Opioid Use Disorder: A Qualitative Exploratory Analysis of Potential Misunderstandings in Patients with Chronic Non-Cancer Pain.

Purpose: Substance use disorders (SUD) are a challenging comorbidity in patients with chronic non-cancer pain (CNCP) as they complicate diagnosis and therapy, especially when opioids are part of the therapeutic regimen. A definite diagnosis of opioid use disorder (OUD) in patients with CNCP on long-term opioid therapy (LTOT) is a prerequisite for effective and targeted therapy but may be complicated as some criteria of OUD might be attributed to the desire of the patient to relieve the pain. For instance, the desire to increase the dose can be based on both a SUD as well as inadequate pain therapy. Many scientific studies use standardized questions. Therefore, potential misunderstandings due to possible diagnostic overlaps often cannot be clarified. Methods: 14 qualitative guided interviews were conducted and analyzed (Kuckartz content analysis), with the intention to verify if patient's initial response to simple questions based on the wording of the DSM-5, as commonly used in research and practice, were consistent with the results of a more in-depth inquiry. Results: The results suggest that without in-depth investigation, there is a particular risk of false-positive assessment of the DSM-5 criteria for OUD when opioids are prescribed, especially when the questions are considered independently of chronic pain. The risk of a false-negative assessment has also been shown in isolated cases. Conclusion: Only after asking for and describing specific situations it was possible to determine whether the patient's positive or negative answers were based on a misunderstanding of the question. To avoid misdiagnosis, staff conducting DSM-5 interviews should be trained in pain-specific follow-up questions that may help to uncover diagnostic confounding.

Effectiveness of Medical Cannabis for the Treatment of Depression: A Naturalistic Outpatient Study.

BACKGROUND: There is a lack of studies on the course and effectiveness of medical cannabis in the treatment of major depressive disorder (MDD). METHODS: Retrospective longitudinal (18 weeks) study of n=59 outpatients with MDD, treated with medical cannabis via a telemedical platform. Previous treatment with antidepressant medication was required for inclusion into the study. Standardized data collection was carried out at entry and during monthly consultations. Severity of depression was measured on a 0-10 point rating scale. Side-effects were assessed by a checklist. RESULTS: Patients were 20-54 years old; 72.9% were male; one third reported times of regular cannabis consumption within the previous five years. Drop-out rate was 22% after 18 weeks. Mean severity of depression decreased from 6.9 points (SD 1.5) at entry to 3.8 points (2.7) at week 18 (baseline observation carried forward; 95% CI for the mean difference: 2.4 to 3.8; p<0.001). A treatment response (>50% reduction of the initial score) was seen in 50.8% at week 18. One third of patients complained about side effects, none was considered as severe. Concomitant antidepressant medication (31% of patients) was not associated with outcome. CONCLUSIONS: Medical cannabis was well tolerated and dropout rate was comparable to those in clinical trials of antidepressant medication. Patients reported a clinically significant reduction of depression severity. Further research on the effectiveness of medical cannabis for MDD seems warranted. Risks of this medication, such as sustaining or inducing a cannabis use disorder, or side effects such as poor concentration, must be taken into consideration.

Augmentation of Electroconvulsive Therapy with Oral Caffeine: A Retrospective Analysis of 40 Patients with Major Depression.

OBJECTIVE: Studies have demonstrated the efficacy of injectable caffeine as an augmentation method in electroconvulsive therapy (ECT). This study investigated whether orally administered caffeine increases seizure duration during ECT. METHODS: Medical records of 40 patients treated with a series of ECT were retrospectively analyzed. Patients whose electroencephalogram (EEG) seizure duration had dropped<30 s, or motor seizure duration<15 s were included. They subsequently received oral caffeine (0.2 g) before ECT sessions. Primary outcomes were EEG seizure duration and motor seizure duration, compared with those from the last pre-caffeine session (baseline) and the first five caffeine-augmented sessions. The mental state was assessed with the Global Assessment of Functioning (GAF). In addition, data on maximum heart rate, maximal arterial pressure, and adverse effects were collected. RESULTS: The EEG seizure duration increased by 14.9 s (52%) on average between baseline and the first caffeine-augmented session. The increased length remained widely stable over the subsequent ECT sessions. EEG seizure duration was>30 s in more than 80% of sessions. A statistically significant increase in motor seizure duration appeared only in the 2nd and 3rd of five sessions with augmentation. Oral caffeine pretreatment was overall well tolerated. The percentage of patients with at least serious mental impairment (GAF score≤50) dropped from 77.5 to 15%. CONCLUSIONS: Results suggest the utility of oral caffeine (0.2 g) to increase ECT-induced seizures in patients with durations below clinically significant thresholds.

Patient Perspectives on Pharmacotherapy of Alcohol Dependence.

INTRODUCTION: Pharmacotherapy with drugs like naltrexone or acamprosate is a well-evaluated element in the treatment of alcohol dependence (AD). However, in many countries, these medications are rarely administered. The objective of the present study was to identify from patients' perspective factors that prevent the initiation and compliance with pharmacological treatment of AD. METHODS: Patients from inpatient alcohol withdrawal treatment underwent a standardized interview. Questions included socio-demographic data, history of AD, treatment history, knowledge and personal experience regarding pharmacotherapy of AD, and personal views about the causes of AD. RESULTS: Three hundred patients (mean age 47.3 years, 27.7% female, mean duration of AD 8.9 years, 67% with a history of previous inpatient withdrawal treatment) were included. The majority of patients (58.7%) already knew drugs for the pharmacotherapy of AD. Thirty percent had ever used such medications, most often acamprosate. Except for disulfiram, pharmacotherapy of AD had lasted only a few weeks, on average. Medication usually had been applied without additional psychotherapy. No severe side effects were reported. Patients had often stopped pharmacotherapy on their own, when assuming they had reached stable abstinence. Openness to start pharmacotherapy for AD was currently stated by 67% of the total sample. In multiple logistic regression, openness was predicted by having a concept of AD as a medical disease and by a shorter duration of AD. DISCUSSION: To improve the administration of pharmacotherapy for AD implementation strategies should be systematically developed and evaluated with a focus on the concept of AD as a medical disease.

Opiate maintenance patients' attitudes and self-reported adherence to protective measures against SARS-CoV-2 infections.

Background: During the COVID-19 pandemic we assessed to which extent patients in opioid maintenance treatment (OMT) adhere to official recommendations regarding preventive intervention strategies against COVID-19. Methods: Patients enrolled in two OMT clinics in Germany were interviewed applying a standardized questionnaire, which covered socio-demographic information, recent psychotropic substance use, recent social activities, the history of SARS-CoV-2 infection, attitudes toward official protection recommendations, and levels of adherence to these suggestions. Current mental and medical diagnoses were retrieved from medical files. In subjects without known infection and without vaccination, blood samples were tested for the identification of anti-SARS-CoV-2-S-antibodies. Interviews were performed between the end of May and the end of September 2021. Results: Patients' (n = 155) average age was 47 years; 74% were males. In addition to the opiate dependence, in nearly 80% of cases another medical disorder was recorded. The range of medical factors that predispose for severe COVID-19 outcomes were present in 39% of patients; 18% of the sample refused to be vaccinated. Nearly all patients reported having carried out a range of activities outside their residence during the week prior to the interviews, including visits of treatment facilities (86.5%; 95% confidence interval [80.2%; 91.0%]) or meeting with friends (64.5% [65.7-71.6%]). Despite the fact that only about 47.1% [39.2%; 55%] felt well informed about measures against infection, adherence to COVID-19 countermeasures was generally high: 83.9% [77.3; 88.8%] claimed to have worn face masks always/nearly always; social distancing was performed always/nearly always by 58.7% [50.8%; 66.2%]; and hand hygiene was conducted by 64.5% [56.7%; 71.6%] of participants. None out of n = 25 tests from unvaccinated subjects was positive for anti-SARS-CoV-2-S-antibodies. Psychiatric comorbidity and educational degree were not statistically significantly associated with attitudes and compliance, except that patients with lower education felt relatively worse informed. Conclusion: Self-reported adherence to recommended non-therapeutic intervention strategies and vaccination rates were similar to the German general population. Provision of more health-related information tailored to OMT patients appears necessary.

Exploratory Growth Mixture Modeling of Cannabis-Withdrawal Syndrome Trajectories of Adult Pure Cannabis Dependents During Detoxification: Two Subtypes?

As clinical studies about subtypes of the cannabis withdrawal syndrome (CWS) are scant, we performed a re-analysis of longitudinal data with German adult cannabis-users seeking inpatient cannabis detoxification-treatment. Sixty-seven cannabis-dependents without active comorbidity were included for growth-mixture-analysis (GMM) of their CWS-severity-trajectories during a scheduled 24-day detox-treatment. As of treatment-day 12, thirty-six (53.7%) of 67 patients were discharged after successful detoxification. This led to artificial imputations for I-GMM. Therefore, we preferred the results of the GMM including raw data-only (R-GMM). By both, I-GMM and R-GMM, we found two classes of CWS severity time-courses. Class one (n = 44, R-GMM) showed a continuously decreasing CWS-severity; class two (n = 23, R-GMM) exhibited a sharp peak (generally between days 2-6 post-cessation). A short inpatient treatment-period and low urinary 11-nor-9-carboxy-Δ9 -tetrahydrocannabinol-level upon admission predicted the peaking trajectory of R-GMM-class-two-CWS. Withdrawal syndrome medication (PRN), comorbidity, cannabis-history data and gender balance were not significantly different between the CWS-classes. Although possibly confounded by PRN-medication, this exploratory study supports the presence of two CWS-variants in adult cannabis-dependents, characterized by a slowly decreasing ("protracted") slope (class one) or a clear crescendo-decrescendo trajectory (class two). The latter was associated with a significantly shorter inpatient detoxification period and lower urinary THC-COOH-levels at admission.

The Role of Gabapentinoids in the Substance Use Pattern of Adult Germans Seeking Inpatient Detoxification Treatment - A Pilot Study.

To shed more light on the addictive power of the gabapentinoids (GPTs) gabapentin and pregabalin, we performed a structured face-to-face interview with GPT-users about DSM-IV-dependence-criteria (sedatives), consume-motives and cessation-needs. Among 100 patients consecutively admitted to a detoxification-ward, fifteen (15%) reported lifetime GPT-use (18-50 years old, 2 females): seven (7%) used gabapentin, twelve (12%) pregabalin and four had lifetime experiences with both GPTs. Of the seven gabapentin-users, three patients were dependent including one person with a spontaneous remission. Of the 12 pregabalin-users, five were dependent, including two persons with a spontaneous remission. Fourteen of fifteen cases reported GPT-use side-by-side with an opioid-use, mostly for sparing opioids. Twelve GPT-users additionally co-used benzodiazepines. In no case, a GPT was the reason for detoxification treatment or reported to be involved in an emergency event. Altogether, every 7th patient (n = 15) of our inpatient detoxification-seeking sample reported GPT-use including 50% (n = 8) who were dependent. Among them, 35% (3/8) had been already spontaneously remitted. As GPT-users reported no cession-need and the vast majority were primarily affected by co-occurring opioid- and benzodiazepine-addiction, we assume that GPTs more likely played a bystander-role than mediating the addictive behavior of this population with multiple recreational drug use experience.

[Need of Help and Social Support of Parents with a Mental Disorder]. / Hilfsbedarf und soziale Unterstützung bei psychisch erkrankten Elternteilen mit minderjährigen Kindern.

Studies could already show that parents with a mental disorder have a high need for social support but the use of offered help is scarce. The main goal of this study was therefore to assess the need of help as well as the extent of social support of parents with mental illness. N = 100 psychiatric inpatients (49 % female) with underaged children were assessed for need of help, use of help and social support. 99 % of patients reported to have received help. 53 % of patients reported to have further need for social support. 36 % of patients reported a below-average extent of social support. There were sociodemographic differences in the extent of social support. Even though, parents with mental illness make use of offered help, they do not experience social support in the extent that they need it. This underlines the high need as well as the importance of social support for parents with mental illness.

Cannabis use, abuse and dependence during the COVID-19 pandemic: a scoping review.

The interaction between cannabis use or addiction and SARS-COV-2 infection rates and COVID-19 outcomes is obscure. As of 08/01/2022 among 57 evaluated epidemiological/clinical studies found in Pubmed-database, most evidence for how cannabis use patterns were influenced by the pandemic was given by two systematic reviews and 17 prospective studies, mostly involving adolescents. In this age group, cannabis use patterns have not changed markedly. For adults, several cross-sectional studies reported mixed results with cannabis use having increased, decreased or remained unchanged. Two cross-sectional studies demonstrated that the severity of adults´ cannabis dependence was either increased as a consequence of increasing cannabis use during the pandemic or not changed. Regarding the effect of cannabis use on COVID-19 outcomes, we found only five retrospective/cross-sectional studies. Accordingly, (i) cannabis use did not impact mild COVID-19 symptoms; (ii) cannabis using individuals experienced more COVID-19-related hospitalizations; (iii) cannabis using veterans were associated with reduced SARS-COV-2 infection rates; (iv) frequent cannabis use was significantly associated with COVID-19 mortality, and (v) cannabis dependents were at higher risk of COVID-19 breakthrough after vaccination. It should be outlined that the validity of these retrospective/cross-sectional studies (all self-reports or register/e-health-records) is rather low. Future prospective studies on the effects of cannabis use on SARS-COV-2 infection rates and COVID-19 outcomes are clearly required for conclusive risk-benefit assessments of the role of cannabis on users' health during the pandemic. Moreover, substance dependence (including cannabis) is associated with (often untreated) somatic comorbidity, which severity is a proven key risk factor for worse COVID-19 outcomes.

[Comparative Harm/Benefit Analysis of Various Psychotropic Substances from the Perspective of German Drug Users and Addiction Medicine Experts - A Contribution to Psychoeducation of Substance-Addicted Individuals and Restriction/Legalization Debates]. / Vergleichende Risiko/Nutzen-Analyse verschiedener psychotroper Substanzen aus der Perspektive deutscher Drogenkonsumenten und Suchtmediziner ­ Ein Beitrag für die Psychoedukationsarbeit mit Abhängigkeitserkrankten und Restriktions-/Legalisierungsdebatten.

BACKGROUND: To date, we cannot find any current international comparative study on the assessment of a benefit/harm profile of various licit and illicit psychoactive substances conducted by adult drug users and addiction experts as well. Particularly, there is no study from the German-speaking area of Western Europe. METHODS: In addition to the data already published by 101 German addiction medicine experts (published in this journal, [1]), we carried out interviews using a structured questionnaire with 100 German substance dependent users, residing in acute and rehabilitation clinical setting, to evaluate 34 psychoactive substances regarding their health and social harm potential for users and others as well as their potential benefit. RESULTS: Both, users and experts estimated traditional illicit drugs, such as heroin, crack/cocaine and methamphetamine, to be particularly harmful. Synthetic cannabinoids, alcohol and benzodiazepines were in the upper midfield, cannabis and psychotropic mushrooms in the lower midfield, and gabapentinoids at the bottom of the harm rankings of both, users and experts. In comparison with the experts, the users estimated methadone and benzodiazepines to be significantly more harmful. In the benefit analysis, users rated traditional illicit drugs including cannabis and psychotropic mushrooms as well as nicotine as significantly more useful than the experts. In contrast to the experts (traditional illicit drugs), the users did not assess any substance as very harmful and very useless at the same time. Only a few users reported to have experiences with opioid analgesics which, however, did not differ between the users´ and experts´ harm/benefit-assessments. Neither users nor experts predicted cannabis-legalization to change the overall risk potential of cannabis. Specific cognitive valuation biases seemed to be prominent in both groups. CONCLUSION: This study presents first harm/benefit assessments of psychotropic substances from the perspective of German addiction medicine experts and drug users. The results can be valuable to the psychoeducation of substance-addicted individuals and to current restriction or legalization debates.

Differences between users' and addiction medicine experts' harm and benefit assessments of licit and illicit psychoactive drugs: Input for psychoeducation and legalization/restriction debates.

Background: There is a lack of benefit/harm assessments of illicit and licit psychoactive substances performed by substance-dependent users in comparison to addiction medicine experts. Methods: We extended the analyses of substance harm/benefit assessments of German addiction medicine experts (N = 101), in parts reported recently in this journal [doi.org/10.3389/fpsyt.2020.59219], by the perspectives of substance-addicted persons. The same questionnaire as used for the abovementioned "experts-study" was handed out to inpatient detoxification or rehab treatment seeking German substance-dependent adults (N = 117) for a subsequent structured interview about harms and benefits of 33 new and traditional psychoactive substances comprising also prescription drugs. Results and discussion: Both, users and experts, ranked the traditional illicit psychoactive substances heroin, cocaine and amphetamines within the top overall harm level group. Synthetic cannabinoids, alcohol and benzodiazepine were in a subordinate top-harm level position. Both cohorts also ranked methadone, nicotine and cannabis within the midrange and buprenorphine as well as psychotropic mushrooms within the lowest harm level positions. Experiences with prescription drugs (including opioidergic analgesics and gabapentinoids), cathinones, GHB, methamphetamine and methylphenidate was not prevalent in our user population. The same applied to barbiturates, propofol, kratom, ayahuasca with nearly zero assessments for each substance. The most user-experiences (>50% per assessed substance) were reported with nicotine, cannabis, alcohol, cocaine, heroin, amphetamine and methadone (core group). The user's overall harm ratings in terms of these psychoactive substances were similar to those of the experts with the exception of the methadone assessment which was rated by the experts to be significantly less harmful if compared with the users' estimation (supposed "treatment bias" of experts). The users' benefit ratings for the traditional illicit psychoactive substances, cannabis as well as for nicotine were significantly more positive in comparison to those of the experts (supposed "attraction bias" of users). Both, experts and users, ranked the harms arising from the use of alcohol or benzodiazepines (usually unregulated substances) higher than the harms caused by the use of methadone, cannabis or psychotropic mushrooms (regulated by most Western narcotic acts). Users attributed the most benefits to buprenorphine, methadone and cannabis. This might reflect a main limitation of the study as the data are from an user population comprising over 50% patients who sought detoxification-treatment of opiates where methadone and buprenorphine are usual transient medications (supposed "selection bias"). Conclusion: This study addressed current trends of psychoactive substance abuse (e.g., synthetic cannabinoids, prescription drugs) and provides from both perspectives (that of the user and that of the addiction medicine experts) robust harm/benefit evaluations at least of a core group of psychoactive substances (traditional illicit psychoactive substances, cannabis, methadone, alcohol and nicotine). The results of this study can be valuable to the psychoeducation of substance-addicted individuals and to current restriction/legalization debates, especially in the Western-EU.

Novel Synthetic Opioids (NSO) Use in Opioid Dependents Entering Detoxification Treatment.

Introduction: Over the last decade, the use of New/Novel Synthetic Opioids (NSO) has emerged as an increasing problem, and especially so in the USA. However, only little is known about the prevalence and history of NSO use in European heroin dependents. Method: A cross-sectional multicenter study, carried out with the means of both standardized interviews and urine toxicology enhanced screening, in a sample of opioid addicted patients referred for an in-patient detoxification treatment. Results: Sample size included here n = 256 patients; prior to admission, 63.7% were prescribed with an opioid maintenance treatment. Lifetime use of heroin and opioid analgesics was reported by 99.2 and 30.4%, respectively. Lifetime NSO/fentanyl use was reported by 8.7% (n = 22); a regular use was reported by 1.6% (n = 4), and ingestion over the 30 days prior to admission by 0.8% (n = 2). Most typically, patients had started with a regular consumption of heroin, followed by maintenance opioids; opioid analgesics; and by NSO. Self-reported data were corroborated by the toxicology screenings carried out; no evidence was here identified for the presence of heroin being contaminated by fentanyl/derivatives. Discussion: NSO and also opioid analgesics did not play a relevant role in the development and the course of opioid/opioid use disorders in German patients referred for an inpatient detoxification treatment.

[Psychological Abnormalities in Children from the Perspective of Parents with a Mental Disorder]. / Psychische Auffälligkeiten bei Kindern aus Sicht des psychisch erkrankten Elternteils.

BACKGROUND: There is increased risk for children with a mentally ill parent to get a mental illness. In Germany, it is assumed that the risk for psychological abnormalities in children with a mentally ill parent is increased by a factor of 2,4. The aim of this study was to give an overview of psychological abnormalities in children with mentally ill parents. METHODS: Patients were asked about their children and possible psychological abnormalities in their children during their stay in a psychiatric ward. Data of n=118 children (51,7%) of psychiatric inpatients could be used for analyses. RESULTS: One-fourth of the children showed psychological abnormalities. According to their parent, one fourth was also in psychotherapeutic/psychiatric treatment. There were no differences in the abnormalities associated with sociodemographic factors of the parent. CONCLUSION: Our results show that children of a mentally ill parent also suffer from psychological abnormalities. More explicit analyses of the care situation of these children as well as data from direct interviews with them are needed.

Professionals' Digital Training for Child Maltreatment Prevention in the COVID-19 Era: A Pan-European Model.

The responsiveness of professionals working with children and families is of key importance for child maltreatment early identification. However, this might be undermined when multifaceted circumstances, such as the COVID-19 pandemic, reduce interdisciplinary educational activities. Thanks to technological developments, digital platforms seem promising in dealing with new challenges for professionals' training. We examined a digital approach to child maltreatment training through the ERICA project experience (Stopping Child Maltreatment through Pan-European Multiprofessional Training Programme). ERICA has been piloted during the pandemic in seven European centers involving interconnected sectors of professionals working with children and families. The training consisted of interactive modules embedded in a digital learning framework. Different aspects (technology, interaction, and organization) were evaluated and trainers' feedback on digital features was sought. Technical issues were the main barrier, however, these did not significantly disrupt the training. The trainers perceived reduced interaction between participants, although distinct factors were uncovered as potential favorable mediators. Based on participants' subjective experiences and perspectives, digital learning frameworks for professionals working with children and families (such as the ERICA model nested in its indispensable adaptation to an e-learning mode) can represent a novel interactive approach to empower trainers and trainees to tackle child maltreatment during critical times such as a pandemic, and as an alternative to more traditional learning frameworks.

[Weighing the benefits and harms of psychotropic and analgesic substances - A perspective of German addiction medicine experts]. / Abwägung von Nutzen und Schädlichkeit von berauschenden und schmerzlindernden Substanzen aus der Perspektive von deutschen Suchtmedizinern.

BACKGROUND: In Europe, there have been several addiction-expert rankings of harms related to the use of psychotropic substances in the last 15 years. Among them, only one expert ranking took into account the potential benefits of these drugs. Non-Opioidergic Analgesics (NOAs), such as gabapentinoids and NSAIDs, which have been increasingly the subject of abuse / misuse reports, have not been considered in such expert rankings. Likewise, there is currently no multi-substance comparison as to whether the valuation rank of the harmfulness of an illegal drug may change along with an imagined change in legal status in Germany. OBJECTIVES AND METHODS: Using a questionnaire, 101 experienced addiction physicians (first cohort) evaluated 33 psychoactive substances including analgesics with regard to their health and social harms as well as potential usefulness for the consumer and their environment / society ('others'). In addition, this cohort investigated whether the harmfulness assessment of an illegal substance changes if it would be legalized. In order to obtain the average overall harmfulness (overall risk) of a substance, the percentage contribution of each dimension to the overall harmfulness was determined in a second survey (second cohort, 36 experienced addiction medicine experts). Finally, the average benefit and overall risk ratings of each substance were related to each other. RESULTS: Prescription psychoactive substances such as analgesics, NOAs (including gabapentinoids) and opioidergic maintenance medications to treat opiate dependence were judged to have a favorable benefit-harm profile. Cannabis and ketamine were placed in the midfield of both, the harm and benefit rankings. Together with most illicit narcotic drugs, alcohol and nicotine, have been ranked among the most harmful and least useful substances, whereby alcohol was judged on average to be more harmful but also more useful than nicotine. In the event of potential legalization, the overall harm of the traditional illegal drugs methamphetamine, heroin, cocaine and cannabis was estimated to be reduced. This was mainly due to a more favorable valuation of the harm to others under these virtual conditions. CONCLUSION: Prescription substances including opioidergic and non-opioidergic analgesics as well as opioid maintenance therapy medications (methadone and buprenorphine) were assigned a favorable benefit-harm profile. Alcohol, nicotine and traditional illicit drugs (with the exception of cannabis and ketamine) were determined to have an unfavorable profile. The overall harm of traditional illicit drugs was assessed to decrease along with legalization, mainly by decreasing the harm to others in this virtual event.

[Identification of polypharmacy-associated risks among nursing home residents]. / Risikoidentifikation bei Polypharmazie in einer Pflegeheimpopulation.

INTRODUCTION: Multimorbidity in old age is one reason for intensified pharmacotherapy. At the same time, an increase in medications could augment multimorbidity, especially when drug interactions leading to undesired drug effects occur. METHODS: In this cross-sectional study 918 mentally ill seniors living in nursing homes (mean age 79.3 (±11.6) years; 31.8% male) were included. Two different approaches to assess risks due to pharmacotherapy were applied: first mediQ, an online-based clinical decision support software (CDSS) and the PRISCUS list, which indicates potentially inappropriate medication. PRISCUS is the German equivalent to the American Geriatrics Society Beers criteria. RESULTS: Of the patients in the study 76.3% were at clinical risk, 2.2% at potentially high risk for drug interactions regarding the entire medication as tested by mediQ, and about 25% of the studied population received potentially inappropriate medication according to the PRISCUS list. CONCLUSION: This difference clearly underlines the cumbersome complexity of identifying patients at risk by using these exemplary devices. The focus of avoiding undesired drug side effects should be taking medication only after thorough verification of clinical indications and under close monitoring. The CDSS or negative lists may support this process.

Trail Making Test Normative Data for the German Older Population.

OBJECTIVE: We provide normative data for the Trail Making Test (TMT)-A and B and the derived scores B - A and B/A, for the German general population aged 57-84 years. METHODS: Data were derived from the third examination of the population-based Heinz Nixdorf Recall study. We excluded participants with a history of dementia or stroke, a depression score above cutoff (CES-D Center for Epidemiologic Studies Depression Scale score ≥ 18), or mild cognitive impairment according to a neurocognitive test battery. The normative sample (n = 2,182) was stratified by age, using the interval superposition approach, and by three levels of educational attainment (up to 10 years of schooling; >10 years of schooling; and university degree). RESULTS: We tabulated test performance scores at percentage rank thresholds 5, 10, 15, 20, 25, 50, 75, and 90. In multiple linear regression, TMT-A performance declined by 1 s each year of life, and TMT-B performance by 3 s; educational level had an impact of up to 30 s in TMT-B. TMT-B/A was only weakly associated with age and education. TMT-B and B - A correlated r = 0.96. Completion of the TMT-B within the time limit of 300 s was not achieved by 10.9% of participants >74 years, and especially by those >74 years who were on the lowest educational level (13.9%). CONCLUSIONS: For TMT-A, TMT-B, and B - A, the narrow age categorization and distinction between three educational levels proved meaningful. The 300 s limit for the TMT-B impedes the identification of thresholds for very low performance in this age group and needs reconsideration.

Long-Term Frequent Cannabis Use and Related Serum Cannabinoid Levels Are Not Associated with Kidney Dysfunction.

Introduction: Human studies about the impact of cannabis use on both healthy kidneys as well as kidney function in patients with kidney disease are lacking. To shed more light on this understudied topic, we reevaluated a previous clinical study. The sample of this study was exclusively suited for investigating effects of recreational long-term cannabis use on humans under real-life conditions. Methods: This special sample had sought and was undergoing inpatient detox-treatment. It was characterized by a lone and considerable cannabis-dependence without any other relevant active comorbidity (except of a concurrent nicotine-dependence). In the present post hoc analysis, we are focused on this sample's routine laboratory tests at admission, including the glomerular filtration rate (GFR), which is the key routine parameter for kidney function assessment. Next, we investigated the association between participants' GFR and their cannabis-related data, including serum cannabinoid levels (Δ-9-tetrahydrocannabinol and main metabolites 11-Hydroxy-Δ-9-tetrahydrocannabinol and 11-Nor-9-carboxy-Δ-9-tetrahydrocannabinol). Results: In the whole sample (N=42; 9 females; mean 28.7 years old), we found five persons (12%; 95% confidence interval [2.1-21.7%]) with a mild kidney dysfunction (GFR; 86-75 mL/min). These persons (two females), however, had reported a stronger nicotine misuse. Furthermore, we found no significant association between the study-populations' GFR and reported cannabis burden (median daily use 2.5 g for 36 months, moderate general symptom-load). Most remarkably, the GFR was also not significantly correlated with the serum cannabinoid-levels. Conclusion: Chronic recreational cannabis-use (including its related discomfort) did not affect the kidney function of our almost selectively "cannabis-burdened" population in a relevant manner.

New Access Routes to Undertreated Populations; How Do Problem Substance Users Recruited from an Unemployment Office Differ from Detoxification Treatment Inpatients?

BACKGROUND: Only a minority of subjects with substance use disorders (SUDs) are in addiction-specific treatment (treatment gap). Co-operation between an unemployment office and a psychiatric hospital was established for the assessment and counseling of long-term unemployed clients with SUD. We aim at validating whether such a treatment gap exists in that group, and whether clients from an unemployment office differed from a matched group of inpatient detoxification patients with regard to socio-economic characteristics, substance use and treatment history, and the prevalence of mental disorders Methods: Unemployment office clients (n = 166) with an SUD were assessed using a standardized sociodemographic and clinical interview. They were compared with 83 inpatients from a local detoxification ward, matched for age, sex, and primary addictive disorder (matching ratio 2:1). RESULTS: Most (75.9%) subjects were males, with an average age of 36.7 years. The SUDs mostly related to alcohol (63.9%) and cannabis (27.7%). Although most unemployment office clients had a long SUD history, only half of them had ever been in addiction-specific treatment during their lifetime, and only one in four during the last year. There were no statistically significant differences between the groups regarding age at onset of problematic substance use, the proportion of migrants, and prevalence of comorbid mental disorders. The unemployment office sample showed lower levels of education (p < 0.001), job experience (p = 0.009), and current employment rates (p < 0.001). Conversely, inpatients showed lower rates of imprisonment (p < 0.001), more inpatient detoxification episodes (p < 0.03); and longer abstinence periods (p < 0.005). CONCLUSIONS: There was a lifetime and recent treatment gap in the group of long-term unemployed subjects with alcohol and cannabis dependence. The markedly lower educational attainment, chronic employment problems and higher degree of legal conflicts in the client group, as compared with patients in detoxification treatment, might require specific access and treatment options. The co-operation between the psychiatric unit and the unemployment office facilitated access to that group.

Availability of Illegal Drugs During the COVID-19 Pandemic in Western Germany.

Background: In response to the COVID-19-pandemic, a lockdown was established in the middle of March 2020 by the German Federal Government resulting in drastic reduction of private and professional traveling in and out of Germany with a reduction of social contacts in public areas. Research Questions: We seek evidence on whether the lockdown has led to a reduced availability of illegal drugs and whether subjects with substance-related problems tried to cope with possible drug availability issues by increasingly obtaining drugs via the internet, replacing their preferred illegal drug with novel psychoactive substances, including new synthetic opioids (NSO), and/or by seeking drug treatment. Methods: A questionnaire was anonymously filled in by subjects with substance-related disorders, typically attending low-threshold settings, drug consumption facilities, and inpatient detoxification wards from a range of locations in the Western part of Germany. Participants had to both identify their main drug of abuse and to answer questions regarding its availability, price, quality, and routes of acquisition. Results: Data were obtained from 362 participants. The most frequent main substances of abuse were cannabis (n = 109), heroin (n = 103), and cocaine (n = 75). A minority of participants reported decreased availability (8.4%), increased price (14.4%), or decreased quality (28.3%) of their main drug. About 81% reported no change in their drug consumption due to the COVID-19 pandemic and the lockdown. A shift to the use of novel psychoactive substances including NSO were reported only by single subjects. Only 1-2% of the participants obtained their main drug via the web. Discussion: Present findings may suggest that recent pandemic-related imposed restrictions may have not been able to substantially influence either acquisition or consumption of drugs within the context of polydrug users (including opiates) attending a range of addiction services in Germany.