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1.
Psychiatry Res ; 289: 113096, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-33242814

RESUMEN

The COVID-19 pandemic has brought major challenges to healthcare systems and public health policies globally, as it requires novel treatment and prevention strategies to adapt for the impact of the pandemic. Individuals with substance user disorders (SUD) are at risk population for contamination due to multiple factors-attributable to their clinical, psychological and psychosocial conditions. Moreover, social and economic changes caused by the pandemic, along with the traditional difficulties regarding treatment access and adherence-will certainly worsen during this period, therefore aggravate their condition. In addition, this population are potential vectors of transmission. In that sense, specific strategies for prevention and treatment must be discussed. health care professionals dealing with SUD must be aware of the risks and challenges they will meet during and after the COVID-19 outbreak. Addiction care must be reinforced, instead of postponed, in order to avoid complications of both SUD and COVID-19 and to prevent the transmission of coronavirus.


Asunto(s)
/complicaciones , Trastornos Relacionados con Sustancias/prevención & control , Trastornos Relacionados con Sustancias/terapia , Concienciación , /transmisión , Humanos , Pandemias , Trastornos Relacionados con Sustancias/etiología
2.
Cancer Cytopathol ; 128(10): 679-680, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33006815
3.
J Addict Med ; 14(6): e287-e289, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33009167

RESUMEN

: Globally, there are concerns about access to healthcare and harm reduction services for people who use drugs (PWUD) during the coronavirus disease 2019 (COVID-19) pandemic. Members from the Network of Early Career Professionals working in Addiction Medicine shared their experiences of providing treatment to PWUD during the COVID-19 pandemic. Drawing on these qualitative reports, we highlight the similarities and discrepancies in access to services for PWUD in 16 countries under COVID-10 restrictions. In most countries reported here, efforts have been made to ensure continued access to services, such as mobilising opioid agonist maintenance treatment and other essential medicines to patients. However, due to travel restrictions and limited telemedicine services, several Network of Early Career Professionals working in Addiction Medicine members from lower-resourced countries experienced challenges with providing care to their patients during periods of COVID-19 lock-down. The insights provided in this commentary illustrate how the COVID-19 lock-down restrictions have impacted access to services for PWUD.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Accesibilidad a los Servicios de Salud , Neumonía Viral/epidemiología , Trastornos Relacionados con Sustancias/terapia , Atención Ambulatoria , Infecciones por Coronavirus/prevención & control , Servicio de Urgencia en Hospital , Reducción del Daño , Humanos , Control de Infecciones , Programas de Intercambio de Agujas , Tratamiento de Sustitución de Opiáceos , Trastornos Relacionados con Opioides/prevención & control , Trastornos Relacionados con Opioides/terapia , Pandemias/prevención & control , Neumonía Viral/prevención & control , Trastornos Relacionados con Sustancias/prevención & control
4.
J Stud Alcohol Drugs ; 81(5): 556-560, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-33028465

RESUMEN

People who use drugs (PWUD) face concurrent public health emergencies from overdoses, HIV, hepatitis C, and COVID-19, leading to an unprecedented syndemic. Responses to PWUD that go beyond treatment--such as decriminalization and providing a safe supply of pharmaceutical-grade drugs--could reduce impacts of this syndemic. Solutions already implemented for COVID-19, such as emergency safe-supply prescribing and providing housing to people experiencing homelessness, must be sustained once COVID-19 is contained. This pandemic is not only a public health crisis but also a chance to develop and maintain equitable and sustainable solutions to the harms associated with the criminalization of drug use.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por VIH/epidemiología , Hepatitis C/epidemiología , Neumonía Viral/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Sindémico , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/prevención & control , Criminales , Sobredosis de Droga/complicaciones , Sobredosis de Droga/epidemiología , Sobredosis de Droga/prevención & control , Servicios Médicos de Urgencia , Infecciones por VIH/complicaciones , Infecciones por VIH/prevención & control , Hepatitis C/complicaciones , Hepatitis C/prevención & control , Vivienda , Humanos , Pandemias/prevención & control , Neumonía Viral/complicaciones , Neumonía Viral/prevención & control , Prescripciones , Trastornos Relacionados con Sustancias/prevención & control , Estados Unidos/epidemiología , United States Public Health Service
5.
AAPS PharmSciTech ; 21(7): 270, 2020 Oct 06.
Artículo en Inglés | MEDLINE | ID: mdl-33025237

RESUMEN

Abuse-deterrent formulations (ADFs) using physical/chemical barrier approaches limit abuse by providing resistance to dosage form manipulation to limit drug extraction or altered release. Standardizing in vitro testing methods to assess the resistance to manipulation presents a number of challenges, including the variation in particle sizes resulting from the use of various tools to alter the tablet matrix (e.g., grinding, chipping, crushing). A prototype, direct-compression ADF using a sintered polyethylene oxide (PEO) matrix containing dextromethorphan, an enantiomeric form of the opioid, levorphanol, was developed to evaluate testing methodologies for retention of abuse-deterrent properties following dosage form tampering. Sintered PEO tablets were manipulated by grinding, and drug content and release were evaluated for the recovered granules. Drug content analysis revealed that higher amounts of drug were contained in the smaller size granules (< 250 µm, 190% of the theoretical amount) compared with the larger particles (> 250 µm, 55-75% of theoretical amount). Release testing was performed on various size granule fractions (> 850 µm, 500-850 µm, 250-500 µm, and < 250 µm) using USP type I (basket), type II (paddle), and type IV (flow-through) apparatus. The USP type I and type II apparatus gave highly variable release results with poor discrimination among the release rates from different size granules. The observed sticking of the hydrated granules to the baskets and paddles, agglomeration of hydrated granules within the baskets/vessels, and ongoing PEO hydration with subsequent gel formation further altered the particle size and impacted the rate of drug release. The use of a flow-through apparatus (USP type IV) resulted in improved discrimination of drug release from different size granules with less variability due to better dispersion of granules (minimal sticking and aggregation). Drug release profiles from the USP type IV apparatus showed that the larger size granules (> 500 µm) offered continued resistance to drug release following tablet manipulation, but the smaller size granules (< 500 µm) provided rapid drug release that was unhindered by the hydrated granule matrix. Since < 500-µm size particles are preferred for nasal abuse, improved direct-compression ADF formulations should minimize the formation of these smaller-sized particles following tampering to maintain the product's abuse-deterrent features.


Asunto(s)
Liberación de Fármacos , Polietilenglicoles/química , Trastornos Relacionados con Sustancias/prevención & control , Comprimidos/química , Preparaciones de Acción Retardada/química , Composición de Medicamentos/métodos , Humanos , Tamaño de la Partícula
9.
Med Care ; 58 Suppl 2 9S: S88-S93, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32826777

RESUMEN

OBJECTIVES: Nonpharmacological options to treat pain are in demand, in part to address the opioid crisis. One such option is acupuncture. Battlefield acupuncture (BFA) is an auricular needling protocol currently used to treat pain in the Veterans Health Administration. We aimed to identify the advantages and disadvantages of BFA from providers' perspectives. METHODS: We rely on an inductive qualitative approach to explore provider perceptions through thematic analysis of semistructured interviews with 43 BFA providers across the nation. RESULTS: We identified the following themes. Disadvantages included: (1) clinical guidelines are insufficient; (2) patients often request multiple BFA visits from providers; (3) BFA can be uncomfortable; (4) BFA may not be an effective treatment option unless it can be provided "on demand"; and (5) BFA can promote euphoria, which can have deleterious consequences for patient self-care. Perceived advantages included: (1) BFA can simultaneously effectively control pain while reducing opioid use; (2) BFA may alleviate the pain that has been unsuccessfully treated by conventional methods; (3) BFA gives providers a treatment option to offer patients with substance use disorder; (4) BFA helps build a trusting patient-provider relationship; (5) BFA can create the opportunity for hope. CONCLUSIONS: Providers perceive BFA to have many benefits, both clinical and relational, including ways in which it may have utility in addressing the current opioid crisis. BFA is easy to deliver and has potential clinical and relational utility. Efforts to better understand effectiveness are warranted.


Asunto(s)
Acupuntura Auricular/métodos , Actitud del Personal de Salud , Manejo del Dolor/métodos , Acupuntura Auricular/efectos adversos , Analgésicos Opioides/administración & dosificación , Protocolos Clínicos , Euforia/fisiología , Femenino , Humanos , Masculino , Guías de Práctica Clínica como Asunto , Investigación Cualitativa , Calidad de Vida , Automanejo/métodos , Automanejo/psicología , Trastornos Relacionados con Sustancias/prevención & control , Factores de Tiempo , Salud de los Veteranos
10.
Artículo en Inglés | MEDLINE | ID: mdl-32759842

RESUMEN

This study aims to identify and describe the patterns of shared perspectives of students and supervisory staff associated with their interaction in drug use prevention. We applied the Q methodology to cluster participants into groups according to the similarities of their Q sorts. A total of 31 pairs of students and their supervisory staff participated in the study to rank the designed Q statements. The Q factor analysis for supervisory staff revealed a five-factor solution that accounted for 58% of the total variance. Another five-factor solution for the students explained 49% of the total variance. One similarity between the groups was the need to enhance the involvement of significant others to help the students quit drugs. A major identified difference between the groups was that whereas the students highlighted the importance of health consequences of drug use in helping them stop use, the supervisory staff did not. The elucidation of similarities and differences between supervisory staff and students could offer more insightful strategies of preventing the drug use.


Asunto(s)
Estudiantes , Trastornos Relacionados con Sustancias , Adolescente , Análisis Factorial , Femenino , Humanos , Masculino , Trastornos Relacionados con Sustancias/prevención & control
11.
BMC Public Health ; 20(1): 1235, 2020 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-32795290

RESUMEN

BACKGROUND: The Icelandic Prevention Model (IPM) is a collaborative upstream model that was designed to influence risk and protective factors related to substance use within the community, school, peer and family contexts. By engaging whole communities, the IPM has been found to be effective in reducing youth substance use behaviours across Iceland. As an extension to the IPM's participatory approach, this research will examine how youth involvement can enhance outcomes. In addition, this research will evaluate whether the IPM approach is beneficial for mental health promotion and general youth wellbeing. METHODS: The present research protocol applies the bioecological model within a participatory mixed-method case study design to examine the implementation of the IPM in a rural community in Canada. This study was designed to identify whether the Icelandic substance use prevention model is effective in reducing substance use and promoting mental health and development for Canadian youth. It will also explore how to engage youth within the approach and how this adaptation influences implementation and outcomes. DISCUSSION: The findings from this study will contribute to our understanding of upstream prevention of youth substance use and will be used to support scaling of the IPM across Canada.


Asunto(s)
Modelos Organizacionales , Prevención Primaria/organización & administración , Población Rural , Trastornos Relacionados con Sustancias/prevención & control , Adolescente , Canadá , Femenino , Humanos , Masculino , Proyectos de Investigación
12.
PLoS One ; 15(8): e0237327, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32797074

RESUMEN

INTRODUCTION: In order to foster dental and dental hygiene practices that are inclusive, sensitive to diversity, equitable, and without prejudice, a call to broadly teach cultural diversity within dental and dental hygiene education has been made. The research question of this study was "to what extent can an interactive and open dialogue about substance use, queer health, and social responsibility foster transformative learning?" METHODS: A collaborative and interdisciplinary project engaged the community as a teacher over the Summer and Fall of 2019 to address issues of substance use, queer health, and social responsibility and was delivered to 55 first-year undergraduate dental and 23 third-year dental hygiene students over three educational sessions. Dental and dental hygiene students were asked to reflect, in writing, on each session using between 200 and 400 words. Textual information from students' self-reflections and from the community's feedback were analyzed thematically for content (e.g., codes and themes). RESULTS: In total, 128 written reflections-for an average of 42 reflections per session-were gathered and analyzed interactively by the authors. Three major themes emerged: feeling privileged, breaking stereotypes, and coalescing learning. Feedback from the participating community members highlighted changes to be implemented in these sessions in the future, including more opportunities for small group activities in class. CONCLUSIONS: The three major themes that emerged from the thematic analysis of the self-reflections and community member feedback (feeling privileged, breaking stereotypes, and coalescing leaning) further highlighted the impact of community-driven curricula on students' learning in regard to substance use, queer health, and social responsibility. Further work is critical to understand the impact of such a pedagogy on students' practices once they leave their undergraduate programs.


Asunto(s)
Participación de la Comunidad , Educación en Odontología/métodos , Prácticas Interdisciplinarias , Higiene Bucal/psicología , Canadá , Curriculum , Humanos , Aprendizaje , Educación del Paciente como Asunto , Minorías Sexuales y de Género/psicología , Responsabilidad Social , Estudiantes de Odontología , Trastornos Relacionados con Sustancias/prevención & control
13.
Pediatrics ; 146(3)2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32769198

RESUMEN

CONTEXT: An updated synthesis of research on substance abuse prevention programs can promote enhanced uptake of programs with proven effectiveness, particularly when paired with information relevant to practitioners and policy makers. OBJECTIVE: To assess the strength of the scientific evidence for psychoactive substance abuse prevention programs for school-aged children and youth. DATA SOURCES: A systematic review was conducted of studies published up until March 31, 2020. STUDY SELECTION: Articles on substance abuse prevention programs for school-aged children and youth were independently screened and included if they met eligibility criteria: (1) the program was designed for a general population of children and youth (ie, not designed for particular target groups), (2) the program was delivered to a general population, (3) the program only targeted children and youth, and (4) the study included a control group. DATA EXTRACTION: Two reviewers independently evaluated study quality and extracted outcome data. RESULTS: Ninety studies met eligibility criteria, representing 16 programs. Programs evaluated with the largest combined sample sizes were Drug Abuse Resistance Education, Project Adolescent Learning Experiences Resistance Training, Life Skills Training (LST), the Adolescent Alcohol Prevention Trial, and Project Choice. LIMITATIONS: Given the heterogeneity of outcomes measured in the included studies, it was not possible to conduct a statistical meta-analysis of program effectiveness. CONCLUSIONS: The most research has been conducted on the LST program. However, as with other programs included in this review, studies of LST effectiveness varied in quality. With this review, we provide an updated summary of evidence for primary prevention program effectiveness.


Asunto(s)
Prevención Primaria/normas , Evaluación de Programas y Proyectos de Salud/normas , Trastornos Relacionados con Sustancias/prevención & control , Adolescente , Niño , Humanos , Prevención Primaria/métodos , Evaluación de Programas y Proyectos de Salud/métodos , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/psicología
14.
J Card Surg ; 35(10): 2657-2662, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32720337

RESUMEN

BACKGROUND AND AIM: The opioid epidemic has become a major public health crisis in recent years. Discharge opioid prescription following cardiac surgery has been associated with opioid use disorder; however, ideal practices remain unclear. Our aim was to examine current practices in discharge opioid prescription among cardiac surgeons and trainees. METHODS: A survey instrument with open- and closed-ended questions, developed through a 3-round Delphi method, was circulated to cardiac surgeons and trainees via the Canadian Society of Cardiac Surgeons. Survey questions focused on routine prescription practices including type, dosage and duration. Respondents were also asked about their perceptions of current education and guidelines surrounding opioid medication. RESULTS: Eighty-one percent of respondents reported prescribing opioids at discharge following routine sternotomy-based procedures, however, there remained significant variability in the type and dose of medication prescribed. The median (interquartile range) number of pills prescribed was 30 (20-30) with a median total dose of 135 (113-200) Morphine Milligram Equivalents. Informal teaching was the most commonly reported primary influence on prescribing habits and a lack of formal education regarding opioid prescription was associated with a higher number of pills prescribed. A majority of respondents (91%) felt that there would be value in establishing practice guidelines for opioid prescription following cardiac surgery. CONCLUSIONS: Significant variability exists with respect to routine opioid prescription at discharge following cardiac surgery. Education has come predominantly from informal sources and there is a desire for guidelines. Standardization in this area may have a role in combatting the opioid epidemic.


Asunto(s)
Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Procedimientos Quirúrgicos Cardíacos , Trastornos Relacionados con Opioides/etiología , Trastornos Relacionados con Opioides/prevención & control , Manejo del Dolor/métodos , Dolor Postoperatorio/tratamiento farmacológico , Prescripciones/estadística & datos numéricos , Trastornos Relacionados con Sustancias/etiología , Trastornos Relacionados con Sustancias/prevención & control , Encuestas y Cuestionarios , Apoyo a la Formación Profesional , Canadá/epidemiología , Femenino , Humanos , Masculino , Trastornos Relacionados con Opioides/epidemiología , Alta del Paciente , Pautas de la Práctica en Medicina/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Cirujanos
15.
Prax Kinderpsychol Kinderpsychiatr ; 69(4): 353-374, 2020 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-32615894

RESUMEN

Mindfulness in Development-oriented Approaches to Substance Use Prevention and Therapy: Rationale, Design and Objectives of the Research Consortium IMAC-Mind Substance use disorders (SUD) are a major contributor to morbidity and mortality. They are typically initiated during adolescence and can have fatal implications for healthy development. Despite substantial scientific advances, there remains a need to prioritize research directed at reducing risks for SUD, particularly in vulnerable periods and populations from a developmental perspective. Research indicates that reward sensitivity, impulsivity, deficient self-regulation, and stress reactivity develop markedly in childhood and adolescence and play an important role in the initiation and maintenance of SUD. A growing number of research results suggest that these factors can be favorably influenced by mindfulness-based interventions and that mindfulness-based exercises can be successfully integrated into established prevention and treatment programs. In this paper we summarize the conceptual relationships between the development and maintenance of addiction disorders and mindfulness, discuss existing empirical findings with regard to childhood and adolescence, and present the aims, study designs and intervention models of the subprojects from the ongoing research network "IMAC-Mind: Improving Mental Health and Reducing Addiction in Childhood and Adolescence through Mindfulness: Mechanisms, Prevention and Treatment".


Asunto(s)
Salud Mental , Atención Plena , Trastornos Relacionados con Sustancias/prevención & control , Trastornos Relacionados con Sustancias/terapia , Adolescente , Conducta Adictiva/prevención & control , Conducta Adictiva/terapia , Niño , Humanos , Imidazoles
16.
Psychol Trauma ; 12(S1): S274-S275, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32496105

RESUMEN

Globally, the Coronavirus-2019 (COVID-19) pandemic situation has affected the education system, forcing students to start distance learning. Consequently, education of students reverted to online platforms or TV station broadcasts. Extracurricular programs have also experienced a setback given the natural prioritization of mandatory school subjects. Meanwhile, the United Nations Office on Drugs and Crime (UNODC) was implementing a teacher-led extracurricular activity for children of age 10-15 years to prevent substance use and other negative life and social consequences (Lions Quest Skills for Adolescence [LQSFA]). Due to the COVID-19 pandemic, LQSFA was difficult to sustain, partly as it was considered extracurricular and partly given its interactive requirement that was difficult to apply through distance learning. Nevertheless, schools' facilitators managed to adapt the program information sharing and communication strategies with the student groups and identified essential sessions allowing continuity of program implementation and utilization of critical program skills during COVID-19 pandemic. The practical implication of the facilitators' assessment of the relevance, value, motivation and feasibility of the implementation of the LQSFA program within the current COVID-19 circumstances calls for the eminent need for adaptation of its implementation modality to meet the current educational delivery circumstances. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Asunto(s)
Infecciones por Coronavirus , Educación a Distancia , Pandemias , Neumonía Viral , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Aprendizaje Social , Estudiantes , Trastornos Relacionados con Sustancias/prevención & control , Adolescente , Niño , Croacia , Humanos
17.
JAMA ; 323(22): 2310-2328, 2020 06 09.
Artículo en Inglés | MEDLINE | ID: mdl-32515820

RESUMEN

Importance: Illicit drug use is among the most common causes of preventable morbidity and mortality in the US. Objective: To systematically review the literature on screening and interventions for drug use to inform the US Preventive Services Task Force. Data Sources: MEDLINE, PubMed, PsycINFO, Embase, and Cochrane Central Register of Controlled Trials through September 18, 2018; literature surveillance through September 21, 2019. Study Selection: Test accuracy studies to detect drug misuse and randomized clinical trials of screening and interventions to reduce drug use. Data Extraction and Synthesis: Critical appraisal and data abstraction by 2 reviewers and random-effects meta-analyses. Main Outcomes and Measures: Sensitivity, specificity, drug use and other health, social, and legal outcomes. Results: Ninety-nine studies (N = 84 206) were included. Twenty-eight studies (n = 65 720) addressed drug screening accuracy. Among adults, sensitivity and specificity of screening tools for detecting unhealthy drug use ranged from 0.71 to 0.94 and 0.87 to 0.97, respectively. Interventions to reduce drug use were evaluated in 52 trials (n = 15 659) of psychosocial interventions, 7 trials (n = 1109) of opioid agonist therapy, and 13 trials (n = 1718) of naltrexone. Psychosocial interventions were associated with increased likelihood of drug use abstinence (15 trials, n = 3636; relative risk [RR], 1.60 [95% CI, 1.24 to 2.13]; absolute risk difference [ARD], 9% [95% CI, 5% to 15%]) and reduced number of drug use days (19 trials, n = 5085; mean difference, -0.49 day in the last 7 days [95% CI, -0.85 to -0.13]) vs no psychosocial intervention at 3- to 4-month follow-up. In treatment-seeking populations, opioid agonist therapy and naltrexone were associated with decreased risk of drug use relapse (4 trials, n = 567; RR, 0.75 [95% CI, 0.59 to 0.82]; ARD, -35% [95% CI, -67% to -3%] and 12 trials, n = 1599; RR, 0.73 [95% CI, 0.62 to 0.85]; ARD, -18% [95% CI, -26% to -10%], respectively) vs placebo or no medication. While evidence on harms was limited, it indicated no increased risk of serious adverse events. Conclusions and Relevance: Several screening instruments with acceptable sensitivity and specificity are available to screen for drug use, although there is no direct evidence on the benefits or harms of screening. Pharmacotherapy and psychosocial interventions are effective at improving drug use outcomes, but evidence of effectiveness remains primarily derived from trials conducted in treatment-seeking populations.


Asunto(s)
Tamizaje Masivo/normas , Antagonistas de Narcóticos/uso terapéutico , Psicoterapia , Detección de Abuso de Sustancias/normas , Trastornos Relacionados con Sustancias/diagnóstico , Adolescente , Adulto , Femenino , Humanos , Tamizaje Masivo/efectos adversos , Tamizaje Masivo/métodos , Naloxona/efectos adversos , Naloxona/uso terapéutico , Antagonistas de Narcóticos/efectos adversos , Guías de Práctica Clínica como Asunto , Embarazo , Sensibilidad y Especificidad , Detección de Abuso de Sustancias/métodos , Trastornos Relacionados con Sustancias/tratamiento farmacológico , Trastornos Relacionados con Sustancias/prevención & control , Trastornos Relacionados con Sustancias/terapia , Encuestas y Cuestionarios
18.
JAAPA ; 33(6): 31-33, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32452959

RESUMEN

Cancer-related pain is an ongoing concern for patients and families. Clinicians should include pain management or palliative care specialists who have advanced knowledge in pharmacotherapy and who have the ability to perform interventional procedures to help alleviate patients' pain and reduce opioid use. This article discusses available interventions for patients with cancer pain.


Asunto(s)
Dolor en Cáncer/terapia , Colaboración Intersectorial , Manejo del Dolor/métodos , Cuidados Paliativos/métodos , Grupo de Atención al Paciente , Analgésicos/administración & dosificación , Analgésicos Opioides/efectos adversos , Utilización de Medicamentos/estadística & datos numéricos , Humanos , Bloqueo Nervioso , Estimulación de la Médula Espinal/instrumentación , Trastornos Relacionados con Sustancias/prevención & control
20.
JAMA ; 323(20): 2067-2079, 2020 05 26.
Artículo en Inglés | MEDLINE | ID: mdl-32453373

RESUMEN

Importance: Illicit and nonmedical (use in ways other than instructed) drug use is common in adolescents and young adults and increases the risk of harmful outcomes such as injuries, violence, and poorer academic performance. Objective: To review the benefits and harms of interventions to prevent illicit and nonmedical drug use in children, adolescents, and young adults to inform the US Preventive Services Task Force. Data Sources: MEDLINE, PubMED, PsycINFO, and the Cochrane Central Register of Controlled Trials (January 1, 2013, to January 31, 2019 [children and adolescents]; January 1, 1992, to January 31, 2019 [young adults <25 years]); surveillance through March 20, 2020. Study Selection: Clinical trials of behavioral counseling interventions to prevent initiation of illicit and nonmedical drug use among young people. Data Extraction and Synthesis: Critical appraisal was completed independently by 2 investigators. Data were extracted by 1 reviewer and checked by a second. Random-effects meta-analysis was used to estimate the effect sizes associated with the interventions. Main Outcomes and Measures: Number of times illicit drugs were used; any illicit drug or any cannabis use. Results: Twenty-nine trials (N = 18 353) met inclusion criteria. Health, social, or legal outcomes such as mental health symptoms, family functioning, consequences of drug use, and arrests were reported in 19 trials and most showed no group differences. The effects on illicit drug use in 26 trials among nonpregnant youth (n = 17 811) were highly variable; the pooled result did not show a clinically important or statistically significant association with illicit drug use (standardized mean difference, -0.08 [95% CI, -0.16 to 0.001]; 24 effects [from 23 studies]; n = 12 801; I2 = 57.0%). The percentage of participants using illicit drugs ranged from 2.3% to 38.6% in the control groups and 2.4% to 33.7% in the intervention groups at 3 to 32 months' follow-up. The median absolute risk difference between groups was -2.8%, favoring the intervention group (range, -11.5% to 14.8%). The remaining 3 trials provided a perinatal home-visiting intervention to pregnant Native American youth. One trial (n=322) found a reduction in illicit drug use at 38 months (eg, cannabis use in the previous month, 10.7% in the intervention group and 15.6% in the control group) but not at earlier follow-up assessments. Across all 29 trials, only 1 trial reported on harms and found no statistically significant group differences. Conclusions and Relevance: The evidence for behavioral counseling interventions to prevent initiation of illicit and nonmedical drug use among adolescents and young adults was inconsistent and imprecise, with some interventions associated with reduction in use and others associated with no benefit or increased use. Health, social, and legal outcomes were sparsely reported, and few showed improvements.


Asunto(s)
Terapia Conductista , Consejo , Educación en Salud , Drogas Ilícitas , Medicamentos bajo Prescripción , Atención Primaria de Salud , Trastornos Relacionados con Sustancias/prevención & control , Adolescente , Consumo de Bebidas Alcohólicas/prevención & control , Niño , Ensayos Clínicos como Asunto , Humanos , Abuso de Marihuana/prevención & control , Guías de Práctica Clínica como Asunto , Uso de Tabaco/prevención & control , Adulto Joven
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