The use of premixed drugs in commodity packets in the population: prevalence and correlates revealed by the 2018 National Survey of Substance Use in Taiwan.

BACKGROUND: Administering premixed drugs in commodity packets was first reported in Asia in 2015, but there continues to be a dearth of related population-based data. This study aimed at examining (1) the prevalence of drug packet use in the population and (2) the sociodemographic profiles, particularly gender distribution, of drug packet users. METHODS: Data were derived from a survey of 18,626 Taiwanese civilians, aged 12-64 years, using stratified, multi-stage, random sampling in 2018. Participants anonymously completed a computer-assisted self-interview on tablet computers which covered the use and problematic use of illicit drugs/inhalants, prescription drugs and other psychoactive substances, among others. RESULTS: Approximately 1.46% of respondents had a lifetime use of illicit drugs, with drugs in commodity packets (0.18%) being ranked the fifth-most commonly used illicit drugs, higher than nitrous oxide (0.14%) and heroin (0.09%). Ten formats of drug packets were endorsed by users. Approximately 81.6% of persons with drug packet use had a lifetime use of other illicit drugs. The correlates of the use of drugs in commodity packets were similar to those of the exclusive use of other drugs except that there was a lack of gender differences in the use of drugs in commodity packets but not in the exclusive use of other drugs. CONCLUSION: Drugs in commodity packets have become a common way of administering illicit drugs in the population in Taiwan, and there were no gender differences among users. Our findings have implications for more efficient drug testing and culturally appropriate intervention for drug packet use.

Population-based prevalence of somatic symptom disorder and comorbid depression and anxiety in Taiwan.

OBJECTIVE: The nationwide prevalence of somatic symptom disorder (SSD) has not yet been investigated in Asia. SSD is often comorbid with depression and anxiety, and the effects of these conditions on medical utilization await clarification. We hence performed a study in Taiwan to explore these issues. METHODS: Using telephone-based sampling and interview, we obtained data for 3161 participants whose age, gender and living area were compatible with the Taiwan population. We gathered scores of the Patient Health Questionnaire-15 (PHQ-15), Health Anxiety Questionnaire (HAQ) and Patient Health Questionnaire-4 (PHQ-4). Individuals with a PHQ-15 score of at least 4 and a HAQ score of at least 17 were considered to have SSD. Descriptive statistics were used to clarify the prevalence and normative data of the questionnaires. We used multiple logistic regression analyses to investigate the relation between diagnoses and medical utilization. RESULTS: The prevalence of SSD was 5.00% and women had a higher SSD prevalence than men; participants aged 40-49 years had the highest SSD prevalence. In SSD patients, 33.58% had depression or anxiety. After correcting for demographics, SSD and anxiety (but not depression) were associated with a significantly high level of outpatient/emergency department attendance. Comorbid depression or anxiety did not significantly increase the medical utilization of SSD patients. CONCLUSION: The nationwide SSD prevalence in Taiwan is compatible with the description in the DSM-5. The comorbidity of SSD and depression/anxiety is common, but depression or anxiety does not significantly increase the SSD patients' medical utilization.

Men's decrease and women's increase in harmful alcohol use from the 2014 to 2018 national surveys in Taiwan: A harbinger for an emerging national trend in East Asia?

BACKGROUND: Gender differences in alcohol use have narrowed in Western societies, but that in Asia has been less investigated. By comparing the 2014 and 2018 waves of the national survey in Taiwan, we aimed to examine the gender differences in population trends in past-month alcohol use, binge drinking, and harmful alcohol use. METHODS: The national survey enrolled 17,837 participants in 2014 and 18,626 participants in 2018. Binge drinking was defined as having ≥5 drinks on one occasion in the past month, and harmful alcohol use as having an Alcohol Use Disorders Identification Test score of ≥8. RESULTS: There were significant decreases from 2014 to 2018 in the population's prevalence of past-month alcohol use, binge drinking, and harmful alcohol use. However, males and females had different trends: males showed significant reductions in all three alcohol use behaviours (a decrease of 3.79%, 1.59%, and 2.60%, respectively), while females exhibited a significant rise in harmful alcohol use (from 1.32% to 1.72%), particularly among those aged 18-29 years. CONCLUSION: There was gender convergence in alcohol use in Taiwan, mainly due to men's decrease and women's increase in harmful alcohol use. Our findings have important implications for the intervention and prevention of the problematic use of alcohol in East Asia.

The impact of Taiwan's implementation of a nationwide harm reduction program in 2006 on the use of various illicit drugs: trend analysis of first-time offenders from 2001 to 2017.

BACKGROUND: After implementing a nationwide harm reduction program in 2006, a dramatic decline in the incidence of human immunodeficiency virus (HIV) infection among people with injection drug use (IDU) was observed in Taiwan. The harm reduction program might have sent out the message discouraging the choice of IDU among illicit drug users in early stage. Based on the yearly first-time offense rates from 2001 to 2017, this study aimed to examine (1) whether the nationwide implementation of the harm reduction program in 2006 led to changes in first-time offenders' use of heroin; (2) whether the intervention had a similar effect on the use of other illicit drugs; and (3) whether the effect of the intervention was limited to the first-time offenders of young age groups. METHODS: Yearly first-time illicit-drug offense rates from 2001 to 2017 in Taiwan were derived from two national databases for drug arrests that were verified using urine tests: the Criminal Record Processing System on Schedule I/II Drugs and the Administrative Penalty System for Schedule III/IV Substances. A hierarchy of mutually exclusive categories of drug uses was defined by the drug with the highest schedule level among those tested positive in an arrest. Segmented regression analyses of interrupted time series were used to test for the impact of the 2006 intervention. RESULTS: There was a decrease of 22.37 per 100,000 in the rate for heroin but no detectable level changes in that for methamphetamine or ecstasy after the 2006 intervention in Taiwan. There were baseline decreasing trends in the first-time offense rate from 2001 to 2017 for heroin and ecstasy and an increasing trend for methamphetamine, with the slopes not altered by the 2006 intervention. The postintervention decrease in the first-time offense rate for heroin was detectable among offenders less than 40 years old. CONCLUSIONS: Our results indicate a diffusion effect of the 2006 intervention on decreasing heroin use among young offenders and have policy implications for better prevention and treatment for different age groups.

Associations of parental and peer cross-substance use with 12-17-year-old adolescents' problematic alcohol use: A parent-child dyadic gender analysis.

BACKGROUND: Adolescent alcohol use was found to be influenced by parental and peer alcohol use. Drinking behaviors also differed by gender. However, previous studies mainly focused on adolescents' substance use in relation to the same substance use among their salient others. Hence, this study investigated the cross-substance relationships of alcohol and tobacco use of parents and peers with adolescents' problematic alcohol use, separately by gender. METHODS: Data were derived from 4445 adolescents aged 12-17 years from the 2014 National Survey of Substance Use, a nationally representative survey in Taiwan. Problematic alcohol use was assessed using the Alcohol Use Disorders Identification Test (AUDIT). Multivariate multinomial logistic regression was used, stratified by gender. RESULTS: For males, maternal (adjusted odds ratio [aOR] = 1.73) and peer (aOR = 2.57) alcohol use was related to social drinking (AUDIT < 2); paternal (aOR = 3.58), maternal (aOR = 2.18), peer alcohol use (aOR = 5.37), and their own tobacco use (aOR = 4.72) were related to problem drinking (AUDIT ≥ 2). For females, maternal (aOR = 2.26) and peer (aOR = 2.84) alcohol use was related to social drinking; maternal (aOR = 2.35) and peer tobacco use (aOR = 3.48), and paternal (aOR = 4.56) and peer alcohol use (aOR = 3.36) were linked to problem drinking. CONCLUSIONS: Both male and female adolescents' alcohol use was associated with their peer alcohol use, and gender differences were found in relation to their parental and peer substance use. Specifically, the parental role-modeling of smoking was only significant in mother-daughter dyads. These findings could inform multifaceted adolescent alcohol prevention programs, tailoring for males and females and also targeting their parental and peer substance use.

Moderating effect of illicit drug use on the relationship between sexual behaviours and prevalence of HIV or sexually transmitted infections.

INTRODUCTION AND AIMS: We aimed to: (i) investigate sexual behaviours, substance use, HIV and sexually transmitted infections (STI) prevalence among a population of men who have sex with men (MSM) in Taiwan; and (ii) examine the moderating effects of substance use in the relationship of sexual behaviours and HIV and STI diagnosis. DESIGN AND METHODS: We used the Taiwan 2013 Internet MSM Sex Survey conducted cross-sectionally online. We examined the association between sexual behaviours and HIV and STIs using logistic regression models. We then assessed the moderating effects of substance use between specific sexual behaviours and HIV and STI using interaction term. RESULTS: Among the 2020 MSM participants, 5.5% of them had reported having been diagnosed with HIV and 7.4% with STIs. Reporting having a sex partner found online, having unprotected anal sex with a casual male partner, alcohol and illicit drug use were all significantly associated with HIV and STI diagnosis. Those reporting having sex with partners found via mobile apps were more likely to report being HIV positive as a function of illicit drug use. A similar finding was evident for STIs. Interestingly, alcohol had no moderating effects in similar analyses. DISCUSSION AND CONCLUSIONS: This study sheds light on future development of interventions that target at mobile apps which better integrate drug prevention and HIV prevention programs for the MSM population.

First-time offenders for recreational ketamine use under a new penalty system in Taiwan: incidence, recidivism and mortality in national cohorts from 2009 to 2017.

BACKGROUND AND AIMS: Ketamine has become a new recreational drug of choice among young people in parts of Asia. Using national databases in Taiwan, this study aimed to (1) examine the yearly trend in the ketamine offence rate over time; (2) estimate the 3-year risk of drug-related re-offence and its correlates among the first-time offenders; and (3) estimate the 3-year standardized mortality ratio (SMR) among the first-time offenders. DESIGN, SETTING AND PARTICIPANTS: Retrospective cohort studies of offenders for recreational ketamine use in a penalty system initiated in 2009. Offenders for recreational ketamine use were identified from the Administrative Penalty System for Schedule III/IV Substances database from 2009 to 2017, and the re-offence rate and mortality among first-time offenders were assessed via record-linkage within the database as well as with both the criminal drug offence database and the national mortality database. The cohort from 2009 to 2016 (n = 39 178) was used for the recidivism analysis and the cohort from 2009 to 2013 (n = 25 357) was used for the 3-year SMR analysis. MEASUREMENTS: Recidivism was estimated using survival analysis of the event as re-arrest for using ketamine, more serious illicit drugs (Schedules I/II), or any illicit drugs (ketamine or Schedules I/II). SMRs were estimated for overall and cause-specific death within 3 years after the first offence for ketamine use. FINDINGS: The age-standardized rates for both prevalent (1.38 per 1000) and first-time offenders (0.65 per 1000) peaked in 2013 and then decreased steadily. The 3-year risk of re-offence was 33.85% [95% confidence interval (CI) = 33.23-34.47%) for ketamine use and 39.52% (95% CI = 39.00-40.04%) for any illicit drug use. These first-time offenders had an SMR of 4.9 (95% CI = 4.3-5.4) for overall mortality, 2.1 (95% CI = 1.6-2.7) for natural deaths and 7.6 (95% CI = 6.7-8.6) for unnatural deaths. CONCLUSIONS: Recreational ketamine use in Taiwan appears to lead not only to high risk for drug-related re-offence but also to excess mortality.

Residential Socioeconomic Environments and Areca Nut Use in Taiwan: A Comparison with Alcohol and Tobacco Use in Multilevel Analysis.

BACKGROUND: While the association between residential socioeconomic environments and the use of globally common substances such as alcohol and tobacco has been well documented in Western countries, it remains little known about regionally important substances, such as areca nut in Asia. Objective: This study was aimed to develop residential environmental indicators in the context of Taiwan and examine their associations with areca nut use, in comparison to alcohol and tobacco use. Methods: Data were drawn from 13,392 adults across 168 townships in the 2014 National Survey on Substance Use in Taiwan. Residential socioeconomic environment variables were derived from the census and analyzed using factor analysis. Multilevel logistic regression models were used to examine the association of individual- and residential-level factors with the use of areca nut (use/nonuse), alcohol (harmful use, low-risk use, or nonuse), and tobacco (nicotine dependence, regular active use, or nonuse). Results: A three-factor structure of socioeconomic environments derived from 16 residential-level variables consisted of Rural Disadvantage, Affluence, and Family Fragmentation. Multilevel analyses showed that areca nut use was associated with both individual-level (male sex, age group 35-44 years, being divorced/widowed/separated, low educational attainment, and the occupational group of labors) and residential-level (Rural Disadvantaged and Family Fragmented) variables; such a profile was most similar to that of nicotine dependence. Conclusions: A three-factor structure could be derived for the residential-level socioeconomic environments in the Taiwanese context. Rural Disadvantaged and Family Fragmented were associated with areca nut use, which have implications for interventions targeted at the community level.

Nonmedical prescription drug use of analgesics and sedatives/hypnotics in Taiwan: Results from the 2014 National Survey of Substance Use.

Nonmedical prescription drug use (NMPDU) has become a major public health issue but little is known in Asian populations. This study aimed to investigate the prevalence and correlates of NMPDU in Taiwan. Participants from the 2014 national survey of 17,837 individuals, aged 12 to 64 year, completed anonymously a computer-assisted self-interview. Past-year prescription drug use was divided into medical use only (MUO) and nonmedical use (NMU), defined as using the drug without a prescription, or more frequently, or in larger doses than prescribed. Problematic alcohol use was measured using the Alcohol Use Disorders Identification Test (AUDIT), problematic drug use using the 20-item Drug Abuse Screening Test (DAST), and depressive symptoms using the Center for Epidemiological Study-Depression (CES-D). The prevalence of past-year NMU was 3.02% for analgesics, 0.71% for sedatives/hypnotics, and 3.66% for either drug, with a very small overlap of NMU between analgesics and sedatives/hypnotics (0.07%). When individuals with NMU were compared to those without NMU (Non-NMU) and those with MUO, respectively, some correlates consistently identified, including young adulthood, tobacco smoking, alcohol drinking, and greater AUDIT's scores for analgesics, as well as hard drug use and greater DAST's scores for sedatives/hypnotics. NMU was associated with greater CES-D's scores for both analgesics and sedatives/hypnotics when compared to Non-NMU but not to MUO. Robust correlates of NMPDU could offer implications for development of prevention strategies of NMPDU.

E-Cigarette Use in a Country With Prevalent Tobacco Smoking: A Population-Based Study in Taiwan.

BACKGROUND: The different profiles of e-cigarette users in different age groups have seldom been investigated, particularly in populations facing a high prevalence of cigarette smoking. This study aims to examine the prevalence and correlates of e-cigarette use separately for adolescents and adults in nationally representative samples in Taiwan. METHODS: Among 17,837 participants in the 2014 National Survey of Substance Use in Taiwan, 4445 were aged 12 to 17 years and 13,392 were aged 18 to 64 years. Individuals' lifetime tobacco use was divided into four groups: non-use, exclusive e-cigarette use, exclusive cigarette use, and dual use. Questions on sociodemographic features, use and problematic use of tobacco, alcohol, and other drugs, and psychosocial distress, among others, were administered using a computer-assisted self-interview on tablet computers. RESULTS: Among lifetime users of e-cigarette (2.2% for adults and 0.8% for adolescents), 4.5% for adults and 36.6% for adolescents were exclusive e-cigarette users. From use of exclusive e-cigarettes to use of exclusive cigarettes to dual use, those usage groups were related to an increasing trend of adjusted odds ratios for use of other psychoactive substances, particularly problematic use of alcohol or drugs, and with more depressive symptoms. Two correlates were specific to e-cigarette use: alcohol use had stronger relationships with e-cigarette use among adolescents, and younger adults (18-34) were more likely to try e-cigarettes compared to older adults. CONCLUSIONS: These results provide essential information regarding e-cigarette use in the general population, and future prevention strategies should account for its specific correlates in young people.

Time-evolution of the electrical characteristics of MoS2 field-effect transistors after electron beam irradiation.

As the feature sizes of devices decrease to the nanoscale, electron microscopy and lithography will become increasingly essential techniques for fabrication and inspection. In this study, we probed the memory effects of MoS2 field-effect transistors (FETs) subjected to electron beam (e-beam) irradiation; after fabricating the devices on 300 nm SiO2/Si substrates, we irradiated the MoS2 FETs with various doses of irradiation from a 30 kV e-beam. The threshold voltage shifted to the negative side and the mobility increased-a so-called memory effect-upon increasing the e-beam dose. These changes resulted from positively charged oxide traps, formed upon e-beam irradiation, in the gate oxide layer. Interestingly, the electrical characteristics of the MoS2 FETs after e-beam irradiation continued to change upon aging: the threshold voltage shifted toward the positive side and the mobility decreased, suggesting that the dominant mechanism changed from the presence of positively charged oxide traps to the presence of negatively charged interface traps. Notably, the threshold voltage shifts of the MoS2 FETs could be retained for one or two days. This behavior should be useful for preparing property-adjustable nanodevices, with particular potential for applications in multi-level memory devices.

Differences in prevalence, socio-behavioral correlates, and psychosocial distress between club drug and hard drug use in Taiwan: Results from the 2014 National Survey of Substance Use.

BACKGROUND: This study examined variation between users of 'club' and 'hard' drugs in Taiwan in terms of prevalence of use and demographics and psychosocial characteristics. METHODS: Data were derived from a survey of 17,837 Taiwanese civilians, aged 12-64 years, using stratified, multi-stage, random sampling. Participants completed a computer-assisted self-interview on tablet computers which covered use of legal substances, sedatives/hypnotics and prescription analgesics; use of illicit drugs/inhalants, risky sexual experiences; expectations of drugs; and psychological distress. FINDINGS: Approximately 1.29% of respondents reported ever using an illicit drug in their lifetime; prevalence estimates of club drugs (mainly ketamine, marijuana, and ecstasy) were slightly higher than hard drugs (mainly methamphetamine and heroin). Concurrent use of legal substances, particularly problematic use of alcohol and tobacco, as well as non-medical use of prescription drugs, were strong correlates of illicit drug use in general, with club drug use exhibiting an extremely strong association with alcohol use. Club drug users were demographically different from hard drug users, including in terms of their gender, age, and level of educational attainment. They were also more likely to be divorced or widowed, to report risky sexual partnerships and more depressive symptoms than hard drug users. CONCLUSIONS: Our findings indicate drug type specific distinct psychosocial characteristics, which may warrant further attention in the design of treatment and intervention programs.