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Behavioral Sciences (Basel, Switzerland) Dec 2022Chemsex is presented as a major challenge in public health, with numerous physical and mental consequences. The general objective of this review was to analyze the... (Review)
Review
Chemsex is presented as a major challenge in public health, with numerous physical and mental consequences. The general objective of this review was to analyze the relationship between the practice of chemsex and the development of psychosis. A mixed systematic review model was chosen. PubMed, PsycINFO, and Web of Science databases were searched following a predetermined search strategy. The studies were selected, and their information was extracted following a systematic method. A total of 10 articles were included. Psychotic symptoms ranged from 6.7% to 37.2%, being one of the most frequent psychiatric diagnoses. Slamsex, polydrug use and smoked methamphetamine posed up to a 3-fold increased risk of psychosis within this practice. The risk factors found were foreign or ethnic minority status, location in large cities, stress and anxiety, trauma, loneliness, sexually transmitted infections (STIs), hepatitis, and previous psychotic history. In conclusion, chemsex is associated with psychosis development; we found numerous converging risk factors and a clear mediating role of drugs. It is important, in approaching the prevention and treatment of this addiction, to take into account motivations and psychosocial circumstances.
PubMed: 36546999
DOI: 10.3390/bs12120516 -
Brain Sciences Nov 2022cocaine craving is a core feature of cocaine use disorder and remains a critical challenge for abstinence and relapse prevention. This review summarizes the anti-craving... (Review)
Review
BACKGROUND
cocaine craving is a core feature of cocaine use disorder and remains a critical challenge for abstinence and relapse prevention. This review summarizes the anti-craving efficacy of pharmacotherapies tested for cocaine use disorder, in the context of randomized-controlled clinical trials.
OBJECTIVES
we assessed the databases of the U.S. National Library of Medicine, Google Scholar, and PsycINFO, without date restrictions up to August 2022, to identify relevant studies.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS
we included double-blinded randomized-controlled trials investigating pharmacotherapies for cocaine craving and/or cocaine use disorder whose outcomes included cocaine craving.
STUDY APPRAISAL AND SYNTHESIS METHODS
Two authors screened studies' titles and abstracts for inclusion, and both read all the included studies. We systematically gathered information on the following aspects of each study: title; author(s); year of publication; sample size; mean age; sample characteristics; study set-ting; whether participants were treatment-seeking; study design; craving measures; study interventions; drop-out rates; and other relevant outcomes.
RESULTS
Overall, we appraised 130 clinical trials, including 8137 participants. We further considered the drugs from the studies that scored equal to or greater than six points in the quality assessment. There was a correlation between craving and cocaine use outcomes (self-reports, timeline follow-back or urinary benzoylecgonine) in the vast majority of studies. In the short-term treatment, acute phenylalanine-tyrosine depletion, clonidine, fenfluramine, meta-chlorophenylpiperazine (m-CPP) and mecamylamine presented promising effects. In the long term, amphetamine, biperiden, carbamazepine, lisdexamfetamine, lorcaserin, methamphetamine, mirtazapine, pioglitazone, progesterone, guanfacine, levodopa, nefazodone presented promising anti-craving effects. Unfortunately, the highly tested medications were not successful in most of the trials, as follows: propranolol in the short term; amantadine, aripiprazole, bromocriptine, citicoline, ketamine, modafinil, olanzapine, topiramate in the long term. The remaining 52 medications had no positive anti-craving outcomes.
LIMITATIONS
Our review was limited by high heterogeneity of craving assessments across the studies and by a great range of pharmacotherapies. Further, the majority of the studies considered abstinence and retention in treatment as the main outcomes, whereas craving was a secondary outcome and some of the studies evaluated patients with cocaine use disorder with comorbidities such as opioid or alcohol use disorder, schizophrenia, bipolar disorder or attention deficit hyperactivity. Lastly, most of the studies also included non-pharmacological treatments, such as counseling or psychotherapy.
CONCLUSIONS
There is a direct association between craving and cocaine use, underscoring craving as an important treatment target for promoting abstinence among persons with cocaine use disorder. Clonidine, fenfluramine and m-CPP showed to be promising medications for cocaine craving in the short-term treatment, and amphetamine, biperiden, carbamazepine, lisdexamfetamine, lorcaserin, methamphetamine, mirtazapine, pioglitazone, progesterone, guanfacine, levodopa, nefazodone in the long-term treatment.
PubMed: 36421870
DOI: 10.3390/brainsci12111546 -
Cureus Oct 2022The use of illicit stimulants continues to pose a significant challenge to different health sectors. In Australia, four particular stimulants, namely amphetamines and... (Review)
Review
The use of illicit stimulants continues to pose a significant challenge to different health sectors. In Australia, four particular stimulants, namely amphetamines and their derivatives, methamphetamine, ecstasy or 3,4-methylenedioxy-methamphetamine (MDMA), and cocaine cause a significant challenge to EDs as managing patients who use stimulants can be labor and resource intensive. While Australian data are available for stimulant-related ambulance attendances and hospitalizations, little is known about ED presentations of people who use stimulants. The aim of this paper is to systematically review the available literature related to the rates and patterns of ED presentations of people who use stimulants in Australia. A search was conducted on EBSCOhost, CINAHL Complete, and PubMed databases, as well as Google Scholar. Search terms consisted of combinations of the following terms: 1) stimulant AND ED AND Australia; 2) stimulants AND emergency presentations OR accident and emergency AND Australia, 3) amphetamine OR methamphetamine OR ecstasy OR cocaine AND ED AND Australia. Articles that met the inclusion criteria were included in the review and subjected to a quality appraisal. Data were extracted from the selected papers, including patient demographics, presentation rates, type of stimulant, reasons for presentations, police or ambulance service involvement, comorbidities, mental health issues, triage codes, admissions, and separations. The results of the review are reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were eligible if they were English-language peer-reviewed articles published between January 2011 and December 2021 and if they included data on Australian ED presentations of people who use non-prescription illicit stimulants. Studies were excluded if they did not include stimulant-related ED presentations or focused on ED presentations related to prescription stimulants, including Ritalin and Adderall, non-stimulant drugs, or caffeine for attention deficit disorder (ADD) or attention-deficit hyperactivity disorder (ADHD). The selected articles were appraised for quality, rigor, and risk of bias by two authors. The studies were assessed using the Newcastle Ottawa Scale (NOS) for cross-sectional, cohort, and case-control studies depending on the methodology identified in the study. A total of 19 articles were included in this study. Males represented 53 to 85% of ED presentations of people who use stimulants with an age range of 0 to 65 and are more likely to be transported by police or ambulance. People who use stimulants presented to EDs with varying psychological and behavioral concerns such as psychosis, self-harm, suicidal ideations, hallucinations, agitations, and aggressiveness, as well as medical conditions, including heart palpitations, nausea and vomiting, and significant physical injuries.
PubMed: 36407224
DOI: 10.7759/cureus.30429 -
Health Science Reports Nov 2022Substance use among adolescents is one of the most challenging behavioral disorders with direct consequences. It is of the essence (that) the prevalence of substance use...
BACKGROUND AND AIMS
Substance use among adolescents is one of the most challenging behavioral disorders with direct consequences. It is of the essence (that) the prevalence of substance use is investigated among Iranian male adolescents.
METHODS
The present study is a systematic review and meta-analysis. All published articles titled "prevalence of substance use among Iranian adolescents" authored in Persian and English from 2004 to 2020 on Pub Med, Scopus, SID, and Google Scholar, a top list of academic research databases, were reviewed. Thirty-three out of 805 articles, hinge on the inclusion and exclusion criteria, were eligible. Statistical analysis carried out in STATA 14.0.Q index, I2 index, and test were applied.
RESULTS
Overall prevalence reported with (95% confidence interval) for substance use 7% (4%-11%), methamphetamine 4% (3%-6%), tobacco 10% (3%-19%), and any addictive substances 4% (2%-7%) among male adolescents respectively. Besides, overall prevalence of alcohol consumption reported 10% (8%-11%).
CONCLUSION
The prevalence of substance use among male adolescents is high, so it is indispensable for researchers to pay special attention to this issue.
PubMed: 36304760
DOI: 10.1002/hsr2.885 -
Frontiers in Pharmacology 2022Methamphetamine, commonly referred to as METH, is a highly addictive psychostimulant and one of the most commonly misused drugs on the planet. Using METH continuously...
Methamphetamine, commonly referred to as METH, is a highly addictive psychostimulant and one of the most commonly misused drugs on the planet. Using METH continuously can increase your risk for drug addiction, along with other health complications like attention deficit disorder, memory loss, and cognitive decline. Neurotoxicity caused by METH is thought to play a significant role in the onset of these neurological complications. The molecular mechanisms responsible for METH-caused neuronal damage are discussed in this review. According to our analysis, METH is closely associated with programmed cell death (PCD) in the process that causes neuronal impairment, such as apoptosis, autophagy, necroptosis, pyroptosis, and ferroptosis. In reviewing this article, some insights are gained into how METH addiction is accompanied by cell death and may help to identify potential therapeutic targets for the neurological impairment caused by METH abuse.
PubMed: 36059947
DOI: 10.3389/fphar.2022.980340 -
Drug and Alcohol Review Jan 2023Cessation of methamphetamine use may result in a characteristic withdrawal syndrome, no medication has been approved for this indication. This systematic review aims to... (Meta-Analysis)
Meta-Analysis Review
ISSUES
Cessation of methamphetamine use may result in a characteristic withdrawal syndrome, no medication has been approved for this indication. This systematic review aims to assess the efficacy of pharmacotherapy for methamphetamine withdrawal, the first comprehensive meta-analysis since 2008.
APPROACH
MEDLINE (1966-2020), CINAHL (1982-2020), PsychINFO (1806-2020) and EMBASE (1947-2020) were systematically searched. Studies were included if they were randomised controlled trials (RCT) investigating pharmacological treatments for methamphetamine withdrawal, reviewing outcomes of treatment discontinuation, mental health outcomes, withdrawal symptoms (including craving) and patient safety. The relative risk (RR) and weighted mean difference (MD) were used to meta-analyse dichotomous and continuous data respectively, with 95% confidence intervals. Risk of bias and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessments were conducted.
KEY FINDINGS
Nine RCTs of six medications (n = 242 participants) met inclusion criteria, however, only six trials of four medications (n = 186) could be meta-analysed. Mean sample size across studies was 27 participants, and 88% of participants were male. The quality of evidence in this review varies from low to very low on GRADE assessments. Amineptine may reduce discontinuation rates (RR 0.22, 95% confidence interval [CI] 0.07, 0.72, p = 0.01), and improve global state (MD -0.49, 95% CI -0.80, -0.17), compared with placebo, however, this medication is no longer approved. No other medications improved any domain when compared with placebo. Due to lack of reporting safety profiles could not be established.
CONCLUSIONS
There is insufficient evidence to indicate any medication is effective for the treatment of methamphetamine withdrawal. The poor quality of the evidence indicates a need for better powered, high-quality trials.
Topics: Male; Humans; Female; Substance Withdrawal Syndrome; Methamphetamine; Randomized Controlled Trials as Topic
PubMed: 35862266
DOI: 10.1111/dar.13511 -
Addiction (Abingdon, England) Jan 2023The ability to regulate emotions effectively has been associated with resilience to psychopathology. Individuals with substance use disorders (SUDs) have been shown to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
The ability to regulate emotions effectively has been associated with resilience to psychopathology. Individuals with substance use disorders (SUDs) have been shown to have higher levels of negative emotionality, with some evidence suggesting impairment in emotion regulation compared with individuals without SUDs. However, no previous attempt has been made to systematically review the literature to assess the magnitude of this difference. We aimed to assess the association between SUD diagnosis and emotion regulation as measured by the Difficulties in Emotion Regulation Scale (DERS) and Emotion Regulation Questionnaire (ERQ) through a systematic review and meta-analysis of existing findings.
METHODS
The systematic review was conducted using PubMed, PsycINFO and Embase. We examined cross-sectional studies that compared a SUD group with a control group and measured emotion regulation using the DERS or the ERQ. The primary analysis focused on papers using the DERS, as this was the predominant instrument in the literature.
RESULTS
Twenty-two studies met our primary analysis criteria, representing 1936 individuals with a SUD and 1567 controls. Individuals with SUDs relative to controls had significantly greater DERS scores, with a mean difference of 21.44 [95% confidence interval (CI) = 16.49-26.40, P < 0.001] and Hedges' g = 1.05 (95% CI = 0.86-1.24, P < 0.001). The difference was robust, remaining significant after removing outliers and studies with high risk of bias. Individuals with SUDs demonstrated poorer emotion regulation on each subscale of the DERS, with the largest deficits in the Strategies and Impulse subscales. The ERQ analysis revealed greater use of expressive suppression in those with SUDs relative to controls (Hedges' g = 0.76, 95% CI = 0.25-1.28, P = 0.004).
CONCLUSIONS
People with substance use disorders appear to have greater difficulties in emotion regulation than people without substance use disorders.
Topics: Humans; Emotional Regulation; Cross-Sectional Studies; Substance-Related Disorders; Emotions; Surveys and Questionnaires
PubMed: 35851975
DOI: 10.1111/add.16001 -
Frontiers in Psychiatry 2022Repetitive transcranial magnetic stimulation (rTMS) has demonstrated therapeutic potential for treating patients with methamphetamine use disorder (MUD). However, the...
Efficacy of Repetitive Transcranial Magnetic Stimulation in Patients With Methamphetamine Use Disorder: A Systematic Review and Meta-Analysis of Double-Blind Randomized Controlled Trials.
BACKGROUND
Repetitive transcranial magnetic stimulation (rTMS) has demonstrated therapeutic potential for treating patients with methamphetamine use disorder (MUD). However, the most effective target and stimulation frequency of rTMS for treating MUD remains unclear. This meta-analysis explored the effect of rTMS on MUD.
METHODS
In this study, PubMed, Cochrane Systematic Reviews, and the Cochrane Collaboration Central Register of Controlled Clinical Trials were searched electronically for double-blind randomized controlled trials that used rTMS for treating MUD. We used published trials to investigate the efficacy of rTMS in MUD up to March 5, 2022, and pooled studies using a random-effect model to compare rTMS treatment effects. Patients who were diagnosed with MUD according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders were recruited. Clinical craving scores between baseline and after rTMS were compared using the standardized mean difference (SMD) with 95% confidence intervals (CIs). The heterogeneity of the included trials was evaluated through a visual inspection of funnel plots and the I statistic.
RESULTS
We identified seven trials with 462 participants with MUD that met the inclusion criteria. All the studies evaluated craving scores, with rTMS demonstrating a more significant effect than the sham treatment on reducing craving scores (SMD = 0.983, CI = 0.620-1.345, ≤ 0.001). A subgroup meta-analysis revealed that intermittent theta-burst stimulation (iTBS) had a greater positive effect than 10-Hz rTMS. A metaregression revealed that the SMDs increased with the increase in baseline craving scores, whereas they decreased with the increase in the proportion of men and duration of abstinence.
CONCLUSION
The meta-analysis suggests that rTMS may be associated with treatment effect on craving symptoms in patients with MUD. iTBS may have a greater positive effect on craving reduction than 10-z rTMS.
PubMed: 35711590
DOI: 10.3389/fpsyt.2022.904252 -
Current HIV/AIDS Reports Aug 2022Patterns of sexualized drug use, including stimulants (e.g., methamphetamine) and chemsex drugs, are key drivers of HIV incidence among sexual minority men (SMM).... (Review)
Review
PURPOSE OF REVIEW
Patterns of sexualized drug use, including stimulants (e.g., methamphetamine) and chemsex drugs, are key drivers of HIV incidence among sexual minority men (SMM). Although pre-exposure prophylaxis (PrEP) mitigates HIV risk, there is no consensus regarding the associations of substance use with the PrEP care continuum.
RECENT FINDINGS
SMM who use substances are as likely or more likely to use PrEP. Although SMM who use stimulants experience greater difficulties with daily oral PrEP adherence, some evidence shows that SMM who use stimulants or chemsex drugs may achieve better adherence in the context of recent condomless anal sex. Finally, SMM who use substances may experience greater difficulties with PrEP persistence (including retention in PrEP care). SMM who use stimulants and other substances would benefit from more comprehensive efforts to support PrEP re-uptake, adherence, and persistence, including delivering behavioral interventions, considering event-based dosing, and providing injectable PrEP.
Topics: Anti-HIV Agents; Continuity of Patient Care; HIV Infections; Homosexuality, Male; Humans; Male; Pre-Exposure Prophylaxis; Running; Sexual Behavior; Sexual and Gender Minorities; Substance-Related Disorders
PubMed: 35701713
DOI: 10.1007/s11904-022-00608-y -
Frontiers in Psychiatry 2022Abuses of most illegal drugs, including methamphetamine, marijuana, cocaine, heroin, and polydrug, are usually in conjunction with alcohol and tobacco. There are...
Abuses of most illegal drugs, including methamphetamine, marijuana, cocaine, heroin, and polydrug, are usually in conjunction with alcohol and tobacco. There are similarities and associations between the behavior, gene, and neurophysiology of such abusers, but the neural overlaps of their cue-reactivity and the correlation of neural overlap with drug craving still needs to be further explored. In this study, an Activation Likelihood Estimation (ALE) was performed on brain activation under legal (tobacco, alcohol) and illegal drug cues, for identifying the similarities in brain functions between different craving states. A Comprehensive meta-analysis (CMA) on the correlation coefficient between brain activation and craving scores in the selected literatures with subjective craving reports explained the degree of the craving via brain imaging results. In ALE, co-activation areas of the three cue-reactivity (posterior cingulate, caudate, and thalamus) suggest that the three cue-reactivity may all arouse drug-use identity which is a predictor of relapse and generation of conditioned reflexes under reward memory, thus leading to illegal drug relapses. In CMA, the brain activation was significantly correlated with subjective craving, with a correlation coefficient of 0.222. The neural overlap of tobacco, alcohol and most of the prevalent illegal drug cues not only further helps us understand the neural mechanism of substance co-abuse and relapse, but also provides implications to detoxification. Furthermore, the correlation between brain activation and craving is low, suggesting the accuracy of craving-based quantitative evaluation by neuroimaging remains unclear.
PubMed: 35463497
DOI: 10.3389/fpsyt.2022.779239