI: 10.1016/j.jad.2024.05.116 -
Journal of Dental Research Aug 2023Evidence connects mental illness to other adverse health conditions, including oral health. However, longitudinal associations between mental and oral health remain...
Evidence connects mental illness to other adverse health conditions, including oral health. However, longitudinal associations between mental and oral health remain understudied. We aimed to examine mental health-oral health associations prospectively in a nationally representative US cohort. Data were from the Population Assessment of Tobacco and Health (PATH) Study. The Global Appraisal of Individual Needs-Short Screener measured 3 types of mental health symptoms: internalizing, externalizing, and substance use problems. Six self-reported oral health conditions related to periodontal disease were evaluated: self-rated oral health, bleeding gums, loose teeth, tooth extraction, gum disease, and bone loss around teeth. Cross-sectional analysis within PATH Study wave 4 (2016 to 2018, = 30,746) compared the survey-weighted prevalence of the 6 oral health outcomes according to severity of mental health problems. Prospectively, oral health outcomes were assessed 2 y later (wave 5, 2018 to 2019) according to wave 4 (baseline) mental health problems ( = 26,168). Survey-weighted logistic regression models controlled for confounders (age, sex, tobacco use, etc.) with imputation for missing values. All 6 adverse oral health conditions were greater in prevalence among participants with severe internalizing problems. Multiple conditions were also associated with severe externalizing or substance use problems. Longitudinally associations attenuated, but multiple associations of meaningful magnitude persisted, most with internalizing problems. For example, the adjusted odds ratio was 1.27 (95% CI, 1.08 to 1.50) for bleeding gums and 1.37 (95% CI, 1.12 to 1.68) for tooth extraction when we compared severe versus none/low internalizing problems. Providers should expect higher levels of oral disease among patients with adverse mental health symptoms. Independent of externalizing and substance use problems, symptoms of internalizing problems (related to depression and/or anxiety) are plausible risk factors for future oral disease. Better integration and coordination of mental and oral health treatment and prevention are recommended.
Topics: Humans; Mental Health; Oral Health; Cross-Sectional Studies; Substance-Related Disorders; Tobacco Use
PubMed: 37246825
DOI: 10.1177/00220345231171108 -
Psychiatry Research Mar 2024We characterized the genetic architecture of the attention-deficit hyperactivity disorder-substance use disorder (ADHD-SUD) relationship by investigating genetic...
We characterized the genetic architecture of the attention-deficit hyperactivity disorder-substance use disorder (ADHD-SUD) relationship by investigating genetic correlation, causality, pleiotropy, and common polygenic risk. Summary statistics from genome-wide association studies (GWAS) were used to investigate ADHD (N = 51,568), cannabis use disorder (CanUD, N = 161,053), opioid use disorder (OUD, N = 57,120), problematic alcohol use (PAU, N = 502,272), and problematic tobacco use (PTU, N = 97,836). ADHD, CanUD, and OUD GWAS meta-analyses included cohorts with case definitions based on different diagnostic criteria. PAU GWAS combined information related to alcohol use disorder, alcohol dependence, and the items related to alcohol problematic consequences assessed by the alcohol use disorders identification test. PTU GWAS was generated a multi-trait analysis including information regarding Fagerström Test for Nicotine Dependence and cigarettes per day. Linkage disequilibrium score regression analyses indicated positive genetic correlation with CanUD, OUD, PAU, and PTU. Genomic structural equation modeling showed that these genetic correlations were related to two latent factors: one including ADHD, CanUD, and PTU and the other with OUD and PAU. The evidence of a causal effect of PAU and PTU on ADHD was stronger than the reverse in the two-sample Mendelian randomization analysis. Conversely, similar strength of evidence was found between ADHD and CanUD. CADM2 rs62250713 was a pleiotropic SNP between ADHD and all SUDs. We found seven, one, and twenty-eight pleiotropic variants between ADHD and CanUD, PAU, and PTU, respectively. Finally, OUD, CanUD, and PAU PRS were associated with increased odds of ADHD. Our findings demonstrated the contribution of multiple pleiotropic mechanisms to the comorbidity between ADHD and SUDs.
Topics: Humans; Attention Deficit Disorder with Hyperactivity; Alcoholism; Genome-Wide Association Study; Substance-Related Disorders; Comorbidity; Opioid-Related Disorders
PubMed: 38335780
DOI: 10.1016/j.psychres.2024.115758 -
Psychiatric Services (Washington, D.C.) Nov 2023
Topics: Humans; Substance-Related Disorders
PubMed: 37908081
DOI: 10.1176/appi.ps.23074018 -
Substance Abuse Treatment, Prevention,... Jul 2023Encephalopathy can occur from a non-fatal toxic drug event (overdose) which results in a partial or complete loss of oxygen to the brain, or due to long-term substance...
BACKGROUND
Encephalopathy can occur from a non-fatal toxic drug event (overdose) which results in a partial or complete loss of oxygen to the brain, or due to long-term substance use issues. It can be categorized as a non-traumatic acquired brain injury or toxic encephalopathy. In the context of the drug toxicity crisis in British Columbia (BC), Canada, measuring the co-occurrence of encephalopathy and drug toxicity is challenging due to lack of standardized screening. We aimed to estimate the prevalence of encephalopathy among people who experienced a toxic drug event and examine the association between toxic drug events and encephalopathy.
METHODS
Using a 20% random sample of BC residents from administrative health data, we conducted a cross-sectional analysis. Toxic drug events were identified using the BC Provincial Overdose Cohort definition and encephalopathy was identified using ICD codes from hospitalization, emergency department, and primary care records between January 1st 2015 and December 31st 2019. Unadjusted and adjusted log-binomial regression models were employed to estimate the risk of encephalopathy among people who had a toxic drug event compared to people who did not experience a toxic drug event.
RESULTS
Among people with encephalopathy, 14.6% (n = 54) had one or more drug toxicity events between 2015 and 2019. After adjusting for sex, age, and mental illness, people who experienced drug toxicity were 15.3 times (95% CI = 11.3, 20.7) more likely to have encephalopathy compared to people who did not experience a drug toxicity event. People who were 40 years and older, male, and had a mental illness were at increased risk of encephalopathy.
CONCLUSIONS
There is a need for collaboration between community members, health care providers, and key stakeholders to develop a standardized approach to define, screen, and detect neurocognitive injury related to drug toxicity.
Topics: Humans; Male; British Columbia; Cross-Sectional Studies; Substance-Related Disorders; Drug Overdose; Brain Diseases; Drug-Related Side Effects and Adverse Reactions
PubMed: 37420239
DOI: 10.1186/s13011-023-00544-z -
Brain and Nerve = Shinkei Kenkyu No... Jan 2024Several causes of drug addiction in people remain unknown. It is known that only a small percentage of those who use potent dependent drugs, such as methamphetamine and...
Several causes of drug addiction in people remain unknown. It is known that only a small percentage of those who use potent dependent drugs, such as methamphetamine and heroin, develop addiction. In addition, some studies suggest that the choice of preferred drugs among drug addicts is made proactively according to criteria other than the strength of pharmacological dependence. Therefore, this paper discusses the pathogenesis of drug dependence, focusing on the "self-medication hypothesis" of Khantzian et al.
Topics: Humans; Substance-Related Disorders; Methamphetamine
PubMed: 38191144
DOI: 10.11477/mf.1416202562