Tampering with prescription opioids: nature and extent of the problem, health consequences, and solutions.

BACKGROUND: Transdermal and solid oral prescription opioid (PO) formulations can be abused by ingesting (with or without tampering), snorting, or injection (both requiring tampering). OBJECTIVE: To determine the patterns of tampering with POs for abuse. METHODS: Information was collected from published studies and databases. RESULTS: Tampering with POs for abuse is common practice. Ingestion is the most prevalent method of abuse, followed by snorting and injection. From 1992 to 2002, injecting POs has decreased in favor of ingesting and snorting. Methods of abuse vary widely by product. Abuse methods with the highest morbidity are injection and inhalation. CONCLUSIONS: The seriousness of health outcomes associated with tampering with POs warrants the development of PO formulations that prevent or deter tampering.

Number of addictive substances used related to increased risk of unnatural death: a combined medico-legal and case-record study.

BACKGROUND: Substance use disorders have repeatedly been found to lead to premature death, i.e. drug-related death by disease, fatal intoxications, or trauma (accidents, suicide, undetermined suicide, and homicide). The present study examined the relationship between multi-drug substance use and natural and unnatural death. METHODS: All consecutive, autopsied patients who had been in contact with the Addiction Centre in Malmö University Hospital from 1993 to 1997 inclusive were investigated. Drug abuse was investigated blindly in the case records and related to the cause of death in 387 subjects. RESULTS: Every substance apart from alcohol used previously in life added to the risk of unnatural death in a linear way. There were independent increased risks of fatal heroin overdoses or undetermined suicide. Death by suicide and violent death were unrelated to additional abuse. CONCLUSION: The number of drugs used was related to an increased risk of unnatural death by undetermined suicide (mainly fatal intoxications) and heroin overdose.

Mortality in older adults with frequent alcohol consumption and use of drugs with addiction potential - The Nord Trøndelag Health Study 2006-2008 (HUNT3), Norway, a population-based study.

BACKGROUND: The aim of this study was to investigate whether frequent drinking, use of drugs with addiction potential and the possible combination of frequent drinking and use of prescribed drugs with addiction potential were associated with all-cause mortality in older adults. METHODS: We used data from the Nord-Trøndelag Health Study (HUNT3 2006-08), a population-based study in Norway. A total of 11,545 (6,084 women) individuals 65 years and older at baseline participated. We assessed frequent drinking (≥ 4 days a week), occasional drinking (i.e. a few times a year), never drinking and non-drinking in the last year. Drugs with addiction potential were defined as at least one prescription of benzodiazepines, z-hypnotics or opioids during one year for a minimum of two consecutive years between 2005 and 2009. This information was drawn from the Norwegian Prescription Database. The main outcome was all-cause mortality with information drawn from the Norwegian Cause of Death Registry. Follow-up continued until death or latest at 31 December 2013. Logistic regression analyses were used to investigate all-cause mortality since date of study entry and exact age at time of death was unknown. RESULTS: The adjusted logistic regression analyses showed that frequent drinking was not associated with all-cause mortality compared to occasional drinking. Men who reported to be never drinkers and non-drinkers in the last year had higher odds of mortality compared to those who drank occasionally. Use of prescribed drugs with addiction potential was associated with increased mortality in men, but not in women. No association was found between the possible combination of frequent drinking and use of prescribed drugs with addiction potential and mortality. CONCLUSION: Neither frequent drinking nor the possible combination of frequent drinking and use of prescribed drugs with addiction potential were associated with all-cause mortality in older women and men. Use of prescribed drugs with addiction potential was associated with higher odds of mortality in men. This finding should lead to more caution in prescribing drugs with addiction potential to this group.

Meta-analysis of disease risk associated with smoking, by gender and intensity of smoking.

BACKGROUND: The risks associated with cigarette smoking can be substantial, particularly for females. In 2000, the mortality rate for lung cancer among women was higher than that for breast cancer. OBJECTIVE: To obtain overall risk for intensity of smoking for both males and females, a meta-analysis was performed on recent studies that assessed the morbidity and mortality associated with smoking. METHODS: Using the PubMed database, a literature search was conducted for cohort and case-control studies on the effect of smoking on morbidity and mortality. Only studies that had quantified the risk of disease associated with smoking were included. Nineteen studies were selected, with data obtained on the disease affected by smoking, point estimates of risk, 95% CIs, sample size, type of study, and the number of patients of each sex. Meta-analyses were performed for low level of use, defined as 1 to 20 cigarettes per day, and for high level of use, >20 cigarettes per day. RESULTS: For low level of use, the rate ratio point estimate of 1.77 (95% CI, 1.40-2.24) for females was higher than that of 1.42 (95% CI, 1.23-1.64) for males, indicating a gender effect associated with smoking as a disease risk. The point estimate for females who smoked at high levels was 2.75 (95% CI, 2.14-3.52), well beyond the estimate of 1.95 (95% CI, 1.70-2.24) for males, indicating there was a substantial gender effect with high-level use. All point estimates for low and high levels of smoking were significant; those for each sex at high levels of smoking exceeded those found for low levels. The increase in risk from low to high levels of smoking was greater for females than for males. CONCLUSIONS: Few systems in the body were unaffected by smoking, and intensity was a risk factor for disease. Results were consistent with and strengthened previous research demonstrating an increase in overall risk with an increase in smoking intensity. In addition, gender differences were noted that may contribute to risk magnitude.

Epicrisis triste para una muerte en un cajero / A troubling epicrisis: on the death of a man in an ATM

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Drug abuse-related mortality: a study of teenage addicts over a 20-year period.

BACKGROUND: There is growing concern about increase in illicit drug use and associated fatalities in young people. METHOD: This longitudinal analysis of successive cohorts of addicts in England and Wales aged 15-19 years followed up over a 20-year period covering 1974 to 1993 (1) investigated trends in all-causes mortality; (2) examined teenage-specific mortality, i.e. deaths during ages 15-19 years; (3) determined excess teenage-specific mortality; and (4) identified the main underlying causes of teenage-specific death in this population. The main outcome measures were overall mortality rates, teenage-specific mortality and standardised mortality ratios calculated for four 5-year (period) successive cohorts. RESULTS: Overall mortality rate in the study population (N = 9491) was 4.7/1000 person-years. The median age at death was 23 years (semi interquartile range = 3), with the majority (91.3%) of deaths occurring between ages 15 and 29 years. Excess teenage-specific mortality in the population was 10.7 in males and 21.2 in females (general population = 1), and increase in excess mortality in both sexes was evident in the last 5-year period of study. The majority of deaths (64.3%) resulted from accidental poisoning. Methadone and heroine/morphine accounted for about two-thirds of accidental poisoning deaths, while suicide accounted for 11.4% of teenage-specific deaths. CONCLUSIONS: It is strongly recommended that treatment services should be more responsive to the need for careful prescribing, dispensing and administration of substitute medication to teenage addicts in their care. The development of needs-led, case-sensitive treatment services for young addicts is indicated.

Nuevas técnicas de neuroestimulación en las adicciones / New neurostimulation techniques in adicctions

Las adicciones se asocian a modificaciones en los patrones de activación cerebral. En los últimos años se han desarrollado nuevas técnicas de neuroestimulación capaces de modificar la actividad de los circuitos cerebrales, y que se están explorando en el tratamiento de las adicciones. Las más importantes son la Estimulación Magnética Transcraneal (EMT), la Estimulación Transcraneal de Corriente Directa (ETCD), la Estimulación del Nervio Vago (ENV) y la Estimulación Cerebral Profunda (ECP). Los hallazgos publicados hasta ahora son aún insuficientes para proponerlas como alternativas terapéuticas en los trastornos por uso de sustancias (AU)

Addiction is associated with changes in brain activation patterns. In recent years new techniques of neurostimulation that can alter the activity of brain circuits have been developed, and are being explored in the treatment of addictions. The most important of these techniques are Transcranial Magnetic Stimulation (TMS), Transcranial Direct Electrical Stimulation (tDCS), Vagus Nerve Stimulation (VNS) and Deep Brain Stimulation (DBS). The findings reported are clearly still insufficient for them to be considered as therapeutic alternatives in substance use disorders (AU)