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Rev Prat ; 70(6): 657-659, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-33058613


Epidemiology of illicit substances use in france The landscape of illicit substances use is evolving in France, with dealers going digital. Cannabis and cocaine are consumed by 44% and 5% of French subjects, respectively, and are the most frequent motive for care. Other illicit substances such as ecstasy (MDMA), amphetamines, LSD and other hallucinogenic products are used by 2-3% of French subjects. Heroin and other opiates, although regularly used by less than 1% of French subjects, are provoking both a severe dependence and medical complications that require a specific treatment.

Cannabis , Drogas Ilícitas , Anfetaminas , França/epidemiologia
MMWR Morb Mortal Wkly Rep ; 69(35): 1189-1197, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32881854


INTRODUCTION: Provisional estimates indicate that drug overdose deaths increased in 2019 after a slight decrease in 2018. In 2018, overdose deaths primarily involved opioids, with continued increases in deaths involving illicitly manufactured fentanyls (IMFs). Deaths involving stimulants such as cocaine and methamphetamine are also increasing, mainly in combination with opioids. METHODS: CDC analyzed data on drug overdose deaths during January-June 2019 from 24 states and the District of Columbia (DC) in the State Unintentional Drug Overdose Reporting System to describe characteristics and circumstances of opioid- and stimulant-involved overdose deaths. RESULTS: Among 16,236 drug overdose deaths in 24 states and DC, 7,936 (48.9%) involved opioids without stimulants, 5,301 (32.6%) involved opioids and stimulants, 2,056 (12.7%) involved stimulants without opioids, and 943 (5.8%) involved neither opioids nor stimulants. Approximately 80% of overdose deaths involved one or more opioid, and IMFs were involved in three of four opioid-involved overdose deaths. IMFs, heroin, cocaine, or methamphetamine (alone or in combination) were involved in 83.8% of overdose deaths. More than three in five (62.7%) overdose deaths had documentation of at least one potential opportunity for overdose prevention intervention. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Identifying opportunities to intervene before an overdose death and implementing evidence-based prevention policies, programs, and practices could save lives. Strategies should address characteristics of overdoses involving IMFs, such as rapid overdose progression, as well as opioid and stimulant co-involvement. These efforts should be complemented by efforts to prevent initiation of prescription opioid and stimulant misuse and illicit drug use.

Analgésicos Opioides/envenenamento , Estimulantes do Sistema Nervoso Central/envenenamento , Overdose de Drogas/mortalidade , Adolescente , Adulto , Idoso , District of Columbia/epidemiologia , Feminino , Humanos , Drogas Ilícitas/envenenamento , Masculino , Pessoa de Meia-Idade , Uso Indevido de Medicamentos sob Prescrição/efeitos adversos , Estados Unidos/epidemiologia , Adulto Jovem
Environ Pollut ; 266(Pt 3): 115162, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32771868


Chemical analysis of plasma samples of wild fish from the Sava River (Croatia) revealed the presence of 90 different pharmaceuticals/illicit drugs and their metabolites (PhACs/IDrgs). The concentrations of these PhACs/IDrgs in plasma were 10 to 1000 times higher than their concentrations in river water. Antibiotics, allergy/cold medications and analgesics were categories with the highest plasma concentrations. Fifty PhACs/IDrgs were identified as chemicals of concern based on the fish plasma model (FPM) effect ratios (ER) and their potential to activate evolutionary conserved biological targets. Chemicals of concern were also prioritized by calculating exposure-activity ratios (EARs) where plasma concentrations of chemicals were compared to their bioactivities in comprehensive ToxCast suite of in vitro assays. Overall, the applied prioritization methods indicated stimulants (nicotine, cotinine) and allergy/cold medications (prednisolone, dexamethasone) as having the highest potential biological impact on fish. The FPM model pointed to psychoactive substances (hallucinogens/stimulants and opioids) and psychotropic substances in the cannabinoids category (i.e. CBD and THC). EAR confirmed above and singled out additional chemicals of concern - anticholesteremic simvastatin and antiepileptic haloperidol. Present study demonstrates how the use of a combination of chemical analyses, and bio-effects based risk predictions with multiple criteria can help identify priority contaminants in freshwaters. The results reveal a widespread exposure of fish to complex mixtures of PhACs/IDrgs, which may target common molecular targets. While many of the prioritized chemicals occurred at low concentrations, their adverse effect on aquatic communities, due to continuous chronic exposure and additive effects, should not be neglected.

Drogas Ilícitas , Poluentes Químicos da Água/análise , Animais , Croácia , Monitoramento Ambiental , Peixes , Rios
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32661188


Cannabinoids, the psychoactive compounds in marijuana, are one of the most commonly used substances in the United States. In this review, we summarize the impact of marijuana on child and adolescent health and discuss the implications of marijuana use for pediatric practice. We review the changing epidemiology of cannabis use and provide an update on medical use, routes of administration, synthetic marijuana and other novel products, the effect of cannabis on the developing brain, other health and social consequences of use, and issues related to marijuana legalization.

Cannabis , Uso da Maconha , Adolescente , Comportamento do Adolescente/efeitos dos fármacos , Animais , Encéfalo/efeitos dos fármacos , Encéfalo/embriologia , Encéfalo/crescimento & desenvolvimento , Canabidiol/farmacologia , Canabidiol/uso terapêutico , Canabinoides/efeitos adversos , Canabinoides/síntese química , Canabinoides/farmacologia , Cannabis/efeitos adversos , Cannabis/química , Cannabis/envenenamento , Criança , Comportamento Infantil/efeitos dos fármacos , Interações Medicamentosas , Endocanabinoides/fisiologia , Feminino , Feto/efeitos dos fármacos , Humanos , Drogas Ilícitas/efeitos adversos , Masculino , Abuso de Maconha/epidemiologia , Abuso de Maconha/terapia , Uso da Maconha/efeitos adversos , Uso da Maconha/epidemiologia , Uso da Maconha/legislação & jurisprudência , Uso da Maconha/psicologia , Meios de Comunicação de Massa , Maconha Medicinal/efeitos adversos , Maconha Medicinal/uso terapêutico , Leite Humano/química , Transtornos Neurocognitivos/induzido quimicamente , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Receptores de Canabinoides/efeitos dos fármacos , Receptores de Canabinoides/fisiologia , Uso de Tabaco/epidemiologia
J Anal Toxicol ; 44(7): 697-707, 2020 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-32685960


New psychoactive substances (NPS) are a major public health problem, primarily due to the increased number of acute poisoning cases. Detection of these substances is a challenge. The aim of this research was to develop and validate a sensitive screening method for 104 drugs of abuse, including synthetic cannabinoids, synthetic cathinones, fentanyl analogues, phenethylamines and other abused psychoactive compounds (i.e., THC, MDMA, LSD and their metabolites) in oral fluid by liquid chromatography-tandem mass spectrometry (LC-MS-MS). The Quantisal™ oral fluid device was used to collect oral fluid samples. The oral fluid-elution buffer mixture (500-µL sample) was extracted with t-butyl methyl ether, and chromatographic separation was performed on a Raptor™ biphenyl column (100 × 2.1 mm ID, 2.7 µm), with a total run time of 13.5 min. Limits of detection were established at three concentrations (0.05, 0.1 or 1 ng/mL) for most analytes, except for acetyl norfentanyl and mescaline (5 ng/mL). Matrix effects were generally <20% and overall extraction recoveries >60%. The highest matrix effect was observed within the synthetic cannabinoid group (PB22, -55.5%). Lower recoveries were observed for 2C-T (47.2%) and JWH-175 (58.7%). Recoveries from the Quantisal™ device were also evaluated for all analytes (56.7-127%), with lower recoveries noted for 25I-NBOMe, valerylfentanyl and mCPP (56.7, 63.0 and 69.9%, respectively). Drug stability in oral fluid was evaluated at 15, 60 and 90 days and at 25, 4 and -20°C. As expected, greater stability was observed when samples were stored at -20°C, but even when frozen, some NPS (e.g., synthetic cannabinoids) showed more than 20% degradation. The method was successfully applied to the analysis of seven authentic oral fluid samples positive for 17 different analytes. The method achieved good sensitivity and simultaneous detection of a wide range of NPS.

Drogas Ilícitas/análise , Psicotrópicos/análise , Detecção do Abuso de Substâncias/métodos , Canabinoides , Cromatografia Líquida , Limite de Detecção , Piperazinas , Espectrometria de Massas em Tandem
Rev. int. androl. (Internet) ; 18(2): 75-78, abr.-jun. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193763


OBJETIVOS: La utilización con fines recreativos de sustancias de abuso asociadas a algunos medicamentos también empleados en estos contextos obliga al profesional a conocer la posibilidad de interacciones entre ambos. El objetivo de la presente revisión sistemática es actualizar la información disponible sobre la seguridad cardiovascular de la asociación de cannabis y sildenafilo. MATERIALES Y MÉTODOS: Se llevó a cabo una revisión sistemática en las bases de datos PubMed, PreMedline, Medline, Embase, ChemID, HSRPROJ, POPLINE y TOXLINE, desde el inicio de las bases de datos hasta el 1 de marzo del 2018 con los términos clave «sildenafil», «vardenafil», «tadalafil», «phosphodiesterase inhibitors» y «cannabis», combinándolos y cruzándolos mediante operadores booleanos con «adverse effects» y «cardiovascular». No se restringió por idioma ni por tipo de estudio. RESULTADOS: Se encontraron 13 publicaciones, de las cuales 5 analizaban la combinación de cannabis y sildenafilo como un nuevo estilo de uso recreativo, no médico, del consumo conjunto de ambas sustancias, pero solo 3lo relacionaban con alteraciones cardiacas: un infarto posterior sin onda Q, otro sin elevación ST y un síndrome coronario agudo. CONCLUSIONES: La gravedad de los eventos cardiovasculares de sildenafilo asociado a cannabis obliga al profesional a tenerlos en cuenta ante cuadros de miocardiopatía isquémica de difícil filiación

OBJECTIVES: The recreational use of drugs of abuse associated to therapeutically used drugs in sexual contexts forces the health care professional to know the possibility of drug-drug interactions among them. The aim of this review is updating the available information on cardiovascular safety of recreational use of sildenafil and cannabis. MATERIALS AND METHODS: A systematic search in databases PubMed, PreMedline, Medline, Embase, ChemID, HSRPROJ, POPLINE and TOXLINE, from the start of the databases until to March 1, 2018 was made. Search terms were "sildenafil", "vardenafil", "tadalafil", "phosphodiesterase inhibitors" and "cannabis", combining and crossing them by means of Boolean operators with "adverse effects" and "cardiovascular". No restrictions for language or type of study were made. RESULTS: Thirteen papers were found, 5out of them analyzed cannabis and sildenafil combination as a new style of recreational non-medical use. Only 3papers related sildenafil-cannabis association with cardiovascular events: one posterior myocardial infarction without Q wave, one myocardial infarction without ST elevation and one acute coronary syndrome. CONCLUSIONS: Severity of sildenafil-cannabis-related cardiovascular events forces the healthcare professionals to take them into account and considering them in clinical pictures of an ischemic cardiomyopathy hard to classify

Humanos , Masculino , Uso da Maconha/efeitos adversos , Citrato de Sildenafila/efeitos adversos , Interações Medicamentosas , Vasodilatadores/efeitos adversos , Drogas Ilícitas/efeitos adversos , Doença das Coronárias
Rev. SPAGESP ; 21(1): 143-152, jan.-jun. 2020. tab
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-1092178


Este artigo tem como objetivo analisar o conceito de resiliência oculta expresso nas letras de músicas do gênero rap. O estudo se configura como de natureza qualitativa, exploratório-descritivo, a partir da pesquisa documental. A pesquisa utilizou a musicografia do grupo de rap "Facção Central". No total, foram analisadas 125 músicas, sendo que 12 delas faziam menção direta a aspectos relacionados à resiliência oculta. A partir do material analisado, foram elaboradas 3 categorias: 1) Recursos materiais obtidos no crime; 2) Identidade e sensação de poder; 3) Relacionamentos afetivo-sexual. Os resultados apontam que, mesmo com os possíveis danos, pessoais e sociais, as atividades ilícitas, em especial o tráfico de drogas, podem trazer sentidos pessoais positivos às pessoas, sobretudo adolescentes e jovens de camadas sociais desfavorecidas. Os achados deste estudo reiteram as hipóteses sobre o conceito de resiliência oculta e convida pesquisadores a investirem neste campo temático.

This article aims to analyze the concept of hidden resilience expressed in the lyrics of rap songs. The study is configured as qualitative, exploratory-descriptive, based on documentary research. The research used the musicography of the rap group "Facção Central". In total, 125 songs were analyzed, 12 of which made direct mention of aspects related to hidden resilience. From the analyzed material, 3 categories were elaborated: 1) Material resources obtained in the crime; 2) Identity and feeling of power; 3) Affective-sexual relationships. The results show that even with the possible personal and social damage, illicit activities especially drug trafficking can bring positive personal meanings to people mainly adolescents and young people from disadvantaged social strata. The findings of this study reiterate the hypotheses about the concept of hidden resilience and invite researchers to invest in this thematic field.

Este artículo tiene como objetivo analizar el concepto de resistencia oculta expresado en las letras de las canciones de rap. El estudio está configurado como cualitativo, exploratorio-descriptivo, basado en la investigación documental. La investigación utilizó la musicografía del grupo de rap "Facção Central". En total, se analizaron 125 canciones, 12 de las cuales mencionaron directamente aspectos relacionados con la resistencia oculta. A partir del material analizado, se elaboraron 3 categorías: 1) Recursos materiales obtenidos en el delito; 2) Identidad y sentimiento de poder; 3) Relaciones afectivo-sexuales. Los resultados muestran que, incluso con el posible daño, las actividades ilícitas personales y sociales, especialmente el tráfico de drogas, pueden traer significados personales positivos a las personas, especialmente a los adolescentes y jóvenes de estratos sociales desfavorecidos. Los resultados de este estudio reiteran las hipótesis sobre el concepto de resiliencia oculta e invitan a los investigadores a invertir en este campo temático.

Poder Psicológico , Drogas Ilícitas , Crime , Vulnerabilidade Social , Populações Vulneráveis , Resiliência Psicológica , Tráfico de Drogas , Música
RECIIS (Online) ; 14(2): 431-443, abr.-jun. 2020. ilus
Artigo em Português | LILACS | ID: biblio-1102832


O estudo que fundamenta este artigo parte das premissas de que o Jornal Nacional da Rede Globo é um jornal de referência e de grande audiência, e de que a imprensa, ao enfocar determinado assunto, e apresentar um enquadramento específico para tal tema ­ no caso, o consumo do crack e as consequências sociais desse consumo ­ influencia, de certa forma, a percepção pública sobre o tema. Quais são os enquadramentos midiáticos dados ao consumo do crack e às implicações sociais da droga na cobertura televisiva feita pelo Jornal Nacional, da Rede Globo? O objetivo é compreender os enquadramentos fornecidos pelo telejornal acerca do consumo do crack, a partir da análise sobre o modo como esse noticiário organiza o conteúdo informativo. Foi aplicada a análise de conteúdo nas reportagens veiculadas no JN no período de 2012 a 2017 e nas entrevistas realizadas com os repórteres responsáveis pela cobertura. Identificamos que o telejornal enquadrou o consumo do crack e as implicações sociais decorrentes do uso da droga como um problema de saúde pública e como um problema social crônico (em menor medida), por um lado; e, por outro, como um problema de segurança pública, em maior medida. A maneira como esse telejornal organiza e dá sentido à questão pode, potencialmente, influir na formulação de políticas públicas, assim como na maneira como a sociedade interpreta o assunto e dá significado ao quadro social do fenômeno do consumo do crack.

The study presented in this article is based on the assumptions that the Jornal Nacional (National News), broadcast by Rede Globo (Globe television networking), is a reference and large audience newscast and that the press, in focusing on a certain subject and presenting a specific framework for some theme ­ in this case, crack use and the social consequences of this use ­ influences, to some extent, the public perception of the topic. What are the frameworks given by media coverage to crack use and the social implications of the drug on televisionthrough the newscast called Jornal Nacional, broadcast by Rede Globo? The goal is to understand the frameworks provided by this newscast about crack consumption, based on the analysis of how it organizes informative content. The content analysis was applied to the reports exhibited in JN from 2012 to 2017 and to interviews with reporters responsible for the coverage of the crack. We identified that the newscast framed the crack use and the social implications of the drug use as a public health problem and as a chronic (to a lesser extent) social problem, on the one hand; and as a public safety issue to a greater extent on the other hand. The way of this newscast organizing and to give meaning to the issue can potentially influence the formulation of public policies, as well as the way of society interpreting the issue and to give meaning to the social context of the crack consumption phenomenon.

El estudio que fundamenta este artículo parte de los supuestos de que el Jornal Nacional de la Rede Globo es un noticiero de referencia y de mucha audiencia, y que la prensa, al centrarse en un tema en particular y presentar un marco específico para ese tema ­ en este caso, el uso del crack y las consecuencias sociales del uso del crack ­ influye, en cierta medida, en la percepción pública del problema. ¿Cuáles son los marcos mediáticos dados al uso de crack y a las implicaciones sociales de la droga en la cobertura televisiva de Jornal Nacional de la Rede Globo? El objetivo es comprender los marcos proporcionados por las noticias del telediario acerca del consumo de crack, basada en el análisis de como ese noticiero organiza el contenido informativo. El análisis de contenidos se aplicó a los reportajes difundidas en el JN de 2012 hasta 2017 y a las entrevistas con los reporteros responsables de la cobertura del crack. Identificamos que el noticiero enmarcó el uso del crack y las implicaciones sociales del uso suyo como un problema de salud pública y como un problema social crónico (en menor medida), por un lado; y como un problema de seguridad pública en mayor medida, por otro lado. La manera como ese telediario organiza y da sentido al problema pueden potencialmente influir en la formulación de políticas públicas, así como en la forma de la sociedad interpretar el tema y de dar sentido al contexto social del fenómeno del consumo de crack.

Humanos , Política Pública , Drogas Ilícitas , Cocaína Crack , Jornalismo , Meios de Comunicação de Massa , Violência , Brasil , Vulnerabilidade Social
PLoS One ; 15(6): e0234639, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525924


BACKGROUND AND AIM: Kratom, or Mitragyna speciosa Korth., is a tropical plant that has been reported to exhibit opioid-like effects. Although opioids have been demonstrated to alter the lipid profile of regular users, data on the lipid-altering effects of kratom are scarce. This study aimed to compare the fasting lipid profile of regular kratom users to that of healthy subjects who do not use kratom. It also determined the association between various characteristics of kratom users and the serum triglycerides, total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels of regular kratom users. METHODS: A total of 200 participants (n = 100 kratom users and n = 100 healthy subjects who do not use kratom) were recruited for this analytical cross-sectional study. Data on sociodemographic status, kratom use characteristics, cigarette smoking, physical activity, body mass index (BMI), fasting serum lipid profile, and liver function were collected from all participants. RESULTS: The liver parameters of the study participants were within normal range. The serum total cholesterol and LDL of kratom users were significantly lower than those of healthy subjects who do not use kratom. There were no significant differences in the serum triglyceride and HDL levels. However, higher average daily frequency of kratom use and increasing age were associated with increased serum total cholesterol among kratom users. Other kratom use characteristics such as age of first kratom intake, duration of kratom use, and quantity of daily kratom intake were not associated with increased serum triglyceride, total cholesterol, LDL, and HDL levels. CONCLUSIONS: Our findings suggest regular kratom consumption was not linked to elevated serum lipids, except when there is a higher frequency of daily kratom intake. However, the study was limited by the small sample size, and hence a more comprehensive study with larger sample size is warranted to confirm the findings.

Alcaloides/farmacologia , Drogas Ilícitas/farmacologia , Metabolismo dos Lipídeos , Mitragyna/química , Extratos Vegetais/farmacologia , Adulto , Estudos de Casos e Controles , Colesterol/sangue , Feminino , Humanos , Vida Independente , Lipoproteínas LDL/sangue , Fígado/efeitos dos fármacos , Fígado/metabolismo , Masculino , Triglicerídeos/sangue
Environ Sci Pollut Res Int ; 27(29): 36037-36051, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32594443


Wastewater-based epidemiology (WBE) is a complementary, well-established comprehensive, cost-effective, and rapid technique for monitoring of illicit drugs used in a general population. This systematic review and meta-analysis is the first to estimate the rank and consumption rate of illicit drugs through WBE studies. In the current study, the related investigations regarding the illicit drug consumption rate based on WBE were searched among the international databases including Scopus, PubMed, Science direct, Google scholar, and local database, Magiran from 2012 up to May 2019. The illicit drug consumption rate with 95% confidence intervals was pooled between studies by using random effect model. The heterogeneity was determined using I2 statistics. Also, subgroup analyses were conducted to examine the possible effects of year and location of studies on observed heterogeneity. Meta-analysis of 37 articles indicates that the overall rank order of illicit drugs according to their pooled consumption rate can be summarized as tetrahydrocannabinol or cannabis (7417.9 mg/day/1000 people) > cocaine (655.7 mg/day/1000 people) > morphine (384.9 mg/day/1000 people) > methamphetamine (296.2 mg/day/1000 people) > codeine (222.7 mg/day/1000 people) > methadone (200.2 mg/day/1000 people) > 3,4-methylenedioxymethamphetamine (126.3 mg/day/1000 people) > amphetamine (118.2 mg/day/1000 people) > 2-ethylidene-1,5-dimethyl-3, 3-diphenylpyrrolidine (33.7 mg/day/1000 people). The pooled level rate was 190.16 mg/day/1000 people for benzoylecgonine (main urinary cocaine metabolite), 137.9 mg/day/1000 people for 11-nor-9-carboxy-delta9-tetrahydrocannabinol (main metabolite of cannabis), and 33.7 mg/day/1000 people for 2-ethylidene-1,5-dimethyl-3, 3-diphenylpyrrolidine (main metabolite of methadone). The I2 values for all selected drugs were 100% (P value < 0.001). The results of year subgroup indicated that the changes of heterogeneity for all selected drugs were nearly negligible. The heterogeneity within studies based on continents subgroup just decreased in America for drugs like 11-nor-9-carboxy-delta9-tetrahydrocannabinol (I2 = 24.4%) and benzoylecgonine (I2 = 94.1%). The outcome of this meta-analysis can be used for finding the illicit drugs with global serious problem in view of consumption rate (i.e., cannabis and cocaine) and helping authorities to combat them.

Drogas Ilícitas , Metanfetamina , Poluentes Químicos da Água/análise , Humanos , Detecção do Abuso de Substâncias , Águas Residuárias/análise , Vigilância Epidemiológica Baseada em Águas Residuárias
PLoS One ; 15(6): e0234923, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555604


BACKGROUND: Methamphetamine (MA) is a commonly used substance among youths, particularly those who are living in poor economic conditions with low levels of education and who have had bad childhood experiences. The Akha and Lahu hill tribe youths living on the Thailand-Myanmar-Laos border are identified as the group most vulnerable to MA use in Thailand. The study aimed to estimate the prevalence of MA use and determine its associations with childhood experiences among Akha and Lahu youths aged 15-24 years in northern Thailand. METHODS: A cross-sectional study was performed. Validated and sealed questionnaires were used to gather information from participants after obtaining the informed consent form. Questionnaires were completed by participants and their parents at home. Logistic regression was used to identify the associations between variables at the α = 0.05 level. RESULTS: A total of 710 participants participated in the study: 54.2% were Akha, 52.5% were females, 50.6% were aged 15-17 years, and 11.4% did not have Thai identification card (ID) cards. The overall prevalence of MA use at least once among Akha and Lahu youths was 14.5%. After controlling for all potential confounding factors, 8 variables were found to be associated with MA use. Males had a greater chance of MA use than females (AOR = 4.75; 95% CI = 2.27-9.95). Participants aged 21-24 years had a greater chance of MA use than those aged 15-17 years (AOR = 2.51; 95% CI = 1.11-5.71). Those who had a family member who used MA had a greater chance of MA use than those who did not (AOR = 5.04; 95% CI = 1.66-15.32). Those who had been physically assaulted by a family member while aged 0-5 years had a greater chance of MA use than those who had not (AOR = 2.29; 95% CI = 1.02-5.12). Those who had been physically assaulted by a family member while aged 6-14 years had a greater chance of MA use than those who had not (AOR = 3.15; 95% CI = 1.32-7.54). Those who had a close friend who used alcohol had a greater chance of MA use than those who did not (AOR = 2.24; 95% CI = 1.24-4.72). Those who had a highly confident personality had a greater chance of MA use than those who did not (AOR = 2.35; 95% CI = 1.17-4.69), and those who smoked had a greater chance of MA use than those who did not (AOR = 8.27; 95% CI = 4.42-15.46). CONCLUSIONS: All relevant government and nongovernment agencies together with the Ministry of Public Health Thailand should address MA use among Akha and Lahu youths by properly developing a community health intervention that lowers risk of MA use by addressing family relationships, male youth behaviors, and focused on those individuals with a highly confident personality.

Experiências Adversas da Infância/estatística & dados numéricos , Drogas Ilícitas , Metanfetamina , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Estudos Transversais , Usuários de Drogas , Grupos Étnicos , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Inquéritos e Questionários , Tailândia/epidemiologia , Adulto Jovem
JAMA ; 323(20): 2067-2079, 2020 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-32453373


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.

Terapia Comportamental , Aconselhamento , Educação em Saúde , Drogas Ilícitas , Medicamentos sob Prescrição , Atenção Primária à Saúde , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Consumo de Bebidas Alcoólicas/prevenção & controle , Criança , Ensaios Clínicos como Assunto , Humanos , Abuso de Maconha/prevenção & controle , Guias de Prática Clínica como Assunto , Uso de Tabaco/prevenção & controle , Adulto Jovem
JAMA ; 323(20): 2060-2066, 2020 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-32453374


Importance: In 2017, an estimated 7.9% of persons aged 12 to 17 years reported illicit drug use in the past month, and an estimated 50% of adolescents in the US had used an illicit drug by the time they graduated from high school. Young adults aged 18 to 25 years have a higher rate of current illicit drug use, with an estimated 23.2% currently using illicit drugs. Illicit drug use is associated with many negative health, social, and economic consequences and is a significant contributor to 3 of the leading causes of death among young persons (aged 10-24 years): unintentional injuries including motor vehicle crashes, suicide, and homicide. Objective: To update its 2014 recommendation, the USPSTF commissioned a review of the evidence on the potential benefits and harms of interventions to prevent illicit drug use in children, adolescents, and young adults. Population: This recommendation applies to children (11 years and younger), adolescents (aged 12-17 years), and young adults (aged 18-25 years), including pregnant persons. Evidence Assessment: Because of limited and inadequate evidence, the USPSTF concludes that the benefits and harms of primary care-based interventions to prevent illicit drug use in children, adolescents, and young adults are uncertain and that the evidence is insufficient to assess the balance of benefits and harms. More research is needed. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care-based behavioral counseling interventions to prevent illicit drug use, including nonmedical use of prescription drugs, in children, adolescents, and young adults. (I statement).

Terapia Comportamental , Aconselhamento , Educação em Saúde , Drogas Ilícitas , Medicamentos sob Prescrição , Atenção Primária à Saúde , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Consumo de Bebidas Alcoólicas/prevenção & controle , Criança , Humanos , Abuso de Maconha/prevenção & controle , Programas de Rastreamento , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Uso de Tabaco/prevenção & controle , Adulto Jovem
Toxicol Lett ; 331: 42-52, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32464236


Synthetic cathinones abuse remains a serious public health problem. Kidney injury has been reported in intoxications associated with synthetic cathinones, but the molecular mechanisms involved have not been explored yet. In this study, the potential in vitro nephrotoxic effects of four commonly abused cathinone derivatives, namely pentedrone, 3,4-dimethylmethcatinone (3,4-DMMC), methylone and 3,4-methylenedioxypyrovalerone (MDPV), were assessed in the human kidney HK-2 cell line. All four derivatives elicited cell death in a concentration- and time-dependent manner, in the following order of potency: 3,4-DMMC >> MDPV > methylone ≈ pentedrone. 3,4-DMMC and methylone were selected to further elucidate the mechanisms behind synthetic cathinones-induced cell death. Both drugs elicited apoptotic cell death and prompted the formation of acidic vesicular organelles and autophagosomes in HK-2 cells. Moreover, the autophagy inhibitor 3-methyladenine significantly potentiated cell death, indicating that autophagy may serve as a cell survival mechanism that protects renal cells against synthetic cathinones toxicity. Both drugs triggered a rise in reactive oxygen and nitrogen species formation, which was completely prevented by antioxidant treatment with N­acetyl­L­cysteine or ascorbic acid. Importantly, these antioxidant agents significantly aggravated renal cell death induced by cathinone derivatives, most likely due to their autophagy-blocking properties. Taken together, our results support an intricate control of cell survival/death modulated by oxidative stress, apoptosis and autophagy in synthetic cathinones-induced renal injury.

Alcaloides/toxicidade , Apoptose/efeitos dos fármacos , Autofagia/efeitos dos fármacos , Drogas Ilícitas/toxicidade , Rim/efeitos dos fármacos , Alcaloides/química , Benzodioxóis/química , Benzodioxóis/toxicidade , Técnicas de Cultura de Células , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Relação Dose-Resposta a Droga , Humanos , Rim/metabolismo , Rim/patologia , Metanfetamina/análogos & derivados , Metanfetamina/química , Metanfetamina/toxicidade , Metilaminas/química , Metilaminas/toxicidade , Pentanonas/química , Pentanonas/toxicidade , Pirrolidinas/química , Pirrolidinas/toxicidade , Espécies Reativas de Nitrogênio/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Fatores de Tempo
Environ Sci Pollut Res Int ; 27(25): 30998-31034, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32361972


Illicit drugs (IDs) and their metabolites are recognized as contaminants of emerging concern. After consumption, illicit drugs are partially metabolized and excreted unchanged in urine and feces or as active metabolites reaching wastewater treatment plants (WWTPs). Furthermore, most WWTPs are insufficient in the treatment of effluents containing IDs, which may be released into aquatic ecosystems. Once in the water or sediment, these substances may interact and affect non-target organisms and some evidences suggest that illicit drugs may exhibit pseudo-persistence because of a continuous environmental input, resulting in long-term exposure to aquatic organisms that may be negatively affected by these biologically active compounds. We reviewed the literature on origin and consumption, human metabolism after consumption, aquatic occurrences, and toxicity of the major groups of illicit drugs (opioids, cannabis, synthetic drugs, and cocaine). As a result, it could be concluded that illicit drugs and their metabolites are widespread in diverse aquatic ecosystems in levels able to trigger sublethal effects to non-target organisms, besides to concentrate in seafood. This class of emerging contaminants represents a new environmental concern to academics, managers, and policymakers, whose would be able to assess risks and identify proper responses to reduce environmental impacts.

Drogas Ilícitas , Poluentes Químicos da Água/análise , Ecossistema , Monitoramento Ambiental , Humanos , Águas Residuárias
PLoS One ; 15(5): e0232538, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32365132


BACKGROUND: After decades of increased opioid pain reliever prescribing, providers are rapidly reducing prescribing. We hypothesized that reduced access to prescribed opioid pain relievers among patients previously reliant upon opioid pain relievers would result in increased illicit opioid use. METHODS AND FINDINGS: We conducted a retrospective cohort study among 602 publicly insured primary care patients who had been prescribed opioids for chronic non-cancer pain for at least three consecutive months in San Francisco, recruited through convenience sampling. We conducted a historical reconstruction interview and medical chart abstraction focused on illicit substance use and opioid pain reliever prescriptions, respectively, from 2012 through the interview date in 2017-2018. We used a nested-cohort design, in which patients were classified, based on opioid pain reliever dose change, into a series of nested cohorts starting with each follow-up quarter. Using continuation-ratio models, we estimated associations between opioid prescription discontinuation or 30% increase or decrease in dose, relative to no change, and subsequent frequency of heroin and non-prescribed opioid pain reliever use, separately. Models controlled for demographics, clinical and behavioral characteristics, and past use of heroin or non-prescribed opioid pain relievers. A total of 56,372 and 56,484 participant-quarter observations were included from the 597 and 598 participants available for analyses of heroin and non-prescribed opioid pain reliever outcomes, respectively. Participants discontinued from prescribed opioids were more likely to use heroin (Adjusted Odds Ratio (AOR) = 1.57, 95% CI: 1.25-1.97) and non-prescribed opioid pain relievers (AOR = 1.75, 1.45-2.11) more frequently in subsequent quarters compared to participants with unchanged opioid prescriptions. Participants whose opioid pain reliever dose increased were more likely to use heroin more frequently (AOR = 1.67, 1.32-2.12). Results held throughout sensitivity analyses. The main limitations were the observational nature of results and limited generalizability beyond safety-net settings. CONCLUSIONS: Discontinuation of prescribed opioid pain relievers was associated with more frequent non-prescribed opioid pain reliever and heroin use; increased dose was also associated with more frequent heroin use. Clinicians should be aware of these risks in determining pain management approaches.

Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Drogas Ilícitas , Estudos de Coortes , Prescrições de Medicamentos , Feminino , Heroína/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Manejo da Dor , Atenção Primária à Saúde , Estudos Retrospectivos , São Francisco