Psychotropic medicine prescribing and polypharmacy for people with dementia entering residential aged care: the influence of changing general practitioners.

OBJECTIVE: To examine relationships between changing general practitioner after entering residential aged care and overall medicines prescribing (including polypharmacy) and that of psychotropic medicines in particular. DESIGN: Retrospective data linkage study. SETTING, PARTICIPANTS: 45 and Up Study participants in New South Wales with dementia who were PBS concession card holders and entered permanent residential aged care during January 2010 - June 2014 and were alive six months after entry. MAIN OUTCOME MEASURES: Inverse probability of treatment-weighted numbers of medicines dispensed to residents and proportions of residents dispensed antipsychotics, benzodiazepines, and antidepressants in the six months after residential care entry, by most frequent residential care GP category: usual (same as during two years preceding entry), known (another GP, but known to the resident), or new GP. RESULTS: Of 2250 new residents with dementia (mean age, 84.1 years; SD, 7.0 years; 1236 women [55%]), 625 most frequently saw their usual GPs (28%), 645 saw known GPs (29%), and 980 saw new GPs (44%). The increase in mean number of dispensed medicines after residential care entry was larger for residents with new GPs (+1.6 medicines; 95% CI, 1.4-1.9 medicines) than for those attended by their usual GPs (+0.7 medicines; 95% CI, 0.4-1.1 medicines; adjusted rate ratio, 2.42; 95% CI, 1.59-3.70). The odds of being dispensed antipsychotics (adjusted odds ratio [aOR], 1.59; 95% CI, 1.18-2.12) or benzodiazepines (aOR, 1.69; 95% CI, 1.25-2.30), but not antidepressants (aOR, 1.32; 95% CI, 0.98-1.77), were also higher for the new GP group. Differences between the known and usual GP groups were not statistically significant. CONCLUSIONS: Increases in medicine use and rates of psychotropic dispensing were higher for people with dementia who changed GP when they entered residential care. Facilitating continuity of GP care for new residents and more structured transfer of GP care may prevent potentially inappropriate initiation of psychotropic medicines.

[PROBLEMS OF REGULATORY AND LEGAL SUPPLY OF DRUGS CONTAINING NARCOTIC AND PSYCHOTROPIC SUBSTANCES OF OVERSEAS VESSEL].

In the context of the COVID-19 pandemic, the issue of protecting the vital functions of crew members on ship's board in conditions of a long voyage and stay in a confined space is urgent. In addition, excluding cases of infection with a new coronavirus infection, one must not forget about the readiness to provide first and subsequent medical assistance in case of urgent need to any crew member, and this can sometimes be done only by using drugs containing narcotic drugs and psychotropic substances in treatment or medical care. The analysis carried out indicates that there is no normative legal regulation of the composition of a first-aid kit in the Russian Federation, and many of the available international documents are for the most part advisory in nature. In this regard, the article carried out a detailed analysis of the regulatory framework governing the procedure for providing ships for overseas navigation with drugs, including those containing narcotic drugs and psychotropic substances, to protect the health of crew members of sea vessels in the context of the spread of COVID-19 and formulated the appropriate conclusions and recommendations.

New psychoactive substances on dark web markets: From deal solicitation to forensic analysis of purchased substances.

The dark web scene has been drawing the attention of law enforcement agencies and researchers alike. To date, most of the published works on the dark web are based on data gained by passive observation. To gain a more contextualized perspective, a study was conducted in which three vendors were selected on the "Dream Market" dark web marketplace, from whom subsequently several new psychoactive substances (NPS) were ordered. All transactions were documented from the initial drug deal solicitation to the final qualitative analysis of all received samples. From the selected vendors, a total of nine NPS samples was obtained, all of which were analyzed by NMR, HRMS, LC-UV, and two also by x-ray diffraction. According to our analyses, four of the five substances offered under already known NPS names contained a different NPS. The selected vendors therefore either did not know about their product, or deliberately deceived the buyers. Furthermore, two of three obtained samples of purportedly novel NPS were identified as already documented substances sold under a different name. However, the third characterized substance sold as "MPF-47700" was a novel, yet uncharacterized, NPS. Finally, we received a single undeclared substance, later identified as 5F-ADB. In addition to chemical analysis of the nine obtained NPS samples, the methodology used also yielded contextual information about the accessibility of NPS on the dark web, the associated purchase process, and the modus operandi of three NPS vendors. Direct participation in dark web marketplaces seems to provide additional layers of information useful for forensic studies.

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Legislation targeting head shops selling new psychoactive substances and changes in drug-related psychiatric admissions: A national database study.

AIM: New psychoactive substance (NPS) use can negatively impact mental health and may result in drug-related psychiatric admissions (DRPA). Irish youth reported very high rates of NPS use by international standards, the most common being synthetic cannabinoids and cathinones. This occurred in the context of a rapid expansion in specialist high street shops, called head shops, selling NPS in 2010. Government responded to public protests about head shops by enacting legislation in May and August 2010 to end this trade. Many academics argued that such actions were futile. We sought to determine if changes in head shop activity coincided with changes in DRPA. METHOD: The national database on psychiatric admissions was examined focusing on young adults admitted from 2008 to 2012. Joinpoint regression analysis was utilized to examine for the presence of trend changes in DRPA. RESULTS: The monthly rate of DRPA was higher in 2010 than 2008, 2009 and 2012 (P < 0.01). Joinpoint regression analysis identified a significant downward trend change which occurred in July 2010 (95% CI Feb 2010 to April 2011). Young males aged 18 to 24 years showed evidence of greatest change, DRPA falling by 1.4% per month (95% CI 0.7 to 3.7% decline) from May 2010 to December 2012. CONCLUSIONS: Cessation of NPS sale by head shops coincided with a reversal in the upward trend of DRPA, this change being most evident in young men. While correlation does not imply causation, legislation which successfully targets the sale of NPS may result in reduced drug-related mental disorders.

Limiting psychotropic medication prescription on discharge from psychiatric inpatient care: a possible suicide intervention?

OBJECTIVES: Restricting access to lethal means is an effective suicide prevention strategy. However, there is little discussion in the literature about the potential contribution of prescribing practices on discharge from inpatient psychiatric care (which has been established as a high-risk period for suicide) to suicide deaths by overdose of prescribed medication. This study aimed to assess the quantity, toxicity and potential lethality of psychotropic medication being prescribed on discharge from psychiatric care to those with and without indices of suicidality. METHODS: Patient demographic, clinical and prescription data were collected from 50 randomly selected charts following discharge from inpatient psychiatric care. Psychotropic medications (dose × duration) on discharge were converted to their equivalent doses of neuroleptics, antidepressants and anxiolytics to rate toxicity and potential lethality, using the Maudsley Prescribing Guidelines. Mood stabilizing medications were also documented. RESULTS: 39% of prescriptions analysed contained toxic and potentially fatal doses of either neuroleptic or antidepressant equivalent medication. CONCLUSIONS: Patient discharge from inpatient psychiatric care presents a golden opportunity to moderate access to potentially fatal psychotropic medication. Iatrogenic provision of lethal means for suicide during a period of increased risk and in a group at increased suicide risk may impact suicide prevention efforts and requires further in-depth research. Current prescribing practices may be a missed opportunity to intervene in this regard.

Perception of Community Pharmacists in Malaysia About Mental Healthcare and Barriers to Providing Pharmaceutical Care Services to Patients with Mental Disorders.

The aim of this study was to assess community pharmacists' (CPs) perceptions toward mental healthcare, and the barriers faced in providing pharmaceutical care (PC) services to these patients. A 40-item survey was posted to CPs. Ninety-six pharmacists participated. The majority (84.2%) agreed there is a role for CPs to play in mental health care, while approximately 60% agreed it is their responsibility to provide PC to these patients. The biggest barrier to providing this service is the lack of knowledge, cited by close to 50% of respondents. This corresponds with the revelation that close to 60% believe that they have a poor or fair understanding of mental disorders. About 30% of respondents said they do not stock psychotropic drugs at all, mainly due to medico-legal reasons, and low prescription requests. Our findings highlight the need for more training of CPs in managing patients with mental disorders.

[Safety signal detection by the French Addictovigilance Network: Innovative methods of investigation, examples and usefulness for public health]. / Détection des signaux du réseau français d'addictovigilance : méthodes innovantes d'investigation, illustrations et utilité pour la santé publique.

The French Addictovigilance Network aims to monitor all psychoactive substances with abuse potential including prescription drugs and other legal and illegal substances such as new psychoactive substances (NPS) and its consequences in humans. Created in 1990 through a network of regional addictovigilance centres covering the entire country, these pharmacologists with expertise in addictovigilance have developed interface with different partners (physicians, toxicologists, network of community pharmacies, addictology care centers…) and implemented several original tools of pharmacosurveillance (such as DRAMES [death related to the abuse of medicines] in strong collaboration with toxicologists or such OPPIDUM [observation of illegal products and misuse of psychotropic medications]), complementary to the spontaneous reporting. A such multidimensional approach including proactive surveillance by these tools and also among several heterogenous data sources (such as data from hospitals or claims database) is able to detect early addictovigilance signals and warnings as illustrated with three following examples: cannabis use and acute serious cardiovascular disorders, new synthetic opioids (ocfentanil, carfentanil) and severe opiate overdose or deaths, the diverted use of psychoactive drugs (codeine analgesics or sedative H1 antihistamines called purple drank) by adolescents and young adults. The choice of a broad strategy and the multifaceted system implemented by the French Addictovigilance Network using elements of pharmacology (fundamental, clinical, pharmacoepidemiology) expertise is an innovative method to detect early addictovigilance signals, and to describe its characteristics in order to increase awareness of psychoactive substances by patients, users and health professionals.

Nonmedical prescription psychiatric drug use and the darknet: A cryptomarket analysis.

BACKGROUND: Nonmedical prescription psychiatric drug use (NMPDU) is an increasing global health problem, with recent concern focusing on darknet cryptomarkets as sources of procurement. There is a shortage of evidence regarding comparative worldwide NMPDU trends, due in part to data collection difficulties. This problem is particularly marked for non-opioid drugs, particularly those psychiatric drugs which act on the central nervous system (CNS) and have high misuse potential and are associated with high levels of dependency and fatal overdose. This paper therefore has two goals: 1) to report on the kinds of psychiatric prescription drugs available on cryptomarkets, and 2) to use this data to uncover temporal and geographical trends in sales of these products, potentially informing policy regarding NMPDU more generally. METHOD: Digital trace data collected from 31 cryptomarkets in operation between September 2013 and July 2016 was analysed by country of origin descriptively and for trends in the sales for 7 psychiatric drug groupings, based on their main indication or intended use in psychiatric practice. RESULTS: Sedatives (such as diazepam and alprazolam) and CNS stimulants (mainly Adderall, modafinil and methylphenidate) had the greatest share of sales, but usage and trends varied by location. The UK has high and rising levels of sedative sales, whilst the USA has the greatest stimulant sales and increasing sedative rates. Sales of drugs used in the treatment of opioid dependency are also substantial in the USA. The picture is less clear in mainland Europe with high sales levels reported in unexpected Central and Northern European countries. There is evidence of a move towards the more potent sedative alprazolam - already implicated as a source of problematic NMPDU in the USA - in Australia and the UK. Sales of drugs such as antidepressants, antipsychotics, mood stabilisers and antidementia drugs - all drugs with limited abuse potential - were negligible, indicating minimal levels of online cryptomarket procurement for self-medicating mental health problems. CONCLUSION: Predominantly, psychiatric drugs with potent sedative, stimulant or euphoriant effects are sold on cryptomarkets and this varies by country. With some caveats regarding the limitations of cryptomarket digital trace data taken into account, the study of trends of these products sold online over time may offer a novel and increasingly important window onto wider drug purchasing habits.

[Prescription of Psychotropic Drugs with Potentially Restraining Effect: An Analysis of Care Need Assessment Data by MDK Bayern]. / Psychopharmakaverordnungen mit potentiell freiheitseinschränkender Wirkung ­ eine Auswertung von Pflegebegutachtungsdaten des MDK Bayern.

OBJECTIVE: Physical restraints in home care and residential care settings in the form of restraining devices have been reduced in the last years. Now psychotropic drugs with sedating and thus potentially restraining effect are of increasing interest. The objective of this study was to describe prescription of psychotropic drugs for insurants in need of care and factors influencing such prescription. METHODS: On the "Annual Word Elder Abuse Awareness Day", the Medical Service of the Statutory Health Insurance undertook a reference day analysis. During the regular assessment of care needs, distribution of psychotropic drugs according to relevant aspects of care were analyzed. Additionally, prescribed drugs were rated with respect to inappropriateness for elder people according to the Priscus list. RESULTS: Data on 706 insured people were analyzed; 43% of them received at least one psychotropic drug as a regular medication, 22% of them at least one potentially sedating drug. According to the Priscus list, 16% of prescribed drugs were identified as potentially inappropriate for elder people. Significant correlation was shown between prescription of psychotropic drugs and location of assessment, care need, diagnosis and the degree of limitation in daily living skills. CONCLUSION: This paper supports results in literature and emphasizes the discrepancy between restraint in the prescription of psychotropic drugs as advised by experts and distribution of these drugs in reality. Further studies analyzing the quality of prescriptions taking into consideration the individual circumstances of patients are desirable.

[Qualitative study on risk and care practices in nightlife settings with massive presence of people in Buenos Aires City]. / Estudio cualitativo sobre prácticas de riesgo y de cuidado en escenarios nocturnos de presencia masiva de la Ciudad Autónoma de Buenos Aires.

The aim of the present study was to investigate care and risk practices carried out in nightlife settings with massive presence of people in the Autonomous City of Buenos Aires. In addition to this, the perceived reasons behind the consumption of psychoactive substances were investigated. For this purpose, 16 young people between 21 and 35 years of age were interviewed. The data was analyzed following the approach proposed in the grounded theory and using the Atlas.Ti program. Practices were studied at individual, group and environmental levels. Among the risk practices, substance availability, excessive intake and substance mixing were frequently mentioned. Regarding care practices, the value of the group was highlighted by keeping together and providing help to its members. Practical implications of these results are discussed, and limitations and future lines of research are presented.

El objetivo del presente estudio fue indagar las prácticas de cuidado y de riesgo que se despliegan en escenarios nocturnos de presencia masiva de la Ciudad Autónoma de Buenos Aires. Asimismo, se indagaron los motivos percibidos para el consumo de sustancias psicoactivas. Para ello se entrevistó a 16 jóvenes de entre 21 a 35 años de edad. Los datos fueron analizados siguiendo la propuesta de la teoría fundamentada y con el soporte del programa Atlas.Ti. Se analizaron prácticas individuales, prácticas grupales, y a nivel del entorno. Entre las prácticas de riesgo se mencionaron con frecuencia la disponibilidad de las sustancias, la ingesta excesiva y las mezclas. Respecto de las prácticas de cuidado, se destacó el valor del grupo al mantenerse todos juntos y brindar ayuda a sus miembros. Se discuten las implicancias prácticas de estos resultados, y se presentan las limitaciones y líneas futuras de investigación.

Estudio cualitativo sobre prácticas de riesgo y de cuidado en escenarios nocturnos de presencia masiva de la Ciudad Autónoma de Buenos Aires / Qualitative study on risk and care practices in nightlife settings with massive presence of people in Buenos Aires City

RESUMEN El objetivo del presente estudio fue indagar las prácticas de cuidado y de riesgo que se despliegan en escenarios nocturnos de presencia masiva de la Ciudad Autónoma de Buenos Aires. Asimismo, se indagaron los motivos percibidos para el consumo de sustancias psicoactivas. Para ello se entrevistó a 16 jóvenes de entre 21 a 35 años de edad. Los datos fueron analizados siguiendo la propuesta de la teoría fundamentada y con el soporte del programa Atlas.Ti. Se analizaron prácticas individuales, prácticas grupales, y a nivel del entorno. Entre las prácticas de riesgo se mencionaron con frecuencia la disponibilidad de las sustancias, la ingesta excesiva y las mezclas. Respecto de las prácticas de cuidado, se destacó el valor del grupo al mantenerse todos juntos y brindar ayuda a sus miembros. Se discuten las implicancias prácticas de estos resultados, y se presentan las limitaciones y líneas futuras de investigación.

ABSTRACT The aim of the present study was to investigate care and risk practices carried out in nightlife settings with massive presence of people in the Autonomous City of Buenos Aires. In addition to this, the perceived reasons behind the consumption of psychoactive substances were investigated. For this purpose, 16 young people between 21 and 35 years of age were interviewed. The data was analyzed following the approach proposed in the grounded theory and using the Atlas.Ti program. Practices were studied at individual, group and environmental levels. Among the risk practices, substance availability, excessive intake and substance mixing were frequently mentioned. Regarding care practices, the value of the group was highlighted by keeping together and providing help to its members. Practical implications of these results are discussed, and limitations and future lines of research are presented.

Effects of Pain, Insomnia, and Depression on Psychoactive Medication Supply in Older Adults With Osteoarthritis.

BACKGROUND: Determinants of prescribing psychoactive medications for symptom management in older adults remain underexamined despite known risks and cautions concerning these medications. OBJECTIVE: To examine independent and combined effects of pain, concurrent insomnia and depression symptoms on psychoactive medications supplied to older adults with osteoarthritis (OA). RESEARCH DESIGN: Survey data on pain, insomnia, and depression obtained from OA patients screened for a randomized controlled trial were used to identify predictors of psychoactive medication supply [opioids, sedatives, tricyclic antidepressants (TCAs), and non-TCAs] over a 4-year period. SUBJECTS: Group Health Cooperative patients with a diagnosis of OA (N=2976). MEASURES: Survey data on pain (Graded Chronic Pain Scale), insomnia (Insomnia Severity Index), and depression (Patient Health Questionnaire-8); and medications supply assessed from electronic medical records. RESULTS: In negative binomial models, pain [incidence rate ratio (IRR), 2.8-3.5; P<0.001], insomnia (IRR, 2.0; P<0.001), and depression (IRR, 1.5; P<0.05) each independently predicted opioid supply. Insomnia (IRR, 3.2; P<0.001) and depression (IRR, 3.0; P<0.001) each independently predicted sedative supply. Pain (IRR, 2.1; P<0.05) and insomnia (IRR, 2.0; P<0.05) independently predicted TCA supply, whereas only depression (IRR, 2.2; P<0.001) independently predicted non-TCA supply. Combined effects of pain and insomnia/depression on these medications were additive and increased the rate of medication supply 1.5-7.5 times. Combined effects increased with insomnia or depression severity. CONCLUSIONS: Concurrent insomnia and depressive symptoms predicted increased supply of opioids, sedatives, and antidepressants after accounting for pain, indicating the importance of sleep and mood disorders as factors increasing supply of these medications.

Responding to New Psychoactive Substances in the European Union: Early Warning, Risk Assessment, and Control Measures.

New psychoactive substances (NPS) are drugs that are not controlled by the United Nations international drug control conventions of 1961 and 1971 but that may pose similar threats to public health. Many of them are traded as "legal" replacements to controlled drugs such as cannabis, heroin, benzodiazepines, cocaine, amphetamines, and 3,4-methylenedioxymethamphetamine (MDMA). Driven by globalization, there has been a large increase in the availability and, subsequently, harms caused by these substances over the last decade in Europe. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is monitoring more than 670 NPS that have appeared on Europe's drug market in the last 20 years, of which almost 90% have appeared in the last decade. While some recent policy responses have been successful in reducing availability and sales of these substances in some settings - such as "legal highs" and "research chemicals" sold openly in the high street and online - and there are signs that growth in the market is slowing, new challenges have emerged. This includes monitoring a growing number of highly potent substances - including 179 synthetic cannabinoid receptor agonists and 28 fentanils - that can pose a high risk of life-threatening poisoning to users and can cause explosive outbreaks. This chapter briefly traces the origins of NPS, provides an overview of the situation in Europe, and discusses the work of the EMCDDA as part of a legal framework of early warning, risk assessment, and control measures that allows the European Union to rapidly detect, assess, and respond to public health and social threats caused by these substances.

Emergence, Diversity, and Control of New Psychoactive Substances: A Global Perspective.

The phenomenon of new psychoactive substances (NPS), which came to the attention of the wider international community at the beginning of the 2010s, has been unprecedented in terms of the sheer number of substances, their rate of emergence, chemical diversity, and range of pharmacological effects. In particular, the chemical diversity has been a challenge to promoting a better understanding of the NPS market - a fundamental requirement for effective policy decisions and interventions. This manuscript highlights the significant chemical diversity of NPS and describes an alternative, complementary, and pragmatic classification based on pharmacological effects, which aligns NPS to traditional controlled drugs and enhances understanding of the phenomenon. It further reviews actions taken at the international level to address the NPS issue, including changes in the scope of control of some NPS and the enhancement of the United Nations Early Warning Advisory on NPS to deal with the dynamics and evolution of the market.

Public health psychopharmacology: a new research discipline comes of age?

Research evidence guiding the identification of pragmatic and effective actions aimed at improving the selection, availability, affordability and rational prescribing of medicines for mental disorders is sparse and inconsistent. In order to boost the development of new research, in this commentary we suggest to organise and classify all the activities in this area under a common theoretical framework and nomenclature, adopting the term 'public health psychopharmacology'. Public health psychopharmacology is proposed as a research discipline, based on contributions from the fields of regulatory science, health services research and implementation science. Implementing the term public health psychopharmacology may offer advantages, as the scientific community would be more focused on common goals and objectives, with, likely, an increasing body of research evidence of practical use.

Psychotropic drugs in Nepal: perceptions on use and supply chain management.

BACKGROUND: Psychotropic drugs play an important role in the treatment of mental, neurological and substance use disorders. Despite the advancement of the use of psycho-pharmaceuticals in the developed countries, the psychotropic drug production and supply chain management in low- and middle- income countries are still poorly developed. This study aims to explore the perceptions of stakeholders involved in all stages of the psychotropic drug supply chain about the need, quality, availability and effectiveness of psychotropic drugs, as well as barriers to their supply chain management. The study was conducted among 65 respondents from the Kathmandu, Chitwan and Pyuthan districts, grouped into four categories: producers, promoters and distributors (N = 22), policy makers and government actors (N = 8), service providers (N = 21) and service users/family members (N = 14). RESULTS: The respondents reported that psychotropic drugs, despite having side effects, are 1) needed, 2) available in major regional centers and 3) are effective for treating mental health problems. The stigma associated with mental illness, however, forces patients and family members to hide their use of psychotropic drugs. The study found that the process of psychotropic drug supply chain management is similar to other general drugs, with the exceptions of strict pre-approval process, quantity restriction (for production and import), and mandatory record keeping. Despite these regulatory provisions, respondents believed that the misuse of psychotropic drugs is widespread and companies are providing incentives to prescribers and retailers to retain their brand in the market. CONCLUSIONS: The production and supply chain management of psychotropic drugs is influenced by the vested interests of pharmaceutical companies, prescribers and pharmacists. In the context of the government of Nepal's policy of integrating mental health into primary health care and increased consumption of psychotropic drugs in Nepal, there is a need for massive education and awareness as well as strict monitoring and supervision to avoid the misuse of psychotropic drugs.

LEGAL REGULATION OF PROCUREMENT OF NARCOTIC DRUGS IN UKRAINE WITH INVOLVEMENT OF INTERNATIONAL SPECIALIZED ORGANIZATIONS.

The purpose of the study is to analyze specific problems of legal regulation of the procurement of narcotic drugs in Ukraine with the involvement of international specialized organizations. To achieve this goal, statistics have been analyzed concerning the number of people who receive narcotic drugs for the SMT program, the number of their treatment applications, the quantity of drugs purchased for them from the state budget. It is proposed to divide the regulatory legal acts regulating the purchase of narcotic drugs, general and special, and analyze them. The understanding of legal constructions "state procurement" and "public procurement" in scientific literature, national legislation and international legal documents is analyzed. Two groups of subjects of legal relations in the field of procurement of narcotic drugs with the involvement of international specialized organizations have been distinguished out. In the course of the study, a number of problems have been identified that require urgent solutions: insufficient budget financing of drug provision for SMT programs; absence of control over the use of methadone and buprenorphine for SMT programs at the legislative level, as well as the differentiation of the terms "narcotic drugs", "psychotropic substances" and "drugs containing narcotic drugs, psychotropic substances and precursors"; absence of the price of the drug in the selection criteria of international organizations, the lack of economic competition in this field, existence of prepayment for SMT drugs for more than one year, which affects the efficiency of using budgetary funds. It is proposed to make a number of changes to the relevant legal acts.