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British Journal of Clinical Pharmacology Apr 2021To estimate prevalence of last 12-month nonmedical use (NMU) of benzodiazepines and Z-drugs (the nonbenzodiazepine hypnotics zaleplon, zolpidem and zopiclone) in the UK.
AIMS
To estimate prevalence of last 12-month nonmedical use (NMU) of benzodiazepines and Z-drugs (the nonbenzodiazepine hypnotics zaleplon, zolpidem and zopiclone) in the UK.
METHODS
Data were collected using the Non-Medical Use of Prescription Drugs survey with poststratification weighting applied to be representative of the UK population (≥16 years). Participants were questioned about whether they had nonmedically used benzodiazepines and/or Z-drugs in the last 12-months and from where they had obtained the drug (including via a prescription, or illicitly from a friend/family member, a dealer or via the internet). Additional questions were asked about last 12-month use of illicit drugs (cannabis, cocaine, 3,4-methylenedioxymethylamphetamine [MDMA], non-pharmaceutical amphetamine, crack cocaine and/or heroin).
RESULTS
The study included 10 006 eligible participants representing approximately 52 927 000 UK adults. The estimated prevalence of past 12-month NMU of any benzodiazepine and/or Z-drug was 1.2% (95% confidence interval: 1.0-1.5) corresponding to approximately 635 000 adults; amongst this group only an estimated 4.6% (1.2-8.0) had NMU of both a benzodiazepine and a Z-drug. The highest prevalence of NMU for only Z-drugs was among those who had used heroin in the last 12-months (5.4%, 2.7-10.5), whilst the highest prevalence of NMU for only benzodiazepines was among those who had used illicit stimulants in the last 12-months: cocaine (5.9%, 3.8-8.9), amphetamine (5.6%, 3.1-10.0) and MDMA (5.2%, 3.1-8.8). The drug non-medically used was more commonly acquired without than with a prescription for both only benzodiazepines (70.2%, 59.4-81.1 compared to 51.3%, 41.5-64.6) and only Z-drugs (75.6%, 61.6-89.7 compared to 33.9%, 16.9-51.0).
CONCLUSION
There is little overlap between benzodiazepine and Z-drug NMU suggesting distinct nonmedical use of the drugs; future studies need to explore whether this relates to personal preference, drug availability or other factors. A significant proportion are acquiring these drugs for NMU without a prescription, so without guidance and monitoring from a medical practitioner. While the dangers of mixing benzodiazepines and heroin/other opioids are well documented, there is a paucity of data regarding concomitant NMU of benzodiazepines and stimulant drugs, or NMU of Z-drugs and opioids, and, given the prevalence of these combinations, this requires further investigation.
Topics: Adult; Benzodiazepines; Central Nervous System Stimulants; Humans; Illicit Drugs; Substance-Related Disorders; United Kingdom
PubMed: 32472941
DOI: 10.1111/bcp.14397 -
The International Journal on Drug Policy Nov 2022In the US, spikes in drug overdose deaths overlapping with the COVID-19 pandemic create concern that persons who use drugs are especially vulnerable. This study aimed to...
BACKGROUND
In the US, spikes in drug overdose deaths overlapping with the COVID-19 pandemic create concern that persons who use drugs are especially vulnerable. This study aimed to compare the trends in opioid overdose deaths and characterize opioid overdose deaths by drug subtype and person characteristics pre-COVID (2017-2019) and one-year post-COVID-19 emergence (2020).
METHODS
We obtained death certificates on drug overdose deaths in Arkansas from January 1, 2017, through December 31, 2020. Our analyses consisted of an interrupted time-series and segmented regression analysis to assess the impact of COVID-19 on the number of opioid overdose deaths.
RESULTS
The proportion of opioid overdose deaths increased by 36% post-COVID emergence (95% CI: 14%, 59%). The trend in overdose deaths involving synthetic narcotics other than methadone, such as fentanyl and tramadol, has increased since 2018 (74 in 2018 vs 79 in 2019; p=0.02 and 79 in 2019 versus 158 in 2020; p = 0.03). Opioid overdose deaths involving methamphetamine have more than doubled (36 in 2019 vs 82 in 2020; p = 0.06) despite remaining steady from 2018 to 2019. Synthetic narcotics have surpassed methamphetamine (71% vs. 37%) as the leading cause of opioid overdose deaths in Arkansas during the pandemic. This study found that synthetic narcotics are the significant drivers of the increase in opioid overdose deaths in Arkansas during the pandemic.
CONCLUSIONS
The co-occurrence of the COVID-19 pandemic and the drug abuse epidemic further highlights the increased need for expanding awareness and availability of resources for treating substance use disorders.
Topics: Humans; Opiate Overdose; COVID-19; Analgesics, Opioid; Tramadol; Arkansas; Pandemics; Drug Overdose; Fentanyl; Methadone; Substance-Related Disorders; Methamphetamine; Narcotics
PubMed: 36027767
DOI: 10.1016/j.drugpo.2022.103836 -
Frontiers in Public Health 2021Adolescents have become a prime target for drug dealers in various countries around the world, including in Indonesia. To reduce the high number of drug users amongst...
Adolescents have become a prime target for drug dealers in various countries around the world, including in Indonesia. To reduce the high number of drug users amongst adolescents, effective drug prevention programs should be developed and implemented. The present study aimed to identify effective school-based drug prevention programs for adolescents from the perspectives of former drug users and health professionals. This qualitative research used Focus Group Discussions (FGDs) to collect the data. The study participants consisted of eight Ex-Drug Users (EDUs) and eight Health Professionals (HPs) from health educational institutions and health service settings that were selected through purposive sampling. Data analysis was performed using the qualitative content analysis. Five themes were identified from both EDUs and HPs, including the negative effects of drugs, the socialization of drug abuse, the rehabilitation of drug addicts, the partner collaboration, and the obstacles in preventing drug use. All participants agreed that the drug prevention programs such as school-based drug prevention programs are necessary in order to minimize the adverse effects of drug use. While EDUs tended to focus on the social and psychological effects of drugs, the HPs were more inclined toward the risks of diseases, social impacts, and economic problems of the drugs as the reasons for program importance. In terms of the intervention programs, both EDUs and HPs proposed conducting socialization through the use of active methods and agreed that rehabilitation as an effective way for addict students. Also, both groups of participants agreed on the significance of internal and external support, as well as coordination and collaboration to produce an effective and quality program. While the EDUs cited external factors as the main obstacle to the success of program implementation, the HPs mentioned internal factors of the users. School-based drug prevention programs are an important and potentially effective strategy to reduce the use and the effects of drug use among adolescents. The support of various relevant stakeholders is needed to further increase the effectiveness of the programs and eliminate possible barriers to the implementation of the intervention programs.
Topics: Adolescent; Drug Users; Humans; Indonesia; Pharmaceutical Preparations; Qualitative Research; Schools; Substance-Related Disorders
PubMed: 33643994
DOI: 10.3389/fpubh.2021.631212 -
Cellular and Molecular Life Sciences :... May 2021HIV-associated neurocognitive disorder (HAND) is characterized by cognitive and behavioral deficits in people living with HIV. HAND is still common in patients that take... (Review)
Review
HIV-associated neurocognitive disorder (HAND) is characterized by cognitive and behavioral deficits in people living with HIV. HAND is still common in patients that take antiretroviral therapies, although they tend to present with less severe symptoms. The continued prevalence of HAND in treated patients is a major therapeutic challenge, as even minor cognitive impairment decreases patient's quality of life. Therefore, modern HAND research aims to broaden our understanding of the mechanisms that drive cognitive impairment in people with HIV and identify promising molecular pathways and targets that could be exploited therapeutically. Recent studies suggest that HAND in treated patients is at least partially induced by subtle synaptodendritic damage and disruption of neuronal networks in brain areas that mediate learning, memory, and executive functions. Although the causes of subtle neuronal dysfunction are varied, reversing synaptodendritic damage in animal models restores cognitive function and thus highlights a promising therapeutic approach. In this review, we examine evidence of synaptodendritic damage and disrupted neuronal connectivity in HAND from clinical neuroimaging and neuropathology studies and discuss studies in HAND models that define structural and functional impairment of neurotransmission. Then, we report molecular pathways, mechanisms, and comorbidities involved in this neuronal dysfunction, discuss new approaches to reverse neuronal damage, and highlight current gaps in knowledge. Continued research on the manifestation and mechanisms of synaptic injury and network dysfunction in HAND patients and experimental models will be critical if we are to develop safe and effective therapies that reverse subtle neuropathology and cognitive impairment.
Topics: Actin Cytoskeleton; Animals; Astrocytes; Dendritic Spines; HIV Infections; Humans; Neurocognitive Disorders; Neurons; Receptors, Ionotropic Glutamate; Substance-Related Disorders
PubMed: 33585975
DOI: 10.1007/s00018-021-03785-y -
Nature Reviews. Genetics Nov 2021Substance use disorders (SUDs) are conditions in which the use of legal or illegal substances, such as nicotine, alcohol or opioids, results in clinical and functional... (Review)
Review
Substance use disorders (SUDs) are conditions in which the use of legal or illegal substances, such as nicotine, alcohol or opioids, results in clinical and functional impairment. SUDs and, more generally, substance use are genetically complex traits that are enormously costly on an individual and societal basis. The past few years have seen remarkable progress in our understanding of the genetics, and therefore the biology, of substance use and abuse. Various studies - including of well-defined phenotypes in deeply phenotyped samples, as well as broadly defined phenotypes in meta-analysis and biobank samples - have revealed multiple risk loci for these common traits. A key emerging insight from this work establishes a biological and genetic distinction between quantity and/or frequency measures of substance use (which may involve low levels of use without dependence), versus symptoms related to physical dependence.
Topics: Alcoholism; Animals; Brain; Epigenomics; Genome-Wide Association Study; Humans; Illicit Drugs; Nicotine; Substance-Related Disorders
PubMed: 34211176
DOI: 10.1038/s41576-021-00377-1 -
Scientific Reports Jul 2021Despite recently resurrected scientific interest in classical psychedelics, few studies have focused on potential harms associated with abuse of these substances. In...
Despite recently resurrected scientific interest in classical psychedelics, few studies have focused on potential harms associated with abuse of these substances. In particular, the link between psychedelic use and psychotic symptoms has been debated while no conclusive evidence has been presented. Here, we studied an adult population (n = 1032) with a special focus on young (18-35 years) and healthy individuals (n = 701) to evaluate the association of psychedelic drug use with schizotypy and evidence integration impairment typically observed in psychosis-spectrum disorders. Experimental behavioural testing was performed in a subsample of the subjects (n = 39). We observed higher schizotypy scores in psychedelic users in the total sample. However, the effect size was notably small and only marginally significant when considering young and healthy subjects (Cohen's d = 0.13). Controlling for concomitant drug use, none of our analyses found significant associations between psychedelic use and schizotypal traits. Results from experimental testing showed that total exposure to psychedelics (frequency and temporal proximity of use) was associated with better evidence integration (Cohen's d = 0.13) and a higher sensitivity of fear responses (Cohen's d = 1.05) to the effects instructed knowledge in a reversal aversive learning task modelled computationally with skin conductance response and pupillometry. This effect was present even when controlling for demographics and concomitant drug use. On a group level, however, only difference in sensitivity of fear responses to instructed knowledge reached statistical significance. Taken together, our findings suggest that psychedelic drug use is only weakly associated with psychosis-like symptoms, which, in turn, is to a large extent explained by psychiatric comorbidities and use of other psychoactive substances. Our results also suggest that psychedelics may have an effect on flexibility of evidence integration and aversive learning processes, that may be linked to recently suggested therapeutic effects of psychedelic drugs in non-psychotic psychiatric populations.
Topics: Adolescent; Adult; Fear; Female; Hallucinogens; Humans; Male; Psychotic Disorders; Schizotypal Personality Disorder; Substance Withdrawal Syndrome; Substance-Related Disorders; Young Adult
PubMed: 34301969
DOI: 10.1038/s41598-021-94421-z -
The Science of the Total Environment Jan 2022Estimation of illicit drug use on a community level by wastewater-based epidemiology (WBE) is both an objective and reliable way to establish near real-time results....
Estimation of illicit drug use on a community level by wastewater-based epidemiology (WBE) is both an objective and reliable way to establish near real-time results. Wastewater samples were collected at eleven timepoints in Reykjavik from 2017 to 2020. The use of commonly abused illicit drugs in Iceland (amphetamine, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), cocaine, and cannabis) was estimated. Solid phase extraction and ultra-high performance liquid chromatography coupled to tandem mass spectrometry was used for analysis. Estimated amphetamine and methamphetamine use showed signs of an increase from 2017 to 2020 with amphetamine being the dominant stimulant on the market. MDMA use remained stable from 2017 to 2020. Results showed a large increase in cocaine use from 2017 to 2019 but interestingly, a marked decrease in 2020 during the COVID-19 pandemic. Cannabis use was stable from 2017 to 2019 but showed signs of an increase during the pandemic in 2020. Results by WBE corresponded with data based on two other indicators of drug use, seizure data and driving under the influence cases. Both temporal and spatial trends in illicit drug use were successfully estimated by using WBE, complimenting other indicators which provided a comprehensive picture of drug abuse in Reykjavik.
Topics: COVID-19; Humans; Illicit Drugs; Pandemics; SARS-CoV-2; Substance Abuse Detection; Substance-Related Disorders; Wastewater; Wastewater-Based Epidemiological Monitoring; Water Pollutants, Chemical
PubMed: 34482138
DOI: 10.1016/j.scitotenv.2021.149795 -
International Journal of Molecular... Sep 2022Recent data show that young people, mainly due to the pressure of some risk factors or due to disrupted interpersonal relationships, utilise greater reward value and... (Review)
Review
Could Alcohol Abuse and Dependence on Junk Foods Inducing Obesity and/or Illicit Drug Use Represent Danger to Liver in Young People with Altered Psychological/Relational Spheres or Emotional Problems?
Recent data show that young people, mainly due to the pressure of some risk factors or due to disrupted interpersonal relationships, utilise greater reward value and display greater sensitivity to the reinforcing properties of "pleasurable stimuli", specifically in those situations in which an enhanced dopamine release is present. Alcoholic beverages, foods rich in sugar and fat, and illicit drug use are pleasurable feelings associated with rewards. Research shows that there is a link between substance abuse and obesity in brain functioning. Still, alcohol excess is central in leading to obesity and obesity-related morbidities, such as hepatic steatosis, mainly when associated with illicit drug dependence and negative eating behaviours in young people. It is ascertained that long-term drinking causes mental damage, similarly to drug abuse, but also affects liver function. Indeed, beyond the pharmacokinetic interactions of alcohol with drugs, occurring in the liver due to the same metabolic enzymes, there are also pharmacodynamic interactions of both substances in the CNS. To complicate matters, an important noxious effect of junk foods consists of inducing obesity and obesity-related NAFLD. In this review, we focus on some key mechanisms underlying the impact of these addictions on the liver, as well as those on the CNS.
Topics: Adolescent; Alcoholism; Dopamine; Humans; Illicit Drugs; Liver; Obesity; Substance-Related Disorders; Sugars
PubMed: 36142317
DOI: 10.3390/ijms231810406 -
Neuropharmacology Aug 2020Converging evidence suggests that parental exposure to drugs of abuse can affect offspring phenotypes. The impacts of drug abuse on germ cell quality may mediate... (Review)
Review
Converging evidence suggests that parental exposure to drugs of abuse can affect offspring phenotypes. The impacts of drug abuse on germ cell quality may mediate multigenerational and transgenerational inheritance, although biological pathways underlying this mode of inheritance are not yet characterized. Germline epigenetic marks are modified by drug exposure and have emerged as promising mechanistic candidates in recent work. Drug exposure also impacts overall germline integrity and reproductive functioning, although the role of these consequences in multi/transgenerational inheritance is unclear. This review synthesizes literature on effects of exposure to alcohol, cocaine, and nicotine on the germline with a focus on epigenetic modifications following drug exposure and broader impacts on germline integrity and reproductive functioning. We discuss potential interactions between reproductive functioning, germline integrity, and germline epigenome/transcriptome in pathways underlying multi/transgenerational inheritance. We find that existing data may support independent or interactive contributions of these germline impacts on offspring phenotypes in a manner that may mediate multi/transgenerational inheritance.
Topics: Animals; Cocaine; DNA Methylation; Epigenesis, Genetic; Epigenome; Epigenomics; Ethanol; Gene Expression Regulation, Developmental; Germ Cells; Humans; Nicotine; Substance-Related Disorders; Wills
PubMed: 32413368
DOI: 10.1016/j.neuropharm.2020.108127 -
PloS One 2022Prior research has found a high prevalence of childhood sexual abuse (CSA) among sexual minority men (SMM) in the US, and has indicated that CSA is associated with...
BACKGROUND
Prior research has found a high prevalence of childhood sexual abuse (CSA) among sexual minority men (SMM) in the US, and has indicated that CSA is associated with higher rates of alcohol and drug use disorders. However, most of these studies have focused almost exclusively on White SMM. We assessed associations of CSA, alcohol use, and drug use problems among adult Black SMM.
METHODS
Participants were 1,016 Black SMM recruited from six US cities (Atlanta, Boston, Los Angeles, New York City, San Francisco, and Washington, DC) between July 2009 and December 2011. We used hierarchical logistic regression to evaluate the associations between CSA, alcohol use problems (≥ 8 AUDIT), and drug use problems (excluding marijuana).
RESULTS
Mean (SD) age was 37.8 (11.7) years, and 28.6% and 49.2% reported alcohol and drug use disorders in the past six months, respectively. Most of the study participants reported history of CSA (70.3%). Adjusting for sociodemographic and confounding variables, CSA was associated with higher odds of alcohol use problems (odds ratio (OR) = 1.52, 95% CI 1.09, 2.12) and drug use problems (OR = 1.58, 95% CI 1.19, 2.10) than non-CSA group.
CONCLUSION
Prevalence of CSA is high among BSMM in the US and is positively associated with alcohol and drug use problems. Substance use interventions should address the psychological health needs of BSMM with a history of CSA.
Topics: Male; Adult; Child; Humans; Alcoholism; Cities; Child Abuse, Sexual; Substance-Related Disorders; Sexual and Gender Minorities
PubMed: 36548261
DOI: 10.1371/journal.pone.0279238