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Suardi, N. E., M. Preve, M. Godio, E. Bolla, R. A. Colombo, and R. Traber. "Misuse of pregabalin: Case series and literature review." European Psychiatry 33, S1 (March 2016): S312. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1067.
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IntroductionPregabalin is widely used in neurology, psychiatry and primary healthcare, and recently in literature different studies explain the possible misuse [1,2]. Pregabalin has shown greater potency in preclinical models of epilepsy, pain and anxiety, and may have potential in the treatment of cocaine addiction [3]. The purpose of this report is to review the clinical evidence for the potential of abuse and misuse of pregabalin. We propose ten different cases and literature review.MethodTen inpatients with misuse of pregabalin were assessed with: the SCID-P, Anamnestic Folio, HAM-A and DAST. We conducted a systematic review of the literature (PubMed, Embase, PsychInfo), using the terms “pregabalin”, “misuse”.ResultsAll our patients present: cocaine, alcohol and/heroin positive in drugs urine screening at admission; a significant high level of total anxiety at the HAM-A Tot (P < .001), and especially at the item 7 (P < .001); the misuse of pregabalin is made for sniffing; the predominant symptoms assessed were euphoria, psychomotor activation and sedation.Discussion and conclusionSchifano F et al., [1,2] suggest that pregabalin should carefully prescribe in patients with a possible previous history of drug abuse. Our result identifies a particular population the misuse pregabalin that are abuser of cocaine, alcohol and/or heroin. Further research is warranted to replicate our clinical and qualitative observations and, in general, quantitative studies in large samples followed up over time are needed. Methodological limitations, clinical implications and suggestions for future research directions are considered.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Bah, Yahya Muhammed. "Drug Abuse Among Street Children (Case Study: Commercial Vans Casual Apprentices at Car Parks)." Journal of Advance Research in Medical & Health Science (ISSN: 2208-2425) 4, no. 9 (September 30, 2018): 110–36. http://dx.doi.org/10.53555/nnmhs.v4i9.608.
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In The Gambia like all nations, drug abuse is seen as a social and health problem that has many serious implications for the physical, social, psychological and intellectual development of the victims more especially, the children. Therefore, it continues to be a concern to families, community leaders, educators, social workers, health care professionals, academics, government and its development partners. Though there are some studies on drug abuse, there is none on children and drug abuse focusing on the street children the most vulnerable category. Street children are hypothesized to be more at risk of any epidemic including drug abuse. This study sought to determine the risk and prevalence of drug abuse among street children focusing on those in the car parks. The research was focused on six critical areas: level of knowledge of drug abuse, perception towards it, level of knowledge of the causes of it in the community and among street children, level of knowledge of negative impacts of it, level of knowledge of the preventive methods; and level of knowledge of the support services and treatments needed by victims. A structured questionnaire was used to collect the data from thirty five participants (i.e. one driver and six casual apprentices from each of the five car parks) were interviewed. The data was presented and analyzed using tables and percentage. The findings revealed among other things, that there is high level of awareness of drug abuse but the feelings towards it are mixed. Like other children, street children are abusing drugs mainly due to peer influence with the ultimate objective of getting high to relief stress, group recognition, desire to be trusted by peers, etc. Similarly, participants are highly aware of the negative impacts encompassing fighting, stealing, mental illness, etc. To finance the behavior, victims are engaged in all types of dangerous antisocial behavior including romantic ones exposing them to a range of diseases including STIs and HIV/AIDS. Marijuana is the most commonly abused drug. Though in the minority, some have started experimenting cocaine/coke, hashish; and heroin. While participants have good knowledge of the critical methods to fight drug abuse, the support services needed by victims, victims are mostly reluctant to seek the services not only because they are hard to find but fear societal stigmatization, exclusion and discrimination and professionals’ maltreatments.
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Agorastos, A., H. Zurhold, A. Petridou, and C. Haasen. "Addiction Services in Cyprus: Results of the EU Twinning Project Evaluation." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70539-5.
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In April 2007 a European twinning project started between Cyprus and Germany, in order to assist Cyprus as a new Candidate Country in the implementation and harmonisation with the European Community's legislation, by evaluating the governmental drug services in Cyprus and their coordination and promoting the improvement and introduction of new drug treatment services. A field investigation studied parameters as population in need, treatment demand and coverage, as well as high risk patterns and their trend over the last years, showing an individual place of Cyprus in the international drug ranking, with the highest prevalence of cannabis and second highest on ecstasy abuse and one of the smallest in opiates and amphetamine consumption. Nevertheless heroin remains the primary drug of abuse in persons seeking treatment, although Cyprus was until 2008 the only country of the European Union without a substitution treatment. Furthermore this project studies in detail the current availability of the governmental drug facilities, their structure and coordination as well as the legal framework in which they operate, showing a still adapting drug care system, trying to keep up with the increasing special needs of the Cypriot population, but offering the presuppositions for an efficient and good functioning drug care system in the future.
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Gerra, Gilberto, Matteo Manfredini, Lorenzo Somaini, Icro Maremmani, Claudio Leonardi, and Claudia Donnini. "Sexual Dysfunction in Men Receiving Methadone Maintenance Treatment: Clinical History and Psychobiological Correlates." European Addiction Research 22, no. 3 (November 24, 2015): 163–75. http://dx.doi.org/10.1159/000441470.
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Abstract: A variety of studies evidenced a relationship between drug use disorders and sexual dysfunction. In particular, heroin and opioid agonist medications to treat heroin dependence have been found to be associated with erectile dysfunction and reduced libido. Controversial findings also indicate the possibility of factors other than the pharmacological effects of opioid drugs concurring to sexual dysfunction. With the present study, we investigated the link between sexual dysfunction and long-term exposure to opioid receptor stimulation (heroin dependence, methadone maintenance treatment, methadone dosage), the potentially related hormonal changes reflecting hypothalamus-pituitary-gonadal axis function and prolactin (PRL) pituitary release, the role of adverse childhood experiences in the clinical history and the concomitant symptoms of comorbid mental health disorders in contributing to sexual problems. Forty male patients participating in a long-term methadone treatment program were included in the present study and compared with 40 healthy control subjects who never used drugs nor abused alcohol. All patients and controls were submitted to the Arizona Sexual Experiences Scale (ASEX), Child Experiences of Care and Abuse-Questionnaire (CECA-Q) and the Symptom Check List-90 Scale. A blood sample for testosterone and PRL assays was collected. Methadone dosages were recorded among heroin-dependent patients on maintenance treatment. Methadone patients scored significantly higher than controls on the 5-item rating ASEX scale, on CECA-Q and on Symptoms Check List 90 (SCL 90) scale. Testosterone plasma levels were significantly lower and PRL levels significantly higher in methadone patients with respect to the healthy control group. ASEX scores reflecting sexual dysfunction were directly and significantly correlated with CECA-Q neglect scores and SCL 90 psychiatric symptoms total score. The linear regression model, when applied only to addicted patients, showed that methadone dosages were not significantly correlated with sexual dysfunction scores except for ‘erectile dysfunction', for which an inverse association was evidenced. Testosterone values showed a significant inverse correlation with ASEX sexual dysfunction scores, CECA-Q neglect scores and psychiatric symptom at SCL 90 among methadone patients. PRL levels were directly and significantly correlated with sexual dysfunction scores, psychiatric symptoms at SCL 90 and CECA-Q neglect scores. Both testosterone and PRL did not correlate with methadone dosages. The present findings appear to support the view of childhood adversities and comorbid psychiatric symptoms contributing to sexual dysfunction and related hormonal changes among methadone patients, challenging the assumption that attributes sexual problems entirely to the direct pharmacological effects of opioid agonist medications.
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Luque, Bárbara, Victoriana García, and Carmen Tabernero. "Depression and Cognitive Impairment in a Spanish Sample of Psychoactive Substance Users Receiving Mental Health Care." Healthcare 10, no. 5 (May 11, 2022): 887. http://dx.doi.org/10.3390/healthcare10050887.
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(1) Background: Numerous studies state that the abuse of psychoactive substances produces cognitive, emotional and behavioral disorders. The aim of this study is to analyze the relationship between the consumption of different psychoactive substances with cognitive performance and depression. (2) Methods: The sample was composed of 254 individuals (M = 41.81; SD = 10.74, from 18 to 69; 76% male) who received psychological treatment related to the use of substances. Participants were classified according to the main substance consumed: alcohol (42.9%), cannabis (20.5%), cocaine (15.4%), heroin (13%) and benzodiazepines (8.3%). The Montreal Cognitive Assessment and the Beck’s Depression Inventory were administrated. (3) The results indicated no statistically significant differences between levels of depression depending on the substance consumed. Regarding cognitive impairment, it was found that cocaine consumers have the worst level of cognitive impairment, while cannabis consumers have the best level of cognitive functioning. Finally, it was found that participants with severe depression have higher cognitive impairment than those who were diagnosed with moderate depression. (4) Conclusions: Given the high prevalence of depression and cognitive impairment with the abuse of psychoactive substances, early treatment is recommended to avoid a higher cognitive and emotional affectation.
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Dannatt, Lisa, Karen Jacqueline Cloete, Martin Kidd, and Lize Weich. "Frequency and correlates of comorbid psychiatric illness in patients with heroin use disorder admitted to Stikland Opioid Detoxification Unit, South Africa." South African Journal of Psychiatry 20, no. 3 (August 30, 2014): 6. http://dx.doi.org/10.4102/sajpsychiatry.v20i3.540.
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<p><strong>Background</strong>. There is a lack of studies addressing the frequency and correlates of comorbidities among heroin users admitted for treatment in South Africa (SA). Objective. To assess the frequency and correlates of psychiatric comorbidity among patients with heroin use disorder admitted to the Opioid Detoxification Unit at Stikland Hospital in the Western Cape, SA.</p><p><strong>Method.</strong> Participants (<em>N</em>=141) were assessed for psychiatric illness (Mini International Neuropsychiatric Interview), comorbid substance use disorders (World Health Organization’s Alcohol Smoking Substance Involvement Screening Tool), and legal and social problems (Maudsley Addiction Profile). Demographic, personal, psychiatric and substance-use history, in addition to mental state examination on admission, were collected from the case notes.</p><p><strong>Results.</strong> The largest group of patients (<em>n</em>=56, 40%) had not been abstinent from heroin use since drug debut, and most had been arrested for drug-related activities (<em>n</em>=117, 83%) and had family conflicts related to use <em>(n</em>=135, 96%). Nicotine was the most common comorbid substance of dependence (<em>n</em>=137, 97%) and methamphetamine was the most common comorbid substance abused (<em>n</em>=73, 52%). The most common comorbid psychiatric illness was previous substance-induced psychosis (<em>n</em>=42, 30%) and current major depressive disorder (<em>n</em>=37, 26%). Current major depressive disorder was significantly associated with females (p=0.03), intravenous drug use (<em>p</em>=0.03), alcohol use (<em>p</em>=0.02), and a higher number of previous rehabilitation attempts (<em>p</em>=0.008).</p><p><strong>Conclusion.</strong> Patients with heroin use disorders present with high rates of psychiatric comorbidities, which underscores the need for substance treatment services with the capacity to diagnose and manage these comorbidities.</p>
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Duraes, Eliana F., Mohammed Asif, Ashley Modica, Giulia Sikorski, C. Scott Hultman, and Julie Caffrey. "863 Drug Addiction and Opioid Use in the Acute Burn Patient." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S269—S270. http://dx.doi.org/10.1093/jbcr/iraa024.429.
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Abstract Introduction In light of the opioid crisis, there is an increased interest in the acute pain management of patients with history of drug addiction. There is no consensus on pain management among different burn centers and the amount of narcotic prescription reportedly doubled over a seven year period according to Tully in 20191. Our aim was to study the association of previous drug addiction history and the treatment of acute burn patients with special interest on the daily morphine equivalent requirements. Methods A prospectively maintained database was queried to study acute burn patients admitted in a reference burn center from 2013 to 2018. Patients with a previous history of drug addiction (group 1) were compared to patients without it (group 2). Drug abuse was defined as patients with history of opioids abuse, heroin, cocaine, cannabis, inhalants, and alcoholism, specifically those with diagnostic codes on file. The expected mortality was calculated using the Premier® database. A p0.05 was considered significant. Results A total of 3046 patients were studied, 502 (16.5%) had previous history of drug abuse on file. Compared to group 2, group 1 had: more males - 343 (68.3%) vs 1456 (57.2%) p0.001; was younger - 45.7914.65 vs 52.0219.57 p0.001; required intubation at a higher rate - 100 (19.9%) vs 329 (12.9%) p0.001; longer intubation period - 2.4310.05 vs 1.377.71 p0.001; had a prolonged admission - 13.8728.82 vs 8.4816.58 p0.001; more surgeries - 1.213.30 vs 0.71.58 p=0.002, and a higher daily morphine milligram equivalent requirement - 148.34320.56 vs 56.0297.81 p0.001. The groups had similar expected mortality rates: 3.03% vs 3.56%p=0.483; which may be partly explained by the fact that the drug use history is not accounted for on the formula. No significant difference was seen on the burned area between the groups. Conclusions Drug addiction was associated with increased need for intubation and length of intubation, prolonged admission, increased surgery rate and a higher daily morphine equivalent usage. Further studies are necessary guide the treatment of the specific needs of these increasingly common burn patients subgroup and also to define the need of including the history of drug use on the expected mortality rate formula. Applicability of Research to Practice This study adds to the literature differences in the treatment of burn patients with history of drug addiction and highlights the need for specific protocols for improved care.
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Pacini, Matteo. "A case of drug abuse." Clinical Management Issues 2, no. 3 (September 15, 2008): 135–41. http://dx.doi.org/10.7175/cmi.v2i3.569.
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Methadone maintenance is one of the well-known harm reduction strategies for public health intervention in heroin addiction. The significance of methadone treatment in preventing needle sharing, which in turn reduces the risk of HIV and HCV transmission among injectors, has been demonstrated. Methadone maintenance is also considered gathering site where heroin addicts can effectively acquire knowledge on harm reduction and drug rehabilitation. We report a case of a 34-years-old patient with a history of heroin abuse. Therapy with methadone was essential for an adequate management of the case. The article describe difficulties and complexities of heroin abuse management and the therapeutic role of methadone.
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Browne, Thom, Mark S. Gold, and David M. Martin. "The Rapidly Changing Composition of the Global Street Drug Supply and its Effects on High-risk Groups for COVID-19." Current Psychopharmacology 10, no. 2 (June 8, 2021): 138–54. http://dx.doi.org/10.2174/2211556010666210125124645.
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Background: Globally, an alarming number of pharmaceutically active compounds are now routinely added to the street drugs of abuse, cocaine and heroin. In some cases, seventeen (17) or more potentially toxic compounds are found in a single street purchased bag or block of cocaine or heroin. Pharmacologically active compounds, impurities, or breakdown products from drug manufacturing and industrial chemicals (collectively referred to as toxic adulterants) are now found in street drugs. They include, but are not limited to: antipsychotics, antidepressants, anxiolytics, antihistamines, anthelmintics, anesthetics, antiinflammatorys, antipyretics, analgesics, antispasmodics, antiarrhythmics, antimalarials, veterinary medications, bronchodilators, expectorants, sedatives, muscle relaxers, natural/synthetic hallucinogens, decongestants, new psychoactive substances (NPS), industrial compounds, fungicides, and impurities in the manufacturing process. All can be found within a single street purchase of heroin or cocaine. Routine clinical or workplace drug testing will not detect all these toxic adulterants. Only specialty forensic tests, specifically ordered, will detect them. The synergistic effect on the human body of such an unprecedented combination of pharmacologically active compounds is unknown and potentially deadly. This is especially seen in daily substance users who are exposed to these combinations multiple times a day over an extended period of time. Individuals with substance use disorders (SUDs) have several co-occurring health problems that make them more susceptible to COVID-19, including compromised immune, pulmonary, cardiovascular, and respiratory systems. These problems are high-risk factors for the acquisition of COVID-19 infection and more serious complications from the virus, including hospitalization and death. Objective: The study aims to bring to the attention of public health officials, addiction medicine specialists, treatment officials, therapists, and the general public the alarming increase of dangerous toxic adulterants being added to street drugs and their potentially lethal synergistic effects. Also, it aims to provide insights into how these new formulations can have serious pathophysiological effects on individuals with Substance Abuse Disorders (SUDs) during the COVID-19 pandemic. Methods: The literature on street drug cutting agents, toxic adulterants, NPS, manufacturing byproducts, and other industrial compounds will be reviewed. Also, a review of the literature of pathophysiological effects, especially on SUD patients, in light of the COVID-19 pandemic will be presented. This is combined with international and USA studies that were carried out by the Colombo Plan that identified these new combinations of toxic adulterants in street drugs, using state-of-the-art field and forensic laboratory detection technologies. Results: The majority of street drugs, in some cases more than ninety-five percent, now have multiple toxic adulterants. It is rare that a street purchase of cocaine or heroin does not contain multiple toxic adulterants, cutting agents, NPS, manufacturing byproducts, or industrial chemicals. Conclusion: This dangerous new composition in world street drug supply is unprecedented and may be the undetected cause of many psychostimulant and opioid overdose deaths, as many toxic adulterants are not routinely tested in post-mortem or street drug seizure cases. In addition, several of these toxic adulterants create a catastrophic drop in white blood cells, causing neutropenia and making the substance users susceptible to a wide range of opportunistic infections, including COVID-19. This profound change in the world street drug supply has catastrophic implications for individuals with SUDs and our health care system, especially in the era of the COVID-19 pandemic.
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Molavi, N., A. Ghaderi, and HR Banafshe. "Determination of thallium in urine, blood, and hair in illicit opioid users in Iran." Human & Experimental Toxicology 39, no. 6 (February 3, 2020): 808–15. http://dx.doi.org/10.1177/0960327120903487.
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Context: Heavy metals, including thallium and lead, are introduced to illicit drug users’ body as a result of using drugs such as cocaine and heroin. Objective: This study aimed to determine urine, blood, and hair thallium (Tl) concentrations in illicit opioid users along with the relevant clinical signs and symptoms consistent with thallotoxicosis and to compare them with the corresponding variables in the control non-opioid user group. Materials and Methods: This case–control study was conducted on 50 illicit opioid users who had abused opioids continuously for more than a year, referred to Amirie Drug Abuse Treatment Clinic in Kashan, Iran. The control group included 50 non-opioid users. Thallium concentrations in urine, blood, and hair were assessed in both groups ( n = 100) using electrothermal (graphite furnace) atomic absorption spectrometry (ET AAS, GF AAS). Results: In the studied group, the median (interquartile range) concentrations of thallium in urine, blood, and hair were 54.8 ± 79.9 μg/L, 14.5 ± 11.1 μg/L, and 5.4 ± 3.7 µg/g, respectively; these values were 4.8 ± 5.2 μg/L, 2.5 ± 2.4 μg/L, and 1.4 ± 1.1 µg/g, respectively, in the control group. There were significant differences in urine, blood, and hair thallium concentrations between the study group and the control group ( p < 0.001). There were significant correlations between duration of illicit opioid use and urine thallium concentrations ( r = 0.394, p = 0.005) and hair thallium concentrations ( r = 0.293, p = 0.039), but not with blood thallium concentrations ( r = 0.246, p = 0.085). Urine and blood thallium concentrations of illicit opioid users with clinical signs and symptoms consistent with thallotoxicosis of weakness ( p = 0.01), depression ( p = 0.03), and headache ( p = 0.03) were higher than users without these problems. Discussion and conclusion: The results of the study showed that thallium concentrations in urine, blood, and hair in illicit opioid users were significantly higher than the comparable concentrations in the control group. This can be due to the use of illicit opioids adulterated with thallium. Also, this study showed long-term illicit opioid use may lead to thallium exposure. In addition, cigarette smoking was associated with increased thallium exposure.
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Figueroa, Alegyari, Yaniris Garcia, Josue Ocasio, Ivanisse Ortiz, Ivan Rivera, Neshma Roman Velez, Ada Santiago, Ernesto Sola Sanchez, and Marina Torres Tores. "ODP499 Myxedema Coma: A Challenging Presentation of an Uncommon Disease." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A774. http://dx.doi.org/10.1210/jendso/bvac150.1599.
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Abstract Myxedema coma is a rare diagnosis but if not early recognized, this medical emergency possesses a high mortality rate. Over the years, it has been described predominantly in elderly women with history of hypothyroidism and as a precipitant factor that converges to evolve in a full presentation. We report a case of myxedema coma in a young male without risks for this disease. A 38 y/o Latin-American male with medical history ofhepatitis C virus and intravenous drug abuser that was brought to the emergency department after being found in the streets. The patient was agitated, oriented only to person, had slurred speech and reports last dose of heroin was two days ago. Denied other condition or medications. Vital signs BP 103/90mmHg, pulse: 41 bpm, T: 35.8°C RR: 19 rpm, SPO2: 99% at room air and BMI: 23.9. kg/m 2 . Physical examination pertinent for a disheveled male with anasarca, diffused dry skin with piloerection without surgery scars, non-palpable nor tender thyroid gland, bilateral exophthalmos, decreased bowel sound, positive fluid wave and abdomen diffusely tender to palpation with bilateral lower extremities infected ulcers. Blood workup showed impaired renal function, severe azotemia, hyponatremia, hypoglycemia and normocytic anemia. TSH 147uIU/mL. Imaging studies remarkable for bilateral pleural effusions, intestinal ileus, and negative brain CT scan. Patient was admitted with diagnosis of uremic encephalopathy, drug withdrawal and soft skin tissue infection. Patient was treated with emergent hemodialysis, drug withdrawal measures and IV antibiotics. Despite treatment, patient's clinical condition began to decline. He was found obtunded requiring endotracheal intubation. TSH was persistently elevated in 55.7uIU/mL with suppressed free T4 <0.42ng/dL. Patient noted with persistent sinus bradycardia, hypothermia, ileus, ascites, bilateral pleural effusions, and hypotension. Patient was consulted to endocrinology department who evaluated the overall clinical presentation and myxedema coma was diagnosed. He was treated with levothyroxine 100mg IV for two days, but eventually developed multiorgan failure and unfortunately died. Myxedema coma is a complication of severe hypothyroidism that slows down the functions of multiple organs and directly affects their function. It is an endocrinologic emergency that leads to decline of the clinical presentation of patients. The epidemiology favors this presentation in patients with history of hypothyroidism, more specifically elderly women. Multiple conditions may present with similar signs and symptoms. Physicians must be aware that myxedema coma must be suspected in a patient with altered mental status, hypothermia, hypoglycemia, hypotension, anasarca among others even in the presence of more common conditions and in rare populations like our patient. Opioid Induced Endocrinopathies still remain a complication that is underdiagnosed. The aim of this case is to createmedical awareness on the importanceto consider myxedema coma in patients with Opioid abuse and withdrawal. Presentation: No date and time listed
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Kreuter, Eric A., Gregory R. Gilligan, Ann Knickerbocker, and Jared F. Rodriguez. "Long-term Recovery from Addiction and Underlying Psychological Issues using Expressive Writing as a Potent Tool." Journal of Psychology and Psychotherapy Research 9 (June 1, 2022): 41–103. http://dx.doi.org/10.12974/2313-1047.2022.09.4.
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This article follows a recently published book, titled: Effective use of Creative Writing in the Treatment of Chemical Addiction (Kreuter, 2021 – Nova Science Publishers). In that book, the writing of over sixty men in recovery from addiction express their feelings, thoughts, inspirations, and creative works all geared towards their long-term recovery. This article features work of men and women in both short-term recovery (28-day and 90-day settings, as well as beyond the dates of completion of their respective rehabilitation programs. Through ongoing weekly creative writing workshops, the alumni of Kreuter’s work at St. Christopher’s and Kreuter and Gilligan’s work at Resource Recovery of Orange County, deeper writing demonstrates the effectiveness of the therapeutic device referred to as creative writing. As case studies herein demonstrate, use of creative exposition guided by topical prompts and the offering of therapeutic insight yielded significant benefits to those who suffer from traumatic incident(s) in their lives. Through the writing of stories and letters, writers who came to the drug and alcohol rehabilitation center for chemical abuse are impacted in a healthy way through the attenuation of, at least, part, of their deeply repressed angst over the trauma. In theory, they may have a much easier time completing their recovery program and continuing their active lives with less risk of relapse because of the work they did on the underlying psychological condition. The use of profanity in some of the writings is purposefully left uncensored out of respect for the authors and has been found that such use signifies sincerity on the point of the writer. Use of language is a frequent topic in rehabilitation.
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Nikic, M., S. Alcaz, S. Vucetic-Arsic, and G. Popadic. "Bipolar disorder and heroin addiction-case report." European Psychiatry 26, S2 (March 2011): 237. http://dx.doi.org/10.1016/s0924-9338(11)71947-2.
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BackgroundIt was estimated that in general adult population represented in 2–3% co-occurring mental and substance use disorders.In our case we represented the patient who is a long-time heroin addict with a dual diagnosis of bipolar disorder. Special attention was payed to influence of the primary psychiatric disorder to a course and treatment of substance abuse.MethodsPatient is observed during the five years from March 2005 to March 2010. In the evaluation of the case we used History of illness, MINI, HAMD. and psychological tests battery (MMPI 202, Drawing Human Figure, EGO Perception and EGO Ideal Test).ResultsDuring the observation we have noticed that the patient was started treatment in periods of depression decompensation, because of heroin relapse. In that moment HAMD score was between 20 and 24 points. After detoxification, the patient was experiencing a switch in hippomanic state, which resulted in drop-out in the first month of treatment. This course of disease was repeated five times during our observation. Because the patient retained in treatment, we were able to progress. Now, the patient has been in abstinence for eight months, and he is in acceptable affective stability.ConclusionBipolar Disorder is increased risk for frequent heroin relapses and continuity in the therapeutic treatment. This influence may involve direct effects of drugs on the initiation of affective symptoms and indirect effects on treatment compliance. When symptoms are controlled through these psychiatric medications, patients will benefit from therapeutic treatment of their substance abuse.
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Hsu, Wen-Yu, Nan-Ying Chiu, Jui-Ting Liu, Chieh-Hui Wang, Ting-Gang Chang, Yi-Cheng Liao, and Pei-I. Kuo. "Sleep quality in heroin addicts under methadone maintenance treatment." Acta Neuropsychiatrica 24, no. 6 (December 2012): 356–60. http://dx.doi.org/10.1111/j.1601-5215.2011.00628.x.
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Hsu W-Y, Chiu N-Y, Liu J-T, Wang C-H, Chang T-G, Liao Y-C, Kuo P-I. Sleep quality in heroin addicts under methadone maintenance treatment.Background: Sleep disturbance is a common phenomenon among opiate addicts. The side effects of opiate addiction or opiate withdrawal might result in sleep disturbance. However, their problems might be related to sedative medication abuse, alcohol abuse or heroin relapse. Sleep is an important issue in this population.Objective: To evaluate the prevalence of sleep disorders in heroin addicts receiving methadone maintenance treatment (MMT) and analyse the correlation between related factors, such as age at opiate exposure, opiate exposure duration, duration in MMT, methadone current dosage, methadone attendance rate and the severity of sleep disorders.Method: We enrolled 121 heroin addicts who were receiving MMT. We collected data on the duration of insomnia, hypnotic history, Visual Analogue Scale-10 of sleep quality, Pittsburgh Sleep Quality Index (PSQI), methadone dosage, methadone history and opiate history.Results: The mean of the PSQI was 9.1 ± 5.4, and 70.2% of patients had PSQI scores >5, indicating they were poor sleepers. We also found the PSQI scores were correlated significantly with the methadone dosage.Conclusions: The sleep disturbance prevalence rate of opiate addicts under MMT was high in Taiwan, as shown in the previous studies, and the severity of sleep disturbance has been underestimated.
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Protopapa, Maria-Nikoletta, Maria Lagadinou, Theodoros Papagiannis, Charalambos A. Gogos, and Elena E. Solomou. "Hepatocellular Carcinoma: An Uncommon Metastasis in the Orbit." Case Reports in Oncological Medicine 2020 (February 26, 2020): 1–3. http://dx.doi.org/10.1155/2020/7526042.
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Hepatocellular carcinoma (HCC) represents the most common type of primary cancer of the liver and is associated with poor prognosis. It is the most common cause of death in cirrhotic patients and in different studies was shown as the third most common cause of cancer-related deaths worldwide. Each year, approximately half a million people are diagnosed with HCC. In recent decades, the prognosis of patients with HCC has improved because more cases are diagnosed and treated at early stages; high-risk patients (i.e., with chronic HBV or HCV infection) are followed more often for the possibility of HCC, and novel treatment options such as locoregional therapy are used with better overall results. The extrahepatic metastases represent a poor prognostic factor. The most common sites of metastasis in advanced hepatocellular carcinoma are the lung (44%), portal vein (35%), and portal lymph nodes (27%). Also, intra-abdominal lymph nodes and bones are common sites. Orbital metastases rarely occur, representing the 3-7% of orbital masses. These metastases are usually found in advanced tumor stages. The mechanism of metastasis to the orbit is difficult to determine. A hematogenous route, as for other primary neoplasms of the abdomen, may be suspected. Tumor cells may circulate through the vena cava, beyond the pulmonary filter to the heart, and finally be distributed to the orbital region through the arterial systemic circulation. We describe herein a case of an adult male with liver cirrhosis due to alcohol abuse who presented with concomitant diagnosis of HCC and orbit metastasis.
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Zaller, PhD, Nickolas D., Portia Thurmond, MPH, Jon Brett, PhD, James C. Carleton, MS, and Josiah D. Rich, MD, MPH. "Linkage to methadone treatment from acute opiate detoxification treatment." Journal of Opioid Management 2, no. 6 (November 1, 2006): 341. http://dx.doi.org/10.5055/jom.2006.0050.
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Methadone maintenance treatment (MMT) is a safe pharmacological treatment strategy for addiction to heroin and other opiates; however, linking individuals to MMT is often challenging. We present results from a pilot project (Project VISTA) funded by the Center for Substance Abuse Treatment that helps heroin-dependent injection drug users (IDUs) transition from acute heroin detoxification to MMT. Participants are referred to Project VISTA by the state detoxification center, and Project VISTA facilitates entry into an MMT program, providing full financial support for up to 24 weeks. In addition, Project VISTA provides case management and referral to ancillary services such as housing, other medical care, and mental health treatment. From May 2005 to May 2006, 60 individuals were enrolled in Project VISTA. A total of 41 participants (69.5 percent) remained in treatment for at least 24 weeks, with a mean number of weeks in treatment of 31. A Kaplan-Meier analysis was performed on all participants, and the incidence of individuals being discharged from treatment was 2 percent per week. Project VISTA, in cooperation with the state detoxification center and a Providence-based MMT program, has created a model that provides continuity of treatment services to high-risk, HIV-negative IDUs. Our model demonstrates that through facilitating the transition from an opiate detoxification program into an MMT program, individuals with chronic heroin addiction can successfully access and engage in treatment.
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Derbas, A. N., and M. K. Al Haddad. "Factors associated with immediate relapse among Bahraini heroin abusers." Eastern Mediterranean Health Journal 7, no. 3 (September 15, 2001): 473–80. http://dx.doi.org/10.26719/2001.7.3.473.
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Demographic characteristics and factors associated with immediate relapse to heroin use among 40 male Bahraini heroin abusers were studied 1 week after discharge from the Drug and Alcohol Rehabilitation Unit in Bahrain. The mean age of the patients was 32.7 years, the age at which drug abuse began ranged from 12 years to 31 years, and the age range of regular use was 15-37 years. More than half the patients were single, unemployed, unskilled labourers with secondary-school education. The vast majority used heroin intravenously. Negative emotional states and drug-related cues were seen by the majority of the subjects as influential in their immediate relapse after discharge. Findings suggest that the treatment and rehabilitation unit in Bahrain should look into the issues of after-care.
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Bumbasirevic, Marko, Slavisa Zagorac, Aleksandar Lesic, Vesna Bumbasirevic, and Ljubomir Djurasic. "Psoas major abscess by heroin addictive patients: A case report." Acta chirurgica Iugoslavica 58, no. 3 (2011): 117–20. http://dx.doi.org/10.2298/aci1103117b.
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Drug abuse is related to many medical complications, which depend on the drug type, dose injected, the method of delivery and site of injection. We report a case of psoas abscess in young heroin addict, HIV negative, who was admitted in Emergency Center of Clinical Center in Belgrade because of fever, anaemia, prostration and right groin pain. Clinical and radiological examination were performed. CT showed large abscess of the right psoas muscle, 12x4cm large. Treatment included percutaneous drainage and administration of iv antibiotics. There is regression of inflamation. At discharge patient was in good condition without signs of infection.
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HANLON, THOMAS E., DAVID N. NURCO, RICHARD W. BATEMAN, and KEVIN E. O'GRADY. "The Relative Effects of Three Approaches to the Parole Supervision of Narcotic Addicts and Cocaine Abusers." Prison Journal 79, no. 2 (June 1999): 163–81. http://dx.doi.org/10.1177/0032885599079002003.
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This study examined the 1-year parole outcomes of 504 newly released parolees with a history of heroin and/or cocaine abuse who were randomly assigned, within gender, race, and primary drug of choice, to one of the following three interventions: a program of “social support,” combining weekly urine monitoring with counseling, case management, and case advocacy; weekly urine monitoring alone; and routine parole. Results indicated a superiority of social support treatment over the other two comparison conditions, particularly urine monitoring alone. Supplemental analyses indicated a general superiority of substance abuse treatment over no treatment, whether or not treatment was delivered within the social support framework.
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Esther, S. "Drug Abuse Among Youth: Profile of Substance Abusers From Lifeline Rehab Drug Deaddiction Centre Kathua District, Jammu." Indian Journal of Social Science and Literature 2, no. 2 (December 12, 2022): 7–10. http://dx.doi.org/10.54105/ijssl.b1034.122222.
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The union territory of Jammu and Kashmir, problem relating to heroin addiction among young generation is increasing day by day. Drug trafficking and illicit cultivation of opium within the union territory are affecting youth. The geographical location of Jammu and Kashmir (UT) is highly vulnerable as illegal routing drugs (heroin) from Pakistan to Jammu and Kashmir. Methods: This study examined socio-demographic profile of substance abusers (85 patients registered during Jan2019 to September 2020) who attended treatment at Lifeline Rehab drug de-addiction centre Kathua district, Jammu. Objective: 1.To studies the socio demographic profile variables of the substances abusers 2. To identify the most commonly consumed substances among youth. Results: The results indicate that majority of patients were ages group between 25-30 years (40.4%) and between 17-24 years (30.5%). Most of the patient’s qualifications were higher secondary (44.3%) and matriculation (22.3%). A very high number of patients first use of substances at the ages of 16-20 years (56.4%) and ages between 12-15 years (22.3%). Heroin is the most common substance abuse by Kathua youth (63.5%). After heroin alcohol is the next commonly abuse substance (22.3%).
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Djezzar, S., F. Vorspan, D. Chataigner, E. Burin, R. Garnier, and J. P. Lépine. "Mephenesin dependence: A case series." European Psychiatry 26, S2 (March 2011): 29. http://dx.doi.org/10.1016/s0924-9338(11)71740-0.
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IntroductionMephenesin is a central muscle relaxant, acting through a depression of the activity of some neurones in the caudate nucleus. It was proposed as a potential treatment of alcohol withdrawal syndrome in the 50s. This over the counter medicine is now mainly prescribed to treat spasticity or as an adjunctive treatment of painful muscle spasm. We know little about this substance except that side effects are venous thrombosis, haemolysis or cutaneous intolerance. Yet, no case of abuse or dependence has been reported.AimsTo report a series of 5 clinical cases in patients who developed abuse or dependence to mephenesin.MethodsWe performed a systematic search in data bases of both Paris addictovigilance and poison centres from 1999 to 2010. Clinical details were obtained from clinicians when possible. A literature search was also performed to describe mephenesin mechanisms of actions that could be implied.ResultsThree (3) women et 2 men aged 35 to 52 years (m : 43.6) were identified as abusing mephenesin, among which 4 patients had a full DSM IV criteria of dependence. All had a previous history of abuse or substance dependence (alcohol, heroin, codeine, ketamine…).The average mephenesin daily intake was 13 g (9 to 24 g) when the maximum recommended dosage is 3 gr/d. In one case, a withdrawal syndrome was observed (tremor, aggressiveness).ConclusionMephenesin may be abused by patients with previous risk factors, especially a personal history of alcohol dependence.
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Radunovic-Gojkovic, Tatjana, and Gordana Velisavljev-Filipovic. "Neonatal withdrawal syndrome: Case report." Medical review 62, no. 3-4 (2009): 181–84. http://dx.doi.org/10.2298/mpns0904181r.
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Introduction. Maternal drug abuse has increased over the past decade. It has a multiple negative influence on a pregnant woman, as well as her newborn. Practically, every drug taken during pregnancy crosses the placenta, and the developing fetus may also be affected by the effects of a drug. After delivery, an infant of a drug-abusing mother may potentially develop neonatal withdrawal syndrome. Existing studies on the neonatal effects of drug exposure in utero are subject to many factors. Many studies have relied on the history obtained from the mother, which is innacurate. Urine testing for drug abuse does not reflect exposure to a drug through pregnancy and does not provide quantitative information. Social and economic deprivation is common among drug abusers, and this factor has a major effect on long term studies of infant outcome. The purpose of this article is to underline the problems during management of a neonatal withdrawal syndrom, and growing incidence of it in our society. Case report. A case of an infant of a heroin-abusing mother is reported. Conclusion. It is very important to take care of an infant with neonatal withdrawal syndrome, but it is also of a great importance to supervise these children for a long period of time.
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Ahmadinejad, Mjtaba, Elham Valimohammdi, Ghazale Molaverdi, Seydehamideh Hashemi, Mohammad Hadi Bahri, and Javad Zebarjadi Bagherpour. "Can Heroin Poisoning Lead to Stomach Necrosis? A Case Report." International Journal of Medical Toxicology and Forensic Medicine 12, no. 4 (October 1, 2022): 38932. http://dx.doi.org/10.32598/ijmtfm.v12i4.38932.
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Background: According to the last report of the United Nations Office on Drugs and Crime (UNOCD), opiate use (including heroin) is 1.2% of the world population. In Iran, about 2 million people are drug addicts. Heroin reduces gastric motility and prolongs gastric emptying time and causes gastric dilation which can be a reason for gastric ischemia. Gastric ischemia is an uncommon condition due to the rich gastric blood perfusion and collateral arteries. As some studies show, gastric dilation can be the cause of gastric necrosis. Methods: A 22-year-old woman presented to our hospital with severe abdominal pain and several episodes of vomiting. The patient declared that she had a history of addiction to methamphetamine and heroin. Abdominal examination revealed a soft and non-distended abdomen with generalized tenderness, mostly in the hypogastric region without rebound tenderness. Abdominal radiograph revealed that the stomach was highly distended. Abdominal CT without contrast confirmed severe gastric dilatation. In endoscopy, multiple necrotic lesions were seen throughout the stomach and mostly in the proximal part. Our finding in the laparotomy was gastric necrosis in the proximal part, which resulted in a total gastrectomy. Esophagojejunostomy was performed with roux en y reconstruction after total gastrectomy. Conclusion: Opioids can increase the risk of gastrointestinal (GI) dysfunction and can increase the risk of infection in the GI tract. In our case, heroin abuse caused gastric dilation and massive gastric necrosis.
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Schellekens, A., T. Oosteren, T. Knuijver, R. J. verkes, and M. Belgers. "Treatment of heroin dependence with ibogaine." European Psychiatry 33, S1 (March 2016): S10—S11. http://dx.doi.org/10.1016/j.eurpsy.2016.01.799.
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BackgroundThe use of the hallucinogen ibogaine as an anti-addiction agent has been described in several case reports, dating back to the eighties. The anti-addiction properties of ibogaine have been confirmed in a large body of animal work. Ibogaine has been shown to be effective in reducing withdrawal severity and substance use for a variety of substances, including cocaine and opiates. Animal studies also show some potentially dangerous adverse reactions, including cerebellar toxicity and potential cardiac effects. While pharmacological treatment options for opiate and cocaine dependence are still limited, ibogaine assisted treatment might be a promising new option. Therefore more systematic studies on its toxicity and efficacy are warranted. In our studies we address these two research questions: is ibogaine treatment for opiate dependence safe and effective for treating opiate withdrawal and relapse prevention? A secondary objective is to explore the pharmacokinetic properties of ibogaine.MethodsAnimal work: first we performed a systematic review and meta-analysis of animal studies on ibogaine. Thirty studies were included in the systematic review, of which 27 could be analyzed in meta-analysis. Human studies: fifteen opiate dependent patients will be treated with ibogaine (10 mg/kg), on top of treatment as usual. Ibogaine toxicity will be assessed through close monitoring with electrocardiography, with QTc prolongation as main outcome measure, repeated assessments of ataxia using the (SARA) and observation of psychotic symptoms by using the Delirium Observations Scale (DOS). Ibogaine efficacy will be measured, using repeated evaluations of opiate withdrawal severity (Subjective Opiate Withdrawal Scale: SOWS; Objective Opiate Withdrawal Scale: OOWS), craving intensity (using a Visual Analogue Scale) and substance use, with a six-month follow-up. Clinical observations in ibogaine treated individuals will be compared with a cohort of opiate dependent patients treated with a rapid detoxification procedure. Both acute and long-term effects will be linked with serum ibogaine and noribogaine levels.ResultsAnimal work: overall, ibogaine reduced drug self-administration, particularly during the first 24 hours after administration. Ibogaine had no effect on drug-induced conditioned place preference. Ibogaine administration resulted in motor impairment in the first 24 hours after supplementation, and cerebral cell loss even weeks after administration. Data on ibogaines effect on cardiac rhythm as well as on its neuropharmacological working mechanisms are limited. Human studies: human data are still being collected. Treatment of the first patients confirmed strong effects of ibogaine on heart rhythm (QTc prolongation) and ataxia, while the opiate withdrawal symptoms were relatively mild. The first observations on the clinical effect of ibogaine on craving and substance use will also be shared.ConclusionsBased on our meta-analysis of animal data, there is strong evidence that ibogaine is effective in reducing drug self-administration in animals. This warrants further studies into the clinical efficacy of ibogaine in substance dependent patients in reducing craving and substance use. Our first clinical experiences in a limited number of patients confirm that ibogaine treatment may be effective in reducing opiate withdrawal, but can potentially have transient cardiac and cerebellar toxicity.Disclosure of interestThe authors have not supplied his declaration of competing interest.
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Wylie, Sadie C., Christopher Cullum, and Robert Brarens. "Considerations in the Diagnosis and Management of Lower-Extremity Infections in Injection Heroin Users: A Case Series." Journal of the American Podiatric Medical Association 109, no. 6 (November 1, 2019): 437–44. http://dx.doi.org/10.7547/17-159.
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Background: On a national level, heroin-related hospital admissions have reached an all-time high. With the foot being the fourth most common injection site, heroin-related lower-extremity infections have become more prevalent owing to many factors, including drug preparation, injection practices, and unknown additives. Methods: We present a 16-month case series in which eight patients with lower-extremity infections secondary to heroin abuse presented to The Jewish Hospital in Cincinnati, Ohio. Results: Three cases of osteomyelitis were seen. All of the infections were cultured and yielded a wide array of microbes, including Staphyloccoccus, Streptococcus, Bacillus, Serratia, Prevotella, and Eikenella. All of the patients were treated with intravenous antibiotic agents, with nearly all receiving combination therapy. Seven of the eight patients underwent surgery during their hospital stay, with two undergoing amputation. Only half of the patients followed up after discharge. Conclusions: This case series brings to light many considerations in the diagnosis and management of the heroin user, including multivariable attenuation of immunity, existing predisposition to infection backed by unsterile drug preparation and injection practices, innocuous presentation of deep infections, microbial spectrum, and recommendations on antimicrobial intervention, noncompliance, and poor follow-up. By having greater knowledge in unique considerations of diagnosis and treatment, more efficient care can be provided to this unique patient population.
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McCuish, Evan C. "Substance Use Profiles Among Juvenile Offenders: A Lifestyles Theoretical Perspective." Journal of Drug Issues 47, no. 3 (March 15, 2017): 448–66. http://dx.doi.org/10.1177/0022042617699197.
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Base rates of illicit substances such as cocaine, crack cocaine, and heroin are typically low in community-based studies, which often inhibit more complex multivariate analysis. Additionally, single-item measures and aggregate scales mask within-group differences among those showing versatility in their substance use. Latent class analysis was used to model the substance use profiles of adjudicated female ( n = 98) and male ( n = 378) youth. Alcohol, marijuana, acid, mushrooms, ecstasy, cocaine, crack cocaine, heroin, crystal methamphetamine, and nonmedical use of prescription pills were used to define latent profiles of substance use. Three latent classes were identified that were qualitatively different across males and females. Multinomial logistic regression analyses indicated that time spent outside of the home of the biological parents, early substance use, and parental substance abuse were informative of the use of substances such as cocaine, crack cocaine, and heroin. Implications for more individualized treatment strategies are discussed.
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Sau, Manabendra, Amal Kumar Sinha Roy, Pausali Das, and Jitendra Kumar Singh. "Pattern of substance abuse: a community based study in West Bengal." International Journal Of Community Medicine And Public Health 5, no. 8 (July 23, 2018): 3394. http://dx.doi.org/10.18203/2394-6040.ijcmph20183068.
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Background: Drug addiction produces serious pervasive and expensive social problems. Regardless of whether substance abuse is a sin, a crime, a bad habit or an illness society has a right to expect that an effective approach to drug abuse problem will reduce drug related crime unemployment, family dysfunction and disproportionate use of medical care. Science has made great progress over the past several years, but it is still not possible to account fully the physiological and psychological process that transform controlled voluntary use of drugs into uncontrolled is voluntary dependence on those substances, and these is still no cine. The objective of the study was to find out pattern of different types of substance abuse in a community in West Bengal.Methods: An observational cross-sectional community based study during April 2017-September 2017 in a community of West Bengal among 142 addicted persons.Results: In the studied 142 cases, Brown sugar (an adulterated form of Heroin) was primary drug of abuse in urban area contrary to alcohol in rural area. Commonest age of initiation was between 15-20 years (57.75%). Polydrug abusers (59.1%) were common.Conclusions: Our study revealed that in spite of having strict legislation for prohibition of substance abuse, people are still addicted with alcohol, cannabis, drugs etc. Substance use is prevalent in the studied area, with a higher prevalence in males. Substance users rarely seek treatment for substance use. This needs continuous awareness and community-level services for the treatment of substance use disorders.
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Shiferaw, Bethel, Ebisa Bekele, Sara Syed, Lu Fan, Nirav Patel, Samia Qazi, and Nicolas Biro. "A Case Report of Acute Esotropia in a Young Woman following Heroin Withdrawal." Case Reports in Medicine 2015 (2015): 1–3. http://dx.doi.org/10.1155/2015/740710.
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Introduction. Esotropia is a form of strabismus that can give the affected individual a “cross-eyed” appearance. Acute onset of esotropia is an uncommon form; in the vast majority of cases, no underlying neurological etiology is found.Case Presentation. A 22-year-old female with a long history of opiate abuse presented with acute onset of diplopia. She noted her eyes were crossing and started seeing double. She stopped using heroin 11 days prior to presentation. There was large inward deviation of her left eye. Convergence was difficult and accompanied by horizontal nystagmus. Diplopia resolved by covering each eye. Further investigations including imaging studies were normal.Discussion. Acute onset esotropia is rare and must be investigated right away to exclude central nervous system pathologies, where no opiates use is reported. Diplopia in the form of acute esotropia may manifest in up to 30% of individuals undergoing heroin withdrawal. Evaluating acute esotropia requires detailed information of medical history with an emphasis on drug use.Conclusion. Acute onset esotropia with double vision can be caused by abrupt withdrawal of opiates. This case should serve to raise awareness among health care professionals, to avoid costly and unnecessary diagnostic evaluations and interventions.
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Saleh, Shadi S., Thomas Vaughn, James Hall, Samuel Levey, Laurence Fuortes, and Tanya Uden-Holmen. "Effectiveness of Case Management in Substance Abuse Treatment." Care Management Journals 3, no. 4 (December 2002): 172–77. http://dx.doi.org/10.1891/cmaj.3.4.172.57448.
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Health officials have promoted case management as a promising intervention in substance abuse treatment (Ridgely & Willenbring, 1992). The relationship between organizational mission combined with case management and different types of outcomes has not been explored in studies, but they are worth noting and exploring further. This study, which is part of a larger clinical trial, examined the 3-, 6-, and 12-month effectiveness of case management in a residential setting for individuals treated for substance abuse. Clients who agreed to participate were randomly assigned to one of four study groups. Two groups received face-to-face case management and one telecommunication case management, while the fourth was the control group. Results from the analysis revealed only modest support for the effectiveness of case management as a supplement to traditional treatment. The face-to-face case-managed groups achieved improvements on the legal, employment, and psychiatric domains exceeding that achieved by the control group. Because of the short-term follow-up of the study, conclusive evidence of the effects of case management could not be drawn. This study is a valuable stepping stone, however, to further research in the field and as an aid to policymakers who are interested in knowing more about the effects of case management.
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Sergeonery, Lively. "Treatment Pattern of Patients with Narcotics and Psychotropic Abuse (Case Study at the Bandung Rehabilitation Clinic)." Indonesian Journal of Pharmaceutical Research 1, no. 2 (September 30, 2021): 52–58. http://dx.doi.org/10.31869/ijpr.v1i2.2898.
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Narcotics, psychotropics, and addictive substances abuse can cause addiction, which is a chronic disorder characterized by compulsive drug seeking and use despite adverse consequences. This is a concurrent descriptive study carried out by evaluating medical records and MMAS-8 questionnaire for assessing patients’ adherence. In addition, therapeutic success and quality of life were also evaluated using WHOQOL-BREF questionnaire. The study took place in the period of September-November 2018 at Medika Antapani Clinic. Data collected from patients under drug maintenance was used to identify the types of drug mostly used by the patients and their treatment, assess the impact of the management, and identify factor influencing therapeutic success. The results showed that there were 40 drug abusers at Medika Antapani Clinic. The abused drugs were amphetamine (80%), cannabis (72%), heroin (35%), benzodiazepine (25%), and nitrazepam (20%). Therapeutic measures used to treat drug abuse were alprazolam in 38 patients (95%), clonazepam in 33 patients (82.5%), nitrazepam in 29 patients (72.5%), lorazepam in 22 patients (55%), and diazepam in 14 patients (35%). Drug rehabilitation patients had low adherence of only 50%. Measurement of quality of life revealed social relation as the dimension with the highest score of 69 + 20.44, with most patients categorized as having moderate quality of life. Therapy with benzodiazepine has potential to cause dependence so it must be practiced with caution.
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Bah, Yahya Muhammed. "Drug abuse among street children." COUNS-EDU: The International Journal of Counseling and Education 4, no. 1 (May 16, 2019): 1. http://dx.doi.org/10.23916/0020190416610.
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In The Gambia like all nations, drug abuse is seen as a social and health problem that has many serious implications for the physical, social, psychological and intellectual development of the victims more especially, the children. Therefore, it continues to be a concern to families, community leaders, educators, social workers, health care professionals, academics, government and its development partners. Though there some studies on drug abuse, there is none on children and drug abuse focusing on the street children the most vulnerable category. Street children are hypothesized to be more at risk of any epidemic including drug abuse. This study sought to determine the risk and prevalence of drug abuse among street children focusing on those in the car parks. The research was focused on six critical areas: level of knowledge of drug abuse, perception towards it, level of knowledge of the causes of it in the community and among street children, level of knowledge of negative impacts of it, level of knowledge of the preventive methods; and level of knowledge of the support services and treatments needed by victims. A structured questionnaire was used to collect the data from thirty five participants (i.e. one driver and six casual apprentices from each of the five car parks) were interviewed. The data was presented and analysed using tables and percentage. The findings revealed among other things, that there is high level of awareness of drug abuse but the feelings towards it is mixed. Like other children, street children are abusing drugs mainly due to peer influence with the ultimate objective of getting high to relief stress, group recognition, trusted by peers, etc. Similarly, participants are highly aware of the negative impacts encompassing fighting, stealing, mental illness, etc. To finance the behaviour, victims are engaged in all types of dangerous antisocial behaviour including romantic ones exposing them to a range of diseases including STIs and HIV/AIDS. Marijuana is the most commonly abused drug. Though in the minority, some have started experimenting cocaine/coke, hashish; and heroin. While participants have good knowledge of the critical methods to fight drug abuse, the support services needed by victims, victims are mostly reluctant to seek the services not only because they are hard to find but fear societal stigmatization, exclusion and discrimination and professionals’ maltreatments.
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Bah, Yahya Muhammed. "Drug Abuse among Street Children." Journal of Clinical Research In HIV AIDS And Prevention 3, no. 3 (November 28, 2018): 12–45. http://dx.doi.org/10.14302/issn.2324-7339.jcrhap-18-2291.
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In The Gambia like all nations, drug abuse is seen as a social and health problem that has many serious implications for the physical, social, psychological and intellectual development of the victims more especially, the children. Therefore, it continues to be a concern to families, community leaders, educators, social workers, health care professionals, academics, government and its development partners. Though there are some studies on drug abuse, there is none on children and drug abuse focusing on the street children the most vulnerable category. Street children are hypothesized to be more at risk of any epidemic including drug abuse. This study sought to determine the risk and prevalence of drug abuse among street children focusing on those in the car parks. The research was focused on six critical areas: level of knowledge of drug abuse, perception towards it, level of knowledge of the causes of it in the community and among street children, level of knowledge of negative impacts of it, level of knowledge of the preventive methods; and level of knowledge of the support services and treatments needed by victims. A structured questionnaire was used to collect the data from thirty five participants (i.e. one driver and six casual apprentices from each of the five car parks) were interviewed. The data was presented and analyzed using tables and percentage. The findings revealed among other things, that there is high level of awareness of drug abuse but the feelings towards it are mixed. Like other children, street children are abusing drugs mainly due to peer influence with the ultimate objective of getting high to relief stress, group recognition, desire to be trusted by peers, etc. Similarly, participants are highly aware of the negative impacts encompassing fighting, stealing, mental illness, etc. To finance the behavior, victims are engaged in all types of dangerous antisocial behavior including romantic ones exposing them to a range of diseases including STIs and HIV/AIDS. Marijuana is the most commonly abused drug. Though in the minority, some have started experimenting cocaine/coke, hashish; and heroin. While participants have good knowledge of the critical methods to fight drug abuse, the support services needed by victims, victims are mostly reluctant to seek the services not only because they are hard to find but fear societal stigmatization, exclusion and discrimination and professionals’ maltreatments.
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Di Trana, Annagiulia, Diletta Berardinelli, Eva Montanari, Paolo Berretta, Giuseppe Basile, Marilyn A. Huestis, and Francesco Paolo Busardò. "Molecular Insights and Clinical Outcomes of Drugs of Abuse Adulteration: New Trends and New Psychoactive Substances." International Journal of Molecular Sciences 23, no. 23 (November 23, 2022): 14619. http://dx.doi.org/10.3390/ijms232314619.
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Adulteration is a well-known practice of drug manufacturers at different stages of drug production. The intentional addition of active ingredients to adulterate the primary drug may enhance or mask pharmacological effects or may produce more potent drugs to increase the number of available doses and the dealer’s profit. Adulterants found in different drugs change over time in response to different factors. A systematic literature search in PubMed and Scopus databases and official international organizations’ websites according to PRISMA guidelines was performed. A total of 724 studies were initially screened, with 145 articles from PubMed and 462 from Scopus excluded according to the criteria described in the method section. The remaining 117 records were further assessed for eligibility to exclude articles without sufficient data. Finally, 79 studies were classified as “non-biological” (n = 35) or “biological” (n = 35 case reports; n = 9 case series) according to the samples investigated. Although the seized samples analyses revealed the presence of well-established adulterants such as levamisole for cocaine or paracetamol/acetaminophen for heroin, the reported data disclosed new adulteration practices, such as the use of NPS as cutting agents for classic drugs of abuse and other NPS. For example, heroin adulterated with synthetic cannabinoids or cocaine adulterated with fentanyl/fentalogues raised particular concern. Notably, adulterants play a role in some adverse effects commonly associated with the primary drug, such as levamisole-adulterated cocaine that may induce vasculitis via an autoimmune process. It is essential to constantly monitor adulterants due to their changing availability that may threaten drug consumers’ health.
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Farabee, David, Vandana Joshi, and M. Douglas Anglin. "Addiction Careers and Criminal Specialization." Crime & Delinquency 47, no. 2 (April 2001): 196–220. http://dx.doi.org/10.1177/0011128701047002003.
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For many drug users, the initiation of drug use and the subsequent transition to an addiction career is accompanied by criminal activities. However, the use of general crime and drug use categories often obscures important features of their relationship. In the present study, data from the national Drug Abuse Treatment Outcome Studies sample of 7,189 clients in substance abuse treatment were analyzed to explore the relationships between several addiction career variables and the likelihood of lifetime participation in predatory, victimless, and nonspecialized criminal behaviors. The order of initiation of addiction and criminal careers was significantly related to participation in certain types of crimes, with those beginning criminal careers after beginning their addiction careers being more likely to engage exclusively in victimless than in predatory crimes. Likewise, dependence on cocaine, heroin, or both, relative to alcohol, was associated with greater criminal diversity but a reduced likelihood of participating specifically in predatory crimes.
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PLATT, JEROME J., MINDY WIDMAN, VICTOR LIDZ, DAVID RUBENSTEIN, and ROBERT THOMPSON. "The Case for Support Services in Substance Abuse Treatment." American Behavioral Scientist 41, no. 8 (May 1998): 1050–62. http://dx.doi.org/10.1177/0002764298041008003.
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Awuzu, Epaenetus A., Emmanuel Kaye, and Patrick Vudriko. "Prevalence of Cannabis Residues in Psychiatric Patients: A Case Study of Two Mental Health Referral Hospitals in Uganda." Substance Abuse: Research and Treatment 8 (January 2014): SART.S13254. http://dx.doi.org/10.4137/sart.s13254.
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Various studies have reported that abuse of cannabis is a risk factor for psychosis. The aims of this study were to determine the prevalence of delta 9-tetrahydrocanabinol (Δ 9 -THC), a major metabolite of cannabis, in psychiatric patients in Uganda, and to assess the diagnostic capacity of two referral mental health hospitals to screen patients for exposure to cannabis in Uganda. Socio-demographic characteristics of the patients were collected through questionnaires and review of medical records. Urine samples were collected from 100 patients and analyzed using Δ 9 -THC immunochromatographic kit (Standard Diagnostics®, South Korea). Seventeen percent of the patients tested positive for Δ 9 -THC residues in their urine. There was strong association ( p < 0.05) between history of previous abuse of cannabis and presence of Δ 9 -THC residues in the urine. Alcohol, cocaine, heroin, pethidine, tobacco, khat and kuber were the other substances abused in various combinations. Both referral hospitals lacked laboratory diagnostic kits for detection of cannabis in psychiatric patients. In conclusion, previous abuse of cannabis is associated with occurrence of the residues in psychiatric patients, yet referral mental health facilities in Uganda do not have the appropriate diagnostic kits for detection of cannabis residues as a basis for evidence-based psychotherapy.
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Chen, Guohong, and Takeo Fujiwara. "Impact of One-Year Methadone Maintenance Treatment in Heroin Users in Jiangsu Province, China." Substance Abuse: Research and Treatment 3 (January 2009): SART.S2914. http://dx.doi.org/10.4137/sart.s2914.
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Context Although the effectiveness of methadone maintenance treatment (MMT) is well-established in many countries, it is a relatively new therapy for heroin users in China. Jiangsu Province, a relatively wealthy province, set up 4 MMT clinics in February 2006. No previous studies have evaluated the impact of MMT in a wealthy Chinese province. Objective The aim of this study is to evaluate the impact of a 1-year MMT among heroin users in Jiangsu Province. We investigated the impact of the treatment by examining the following outcomes: 1) reduction of heroin use, 2) increase of appropriate sexual intercourse, 3) reduction of antisocial behavior, 4) increase of better social and family relationships, and 5) HIV prevalence among heroin users in MMT clinics. Design and Setting Repeated cross-sectional surveys were conducted before and after heroin users in Jiangsu Province received at least 1-year of treatment in the MMT clinics. A questionnaire survey was implemented for those who agreed to participate from March to April 2006, before the initiation of MMT (N = 554). The second survey was from August to September 2007 and was administered to those who received MMT for more than 1 year (N = 804). One hundred and ninety-six patients who were investigated in both surveys were included in a longitudinal study to evaluate the factors attributable to behavior change. Results MMT helped in reducing the percentage of heroin injection and also improved social and familial relationships. Antisocial behavior, including theft, prostitution, and dealing in heroin, decreased after 1-year treatment in the MMT clinics. However, the percentage of patients using condoms was not statistically significant. No case was found to be HIV-positive among those who received more than 1 year MMT. In the longitudinal study of 196 patients who participated in both surveys, no specific demographic variables were found to be associated with heroin use, anti-social behaviors after 1-year MMT. Conclusions MMT was thought to reduce heroin use, antisocial behaviors and HIV prevalence, and increased appropriate sexual intercourse behaviors and better social and family relationships among heroin users in a wealthy province in China, which was true regardless of gender, age, marital status, or working status.
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Anderson, James F., and Kelley Reinsmith-Jones. "Opioid Addiction in Rural North Carolina: A Criminal Justice and Public Health Issue." International Journal of Social Science Studies 5, no. 7 (June 19, 2017): 42. http://dx.doi.org/10.11114/ijsss.v5i7.2495.
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Opioid addiction and abuse has become a nationwide epidemic in America. Chief among the states where this behavior is most pervasive is North Carolina. Current statistics reveal that not only are addiction, abuse, and untimely deaths owing to overdose (especially from heroin use) are found in urban areas, but these behaviors are also pervasive in rural areas of the state where health experts and criminal justice officials struggle with the challenges of addressing public health and criminal justice consequences that come with drug addiction and abuse such as treatment, prevention, and punishments, respectively. Unlike urban areas that often have adequate resources to address these concerns, this is not the case in rural areas that struggle with more addicts and offenders than resources to manage this current crisis. Because of the complexity of the opioid crisis and many of the past lessons learned from the crack cocaine epidemic of the 1980s, we believe that society can more effectively address the new opioid epidemic by relying on both criminal justice as well as public health strategies.
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Khalili, Seyed Parham, Alyssa Elman, Sunday Clark, Yuhua Bao, Yiye Zhang, Philip Jeng, Katherine Wen, and Tony Rosen. "Substance Use Is Common in Elder Abuse Cases: Qualitative Findings From a Multi-Disciplinary Team." Innovation in Aging 4, Supplement_1 (December 1, 2020): 446. http://dx.doi.org/10.1093/geroni/igaa057.1442.
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Abstract Elder abuse is mistreatment of an older adult by a caregiver or another person in a position with an expectation of trust. Adversely affecting as many as 10% of community-dwelling older adults in the US, it may include physical abuse, sexual abuse, psychological abuse, financial exploitation and neglect. Mental illness and substance use by caregivers, family members and victims themselves have been described as risk factors for multiple forms of elder abuse in prior cross-sectional analyses but the impact on these cases is poorly understood. To explore this association we conducted a focus group using a semi-structured format involving an inter-disciplinary group of elder abuse professionals that are part of the New York City Elder Abuse Center enhanced multi-disciplinary team (EMDT) in Staten Island, New York. Focus group participants reported that opioid, cocaine, cannabis and alcohol use is common among perpetrators of elder abuse, especially in cases of financial mistreatment, verbal and physical abuse. Other potential consequences included eviction of the older adult victim, co-dependency and involvement of the older adult in the procurement of illicit substances, and substance use by the older adult. Respondents specifically expressed concerns that the opioid epidemic, including rising heroin use, may be changing the frequency and nature of elder abuse, and that case investigations offer an opportunity to facilitate referrals for formal substance use disorder assessment and treatment. Future work includes additional focus groups and quantitative analysis to clarify the intersection between substance use and elder abuse and inform intervention and prevention strategies.
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Hernández-Mejía, Benjamín Iván, and Edison Ricardo Espinoza-Saquicela. "Giant right coronary artery aneurysm. Case Report." Case reports 6, no. 1 (January 1, 2020): 70–76. http://dx.doi.org/10.15446/cr.v6n1.82446.
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Introduction: Coronary aneurysms are rare and are linked to drug abuse; symptomatology depends on the coronary anatomy. This is a case of acute coronary syndrome associated with a giant right coronary aneurysm.Case description: A 40-year-old male, with history of heroin and crack use since age 20, attended consultation due to dyspnea, stable angina and diaphoresis. An electrocardiogram showed ST segment overlay on the underside and troponin problems. A coronary catheterization was performed, which revealed apparent inconclusive aortato-right atrium fistula. Based on the findings, angiotomography and magnetic resonance imaging were performed, finding a giant right coronary aneurysm. The aneurysm was resected using extracorporeal circuit, femoral cannulation, moderate hypothermia, aortic cross-clamping and cardioplegia, and the right coronary artery was revascularized with the left internal saphenous vein. The patient had a satisfactory postoperative period and was discharged after 7 days.Conclusion: There is an important association between drug use and the development of coronary aneurysms. Aneurysm size makes diagnosis difficult, so complementary studies are necessary to establish a differential diagnosis. An appropriate surgical approach allows for a complete resection of the aneurysm and optimal coronary revascularization.
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Zangrando, A., F. Babici, E. Pascolo-Fabrici, and A. Riolo. "Paliperidone palmitate could reduce the consumption of drugs of abuse in psychotic patients?" European Psychiatry 33, S1 (March 2016): S386. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1387.
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IntroductionIt's not easy to choose between different antipsychotics in the treatment of patients with schizophrenia that use drugs of abuse both legal (alcohol, benzodiazepine, anticholinergics) and illicit (heroin, cannabis, cocaine). The use of substances is a powerful risk factor for poor outcome. From CATIE study, we know that the discontinuity is lower with Olanzapine but psychotic patients continue to take drugs of abuse despite medication. Probably, an important aspect is the anhedonia secondarily produced by neuroleptics.ObjectiveWe want to evaluate if Paliperidone Palmitate reduces addictive behaviors in a small group of psychotic patient who have agreed to recived injection after the switch from other antipsychotics.MethodWe have identified four individual with chronic use of drugs of abuse in a Mental Health Center. These subjects were abusing alcohol, cannabis, spice and benzodiazepine. We administered before new treatment and after 2 months the Snaith-Hamilton Pleasure Scale of Snaith et al. (1995) and the Leeds Dependence Questionaire of Raistrick et al. (1994).ResultsThe hedonic tone tends to improve and the addictive behavior decreased.ConclusionThe therapy with Paliperidone Palmitato is associated with a reduction of the addictive behaviors but we need studies with a larger number of patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Baldacchino, A., D. J. K. Balfour, and K. Matthews. "Impulsivity and opioid drugs: differential effects of heroin, methadone and prescribed analgesic medication." Psychological Medicine 45, no. 6 (August 28, 2014): 1167–79. http://dx.doi.org/10.1017/s0033291714002189.
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Background.Previous studies have provided inconsistent evidence that chronic exposure to opioid drugs, including heroin and methadone, may be associated with impairments in executive neuropsychological functioning, specifically cognitive impulsivity. Further, it remains unclear how such impairments may relate of the nature, level and extent of opioid exposure, the presence and severity of opioid dependence, and hazardous behaviours such as injecting.Method.Participants with histories of illicit heroin use (n = 24), former heroin users stabilized on prescribed methadone (methadone maintenance treatment; MMT) (n = 29), licit opioid prescriptions for chronic pain without history of abuse or dependence (n = 28) and healthy controls (n = 28) were recruited and tested on a task battery that included measures of cognitive impulsivity (Cambridge Gambling Task, CGT), motor impulsivity (Affective Go/NoGo, AGN) and non-planning impulsivity (Stockings of Cambridge, SOC).Results.Illicit heroin users showed increased motor impulsivity and impaired strategic planning. Additionally, they placed higher bets earlier and risked more on the CGT. Stable MMT participants deliberated longer and placed higher bets earlier on the CGT, but did not risk more. Chronic opioid exposed pain participants did not differ from healthy controls on any measures on any tasks. The identified impairments did not appear to be associated specifically with histories of intravenous drug use, nor with estimates of total opioid exposure.Conclusion.These data support the hypothesis that different aspects of neuropsychological measures of impulsivity appear to be associated with exposure to different opioids. This could reflect either a neurobehavioural consequence of opioid exposure, or may represent an underlying trait vulnerability to opioid dependence.
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Patel, Dev, Ishandeep Gandhi, Faisal Malek, Camille Olechowski, and Alan R. Hirsch. "131 A Marionettist Pulling My Strings: A Case of Buprenorphine-induced Chorea." CNS Spectrums 25, no. 2 (April 2020): 282–83. http://dx.doi.org/10.1017/s1092852920000474.
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Abstract:Introduction:Choreaform movements provoked by opiates is an infrequent adverse event. Buprenorphine induction of chorea has not heretofore been described. Such a case is presented.METHOD:Case Study: A 38-year-old female presented with a decade long history of alcohol, cocaine, benzodiazepine, and heroin abuse. The patient was insufflating 1.5 grams of heroin daily. On presentation, she was actively withdrawing, scoring 17 on the Clinical Opioid Withdrawal Scale. Urine toxicology screening was positive for opiates, cocaine, and cannabinoids. Buprenorphine 4 mg sublingual was initiated. Within one hour, she observed, “My legs were moving uncontrollably as if I was a marionette.” These dance-like movements were isolated to both legs and gradually resolved after discontinuation of buprenorphine: most of the movements manifested in the first 8 hours, and dissipated over the next 2 days. She did have similar movements after treatment with quetiapine during a previous hospitalization, years earlier.RESULTS:Abnormalities in physical examination: General: goiter, bilateral palmar erythema. Neurological examination: Cranial Nerve (CN) Examination: CN I: Alcohol Sniff Test: 2 (anosmia). Motor Examination: Drift testing: mild right pronator drift. Reflexes: 3+ bilateral lower extremities. Neuropsychiatric Examination: Clock Drawing Test: 3 (abnormal). Animal Fluency Test: 18 (normal). Go-No-Go Test 6/6 (normal).DISCUSSION:Buprenorphine induced chorea could be a result of partial mu-opioid agonism, or kappa and delta receptor antagonism (Burke, 2018; Cowan, 1977). Mu-opioid receptor activation causes increased dopamine turnover in the nigrostriatum, which is responsible for locomotor sensitization (Campos-Jurado, 2017). With the addition of mu-opioid receptor modulation of dopamine release, kappa-opioid receptor alters various neurotransmitters in the basal ganglia, potentiating hyperkinetic movements. Buprenorphine’s choreiformogenic action may be due to kappa-opioid receptors ability to augment neurotransmission in the striatum (Escobar, 2017; Bonnet, 1998). The combination of simultaneous activity of these three opioid receptors may cause chorea, since they act to modulate dopamine, glutamate, and GABA in the direct and indirect pathways within the basal ganglia (Abin, 1989; Cui, 2013; Allouche, 2014; Trifilieff, 2013). This patient’s history of heroin and cocaine use may have caused supersensitization of dopamine receptors (Memo, 1981), provoking hyperkinesia. Involvement of substance-induced sensitization with concurrent kappa-opioid receptor neurotransmitter augmentation in direct and indirect pathways in the basal ganglia may have primed our patient to the development of chorea after buprenorphine administration. Further investigation for the presence of extrapyramidal movements in those undergoing buprenorphine treatment is warranted.
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Fahy, Sabina, Roy Browne, Darina Sloan, Shay Keating, and John O'Connor. "An audit of violent incidents in a drug treatment centre." Irish Journal of Psychological Medicine 17, no. 1 (March 2000): 29–33. http://dx.doi.org/10.1017/s0790966700004031.
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AbstractObjectives: The aim of this study was to examine the prevalence of, and factors associated with violence in a drug treatment centre.Method: This study is a retrospective audit of all incident forms completed at an urban drug treatment centre between December 1991 and July 1996 with reference to case notes for additional clinical information on individuals involved in violent incidents.Participants included all patients attending the centre in the aforementioned time period who were involved in violent incidents. Information was obtained about the prevalence and severity of violent incidents and patient details including main drug of abuse, route of use, reason for attendance, comorbid axis 1 diagnosis, history of previous incidents and HIV status at the time of the incident.Results: One per cent of all patients were involved in violent incidents. Less than one quarter of incidents involved serious injury or assault. Most perpetrators were male intravenous heroin users on a methadone maintenance programme. Nurses and doctors were most frequently the victims of incidents. Ten per cent of patients had a history of previous incidents and almost half the perpetrators were HIV positive. A comorbid axis 1 diagnosis was found in 9% of perpetrators (n = 6), mainly alcohol dependence syndrome.
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Rahmawati, Iva Milia Hani, and Inayatur Rosyidah. "Family Psychoeducation Therapy to Improve Family's Ability to Care for Victims of Sexual Abuse." NurseLine Journal 6, no. 2 (November 17, 2021): 104. http://dx.doi.org/10.19184/nlj.v6i2.23532.
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Background: Sexual abuse is increasingly occurring but it is difficult to detect. Victims and their families usually do not want to reveal the sexual abuse clearly, complicates intervention efforts. The most incidents of sexual abuse occurred in children and adolescents, which is called child sexual abuse. Aim This study was conducted to analyze the effect of Family Psychoeducation (FPE) therapy on family’s ability to care for children who experienced sexual abuse (post sexual abuse) in the working area of Women's Crisis Center (WCC), Jombang Regency, East Java. Method: This study utilized pre-experimental design with one group pretest-posttest design; using one treatment group, with observations conducted to the group before and after treatment. The population in this study were all families with children who experienced sexual abuse with a total of 133 respondents. By using simple random sampling technique, 100 samples were obtained. The measuring instrument used was a questionnaire on both variables. Data processing was carried out by editing, coding, scoring, and tabulating, while data were analyzed using the Wilcoxon test. Results: Results obtained p value = 0.000 (<0.005), indicating that H1 was accepted. It means that there was an effect of Family Psychoeducation (FPE) therapy on the family's ability to care for children who experienced sexual abuse (post sexual abuse) in the working area of Women's Crisis Center, Jombang Regency. Conclusion: This study concludes that the most common case of sexual abuse is sexual violence. The results show that there is an effect of family psychoeducation (FPE) therapy on the family’s ability to care for children who experienced sexual abuse (post sexual abuse).
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Overcash, J. Scott, William O’Riordan, Megan Quintas, Laura Lawrence, Carol Tseng, and Sue Cammarata. "470. Treatment of Acute Bacterial Skin and Skin Structure Infections (ABSSSI) in Patients with Significant Drug Abuse: Outcomes from Global Phase 3 Studies of Delafloxacin (DLX)." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S230. http://dx.doi.org/10.1093/ofid/ofz360.543.
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Abstract Background Delafloxacin (DLX), an IV/oral anionic fluoroquinolone antibiotic, is approved for the treatment of ABSSSI including those due to MRSA and Gram-negative pathogens including P. aeruginosa. Two global phase 3 ABSSSI trials included patients with substance abuse including IV drugs. Methods Two multicenter, double-blind, double-dummy trials of adults with ABSSSI randomized patients 1:1 to receive either DLX monotherapy or vancomycin 15 mg/kg + aztreonam (VANAZ) for 5–14 days. Study 302 used DLX 300 mg BID IV only; study 303 used DLX 300 mg BID IV for 3 days with a mandatory blinded switch to DLX 450 mg oral BID. Key endpoints were Objective Response at 48–72 hours with ≥20% reduction in lesion size, and Investigator assessment of outcome at Follow-up (FU, Day 14), both in the Intent To Treat population. Results In the 2 studies, 620 patients with substance abuse, excluding alcoholism, including heroin, cocaine and methamphetamine abuse, were randomized in the United States. 71% were male with mean age 44 years. Average erythema area at baseline was ~230 cm2. 16% percent had cellulitis, 30% abscesses, and 53% wound. S. aureus (SA) was the most frequent pathogen. DLX was non-inferior to VANAZ for the Objective Response: 85.9% DLX vs. 84.4% VANAZ [∆2.6 (95% CI −2.9, 8.1)] as well as the assessment of outcome at FU: 82.0% DLX vs. 79.3% VANAZ [∆3.2 95% (CI −3, 9.4)]. Micro success in evaluable patients with SA was seen in 99.1% DLX vs. 100% VANAZ as well as 98.2% DLX vs. 100% VANAZ in patients with MRSA. The overall % of patients with at least one adverse event (AE) was comparable for DLX (49.0%) compared with VANAZ (56.1%). The most frequent treatment-related AEs were gastrointestinal in nature, including nausea seen in 9.7% DLX and 5.8% VANAZ patients, primarily mild to moderate in severity. There were no cases of C.difficile diarrhea. Discontinuations due to treatment-related AEs were lower with DLX (0.3%) compared with VANAZ (2.2%). Conclusion Fixed-dose monotherapyDLX was comparable to VANAZ in treatment of ABSSSI in patients with substance abuse based on the Objective Response as well as investigator-assessed outcome. DLX was also comparable to VANAZ in treating patients with SA and MRSA. DLX appears effective and well tolerated in patients with ABSSSI and significant substance abuse. Disclosures All authors: No reported disclosures.
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Schippers, Maria C., Mathijs Gaastra, Tanja Mesman, Dustin Schetters, Yvar van Mourik, Damiaan Denys, Tommy Pattij, and Taco J. De Vries. "Deep brain stimulation of the nucleus accumbens core but not shell reduces motivational components of heroin taking and seeking in rats." Brain and Neuroscience Advances 1 (January 1, 2017): 239821281771108. http://dx.doi.org/10.1177/2398212817711083.
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Background: Deep brain stimulation is explored as a new intervention for treatment-resistant substance use dependence. A candidate brain region is the nucleus accumbens, due to its involvement in reward and motivation. This study aimed to explore effects of NAcore and NAshell deep brain stimulation on aspects of heroin taking and seeking in a self-administration model for rats. Methods: NAcore and NAshell deep brain stimulation was applied during 25 or 100 µg/kg/infusion heroin self-administration on an FR4 schedule of reinforcement and during cue- and heroin-induced reinstatement. In a separate group, effects of NAcore deep brain stimulation on heroin self-administration on a progressive ratio schedule and the first extinction session were examined. Results: NAcore and NAshell deep brain stimulation did not alter heroin self-administration on an FR4 schedule. NAcore deep brain stimulation decreased cue – but not drug-induced reinstatement of heroin seeking, whereas NAshell deep brain stimulation did not affect reinstatement responding. In the second experiment, NAcore deep brain stimulation reduced responding during a progressive ratio schedule of heroin reinforcement. Finally, deep brain stimulation facilitated extinction from day 1 throughout the course of extinction learning. Conclusion: Taken together, the differential effects of NAcore and NAshell deep brain stimulation on heroin taking and seeking are in line with the distinct functional roles of these sub-regions therein. Conditioned cues have been shown to be very powerful stimuli for the persistence of addiction and relapse to drug use. Therefore, the present findings that NAcore deep brain stimulation decreases motivation for heroin taking and cue-conditioned behaviour and facilitates extinction learning are very promising, supporting the positive findings from clinical case studies.
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Majumder, Udayan, Rajesh Das, and Rajkumar Lenin Singh. "Zolpidem dependence with frontal lobe syndrome: a case report." International Journal of Basic & Clinical Pharmacology 6, no. 12 (November 23, 2017): 2936. http://dx.doi.org/10.18203/2319-2003.ijbcp20175222.
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Zolpidem is a non-benzodiazepine sedative hypnotic that binds to the benzodiazepine binding site on the gammaaminobutyric acid type A (GABA-A) receptors. It is the most commonly prescribed sleep medication which has been shown to be effective for treating insomnia on a short-term basis with fewer side effects than traditional benzodiazepines, which are feared for their abuse and dependence potential. Many studies have reported efficacy and safety of zolpidem in treatment of insomnia keeping in mind about its low abuse, and dependence capability. We present a case of zolpidem dependence in a 36-year-old male to emphasize that zolpidem also should be judiciously prescribed under supervision so that it does not develop tolerance, abuse and dependence.
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Peles, E., S. Schreiber, and M. Adelson. "No NREM Phase 3-4 (Deep Sleep) Among Benzodiazepine Abuse Patients in Methadone Maintenance Treatment (MMT)." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71462-2.
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Aims:As benzodiazepines (BDZ) abuse is highly prevalent among former heroin addicts, current MMTpatients, and poor sleep is highly prevalent complaint, we studied objective sleep patterns by polysomnography (PSG) and it relation with BDZ abuse.Methods:Urine results for BDZ (and opiates, cocaine, cannabis, amphetamines) which are routinely monitored, were taken at the month before PSG night. Pittsburgh Sleep Quality Index (PSQI), a self report questionnaire, questionnaire for pain (chronic pain defined if patient had current pain that lasted for ≥6month, of moderate or worse intensity), and DSM-IV-TR lifetime psychiatric diagnosis were studied.Results:Of 67 patients, 44(64.7%) were positive to BDZ. Patients included 86% males, 64.2% with any DSM-IV-TR axis I psychiatric diagnosis, 47% with chronic pain, with no differences between BDZ groups. PSQI scores and objective sleep efficiency were similar between yes and no BDZ groups (12.4±4.1 vs. 11.1±4.5, p=0.3, and 78±17.4% vs. 74±19.5%, p=0.4), but architecture differed notably. Specifically, 23(53.5%) of BDZ group had no non-REM deep sleep (phases 3+4) at all as compared with 4(16.7%) of the no-BDZ patients. REM phase was shorter among BDZ group (10.5±8.9 vs. 15.4±7.3, F=5.4, p=0.02). No other differences were found, and the absence of phase 3-4 was not related to methadone dose, treatment duration, or history of opiate abuse.Conclusions:Chronic / prolonged use of BDZ (which at times are prescribed for sleep), may disturb sleep, as shown to absolutely delete all restorative sleep phase. BDZ discontinuation is of important, but further studies are needed to establish the best way.
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Bozarth, Michael A. "New perspectives on cocaine addiction: recent findings from animal research." Canadian Journal of Physiology and Pharmacology 67, no. 9 (September 1, 1989): 1158–67. http://dx.doi.org/10.1139/y89-185.
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Research with laboratory animals has provided several insights into the nature of cocaine abuse and addiction. First, the nature of drug addiction has been reevaluated and the emphasis has shifted from physical dependence to compulsive drug-taking behavior. Second, animal studies suggest that cocaine is at least as addictive as heroin and possibly even more addictive. Third, cocaine is potentially more dangerous than heroin as evidenced by the higher fatality rate seen in laboratory animals given unlimited access to these drugs. Fourth, the neural basis of cocaine reinforcement has been identified and involves an enhancement of dopaminergic neurotransmission in the ventral tegmental dopamine system. Other addictive drugs (e.g., opiates) may also derive at least part of their reinforcing impact by pharmacologically activating this reward system. Fifth, although the biological consequences of repeated cocaine self-administration on central nervous system functioning are poorly understood, preliminary findings suggest that intravenous cocaine self-administration may decrease neural functioning in this brain reward system. This has important clinical implications because diminished functioning of an important brain reward system may significantly contribute to relapse into cocaine addiction. These and other findings from experimentation with laboratory animals suggest new considerations for the etiology and treatment of drug addiction.Key words: addiction, cocaine, dopamine, reward, withdrawal syndrome.