ADHD: prevalence and effect on opioid use disorder treatment outcome in a French sample of patients receiving medication for opioid use disorder-the influence of impulsivity as a mediating factor.

BACKGROUND: Opioid use disorder (OUD) poses a global health challenge, and despite medications for opioid use disorder (MOUD) and psychosocial interventions, relapse remains a significant concern. Comorbid psychiatric disorders, including attention deficit hyperactivity disorder (ADHD), are one of the major factors associated with poor OUD treatment outcome. We aimed to estimate the frequency of probable ADHD (in childhood and in adulthood) in patients with OUD; to assess the factors associated with this comorbidity; and to explore the factors that mediate the relationship between ADHD and OUD treatment outcome. METHODS: We conducted an observational study using a sample of 229 patients aged 18 years and older who were diagnosed with OUD and had received MOUD for at least six months. Participants were assessed through a structured interview and self-report questionnaires. Multivariate logistic regressions and a mediation analysis were performed. RESULTS: Almost half of the participants reported probable ADHD in childhood, and ADHD persisted into adulthood among two-thirds of the patients. The factors associated with poor OUD treatment outcome included earlier onset of OUD, lower education, and greater impulsivity. There was no direct effect of probable ADHD in childhood on OUD treatment outcome, but there was an indirect effect through negative urgency, the tendency to respond impulsively to negatively connoted emotional experiences. CONCLUSIONS: The findings suggest that ADHD symptoms, particularly impulsivity, may contribute to vulnerability in opioid use and play a crucial role in treatment outcomes for this population. TRIAL REGISTRATION: ClinicalTrials identifier NCT01847729.

Chemsex Among Men Having Sex with Men: A Scoping Review on Management, Support, and Harm Reduction Strategies.

Chemsex defines the practice of sexual activity under the influence of psychoactive substances, mainly by Men who have Sex with Men (MSM). This activity can be associated with negative health consequences, yet there are no recommendations to guide management of individuals who engage in chemsex. The aim of this scoping review was to identify and describe the existing treatments (pharmacological or not) and risk/harm reduction strategies for MSM who engage in chemsex. This scoping review was performed using PubMed and Embase databases and according to the PRISMA Extension for Scoping Review criteria. Overall, 19 studies were included in the review. Among these studies, four main themes were identified: management and harm reduction strategies, key actors involved in managing MSM who engage in chemsex, perceived barriers to care and the role of pre-exposure prophylaxis, and medical information sought by MSM who engage in chemsex. This scoping review concludes with the need to develop multidisciplinary approaches to improve communication about chemsex, and to design interventional studies that target MSM who engage in chemsex.

Effect of early intervention for early-stage psychotic disorders on suicidal behaviours - a systematic review protocol.

Background: The early stages of psychotic disorders correspond to the early phases of the disease and include the prodromal phase and first-episode psychosis; they constitute a period at high risk of suicidal behaviour. A long duration of untreated psychosis (DUP) is among the risk factors of suicidal behaviour identified in this early period. Many studies have shown the effectiveness of early interventions on the overall prognosis of psychotic disorders in the early stages, and early intervention strategies have been developed and tested worldwide. Several authors reported an improvement in suicidal behaviours; however, all these data have not been systematically analysed yet. The main objective of this systematic review was to collect evidence on the effect on suicidal behaviour of early interventions for patients in the early stages of psychotic disorders. Methods: We will carry out a systematic review of the literature according to the PRISMA criteria by searching articles in five databases (PubMed, Cochrane, PsycINFO, Scopus, EMBASE), without restriction on the publication date. The selection criteria are: articles (any type; e.g. prospective, retrospective, controlled or uncontrolled, and literature reviews) on early interventions for psychotic disorders in the early stages with data on suicide attempts, death by suicide, suicidal ideation; articles written in English or French. Exclusion criteria are: articles on suicidal behaviours in patients with psychotic disorders in the early stages, but without early intervention, and articles on early-stage psychotic disorders without data on suicidal behaviours. Discussion: If this review confirms the effectiveness on suicidal behaviours of early interventions for young patients with psychotic disorders, the development/implementation of such intervention programmes should be better promoted. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021237833.

How Do Young Adult Drinkers React to Varied Alcohol Warning Formats and Contents? An Exploratory Study in France.

Research on alcohol warnings has increased in the last decade, providing key evidence to governments on warning format and contents. The bulk of this research, however, has been conducted in Anglosphere countries, whereas fewer studies have focused on other countries which have high per capita alcohol consumption, and where the high social acceptability of drinking is liable to affect how people accept and react to prevention measures. Since France has one of the highest per capita alcohol consumption rates in the world according to the World Health Organization (WHO), we therefore explore how young adults in France react to warnings on alcoholic beverage advertisements. We conducted 25 in-depth interviews, in 2017, with 18-25-year-old drinkers in France. Respondents were asked open-ended questions on the perceived impact of various warning contents (i.e., on health risk, social-cost risk, and on short- vs. long-term risk) and formats (text only vs. larger text combined with colored pictograms). Warnings that targeted youth-relevant risks (i.e., road accidents or sexual assault) were considered to be the most meaningful and credible, although warnings communicating longer term risks (i.e., brain, cancer) were also thought to be influential. Less familiar risks, such as marketing manipulation and calorie intake, elicited the most negative reactions. Larger text-and-pictogram warnings were considered to be the most effective format in capturing attention and increasing awareness. Regardless of format and content, however, these warnings were not perceived as effective for decreasing alcohol consumption.

Practical dietary interventions to prevent cardiovascular disease suitable for implementation in primary care: an ADAPTE-guided systematic review of international clinical guidelines.

PURPOSE: Cardiovascular diseases (CVD) are the leading cause of death globally. The current model of care for high-income countries involves preventive medication and highly trained healthcare professionals, which is expensive and not transposable to low-income countries. An innovative, effective approach adapted to limited human, technical, and financial resources is required. Measures to reduce CVD risk factors, including diet, are proven to be effective. The survey "Scaling-up Packages of Interventions for Cardiovascular disease prevention in selected sites in Europe and Sub-Saharan Africa" aims to develop non-pharmacological cardiovascular prevention and control programs in primary care and community settings in high, middle, and low-income countries. This review aims to identify the existing, validated dietary interventions for primary CVD prevention from national and international clinical guidelines that can be implemented in primary care and communities. METHODS: A systematic review of CVD prevention guidelines was conducted between September 2017 and March 2023 using the Turning Research Into Practice medical database, the Guidelines International Network, and a purposive search. The ADAPTE procedure was followed. Two researchers independently conducted the searches and appraisals. Guidelines published after 01/01/2012 addressing non-pharmacological, dietary interventions for primary CVD prevention or CVD risk factor management, in the adult general population in primary care or in community settings were included and appraised using the Appraisal of Guidelines Research and Evaluation II score. Individual dietary recommendations and the studies supporting them were extracted. Then supporting data about each specific dietary intervention were extracted into a matrix. RESULTS: In total, 1375 guidelines were identified, of which 39 were included. From these, 383 recommendations, covering 10 CVD prevention themes were identified. From these recommendations, 165 studies for effective dietary interventions for CVD prevention were found. Among these, the DASH diet was the most effective on multiple CVD risk factors. Combining diet with other interventions such as exercise and smoking cessation increased efficacy. No guidelines provided detailed implementation strategies. CONCLUSION: The DASH diet combined with other interventions was the most effective on an individual basis. However, expansion in the wider population seems difficult, without government support to implement regulations such as reducing salt content in processed food. TRIAL REGISTRATION: Clinical Trials NCT03886064.

Heart disease is the leading cause of death around the world. Strategies to prevent heart disease in high-income countries rely on medications and the skills of highly trained healthcare professionals. However, this is expensive and unsuitable for low-income countries. Consequently, an innovative, effective approach, which can be adapted to countries with limited human, technical and financial resources is needed. A program called SPICES was developed to identify strategies other than medication to prevent and control heart disease. This program reviewed the evidence for smoking cessation, physical activity, and dietary strategies, which may be useful to prevent heart disease in communities with limited resources.In this review, the investigators searched online databases to find clinical guidelines that recommended dietary strategies to manage heart disease worldwide. The information found from this search revealed that the DASH diet, inspired by the Mediterranean diet, helps with weight loss, and improves blood pressure and cholesterol levels making it the most effective diet for preventing heart disease. It is even more effective if it is combined with other strategies such as exercise, stopping smoking or reducing the amount of alcohol consumed. However, this works well for individuals but is difficult to expand to the wider population. Therefore, government support is needed to implement regulations such as reducing salt content in processed food.

Changes in Alcohol Consumption after 1 Year of the COVID-19 Pandemic: A Cross-Sectional Study in a Region of France.

BACKGROUND: There is conflicting evidence on how the COVID-19 pandemic changed patterns of alcohol consumption. While some studies have suggested that alcohol consumption decreased at the beginning of the pandemic, there are limited data for a longer period. The objective of this study was to investigate changes in alcohol consumption 1 year after the onset of the COVID-19 pandemic in France, and to identify vulnerable subgroups in a French adult population. METHODS: This was a single-center, cross-sectional, descriptive study. Self-reported changes in alcohol consumption were collected from 2491 respondents in a survey carried out in western Brittany from 18 January to 9 March 2021. RESULTS: Of respondents, 27.64% reported that they had increased their alcohol consumption, 14.7% had decreased, 3.94% had ceased, and 53.72% reported no change in their alcohol consumption. Increased alcohol use was associated with male gender, age 26 to 44 years, living with a family, not being a health professional, having had a physical or psychological health problem during lockdowns, smoking tobacco, and using cannabis. Reduced alcohol use or cessation was associated with male gender, age 18 to 25 years, living in Brest, living alone, and using cannabis. CONCLUSIONS: Our study suggests that during the COVID-19 pandemic, a significant number of people increased their alcohol consumption in France, even outside lockdowns. These results should encourage health professionals and public authorities to implement more specific prevention measures to limit the risks associated with alcohol consumption.

Tobacco Tax Increases: A Discourse Analysis of the French Print and Web News Media from 2000 to 2020.

Lobbying led by the tobacco industry and tobacconists is a barrier to reducing smoking prevalence in France. Here, we analyze the discourse of the tobacco industry and other key actors (public health agencies, politicians, etc.) in the French general-audience news media from 2000 to 2020 around tobacco tax increases, which is one of the most effective tobacco control measures, especially amongst youth. We queried Europresse (a European news media and specialized press database) using the keywords "increase", "price or taxes", and "tobacco or cigarettes", and found 5409 topic-relevant articles, from which we extracted 8015 arguments for or against the measure. In total,64.3% were against the measure (mostly on grounds of "ufueling the black market"), 32.1% were for the measure (mostly claiming it is "effective at reducing smoking prevalence"), and 1.8% proposed alternative measures. Tobacconists, the primary source of media content on the topic, led a discourse that was strongly opposed to tax increases. Public health agencies, which attracted only half as much media attention, were strongly supportive of the measure. Analysis of discourses relayed in the French general-audience press revealed overwhelming opposition to tobacco tax increases, and this discourse was widely advanced by tobacconists. The results were congruent with international literature that had highlighted a similar set of arguments to those found in the French general press that were broadcasted by the tobacco industry and its allies (tobacconists in France) in an effort to block this evidence-based public health measure.

Parkinson's disease and iatrogenic impulsive-compulsive behaviors: A case/non-case study to build a complete model of individual vulnerability.

Background and aims: Parkinson's disease (PD) is one of the most prevalent neurodegenerative diseases. First-line medications consist of drugs that act by counteracting dopamine deficiency in the basal ganglia. Unfortunately, iatrogenic impulsive-compulsive behaviors (ICBs) can occur in up to 20% of PD patients over the course of their illness. ICBs must be considered multifactorial disorders that reflect the interactions of the medication with an individual's vulnerability and the underlying neurobiology of PD. We aimed to explore the predictive genetic, psychopathological and neurological factors involved in the development of ICBs in PD patients by building a complete model of individual vulnerability. Methods: The PARKADD study was a case/non-case study. A total of 225 patients were enrolled ("ICB" group, N = 75; "no ICB" group, N = 150), and 163 agreed to provide saliva samples for genetic analysis. Sociodemographic, neurological and psychiatric characteristics were assessed, and genotyping for the characterization of polymorphisms related to dopaminergic and opioid systems was performed. Results: Factors associated with "ICBs" were younger age of PD onset, personal history of ICB prior to PD onset and higher scores on the urgency and sensation seeking facets of impulsivity. No gene variant was significantly associated, but the association with the opioid receptor mu 1 (OPRM1) rs1799971 polymorphism was close to significance. Discussion and conclusions: The influence of gene-environment interactions probably exists, and additional studies are needed to decipher the possible role of the opioid system in the development of ICBs in PD patients.

How do people who use drugs receiving Opioid Medication Therapy perceive their treatment ? A multicentre study.

BACKGROUND: The resurgence of heroin use and the misuse of pharmaceutical opioids are some of the reasons for a worldwide increase in opioid dependence. Opioid Medication Therapies (OMT) have amply demonstrated their efficacy. From a medical point of view, the main objectives of OMT concern medical and social outcomes, centred on risk reduction and the cessation of opioid use. But patient points of view can differ and few studies have explored opioid-dependent patient viewpoints on their OMT. This variable seems important to consider in a patient-centred approach. The aim of our study was to explore points of view of people who use drugs (PWUD) treated with OMT, in a large multicentre sample. METHOD: A cross-sectional multicentre study explored the points of view of PWUD with Opioid Use Disorder following OMT. Data regarding the patients' points of view were collected using a self-administered questionnaire developed by the scientific committee of the study. A descriptive analysis and an exploratory factor analysis were performed to explore the structure of items exploring patient viewpoints. RESULTS: 263 opioid dependent PWUD were included, a majority were men consuming heroin prior to being prescribed OMT. 68% were on methadone, 32% were on buprenorphine. Most PWUD identified a positive impact on their lives, with 92.8% agreeing or strongly agreeing that OMT had changed a lot of things in their lives. The exploratory factor analysis identified three factors: (F1) items related to points of views concerning the objectives and efficacy of OMT; (F2) items related to the legitimacy of OMT as a treatment compared to a drug, (F3) items related to experiences and relationships with OMT. CONCLUSION: Patient viewpoints on efficacy were correlated with the pharmacological benefits of OMT and with the associated psychosocial measures. The implications of OMT in relationships, such as the feeling of being judged, concerned a majority. Points of view were ambivalent concerning the role of OMT as a treatment or as a drug. Involving patient points of view in therapeutic strategies decisions could help enhance positive views among PWUD on OMT and help PWUD towards their recovery. TRIAL REGISTRATION: OPAL study was registered: (NCT01847729).

Analysis of How Lobbying by the Alcohol Industry Has Eroded the French Évin Law Since 1991.

OBJECTIVE: The French Évin Law was passed in 1991 to prohibit alcohol advertising in media from targeting young people and to regulate content in authorized media. This research analyzes how lobbying by the alcohol industry has undermined this law over the last 30 years. METHOD: A narrative approach, consisting of the collection and analysis of semistructured interviews with persons who recount their experience and offer interpretation, was used to analyze lobbying by the alcohol industry against the Évin Law from 1991 to 2020. We conducted 18 interviews with key French informants involved in implementing and/ or changing the Évin Law (including founders of the law) to identify strategies and arguments used by the alcohol industry. An established framework of corporate political activity specific to the alcohol industry was used to classify the findings. RESULTS: The industry tactics and arguments were found to be similar to those in other countries; however, some were specific to France, such as highlighting winegrowing as central to French culture and integrating the wine industry into decision-making bodies, alliances with parliamentarians, and circumventions of the law. These specific features may be explained by the age of the Évin Law (30 years) and the economic weight of alcohol and wine at the heart of French culture. CONCLUSIONS: The Évin Law has been continuously weakened since its initial implementation. This research analyzes the long-term lobbying strategies and arguments that have been used to erode it. The results are useful for other countries that have implemented alcohol marketing regulations to help anticipate tactics and arguments deployed by the alcohol industry to weaken marketing regulations.

Nine Forward-Backward Translations of the Hopkins Symptom Checklist-25 With Cultural Checks.

Introduction: The Hopkins Symptom Checklist-25 (HSCL-25) is an effective, reliable, and ergonomic tool that can be used for depression diagnosis and monitoring in daily practice. To allow its broad use by family practice physicians (FPs), it was translated from English into nine European languages (Greek, Polish, Bulgarian, Croatian, Catalan, Galician, Spanish, Italian, and French) and the translation homogeneity was confirmed. This study describes this process. Methods: First, two translators (an academic translator and an FP researcher) were recruited for the forward translation (FT). A panel of English-speaking FPs that included at least 15 experts (researchers, teachers, and practitioners) was organized in each country to finalize the FT using a Delphi procedure. Results: One or two Delphi procedure rounds were sufficient for each translation. Then, a different translator, who did not know the original version of the HSCL-25, performed a backward translation in English. An expert panel of linguists compared the two English versions. Differences were listed and a multicultural consensus group determined whether they were due to linguistic problems or to cultural differences. All versions underwent cultural check. Conclusion: All nine translations were finalized without altering the original meaning.

Innovative cardiovascular primary prevention population-based strategies: a 2-year hybrid type 1 implementation randomised control trial (RCT) which evaluates behavioural change conducted by community champions compared with brief advice only from the SPICES project (scaling-up packages of interventions for cardiovascular disease prevention in selected sites in Europe and sub-Saharan Africa).

BACKGROUND: Cardiovascular diseases (CVD) caused 17.9 million deaths worldwide in 2016, being the world's leading cause of death. Prevention of CVD in high-income countries is expensive and fails to reach the population at risk. In low-income countries, it is under-developed. The SPICES project implements a community-based program to improve CVD prevention in 3 European countries and 2 Sub-Saharan countries, based on using community champions to effect behavioural changes. In France, the project operates in "Pays Centre Ouest Bretagne" (COB) which is the Central West Brittany area, and a vulnerable, rural setting. The aim of this study is to assess this innovative prevention strategy versus brief advice. METHODS: A two-step RCT hybrid type 1 implementation study will first of all screen a population using the Non-Laboratory INTERHEART Score (NL-IHRS) and will involve health-care students at public events in the COB area until 1000 participants have been recruited. Second, a RCT will be carried out. The research team will contact each participant with an intermediate NL-IHRS in order to include them. Participants will be over 18 years of age and work or live in the COB area. Participants will be equally randomised in two groups. The intervention group will receive brief advice plus behavioural change guidance carried out by community champions. The control group will receive brief advice only. The main objective for the RCT is to assess a difference of at least 15% in the NL-IHRS between the two groups after 24 months. The primary outcome will be analysed with intention to treat. Secondary outcomes for the RCT will be assessed using validated questionnaires: the WHOQOL-BREF, the DASH Q questionnaire, the IPAQ-short; smoking level will be assessed according to the NL-IHRS scoring system; a modified self-declared alcohol consumption questionnaire has been developed and gauges will be used to assess BMI. The implementation strategy will use mixed methods: qualitative research methods and quantitative epidemiological studies. DISCUSSION: A difference in the mean NL-IHRS of 15% will provide an argument in favour of reorganising prevention policies. A substantial change would favour relocating primary prevention from healthcare professionals to lay people and the community. TRIAL REGISTRATION: Clinical Trials NCT03886064 - the study was recorded on ClinicalTrials.gov , the 22nd of March 2019.

Prospective Study on Factors Associated with Referral of Patients with Opioid Maintenance Therapy from Specialized Addictive Disorders Centers to Primary Care.

Background: One of the most important issues for opiate maintenance therapy efficacy is the involvement of primary care physicians (PCPs) in opiate use disorder treatment, especially after referral from specialized units. This study aimed to analyze the progress of subjects in a specialized center and after referral to PCPs. Methods: This study was an observational prospective study. Recruitment took place in a specialized addictive disorder center in western France. All patients were evaluated (sociodemographical data, severity of substance use disorders through the TMSP scale, the quality of life through the TEAQV scale) by physicians during the 5-year-follow up of the study. Analysis focused on four main times during follow-up: entry/last visit into specialized care and into primary care. Results: 113 patients were included in this study; 93% were receiving methadone and 7% buprenorphine. Ninety (90) were referred to primary care. In primary care follow-up, the probability of the lowest severity score for substance use disorders remained stable over time. Conclusions: In daily practice, a center specialized in addictive disorders referred OMT management to PCPs for a majority of patients, and benefits regarding substance use disorders severity and quality of life remained stable after referral. Our results need to be confirmed.

Five-year follow-up on a sample of gamblers: predictive factors of relapse.

BACKGROUND AND AIMS: Few studies have been conducted on the long-term evolution of gambling disorder (GD). The aim of this study was to identify factors that could predict GD relapse. METHODS: Data were part of a dataset from a large 5-year cohort of gamblers who were assessed at inclusion and each year thereafter. Participants were recruited from an outpatient addiction treatment center, from various gambling places and through the press. For this specific study, inclusion criteria included (i) transitioning from GD to recovery at a follow-up time and (ii) undergoing at least one follow-up visit afterwards. Participants were evaluated using a structured clinical interview and self-report questionnaires assessing sociodemographic, gambling and clinical characteristics. "Relapse" was defined as the presence of GD (according to the DSM-5) at the N+1th visit following the absence of GD at the Nth visit. A Markov model-based approach was employed to examine predictive factors associated with relapse at a subsequent follow-up visit. RESULTS: The sample consisted of 87 participants, aged 47.6 years (sd = 12.6), who were predominantly male (65%). Among the participants, 49 remained in recovery, whereas 38 relapsed. Participants who reported not having experienced at least one month of abstinence and those with a low level of self-directedness at the previous follow-up visit were more likely to relapse. CONCLUSIONS: Our findings suggest the existence of factors that are predictive of relapse in individuals with GD who had previously achieved recovery. These results can inspire the development of measures to promote long-term recovery.

The efficacy of a targeted PREVENTION programme for addictive behaviour (PREVENTURE) among vulnerable ADOlescents in France - study procotol.

BACKGROUND: Alcohol use is a major public health challenge in France, where at the age of 17 half the young people report an episode of severe alcohol intoxication in the month preceding the survey. Numerous prevention programmes have a general objective, but in adolescence individual vulnerabilities towards addictions differ significantly with personality traits. Prevention targeting personality traits enables work on risk factors for addictive behaviours, and has shown genuine efficacy. Among existing programmes, PREVENTURE has shown an effect on the reduction in alcohol consumption by targeting four personality traits: impulsivity, sensation-seeking, negative thoughts and anxiety. This programme has been tested on samples recruited in adolescent populations in school environments, identifying adolescents at risk, but it has not been tested on a more targeted recruitment of adolescents seen in consultation. METHODS: The main hypothesis of this study is that the targeted prevention programme PREVENTURE will have an impact on the prevalence of binge-drinking episodes. The secondary hypotheses explore other factors such as associated substance use, anxiety and depression, as well as the acceptability of the programme. This article presents the study protocol of "PREVADO" study. We intend to assess the impact of the targeted intervention programme PREVENTURE on the prevalence of binge-drinking episodes among adolescents aged 14 to 17 years consulting in one of the participating centres or referred by a school doctor. The study will be prospective, randomised, controlled and open-label, and will comprise an intervention group and a control group. The adolescents will then be followed and assessed 1, 3, 6 and 12 months after the intervention. The study needs to include 700 subjects in order to reach 340 adolescents randomised, 170 in each group. It will concern 33 centres. DISCUSSION: This project could favour the targeting of addictive behaviours among vulnerable adolescents, and its application on a larger scale could be envisaged. TRIAL REGISTRATION: The Trial registration number is NCT04599270 , and it was registered on the ClinicalTrials.gov public website.

Analgesic Opioid Misuse and Opioid Use Disorder among Patients with Chronic Non-Cancer Pain and Prescribed Opioids in a Pain Centre in France.

(1) Background: Chronic non-cancer pain (CNCP) remains a public health challenge around the world. Opioids (PO) have been increasingly used in the treatment of CNCP in the last 20 years. This study aimed to assess the prevalence of opioid misuse and prescribed-opioid use disorder (p-OUD) among patients with CNCP in a pain centre in France, and to analyse risk factors for moderate or severe p-OUD. (2) Method: A cross-sectional study was conducted, including patients consulting for pain management in the pain centre of Brest University Hospital. A self-questionnaire was administered (sociodemographic data, medical data, PO misuse, and p-OUD according the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) criteria). Descriptive, univariate, and multivariate analyses were conducted, together with a principal component analysis, in order to identify factors associated with p-OUD. (3) Results: In total, 115 patients were included, the majority of whom were women, with a mean age of 52 years old [18-82]; 64.3% (n = 74) had a current prescription for opioid analgesics (weak or strong). In this group, 56.7% (n = 42) had no or only mild p-OUD and 43.3% (n = 32) had current moderate or severe p-OUD. Patients with moderate or severe p-OUD were more likely to have a current antidepressant prescription, to have had psychotherapy, to currently use strong opioids and oxycodone, and to report taking more frequent doses than prescribed and feeling dependent. (4) Conclusions: We showed that the prevalence of current moderate/severe p-OUD concerned 43.3% of the patients with a CNCP seeking treatment in a pain centre. According to these results, several measures are relevant in managing p-OUD among patients with CNCP.

Gambling Marketing Strategies and the Internet: What Do We Know? A Systematic Review.

Background: The gambling industry has developed many types of gambling on Internet in recent years. Gambling is a social activity for a majority of the world population, but problem gambling (PG) can emerge. The trajectories of gamblers from initiation to PG development are influenced by many variables, including individual and environmental variables and also variables linked to the gambling characteristics. Marketing has been reported to influence gamblers' perceptions and behaviors, but this is not as clear for digital marketing. Digital gambling marketing is broad, ranging from the marketing of gambling websites to communication and advertising on the social media and networks. The objective of this article was to fill this gap by conducting a systematic literature review in order to answer the following questions: (1) What are the strategies of digital gambling marketing? (2) What is the effect of this exposure on gambling representations, intentions and practices? Method: A systematic review was conducted following the PRISMA guidelines on Pubmed database (Medline) from February 2020 to March 2020 and Scopus. Existing papers published between January 2000 and February 2020 were identified by searching with this algorithm: ((("internet"[MeSH Major Topic] OR (communications[All Fields] AND media[All Fields])) OR ("social media"[MeSH Terms] OR ("social"[All Fields] AND "media"[All Fields]) OR "social media"[All Fields])) AND "gambling"[MeSH Major Topic]) AND ("marketing"[MeSH Terms] OR "marketing"[All Fields]), in title, keywords or abstract. Results: Ninety-one candidate studies were selected, 21 studies were selected for the systematic review. Sport appeared as a specific target of online gambling marketing. A growing range of platforms for online sport betting and the development of strategies on the social media were identified. Regarding content, a systematic association between sport and gambling was highlighted. Vulnerable populations, such as young people, appeared to be at high risk of exposure to gambling marketing. Conclusion: Little data is available on the strategies of digital gambling marketing or on exposure to it. Sport could be the first target for future research to understand how the industry is targeting specific populations, and what influence these strategies could have on PG development.

What Differs between Patients under Methadone and under Buprenorphine for Opioid Use Disorder (OUD) in Daily Clinical Practice in France? A Short Report.

(1) Background: Opioid use disorder (OUD) is a complex condition that can require long-term treatment. Pharmacological therapy for OUD involves treatment with opioid agonists (OMT) tailored to individual profiles. The aim of our study in daily clinical practice was to compare the profiles of patients treated with methadone (MTD) and those using buprenorphine (BHD or BHD-naloxone-NX). (2) Methods: A cross-sectional multicentre study explored the psychological, somatic and social profiles of patients with Opioid Use Disorder (OUD) following Opioid Maintenance Treatment (BHD, BHD/NX, or MTD). Descriptive and comparative analyses were performed. (3) Results: 257 patients were included, a majority were men using heroin. A total of 68% (178) were on MTD, 32% (79) were on BHD. Patients with MTD were significantly more likely to report somatic damage, and more likely to be younger and not to report oral or sublingual use as the main route for heroin or non-medical opioids. (4) Conclusions: In daily clinical practice, somatic damage was significantly more severe among MTD patients. Age and route of administration also differed, and our results could raise the issue of the type of OMT prescribed in case of non-medical use of prescribed opioids. These hypothesis should be confirmed in larger studies.

Acute pain management among patients with opioid maintenance therapy: specificities and difficulties identified in primary care: a qualitative study.

OBJECTIVES: In the last 30 years, opioid maintenance treatment prescription (OMT) has changed patients' and also changed physicians' practices. General practitioners (GPs) have to deal with patients on OMT who are in acute pain. The objective of this qualitative study was to explore medical care challenges and solutions identified by GPs in the management of acute pain among patients receiving OMT. DESIGN AND SETTING: Qualitative study with semistructured interviews were used as a data collection technique with a sampling strategy using a snowball sampling method to obtain a purposive sample of practicing GPs. Analysis was undertaken using a thematic analysis method. PARTICIPANTS: Twelve GPs, working in France (Brittany) who prescribe OMT were interviewed. RESULTS: The thematic analysis resulted in two main themes relating to specificities and difficulties identified: (1) Medical care and training challenges identified by GPs treating patients on OMT with acute pain, with four subthemes : management of these situations not concerning primary care, lack of training prompts GPs to rely on peer and specialist support, lack of guidelines and conflicting recommendations between clinicians in different settings (2) linked to the patient-GP relationship, with six subthemes: Implementing an individualised centred approach, acute pain management during OMT relies on a relationship based on trust, GPs found difficulties in evaluating and treating pain, difficulties in care adherence, fear of patients destabilisation, fear of misuse and diversion. CONCLUSION: The complexity of acute pain and OMT entails significant challenges for clinicians and patients. In primary care, it is hard to achieve a balance between pain relief and opioid use disorder treatment, in a global patient-centred approach. Fear of misuse or diversion was not a important factor, except for patients not known to the practitioners, but GPs were concerned with the risks of patient destabilisation in situations of acute pain.

Are Seniors Dependent on Benzodiazepines? A National Clinical Survey of Substance Use Disorder.

Benzodiazepines and Z-drugs, zolpidem and zopiclone, (BZD/Z) are used longer than recommended in the elderly population. However, to date, very few attempts have been made to evaluate dependence on BDZ/Z among the elderly population. We conducted a national multicentric observational prospective study aimed at evaluating the prevalence of and risk factors for dependence among elderly adults. Patients aged 65 or older who were treated with BZD/Z for at least 3 months were evaluated through clinical interviews that conformed to official Diagnostic and Statistical Manual of Mental Disorders (DSM) dependence criteria. Among the 1,024 patients included in the survey, 442 of 976 (45.3%) met the dependence criteria. In the multivariate logistic regression model, dependent patients were categorized as follows: younger (odds ratio (OR) = 0.97), living mostly alone (OR = 1.45), showing psychiatric problems (OR = 2.22), having additional treatments (other than BZD/Z; OR = 1.37), having long-lasting treatment (OR = 1.04), exhibiting significant relationship difficulties (OR = 1.96), committing transgressional behaviors to procure BZD/Z (OR = 2.70), and wanting to stop their consumption of BZD/Z (OR = 7.60). A latent class analysis, which was applied to sort out subgroups within dependent patients, identified two profiles according to the prevalence of dependence items: profile 1 (73%), "withdrawal syndrome when BZD/Z is stopped" (100%) and "previous unsuccessful attempts to stop consumption" (82%); and profile 2 (27%), "tolerance" (76%) and "intake in larger amounts or over a longer period than intended" (86%). BZD/Z dependence is frequent in the elderly population, and among dependent patients, we found two profiles corresponding to positive and negative conditioning of the psychoactive effects of BZD/Z. This study is registered as NCT01920581.