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1.
Hastings Cent Rep ; 50(3): 15-16, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32596903

RESUMO

Over the past year, our ethics service has had numerous consultations involving patients who use the emergency department for regular dialysis. Sometimes, they have access to outpatient hemodialysis that they forgo; other times, they've been "fired" from this kind of outpatient facility, and so the ED is their last option. In most of these cases, we're called because the patient is disruptive once admitted to the ICU and behavior plans haven't helped. But the call from a resident this March 2020 morning was different, the patient had end-stage renal disease and often missed hemodialysis, but he wasn't disruptive. "It's just that he comes in after using cocaine, and given scarcity with the coronavirus and ICU beds…." I have come to think that this is one of the more insidious effects of the pandemic: that there will be a resurgence of the view that some patients deserve health care by virtue of their compliant behavior and that those who are nonadherent don't.


Assuntos
Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/ética , Falência Renal Crônica/terapia , Pneumonia Viral/epidemiologia , Diálise Renal/ética , Betacoronavirus , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Consultoria Ética , Alocação de Recursos para a Atenção à Saúde/ética , Humanos , Falência Renal Crônica/epidemiologia , Pandemias , Diálise Renal/métodos
2.
Rev Fac Cien Med Univ Nac Cordoba ; 77(2): 79-85, 2020 05 10.
Artigo em Espanhol | MEDLINE | ID: mdl-32558509

RESUMO

Introduction: the use of cocaine and cannabis during pregnancy is a growing problem, of importance for the World Public Health. Women can present a wide range of complications during pregnancy and perinatally, although knowledge about evolution thereafter is scarce. Objectives: to describe and compare health trajectories up to 4 years pospartum of user and not user women of cocaine and/or cannabis during pregnancy. Methods: retrospective cohort study with a comparison group consisting of 2 not users women for each user during pregnancy. User women were detected in Neonatology Division of a public Hospital with an urine pospartum test, between 2009 and 2013. Results: 29 women cocaine and/or cannabis users during pregnancy, and 58 not users were evaluated. In the first group, 93% women were polydrug users. Users had higher frequency of: history of violence in childhood ((p<0,001), previous (p<0,0045) and acquired (p<0,0007) disease, medical (p<0,0001) and odontological (p=0,0002) emergency consultations, hospitalizations (p<0,0001), and violent deaths in relatives, compared with non users. Conclusions: women who used cocaine and/or cocaine during pregnancy had a greater history of violence and illness, emergency medical and dental consultation, hospitalization and deaths, than non users. Injuries where the main cause of hospitalization. In the variables evaluated, the differences between consumers and non-consumers of pregnancy were significative.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Abuso de Maconha/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Argentina/epidemiologia , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Adulto Jovem
4.
Am J Public Health ; 110(4): 580-586, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32078355

RESUMO

Objectives. To describe and report initial outcomes of a low-threshold, group-based primary care medication for opioid use disorder (OUD) program in a federally qualified health center.Methods. We performed a retrospective chart review of patients enrolled in the program from October 4, 2017, to October 3, 2018, in Philadelphia, Pennsylvania. The main outcome measure was time retained in treatment, defined as time from treatment initiation to unplanned treatment termination. Secondary outcomes were the relationships between treatment retention and cocaine use or housing status. We analyzed retention in treatment using Kaplan-Meier survival estimates.Results. The 3- and 6-month retention rates were 82% and 63%, respectively. The log-rank test showed no significant differences for comparisons between homeless versus not homeless (P = .25) and cocaine use versus no cocaine use (P = .12).Conclusions. The medication for OUD program engaged a large number of patients from marginalized groups. Three- and 6-month retention rates were comparable with those reported of other federally qualified health center populations.Public Health Implications. Integrating treatment of OUD into primary care shows promise for increasing access to and retention in medication for OUD services. The federally qualified health center payment structure supports the sustainability of the group visit model.


Assuntos
Buprenorfina/uso terapêutico , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Cooperação do Paciente/estatística & dados numéricos , Adulto , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Philadelphia , Atenção Primária à Saúde/métodos , Estudos Retrospectivos , Resultado do Tratamento , Populações Vulneráveis
5.
Adicciones (Palma de Mallorca) ; 32(1): 32-39, 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192495

RESUMO

Este estudio tuvo como finalidad realizar un análisis retrospectivo de la secuencia de inicio y progresión de las vías más comunes del inicio del consumo de sustancias en una muestra de la población general española. Recopilamos datos de la encuesta nacional de las viviendas del año 2011 sobre el consumo de sustancias en Cataluña, España, respecto de personas no-institucionalizadas de la población general con edades entre los 15-64 años. La muestra final estaba compuesta de 2.069 personas con la misma distribución de edad que la población general. Mostramos la progresión en el inicio de consumo de sustancias mediante la cuantificación de los cambios de un estado anterior, en términos de número de personas y porcentajes ponderados. Aplicamos análisis de supervivencia para valorar las vías más prevalentes halladas en el análisis descriptivo usando modelos de regresión aditivos. La edad media de inicio de consumo fue decreciendo en todas las cohortes desde 1965 hasta 1985-1996: de 17 a 15 para tabaco, de 20 a 16 para cannabis y de 21 a 18 para cocaína. En las personas que usaban las tres sustancias estudiadas, la vía más frecuente fue "tabaco-uso diario de tabaco-cannabis-cocaína". Dichos resultados requieren políticas de salud y estrategias de prevención para aumentar la percepción de los riesgos de las sustancias legales e ilegales. Esto, unido a intervenciones de compañeros bien diseñadas, podría reducir el riesgo de exposición de sustancias ilegales, como cannabis y cocaína, y, por tanto, reducir la probabilidad de un problema de consumo de sustancias en un futuro


The aim of the present study was to retrospectively study the onset and progression sequence of the most frequent pathways of drug use initiation in a sample of the Spanish general population. Data come from the 2011 household survey on drug use in Catalonia, Spain, on non-institutionalized individuals aged 15-64 in the general population. The final sample was of 2,069 individuals and had the same age distribution as the general population. Progressions of drug initiation were pictured by quantifying transitions from a previous state in terms of the number of individuals and weighted percentages. Survival analyses were employed to assess the most prevalent pathways found in the descriptive analysis using additive regression models. Median ages of onset were decreasing in every cohort from 1965 to 1985-1996: from 17 to 15 in tobacco, 20 to 16 in cannabis and 21 to 18 in cocaine. In people who consumed the three drugs studied, the most frequent pathway was "tobacco-daily tobacco-cannabis-cocaine". These results demand health policies and prevention strategies in order to increase perception of the risks of legal and illegal substances. This, together with well-designed peer interventions could reduce the risk of exposure to illegal drugs such as cannabis and cocaine, thus reducing the likelihood of future problem drug use


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Abuso de Maconha/epidemiologia , Alcoolismo/epidemiologia , Tabagismo/epidemiologia , Estudos Retrospectivos , Espanha/epidemiologia
6.
Rev Mal Respir ; 37(1): 45-59, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31883817

RESUMO

Cocaine can be responsible for many psychiatric and/or somatic disorders. The aim of this systematic literature review of data was to expose relations between cocaine use and pulmonary complications. Cocaine can be responsible for acute respiratory symptoms (cough, black sputum, hemoptysis, dyspnea, wheezing, chest pain) and for various pulmonary disorders including barotrauma (pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumopericardium), airway damage, asthma, bronchiolitis obliterans with organizing pneumonia, acute pulmonary edema, alveolar hemorrhage, alveolar pneumonia with carbonaceous material, bullous emphysema, acute eosinophilic pneumonia, pulmonary granulomatosis caused by talc or cellulose, interstitial pneumonitis and pulmonary fibrosis, vasculitis, pulmonary hypertension, pulmonary embolism and pulmonary infarction, mycotic pulmonary arterial aneurysms, septic emboli, aspiration pneumonia, community-acquired pneumonia, HIV-related opportunistic infections, latent tuberculosis infection, pulmonary tuberculosis, lung cancer and crack lung. Some of these complications are serious and may have a fatal outcome. Pulmonary function tests, thoracic tomodensitometry, bronchial fibroscopy with bronchoalveolar lavage and lung scintigraphy may be an aid to the diagnosis of these pulmonary compications. Cocaine use must be sought in case of respiratory symptoms in young persons.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína/toxicidade , Usuários de Drogas , Pneumopatias/induzido quimicamente , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Usuários de Drogas/estatística & dados numéricos , Humanos , Pneumopatias/diagnóstico , Pneumopatias/epidemiologia , Pneumopatias/terapia
7.
Ann Ist Super Sanita ; 55(4): 338-344, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31850860

RESUMO

INTRODUCTION: Ketamine is an essential medicine used as an anesthetic in low and middle-income countries and in veterinary medicine. Recreational use is widespread throughout the world, especially owing to its lower price compared to other substances. In Western countries its use has been mainly linked to subpopulations of young people who use drugs recreationally. Ketamine misuse is associated with amnesia, dependence, dissociation, lower urinary tract dysfunction and poor impulse control. Regular ketamine use is associated with abdominal pains. AIMS: The aims of this study are to analyze characteristics and main symptoms of ketamine abusers attending emergency departments (EDs) in the metropolitan area of Bologna, Emilia-Romagna Region, northern Italy. METHODS: We identified 74 records of ketamine-related visits: 30% female; 22% non-natives; mean age 25.6 years. Forty-two percent reported ketamine use alone, 46% reported the use of other illegal substance (cocaine 19%, heroin 18%), 26% alcohol misuse. RESULTS: The most common reported symptoms were neurological (soporous state 18%, agitation 14%, confusion 7%, panic attacks 7%, mydriasis 7%, tremors 7%), gastro-intestinal (abdominal pain 15%, vomiting 11%), urological (6.8%) and cardiac (palpitations 5%, chest pain 5%). Complications secondary to falls and cuts (7%) were the most frequent trauma complications. We highlight a significant number of visits regarding suicide attempts (10%) and overdose (4%). CONCLUSIONS: The results highlight a particular population of problematic ketamine users identified using the hospital's ICT system. In particular, poly-drug users who consume ketamine in combination with heroin or cocaine presenting to the ED represent a specific target for targeted prevention projects on non-lethal overdoses and suicide attempts.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Ketamina/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Adulto , Alcoolismo/epidemiologia , Doenças Cardiovasculares/induzido quimicamente , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Comorbidade , Estudos Transversais , Overdose de Drogas/epidemiologia , Feminino , Gastroenteropatias/induzido quimicamente , Humanos , Itália/epidemiologia , Masculino , Transtornos Mentais/induzido quimicamente , Doenças do Sistema Nervoso/induzido quimicamente , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Avaliação de Sintomas , Adulto Jovem
8.
Actas Esp Psiquiatr ; 47(6): 218-28, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31869422

RESUMO

INTRODUCTION: Personality disorders (PD) and substance use disorders (SUD) have a high prevalence and an important health and socioeconomic impact so, it is interesting to study the relationship between them. The objectives of the study are: to compare the prevalence of SUD between patients with and without diagnosis of PD, to analyze if any PD is related to the SUD, and if a specific PD is associated with a specific SUD. MATERIAL AND METHODS: Cross-sectional study in 837 patients from centers of attention to drug addiction and mental health in Madrid, Spain. The Mini International Neuropsychiatric Interview (MINI) and the Personality Diagnostic Questionnaire-4+ (PDQ4+) are used to detect mental disorder and PD, respectively. RESULTS: SUD is significantly higher in antisocial PD (p<0.01); sedative (p<0.01) and alcohol (p<0.05) use disorder in borderline PD; cocaine (p<0.05) and alcohol (p<0.01) use disorder in paranoid PD; and alcohol use disorder in histrionic PD (p<0.01). The SUD for cocaine is lower in obsessive- compulsive PD (p<0.05) and depressive PD (p<0.01). There is a positive correlation between the number of PD of a subject and the number of SUD that it presents. The risk of an alcohol [OR of 1,08 CI (1,01-1,16)] or sedatives [OR of 1,08 CI (1,001-1,17)] use disorders increases if an individual presents more than one type of PD. CONCLUSIONS: There is not differences of SUD prevalence between PD and not PD groups. We found an association between SUD and PD of cluster B (antisocial, borderline and histrionic) and also with paranoid PD. The SUD are more common among man with the exception of sedatives.


Assuntos
Transtornos da Personalidade/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Transtorno da Personalidade Antissocial/diagnóstico , Transtorno da Personalidade Antissocial/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/diagnóstico , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Diagnóstico Duplo (Psiquiatria) , Feminino , Transtorno da Personalidade Histriônica/diagnóstico , Transtorno da Personalidade Histriônica/epidemiologia , Humanos , Masculino , Abuso de Maconha/diagnóstico , Abuso de Maconha/epidemiologia , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtorno da Personalidade Paranoide/diagnóstico , Transtorno da Personalidade Paranoide/epidemiologia , Transtornos da Personalidade/diagnóstico , Prevalência , Espanha/epidemiologia , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico
9.
Subst Abuse Treat Prev Policy ; 14(1): 59, 2019 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-31870379

RESUMO

BACKGROUND: The purpose of this study is to describe the characteristics of individuals who inject drugs, to explore use trends in the past 25 years, and to review the profile of users of various drugs, both legal and illegal, that have been used intravenously without medical prescription in Mexico City. METHODS: Information was drawn from the Drug Information Reporting System (SRID, 1987-2015) and data from the National Center for the Prevention and Control of HIV/aids (CENSIDA, 1983-2018). SRID is based on two 30-day cross-sectional evaluations carried out during June and November. It has served as an uninterrupted epidemiological surveillance system for 32 years, operating both in health and justice institutions in Mexico City and the metropolitan area. The timely identification of changes in use patterns is regarded as the most consistent tool to track the trajectory of the phenomenon. CENSIDA cases were analyzed based on the number of HIV and aids positive injectable drug users during the same period of time in Mexico City. RESULTS: Cocaine users represented the highest number of cases, with a total of N = 293. Back in 2000, the use of this substance showed a significant increase of up to 50%. In turn, heroine and opiates user trends by sex increased from being almost non-existent in 1987 to 13% in 1994. Results provide evidence of the changes in the number of users over the years, with the largest increases being recorded in 1996 (16.5%), 1999 (17%), and 2010 (13%). CONCLUSIONS: The increase observed in the results coincides with domestic and world political situations that have caused an upturn in the use of some substances over the years. It is not far-fetched to think that in the coming years there will be an increase in the number of individuals who inject drugs due to the high production and availability of heroin in Mexico and the emergence of fentanyl use as indicated by ethnographic research in Mexico City and the deaths linked to its consumption. The latest reports, published in 2018, documented at least five cases of fentanyl users.


Assuntos
Infecções por HIV/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Criança , Transtornos Relacionados ao Uso de Cocaína/complicações , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/complicações , Humanos , Masculino , México/epidemiologia , Abuso de Substâncias por Via Intravenosa/complicações , População Urbana/estatística & dados numéricos , Adulto Jovem
10.
Pediatr Clin North Am ; 66(6): 1135-1147, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31679603

RESUMO

Cocaine use by adolescents and young adults continues to be a significant public health issue and the cause of medical and psychological morbidity and mortality. Although use rates are lower than those seen with alcohol, tobacco, and other illicit substances such as marijuana, cocaine is highly addictive and presents significant acute and long-term medical and psychological effects. This article reviews the epidemiology of cocaine use among adolescents and young adults, discusses the pharmacology and neurobiology of cocaine use and dependence, provides information regarding acute intoxication and systemic effects seen with more chronic use, and describes current assessment and treatment approaches.


Assuntos
Transtornos Relacionados ao Uso de Cocaína , Adolescente , Comportamento do Adolescente/psicologia , Cocaína/toxicidade , Transtornos Relacionados ao Uso de Cocaína/diagnóstico , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/terapia , Humanos , Drogas Ilícitas/toxicidade , Estados Unidos/epidemiologia , Adulto Jovem
11.
Lancet ; 394(10209): 1652-1667, 2019 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-31668409

RESUMO

We did a global review to synthesise data on the prevalence, harms, and interventions for stimulant use, focusing specifically on the use of cocaine and amphetamines. Modelling estimated the effect of cocaine and amphetamine use on mortality, suicidality, and blood borne virus incidence. The estimated global prevalence of cocaine use was 0·4% and amphetamine use was 0·7%, with dependence affecting 16% of people who used cocaine and 11% of those who used amphetamine. Stimulant use was associated with elevated mortality, increased incidence of HIV and hepatitis C infection, poor mental health (suicidality, psychosis, depression, and violence), and increased risk of cardiovascular events. No effective pharmacotherapies are available that reduce stimulant use, and the available psychosocial interventions (except for contingency management) had a weak overall effect. Generic approaches can address mental health and blood borne virus infection risk if better tailored to mitigate the harms associated with stimulant use. Substantial and sustained investment is needed to develop more effective interventions to reduce stimulant use.


Assuntos
Anfetaminas/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/mortalidade , Cocaína/efeitos adversos , Adolescente , Adulto , Anfetaminas/uso terapêutico , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/mortalidade , Estimulantes do Sistema Nervoso Central/uso terapêutico , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/prevenção & controle , Inibidores da Captação de Dopamina/efeitos adversos , Feminino , Infecções por HIV/induzido quimicamente , Infecções por HIV/mortalidade , Hepatite C/induzido quimicamente , Hepatite C/mortalidade , Humanos , Incidência , Masculino , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/mortalidade , Pessoa de Meia-Idade , Prevalência , Viroses/sangue , Viroses/induzido quimicamente , Viroses/mortalidade , Adulto Jovem
12.
Subst Abuse Treat Prev Policy ; 14(1): 46, 2019 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694694

RESUMO

BACKGROUND: Substance dependence is considered an international health issue and studies that access the characteristic of this population are required to develop public health programs for harm reduction. To this aim, we purpose to to identify, in a population undergo addiction treatment, if the use of substances leads to sexual risky behavior and also check if another variables influences in this behavior. METHOD: Observational study of clinical sample collected of adult patients seeking treatment to dependence of alcohol and cocaine. The data collected were: socio-demographic, substance use, sexual behavior and childhood abuse. Risky sexual behaviors were considered: inconsistent use of condoms and presence of multiple sexual partners in the past six months. An exploratory analysis of the association between the variable "risky sexual behavior" and the other variables was performed using Pearson's chi-square, followed by a multivariate logistic regression analysis. RESULTS: After analyzing the variables with the presence or absence of risky sexual behavior, were included in the logistic regression the data that presented association with sexual risk behavior, and age appears as an independent factor for risky sexual behaviors. Other factors, such as schooling and unemployment, influence as much as the use of substances in risky sexual behaviors. CONCLUSION: Attributing just to the substance use this risky sexual behavior seems too simplistic. Other structural factors such as schooling, work, age and sexual abuse in childhood can influence decision making for safe sex.


Assuntos
Alcoolismo/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Usuários de Drogas/psicologia , Sexo sem Proteção/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-31618876

RESUMO

Background: Cocaine use disorder (CUD) is a growing public health concern, but so far no effective pharmacotherapies have been demonstrated. Stimulant medications have proved to be promising in CUD treatment. The self-medication hypothesis (SMH) can help to explain this phenomenon better, especially in cases where CUD co-occurs with adult attention deficit hyperactivity disorder (A-ADHD). Methods: In the present retrospective study, a sample of 20 consecutive patients (aged from 18 to 65 years) with dual disorder (A-ADHD/CUD), under treatment with methylphenidate (MPH) or atomoxetine (ATM) medications, was followed to study the effects of A-ADHD treatment on cocaine use. Patients were followed for a mean period of 7 months (minimum 1, maximum 30 months). All individuals were assessed with standardized questionnaires to evaluate diagnosis, treatment efficacy, and clinical improvement. Results: the results showed that behaviors reflecting cocaine addiction were sharply reduced during the stimulant treatment of A-ADHD, and were not correlated with age, gender, familiarity, length of treatment, or medication used. CUD improvement was closely correlated with the A-ADHD improvement. This study supports the validity of the SMH in ADHD patients with co-occurring CUD.


Assuntos
Cloridrato de Atomoxetina/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Transtornos Relacionados ao Uso de Cocaína/tratamento farmacológico , Cocaína/administração & dosagem , Metilfenidato/uso terapêutico , Adolescente , Adulto , Idoso , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
14.
J Prev Med Hyg ; 60(2): E124-E139, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31312742

RESUMO

Few studies have assessed the extent of psychoactive drug consumption in the occupational setting. The trucking sector, in particular, is an important cause for concern, since psychoactive substance use has a relevant impact on the drivers' health and safety, increasing the risk of injuries and traffic accidents, potentially affecting the general public health as well. A systematic review of the literature and meta-analysis was performed in order to provide Occupational Health Professionals and policy-makers with an updated epidemiological perspective regarding this important issue. The results showed a prevalence of overall drug consumption of 27.6% [95%CI 17.8-40.1], particularly high considering illicit CNS-stimulants (amphetamine consumption of 21.3% [95%CI 15.7-28.1], and cocaine consumption of 2.2% [95%CI 1.2-4.1]). It appears that truck-drivers choose stimulant substances as a form of performance enhancing drug, in order to increase productivity. However, chronic and high dose consumption has been shown to decrease driving skills, placing these professional drivers at risk for health and road safety. Further research is required, particularly in Europe, in order to fill the knowledge gap and improve the strength of evidence.


Assuntos
Condução de Veículo , Doenças Profissionais/epidemiologia , Psicotrópicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia , Condução de Veículo/psicologia , Condução de Veículo/estatística & dados numéricos , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Humanos
15.
Int J Behav Med ; 26(5): 542-550, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31313251

RESUMO

BACKGROUND: Post-traumatic stress disorder (PTSD) and stimulant use disorders are highly prevalent, commonly co-occur, and predict faster clinical HIV progression. However, scant research has examined if PTSD and cocaine use are associated with the HIV reservoir that persists in immune cells, lymphoid tissue, and organs of people living with HIV that are receiving effective treatment. METHOD: This cross-sectional study enrolled 48 HIV-positive persons with sustained undetectable viral load (< 20 copies/mL) in the past year to examine the associations of PTSD and recent cocaine use with two measures of HIV persistence in immune cells: (1) proviral HIV DNA and (2) cell-associated (CA)-HIV RNA. RESULTS: Greater PTSD symptoms were significantly associated with lower proviral HIV DNA (r = - 0.30, p = 0.041) but not with CA-HIV RNA. Greater severity of PTSD symptom clusters for intrusions (Standardized Beta = - 0.30, p = 0.038) and hyperarousal (Standardized Beta = - 0.30, p = 0.047) were independently associated with lower proviral HIV DNA. Although participants with recent cocaine use had a significantly shorter duration of sustained undetectable HIV viral load (19.9 versus 26.9 months; p = 0.047), cocaine use was not significantly associated with proviral HIV DNA or CA-HIV RNA. CONCLUSION: Further research is needed to examine the potentially bi-directional pathways linking PTSD symptom severity and HIV persistence.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Infecções por HIV/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Carga Viral
16.
J Nerv Ment Dis ; 207(8): 633-636, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31232907

RESUMO

Schizophrenia is associated with blood inflammatory marker abnormalities. Illicit drug use, which is common in schizophrenia, may modulate inflammatory marker levels. We examined effects of marijuana and cocaine use on white blood cell (WBC) counts in acutely ill, hospitalized patients with schizophrenia using a within-subjects and between-groups design. Mean total and differential WBC counts were first compared in acutely ill patients with schizophrenia for hospitalizations with and without either marijuana (n = 18) or cocaine (n = 24) use. Mean total and differential WBC counts were then compared between patients with schizophrenia with either marijuana or cocaine use and patients with a negative urine drug screen (UDS; n = 43). Patients with schizophrenia had significantly higher total WBC, lymphocytes, and monocytes during hospitalizations with (vs. without) cocaine use. Patients with cocaine use also had significantly higher monocytes and eosinophils than those with a negative UDS. Our findings suggest that substance use, particularly of cocaine, may modulate inflammatory marker levels in acutely ill, hospitalized patients with schizophrenia.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/sangue , Leucócitos , Uso da Maconha/sangue , Transtornos Psicóticos/sangue , Esquizofrenia/sangue , Doença Aguda , Adulto , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Comorbidade , Feminino , Hospitalização , Humanos , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Uso da Maconha/epidemiologia , Pessoa de Meia-Idade , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/imunologia , Esquizofrenia/epidemiologia , Esquizofrenia/imunologia , Adulto Jovem
17.
Artigo em Inglês | MEDLINE | ID: mdl-31212010

RESUMO

Cocaine dependence is a complex psychiatric disorder that is highly comorbid with other psychiatric traits. Twin and adoption studies suggest that genetic variants contribute substantially to cocaine dependence susceptibility, which has an estimated heritability of 65-79%. Here we performed a meta-analysis of genome-wide association studies of cocaine dependence using four datasets from the dbGaP repository (2085 cases and 4293 controls, all of them selected by their European ancestry). Although no genome-wide significant hits were found in the SNP-based analysis, the gene-based analysis identified HIST1H2BD as associated with cocaine-dependence (10% FDR). This gene is located in a region on chromosome 6 enriched in histone-related genes, previously associated with schizophrenia (SCZ). Furthermore, we performed LD Score regression analysis with comorbid conditions and found significant genetic correlations between cocaine dependence and SCZ, ADHD, major depressive disorder (MDD) and risk taking. We also found, through polygenic risk score analysis, that all tested phenotypes are significantly associated with cocaine dependence status: SCZ (R2 = 2.28%; P = 1.21e-26), ADHD (R2 = 1.39%; P = 4.5e-17), risk taking (R2 = 0.60%; P = 2.7e-08), MDD (R2 = 1.21%; P = 4.35e-15), children's aggressive behavior (R2 = 0.3%; P = 8.8e-05) and antisocial behavior (R2 = 1.33%; P = 2.2e-16). To our knowledge, this is the largest reported cocaine dependence GWAS meta-analysis in European-ancestry individuals. We identified suggestive associations in regions that may be related to cocaine dependence and found evidence for shared genetic risk factors between cocaine dependence and several comorbid psychiatric traits. However, the sample size is limited and further studies are needed to confirm these results.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/genética , Estudo de Associação Genômica Ampla , Histonas/genética , Transtornos Mentais/epidemiologia , Transtornos Mentais/genética , Estudos de Casos e Controles , Comorbidade , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Predisposição Genética para Doença/genética , Humanos , Masculino
18.
PLoS One ; 14(6): e0218334, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31226126

RESUMO

Crack cocaine use disorder (CUD) has been related to sex differences. This work aimed to compare the severity of drug use and the severity of other negative related outcomes in males and females with CUD. A total of 1344 inpatients (798 males and 546 females) with crack cocaine use disorder (CUD) were evaluated by a detailed multidimensional clinical assessment, including addiction severity and trauma exposure. Linear regression predicted higher drug use severity (ß = 0.273, p < 0.001) and more problems in domains related to childcare issues (ß = 0.321), criminal involvement (ß = 0.108), work-related problems (ß = 0.281) and social support impairments (ß = 0.142) for females, all with p < 0.001. Alcohol problems were predicted to be higher in males (ß = -0.206, P < 0.001). Females had higher rates of other mental disorders, particularly trauma and stress-related disorders (OR: 3.206, CI: 2.22, 4.61). Important sex differences also emerged in trauma history and HIV infection prevalence. CUD has a more severe clinical presentation among females facing early abstinence. Sex differences in the CUD course indicate the need for consideration of sex-specific interventions and research.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Cocaína Crack/efeitos adversos , Caracteres Sexuais , Adulto , Transtornos Relacionados ao Uso de Cocaína/psicologia , Transtornos Relacionados ao Uso de Cocaína/reabilitação , Comorbidade , Feminino , Hospitalização , Humanos , Modelos Lineares , Masculino
19.
Am J Addict ; 28(4): 238-245, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31165574

RESUMO

BACKGROUND AND OBJECTIVES: Concurrent use of cocaine and opioids is a persistent and challenging problem, particularly within methadone maintenance settings, and there are no approved pharmacotherapies for this population. Galantamine, a cholinesterase inhibitor, was found in a randomized clinical trial to reduce cocaine use among methadone-maintained individuals who were also cocaine dependent. Because of the potential of galantamine to reduce multiple drugs of abuse, it may also reduce opioid use. METHODS: We conducted a secondary analysis of a randomized, double-blind, placebo-controlled trial of 120 methadone-maintained individuals with concurrent cocaine dependence. Participants were randomized to galantamine or placebo in a 12-week trial with a 6-month follow-up (97% of intention to treat sample reached for final follow-up). RESULTS: There was a significant main effect for galantamine over placebo on percent of urine specimens that were negative for opioids, both within treatment (77% for galantamine vs 62% for placebo, F = 5.0, P = 0.027) and through a 6-month follow-up (81% vs 59%, respectively, F = 10.8, P = 0.001). This effect was seen regardless of whether participants used nonprescribed opioids during the baseline period. Galantamine effects were seen early in treatment, with participants in placebo submitting the first opioid-positive urine specimen significantly sooner than participants in galantamine (median day 15 vs 53, Wilcoxon = 5.7, P = 0.02). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: If these results are supported in future trials, galantamine may hold promise across multiple drugs of abuse, including opioids. (Am J Addict 2019;28:238-245).


Assuntos
Analgésicos Opioides/uso terapêutico , Inibidores da Colinesterase/uso terapêutico , Transtornos Relacionados ao Uso de Cocaína/tratamento farmacológico , Galantamina/uso terapêutico , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adolescente , Adulto , Idoso , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Resultado do Tratamento , Adulto Jovem
20.
Rev Mal Respir ; 36(5): 610-624, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31201016

RESUMO

INTRODUCTION: Cocaine use can be responsible for many respiratory complications including asthma. OBJECTIVES: Systematic literature review of data on asthma in cocaine users. DOCUMENTARY SOURCES: PubMed/Medline search, on the period 1980-2017 with the following keywords: "asthma*" or "bronchospasm" and "cocaine" or "freebase*" or "crack", limits "title/abstract"; the selected languages were English or French. Among 108 articles, 43 abstracts underwent dual reading to select 22 studies. RESULTS: In four case reports of asthma associated with cocaine use including 11 patients (mean age: 28.3 years [22-33 years]; sex-ratio: 2.5 [males: 71.5%]), cocaine was sniffed [snorted] (9%), smoked (36.5%) or both sniffed and smoked (54.5%). A medical history of childhood asthma was observed in 45.4% of the cases. Acute respiratory failure, requiring intubation and mechanical ventilation, was observed in 45.4% of the cases. Outcome was rapidly favorable in 82%; 9/11, progressively favorable in one patient, and fatal in another patient. Other studies included 6 cross-sectional studies, 4 case-control studies and 8 longitudinal studies (7 retrospective studies and one prospective study). The mean age was 36.6 years (women: 44.7%). Twenty percent of the subjects used cocaine exclusively, and 80% used cocaine combined with other addictive drugs (cocaine and heroin: 62%). The prevalence of cocaine users was higher in asthmatic subjects and the prevalence of asthma was higher in cocaine users. Cocaine use can be responsible for asthma onset and acute asthma exacerbation. In the case of asthma exacerbation, cocaine users were more likely to be admitted in intensive care units and to require intubation and invasive ventilation. Asthma exacerbations may be fatal in spite of resuscitation measures. Asthma treatment observance was lower in cocaine users. CONCLUSION: Cocaine use may be responsible for asthma onset, acute asthma exacerbations (which may require intubation and invasive ventilation) or death related to asthma. Cocaine use must be systematically considered in the case of asthma exacerbation and practitioners must help cocaine users to stop their consumption.


Assuntos
Asma/epidemiologia , Asma/etiologia , Transtornos Relacionados ao Uso de Cocaína/complicações , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Cocaína/efeitos adversos , Adulto , Feminino , Humanos , Masculino , Fatores de Risco , Adulto Jovem
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