Motivation and context of concurrent stimulant and opioid use among persons who use drugs in the rural United States: a multi-site qualitative inquiry.

BACKGROUND: In recent years, stimulant use has increased among persons who use opioids in the rural U.S., leading to high rates of overdose and death. We sought to understand motivations and contexts for stimulant use among persons who use opioids in a large, geographically diverse sample of persons who use drugs (PWUD) in the rural settings. METHODS: We conducted semi-structured individual interviews with PWUD at 8 U.S. sites spanning 10 states and 65 counties. Content areas included general substance use, injection drug use, changes in drug use, and harm reduction practices. We used an iterative open-coding process to comprehensively itemize and categorize content shared by participants related to concurrent use. RESULTS: We interviewed 349 PWUD (64% male, mean age 36). Of those discussing current use of stimulants in the context of opioid use (n = 137, 39%), the stimulant most used was methamphetamine (78%) followed by cocaine/crack (26%). Motivations for co-use included: 1) change in drug markets and cost considerations; 2) recreational goals, e.g., seeking stronger effects after heightened opioid tolerance; 3) practical goals, such as a desire to balance or alleviate the effects of the other drug, including the use of stimulants to avoid/reverse opioid overdose, and/or control symptoms of opioid withdrawal; and 4) functional goals, such as being simultaneously energized and pain-free in order to remain productive for employment. CONCLUSION: In a rural U.S. cohort of PWUD, use of both stimulants and opioids was highly prevalent. Reasons for dual use found in the rural context compared to urban studies included changes in drug availability, functional/productivity goals, and the use of methamphetamine to offset opioid overdose. Education efforts and harm reduction services and treatment, such as access to naloxone, fentanyl test strips, and accessible drug treatment for combined opioid and stimulant use, are urgently needed in the rural U.S. to reduce overdose and other adverse outcomes.

Anxiety and threat-related attentional biases in adolescents with fragile X syndrome.

BACKGROUND: Fragile X syndrome (FXS) is a single-gene disorder highly associated with anxiety; however, measuring anxiety symptoms in FXS and other neurogenetic syndromes is challenged by common limitations in language, self-awareness and cognitive skills required for many traditional assessment tasks. Prior studies have documented group-level differences in threat-related attentional biases, assessed via eye tracking, in FXS and non-FXS groups. The present study built on this work to test whether attentional biases correspond to clinical features of anxiety among adolescents and young adults with FXS. METHODS: Participants included 21 male adolescents with FXS ages 15-20 years who completed an adapted eye-tracking task that measured attentional bias towards fearful faces of varied emotional intensity. RESULTS: Among participants without anxiety disorders, attentional bias towards fear increased across age, similar to non-FXS paediatric anxiety samples. In contrast, participants with anxiety disorders exhibited greater stability in fear-related attentional biases across age. Across analyses, subtle fear stimuli were more sensitive to within-group anxiety variability than full-intensity stimuli. CONCLUSIONS: Our results provide novel evidence that although threat-related attentional biases may correspond with anxiety outcomes in FXS, these associations are complex and vary across developmental and task factors. Future studies are needed to characterise these associations in more robust longitudinal samples, informing whether and how eye-tracking tasks might be optimised to reliably predict and track anxiety in FXS.

The relationship between pH and concentrations of antioxidants and vasoconstrictors in local anesthetic solutions.

pH affects the efficacy of local anesthetics by determining the percentage of the lipid-soluble base form of the anesthetic available for diffusion and penetration of the nerve sheath. The purpose of this study was to determine the relationship between pH and the concentrations of antioxidant and vasoconstrictor in dental local anesthetic solutions over real-time and after accelerated aging. Several batches of lidocaine and mepivacaine with vasoconstrictors were tested. Results showed that, immediately upon receipt from the manufacturers, three batches were below the USP pH limit (pH 3.3), and two batches contained less than the minimum limit of vasoconstrictors (90%). Real-time tests on batches that were within normal limits revealed that solutions were stable past 4 yr. Accelerated aging tests revealed a strong correlation between a decrease in pH and loss of antioxidants and vasoconstrictors. In conclusion, a quality batch of local anesthetic should remain efficacious long past the manufacturer's stated shelf life; a batch that is less than optimal, or one that is exposed to environmental stresses, will degrade rapidly, and efficacy may be affected by decreases in pH and loss of vasoconstrictor. pH may be an inexpensive, readily available screening test for efficacy of local anesthetics.

Drug-use evaluation programs for psychotropic medications.

Drug-use evaluation (DUE) programs for psychotropic medications at a state-operated mental health center are described. DUE programs were developed at Western Missouri Mental Health Center to monitor prescribing of medications in the hospital and ambulatory-care settings. DUE criteria were developed for all major groups of psychotropic medications: antipsychotics, antidepressants, antianxiety and hypnotic agents, lithium, and antiparkinsonian drugs. The criteria appear on special forms developed for the programs; pharmacists use these forms to evaluate every medication order for inpatients and every 50th medication order for ambulatory-care patients. Physicians are alerted to noncompliant prescribing practices by memorandum, oral consultation, or both. In 3204 inpatient DUEs conducted from July 1986 to December 1988, orders for antiparkinsonian drugs showed the poorest compliance with DUE criteria. In both the hospital and ambulatory-care settings, antiparkinsonian agents required the most follow-up. The overall compliance rate for inpatient DUEs was 84%; for ambulatory-care DUEs, the compliance rate was 64%. As a result of the ambulatory-care DUE program, basic laboratory studies and dyskinesia rating scales are being ordered on a more timely basis. These DUE programs have increased pharmacist monitoring of patient care and improved documentation of medication use.

Comparison of videocassette and personal instruction methods for training pharmacy personnel in aseptic technique.

A videocassette self-instruction method of aseptic-technique training was compared with a one-on-one instructor-trainee method to determine the effectiveness and cost of each method. Pharmacy department personnel and pharmacy students with no previous training in aseptic technique were randomly assigned to receive either personal or videocassette instruction. The trainees completed an identical set of practice activities. Three measures were used to determine competency in aseptic technique: written testing on information presented, direct observation monitoring of trainees' technique in preparing broth admixtures, and sterility testing of end products. A total of 28 individuals participated in the study, 14 in each group. Trainees in the group receiving personal instruction had significantly higher overall test scores than did trainees receiving videocassette instruction. Trainees receiving videocassette instruction had more difficulty in aseptic manipulation of needles, syringes, vials, ampuls, bottles, and bags; in properly cleaning the laminar-airflow hood; and in inspecting the prepared admixtures. However, no broth admixture in either group showed evidence of microbial growth. The personal instruction method was more than two and one-half times as expensive as the videocassette method. A combination of videocassette instruction in aseptic technique and instructor intervention during the training process should result in a cost-effective training method.

Appalachian adolescents' snack patterns: morning, afternoon, and evening snacks.

The snack patterns of 225 adolescents selected from four metropolitan and three rural schools in eastern Tennessee were examined with the use of 24-hour food records kept on a school day. Most (89%) of the respondents ate at least one snack on the day of the survey. Morning snacks, most of which were obtained from school stores or school vending machines, were more likely to include candies and salty snack foods than were afternoon and evening snacks, most of which were eaten at home. Breads and cereals were popular choices for afternoon and evening snacks. Carbonated beverages and desserts were popular during all time periods. Nutrient densities of snacks were low in all time periods but lowest in morning snacks. Nutrients present in lowest amounts were iron, calcium, and vitamin A. Snack patterns of boys and girls were similar, although boys' intakes of energy, calcium, and riboflavin were higher than those of girls.

Appalachian adolescents' eating patterns and nutrient intakes.

Meal and snack patterns of 114 male and 111 female adolescents in a southern Appalachian state were examined from 24-hour food records kept on a school day. Breakfast was skipped by 34% of the respondents, and 27% either skipped lunch or ate a snack-type lunch. The evening meal and snacks, each of which contributed about one-third of the daily energy intake, were eaten by 94% and 89%, respectively. Girls' mean intakes of vitamin A, calcium, and iron were low at all eating occasions throughout the day. Boys' mean intakes of iron were low at breakfast, lunch, and snacks; their vitamin A intakes were low at lunch and snacks. Adolescents who prepared their own breakfasts consumed less energy, protein, fat, and niacin at that meal than did adolescents who ate breakfasts prepared by their mothers. However, adolescent-prepared breakfasts were higher in nutrient density for calcium, riboflavin, and thiamin. Evening meals prepared by adolescents were similar in total nutrient content to meals prepared by their mothers but lower in nutrient density for iron and thiamin. Evening meals prepared by adolescents were more likely to include a sandwich and less likely to include a vegetable than were meals prepared by mothers.