Correlates of Stimulant Use among People Who Use Heroin Undergoing Treatment in Out-Patient Facilities in France, 2010-2020.

Background: Polydrug use has been implicated in driving a "fourth wave" of the overdose crisis in North America, specifically through concurrent use of stimulants and opioids, especially fentanyl. In France, however, heroin has historically been and remains the easiest-to-access opioid, accounting for most drug treatment demand. Whether similar polydrug use is increasing in Western Europe remains understudied, despite severe health implications and potential inadequate public health responses.Methods: We take advantage of a nation-wide dataset containing information on all patients serviced in treatment centers in France from 2010 to 2020. We conduct Poisson regression to determine the main predictors of stimulant use among people who use heroin (PWUH) and opioids (PWUO) generally.Results: Heroin remains the primary opioid within drug treatment in France. A decreasing number of out-patients seeking treatment for heroin use has been accompanied by an increasing trend of stimulant use over time, most commonly with powder cocaine. Our results suggest a significant increase of crack cocaine use among the most vulnerable PWUH. Concurrent use of stimulants among PWUH was positively associated with use of alcohol, cannabis, unprescribed psychotropics and hallucinogens, and negatively with tobacco. Similar results were found for all in-treatment PWUO.Conclusions: Our results uncover heterogeneity in the profiles of PWUH that should be fully acknowledged to ensure better efficiency in substance use clinical practices and policy, while simultaneously drawing attention to trends in concurrent opioid-stimulant use outside North America. We advocate for an extension of the generalized risk framework and its implementation in prevention programs.

Polysubstance use and adherence to antiretroviral treatment in the Miami Adult Studies on HIV (MASH) cohort.

Evidence for a relationship between polysubstance use, depression, and adherence to antiretroviral therapy (ART) is limited. The objectives of this study were to examine the associations of depression, illicit drug, and alcohol use with adherence to ART. People living with HIV (PLHIV) from the Miami Adult Studies on HIV cohort were asked about the number of doses of their ART medication missed to assess ART adherence. Harmful alcohol drinking was evaluated using the Alcohol Use Disorders Identification Test and illicit substance use assessed with self-report and urine screen. The Center for Epidemiologic Studies Depression Scale was used to assess depression symptoms. Of 391 PLHIV, 16.6% missed at least one dose (range:1-4) in the past four days. Cocaine/crack, opiate use, and depression were significantly independently associated with a greater mean number of doses missed. The mean number of doses missed was significantly greater among participants who used alcohol in combination with cocaine/crack, marijuana, and tobacco compared to non-users. In conclusion, polysubstance use increased the risk for poor ART adherence among PLHIV. The use of cocaine/crack or opiates individually and depressive symptoms also promote poor ART adherence. An integrated approach targeting substance disorders and depression may help achieve better ART adherence.

Trends in Substance Use by Gender Among Participants in a Jail-Based Substance Use Disorder Treatment Program: 1998-2016.

Understanding trends in substance use by gender among jail-based treatment program participants can inform policies and programs tailored to this population. Preprogram assessment data from 3509 individuals entering a jail-based substance use disorder treatment program in Missouri between 1998 and 2016 were analyzed. Primary outcome was program participants' strongly preferred substances. Demographic covariates and drug preferences were compared between males and females. Average yearly trends in preferred substances were calculated. While 25.8% of the sample preferred heroin, it was more strongly preferred by women (36.4%) than men (22.0%, p < 0.0001). Alcohol and marijuana were preferred more by males. Overall, preferences for heroin and methamphetamine increased over time while alcohol, marijuana, and other stimulants decreased. Women being more likely to prefer heroin and the increasing preference for heroin over time are consistent with national trends. Offering evidence-based treatment like pharmacotherapy and gender-sensitive approaches can help address the needs of this vulnerable population.

"Minha filha devolveu minha vida": uma cartografia da Rede Cegonha / "Mi hija me devolvió la vida": una cartografía de la Red Cigüeña / "My child gave me my life back": cartography of the "Rede Cegonha"

O estudo analisou o protagonismo do cuidado nas redes de saúde junto dos trabalhadores em uma capital do nordeste brasileiro, por meio dos entrelaces da Rede Cegonha, da Rede de Atenção Psicossocial e das Redes Vivas. Trata-se de uma pesquisa qualitativa e cartográfica sobre a experiência de uma gestante que utilizava drogas, abrangendo a participação de trabalhadores de saúde do território estudado, envolvidos no processo de cuidado. Os instrumentos e as técnicas de análises utilizados neste trabalho foram: oficinas, entrevista em profundidade, diário de campo, observação e fluxograma analisador. Dos resultados alcançados emergiram a fragilidade das redes formais para o cuidado integral dos seus usuários e a potência das redes vivas como espaços eficientes de cuidado. O estudo apresenta uma nova perspectiva de pensar as redes, os seus acessos e os seus fluxos.(AU)

El estudio analizó el protagonismo del cuidado en las redes de salud con los trabajadores en una capital del nordeste brasileño, por medio de dos entrelazamientos de la Red Cigüeña, de la Red de Atención Psicosocial y de las Redes Vivas. Se trata de una encuesta cualitativa y cartográfica sobre la experiencia de una embarazada que utilizaba drogas, incluyendo la participación de trabajadores de salud del territorio estudiado, envueltos en el proceso de cuidado. Los instrumentos y técnicas de análisis utilizados en este trabajo fueron: talleres, entrevista en profundidad, diario de campo, observación y diagrama de flujo analizados. Entre los resultados alcanzados, surgieron la fragilidad de las redes formales para el cuidado integral de sus usuarios y la potencia de las redes vivas como espacios eficientes de cuidado. El estudio presenta una nueva perspectiva para pensar las redes, sus accesos y sus flujos.(AU)

The present study analyzed the protagonist role of health workers in healthcare systems in a capital city of Northeastern Brazil, through the coordinated work of the Rede Cegonha ("Stork Network"), Psychosocial Care Networks, and Redes Vivas ("Living Networks"). This was a qualitative and cartographic study about the experience of a pregnant woman who used drugs, and the participation of health workers in the studied territory, who were involved in her care process. Data collection and analysis was carried out using workshops, in-depth interviews, field diary, observation, and flow charts. The results showed the frailty of formal networks in providing comprehensive care to its users and the power of living networks as efficient spaces of care. The study presents a new perspective for thinking networks, and their access points and work flow.(AU)

Occurrence of bacterial and toxic metals contamination in illegal opioid-like drugs in Iran: a significant health challenge in drug abusers.

BACKGROUND: The toxic metals and/or bacterial contaminants in illicit drugs are the main health problems in drug users worldwide. Hence, the potential risks of these contaminants were evaluated in some of the illicit drugs during 2015 and 2016. METHODS: The metals analysis were performed using graphite furnace atomic absorption spectrophotometry. In addition, all microbiological analysis stages, including handling procedures, dilution, and culture media, were conducted in accordance with the US Pharmacopeia (USP) which are harmonized with the European Pharmacopoeia (EP). RESULTS: In the present study, the highest lead (Pb; 138.10 ± 75.01 µg/g) and chromium (Cr; 447.38 ± 20.27 µg/g) levels were detected in opium samples. In addition, the highest prevalence of microbial contamination was observed in opium samples, and the lowest was recorded in heroin samples. Clostridium tetani, with about 50% of contaminant, was the most common bacteria in the analyzed samples. CONCLUSIONS: Our results indicate that Pb exposure as well as bacterial contamination could be the major threats for drug users. Graphical Abstract ᅟ.

Is Ayahuasca an Option for the Treatment of Crack Cocaine Dependence?

The low efficacy of crack cocaine addiction treatment available in Brazil has led Brazilian users to find alternatives to reduce drug consumption or even to reach abstinence. One of them is the use of entheogenic substances, like ayahuasca, an infusion obtained from two native plant species from the Amazon. The present report aimed to understand how crack cocaine users recover from drug addiction by consuming ayahuasca tea in a religious context. This is a qualitative study with a purposeful sample of 40 crack cocaine users, based on in-depth, semi-structured interviews. Participants reported that ayahuasca allowed them to access a consciousness dimension which enabled them to solve problems and traumas and reduce crack cocaine consumption. The religious ceremony increased the user's spirituality and the reception from the community gave them a sense of self-esteem, strengthening them in an emotional and social way. That positive experience has been incorporated into the daily routine of most participants. Findings indicate that ayahuasca, in a religious context, may have therapeutic value for crack cocaine dependence treatment.

The DARK Side of Total Synthesis: Strategies and Tactics in Psychoactive Drug Production.

Humankind has used and abused psychoactive drugs for millennia. Formally, a psychoactive drug is any agent that alters cognition and mood. The term "psychotropic drug" is neutral and describes the entire class of substrates, licit and illicit, of interest to governmental drug policy. While these drugs are prescribed for issues ranging from pain management to anxiety, they are also used recreationally. In fact, the current opioid epidemic is the deadliest drug crisis in American history. While the topic is highly politicized with racial, gender, and socioeconomic elements, there is no denying the toll drug mis- and overuse is taking on this country. Overdose, fueled by opioids, is the leading cause of death for Americans under 50 years of age, killing ca. 64,000 people in 2016. From a chemistry standpoint, the question is in what ways, if any, did organic chemists contribute to this problem? In this targeted review, we provide brief historical accounts of the main classes of psychoactive drugs and discuss several foundational total syntheses that ultimately provide the groundwork for producing these molecules in academic, industrial, and clandestine settings.

Experiences of adolescent crack users and their relatives with psychosocial care and institucionalization. / Experiências de adolescentes em uso de crack e seus familiares com a atenção psicossocial e institucionalização.

The Drug User Comprehensive Care Policy establishes that care practices should cover biopsychosocial realms. However, evidence reveals an institutionalized practice, in which families prioritize the subject's seclusion from its context of use. This study aimed to understand the implications of psychosocial care and institutionalization in meeting the needs of adolescent crack users and their families. Eleven teenagers and six relatives narrated their experiences through in-depth interviews, which were analyzed in the light of Paul Ricoeur's Phenomenological Hermeneutics. A flow was observed in which teenagers seeking care are initially institutionalized and then referred to replacement services. Thus, there is an urgent need to strengthen the psychosocial care network so that adolescent crack users' care is offered comprehensively, ensuring respect for their fundamental rights, such as the right to freedom and to experience family or community life.

Experiências de adolescentes em uso de crack e seus familiares com a atenção psicossocial e institucionalização / Experiences of adolescent crack users and their relatives with psychosocial care and institucionalization

Resumo A Política de Atenção Integral ao Usuário de Drogas determina que as práticas de cuidado abranjam as dimensões biopsicossociais. Evidências, entretanto, revelam uma prática institucionalizante, na qual as famílias priorizam o afastamento do sujeito de seu contexto de uso. Este estudo objetivou compreender as implicações da atenção psicossocial e da institucionalização no atendimento às necessidades de adolescentes em situação de uso de crack e de seus familiares. Onze adolescentes e seis familiares narraram suas experiências, por meio de entrevistas em profundidade, as quais foram analisadas à luz da Hermenêutica Fenomenológica, de Paul Ricoeur. Observou-se um fluxo, no qual os adolescentes, na busca pelo cuidado, inicialmente, são institucionalizados para, em seguida, serem encaminhados aos serviços substitutivos. Urge, portanto, a necessidade do fortalecimento da rede de atenção psicossocial para que o cuidado ao adolescente usuário de crack seja ofertado de forma integral, garantindo o respeito aos direitos fundamentais dos adolescentes, como o direito à liberdade e à convivência familiar e comunitária.

Abstract The Drug User Comprehensive Care Policy establishes that care practices should cover biopsychosocial realms. However, evidence reveals an institutionalized practice, in which families prioritize the subject's seclusion from its context of use. This study aimed to understand the implications of psychosocial care and institutionalization in meeting the needs of adolescent crack users and their families. Eleven teenagers and six relatives narrated their experiences through in-depth interviews, which were analyzed in the light of Paul Ricoeur's Phenomenological Hermeneutics. A flow was observed in which teenagers seeking care are initially institutionalized and then referred to replacement services. Thus, there is an urgent need to strengthen the psychosocial care network so that adolescent crack users' care is offered comprehensively, ensuring respect for their fundamental rights, such as the right to freedom and to experience family or community life.

The effect of crack cocaine addiction and age on the microstructure and morphology of the human striatum and thalamus using shape analysis and fast diffusion kurtosis imaging.

The striatum and thalamus are subcortical structures intimately involved in addiction. The morphology and microstructure of these have been studied in murine models of cocaine addiction (CA), showing an effect of drug use, but also chronological age in morphology. Human studies using non-invasive magnetic resonance imaging (MRI) have shown inconsistencies in volume changes, and have also shown an age effect. In this exploratory study, we used MRI-based volumetric and novel shape analysis, as well as a novel fast diffusion kurtosis imaging sequence to study the morphology and microstructure of striatum and thalamus in crack CA compared to matched healthy controls (HCs), while investigating the effect of age and years of cocaine consumption. We did not find significant differences in volume and mean kurtosis (MKT) between groups. However, we found significant contraction of nucleus accumbens in CA compared to HCs. We also found significant age-related changes in volume and MKT of CA in striatum and thalamus that are different to those seen in normal aging. Interestingly, we found different effects and contributions of age and years of consumption in volume, displacement and MKT changes, suggesting that each measure provides different but complementing information about morphological brain changes, and that not all changes are related to the toxicity or the addiction to the drug. Our findings suggest that the use of finer methods and sequences provides complementing information about morphological and microstructural changes in CA, and that brain alterations in CA are related cocaine use and age differently.

Intentional cannabis use to reduce crack cocaine use in a Canadian setting: A longitudinal analysis.

BACKGROUND: No effective pharmacotherapies exist for the treatment of crack cocaine use disorders. Emerging data suggests that cannabinoids may play a role in reducing cocaine-related craving symptoms. This study investigated the intentional use of cannabis to reduce crack use among people who use illicit drugs (PWUD). METHODS: Data were drawn from three prospective cohorts of PWUD in Vancouver, Canada. Using data from participants reporting intentional cannabis use to control crack use, we used generalized linear mixed-effects modeling to estimate the independent effect of three pre-defined intentional cannabis use periods (i.e., before, during and after first reported intentional use to reduce crack use) on frequency of crack use. RESULTS: Between 2012 and 2015, 122 participants reported using cannabis to reduce crack use, contributing a total of 620 observations. In adjusted analyses, compared to before periods, after periods were associated with reduced frequency of crack use (Adjusted Odds Ratio [AOR]=1.89, 95% Confidence Interval [CI]: 1.02-3.45), but not the intentional use periods (AOR=0.85, 95% CI: 0.51-1.41). Frequency of cannabis use in after periods was higher than in before periods (AOR=4.72, 95% CI: 2.47-8.99), and showed a tendency to lower frequency than in intentional cannabis use periods (AOR=0.56, 95% CI: 0.32-1.01). CONCLUSIONS: A period of intentional cannabis use to reduce crack use was associated with decreased frequency of crack use in subsequent periods among PWUD. Further clinical research to assess the potential of cannabinoids for the treatment of crack use disorders is warranted.

Prevalence and Factors Associated with Hazardous Alcohol Use Among Persons Living with HIV Across the US in the Current Era of Antiretroviral Treatment.

Hazardous alcohol use is associated with detrimental health outcomes among persons living with HIV (PLWH). We examined the prevalence and factors associated with hazardous alcohol use in the current era using several hazardous drinking definitions and binge drinking defined as ≥5 drinks for men versus ≥4 for women. We included 8567 PLWH from 7 U.S. sites from 2013 to 2015. Current hazardous alcohol use was reported by 27% and 34% reported binge drinking. In adjusted analyses, current and past cocaine/crack (odd ratio [OR] 4.1:3.3-5.1, p < 0.001 and OR 1.3:1.1-1.5, p < 0.001 respectively), marijuana (OR 2.5:2.2-2.9, p < 0.001 and OR 1.4:1.2-1.6, p < 0.001), and cigarette use (OR 1.4:1.2-1.6, p < 0.001 and OR 1.3:1.2-1.5, p < 0.001) were associated with increased hazardous alcohol use. The prevalence of hazardous alcohol use remains high in the current era, particularly among younger men. Routine screening and targeted interventions for hazardous alcohol use, potentially bundled with interventions for other drugs, remain a key aspect of HIV care.

Gravidade da dependência de cocaína (Fumada e Inalada) em indivíduos em tratamento ambulatorial / The Severity of cocaine dependence (smoked and snuffed) in subjects undergoing outpatient treatment

O estudo teve por objetivo avaliar os fatores sociais e de saúde associados à da gravidade da dependência de cocaína (fumada e inalada) entre usuários em tratamento ambulatorial. Trata- se de um estudo transversal de abordagem quantitativa, realizado com 160 indivíduos em tratamento para a dependência química no CAPS-ad de Ribeirão Preto, SP. Os participantes foram selecionados mediante critérios de elegibilidade e avaliação do estado mental por meio da Brief Psychiatric Rating Scale (BPRS-A). Para a coleta de dados um questionário foi elaborado contendo: Informações sociodemográficas, Addiction Severity Index (ASI-6); Short Alcohol Dependence Data (SADD); Alcohol Use Disorders Identification Test- Consumption (AUDIT-C); Severity of Dependence Scale (SDS) e Cocaine Craving Questionnaire - Brief (CCQ-B). Na análise estatística foram utilizados os testes: qui-quadrado, regressão logística, teste Mann Whitney e correlação de Spearman. A amostra foi composta por 78 (48,8%) de cocaína inalada e 82 (51,2%) de crack. Em relação aos aspectos sociais e de saúde, os usuários de crack foram mais velhos (p = 0,028), com menos anos de estudo (p = 0,042),desempregados (p = 0,05), maioria em situação de rua (p < 0,001), com antecedentes de tratamentos (p = 0,019), baixa renda mensal (p < 0.001), renda incompatível com despesas (p = 0,002), mais envolvidos em roubo (p = 0,009), sofreram agressão (por pessoa conhecida e desconhecida (p = 0,005 e p = 0,014), presenciaram agressão/homicídio (p = 0,030), dormiram em albergues (p = 0,011), apresentam problemas para dormir (p = 0,007), sintomas de alucinações (p > 0,001), agressividade (p = 0,031). Os usuários de cocaína inalada se diferenciaram apenas por apresentarem maior contato com amigo íntimo (p = 0,007). Em relação ao uso de drogas, os usuários de crack apresentaram maior tempo de uso na vida de tabaco (p = 0,032) e maconha (p = 0,047), maior frequência de uso do crack (p = 0,009). Nos resultados da análise multivariada, os indivíduos adultos (OR 3,1 95%CI 1,50;6,7) e em situação de rua (OR 4,5 95%CI 1,49;13,61) apresentaram chances aumentadas de utilizar crack. Quanto à avaliação final da ASI, constatou-se que os usuários de crack apresentaram elevados níveis de problemas nas áreas Emprego (p = 0,005) e Psiquiátrica (p = 0,003). Os níveis de problemas relacionados ao álcool, drogas e fissura (AUDIT, SDS, CCQ-B) não se diferenciaram entre os usuários de cocaína, resultando em severos níveis de gravidade independente a via de uso, com exceção da SADD. Das correlações entre as áreas da ASI e o dos instrumentos, destaca-se que a área Álcool foi correlacionada positivamente com os todos os instrumentos, a área Droga e os resultados do AUDIT, SDS e CCQ-B, a área Família com o CCQ-B, a área Psiquiátrica com SDS e CCQ-B, a área Problemas Sociais com a SDS e a CCQ-B. A área Médica foi correlacionada negativamente com a SDS. O uso de cocaína apresenta variações em relação aos níveis de gravidade da dependência da droga e problemas nas áreas emprego e sustento, uso de álcool e de drogas, situação legal social e saúde mental

The aim of this study was to evaluate the social and health factors associated with the severity of cocaine dependence (smoked and snuffed) among users on outpatient treatment. This is a cross-sectional quantitative study conducted with 160 individuals undergoing treatment for chemical dependence in the CAPS-ad in Ribeirão Preto, Sao Paulo. Participants were selected through eligibility criteria and mental status assessment using the Brief Psychiatric Rating Scale (BPRS-A). The data collection instruments were: Addiction Severity Index (ASI-6); Short Alcohol Dependence Data (SADD); Alcohol Use Disorders Identification Test- Consumption (AUDIT-C); Severity of Dependency Scale (SDS) and Cocaine Craving Questionnaire - Brief (CCQ-B). In the statistical analysis, the following tests were used: chi- square, logistic regression, Mann Whitney test and Spearman correlation. The sample consisted of 78 (48.8%) snorted cocaine and 82 (51.2%) of crack. In relation to social and health aspects, crack users were older (p = 0.028), with less years of study (p = 0.042), unemployed (p = 0.05), homeless (p < 0,001), history of previous treatments (p = 0.019), low monthly income (p <0.001), income incompatible with expenses (p = 0.002), more involved in robbery (p = 0.009), suffered aggression (per person known and unknown (p = 0.005 and p = 0.014), witnessed aggression / homicide (p = 0.030), slept in shelters (p = 0.011), trouble sleeping (p = 0.007), hallucinations (p> 0.001) and aggressiveness (p = 0.031). The snuffed cocaine users differed only because they had greater contact with close friends (p = 0.007). Regarding the drug use, crack users had a longer time of use in the life of tobacco (p = 0.032) and marijuana (p = 0.047), a higher frequency of crack use (p = 0.009). In the results of the multivariate analysis, the adult individuals (OR 3.1 95% CI 1.50, 6.7) and homeless (OR 4.5 95% CI 1.49, 13.61) presented increased odds of use crack. Regarding the final evaluation of ASI, It was found that crack users presented high levels of problems in the areas of Employment (p = 0.005) and Psychiatric (p = 0.003). The levels of alcohol, drug and fissure problems (AUDIT, SDS, CCQ-B) did not differ among cocaine users, resulting in increased levels of severity independent of the route of use, with the exception of SADD. From the correlations between the ASI and the instruments, the Alcohol use positively correlated with all the instruments, the Drug area and the results of the AUDIT, SDS and CCQ-B, the Family area with CCQ- B, the Psychiatric area with SDS and CCQ-B, the Social Problems area with SDS and CCQ-B. The Medical area was negatively correlated with SDS. The use of cocaine showed various severity levels of drug dependence and problems in the areas of employment and livelihood, alcohol and drug use, social legal status, and mental health

Addressing the stimulant treatment gap: A call to investigate the therapeutic benefits potential of cannabinoids for crack-cocaine use.

Crack-cocaine use is prevalent in numerous countries, yet concentrated primarily - largely within urban contexts - in the Northern and Southern regions of the Americas. It is associated with a variety of behavioral, physical and mental health and social problems which gravely affect users and their environments. Few evidence-based treatments for crack-cocaine use exist and are available to users in the reality of street drug use. Numerous pharmacological treatments have been investigated but with largely disappointing results. An important therapeutic potential for crack-cocaine use may rest in cannabinoids, which have recently seen a general resurgence for varied possible therapeutic usages for different neurological diseases. Distinct potential therapeutic benefits for crack-cocaine use and common related adverse symptoms may come specifically from cannabidiol (CBD) - one of the numerous cannabinoid components found in cannabis - with its demonstrated anxiolytic, anti-psychotic, anti-convulsant effects and potential benefits for sleep and appetite problems. The possible therapeutic prospects of cannabinoids are corroborated by observational studies from different contexts documenting crack-cocaine users' 'self-medication' efforts towards coping with crack-cocaine-related problems, including withdrawal and craving, impulsivity and paranoia. Cannabinoid therapeutics offer further benefits of being available in multiple formulations, are low in adverse risk potential, and may easily be offered in community-based settings which may add to their feasibility as interventions for - predominantly marginalized - crack-cocaine user populations. Supported by the dearth of current therapeutic options for crack-cocaine use, we are advocating for the implementation of a rigorous research program investigating the potential therapeutic benefits of cannabinoids for crack-cocaine use. Given the high prevalence of this grave substance use problem in the Americas, opportunities for such research should urgently be created and facilitated there.

[Contributions of ludic care in nursing to chemical detoxification due to the use of crack cocaine]. / Contribuições do cuidado lúdico em enfermagem na desintoxicação química devido ao uso de crack.

OBJECTIVE: to understand the contributions of ludic care in nursing by stimulating the acceptance of chemical detoxification from crack on the perception of people in the detoxification process. METHODS: an exploratory, descriptive study with a qualitative approach, performed with five people hospitalized for chemical detoxification from crack, from March to July 2013 in a chemical detox unit of a midsize hospital in the central region of Rio Grande do Sul. Data was collected using a semi-structured interview and was subjected to content analysis. RESULTS: Two categories emerged: Ludic care in nursing as a stimulus to the acceptance of chemical detoxification; Ludic care in nursing in the promotion for healthy living after chemical detoxification. CONCLUSION: ludic care in nursing proved to enhance the acceptance of chemical detoxification from crack in the reality investigated.

Contributions of ludic care in nursing to chemical detoxification due to the use of crack cocaine / Contribuciones del cuidado lúdico en enfermería en la desintoxicación química debido al uso de crack / Contribuições do cuidado lúdico em enfermagem na desintoxicação química devido ao uso de crack

OBJECTIVE: to understand the contributions of ludic care in nursing by stimulating the acceptance of chemical detoxification from crack on the perception of people in the detoxification process. METHODS: an exploratory, descriptive study with a qualitative approach, performed with five people hospitalized for chemical detoxification from crack, from March to July 2013 in a chemical detox unit of a midsize hospital in the central region of Rio Grande do Sul. Data was collected using a semi-structured interview and was subjected to content analysis. RESULTS: Two categories emerged: Ludic care in nursing as a stimulus to the acceptance of chemical detoxification; Ludic care in nursing in the promotion for healthy living after chemical detoxification. CONCLUSION: ludic care in nursing proved to enhance the acceptance of chemical detoxification from crack in the reality investigated. .

OBJETIVO: conocer las contribuciones del cuidado lúdico en enfermería en el estímulo a la aceptación de la desintoxicación química por el uso del crack en la percepción de las personas en ese proceso. MÉTODOS: estudio exploratorio, descriptivo de abordaje cualitativo realizado con cinco personas hospitalizadas para desintoxicación química, en el período de marzo a julio de 2013, en una unidad de desintoxicación química de un hospital de mediano porte de la región central de Rio Grande do Sur. Los datos fueron recolectados por una entrevista semiestructurada y sometidos a análisis de contenidos. RESULTADOS: surgieron dos categorías: El cuidado lúdico en enfermería, como un estímulo a la aceptación y como la promoción para el vivir saludable después de la desintoxicación química. CONCLUSIÓN: el cuidado lúdico en enfermería, se mostró potenciador a la aceptación de la desintoxicación del crack en la realidad investigada. .

OBJETIVO: conhecer as contribuições do cuidado lúdico em enfermagem no estímulo à aceitação da desintoxicação química pelo uso do crack na percepção das pessoas em processo de desintoxicação. MÉTODOS: estudo exploratório, descritivo, de abordagem qualitativa, realizado com cinco pessoas internadas para desintoxicação química do crack, no período de março a julho de 2013, em uma unidade de desintoxicação química de um hospital de médio porte da região central do Rio Grande do Sul. Os dados foram coletados por meio de uma entrevista semiestruturada e foram submetidos à análise de conteúdo. RESULTADOS: emergiram duas categorias: O cuidado lúdico em enfermagem como um estímulo à aceitação da desintoxicação química; Cuidado lúdico em enfermagem na promoção para o viver saudável após a desintoxicação química. CONCLUSÃO: o cuidado lúdico em enfermagem mostrou-se potencializador para a aceitação da desintoxicação química do crack na realidade investigada. .

A pilot feasibility and acceptability study of yoga/meditation on the quality of life and markers of stress in persons living with HIV who also use crack cocaine.

BACKGROUND: Persons living with HIV (PLWH) who also use crack cocaine may have stressful, chaotic lives and typically do not engage in standard medical care that addresses a multitude of extenuating life circumstances. Yoga/meditation (YM) improves quality of life (QOL) and biomarkers of stress, but the effect of this intervention is almost unknown in PLWH, particularly those who use crack cocaine. OBJECTIVES: This pilot study sought to compare the feasibility and acceptability of 60-minute, twice-per-week sessions of YM for 2 months with those of no-contact control and to evaluate the effects of the intervention on QOL (according to the Short Form-36, Perceived Stress Scale [PSS], and Impact of Events Scale [IES]) and salivary cortisol and dehydroepiandrosterone sulfate (DHEA-S) among PLWH who use crack cocaine. DESIGN: Participants were randomly assigned to YM or no-contact control and were assessed at baseline, 2 months after the intervention, and 4 months' follow-up. RESULTS: The YM program was acceptable and feasible, with high overall attendance (89%) and individual participation in yoga sessions (83%). YM participants showed modest improvements on QOL. The PSS total score and the IES intrusion score improved significantly 2 months after the intervention, but cortisol and DHEA-S did not change. CONCLUSIONS: This pilot study showed a high level of feasibility and acceptability and modest effects on measures of QOL among PLWH who use crack cocaine. The results suggest utility of YM as a simple, safe, and inexpensive format to improve QOL in a population that has many medical difficulties and extenuating stressors.

Determination of cocaine/crack biomarkers in colostrum by LC-MS following protein precipitation.

Drug abuse by nursing mothers is an ongoing concern because it may cause many adverse effects to the newborns. The development of analytical methods to analyze drugs of abuse in colostrum (first milk produced after birth) has a huge importance, because it enables the monitoring and the correct follow-up to users and newborns. A liquid chromatography mass spectrometry (LC-MS) method was developed and validated for the determination of cocaine and smoked cocaine (crack) biomarkers in colostrum. Cocaine (COC) and its major metabolite benzoylecgonine (BZE), the pyrolytic products anhydroecgonine methyl ester (AEME) and anhydroecgonine (AEC) were analyzed after a simple protein precipitation procedure using atropine (ATP) as internal standard (IS). Applying a chemometric approach study, all peaks were chromatographically separated at isocratic condition with a Kinetex HILIC column for polar compounds, at 30°C in 12min. One ion was detected for the quantification and three ions for confirmation of each analyte. The method was linear for all analytes in the concentration range of 5-300ng/mL with correlation coefficients (r) between 0.9983 and 0.9996. The lower limit of quantification (LLOQ) was 5ng/mL with acceptable validation parameters. Matrix effect was assessed by post-extraction addition approach and showed good results, demonstrating that protein precipitation cleaning procedure is fast, reliable and demand small quantities of organic solvent. The LC-MS method is fast and cheap compared to other equipments and was also successfully applied to assess real samples of colostrum from nursing mothers who were suspect of cocaine/crack abuse.

Construção social das drogas e do crack e as respostas institucionais e terapêuticas instituídas / Social construction of drugs and crack and the institutional responses and therapeutic approaches

Este artigo é produto parcial de uma pesquisa realizada na região metropolitana de Belo Horizonte com o objetivo de compreender os mecanismos sociais e simbólicos envolvidos na relação entre o tráfico do crack e a disseminação da violência, o uso compulsivo dessa substância, os tratamentos e os serviços de atenção ao usuário. Foram utilizados métodos quantitativos e qualitativos, com análise dos inquéritos policiais, entrevistas com policiais, traficantes, profissionais, pacientes e gestores das instituições que prestam atendimento ao usuário de crack. Pretende-se discutir a construção social do problema das drogas; as imagens negativas construídas socialmente sobre o crack e sobre os usuários da substância; as respostas institucionais que, baseadas nos modelos biomédicos, religiosos e jurídicos propõem, gerenciam e legitimam protocolos burocráticos homogêneos para diferentes tipos de usuários. As representações construídas socialmente interferem diretamente no insucesso do processo terapêutico, na descrença e nas frustrações da equipe de profissionais e nas frequentes recaídas e reinternações dos pacientes, particularmente dos usuários de crack . Além de reproduzir uma política proibicionista obsoleta, reforçar preconceitos, provocar medidas coercitivas e discriminatórias, preterindo os direitos de cidadania.(AU)