Experience of patients on methadone maintenance treatment receiving take-home methadone doses during COVID-19 pandemic: A multi-site study from India.

BACKGROUND: Methadone take-home doses for opioid dependence treatment are strictly regulated due to diversion and overdose concerns, so patients must visit the clinic daily for dispensing. This was also done in India until the COVID-19 pandemic, when lockdown restriction compelled take- home dispensing of methadone. This study examined experience of patients who received take- home methadone during COVID-19 pandemic in India. METHODS: Observational, cross-sectional design. We contacted all consenting methadone centres in India during the lockdown and selected those that provided take-home doses for the study. Patients who received daily methadone before the lockdown and take-home doses after were interviewed using a study-specific questionnaire. RESULTS: The study had 210 participants. Take-home methadone was dispensed for 2.5 days on average in each dispensing. When taking methadone at home, 3.3% split their dose 25% took less than the prescribed dose to save it for a rainy days, and 3.3% reported an overdose episode. Adherence improved in 58.6% participants after take-home methadone. Participants perceived many benefits from take-home methadone such as reduced hospital visits and travel time to collect methadone, improvement in work, and financial savings. About 54.3% participants reported storing their take-home doses safely, and 1.9% reported that their family consumed methadone by mistake. CONCLUSIONS: Take-home methadone was found to be beneficial to most participants in terms of time saved and improved productivity. Preconceived concerns of providing take-home methadone in terms of its overdose, diversion, or accidental ingestion by others are not commonly seen when individuals are provided take-home doses of methadone.

A comparative study of sexual behavior, dysfunction, satisfaction, relationship, and sexual quality of life amongst treatment-naïve and abstinent men (buprenorphine-maintained) with Opioid (heroin) dependence syndrome.

Background: Association between opioid use and sexual functioning is well-known. However, data evaluating the influence of treatment on different aspects of sexuality are lacking. Aim: To compare sexual behavior, functioning, relationship, satisfaction, and sexual quality of life (sQoL) among treatment naïve patients (GROUP-I) with Opioid (heroin) dependence syndrome (ODS-H) with those maintained on buprenorphine (GROUP-II). Methods: Married adult males diagnosed with ODS-H, currently sexually active, and living with their partner were recruited. They were assessed for their sexual practices and high-risk sexual behavior (HRSB) through a semi-structured questionnaire and sexual functioning, relationships, satisfaction, and sQoL through structured questionnaires. Results: A total of 112 individuals (GROUP-I: 63; GROUP-II: 49) were recruited from the outpatient settings. Mean age and employment in GROUP-II were higher (p < 0.05) than in GROUP-I (37 vs 32 years; 94% vs 70%, respectively). Other sociodemographic variables and the age of onset of heroin use were comparable. The current practice of HRSB (e.g., engaging in casual partner sex, sex with commercial sex workers, and sex under intoxication) was higher in GROUP-I while almost no differences were seen in lifetime HRSB. The frequency of erectile dysfunction and premature ejaculation in the two groups were: 78% vs 39% (p < 0.001), and 30% vs 6% (p = 0.001), respectively. GROUP-II had significantly higher scores in all the scales (p < 0.05) as compared to GROUP-I, indicating better sexual satisfaction, quality of life, and sexual relationship. Conclusion: Heroin use is associated with HRSB, poorer sexual functioning, overall satisfaction, and sQoL. Maintenance of Buprenorphine helps with improvement in all these parameters. Comprehensive management for substance use should target sexual problems as well.

Impact of three years of prohibition on extent and pattern of alcohol use in Bihar: Observations and insights from the National Family Health Survey.

Bihar Excise (Amendment) Act, 2016 was promulgated in the state and a complete prohibition on alcohol was declared within the state of Bihar. We aimed to assess the impact of the prohibition on extent and pattern of alcohol use in the state of Bihar using the National Family Health Survey data. We also compared the data from Bihar with the data for the whole country, its neighbouring states and the state of Gujarat. There was a 41.78% reduction in the proportion of men who reported alcohol use in Bihar. Among those who reported alcohol use proportion of those who used 'almost every day' reduced by 29.72%. There was a 69.56% reduction in the proportion of women in Bihar who reported alcohol use. There was a significant increase in proportion of men reporting use of tadi madi and country liquor. Since the prohibition of alcohol in the state of Bihar there has been a reduction in self-reported alcohol use among men and women. However, alcohol use continues to be reported in the state even after the prohibition. There are states in the country that have similar extent of alcohol use as compared to Bihar, despite lack of prohibition. This warrants a relook at the policy to address what the prohibition could not achieve.

How and What are Indians Drinking? Findings from the National Family Health Survey.

AIMS: To assess recent changes in the extent and pattern of alcohol use in India using the National Family Health Survey (NFHS) data. METHODS: We used unit-level data from both rounds of NFHS. The pattern of alcohol use was categorized as: 'almost every day', 'almost once a week' and 'less than once a week'. The information was segregated for the urban and rural settings. Information was also available on the type of alcoholic beverage used by the respondents. The z test for differences in proportions was carried out for the study variables. RESULTS: Findings suggest a 22.37 and 39.02% reduction in the proportion of men and women who reported alcohol use, respectively. The proportion of men reporting 'almost every day' and 'about once a week' consumption of alcohol increased by 24.19 and 7.14%, respectively. CONCLUSIONS: With the caveats of expected limitations of surveys, the findings suggest an overall decrease in alcohol use in India, though the proportion of men with more frequent alcohol has increased. There is a need to strengthen the investment in the initiatives targeted at the harms due to alcohol use.

The "Hidden Story" about Change in Alcohol Use in India over the Past Two Decades: Insights from a Secondary Analysis of Data from the National Family Health Survey.

Background: Studies and published reports have not commented on the change in the proportion of the Indian population that consumed alcohol over the years. Methods: We report the findings on changes in alcohol use in India over the past two decades, based on a secondary analysis of the data gathered over the successive National Family Health Surveys (NFHS-3 to 5). Results: There was a significant decline (P < 0.001) of around 8% and 45% for the current use of alcohol among men and women from NFHS-3 to NFHS-4. There was a decline in the proportion of men reporting alcohol use across all but one state in NFHS-5 compared to NFHS-3. The decline was statistically significant (P < 0.001) for all but one state. There was a decline in the proportion of women reporting alcohol use in 12 states and an increase in three states. Also, there was a significant (P < 0.001) decline in the proportion of men reporting alcohol use in all the states in NFHS-5 compared to NFHS-4. There was an increase in the proportion of women reporting alcohol use in nine states (statistically significant in six states) in NFHS-5 compared to NFHS-4. However, the proportions were more than NFHS-3 values in two states. Conclusions: These observations on changes in alcohol use in the country over the past two decades will help better understand the trends in alcohol consumption and help better plan the future strategy to address alcohol use and alcohol use disorders.

Neuropsychiatric manifestation of the drugs used in the treatment of SARS-2-CoV-2019 (COVID-19) infection and their management: An overview and practice implications.

Treatment guidelines for the COVID-19 treatment are still evolving, moreover, the changing variants of the virus with varying virulence, pose challenges for the healthcare professionals (HCP) not only in managing the primary infection but also a myriad of physical and neuropsychiatric complications. The neuropsychiatric adverse consequences associated with the COVID-19 are attributable to the direct effect of the virus, secondary complications, drug-drug interaction, and neuropsychiatric manifestations of drugs used in its treatment. These neuropsychiatric manifestations not only complicate the ongoing treatment but also adversely affect the prognosis. As the treatment guidelines for the management of the COVID are still evolving, the use of non-evidence-based medications, including their off-label use, are rampant that often extend to their non-judicious or irrational use (more than the recommended dose, multiple medications, etc.). Despite the significance of the topic, literature is sparse. Knowing about the risk factors and the potential neuropsychiatric adverse effects with various anti-COVID-19 medications would help HCPs in effectively preventing, early identifying, and promptly managing these neuropsychiatric symptoms. Therefore, this narrative review is aimed to highlight the neuropsychiatric symptoms associated with medications/interventions used in the management of COVID-19 and how to manage them, especially in view of the world facing the third wave of COVID-19.

Of biofilms and beehives: An analogy-based instructional tool to introduce biofilms in school and undergraduate curriculum.

The concept of biofilms and biofilm-based research is largely absent or minimally described in school and undergraduate life science curriculum. While it is well-established that microbes, such as bacteria and fungi, most often exist in multicellular biofilm communities, descriptions in standard biology textbooks continue to focus on the single-celled form of microbial life. We have developed an analogy-based instructional tool to introduce and explain biofilms to school and undergraduate students. The module employs an analogy with beehives, given that biofilms and beehives are both 'superorganism' states, to explain key biofilm features such as development and structure, chemical communication, division of labor and emergent properties. We delivered this analogy-based learning tool to a cohort of 49 students, including middle-to-high school and undergraduate students, and based on participant feedback and learnings, present a formal evaluation of the instructional tool. Further, we outline prerequisites and learning approaches that can enable the delivery of this module in classroom and virtual learning settings, including suggestions for pre-lesson reading, student-centred interactive activities, and specific learning objectives. Taken together, this instructional analogy holds potential to serve as an educational tool to introduce biofilms in school and undergraduate curricula in a relatable and comprehensible manner.